A United States Socialist Vision of Health

The CPUSA Perspective: The Struggle for Healthy Families

Current State Of the Struggle for Healthy Families in the USA; And What to do About It

The outright greed of the health care industry in the United States generates huge corporate profits on the one hand, and at the same time increasingly excludes access to quality health care for millions of working families across the nation. Untold misery and uncounted premature deaths are left in its wake. These two processes have become inseparable in the United States. They have resulted in the highest health care costs in the world—both in terms of the cost of health care relative to the rest of the nation’s economy, and in terms of the per-person cost of health care. A significant portion of these “costs” are in actuality “profits.” At the same time, the health of American families, compared to the health of the people of all nations, has been steadily falling behind for decades. The World Health Organization continually lists the United States at 37th of all nations in the world.

The class and race aspects of the U.S. system are dramatic. If you have the money, you can afford to pay the excessive out-of-pocket costs for expensive health services like chemotherapy, MRI tests and related diagnostic and treatments. The fancy technology that health industry power brokers proclaim is often reserved for those with financial resources. The racist edge has been proven over and over again. A few simple statistics prove the point: African American males life expectancy is just 61 years old, well below the normal retirement age; and infant mortality in African American inner cities is two to three times greater than in more affluent parts of U.S. cities.

Monopoly is the central feature of the U.S. health care industry. During the last several decades control over vast health resources have been concentrated in the hands of fewer and fewer corporate entities. Hospitals and nursing homes are owned by the hundreds by these entities. The old “health insurance companies” have grown to become diversified international corporations that both sell health insurance on the one hand, and provide health care through vast holdings of hospitals, clinics, and health maintenance organizations (HMOs), on the other. They are “working both sides of the street”, so to speak, in a way that has no precedent in the industry. These health industry giants have come to dominate entire communities, and increasingly entire regions as monopolies.

The invasion of communities by these corporate health care giants has resulted in a series of destructive, sometimes deadly, changes in the capacities of communities to care for families. Where there used to be a large number of health facilities, expanding hospital chains often buy up both public and private nonprofit hospitals in communities. Sometimes they convert them to for-profit hospitals as an acquisition to their holdings, and sometimes they simply close them down. In New York, investor owned hospitals are not allowed, so the massive voluntary, not for profit hospitals are being combined as if they were for profit. These hospitals act is if they are profit generating. The guiding principle is to destroy the health services “competition.” Typically public and private non-profit hospitals provide a higher proportion of “charity” care, so when these facilities are gone, it is tremendously destructive to low-income and racial minority families. Corporate hospital chains also have a long history of eliminating less profitable medical services such as emergency rooms, labor and delivery and burn units—an unequivocal act of profit maximization and the destruction of critical community health needs in one blatant action.

In rural areas, this regional economic monopolization is leaving tens of thousands of people with no hospital and physician access. After all, these companies feel that if a hospital or physician is located with a few hours, this is good access.

Monopoly power has never been greater, In fact, for the first time in our nation’s history, these financial and political power elites have one of their own guiding the United States Senate. U.S. Senator Bill Frist, MD, may be a medical doctor, but more importantly, he is the heir, and financially linked to the Hospital Corporation of America [HCA]. HCA is the largest for-profit hospital chain in the United States. There is desperate and despicable self-interest in HCA’s leaders seeking political power. Their executives have been found guilty of Federal Medicare fraud, with a number of them doing federal prison time.

They are in league with corporate scofflaws like the federally indicted Richard Scrushy, the former CEO HealthSouth. HealthSouth is the largest U.S. chain of outpatient surgery, diagnostic imaging and rehabilitation centers. It was founded by Scrushy in 1984 and has some 50,000 employees and about 1,700 sites in all 50 states and overseas. He was indicted for falsifying the books to enrich him by $2.7 billion.

HCA and HealthSouth are the poster children of “Profits in Health Care”, a system which the Republican Party and too many Democrats are committed to preserving.

The White House’s obsession with trial lawyers and eagerness to dump what Bush refers to as “frivolous law suits” including medical malpractice suits are directly linked to these fraud cases. This is the only country in the industrial world that has a medical malpractice problem because we are only country without a national health program that takes care of people’s medical needs.

