10-02-06, 11:00 am
Communists support a health care system that is comprehensive and free with guaranteed access to quality care whenever needed. But a health care system is more than just medical care. Health care also means prevention of occupational and community environmental hazards and infectious conditions that threaten people’s health. In addition, the lack of affordable housing has become a major public health problem. A comprehensive health care system means that all health workers in hospitals and community clinics must reflect the populations they are serving – we support the aggressive application of affirmative action programs for equal access to medical, nursing, and other professional training and education programs. -- Program of the Communist Party USA
The health care system that captures vast amounts of America’s resources, employs many of its most talented citizens and promises to relieve the burdens of dread disease badly needs to be fixed. Health care costs strain individual, household, employer and public budgets. Often our citizens forego needed treatment because they are priced out of the market . . . We spend nearly $2 trillion on health care each year, yet geography, race, ethnicity, language and money impede Americans from getting appropriate care when they need it.
This may be the first time such a group has called for deep changes:
• Health and health care are fundamental to the well-being and security of the American people. • It should be public policy, established in law, that all Americans have affordable health care coverage. • Assuring health care is a shared social responsibility.”
This Citizens’ Health Care Working Group was established, ironically, by the Bush Medicare legislation.
There is growing anticipation that Republicans will not control Congress when the next Congress takes office in 2007 and increasing confidence that Republicans will be kicked out of the White House in 2008. January 2009 could begin a sea change for politics in the United States. But we cannot take such change for granted. Countering Republican Election Strategies
State and local struggles will be invaluable in countering the Karl Rove “activate the base” strategy. This Republican tactic mobilizes middle-of-the-road people, using social issues such as religion, abortion, and same-sex marriages to sway voters to the right. Countering these ultra-right agendas with working-class issues such as housing, jobs and health is crucial. State and local health struggles are already taking place and should be increased. For example, Michigan, a prime target of the Republican Party’s agenda, needs that kind of countering. The health segment of the CPUSA’s Party Program projects possibilities of significant action and successes. For electoral struggles in general and health struggles in particular, the program is critically important. It helps focus the massive amount of activities and peoples’ involvement without short-circuiting spontaneous movements.
Within the program’s health care section are the seeds of a national health coalition that can bring us a universal, comprehensive health program. As discouraging and terrible as the crisis is today, victory for national health legislation is closer now than ever before in our nation’s history. The last real opportunity to enact national health legislation took place in the mid-1930’s, when national health was, unfortunately, rejected as part of Social Security legislation. It failed. Subsequent efforts in the 1970’s and 90’s fell even shorter. Without a dramatic change in our tactics and strategies, we could be headed toward that same dead end. Economists See the Light
In “The Health Care Crisis and What to Do About It,” Paul Krugman and Robin Wells offer important insights into the current progressive shift in national health reform efforts (New York Review of Books, Vol. 53, No. 5, March 23, 2006). Krugman, a lead writer for the NY Times on its vaunted Op-Ed pages, and required reading for national health care activists, was a strong advocate of free trade agreements. An economist by trade, he recently announced a rethinking of his blanket support of Nafta, etc. This made his health policy article even more widely read and referenced by all sides in the national health care debate.
Current conventional wisdom in liberal and progressive circles has put HR 676, the “single payer” legislation of John Conyers and Physicians for a National Health Program (PNHP), at the center for legislative action. They should be thanked for keeping national health legislation alive. Many local, and some international, unions have expressed support for and/or solidarity with the legislation.
Krugman expresses support for this approach. He then provides a devastating attack on the current, mostly private, health care delivery system as the growing culprit in the crisis, a system HR 676 keeps nearly in tact. By moving in that direction he broadens the discussion. Krugman’s earlier article, “Health Care Confidential,” (January 27, 2006, New York Times) moved the discussion into a new direction, one also taken by Henry J. Aaron, William B. Schwartz, and Melissa Cox. In their review of Can We Say No? The Challenge of Rationing Health Care, the authors observe that
the actual delivery both of insurance and of care is undertaken by a crazy quilt of private insurers, for-profit hospitals, and other players who add cost without adding value . . . we could do even better if we learned from “integrated” systems, like the Veterans Administration, that directly provide some health care…
Activists who admire the British National Health Service support a similar system in our country, one written in Congresswoman Barbara Lee’s national health service bill (HR 3010). Having economists on the side of a comprehensive national health program is crucial to ultimate success.
Krugman added:
Well, I know about a health care system that has been highly successful in containing costs, yet provides excellent care. And the story of this system’s success provides a helpful corrective to anti-government ideology. For the government doesn’t just pay the bills in this system it runs the hospitals and clinics. The system in question is our very own Veterans Health Administration, whose success story is one of the best-kept secrets in the American policy debate.
