by Phil E. Benjamin
The Achilles Heal of the United States health system is the same issue that its advocates claim is its best: Quality & technology.
In the Bush presidential debates in 200 and 2004, he hammered away at the great quality of the US health system. Not just technology, but the overall quality of the system. To paraphrase: "The best system in the world." Neither Gore or Kerry had a real response. Maybe they both thought that with some few exceptions he is right and lets change the subject to talk about the uninsured and Medicare drugs.
The fact of the matter is that the US system deserves to be ranked a lowly 37th system in the world because the World Health Organization takes into consideration how the system is performed in total, not just its technology and heroic surgery.
Bush and practically all Republicans and too many Democrats believe that those who attacking the US profit system are supporting "socialized medicine" and are therefore un-American. It is a continuation of the redbaiting of the McCarthy period when the AMA led the charge against national heath legislation; then, the Wagner, Murray Dingle Bill.
Most progressives understand that socialized medicine is alive and well in Cuba and to a large extent in all European countries. And, these systems are highly popular. Honest US visitors to those countries report the reality of those systems; but these same reporters fear being attacked from the right.
In these countries there is a great appreciation for the quality of health care. For example, simple physician home visits, at no cost, are a regular feature of the French system, throughout the country. No cost of required prescription drugs from pharmacies throughout the country. This is unheard of in the US.
The Economic Crisis
The crisis in health care is a continuing problem; but, now with the economic downturn, patients; patient care and hospital workers, are at far greater risk. The problems start with just trying to find a physician who accepts the insurance than you may have. Fewer and fewer physicians will accept Medicaid, a well know problem; but a growing number are also rejecting Medicare.
Of course, then you have the problem of continuation of care with many physicians flip flopping between different insurance carriers, i.e., will the same doctor cover you the next time. Will your records be forwarded to the next doctor? Of course, if your one of the 47 million without health insurance your looking for a doctor who even see you and then will not charge you too much.
When you have to go to a hospital you quickly understand how deep the problems are. The simplest visit to the Emergency room, with or without insurance, will take at least 3 and most likely 6 to 8 hours just to see a physician. And, the defenders of the US system and attackers of European systems point to the waiting times in the National Health Service of England and in Canada as reasons to reject a national health program.
Usually, the mass media and too many other people believe that the staff reductions are the worse in public hospitals and related health care facilities. It is an almost accepted part of the system. And, make no mistake about it, they are severe.
While hospital staff reductions are worse in public hospitals, all hospitals are facing this crisis. The so-called Not for Profit Hospitals face the same cutbacks and shortages. Nurse coverages on the general medicine floors are woeful, but the problem extends to the intensive care units as well as other high-risk patients, also.
Also there are dangerous speedups in hospital pharmacies and in the operating rooms. A significant number of mistakes become deaths. As documented by the federal Institute of Medicine these needless deaths amount to a disgraceful over 100,000 deaths a year. That is a year. It's almost like a battlefield with friendly fire deaths.
If that many died, you can imagine the number of patients who became short and long term disabled. Again the battlefields are a good analogy of death and disabled.
Ask any doctor or nurse and they will confirm this crisis in the quality of health care.
Racism in health care continues to pervade the system. African American, Latinos and other racially and nationally oppressed patients simply do not get the same level of health care treatment as is needed. Report after report documents this fact. Preventive mammography and reproductive organs is simply not available as it should be. This fact is not even disputed; the problem is that there is a continuing acceptance of this inequality.
The NY Times article which documented the crisis in Grady hospital in Atlanta [NY Times, December, 2007] as well as the other over 1,300 other public hospitals is a point of unity for health care activists. Regardless of which national or state health plan you may support or Democratic Party contender, everyone should seek out the local coalitions in your town and city and support your local public hospital. A national coalition for these public hospitals is a natural for the year 2008 and could set the real tone for national health legislation.
Activists should do what the Times investigative reporters did for Grady. Cite the number of hospitals beds , operating rooms , outpatient visits [850,000 a year], specialties [Only Level 1 trauma Center in Northern Georgia] and also the only place where immigrant workers can get care. That is for Grady, what about yours? And, then we can count up all of these numbers for the whole country.
Medicare: The First Step
Corporate America looks at Medicare in two ways. On the one hand, many would like to get rid of the system and return to the pre-Medicare years before 1965. Ideological right-wingers, as was shown in the Child Health Plus debate, think that all health care should be bought privately. The government role should be eliminated. Bush and all the Republican candidates for President parrot this line. But, since they know that this cannot be achieved in one fell swoop, they are doing the next best way to get their profits, i.e., privatize Medicare into private companies run by the insurance companies and their underhanded sidekicks.
Since the Reagan period, Wall Street financiers see the billions of dollars of taxpayer's money in Medicare in much the same way they view the Defense budget. Continually limiting the government role and increase the private sector, for profit is their main goal.
Demonstrate in front of ERs
An interesting idea would be to bring together patients and community residents to demonstrate in front of every ER in the country to demand IMMEDIATE SERVICE.
Unity is Before Us.
Achieving the broadest coalition for a national health plan that is truly universal and comprehensive is within our grasp.
Heretofore, the struggle has focused on expanding coverage for kids and their families; expanding existing health insurance coverages. It clearly has not been enough.
TO ACCOMPLISH OUR GOAL. WE MUST ALSO DEMAND A MAJOR INCREASE IN THE QUALITY OF CARE. END THE NEEDLESS DEATHS AND DISABILITY CREATED BY A FAILED SYSTEM.
The defense of and expansion of public, i.e., federal state and local, health services are crucial to significantly improving the quality of all health services. Pointing to the massive cutbacks in staffing and starting to provide health services to people who need such services is crucial. In that regard, the example of the San Francisco Health Plan, a plan that brings everyone in – not focusing on insurance coverage, is a good debating starting point.
By combining the fight for quality of health care with the struggle for a true universal health system, we can link up with grass roots activists and help deflect the anti-communist attacks from the right wing and weak Democratic Party politicians who are afraid to return the fire of the right.
There is no blueprint to our struggle, but the immediate steps are clear and being taken.
Everyone's ideas are welcome in this struggle.