But what about... But what about... The Democrats and Republicans we elect can't help but notice we're mad about healthcare. So they have devised a range of proposals to placate us. Many of the reforms Congress has passed or is considering passing would improve the system. But only incrementally.
We asked Kit Costello, President of the California Nurses Association and Labor Party co-chair, about some of these reforms.
Both Democrats and Republicans now have "Patients' Bill of Rights" bills pending before Congress. The Republican version passed the House over the summer, but probably won't make it through the Senate before Congress adjourns. The bill that Clinton and the Democrats support would, among other things, require HMOs to provide access to emergency room care, access to specialists and out-of-plan doctors, and allow patients to sue HMOs for damages. Meanwhile, many states have already adopted HMO patients' rights legislation.
Any legislation that protects patients against the ravages of HMOs is better than none. But none of these protections would be necessary under a universal healthcare system. Why should we have to regulate and seek "protections" from the people who are supposed to be providing us with care?
These bills just don't address the fundamental problem: HMOs and other insurance
companies were created not to provide the best possible care for the least possible money,
but to capture a share of the market and make a profit. Even for not-for-profits, 
the main goal is institutional health and survival. All "patients'
rights" bills can do is to attempt to curb and regulate the worst HMO abuses. They
can't make HMOs become something they are not. Furthermore, these bills do nothing to
address the bureaucratic complexity and wastefulness of our healthcare system.
Says Kit Costello: "Instead of of orchestrating a curbing legislation for the market, we need to be asking, Why are the markets in control in the first place?"
Last year Congress passed another measure intended to patch up an aspect of our healthcare system. The Children's Care Initiative set aside $24 billion over a five-year period to finance a federal program to insure some of the nation's uninsured children.
Again, covering more children is better than nothing. But in reality the effect of this legislation is very limited. Says Costello: "What they're doing is insuring half of the 10 million kids who need healthcare insurance. And to the other half, we say, 'Sorry! You're on your own.' And it's only a five-year program." She also notes that implementation is a problem: In California alone, "there are supposedly 580,000 kids who are eligible for this new program. And yet so far only 11,000 kids have enrolled."
What we need is a universal healthcare plan that covers everyone.
Some people have argued that the way to fundamentally reform the healthcare system is to expand the federal Medicare program to cover everyone, not just the elderly and disabled.
That just won't do the trick. Medicare, argues Costello "is a flawed program. It has been a wonderful way for some hospitals and doctors to fraudulently reimburse their expenses. And it exposes seniors to financial ruin." In 1997, on average and excluding the cost of long-term care, Medicare beneficiaries spent 23 percent of their annual income on medical care not covered by Medicare - and that figure rises every year. The average senior has to pay out $1500 for "Medi-gap" policies to cover what Medicare doesn't. Many Medicare-covered elderly exhaust their savings for nursing homes and long-term care before they finally become poor enough to qualify for Medicaid. Medicare does not guarantee coverage for necessary care, nor does it put any limit on the amount of money seniors must pay out of pocket.
Furthermore, says Costello, "Medicare is getting privatized now anyway as the program gets turned over to HMOs. It's no longer a single payer system with a single risk pool of seniors and the disabled. Instead, it puts people into separate risk pools and essentially has become a way of funneling public money to private industry."
The Labor Party's Just Healthcare proposal, says Costello, would cure Medicare's ills: "We wouldn't have co-payments, hospitals wouldn't be allowed to extra-bill, and individuals wouldn't have to get 'Medi-gap' insurance, because you'd already have everything covered."
No way!! The Clinton plan was far more bureaucratic and cost-inefficient than our Just Healthcare plan. The Clinton plan would have created new levels of healthcare bureaucracy and turned over even more of the healthcare system to HMOs.
Says Costello: "The Clinton plan would have institutionalized the role of private insurance companies in healthcare. Under Clinton's plan you would have had low wage-earners paying 20 percent of their healthcare insurance out of pocket. It would have been an immediate cut in pay. Let's not go down that road!"
The Labor Party's Just Healthcare program would reduce bureaucracy and confusion and take the profit out of health insurance.
Statewide reform might be better than no reform. But if we want a system that's uniform, fair, and efficient, we have to go national. States can't effectively police the behavior of insurance companies and hospitals. And imagine the ultimate effect of requiring employers in a particular state to, say, provide health insurance to all their employees or pay a healthcare tax. Employers would relocate or make citing decisions to escape such an employer mandate.
Americans are acutely unhappy with our healthcare system. And yet when it comes to organizing for comprehensive reform, says Costello, "It's a vacuum out there. We have to get people to start signing on to very clear single-payer principles, a well-designed system that works for us, and not the corporations."
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