Screwed the Undeclared War Against the Middle Class (25 page)

Even the tyrants of communist China provide health care to their people, a bitter irony for the unemployed American factory workers they've displaced and for the poorly insured Wal-Mart workers who sell their goods.

Through some serious online fundraising, we pulled together enough money to pay for Andy's surgery. Unfortunately, the delays in raising that much money meant that his cancer had
advanced to the point where it killed him soon after the surgery. Andy Stephenson's story is something that could happen only in an oligarchic banana republic—or in the USA.

To understand what happened to Andy, we first have to look at the big picture. Is health care a right or a privilege? If it's a right, it's part of the commons. By being born into a society, you are entitled to health care. If it's a privilege, it makes sense that only the rich have full access to it and poor and uninsured working people may die from lack of coverage.

If you go back over the thousands of years of human history, you will discover that health care has always been considered a right. The village shaman was always available. People helped each other.

In this country, in the Golden Age of the middle class—from 1940 to 1980—most states had laws requiring that hospitals be nonprofit organizations and take in anybody who showed up on their doorstep. Most states had laws that required health insurance companies to be nonprofit. Blue Cross and Blue Shield, for example, began as nonprofit companies.

The thinking behind this was that we don't want someone making a profit off our health care—we want them making decisions based on what's best for our health.

All that changed starting in the 1980s, when Reagan, followed by Bush Sr., Clinton, and Bush Jr., began defining health care as a privilege, not a right. Public hospitals started being replaced by private hospitals. Nonprofit insurance was gradually replaced by for-profit insurance—now even many of the Blue Cross/Blue Shield programs are for-profit. People like Senate Majority Leader Bill Frist's father were able to acquire tremendous wealth—literally billions of dollars of personal riches—by privatizing the commons of health care and squeezing all the cash they could out of previously public hospitals.

Of the other thirty-six fully industrialized democracies in the world, every single one of them has concluded that health care is a right. The United States is the only country in which this debate, thanks to the cons, is still going on.

Although we now have the most expensive health-care system in the world, it has not succeeded in making the American people healthy.

The United States ranks twenty-seventh in the world for the quality of its citizens' health.

The United States has 45 million uninsured people.

The United States ranks twenty-fifth in the world in life expectancy, infant mortality, and immunization rates.

Even our health insurance is often tragically deficient—about a quarter of all bankruptcies last year in this nation were among insured people who were wiped out by co-pays, deductibles, and not-covered hospital and health-care expenses. (And with the new 2005 bankruptcy law, such bankruptcies will be infinitely more difficult in the future for anybody who's not a millionaire.)

The cons say there are enough protections in place to help those who fall through the gaping holes in the health-care system. That's simply not true.

Fully insured people have died because their insurance companies refused to cover their treatment, calling it "experimental." Others couldn't get care because their insurance companies claimed their illnesses were "pre-existing conditions" and thus were not covered.

Increasingly, hospitals are turning away people or moving into a for-profit status that lets them avoid the obligation to serve
people who can't pay. The bottom line is that health care is rationed in the United States, as the
Wall Street Journal
noted in a front-page article by Geeta Anand titled "The Big Secret in Health Care: Rationing Is Here."
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The article tells the story of Lorraine Micheletti, an intensive-care unit (ICU) nurse. "As her hospital faces a cost crunch," notes Anand, "she's under pressure to get patients out of the glass-walled unit quickly."

Laying it out in unsparing tones, the
Wall Street Journal
article notes: "The word for what Ms. Micheletti does every day in this 173-bed hospital is one of the big secrets of American health care: Rationing."

The article adds: "Sometimes, rationing causes Ms. Micheletti to take on her own hospital." But, overall, rationing at Northeastern Hospital has worked out well for its owners. "In 2002, it posted a profit of $2.6 million, on an operating budget of around $85 million." Still, it's tough. "While Ms. Micheletti has worked hard to decrease the average patient stay this year, one person can throw off her numbers. 'You can eat up all of your profits if one or two patients linger in the ICU,' she says."

