A United States Socialist Vision of Health

BY: CPUSA Healthcare Commission| April 5, 2005
A United States Socialist Vision of Health

The CPUSA Perspective: The Struggle for Healthy Families

Current State Of the Struggle for Healthy Families in the USA; And What to do About It The outright greed of the health care industry in the United States generates huge corporate profits on the one hand, and at the same time increasingly excludes access to quality health care for millions of working families across the nation. Untold misery and uncounted premature deaths are left in its wake. These two processes have become inseparable in the United States. They have resulted in the highest health care costs in the worldboth in terms of the cost of health care relative to the rest of the nations economy, and in terms of the per-person cost of health care. A significant portion of these costs are in actuality profits. At the same time, the health of American families, compared to the health of the people of all nations, has been steadily falling behind for decades. The World Health Organization continually lists the United States at 37th of all nations in the world.

The class and race aspects of the U.S. system are dramatic. If you have the money, you can afford to pay the excessive out-of-pocket costs for expensive health services like chemotherapy, MRI tests and related diagnostic and treatments. The fancy technology that health industry power brokers proclaim is often reserved for those with financial resources. The racist edge has been proven over and over again. A few simple statistics prove the point: African American males life expectancy is just 61 years old, well below the normal retirement age; and infant mortality in African American inner cities is two to three times greater than in more affluent parts of U.S. cities.

Monopoly is the central feature of the U.S. health care industry. During the last several decades control over vast health resources have been concentrated in the hands of fewer and fewer corporate entities. Hospitals and nursing homes are owned by the hundreds by these entities. The old health insurance companies have grown to become diversified international corporations that both sell health insurance on the one hand, and provide health care through vast holdings of hospitals, clinics, and health maintenance organizations (HMOs), on the other. They are working both sides of the street, so to speak, in a way that has no precedent in the industry. These health industry giants have come to dominate entire communities, and increasingly entire regions as monopolies.

The invasion of communities by these corporate health care giants has resulted in a series of destructive, sometimes deadly, changes in the capacities of communities to care for families. Where there used to be a large number of health facilities, expanding hospital chains often buy up both public and private nonprofit hospitals in communities. Sometimes they convert them to for-profit hospitals as an acquisition to their holdings, and sometimes they simply close them down. In New York, investor owned hospitals are not allowed, so the massive voluntary, not for profit hospitals are being combined as if they were for profit. These hospitals act is if they are profit generating. The guiding principle is to destroy the health services competition. Typically public and private non-profit hospitals provide a higher proportion of charity care, so when these facilities are gone, it is tremendously destructive to low-income and racial minority families. Corporate hospital chains also have a long history of eliminating less profitable medical services such as emergency rooms, labor and delivery and burn unitsan unequivocal act of profit maximization and the destruction of critical community health needs in one blatant action.

In rural areas, this regional economic monopolization is leaving tens of thousands of people with no hospital and physician access. After all, these companies feel that if a hospital or physician is located with a few hours, this is good access.

Monopoly power has never been greater, In fact, for the first time in our nations history, these financial and political power elites have one of their own guiding the United States Senate. U.S. Senator Bill Frist, MD, may be a medical doctor, but more importantly, he is the heir, and financially linked to the Hospital Corporation of America [HCA]. HCA is the largest for-profit hospital chain in the United States. There is desperate and despicable self-interest in HCAs leaders seeking political power. Their executives have been found guilty of Federal Medicare fraud, with a number of them doing federal prison time.

They are in league with corporate scofflaws like the federally indicted Richard Scrushy, the former CEO HealthSouth. HealthSouth is the largest U.S. chain of outpatient surgery, diagnostic imaging and rehabilitation centers. It was founded by Scrushy in 1984 and has some 50,000 employees and about 1,700 sites in all 50 states and overseas. He was indicted for falsifying the books to enrich him by $2.7 billion.

HCA and HealthSouth are the poster children of Profits in Health Care, a system which the Republican Party and too many Democrats are committed to preserving.

The White Houses obsession with trial lawyers and eagerness to dump what Bush refers to as frivolous law suits including medical malpractice suits are directly linked to these fraud cases. This is the only country in the industrial world that has a medical malpractice problem because we are only country without a national health program that takes care of peoples medical needs.

