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April 2003 • Vol 3, No. 4 •

What Healthcare Plan for Workers?

By Charles Walker

A recent news report stated that during 2001 and 2002, about 75 million Americans lacked health insurance. Moreover, the healthcare needs of those uninsured are driving up the insurance costs of all others. That’s because insurance companies and health providers attempt to compensate for the costs of treating the uninsured, or underinsured, by raising their rates for everyone else.

Since most health costs and insurance premiums are job-based, employers are complaining that they are subsidizing the healthcare of the uninsured, mostly poor and minority workers, the jobless, and the destitute. “Employers are now subsidizing the uninsured and the low-paying government programs like Medicare and Medicaid, to the detriment of their own employees. When the government programs pay 65 or 80 cents for a dollar of hospital care, employers end up paying $1.15 or $1.25 for that care,” declared Kate Sullivan at the U.S. Chamber of Commerce (New York Times, 3/6/03).

Not surprisingly, some employers, General Motors for one, are seeking ways to reduce their medical costs by socializing those costs. General Motor’s executive, Bruce E. Bradley, told the Times that, “As a nation, we need to expand coverage for the uninsured and reduce the burden for uncompensated and inefficient care for many payers, whether it’s the government or the hospitals or employers.” In other words, General Motors is looking at ways to spread its healthcare costs around, and if that means public financing, then so be it. Of course, General Motors isn’t an innocent bystander. The corporation’s “downsizing,” permitted under its union contracts and its subcontracting of union work contribute to the number of uninsured and underinsured.

It’s a sure bet that current economic conditions mean that the number of uninsured will continue to rise. “The sluggish economy and rising health costs,” the Institute of Medicine recently reported, “are combining to prompt businesses to cut back coverage or charge their workers more for it, and states are trimming their programs for poor and low-income residents. As a result, the ranks of the uninsured now cut deeper into the middle class” (AP, 3/6/03). And the medical care that the uninsured receive may not include routine preventative health services, may mean poorer care when they are hospitalized and may guarantee that they “die sooner,” according to Dr. Georges C. Benjamin of the American Public Health Association.

And like death and taxes, organized labor’s top representatives are well aware of the healthcare problems workers are enduring and Richard Trumka, second only to AFL-CIO President John J. Sweeney, has said, “Throughout this year, healthcare will be on our radar screen in every forum, on every platform where we speak” (Free Press, 2/27/03). Moreover, the Federation says “we need to turn the 2004 elections into a referendum on whether all Americans should finally be able to get affordable, high quality healthcare with the right to choose their own doctor.” The AFL-CIO “believes strongly that universal coverage is the best and ultimately the only way to achieve the goal of extending affordable, high quality healthcare to all Americans.”

But what would “universal coverage” look like? Medical insurance plans, that are for-profit plans, are part of the costly problem. And certainly, workers wouldn’t want to model a universal coverage system on Medicare or Medicaid, as some advocates are urging. Nor would workers’ experience with Social Security and regressive payroll taxes recommend it as a model to guarantee the “high quality healthcare” that the AFL-CIO advocates.

Fortunately, there is a model that medical practitioners around the world can’t say enough good things about—so there’s no need to reinvent the medical wheel, or a healthy healthcare system. That model is to be found right in America’s back yard, 90 miles or so from Miami’s shore; that’s right, Cuba! The World Health Organization has stated that the Cuba Health Care System is a model for the rest of the world, both the developed nations and the so-called underdeveloped nations. Dr Peter Bourne, visiting scholar at the University of Oxford, and formerly Assistant Director at the White House Special Action Office for Drug Abuse Prevention, says, “What makes the Cuban system unique is the manner in which the delivery of care has been fused with public health. Cuban family physicians are trained to focus, in epidemiological terms, on the overall health of the people they serve.”

The results of Cuban medical care are astonishing. According to the Bay Area Cuba Medical Committee, child mortality rates are seven per thousand live births; down from 60 deaths per thousand before 1959, the year of the overthrow of the U.S.-supported Batista dictatorship. Further, life expectancy now averages 75 years, up from 55 years in 1959.

The explanation for the success of the Cuban model is simple. They believe that medical care is a right to life issue, and if you follow the money you’ll see that they back up that belief with 25 percent of their small gross domestic product. Clearly, with full access to the benefits of modern industry and technology the Cuban population of just 11,250,000 residents could and likely would do much better.

And the residents of the U.S. too would do much better, if twenty-five percent of the U.S. gross domestic product, estimated at slightly more than $10 trillion dollars, were spent on their medical care and physical well-being. With some $2.5 trillion dollars spent yearly and wisely on health services, seemingly life expectancy would rise in the U.S., though not as dramatically as it has in Cuba. But it might easily match the Canadian life expectancy mark of 79.69 years, and an infant mortality rate of 4.95 per thousand live births; improvements over its 6.69 mortality rate per thousand live births, and its average life expectancy of 77.4.

As it is, the U.S. Labor Party estimates that in 1999 U.S. spending on healthcare totaled $1.213 trillion—12.8 percent of the gross domestic product or an average of $4,443 per person. Of that amount employers paid just 20.8 percent, while individuals paid 26.9 percent. Most of the balance is paid by various taxes. The Labor Party has a legislative proposal that would cost the same amount of money currently spent on healthcare, but would redistribute the costs and eliminate the private insurers from the equation. Representative John Conyers (D–MI) has proposed a publicly financed single-payer plan that he claims would reduce annual healthcare costs by $109 billion, without trimming benefits.

The Conyers plan resembles somewhat the Labor Party’s plan, except in one important detail. Under the Labor Party proposal, healthcare workers who lose their jobs due to elimination of duplication of services and the like would receive full pay and educational grants for a four-year period. Both plans, unlike the Cuban model, would retain the private delivery system already in place, not really removing the market and all the profit-seeking from healthcare services.

Collective bargaining by unions for health benefits, increasingly difficult, leave many unionized and many more unorganized workers on the outside looking in. So the AFL-CIO says that while it intends to seek partial legislative remedies to the healthcare crisis at the national, state and local levels, the labor federation is focused on turning the healthcare crisis into an election victory for the Democrats. As they say, they want next year’s presidential election to be a referendum on healthcare. That the labor tops are putting their hopes and workers’ welfare on the Democratic Party has got to be disappointing to workers who remember all too well that party’s record on NAFTA, the Taft-Hartley Act, and strike-breaking. But then the Federation’s officialdom usually does attempt to turn most social issues into campaigns for electing Democrats. But if workers experience with the Democrats is any guide, that’s hardly a strategy for dealing with any social crisis, including workers’ present healthcare choices.





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