The VA system once had a reputation for poor service and care. But a reform beginning in the mid-1990’s transformed the system, and VA is emerging as an example of what health care could be. Quality of Public Hospitals and Salaried Physicians
The stereotypical attack on the British national health system, one used against any government involvement in health care in the US, is the accusation of poor quality of care. Almost every objective analysis of the British national health system, however, has documented good to excellent care for its patients.
Now, the quality of health care in the US is in dismal shape. The Institute of Medicine estimated that over 100,000 die each year due to errors alone. Infections are a constant worry. Krugman cites a very different picture for the VA.
Last year customer satisfaction with the veterans’ health system . . . exceeded that for private health care for the sixth year in a row. This high level of quality (verified by objective measures of performance) was achieved without big budget increases. In fact, the veterans’ system has managed to avoid much of the huge cost surge that has plagued the rest of US medicine.
Oh, and one more thing, the veterans health system bargains hard with medical suppliers, and pays far less for drugs than most private insurers. The V.H.A. bargains effectively on drug prices; the drug bill forbids Medicare from doing the same.
I believe . . . that pundits and policy makers don’t talk about the veterans’ system because they can’t handle the harsh reality. For the lesson of the VHA’s success story – that a government agency can deliver better care at lower cost than the private sector – runs completely counter to the pro-privatization, anti-government conventional wisdom that dominates today’s Washington.
Uwe Rheinhardt, another health economist from Princeton, not known for progressive health policy recommendations, concurs:
We do, of course, have genuine socialist medicine in America, that is, a tax-financed health system in which the government does own and even operate ALL production facilities. Remarkably – indeed, ironically – Americans reserve it for their military veterans, who seem to be glad to have it. Largely due to a group of visionary leaders since the mid-1990’s, that socialist American health system – generally known as the Veterans Administration Health System – is now widely regarded as being in the forefront of the smart use of information technology and of quality assurance, not only in the US, but worldwide.
Without seeking to push any particular approach to health care, I do believe it fair to take issue with the mindless stereotypes so often used in our debate on health policy among them the misuse of the word “socialized medicine.” Coalitions’ Role
How do you go from the HR 676 movement, add the veterans’ struggle to maintain and expand the VA system, and work with the countless local struggles? Struggles against privatization of health services and quality of health care are key grassroots fight-backs that link struggles and bring rank-and-file union activists into the fight.
Bruce Bostick’s, “Health Care Struggles Sweep Ohio” (Peoples’ Weekly World, May 4, 2006) cites the coalition of single payer activists with community health activists: Single Payer Action Network (SPAN) and Universal Health Care Action Network (UHCAN).
In Lorain, a labor-based coalition including the USW and SEIU is building community support. Over 300 people attended a public hearing to demand that the local publicly supported hospital cease its practice of suing poor folks over medical bills. The movement was successful and the hospital has backed off this practice. The coalition is now working to support SEIU hospital workers in their upcoming contract fight.
Why does the VA example help? The VA uses federal money delivered on the local level. And it is delivered directly into a public system, not for-profit hospitals or the private so-called voluntary system. Moreover, the workers in those hospitals are union members, employed by the federal government.
It is clear that gaining a national health program that is comprehensive, no-cost at the point of service, free of racism, with quality health facilities calls for a broad coalition of health forces. Those forces are in motion across the country; only a collective strategy can bring them together. That is where power lies. Labor, Community & Other Struggles
Since the early 1990’s, many states, cities and localities have attempted, with some success, to relieve the health crisis. Here are a few. In New York, MetroHealth, a broad-based membership group made up of professional, labor and community groups, brings a high level of cooperation and solidarity amongst health activists in New York City. They practice mutual support for health care reform across city, state and federal levels. Massachusetts health legislation was enacted at the time that voters in that state were considering a constitutional amendment declaring health care a human right. One begets the other. The “Philadelphia Health Plan” and now the “San Francisco Health Access Plan” go right to the delivery of health services to people. They chose to skip the costly insurance, reimbursement system. In 2005, Seattle voters approved an advisory measure, 69 percent to 31 percent, that health care is a human right. In Chicago, 33 of 50 City Council members have signed on to a city ordinance that would require employers like Wal-Mart to pay a “living wage” of $10 per hour, plus $3 an hour toward benefits. This is part of the Fair Share efforts of AFL-CIO. Similar measures have been passed in Washington, DC; Maryland; Suffolk County, NY; and New York City. The objective truth is, immediate action to solve the health crisis is being demanded in every corner of the country. The dialectical relationship between all of these actions is immense. Transitioning Now
How can activists combine professional, labor and broad community forces? Here are three examples of what is needed. Given growing homelessness and the health care crisis among the homeless, housing advocates are a key constituency, as cited in the Party Program, ripe for recruitment to the health struggle.