The Institute of Medicines report that over 100,000 patients die each year in hospitals has these corporate scofflaws shaking in their boots in fear of legitimate negligence suits which are needed to help victims of medical errors and neglect to put their families back together after massive hospital bills. [The other leg of this anti-law suit attack is the asbestos suits facing corporate scofflaws like Halliburton, Vice President Cheneys company. Bushs recent attack on asbestos law suits is gruesomely anti-victim and a direct payoff to his contributors]

Profits Dictate Health Care The invasion of profit-maximizing health maintenance organizations has forced entire families to abandon their health providers of choice for someone on the list. The health care of families is fragmented when different members of a family fall under different plans, and are forced to use different providers. Too often patients with complicated treatment regimens, such as chemotherapy, are forced to change physicians because of a change in the list.

In Medicare, the sudden collapse of large numbers of entrepreneurial HMOs, spurred on by the privatization of the federal Medicare system, has left untold hundreds of thousands of families in debt or bankrupt from unpaid medical bills that were supposed to have been be paid by the HMO. Moreover, even when bills are paid, elders, among our most frail, suffer discontinuity of, and lapses in, care, as they are shuffled from plan to plan, and doctor-to-doctor.

There is little profit in low-income communities, which are disproportionately minority and/or rural communities. These communities are often entirely abandoned by the health care industry. Families in these communities are forced to use abusive and ineffective Medicaid mills, or the vastly overcrowded and poorly equipped offices of sliding-fee community clinics. Often they simply do without care at all, relying on ineffective over-the-counter drugs, or tailgate venders of fraudulent or outdated drugs.

The soaring costs of health care have pushed it to become in recent years the single most frequent cause of personal bankruptcies in the United States. This has been reflected in decades of health insurance cost increases that have consistently outstripped the annual inflation rate. Employers, who have to use insurance carriers, respond to this dent in their profits by shifting more and more health related costs to workers, while forcing workers to accept increasingly inferior plans. Workers are also forced to choose between much needed wage increases and health benefits. Every year growing numbers of employers have simply abandoned health benefits altogether, often with disastrous consequences for the workers and their families. There are approximately 45 million people in the United States with no health insurance at all. Tens of millions of additional people spend some part of the year uninsured. Finally, additional tens of millions of family members who do have health insurance cannot afford the co-payments and deductibles, and are therefore effectively barred from adequate health care.

The safety net is seriously shredded. Millions of Americans have Medicare health insurance coverage, but physicians are not required to honor it. Medicare and Medicaid are increasingly becoming unredeemable vouchers. As a result, while a community may have an adequate supply of health care providers, few if any may be willing to see a patient with Medicare insurance, because the provider could see a patient with private health insurance and make much more money. Furthermore, Medicare does not cover the cost of drugs. Recent federal prescription drug legislation purports to address this serious omission, but the legislation does not take effect for several years even then it is so plagued with giveaways to corporations, and inferior coverage, and incredible cost overruns, that its effectiveness is seriously in question.

Attacks on Medicare and Medicaid, as weak as these insurance systems have become, are very real cynical efforts to abolish altogether meaningful health care for seniors, dependent children, the working poor, and disabled. In addition, hundreds of thousands, perhaps millions, of additional workers and their families are losing health care coverage in the economic crisis. Meanwhile, hospital and public clinic closings continue unabated. These are life and death struggles that must be met with militant mass action.

Medicare and Medicaid Since their inception in the mid-1060s, Medicare and Medicaid have been increasingly privatized, with grave consequences for cost containment, equity, efficiency, quality and continuity of care. The CPUSA supports the demand to refederalize the Medicare and Medicaid systems, a demand which engages broad sectors of the nation in the struggle. It adds an anti-monopoly and anti-corporate element that every public poll indicates would be very popular among the electorate. In addition, the logical trajectory of this reform leads directly toward the goal of a completely public sector national health service. The popular rallying cry for the struggle could be, Medicare & Medicaid Funds for Health Care, Not Profits. Or, Healthcare for People, Not Profits.

National Health Service The Party has continually supported popular struggles and legislation that pave the way for, or would establish, a national health service (NHS). The uniqueness of a national health service strategic direction is that this form of socialism can and does take place within the capitalist system. The NHS in the United Kingdom remains the jewel of health services despite its underfunding problems. Raising the banner of socialized medicine sends the kind of message that a Party of Socialism needs to communicate. Also, this demand with its logic and realism is the kind of anti-monopoly program that can combine with other peoples struggles such as increased public housing, jobs, etc.

