[Marxism] Healthcare Wars By Bonnie Weinstein Socialist Viewpoint

Bonnie Weinstein giobon at comcast.net
Mon Jun 2 15:06:34 MDT 2008


Healthcare Wars
By Bonnie Weinstein
Socialist Viewpoint
May/June 2008

Being an uninsured San Franciscan, I joined the Community Health Network
(CHN) of San Francisco General Hospital as a patient with sliding-scale
coverage. The monthly fee was $49.00‹a bargain compared to private health
plans, for sure and there was no copayment except a $5 charge for filled
prescriptions. But on April 3, 2008, the CHN sent out a letter to its
patients enumerating new fees:

³Emergency Room visit‹that is not an emergency $50.00; Urgent Care
Visit‹that is not urgent $20.00; Medical and Surgical Specialty Office
Visits $20.00; Certain Radiology visits $20.00; Durable Medical Equipment
$5.00-$20.00 (depending on item cost); Primary Care visits $10.00 depending
on your income. The fee (copayment) is due at the time of visit; Medicines
that are prescribed for you also require copayment that is due to the
pharmacist at the time the prescription is filled. Thank you for your

I had forgotten about a previous notice dated September 4, 2007, that
stated, in addition to the above,

³You must pay the copayment before your visit.... Also on October 16, 2007,
patients with sliding scale coverage and prescription drug benefits through
the CHN will need to pay a copayment for each drug (by prescription or
over-the-counter). The copayment is for both new and refill drugs....
Depending on the drug, you will need to pay a $5.00 or $25.00 copayment for
each drug. [It used to be $5.00 for whatever number of prescriptions the
Doctor gave you at the time.]...ŒOver-the-Counter¹ drugs that do not need a
prescription from a doctor may cost less than your copayment if you buy them
from the drug store.²

But, according to the city¹s new Healthy San Francisco plan for people
without health insurance, these copayments will be in addition to the
quarterly fee (in my case, $150 for three months‹virtually the same as I
paid for the CHN plan) but paid to Healthy San Francisco, plus the
additional copayments paid to San Francisco General¹s clinic (or whatever
clinic you are assigned to) at the time of service.

No matter which way you look at it, healthcare for the uninsured in San
Francisco will be both more expensive and over-crowded.
What is Healthy San Francisco?

According to the website at healthysanfrancisco.org,

³Healthy San Francisco is a program created by the city of San Francisco
that makes health care services accessible and affordable for uninsured
residents. Healthy San Francisco offers a new way for San Francisco
residents who do not have health insurance, to have basic and ongoing
medical care that include: Preventive and Routine Care; Prescription
Medicines; Specialty Care; Urgency and Emergency Care; Hospital Care; Mental
Health Care; and More... Some services such as Vision, Dental, Acupuncture,
and others are not included.... Participants in Healthy San Francisco are
each assigned a Medical Home. A Medical Home (in most cases, a clinic) [Such
as the San Francisco General Hospital CHN clinics] provides all basic health
care services... You may qualify for Healthy San Francisco if you are ALL of
the following: Living on a combined family income at or below 300 percent of
the Federal Poverty Level; a San Francisco resident who can provide proof of
San Francisco residency; Uninsured for at least 90 days; Not eligible for
public insurance programs such as Medi-Cal, Healthy Families, or Healthy
Kids & Young Adults(tm); Between the ages of 18 and 64.... If eligible, you
may join Healthy San Francisco regardless of immigration status or
pre-existing medical conditions. If you qualify, there is room for you in
the program.²

What it doesn¹t say is that not only has there been no increase in
healthcare services to compensate for the increase in patients at the cities
clinics due to Healthy San Francisco, but in fact, services have been cut
back across the board! And all the clinics are now beginning to charge
similar copayments as San Francisco General¹s CHN, even to their poorest
The healthcare crisis is mounting

Cities and states across the country are trying to come up with ways to
handle the increased demand for healthcare from an ever-increasing number of
the uninsured and underinsured. And while none of the politicians like to
talk about it, tens of millions of people in this country are well aware of
the situation, either because of the rising costs of the healthcare they now
have or because they have no healthcare at all. Unfortunately, the solutions
offered by the powers that be offer little more hope.
What else can we look forward to?

