On January 10th and 11th, over 150 union leaders and representatives from 31 states met in St. Louis, Missouri to discuss and share strategies at the Labor Campaign for Single-Payer Healthcare conference. The conference succeeded in drafting a mission statement with a clearly defined goal to “increase and help coordinate labor support for universal, comprehensive, single-payer healthcare as embodied in H.R.676.”
House Resolution 676, also known as the Expanded and Improved Medicare for All Act, was initially proposed by Congressman John Conyers, Jr. (D, MI). To date it has received 92 co-sponsors in Congress and has been endorsed by hundreds of local unions and central labor councils as well as 39 state AFL-CIO federations. In short, it has more support than any other health care reform proposal in Congress. According to Unions for Single Payer Health Care’s online summary of H.R.676, the bill would establish the United States National Health Insurance Program to:
“Provide all individuals residing in the United States and in U.S. territories with free health care that includes all medically necessary care, such as primary care and prevention, prescription drugs, emergency care, and mental health services.”
What is Single-Payer?
Single-payer would replace the chaotic, wasteful and inefficient bureaucracy and market mechanisms of private for-profit health insurance companies with a single national program that covers everyone, a “single payer.” Resources to pay for this would come from a publicly administered fund seeded by existing government revenue sources allocated to healthcare, increased personal income taxes for the top 5 percent of income earners, and a small tax on stock and bond transactions, all of which would be more than offset by the tremendous savings for each individual and the entire American population on health services. Such a program would eliminate all out-of-pocket costs and in fact create jobs in healthcare and related industries to meet the demands of a system that covers every U.S. citizen. Workers formerly employed by the private system would be given priority in hiring, re-training, and job placement. Private insurers would be prohibited from selling coverage that duplicates services provided by the national program. Eliminating for-profit insurance companies will prevent the massive price increases we see today.
What’s Wrong with the American Healthcare System?
For millions of Americans, from workers (many of whom are under-insured), the elderly, single parents and the unemployed, this campaign couldn’t have come a moment too soon. Reports at the St. Louis conference highlighted the worsening healthcare nightmare faced by millions of Americans who are under-insured or do not use what coverage they may have due to high premiums, co-pays, deductibles, and other out-of-pocket costs, or due to pre-existing conditions that insurers routinely refuse to cover. The Centers for Disease Control reports that racial disparities in available rates and access to medical care offered by the for-profit system are rampant, and women are routinely charged more than men by insurance companies. In addition to decreased quality of care and rapidly increasing costs, which have risen three to four times faster than wages in the last decade, and which are projected to reach 44 percent of the average family’s gross wages by 2018, now fewer than 50 percent of employers offer health insurance benefits to workers. And we have yet to mention the uninsured.
The last U.S. Census report on Income, Poverty and Health Insurance Coverage in the United States found that over 45 million Americans have gone without insurance for 12 months or longer. Professor Nancy Welch of the University of Vermont reported in 2007 that when considering “the number of people who lost insurance for part of the year,” say for 6 to 10 months after changing jobs or being laid off, “the picture dramatically worsens: 82 million – one in three non-elderly Americans – with two-thirds losing coverage for six months or more.” It goes without saying that in the present crisis of capitalism, amidst all the job losses and the pressure on American workers to give more and more concessions in the name of “sacrifice,” “competitiveness” and “job security,” that these numbers will increase – and there is no end in sight. No real solution can be found in the “illogic” of the capitalist system.
In light of all these deeply disturbing figures it should come as no great surprise that the United States ranks 22nd in infant mortality and 46th in life expectancy (behind Taiwan and Croatia), and that it also limps in at 37th place in health system performance (after Costa Rica). This, according to the CIA World Factbook and the World Health Organization, respectively. In Monthly Review #55 (Sept. 2003), Vincent Navarro cited research conducted at the Harvard Medical School which found that the United States’ current system of “rationed care” is responsible for 100,000 American deaths each year, far more than the 18,000 deaths claimed in Michael Moore’s 2007 documentary film Sicko. Moore’s figure did not include those deaths resulting from the poor care received at for-profit hospitals, dialysis centers, clinics and nursing/care homes by those who fall into the category of “under-insured” or those who have a history of severe illness that thereby legally(!) allows insurance companies to refuse coverage or payment.
In a single payer system everyone will be covered regardless of income level or employment status, and healthcare will be recognized as a human right, not a privilege. With every doctor covered under the same system and patients no longer limited to “in-network” providers, our choices as to which doctor or hospital we wish to visit would be expanded, not reduced. Physicians for a National Health Program has pointed out that the traditional doctor-patient relationship would be restored by single payer as the system eliminates oversight by managed care reviewers.
