Earlier this fall, with healthcare costs spiraling upward and new Census data showing increasing numbers of Americans without health insurance, the Bush administration quietly changed federal regulations to allow hospitals to turn away more low-income patients from their emergency rooms.

The new rules illustrate Bush’s and the healthcare companies’ plan to deal with the current healthcare crisis: cut services to the bone and make workers and consumers pay more for their health coverage, a deadly combination.

The U.S.’s work-based healthcare system is seriously diseased, and its vital signs are worsening every day. The number of uninsured people grew by 2.4 million in 2002 to 43.6 million - 15% of the population.

Many employers, faced with a stagnant economy that threatens their profits, simply refuse to pay for health benefits. Only 45% of private-sector workers have employers who pay for their health coverage, and 19 million of the uninsured work full-time.

Employers are also shifting the costs of health plans to their employees and making it harder for employees to qualify. Part-time employees at Wal-Mart, the nation’s largest employer, must wait two years for health coverage (full-timers wait six months), and their meager plan does not cover flu shots, eye exams, or child vaccinations, among other services.

Health maintenance organizations (HMOs) market their insurance plans only to the healthiest and wealthiest (leaving many unemployed and contract workers out in the cold), keep members waiting for doctor appointments, and deny coverage for expensive treatments. Yet, with all this cost-cutting, the U.S. still spends $1.6 trillion - 14% of its GDP - on healthcare, more than any other country in the world. Where is all the money going?

One answer lies in the profits of prescription drug companies, whose clout was boosted in the 1990s when the federal government allowed them for the first time to market drugs directly to consumers, bypassing physicians. The airwaves filled with ads urging patients to pop away all their problems with the latest brightly-colored pill. The percentage of U.S. healthcare dollars that went to prescription drugs doubled, and Big Pharma became the most lucrative industry of all, raking in three times more profits than the average of all other industries in 2001.

Executive compensation is also booming; the 25 highest-paid HMO executives collectively made over $200 million in 2000. Add to that the astronomical amount hospitals and insurance companies spend on advertising, bill collection, and other administrative overhead, and it’s no wonder health insurance premiums have risen 75% in the last decade.

Denmark, France, Germany, Sweden, and the United Kingdom all spend less on healthcare per capita than the U.S., yet all provide their people with more hospital beds per capita and more doctors per capita (except the U.K.) than the U.S. according to a 2000 World Health Organization study.

Another 2001 study by the Commonwealth Fund surveyed adults in Australia, Canada, New Zealand, the United Kingdom, and the U.S. on their healthcare experiences. Americans were far more likely to report forgoing needed tests, appointments, and prescriptions because of cost, and having difficulty paying their medical bills. U.S. residents were also more likely to say their country’s healthcare system should be completely rebuilt.

Top-ranking countries in the studies, along with the entire rest of the industrialized world, all have something the U.S. doesn’t: a universal healthcare system, paid for by the government, that provides free healthcare to all.

The British won their universal healthcare system in 1945 with the coming to power of a union-based political party, the Labor Party, based on a mass movement of workers including soldiers returning from the Second World War. The workers demanded healthcare and the party delivered establishing a system that remains the most popular part of Britain’s welfare state, with nine out of 10 Britons opposing healthcare privatization. Similar gains were won by workers in other countries through mass struggle and by building powerful workers’ parties.

Neo-liberal governments have since starved the health systems of funding, leading to staff shortages and long waits for surgery. Still, in spite of all the attacks, healthcare facilities in other countries are more cost-efficient and provide better care to more people than those in the U.S.

The only solution to the growing healthcare crisis is a publicly owned, universal healthcare system. Under such a system, patients and health professionals could make medical decisions based on patients’ needs, not wealthy shareholders’ profits. With payment for healthcare guaranteed by the government, workers would not be pushed to take certain jobs or intimidated from resisting harsh conditions at work for fear of losing their health benefits.

The pharmaceutical, insurance, and other healthcare companies should be taken into public ownership to eliminate the profit motive from all aspects of healthcare and establish a democratically controlled, integrated healthcare system. Rather than squandering billions of dollars on advertising, or producing copy-cat versions of trivial but profitable drugs like cold medicines, we can use these giant companies’ resources to address pressing medical problems such as HIV/AIDS, cancer, and diabetes.

For a publicly owned health system to be run efficiently and in the public interest, it needs to be democratically controlled and managed at the local and national levels by elected representatives of healthcare workers and the public - not government bureaucrats.

While Congress and the White House have no problem finding $87 billion to occupy Iraq or $1.7 trillion in tax breaks for the rich, their response to calls for a just healthcare system has been that the country cannot afford it.

There is no reason why - in the richest country in history - everyone cannot receive quality medical care as a basic human right. In fact, the $1.6 trillion we spend each year on healthcare is more than enough to cover every person under a system.

A free, public health system would be far more efficient economically than the current profit-driven system, by eliminating the 31 cents of every healthcare dollar that currently pays for corporations’ advertising, paperwork, and administrative costs. Eliminating the profit margin of the pharmaceutical industry alone would save $36 billion per year.

If we don’t take action, the dire healthcare crisis will only worsen. Unions and community organizations need to mobilize their members to wage a determined struggle for a free, public, universal healthcare system. We, and the coming generations, deserve nothing less.

Workers Fight to Defend Medical Benefits

Last year, 56% of employers raised healthcare premiums, co-payments, and deductibles, while 12% reduced workers’ benefits. The amount workers pay toward job-based premiums for family coverage climbed 49% over the past 3 years. Health care has been the primary issue in most recent contract battles around the country.

Seventy thousand grocery store workers represented by the United Food and Commercial Workers went on strike October 17 in Southern California, protesting management plans to reduce employer health contributions from $5000 to $1800 per worker per year and force workers to pay up to $780 in annual premiums while eliminating coverage for dental, vision, and preventive office visits.

Shoppers at Vons, Albertsons, Ralphs, and Safeway honored the picket lines, shunning offers of free eggs and soda and reducing business by 20-25% at some stores. The grocery stores pled poverty, but their combined operating profits rose from $5.1 billion in 1998 to $9.7 billion last year.

Another 12,000 supermarket workers in Missouri, Ohio, Kentucky, and West Virginia also recently voted to strike; management at Kroger wants to cut what the amount they pay for workers’ healthcare by $20 million.

If the grocery companies win, businesses will intensify their efforts to off-load healthcare costs onto workers. A victory for the union, however, will be a victory for all of us who are struggling to pay healthcare bills or who are uninsured.

From Justice, paper of Socialist Alternative, cwi in the US

Committee for a workers' International publications

p128

p248 01

p304 02

imgFooter1