By Gillian Pomplun
Crawford County (Wisc.) Independent, February 14, 2018
A ‘Medicare for All’ event held on Saturday, Jan. 27, at the American Legion in Viroqua drew over 80 participants.
Speakers at the event included Megan Grinde of La Crosse; Darrin Von Ruden, president of the Wisconsin Farmers Union; Dr. Taryn Lawler, family physician at the La Farge Medical Clinic; and State Senator Kathleen Vinehout of Alma, Wisconsin.
Representatives from U.S. Senator Tammy Baldwin’s office, and U.S. Representative Ron Kind’s office were also on hand.
Medicare v. Medicaid
Kind’s Deputy Chief of Staff Brad Pfaff explained to the group that U.S. citizens generally access health care in one of five ways: Medicare, Medicaid, the Veteran’s Administration, employer, or a Health Care Exchange.
Medicaid (Badgercare in Wisconsin) provides health coverage to eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.
Medicare is the federal health insurance program for people who are 65 or older. Certain younger people with disabilities, and people with End-Stage Renal Disease (ESRD) are also covered under the program.
Military veterans receive insurance through the Veteran’s Administration. Also, since passage of the Affordable Care Act, individuals and families can sign up for health insurance through state health care exchanges.
Healthcare reform
There is nothing new about the topic of healthcare reform, and the same cast of organizations and companies seem to reassemble perennially to carry the debate forward. Politicians from all political stripes, lobbied by the American Medical Association (AMA), representatives of pharmaceutical and health insurance companies, farmer and labor organizations, and more, seem unable to reach any successful political consensus on the topic.
The idea of following the rest of the industrialized world in creating a ‘Medicare For All,’ or national healthcare program has always battled with the entrenched economic imperatives of the for-profit corporations who would stand to lose if a national single payer health care program was enacted.
Americans became used to associating insurance with employers over the years. This trend paved the way for the beginning of third-party health insurance in the 1930s. In this period, during the Great Depression, more and more people could not afford medical services. In 1933, President Franklin D. Roosevelt directed members of his team to help draft provisions to his pending Social Security legislation to include publicly funded health care programs.
These reforms were at-tacked by the AMA as “compulsory health insurance.” Roosevelt ended up removing the health care provisions from the bill in 1935. Fear of organized medicine’s opposition to universal health care has been a standard feature ever since.
During this time, individ-ual hospitals began offering their own insurance pro-grams, the first of which became Blue Cross. Groups of hospitals as well as phy-sician groups (i.e. Blue Shield) soon began selling group health insurance poli-cies to employers, who then offered the insurance to their employees and collected pre-miums.
During World War 2, the federal government intro-duced wages and price con-trols. In an effort to contin-ue attracting and retaining employees without violating those controls, employers offered and sponsored health insurance to employ-ees in lieu of gross pay. This was a beginning of the third-party paying system that began to replace direct out-of-pocket payments for health care services.
Following World War II, President Harry Truman called for universal health care as a part of his Fair Deal in 1949 but strong opposition stopped that part of the Fair Deal. Then, when Lyndon B. Johnson was elected president, the bills establishing Medicare and Medicaid were passed in 1965.
The health care reform issue continued to be batted around Congress for the next 40 years. The same cast of business interests, lobbying organizations, and even some of the same elected representatives played their predictable roles. Medical and pharmaceutical industry campaign contributions continued to flow into the pockets of candidates seeking public office.
Finally, in January 2007 U.S. Representative John Conyers, Jr. (D-MI) introduced The United States National Health Care Act (HR 676) in the House of Representatives. As of October 2008, HR 676 had 93 co-sponsors. Also in January 2007, U.S. Senator Ron Wyden introduced the Healthy Americans Act (S. 334) in the Senate. As of October 2008, S. 334 had 17 cosponsors.
Start with the state
Wisconsin State Senator Kathleen Vinehout told the audience present at the ‘Medicare for All’ event about her work over the years to craft single-payer health care proposals in the state legislature. She also described the barriers she faced both from Repbulicans and members of her own party.
“My goal was to ensure the same insurance I received as a state senator to every resident of the state,” Vinehout said.
Vinehout told the inspiring story of Tommy Douglas, a Canadian Social-Democratic politician and Baptist minister. Douglas was elected to the Canadian House of Commons in 1935, as a member of the Co-operative Commonwealth Federation (CCF). He left federal politics to become the Saskatchewan CCF’s leader and then the seventh Premier of Saskatchewan from 1944 to 1961.
His government was the first Social-Democratic government in North America, and it introduced the continent’s first single-payer, universal health care program.
“From the time Tommy Douglas started his campaign for health reform in Saskatchewan, until it was enacted into law took twenty-six years,” Vinehout said. “After that, it only took another four years until it was expanded to the entire nation.”
After the Affordable Care Act was passed in 2010, Vinehout advocated for the creation of a state health care marketplace, with Badgercare as a public option. Instead, when Scott Walker was elected Governor in 2011, he repealed all the reforms in health care that Vinehout and others had worked to put in place, and refused to take the Medicaid expansion dollars from the federal government.
Vinehout explained that she supports creation of a single-payer system, but beyond seeing healthcare as a right, she also sees it as “an obligation or responsibility we all have to each other in a civilized society.”