And it's not limited to public hospitals. "Nursing homes also ration care," notes Anand's article. "They have little incentive to take very sick patients, because in many cases they receive a fixed reimbursement rate from insurance which doesn't cover the full cost of care. As a result, nursing homes often try to limit the number of severely ill patients they take, to make sure they can cover costs."

With our largely privatized health-care system, the rich get very good health care. But if you are uninsured and you are not in a crisis—if you have an early-stage symptom, say, of cancer, that could be diagnosed and treated—and you show up at a public hospital, odds are that you will not be diagnosed and not be treated. You will be turned away.

The cons say the solution is more competition. This is nonsense. Right now hospitals compete against each other, insurance companies compete against each other, doctors compete against each other, and we all get screwed. What we need is cooperation.

When hospitals went private, they came under tremendous pressure to cut costs, and they did that by rationing and by laying off experienced nurses and replacing them with nurses' aides. Now nurses take care of eight or nine patients each. A ratio of 1 nurse to 4 patients in a medical/surgical clinic would provide better health care (and a ratio of 1:1 in the ICU). Cutting the nursing staff made a lot of money for the insurance companies and the private hospitals, made Bill Frist's father a billionaire, and made a lot of trouble for the rest of us.

When insurance companies went private, they too came under tremendous pressure to cut costs. They quickly noted that there's an easy way to do that: don't insure people who are likely to get sick. Insurance companies protect their profits by either refusing to insure people with "pre-existing conditions" or by charging them very high rates.

And they set the bar low. If you're self-employed and have tried to get private health insurance recently, you'll know that the companies send an adjustor to your house to screen you. They draw your blood and take your weight. If you weigh a few pounds over their "ideal," or they find any of your blood work a bit off, watch out—you may actually need health care, and therefore you'll pay higher rates, assuming they deign to cover you.

Meanwhile, because most of the system is private, We the People have no way to put a brake on costs. Pharmaceutical companies, for example, can charge as much as they want for their drugs because they know that cost is just passed on to the health insurance companies, who pass the cost on to us. That's why, even though Americans make up just 4 percent of the world's population, in 2004 we spent $4 trillion on health care. That's 40 percent
of the money spent on health care on the entire planet for 4 percent of the world's population.

The problem isn't that American health care needs to be more competitive. The problem is that health care in America is treated as a privilege, and only the privileged have unfettered access to it.

The solution to America's health-care problem is to join the rest of the first world and make health care a right for all citizens. The only question then becomes: How much of a right?

There are two ways to deliver health care in a society that considers health care a right.

One way is to create "socialized medicine" whereby the government provides all of the health care itself, largely through facilities that it owns and doctors and nurses whom it hires as federal employees. There may still be private hospitals or doctors for the very rich, but most of the hospitals in the country would be owned and run by the government, and the vast majority of health-care workers—from technicians to nurses to doctors—would be employees of the government. This is, by and large, the British system.

Another way is the "single-payer system," like they have in Germany. In this system the government is basically the insurance company. The very rich could still pay their own way if they want to be in separate high-end private hospitals (much like they fly in private jets instead of use the airlines), but most people would get their health insurance directly from the government. Hospitals and doctors would still be private—they would manage their own business and even compete with each other—but they would be paid, by and large, by the government's insurance program.

We already have both of these systems in the United States.

The Veterans' Administration is socialized medicine. The U.S. government owns all the VA hospitals and employs all the VA health-care workers. Veterans, just by showing their identification card, which proves they are veterans, can walk into any VA hospital or VA medical clinic and get care free of charge.

Our single-payer system is Medicare. Those Americans eligible for Medicare can mostly choose their own doctors and their own hospitals. They show their Medicare card to their health-care provider, who then bills the government.

Veterans tell me that they like the VA system, but there are also problems with it. When the government gets in a squeeze, it starts cutting back funding—until people get politically active. The problem is that veterans, while being a significant political group, aren't "all of us," so when they yell it's easier for politicians to ignore them than if everybody were yelling. Thus VA doctors, nurses, and other staff often feel underpaid and underequipped.