California Home Care: Terminated!

— Barri Boone

Question: WHAT'S THE BEST health care plan in the U.S.

Answer: Don't get sick!

This used to be a bumper sticker eliciting smiles. Now it is the sad state of affairs. George W. Bush plans to privatize Medicare, and in California the other shoe has dropped.

Governor Arnold Schwarzenegger, the “Terminator” who pledged to clean up the mess caused by Democrat Gray Davis, at his first “State of the State” address on January 6 proposed to terminate health care for the poor and the In Home Support Services (IHSS) program.

IHSS provides services for California's poor disabled and elderly so that they can live in their homes rather than being locked up in institutions called “Nursing Homes.”

In other words, if you're not from a wealthy family that will share their resources when you age or become disabled, you will have two choices: to die slowly in an institution that is organized to ignore your needs in order to make some CEOs and investors wealthy, or to take matters into your own hands quickly now that “assisted suicide” is legal in some states.

Governor Schwarzenegger plans to terminate the entire IHSS program, which many of us have worked hard to develop over the last fifteen years. The unions, SEIU and AFSCME, pushed Governor Davis to release funds to set up the Public Authorities as the state's agent to bargain for living wages and benefits such as health plans and vacation days.

Now Arnie proposes to abolish the funds for the Public Authorities, eliminating “costly” union contracts, and to reduce hourly wages (now $8-10 an hour) back to the minimum, which is $6.75 in California.

The lower the wages, of course, the more difficult it is to obtain and keep any home care worker, much less to motivate them to learn all the particulars relating to your disability, which varies greatly with each individual.

From Home to the Streets

The Gov, supported by other “family values” Republicans, seems unmoved by the fact that he is breaking up families and forcing those of us without families into nursing homes that are more expensive, and grossly inadequate for our needs, if available at all.

In Santa Cruz county over 300 families with members caring for the disabled in their homes, would lose their jobs -- forcing them to work outside the home, thus leaving many with no option but to attempt to place the disabled in nursing homes. But in the entire Santa Cruz county, there are only 14 beds available for those solely dependent on Medicare.

The alternative, then, is the streets or vying for camping space on the local river with hundreds of the homeless -- a death sentence pure and simple!

In places like San Francisco where spaces in a nursing home may be available to a few, the average cost of care and board would be $53,000 per person annually in 2001. Compare this to the average cost of only $8,820 per year for home care services for a family caretaker.

Figures show that if only one out of eight home care recipients lose services and enter a nursing home, the state will have no actual savings from the cuts.

A report by professors in the Department of Social and Behavioral Sciences at the University of California, San Francisco warns that the proposed cuts could result in “many negative consequences for individuals, including: pain, negative health outcomes, hospitalization, nursing home placement and death.” Where are the “family values” in that?

Arnold makes these cuts in the name of making “Cal-i-fornia” ACCESSIBLE to big business, but not to those covered by the ADA (Americans with Disabilities Act)! Our needs are “collateral damage” in the struggle to build up the economy for the rich.

His plans include cutting back Medi-Cal by ten percent, which means that most of the poor would lose what few services we presently have in our broken health care system. Cuts to other programs like “Healthy Families” mean that out of 700,000 kids eligible for the program, 114,000 would be put on a waiting list, according to the advocacy group Children Now.

Those lists and a few bandaids may stop some bleeding temporarily, but it won't produce any surgeries!

Seeking Solutions

The Democrats' response to these unconscionable proposals vary. Some say we must learn to work with Arnold, and accept that there will be pain in various sectors of the population.

Gavin Newsom, the new Democratic mayor of San Francisco who narrowly defeated Green Party candidate Matt Gonzalez was quoted as saying, “Do not run away from Schwarzenegger, but learn from his example.” Learn what?

Senator Dianne Feinstein calls the cuts “pennywise but pound foolish” since they will cut $800 million in matching federal funds.

California Senator Pro Tem John Burton (D-SF) criticizes the cuts saying, “We are for protecting the poor people from onslaughts of this nature -- when there are other ways to get dough . . . It is a very unworthy society that, when looking for money, goes out and looks for the poorest and most vulnerable.”

Burton as well as the state SEIU supports a bond measure proposed by the Governor that is widely viewed as forcing our grandchildren to pay for our present budget deficit. Others like state treasurer Phil Angelides, who plans to run for governor in 2006, are opposed to the bond.