Costs to the system would be controlled and even reduced due to bulk purchasing of medicine and equipment and cutting out the profit motive by eliminating stockholders’ dividends and CEO salaries, advertising, excess bureaucracy and paperwork and all the waste that eats up one-third of every dollar we spend on healthcare in the for-profit system. Socialized single payer care will free nurses, doctors, therapists and other staff to devote more time and energy to providing quality care and, as stated by the Physicians’ Working Group for Single-Payer National Health Insurance, base their clinical decisions on compassion, science and human need rather than the patient’s insurance or economic status.
It is no wonder that so many doctors, nurses and even medical schools support single payer over the current anarchy of market-driven, for-profit, private-pay insurance. A 2008 survey published in Annals of Internal Medicine showed that physicians polled support universal health care and a national single-payer insurance plan by nearly 2 to 1. Single-payer draws support from Physicians for a National Health Program, the California Nurses Association, and The American Medical Student Association. The American College of Physicians is the second largest group of physicians in the U.S. and has called on lawmakers to consider a single-payer system to achieve universal coverage of every United States citizen.
Single-payer is significantly more cost effective than private-pay because it eliminates the redundant bureaucracies of the multitude of private insurance companies. This is relevant because the World Health Organization found in a 2000 study that publicly funded systems in industrial nations around the world spend less on healthcare per capita, and as a percentage of their GDP, yet demonstrate time and again that their populations are both healthier and happier than in nations which utilize private-pay private care. Not only that, but the OECD Health Division found the present inhumane and ineffective American healthcare system to be the most expensive in the world! Also, according to the Institute of Medicine, the United States is the only wealthy, industrialized nation that does not provide its citizens universal health care. Our current system is the most expensive and least effective. Even from a capitalist perspective, this puts the U.S. at a distinct economic disadvantage in a globalized capitalist economy, and is one argument for single-payer advanced by many who might otherwise not support such programs. However, it is clear that the HMOs, private hospitals and pharmaceutical companies will fight universal coverage with everything they’ve got. After all, their colossal private profits are at stake.
Beware of mandated coverage…
Another discussion held at the St. Louis conference was focused on the dangers of so-called “universal” health reforms that mandate those who “can afford it” to buy into a private-pay health plan while those who cannot have their fees to the insurers subsidized by the state or covered by Medicare and other such programs. Panelists and participants pointed out the failures of such plans already in place in several states. Mandated plans, such as those supported by Secretary of State Hillary Clinton and President Barack Obama, preserve the role of the private insurance companies, allowing them to continue price gouging and refusing to cover costly treatments or even dropping severely ill patients when they become “un-profitable.” Mandated plans create a windfall for insurance companies, as they are allowed to cherry pick the healthiest patients and leave the rest to flood and bankrupt the public systems. In short, any mandated coverage that maintains the role of the private insurance industry is no way forward at all for those already suffering at the hands of the current profit-before-people system.
“If there is no struggle, there is no progress…”
For several decades now, and especially under present conditions, employers have sought to shift as much of the cost of healthcare onto the backs of the workers as they can get away with. The present crisis is no exception, and the constant talk of “sacrifice” and concessions, all the pushing and squeezing suffered by the working class is not going to just go away. But if the rank-and-file of the labor unions keeps up the pressure on the labor leaders to mobilize the tremendous power of the workers we can win this fight and say “No!” to the bosses’ demands for concessions. Our unions must lead the way and we must ensure, through constant and determined action, that our leaders do not back down to Democratic policy-makers who tell us that single-payer is “just a pipe dream,” and who want even more concessions. The working class has already given too much! We must not limit ourselves and our resources to a defensive fight to stop concessions, but in fact go on the offensive to win National Socialized Single-Payer Health Care to make a real difference in the lives of each and every person living and/or working in America today.
Frederick Douglass once said that “power concedes nothing without a demand. It never did and it never will.” The campaign for a socialized single-payer national healthcare system is going to be a long and bitter fight, but it is a fight we can win, as it has been won in other countries before. The St. Louis conference shows that this issue has energized a sizable section of the working class and has the potential to mobilize broad layers of the class to action. If universal health care is to become a reality, the labor leaders must mobilize this tremendous power to fight against the colossal resistance of the private health care system.
The WIL fights for a socialist health care system, in which all people are covered for free at the point of service. This means the hospitals, clinics, HMOs, medical machine industry, medical schools, drug companies and the insurance companies would be nationalized under democratic workers’ control. Any employees from these companies who did not find employment in the national health system would be re-trained at government expense and receive their full wages while being re-trained. Then, they could be placed in jobs that are needed by society. In addition, doctors and nurses would be educated for free and would not have a crushing debt upon graduation. House Bill 676 would be an important step in this direction and this is why we support it.
In other countries, universal health care was won only on the basis of mass struggles by the workers and the existence of mass working class political parties. This is why we are for a mass party of labor based on the unions, which must break with the Democrats. Such a party would defend the interests of the workers and the youth with a fighting program and socialist policies, against the attacks of big business and the parties of the ruling class. Mobilized and united we can win. Our health is not a commodity to be traded and sold on Wall Street!