Key elements of a national health service include, but are not limited to:

  1. the elimination of profit from all aspects of health care and public health measures;
  2. payment for all health care including true public health measures from steeply progressive taxes;
  3. the delivery of all health care and public health services from publicly owned hospitals and community health facilities federally financed via global budgeting;
  4. the delivery of all health care and public health services by salaried public health care providers and workers, who earn a living wage, have job security and full benefits and who have the right to organize;
  5. the elimination of all financial barriers to access to health care;
  6. a tiered and publicly system of governance relying on local, regional, and national elected boards;
  7. a national system of quality assurance and guaranteed services;
  8. a regionally based system of publicly owned health care worker education and research facilities which have no financial barriers to access and no ties to corporations.

It is against these anti-monopoly, pro-people principles that all national health insurance and service proposals must be judged.

Insurance Based Systems: Single Payer/National Health Insurance

National health systems based on reimbursement are insurance systems and will inevitably have major gaps in services. These gaps are usually filled easily by people with money, but not by working class people. The racist edge will be apparent, as it is in the Medicaid and to some extent the Medicare systems.

The Party cannot fully support national health insurance schemes that funnel public funds into the for-profit health care industry or a so-called not-for-profit system that behaves the same as profiteers. Such schemes are the health care equivalent of vouchers in education. This is obvious when the high sounding proposals are made by the American Medical Association, the American Hospital Association and even the Insurance Association.

But, there is also no guarantee that a single payer system proposed for individual city and states or the federal government would be comprehensive. Most single payer system that have been proposed in the past would result in an ongoing, giant financial payoff to the health care industry. Costs would rise precipitously, as the government and politicians with feed their industry buddies and single payer would evolve into an ‘unfunded mandate.’ This would result in the uninsured suffering the same problems as faced by Medicare and Medicaid participants. Our Party activists, while playing a role in these movements, should also put forward a more advanced position that actually solves the problems. That is the Communist plus that our Party stands for.

However, we believe it is important to work with single payer advocates in broader coalitions around positions that are open to the advocacy of National Health Service or key elements of NHSfor example, bills that directs Congress to enact legislation that provides real access to comprehensive health care for all Americans. Some proposed single payer bills are far better than other proposed similarly labeled legislation. Some such proposals, for example, seem to exclude any role for insurance carriers, for example as third party administrators. However, even the most advanced single payer proposal, at this time, preserves the antiquated fee-for-service physician payment system at the exclusion of salaried physician emphasis. Single payer insurance-based systems also do not guarantee the delivery of services since hospitals and community clinics would remain in private hands.

There are important physician groups working on one such a proposal, HR 676 [see below], with whom we work. The efforts to gain labor support for HR 676 are very useful for future struggles for national health legislation.

Health Care Policy And Trade Union Work

But, while labor support for HR 676 is increasing there are objective reasons that organized labor has not been at the front of the struggle for national health legislation, i.e., any health legislation. This is a key issue for labor and therefore for our Party.

The key issue for labor is: What happens to our negotiated health benefits in any national health bill? There are major objective reasons that labor union leaders and members worry about any national health program. For example, the year 2003/4 enactment of the Bush Medicare Prescription Drug program could allow employers to cut back on negotiated prescription drug plans. This will further put the worry sign up for labor leaders and members.

In addition for organizing purposes and identification purposes, labor has become wedded to their negotiated health benefit programs. The is a fact that must be taken into consideration by all health care activists.

Solving this series of issues is not easy, but it is achievable. Labor unions must be allowed to continue their current health benefits programs regardless of any national health program. This will help to unite all elements of labor to endorse progressive national health legislation including the building trades, manufacturing, services and public sector unions.

The Party has a special role in making sure that workers are protected from any detrimental actions of their national government. This is also integral to an anti-monopoly strategy.

How can this be accomplished? Our answer would be to ‘grandfather-in’ all labor-negotiated health benefit programs, and fashion a national health insurance program around them. We would also ‘grandfather-in’ the current and refederalized Medicare & Medicaid programs. Individual labor unions could then voluntarily fold their health benefit programs into the federal program, at their own discretion. The Canadian health system was started with this kind of approach. And, the French, German and other European health systems still maintain a special role for organized labor.

This could then be called: ‘Labor Programs Plus Medicare for All’ or ‘Labor/Medicare for All.’ But, first the Medicare agenda must include the demand to fully federalize Medicare and Medicaid. The ‘Medicare for All’ slogan is shorthand for a national health insurance program that would resonate with policy makers, workers, retirees, and many others.

Since the failure to enact national health legislation in 1994, the Democratic Party and the AFL-CIO had agreed to keep health policy issues ‘Off Agenda.’ This approach resulted from a misreading of conditions, since health care was, and is, high on the agenda of all people in the USA. Recent movement by the AFL-CIO on health policy is part of the prescription to throw out the Republicans from Congress and the White House and make health care a right, not a privilege, in our country. It didnt succeed in 2004, but the seeds for future victories have been sown.