Several constituencies, such as those representing people in need of mental health services and groups of students hit with tuition increases, each have their own plans to tax the rich millionaires, but to only benefit their own groups. This falls into the old tactic of fighting one another for crumbs, instead of uniting for a bigger pie!

Plans are under way for an even larger demonstration than the 1200 disabled and SEIU and AFSCME home care workers mobilized on January 6, the night of Arnold's first “State of the State” address, which was covered by the international press.

Ideally each group being affected by cuts -- from the immigrant workers seeking drivers licenses to be able to get to their jobs; to the poor, disabled and elderly; to the teachers and students -- all need to organize for a comprehensive tax-the-rich solution, such as the one proposed by gubernatorial Green Party candidate Peter Camejo during the recent recall.

Health Care vs. Insurance Industry

Meanwhile tens of thousands have no health care coverage. The Democrats are supporting an incremental plan to force all work places with over twenty employees to either provide a health plan for its workers or contribute to a state plan.

A more fundamental plan, proposing the restructuring of the state health care system with a Single Payer plan, is set to come before the state legislature in the next few months. A study has been done by Health Care for All, and a larger coalition including some legislators, showing that if you eliminate the insurance companies that quality universal health care is possible.

The insurance corporations, of course, are planning an attack on Single Payer and are working out their alternative plan to INSURE all and CARE FOR hardly any! That's the Republican plan. Some Democrats have said they will fight it, well . . . as much as their corporate-donated money pots will allow.

The medical system in the United States has become the poster child of how health services get completely distorted under capitalism, where their sole purpose is to make as much profit as possible while pretending to service the sick.

This is accomplished via the middlemen -- the insurance corporations. These corporations are now diversified to the extent that with their healthy profits, they can loan money to the oil companies and electronics industries who pollute our water and air.

Then they invest in pharmaceutical or in tobacco and liquor companies, so they can profit from people's frustrated attempts to self-medicate. They contribute to powerful lobbies to keep the laws on their side and the right-to-know hidden. In short, they keep us sick!

An earlier system of medical coverage was cost-based. Naturally this gave incentive to the upwardly mobile medical establishment to prescribe unnecessary surgeries and tests, plus longer stays in the hospitals.

When this became counter-productive, the era of HMOs (Health Maintenance Organizations) replaced it. HMOs charge a flat-fee payment for each client, giving incentive to all providers to cut corners on service, and therefore cut the quality of care, especially for those who are old, poor, seriously ill or permanently disabled.

The chains like Hospital Corporation of America and Humana grew exponentially during the late seventies and early eighties. The public hospitals, picking up the growing groups who fall through the cracks, do their best to stay afloat by qualifying their patients for public programs like Medicare and Medicaid.

Now even that has become too costly and unmanageable, and both programs are under attack by the Republicans with their “no pharmaceutical left behind” programs tied to plans to privatize any public system left standing.

Bush's Medicare “reform” is to bait health care “consumers” with a choice for a less costly HMO in exchange for some coverage of prescription drugs, leaving the traditional plan for people who can choose any doctor who accepts Medicare. This will go down the path of many workplace and pension plans where the fairly healthy opt out to the HMOs, leaving those with chronic illnesses and permanent disabilities to stay in the original plan.

Soon the original plan is over-burdened with those needing more costly services and it will collapse as not being “fiscally responsible.” So the most vulnerable are dumped into the HMOs who do not have the specialists that some of them require.

Bush's plan appeals at first to some users, until they do the math and see the copays, deductibles, caps on coverage, and low percentages of actual payments for drugs. Add to that, those who need natural supplements because they have adverse side effects from many prescription drugs, and then realize that the plan is simply “no pharmaceutical left behind” and they are stuck with hundreds of dollars monthly to pay out of pocket for their meds.

AARP has shown its true colors by supporting Bush's plan to slash Medicare as we know it. This resulted in over 5000 across the country canceling their memberships in protest.

This crisis, both nationally and here in California, is making transparent the broken health care system in the United States and propelling groups sometimes at odds with one another, to build united fronts while debating their alternate solutions. The spirit of the best of these is reflected in the following poem by Shirley Klein, who has developmental and other disabilities, which was presented
at the rally on January 6 in Sacramento:

United by the promise
Committed to its dream
we will not see it shattered
into bits of slithered hope
Bearing it before us
we will march into your might
so you can see the faces
of those you would deny.
Let our voices crowd your power
and our eyes edge your sleep
yielding no escape
from the gauntlet of our need.

ATC 109, March-April 2004