In Massachusetts, health insurance is now mandatory. The uninsured must buy
health insurance like they have to buy car insurance. And the insurance
companies, like car-insurance companies, must cover all who apply. And like
car insurance, the uninsured are distributed across health-insurance
companies similarly to how car insurance is assigned to the uninsured
motorist. The state determines how much you can afford to pay and exactly
what coverage you will get. According to a November 25, 2007, article in The
New York Times entitled ³Massachusetts Faces a Test on Healthcare,² by Kevin

³The Massachusetts plan was signed into law by former Gov. Mitt Romney. . .
. The law, which requires adults to be covered by Dec. 31, grants exemptions
from the penalty if an income-based formula determines that coverage would
not be affordable. . . . The state established a mild penalty for the first
year [for not purchasing health insurance when mandated to do so]: the loss
of the $219 tax exemption. But in the second year, the fine can amount to
half the cost of the least expensive policy available, probably at least

So, in Massachusetts, the first year you file a tax return without proof of
insurance you lose your whopping $219.00 tax exemption. (Ironically, the
first year, it¹s cheaper to not buy insurance and just lose the tax
exemption!) But if you get caught the next year without insurance you will
be fined at least $1,000.00!

The argument in favor of this kind of healthcare plan is that at least you
can buy coverage even if you happen to have a pre-existing health condition.
The way it commonly is now, it¹s virtually impossible to buy health
insurance if you have had medical problems in the past or have an ongoing
health issue like cancer, asthma, or diabetes‹either the cost of insurance
is fantastically high or they simply decline coverage altogether.

The obvious drawback of the Massachusetts plan is that what the government
says a person can afford for health insurance may not be what the individual
truly can afford. And as the economy deteriorates further and incomes lose
even more ground due to inflation, many more will need exemptions from
income-based fees. So, the more hardship the economy brings, the more
heavily taxed the healthcare system will become.

According to a March 27, 2008, article on e Max Health,entitled
³Massachusetts Officials to Reduce Cost of Health Insurance Law,²

³Massachusetts officials are seeking ways to address the increasing costs of
the state¹s health insurance law as Œthe state faces a recession and pivotal
funding decisions that could make or break health reform,¹ The Boston Globe
reports. The state faces a $1.3 billion budget shortfall, with the health
insurance initiative facing about a $100 million shortfall... According to
The Globe, lawmakers could address the $100 million gap Œquickly if the
state approves an increase in the cigarette tax¹ and uses the money for
health care, as proposed by state House Speaker Salvatore DiMasi (D). A
$1-per-pack increase in the cigarette tax could generate $152 million a
year. A Œlarger issue¹ will be securing a new three-year commitment from the
federal government, which provides about half of the funds for the state¹s
subsidized insurance program Commonwealth Care, The Globe reports.
Massachusetts is seeking $1.5 billion over three years in federal matching
funds, but the ŒBush administration has been cutting back federal payments
to the states,¹ according to The Globe.²

So, already, Massachusetts is in trouble. And who will pay? The
tobacco-addicted consumer‹overwhelmingly poor and among the most in need of
good healthcare and treatment for their addiction‹it is they who will bear
that additional tax burden. And lawmakers will think of more things to tax.
No doubt things poor people eat, or drink, or smoke. So in Massachusetts as
in San Francisco, ³universal healthcare coverage² means everyone is going to
pay except the corporations.

What about the unions? Do they have a solution for healthcare for all?

According to the Executive Summary: Comprehensive Healthcare Reform for
Colorado, as expressed by Andy Stern, President, Service Employees
International Union (SEIU),

³All Americans need financial security and quality health care they can
afford... The time is long overdue for America to address these problems.
America needs a plan for the 21st century. Not a Democratic or Republican
plan, or a business or labor plan. We need an American plan; a plan to
insure that the American Dream endures for our children and grandchildren.²

And, according to the SEIU and the Colorado Association of Public Employees
(CAPE), quality healthcare for all is described as a:

³System to Ensure Access to Affordable Coverage. Health care would be
provided through private market insurance products offered by a Health
Insurance Exchange to ensure a choice of affordable plans with options for
individuals and families. The plan would provide premium assistance to
low-income uninsured for the purchase of health insurance on a sliding
scale, based on income, and individuals would be allowed to voluntarily opt
out to enroll in employer-sponsored insurance, using their premium
assistance to pay for any required employee contribution. SEIU and CAPE
believe this is a cost effective and realistic approach to expanding health
care coverage in Colorado at the present time. We would, however, encourage
the Legislature, the Commission and the Governor to work with the federal
government to continue to expand coverage in the future until every
Coloradan is guaranteed affordable health care.²