If organized labor were to adopt this approach then it could protect their own legitimate interests and once again be at the head of the peoples movement for health.

We believe organized labor and the Medicare movement should work together to write their own bill and then cover everyone else. After all, who has more direct, on-the-ground experience in the organization, delivery and financing of health services. This is a good starting point. Our job is to work with organized labor to support a progressive health bill. The Partys Health Commission members are working with leaders of the labor movement to encourage organized labor to develop, write, and propose labors own national health legislation. This new approach is being well received by health policy people and labor leaders/activists who are trying various ways to get labor to drop its opposition to national health legislation. The issue of protecting currently negotiated health benefits is crucial to continued labor support.

Once this stage of struggle is attained, then the next stage of a National Health Service is within reach.

State Actions

There is a groundswell of activity by various city state labor councils seeking to find solutions to the crisis in health care. Wisconsin and California are two examples of state labor councils seeking state action to get health care for everyone in that state, and others are contemplating similar action. The issue is becoming, Should labor expend its political strength and energy on state governments, or should the focus be on Congress? The AFL-CIO Executive Council made it clear that many actions will be necessary to get health care to be a focus of the year 2004, 2006 and the presidential and congressional elections of 2008.

The key issue remains here as with national health legislation: What happens to our negotiated health benefits? That is the key issue that even the most progressive national legislation reform, HR 676, has failed to address. Labor unions must be allowed to continue their current health benefits programs regardless of any national health program.

The legislative Struggle for National Health Legislation

The details of proposed legislation changes from revision to revision, and certainly from year to year. This is to be expected given the vagaries of Congress and politicians. Nevertheless, we can use recent examples to clarify important health care issues. Three pieces of progressive legislation for national health care that were introduced in the 107th Congress show the levels of action that will probably continue through the next period of time. Congressman John Conyers was the primary sponsor of two of them, and a secondary on the third. Congresswoman Barbara Lee from California is a supporter of all three and lead sponsor of the National Health Service proposal: ‘House Concurrent Resolution 99’ ‘HR 676 Single Payer National Health Bill’ ‘HR 3080 National Health Service Bill’ The tactic of The Health Care Access Resolution (HCAR), embodied in House Concurrent Resolution 99 (H. Con Res. 99), and Senate Concurrent Resolution 41 (S. Con. Res. 41), directed Congress to enact legislation by October 2005 that would provide access to comprehensive health care for all Americans. While not an actual piece of legislation, it was meant to gain broader support for a national health bill. The struggle for national health legislation began taking the form of a House Concurrent Resolution 99 for Universal Health sponsored by Congressman John Conyers. This was seen as an effort to allow all progressive organizations and professionals to unite behind a set of principles. It is the precursor to an actual bill; and, still is. The principles looked very similar to those embodied in HR 676 and HR 3080

The most recent version of a federal Single Payer National Health Insurance system [HR 676] has responded to the demands that previous single payer proposals were deficient. It is vastly superior to the single payer proposal of the late US Senator from Minnesota, Paul Wellstone, since the Conyers proposal is federal and not state-based; and, it the federal government is the administrator, not private insurance companies which mimicked the Medicare mistake. These factors make the current version far more supportable and anti-monopoly in character since there is no role for insurance carriers in the financing aspects. It is a reform that is certainly and short be supportable.

But, the delivery of services under this system is still in private hands and fee-for-service physicians take precedent over salaried physicians. HR 676 sponsors have been unwilling to offer labor the option of maintaining their own health benefit programs.

On the sate and local level, most of the single payer proposals are not on the same level as HR 676.

As we tactically and strategically consider, support and organize for insurance-based national health legislation, we must continue to treat the proposed legislation of Barbara Lee, ‘United States Universal Health Service Act [US UHSA]’ with complete respect. Congresswoman Lee is carrying the torch of Ronald V Dellums in keeping alive the only piece of national health legislation that systematically addresses the major contradictions in our current health system. Its principles are public health and hospital services; salaried doctors to make sure they are available in the urban and rural settings; health planning; educational program for professional positions with maximum affirmative action; etc. It recently had ten sponsors, and it provides a guide to measure other proposals by. In reality it stands as much a chance of passage as bills similar to the two Conyers bills. Conyers has been a sponsor of the Lee bill. HR 3080 is a direct attack on all the monopolies in the health industry.