Hospital care reform is a front burner action point. Bostick reports:
In Cleveland, a coalition organized by UHCAN and several unions is proposing legislation that would require all hospitals receiving public support in that city to provide free treatment to anyone with an income less than twice the poverty rate. . . The Cleveland City Council is holding public hearings on the need for universal health care.
The single payer forces and UHCAN supported those hearings.
There are deep and active struggles by veterans and their families, and politicians seeking their support, to save and expand veterans hospitals. This has become part and parcel of the antiwar efforts of Veterans for Peace and other veterans seeking to end the war in Iraq. The slogan “Money for Health Not for War” has never been more appropriate or real in the lives of everyone in the USA. The health and antiwar movements are natural allies just waiting to be galvanized. Such tactical and strategic alliances are a must as we move ahead.
Well, Why Don’t They Join In?
Some ask why doesn’t everyone just join the HR 676 effort? Some even suggest that local actions should be terminated in favor of that national effort.
As pointed to above, there a few different progressive health bills being proposed by members of Congress. At this juncture the CPUSA supports H.R. 676. At the same time it sees the benefits of other legislation.
All deserve our support. The question is how to unite the different streams in a winning strategy. In this writer’s opinion there are objective and subjective reasons that, as written, HR 676 doesn’t satisfy all.
That doesn’t dispel the need for Congressional action. In a recent editorial, the Los Angeles Times showed the limitations of the Massachusetts, Vermont and Maine state health programs, concluding that the “real solution to the nation’s healthcare problems will have to come from a Washington zip code.” Party Program
The CPUSA Party Program offers significant understandings, principles and a road to victories. The section “Building the Anti-Monopoly Coalition” has as its laboratory test tube the monopolization and privatization of health care in the US. Placing profit and markets at the center of health services has yielded the crisis working people are experiencing. The people’s rage at the drug and insurance carriers has never been greater. The struggle against further privatization, and the resultant reduction of the quality of health care services, is taking place daily across the country, bringing further allies into the fight.
Coalitions for action are the centerpiece. The Program’s “Health Section” makes clear that health reform is not just “medical.” The housing and environmental crises and growing numbers of homeless are public health problems of epic proportions. To leave these movements outside the health policy struggle is to exclude millions of activists who could make the difference in the coming Congressional election and future actions. “Socialized Medicine”: Why Not Call It That?
Cold war ideology tactics won’t hold out against reality forever. Right-wing cries against “socialized medicine” didn’t succeed in blocking the creation of Social Security, unemployment insurance, Medicare or Medicaid. Farsighted thinkers are already suggesting that the example of the Veterans Health Administration represents the true future of American health care. Krugman and Reinhardt are just the tip of the ideological shift.
Progressive activists recognize that without labor’s support, national health care is simply not possible. Labor was divided in all previous attempts that failed. The right wing fully understands this and acts on it daily. The party Program makes it clear,
Organized labor, while protecting its own hard-won benefits, is beginning to see the need and necessity to unite with other national and community-based organizations in the fight for a national health system that provides quality, guaranteed health benefits for everyone.The two unions that represent practically all health care workers, SEIU and AFSCME, have made it a point to not support the “Single Payer” proposal. This objective truth cannot be kicked aside. At a June 16 Brookings Institute Forum SEIU President Andy Stern stated, after making it clear that he supports universal health care, “I think the single payer issue is a stalking horse for I am not sure what because we are going to have a multiplayer system or some kind of system that is built into the costs of goods in America.”
Yet, both unions strongly support the concept of “Universal Health Care for All” and are extremely active in the health care fight. After all, this is their industry. They represent health leadership in both the AFL-CIO and the Change to Win federation. To win over 2006 Congressional candidates and make health care a central issue in the 2008 presidential election and to win organized labor to a unifying national health legislative approach clearly requires a new strategy. The “Medicare for All” slogan is a good example. On the one hand it has a great popular value. Unfortunately, the benefits of Medicare do not measure up to many labor-negotiated benefit plans. To gain labor support for any national health legislative proposal, unions must be able to protect their members’ current health benefits. The same is true for Native Americans, who prefer their current federal health rights, and veterans, who value their VA system.
If national health legislation is to pass Congress and the White House, it must emerge within a labor-led social movement of major proportions. Coupled with new tactical and strategic steps, success is within our grasp.
The slogan, “The People United Will Never be Defeated” was never more relevant than now.
--Phil E. Benjamin is health editor of Political Affairs. send your comments to
