By Ida Hellander, M.D.
[Note: The following essay was a “spoken word performance piece” presented at a vigil for single payer on July 30, 1996.]
“Of all the forms of inequality, injustice in health is the most shocking and the most inhuman.”
— Dr. Martin Luther King Jr. (1929 – 1968)
“When I dare to be powerful — to use my strength in the service of my vision, then it becomes less and less important whether I am afraid.”
— Audre Lorde (1934-1992), who struggled bravely with breast cancer and inspired a whole generation of African American women health activists
When Rosa Parks refused to sit in the back of a bus in Montgomery, Ala., on Dec. 1, 1955, didn’t she want more than a law that allowed her to sit in the front? When black students braved sitting down at lunch counters in Greensboro, N.C., on Feb. 1, 1960, didn’t they want more than a hamburger?
So why should anyone think the widespread complaints of patients and the terrible injustice sick people face in this country — insured and uninsured, working and unemployed alike — will be resolved by this or that piecemeal bit of legislation? We have bills that give, for example, mastectomy patients in Maryland the right to spend the night in the hospital or, as in the current proposals floating around Congress, suddenly ill patients the right to go to an emergency room. Oh, boy. This is health care reform?
Personally, I can’t figure out why a patient shouldn’t be able to go to any hospital, to any doctor, or to any clinic that can help them. I mean, public money pays for the lion’s share of all health care, if you include Medicare, Medicaid, VA, Champus/Tricare, public funding for private health insurance for government employees, and the massive tax breaks we give theoretically not-for-profit health institutions and to employers who buy insurance for their employees (a dwindling breed).
If you add all of those programs up, it works out that taxes (i.e. you and me) pay for over half of all health care.
Individuals (that’s you and me again) pay the second-largest share directly (about a third of a trillion dollars). That’s what all that money we spend on stuff the insurance companies refuse to cover adds up to, like the revolting surgery I had to have for a receding gum line (I can’t have receding gums, I’m only 35!) and had to pay $500 in cash for, because my “managed dental care company” refused to cover the procedure even though, the way I read it, the policy explicitly said it would cover “periodontal surgery.” Go figure.
So that just leaves, well, not much is left for non-public employers to pay for private insurance coverage, less than one-fifth of the whole shabang.
If it seems like your insurance isn’t covering much these days it’s because, well, it isn’t. Even so, your boss just deducts the cost of the premiums out of your paycheck, so really you and I are paying again. Cute, huh?
You should also know, because its important that you have this type of information when you start fighting for your right to health care, that besides paying for most of the health care for regular people (like everybody over 65) in this country, taxes also fund all the health care benefits for all legislators, something that should be taken into consideration when they complain that we can’t afford health care for everyone. In fact, legislators are the only occupational class with 100 percent coverage besides judges; ministers and family farmers are near the middle and bottom of the ranks of the uninsured, respectively.
But that’s not all. Since the turn of the century, public money has been used to train every one of this country’s health professionals as well as for almost every brick of every hospital and clinic ever built. Even the hospitals in for-profit hospital chains like Columbia/HCA, currently under investigation for overcharging Medicare millions, were almost entirely built with Medicare and tax-free charity money. Even most of their day-to-day operations (as well as profits) come from the public purse in the form of Medicare.
So why should patients, you and I, the very people who financed the whole building of the health care system, theoretically the “best in the world” (although if I hear that one more time I am going to puke because it is not even close to true), have to sit in the back of the bus and accept the Kafkaesque and, in many cases, life-threatening intrusion of over 1,000 different insurance plans into who can get medical care, and when and how and for how long and how much? In fact, why do we need private insurance companies running health care at all?
No other industrialized country allows private corporations to make health care decisions for its precious residents: industrialized democracies the world over have national health insurance systems that cover everyone. (Even American tourists who fall ill on their whirlwind European vacations get covered by these national health plans; most don’t even bother trying to collect on U.S. insurance plans – it’s too much hassle.) In general, they cover everybody, provide more doctors visits, more hospital days, more procedures, even more bone marrow transplants for less money than we do.
Perhaps most shocking of all, particularly to those of us in HMOs who are accustomed to getting about 2 minutes (or 2 seconds) of a doctor’s attention during a typical visit, physicians in most countries still make house calls!
How do they do it? Well at least partly because they don’t have private insurance companies that make us waste at least a quarter of every dollar on stuff people don’t even want, like piles of insurance paperwork, incomprehensible 1-800 systems, rich CEOs, billboards and ads in the paper, 40-page itemized hospital bills with surreal prices for Tyenol and sanitary napkins, and the latest outrageous insult, a campaign against the meager “patient bill of rights,” a flimsy document that doesn’t even include the only right patients really need: a right to health care!
The only other wealthy country in the world I can think of that allows its public resources to be used in such a discriminatory fashion is, well, I can’t think of any. Maybe South Africa before the end of apartheid? Anyway, the last time I checked, apartheid was over, and today, the new constitution of South Africa says that all its citizens have a right to health care.
In 1995 and 1996 alone, according to the Centers for Disease Control’s Dr. David Allen, South Africa built over 300 free health care centers for its population, and more are on the way. They don’t have anything like our trillion dollars a year to spend on health care (13.6 percent of our total economy), but they are doing their best. We aren’t.
It is time to end medical apartheid in the United States. Remember that poor, frustrated, HIV-positive man in L.A. who stopped six lanes of traffic and killed himself on the freeway? He had a big, hand-scrawled sign that he rolled out on the pavement before he shot himself (and started a wave of media handwringing over broadcasting a suicide over live TV). His sign said, “HMOs are in it for the money,” and you know what? He was right.
It’s time to politely but firmly eject venture capital and for-profit HMOs and other providers (hospitals, physicians’ groups, nursing homes, etc.) from the driver’s seat on health care policy. The movement for health rights is just getting started, and this time we have to succeed.
This time we must not let the insurance companies and politicians who act like the paid staff of for-profit HMOs write the plan like Clinton did (but I digress). This time the public must write the health plan with their feet. It’s time to march in the streets and push, if we must, the health care bus towards the
Promised Land: a health system that serves everybody.
So we are all on the same page this time around, the plan we need is called “single payer” by policy wonks, “single prayer” by me. Why? Because my single prayer is that within the next four years, there won’t be any Rosas or students or blacks or whites or Latinos or gays or children or seniors or disabled people or people with serious mental illnesses or HIV or cancer victims or documented or undocumented immigrants or artists or musicians or waitresses or janitors or bus drivers or day-care workers or ministers who won’t have health care.
There won’t be anybody who has to go without the care they need so that stockholders, for-profit companies, and health industry CEOs like Leonard Abramson, who personally took home $967 million from the sale of one HMO’s patients (U.S. Healthcare HMO) to another HMO (Aetna), can profit. What Leonard Abramson did and what is routinely happening in the medical-industrial complex every day now, the buying and selling of human lives, was banned over 100 years ago, but no freedom lasts forever if you don’t fight for it.
“Health care is an essential safeguard of human life and dignity, and there is an obligation on the part of society to ensure that every person is able to realize this right.”
— Joseph Cardinal Bernardin
The author would like to acknowledge the assistance of Nancy Wooten, Ph.D., an American History scholar.