We strongly encourage organizing delegations to meet with their U.S. Senators and members of the House of Representatives to get them to co-sponsor all proposed progressive health legislation. We encourage local, national and international labor union leaders and members to join in support. Grassroots movements like these can galvanize a movement to put people before profits in health care, and smash the root cause of the health care crisis.

As a Party, we must be careful about what is called comprehensive, single-payer, full access; and uses all the hot button terms to gain support for a piece of legislation. Measure what is being said against the principles outlined earlier.

Many political candidates put forward their idea for national health care. Most of these ideas are calculated to sound like a universal, fully accessible health care proposal. Some are totally unsupportable. Others proposed by some liberal members of Congress scale back their financing and benefit proposals to withstand the assault from the Republican Party, the Medical-Industrial Complex, and their politicians and media wizards. Candidates fear to be too advanced since the price tag would appear to be too expensive. Typically these proposals are not completely supportable. Nonetheless, it is a good sign that the candidates are at least joining the debate. Critical thinking and critical actions have never been more important for movements to see the unique contribution of Party members working with them.

Big Tent

HCAR 99/S41 came as a response to health activists seeking to bring the broadest number of politicians to begin to pay attention to the issue of national health care. The American Public Health Association, The Universal Health Care Action Network and many other groups have signed on to the proposals. Labor has also joined in. According to the Universal Healthcare Action Network (UHCAN) there were over 450 national, state, and local organizations on board. For the first time since the collapse of health care reform in the early 1990s, the U.S. Senate showed some positive movement. Key liberal Senators signed on to this HCAR movement. They are: Senators Edward Kennedy of Mass; Russell Feingold of Wisconsin; and Jon Corzine of New Jersey. These are the Senators who will have to be in the leadership of the Senate if the Health struggle is to succeed. The formal title of this proposal is Senate Concurrent Resolution 41.

Given the apparent fear by members of Congress–fear of powerful corporate and political enemies–to put forward a serious major piece of comprehensive health legislation, the following statement by UHCAN is important: HCAR is part of a broad effort to educate the American public about the need for affordable access to comprehensive health care for all, and to mobilize them to take action toward that goal. HCAR is seen an essential first step to enacting heath care reform that provides health coverage for everyone.

Popular Actions; Uniting with Social Security Struggle

It is clear that there are many grassroots health care action coalitions developing around the country, from prescription drug campaigns to state and local referendums and legislation demanding comprehensive, universal health care. In Philadelphia a citywide referendum demanding city wide universal health care and in Ohio a statewide effort for reduced prescription drug benefits are good examples of building broad local coalitions. In many areas we are already deeply involved in others we need to join and become active. The new national retiree organization, Association of Retired Americans, is a great way for comrades to become active in the health care fight. Also union retiree organizations, like SOAR are important avenues of struggle.

All health struggles must unite with the struggle to preserve and expand social security against the Bush Agenda of privatization, greed and profit.

Party of Socialism Must Promote Socialist Ideas and Ideals

As stated earlier, the unique feature of a National Health Service is that it is socialized medicine and it is at work in the United Kingdom and is very similar to systems in other European countries. It is an advanced demand that challenges monopoly and greed with practical, within capitalist economic systems.

The Cuban system is a beacon for developing countries. The World Health Organization regularly commends the Cuban health system as the best for developing countries. Health systems in the former Soviet Union and its Socialist country partners worked and worked well. The health status declines and horrendous mortality increases in the decade since 1991 has shown that to be true. This simple fact is critical in exposing the lies about the Soviet Union and its amazing victories and advances during its 75-year history.

Our Party as a Party of Socialism must continue to propose socialist solutions within capitalism that make sense. Socialized Medicine makes sense. And, with the international mobility of our working class, they are seeing, first hand, this fact for themselves.

Progressive insurance-based systems, conjoined with the strategy for labor to write their own national health proposal, that pull the peoples movement toward socialized medicine must be supported and pushed in that direction. These movements will rise and fall and will offer different legislative proposals. They need to be weighed against our socialist alternative, the National Health Service. That is our rudder of action.

Party activists are encouraged to use the big tent approach to health struggles. A united health care movement is our goal. There must be a movement that unites behind clearly stated, broad goals; and, that maximizes the role of labor and its members as the only force, along with Medicare and Medicaid activists, that can have the political weight to gain health care for all and make a constitutional demand of Health Care for the People, Not Profit a reality.

But first, the most important thing we can do, is join the CPUSA! The health movements provide an excellent opportunity for recruitment; lets get to work.

Educational Papers Series A Communist Party Education Commission project for the pre-convention discussion period leading to the CPUSA 28th National Convention July 13, 2005, Chicago Illinois



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