“Just as in our democracy, there’s a lot of talk about our rights,” Vinehout said. “But what is often missed is that along with our rights come responsibilities to be an informed participant in our democracy. It’s the same with healthcare.”
Businesses for it
Vinehout told a story about a recent experience she had in Madison. One day, a woman who worked as an aide for a Republican colleague and who is a personal friend, told her a story while they were discussing health care.
“Before I had my current position, I worked for for a lobbying group that paid me to lobby the Wisconsin Manufacturers & Commerce against your Healthy Wisconsin legislation,” the person told Vinehout. “They paid me to do that because the business community was all for a single-payer system.”
Vinehout explained that businesses like the idea of a single-payer system because it eliminates all the administrative costs and challenges of managing a health insurance program in their company. It also gives them a competitive advantage in employee recruitment when they have branches in other countries where universal health care is available.
A list of some of the other countries in the world that have moved forward with a national single-payer health care program, guaranteeing all of their citizens access to healthcare, includes Norway, Japan, Germany, Belgium, United Kingdom, Sweden, Canada, Netherlands, Austria, Finland, Denmark, Luxembourg, France, Australia, Ireland, Italy, Portugal, Greece, Spain, Switzerland and Israel, to name a few.
Keep telling your story
Vinehout encouraged audience members to keep sharing their health care stories. She had her own story to tell about medical bills and keeping the family farm.
When Vinehout was first running for the state senate, she and her husband were dairy farmers. She remembered when they had to make the choice either to lose their health insurance or lose their cows – they chose to keep the cows.
“I would lie awake at night and worry about my family,” Vinehout remembered. “Farming can be a dangerous occupation and anyone can get sick or get injured.”
Vinehout rememberd that she took a call six weeks before the election, during a campaign meeting, and learned that her son’s appendix had ruptured and he needed emergency surgery.
“My son came through just fine, but the family was faced with a $15,000 medical bill,” Vinehout recalled. “Fortunately for us, we were able to take out a second mortgage on the farm. Not everyone has that kind of equity in their farm, though.”
Weight of the world
Megan Grinde, who grew up on a small, diversified farm north of Melrose, started the presentation out with a personal story.
Grinde told the audience about how her family’s farm had been in the family for five generations. She explained how her family worked hard, and took pride in that history. In the 1980s, Grinde says, she watched as, one after the next, her neighbors lost their farms due to family illnesses and cancer.
“One day between the end of school and the beginning of softball practice, I fell and ruptured my spleen,” Grinde recalled. “I took an ambulance ride and spent a week in pediatric ICU at Gundersen.”
While lying in her hospital bed, with her worried loved ones around her, Grinde recalled seeing people with clipboards and paperwork talking with her parents.
“At some point, I realized that the family wasn’t just worried about me,” Grinde said. “I realized that they were also worried about how they would pay my medical bills, and worried that it might mean they would lose the farm.”
“We shouldn’t have 13-year-olds trying to recover from an injury carrying the weight of the world on their shoulders,” Grinde recounted tearfully.
Other examples
Darrin Von Ruden told the audience that the Wisconsin Farmers Union has been advocating for a single-payer or ‘Medicare for All’ health insurance system for years. Von Ruden shared several experiences with the health care delivery systems in other countries.
“When I was travelling in Norway with a Farmers Union association, the man broke his ankle and had to seek emergency care,” Von Ruden remembered. “After he got home, he kept expecting to receive a bill, but one never came because the service was covered.”
Von Ruden told the audience that the U.S. needs to take a good look at single-payer health care systems in other countries to find what would work best here in our country.
“Another example is when I spoke with the President of the Dairy Farmers of Ontario, who had needed knee replacement surgery,” Von Ruden said. “He wanted to have the surgery in December so he would have the winter to recuperate, but wound up having to wait a little longer than that because it was not an emergency situation.”
Von Ruden explained that advocating for health insurance for farmers was complicated by the fact that nationally farmers now represent less than one percent of the U.S. population.
“And frankly,” Von Ruden said, “we have farmers that sit on both sides of the aisle, politically speaking.”
Doctor’s dilemma
Dr. Taryn Lawler of the LaFarge Medical Clinic spoke of the angst of health care professionals who make diagnoses and dispense care instructions and prescriptions.
“I see so many people, especially the people whose income is just over the threshold for Badgercare, who are in critical need of care and medications, but just can’t afford it,” Lawler said. “Co-pays are just too high, and many people have to make hard choices about buying their needed medications or paying the rent or putting food on the table for their children.
Lawler shared a story of a young patient who suffered from asthma and needs an inhaler.
“When I first started seeing him, he was on Badgercare,” Lawler said. “He was getting the regular tests and inhalers that he needed.”
Lawler said that the young man started to do a little better economically, and his income went up just enough to disqualify him for Badgercare.
“Now he isn’t getting the tests he needs, and he isn’t using the inhalers that he needs,” Lawler says. “And as his doctor, I have to just worry about him. I worry that there is someone out there in our community that may not be able to breathe. Someone who is my patient.”
Lawler supports making Badgercare available as an option for all state residents. She says that 90 percent of state residents would get more and pay less, and there would be no premiums or deductibles.