Again, this is similar to the Massachusetts plan in that everyone will be
required to purchase ³affordable² coverage, as determined by the state and
managed by private insurance companies‹just like car insurance‹and they will
suffer the same fate as Massachusetts. So much for so-called ³universal
healthcare,² which simply means that everyone must buy health insurance one
way or another.
Single-payer healthcare

But some are touting ³single-payer² plans, such as H.R. 676, put forward by
Congressman John Conyers, Jr. This plan is different in that it will be a
nationwide program and will include a conversion from a private to a
nonprofit healthcare system over a fifteen-year period. It promises to be ³a
publicly financed, privately delivered healthcare system that improves and
expands the already existing Medicare program, it would be available to all
U.S. residents, and all residents living in U.S. territories.² It also
promises, ³...to ensure that all Americans will have access, guaranteed by
law, to the highest-quality and most cost-effective healthcare services
regardless of their employment, income, or healthcare status.² Specifically,
it would:

³Cover all medically necessary services, including primary care, inpatient
care, outpatient care, emergency care, prescription drugs, durable medical
equipment, hearing services, long-term care, mental health services,
dentistry, eye care, chiropractic, and substance abuse treatment. Patients
have their choice of physicians, providers, hospitals, clinics, and
practices. No co-pays or deductibles are permissible under this act.²

It sounds pretty good, and certainly it is an improvement over Healthy San
Francisco (which doesn¹t cover dental or eye care) or the Massachusetts and
SEIU plans. But there is a catch. ³Under H.R. 676, a family of four making
the median family income of $56,200 per year would pay about $2,700 for all
healthcare costs, including the current Medicare tax.² So, it¹s not free but
on a sliding scale (which will always be adjusted upward.) And it gives
businesses a real break (which will also always be adjusted upward):

³In 2006, health insurers charged employers an average of $11,500 for a
health plan for a family of four. On average, the employer paid 74 percent
of this premium, or $8,510 per year. This figure does not include the
additional 1.45 percent payroll tax levied on employers for Medicare. Under
H.R. 676, employers would pay a 4.75 percent payroll tax for all healthcare
costs, including the current Medicare tax. For an employee making the median
annual family income of $56,200, the employer would pay about $2,700 per

How will the program be funded in the long run? H.R. 676 will:

³Maintain current federal and state funding for existing healthcare
programs; Establish employer/employee payroll tax of 4.75 percent (includes
present 1.45 percent Medicare tax); Establish a 5 percent health tax on the
top 5 percent of income earners, 10 percent tax on top 1 percent of wage
earners; 1

Of course, this is the proposal that has not been passed. And all the
candidates have distanced themselves from it. But in a New York Times
article dated March 1, 2007, by Robin Toner and Janet Elder entitled, ³Poll
Shows Majority Back Healthcare for All,² it must be noted that, ³A majority
of Americans say the federal government should guarantee health insurance to
every American, especially children, and are willing to pay higher taxes to
do it, according to the latest New York Times/CBS News Poll.²

While it¹s admirable that working people are willing to pay more taxes if it
meant that everyone would have healthcare, it nevertheless should be a
right, like the right to public education and fire protection. If you have
to buy it, it¹s not a right‹except for those who can pay for it!
Who should pay for healthcare?

Prescription drug companies are some of the highest profit-earners on Wall
Street. According to an April 21, 2008, New York Times article entitled
³Merck Profit Jumps on Gain² by The Associated Press,

³Drugmaker Merck (NYSE:MRK) & Co.¹s on Monday reported that its profit
almost doubled in the first quarter due to a $1.4 billion distribution from
a partner drug company; its sales were slightly higher than a year ago....
The maker of allergy and asthma pill Singulair reported net income of $3.3
billion, or $1.52 per share, for the January-March period, up from $1.7
billion, or 78 cents a share, a year ago.... Excluding the $1.4 billion gain
from AstraZeneca PLC (NYSE:AZN) of Britain and other one-time items,
Whitehouse Station, N.J.-based Merck earned 89 cents per share in the latest
quarter.... Revenues totaled $5.82 billion, up 1 percent from $5.77 billion
in the first three months of 2007.²

On the same day, The Associated Press authored an article that appeared in
The Times, entitled ³Eli Lilly Profit Doubles on Higher Sales.² The article
reported that ³Drug maker Eli Lilly and Co. said strong sales for Cymbalta
and Cialis helped double its first-quarter profit² and that, ³The
Indianapolis-based company said earnings jumped to $1.06 billion, or 97
cents per share, from year-ago profit of $508.7 million, or 47 cents per

