Congress' Phony Health Care War

— The Editors

ONE HUNDRED THOUSAND people in the United States of America lose their health insurance every month.  It seems unlikely, however, that this number included the president of Columbia/HCA, the industry leader in for-profit health care, who, as reported in the August 5 New England Journal of Medicine, "resigned in the face of federal fraud investigations .  .  .  with a $10 million severance package and $269 million in company stock."

Against this backdrop, Congress and the Clinton administration have faced off this summer in a highly publicized political showdown over guaranteeing patients' rights in the medical insurance system.  In the headlines, the Clinton administration went to war for "a patients' Bill of Rights," promising the ability to sue the hated Health Maintenance Organizations (HMOs) for refusing needed care, and to bring prescription drugs for the elderly under Medicare coverage.

In reality, this was the biggest phony war since-well, since the Clintons first rode into town promising "universal health care" under the aegis of a "reformed" private insurance system.  That scheme crashed and burned when its main proposed features became clear-to enrich the largest HMO giants while wiping out the smaller fish in the industry, to superimpose a government bureaucracy on the HMOs' already bloated administrative machinery, to finance minimalist health care for the poor by driving down the quality of care and choice for most working people.

The Clintons' plan of 1993-4, however, did achieve its main purpose: It (temporarily) derailed a grassroots movement, many years in the making, for genuine health care reform based on a single-payer (Canadian-style) system.  Today that movement is rapidly reviving, fueled by popular rage over HMO abuse, by unionization drives among physicians who are banned by the insurance industry from even telling their patients about treatment options.

Can a lame-duck post-Monica Bill Clinton once again deflect the pressure for genuine health care reform?  The plan, apparently, is to focus on one among the myriad horrors of a rotten system: elderly Americans suffering and dying because essential prescriptions are not covered by Medicare, and tens of millions of public dollars consumed when folks land in emergency rooms because they couldn't afford their drugs.

The issue is certainly a critical one, and not only for the elderly, as documented by Dr. Neil Shulman ("Prescription: Protest," The Nation, August 9/16), who cites, among numerous other cases: "A school bus driver in North Carolina who could not afford insulin had such high blood sugar levels that she was driving the bus while dizzy."

This time, however, bureaucratic band-aids may not stop the flow of popular anger.  Dr. Shulman vividly recounts a militant demonstration marching into Grady Memorial Hospital in Atlanta, where "overnight the price of a prescription for indigent patients had risen from as low as 50 cents to $10," sending a meeting of the trustees fleeing into the night and winning reinstatement of the low fees.

The single payer movement is also prepared, this time around, to expose the false administration promises.  In the August newsletter of the Michigan Universal Health Care Access Network (MichUHCAN), a retired physician writes:

"The most important part of the (Clinton) reform is to provide some financial support for the cost of prescriptions.  While any step in that direction is welcome, we should all be aware how feeble that step is. First, the program, meager as it is, will not start until 2002.  Second, Medicare will cover only half of the prescription cost [initially capped at $1000 per year, and] There will be a $24 monthly charge to help pay the program's costs." (Ed Pintzuk, "Clinton's Medicare Plan: Not Worth It")

On top of this would be a twenty percent co-pay for laboratory tests!

Dr. Pintzuk concludes: "All of this again points to the rationality of universal health care with a single payer system.  There is ample proof that such a system will meet the health care of all Americans-including those 45,000,000 citizens who have no health insurance at all."

In the above-cited editorial from the New England Journal of Medicine, Physicians for a National Health Policy (PNHP) leaders Drs. Steffie Woolhandler and David Himmelstein demonstrate that for-profit hospitals actually provide inferior and higher-cost services compared to the not-for-profit facilities.  The reason?  "The simplest explanation is that the competitive free market described in textbooks does not and cannot exist in health care."

Rather, hospitals exercise effective monopolies in many areas; effective and informed consumer choice does not exist; and the for-profit health care system is in fact heavily financed by public dollars.  Yet as the authors emphasize, "The most serious problem with (for-profit) care is that it embodies a new value system that severs the communal roots and samaritan traditions of hospitals, makes doctors and nurses the instruments of investors, and views patients as commodities .  .  .

"In our society, some aspects of life are off-limits to commerce.  We prohibit the selling of children and the buying of wives, juries and kidneys .  .  .  Like blood, heath care is too precious, intimate and corruptible to entrust to the market."

Such considerations are undoubtedly far beyond the moral horizons of Bill Clinton or the Republocrats-but it is around that message that a powerful movement can be built, and can win.


ATC 82, September-October 1999