United States

Healthcare Wars

By Bonnie Weinstein

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:

“Emergency 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 cooperation.”

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

“You 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.]...‘Over-the-Counter’ drugs that do not need a prescription from a doctor may cost less than your copayment if you buy them from the drug store.”

But, according to the city’s 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 General’s 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,

“Healthy 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.”

What it doesn’t 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 General’s CHN, even to their poorest patients!

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 “Massachusetts Faces a Test on Healthcare,” by Kevin Sack,

“The 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 $1,000.”

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, it’s 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, it’s 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 “Massachusetts Officials to Reduce Cost of Health Insurance Law,”

“Massachusetts officials are seeking ways to address the increasing costs of the state’s health insurance law as ‘the state faces a recession and pivotal funding decisions that could make or break health reform,’ 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 ‘quickly if the state approves an increase in the cigarette tax’ 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 ‘larger issue’ will be securing a new three-year commitment from the federal government, which provides about half of the funds for the state’s subsidized insurance program Commonwealth Care, The Globe reports. Massachusetts is seeking $1.5 billion over three years in federal matching funds, but the ‘Bush administration has been cutting back federal payments to the states,’ according to The Globe.”

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, “universal healthcare coverage” 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),

“All 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.”

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

“System 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.”

Again, this is similar to the Massachusetts plan in that everyone will be required to purchase “affordable” 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 “universal healthcare,” which simply means that everyone must buy health insurance one way or another.

Single-payer healthcare

But some are touting “single-payer” 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 “a 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.” It also promises, “ 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.” Specifically, it would:

“Cover 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.”

It sounds pretty good, and certainly it is an improvement over Healthy San Francisco (which doesn’t cover dental or eye care) or the Massachusetts and SEIU plans. But there is a catch. “Under 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.” So, it’s 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):

“In 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 year.”

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

“Maintain 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, “Poll Shows Majority Back Healthcare for All,” it must be noted that, “A 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.”

While it’s 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, it’s 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 “Merck Profit Jumps on Gain” by The Associated Press,

“Drugmaker Merck (NYSE:MRK) & Co.’s 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.”

On the same day, The Associated Press authored an article that appeared in The Times, entitled “Eli Lilly Profit Doubles on Higher Sales.” The article reported that “Drug maker Eli Lilly and Co. said strong sales for Cymbalta and Cialis helped double its first-quarter profit” and that, “The 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 share.”

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

“In 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 Johnson’s 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 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.

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 can’t 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 can’t 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 can’t 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 can’t 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 “disintegration box” 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!