According to an article by Adrianne Appel of Inter Press Service dated April
10, 2007, entitled ³More Uninsured Means More Healthcare Corporate Profits,²

³In 2005, the drug companies Procter and Gamble, Merck, Amgen and Abbot and
insurer UnitedHealth Group were among the 50 most profitable Fortune 500
companies in the United States, according to Fortune.... Many large drug
companies richly reward their chief executive officers with salaries and
bonuses. Johnson and Johnson¹s CEO received salary and bonuses in 2006 of
$28 million, according to Dow Jones. And Merck CEO Richard Clark received
$10 million in compensation, according to AFL-CIO Corpwatch.... When former
Pfizer CEO Henry McKinnell left the company in 2006, he was given pension,
stock and other benefits worth $180 million, according to AFL-CIO
Corpwatch.... But CEO William McGuire, of UnitedHealth Group, a health
insurance company, stands alone. His annual salary in 2005 was $124 million,
and he has been provided stock options worth more than $1.7 billion,
according to Forbes.com. As part of his retirement package, he and his
spouse will receive free healthcare for as long as they live, according to
AFL-CIO Corpwatch.²

Clearly, we have the beginning of a base upon which to secure the funds to
provide free healthcare for all, i.e., from soaring corporate profits and
CEO bonuses!

Why is it so hard to demand that these corporations open their books? Or
explain how they can justify accumulating such profits at the expense of the
sick, and the blatant sacrifice of the lives of the poor who can¹t afford
the medication and medical care they need? Yes, working people are willing
to pay‹even for their brothers and sisters who are not insured. But the
wealthiest corporations and the greediest CEOs are not willing to pay a dime
that they can¹t double-back in profits!

What about the profits from corporations that make people sick‹like tobacco
and alcohol companies; all kinds of manufacturing companies that poison the
atmosphere, water, and ground with pollutants; or corporations that
clear-cut forests, or build obsolescence into their products so that they
break down and can¹t be repaired‹wasting precious un-renewable resources
because a new product has to be purchased; or corporations who take risks on
the lives of those who use their services, like the airlines who cut back on
maintenance and air-traffic control, and who sacrifice safety, comfort and
reliability for increased profits?
Is healthcare a right?

Do children have the right to live after they are born no matter what the
economic status of their parents is? Do the old and infirm have the right to
live even though their families can¹t afford to pay for their care and are,
perhaps, unable to give it themselves? Does the working person driven from a
job by firing, layoffs, or buyouts have the right to go on living if he or
she is driven to poverty? Does the family driven from their home by mortgage
foreclosure have the right to go on living? Or should we surrender our
children, our aged parents, ourselves to the ³disintegration box² of Star
Trek fame when we are driven to poverty or unemployment or be too young, or
become too ill to work?

These are questions we have every right to ask ourselves, for these
questions are at the very root of the profit-driven system of capitalism and
the relationship that working people have to it.
Trillions for war

And what of the trillions of dollars spent on the war machine‹the giant
military-industrial complex that is stationed throughout the world, wherever
oil and other natural resources can be found‹to plunder them willy-nilly and
put them at the disposal of U.S. profit-grabbing corporations?

We know what rights the U.S. government and its political lackeys
have‹whatever rights they want to declare for themselves; to invade
countries; to cross any borders they choose with their armies and/or their
profits; to declare war on the basis of lies and falsehoods; to give
tax-cuts to the rich; to increase taxes on the poor; to build jails and
appoint themselves as judges, lawmakers, jailers and executioners; to hide
their profits; to cut wages and jobs; to withhold healthcare‹not just to the
uninsured but to the innocent children born to them‹if it will turn a higher
profit for them. They want the right to keep profits to themselves!
What are our rights?

Working people must start to ask themselves what rights they think they
should have. What rights do they think their children deserve? What kind of
a world do we all deserve?

Working people have to start asking themselves what kind of a world we could
have if the profits created by our labor could be shared the world over,
instead of hoarded by the top one percent of the wealthiest people on the
planet. Working people must start asking themselves whether the trillions of
dollars spent on war and mayhem could be put to better use‹perhaps by ending
the very poverty and injustice that are the true causes of war.

What rights do we working people have? Only the rights we are willing to
organize together, fight for, and take!

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