councilor.org
| Source | Dave Anderson |
| Date | 00/03/14/13:00 |
| The Reasons for Health Care Reform
By Dr. Quentin Young For more than a year, the mainstream media, hitherto captive of the market salvation myth, has shifted to seriously critical reporting of the catastrophic reality of for-profit HMOs and hospital chains. This sustained turn around is of obvious importance to movement seeking a publicly-financed universal system. In fact, an argument can be made for health care as the decisive organizing tool today. Health care has incomparable economic magnitude and a gigantic workforce. No other issue embodies as large a social base. Indeed, the struggle for decent health care crosses race, gender, age, region, and even class divisions. And health care is understood by everyone to be a necessity. An unusual egalitarian consensus exists in favor of the right of a sick or injured person to health care, which is remarkable in a society so deeply divided by the worship of competitive advantage. The possibility of success for progressive initiatives -- the condition of the health-care system in growing disarray -- seethes with opportunities. The system is highly vulnerable. The number of uninsured has risen to 43.4 million (1998), and perhaps 50 million have insurance of such poor quality as to bankrupt any policy-holder who contracts a major illness. Indeed, the most frequent reason for personal bankruptcies continues to be unpaid medical bills. The large-scale takeover of HMO and hospital chains by venture capital has Ied to an explosion of health care denial and obscene executive salaries, as well as stock market profits for investors. This has captured the headlines and the wrath of millions of alienated patients. The effects on the health care workforce of these systemic changes have also been severe: * Large-scale displacement of skilled nurses by unskilled, low-paid substitutes is seriously threatening their profession. As a result, nursing organizations are growing increasingly militant. * Physicians, too, have been stunned by their abrupt, dislocation from the pinnacle of power and prestige in the health care hierarchy. And while the domination by organized medicine of America's health care activity has eased the way for HMOs the destructive by-product of this physician autonomy has been a profound corruption of the patient-doctor interaction. * The rest of the health care workforce, overwhelming female, people of color and disproportionately immigrants -- continues to be highly exploited. Each of these sectors -- nurses, doctors, and other health care workers -- has become dramatically more receptive to the protections of unionization. The engine of this dramatic dysfunction is the Free Market Solution that has been imposed on the previous doctor-dominated system. The sequence of events began with the Health Maintenance Organization Act of 1971 under President Nixon, touted to be the antidote to the worrisome (but, in retrospect quaint) rise in medical costs. Ironically, prepaid group practice, which was initiated in the late 1930s and had an honorable records (but faced AMA denigration), had offered a brake on rising costs. But the authorization of venture capital's entry into the ownership and administration of hospital chains and HMOs opened wide the gates for a new era of robber-baron economics. Among the destructive effects was a massive undermining of not-for-profit, community-linked tradition of the U.S. hospital system. While the record of these hospitals was certainly checkered, they did have the civic virtues of being community oriented. Through conglomeration and buyouts, giant for-profit chains emerged. In the hospital sector the giant is Columbia/HCA, with more than 400 hospitals. But it suddenly destabilized. Its value plummeted, top officials were relieved (with breathtaking golden parachutes, to be sure), and a hundred hospitals were put on the block. The process was enhanced by federal indictments alleging billions of dollars of Medicare fraud. With the massive consolidation of the industry replacing promise of competition with oligopoly, an effusion of alleged illegal activity is speeding the unraveling of the market solution, a trillion-dollar blunder. Yet another destabilizing burden is the rising tide of bankruptcies of poorly capitalized ventures, alongside the monumental profit-taking of the winners in this lottery. Giant "physician management" corporations have emerged. They buy up scores of variously sized practices and then rachet down resources devoted to care. Currently, bankruptcy is the hallmark of this sector as well. In sum the market solution has spawned and army of administrators and their minions who are dedicated to limiting, restricting and denying benefits to patients, maximizing returns to investors, and obscenely rewarding executives in salaries, stock options, and dividends. Recall that "free-marketers" pledged to improve the quality of health care, provide better access and control rising costs. The result has been a colossal failure. Quality is lower, even compared with the highly flawed fee-for-service system. Access has steadily worsened -- there are 100,000 more uninsured every month and ten million more uninsured since 1989. This is a result of basing insurance on employment. To avoid health care costs and other benefits, corporations have redefined the workforce from full time salary, or wage-earning employees to casual, part-time, consultant or temporary workers. A particular irony, given the shameful disinformation which sank the star-crossed 1994 Clinton proposal, is the prevalence of all the bad practices that a national governmental program was supposed to bring us: * Choice of care has become limited to one or two HMO plans that management selects, generally for the lowest bottom line. * Bureaucratic restriction could hardly be worse. * Physician autonomy is now a fiction. In the face of this collective experience and growing public rage, the remedies proffered prove you can't leap an abyss in two jumps. A particularly divisive strategy which has regularly split off liberals and labor from commitment to a universal government system has been what can be dubbed incrementalism. It offers remedies to particularly egregious realities in health care denial, but invariably at great cost, substantial inequity, and with pork barrel giveaways to the insurers and venture capitalists. For example the Kennedy-Kassebaum law proposed to address the horror of job lock and the inability to secure insurance when there is significant history of illness by mandating coverage by private insurers. The companies, obligated under Kennedy- Kassebaum to offer policies, had no problem with this. They could charge any rate they chose, making this "choice" confiscatory and obliterating any intended reform. Likewise, the children's insurance subsidy, through funds transferred to the states, has resulted in a hodgepodge of costly, unequal coverage to millions of unprotected children. Two states so far, Wyoming and Washington, have decided to decline the funds, fearing the babies would become welfare dependent on this federal subsidy. Similarly, the concentrated rage at for-profit HMO abuses has lead to an explosion of "remedies" in all fifty states and the Congress. Many proposals have been stalled by the HMO industry which has well-financed friends in all of the legislatures. In fact, a Managed Care or, alternately, a Patients' "Bill of Rights" will be of little or no help, about like an aspirin for a brain tumor. So what kind of system do we want? The same one the American people choose, steadfastly, whenever polled: universal, comprehensive, publicly financed and progressively taxed. To which we must add not-for profit governance of hospitals and systems. Several characteristics of the current System of U.S. health care support the argument that it is ripe to become the centerpiece of a new progressive Initiative: * Its huge size and high sensitivity to burgeoning economic instability. * Its ubiquity and the unusually good prospects for unity inherent in the anguish shared across the dividing lines of race, gender, age, region and even class. * Its vital necessity when you are ill and the widely held and generally supported expectation that enhancing your health should be a human right. We are rich in health-care resources. If we handle what we have intelligently, free of exploitation, we could easily and promptly resolve the oppressions of our current system and its market-generated abuses. Furthermore, the American people seem ready for organized expression in local. state and national venues. Our demand, of candidates, parties, organizations, and institutions should be: EVERYBODY IN! NOBODY OUT! Quentin Young is the National Coordinator of Physicians for a National Health Program. |
Copyright (c) 1998, Joongpil Cho