The Institute of Medicine’s report that over 100,000 patients die each year in hospitals has these corporate scofflaws shaking in their boots in fear of legitimate negligence suits which are needed to help victims of medical errors and neglect to put their families back together after massive hospital bills. [The other leg of this anti-law suit attack is the asbestos suits facing corporate scofflaws like Halliburton, Vice President Cheney’s company. Bush’s recent attack on asbestos law suits is gruesomely anti-victim and a direct payoff to his contributors]

Profits Dictate Health Care
The invasion of profit-maximizing health maintenance organizations has forced entire families to abandon their health providers of choice for someone “on the list.” The health care of families is fragmented when different members of a family fall under different plans, and are forced to use different providers. Too often patients with complicated treatment regimens, such as chemotherapy, are forced to change physicians because of a change in the “list.”

In Medicare, the sudden collapse of large numbers of entrepreneurial HMOs, spurred on by the privatization of the federal Medicare system, has left untold hundreds of thousands of families in debt or bankrupt from unpaid medical bills that were supposed to have been be paid by the HMO. Moreover, even when bills are paid, elders, among our most frail, suffer discontinuity of, and lapses in, care, as they are shuffled from plan to plan, and doctor-to-doctor.

There is little profit in low-income communities, which are disproportionately minority and/or rural communities. These communities are often entirely abandoned by the health care industry. Families in these communities are forced to use abusive and ineffective “Medicaid mills,” or the vastly overcrowded and poorly equipped offices of sliding-fee community clinics. Often they simply do without care at all, relying on ineffective over-the-counter drugs, or “tailgate” venders of fraudulent or outdated drugs.

The soaring costs of health care have pushed it to become in recent years the single most frequent cause of personal bankruptcies in the United States. This has been reflected in decades of health insurance cost increases that have consistently outstripped the annual inflation rate. Employers, who have to use insurance carriers, respond to this dent in their profits by shifting more and more health related costs to workers, while forcing workers to accept increasingly inferior plans. Workers are also forced to choose between much needed wage increases and health benefits. Every year growing numbers of employers have simply abandoned health benefits altogether, often with disastrous consequences for the workers and their families. There are approximately 45 million people in the United States with no health insurance at all. Tens of millions of additional people spend some part of the year uninsured. Finally, additional tens of millions of family members who do have health insurance cannot afford the co-payments and deductibles, and are therefore effectively barred from adequate health care.

The safety net is seriously shredded. Millions of Americans have Medicare health insurance coverage, but physicians are not required to honor it. Medicare and Medicaid are increasingly becoming unredeemable vouchers. As a result, while a community may have an adequate supply of health care providers, few if any may be willing to see a patient with Medicare insurance, because the provider could see a patient with private health insurance and make much more money. Furthermore, Medicare does not cover the cost of drugs. Recent federal prescription drug legislation purports to address this serious omission, but the legislation does not take effect for several years even then it is so plagued with giveaways to corporations, and inferior coverage, and incredible cost overruns, that its effectiveness is seriously in question.

Attacks on Medicare and Medicaid, as weak as these insurance systems have become, are very real cynical efforts to abolish altogether meaningful health care for seniors, dependent children, the working poor, and disabled. In addition, hundreds of thousands, perhaps millions, of additional workers and their families are losing health care coverage in the economic crisis. Meanwhile, hospital and public clinic closings continue unabated. These are life and death struggles that must be met with militant mass action.

Medicare and Medicaid
Since their inception in the mid-1060s, Medicare and Medicaid have been increasingly privatized, with grave consequences for cost containment, equity, efficiency, quality and continuity of care. The CPUSA supports the demand to refederalize the Medicare and Medicaid systems, a demand which engages broad sectors of the nation in the struggle. It adds an anti-monopoly and anti-corporate element that every public poll indicates would be very popular among the electorate. In addition, the logical trajectory of this reform leads directly toward the goal of a completely public sector national health service. The popular rallying cry for the struggle could be, “Medicare & Medicaid Funds for Health Care, Not Profits.” Or, “Healthcare for People, Not Profits.”

National Health Service
The Party has continually supported popular struggles and legislation that pave the way for, or would establish, a national health service (NHS). The uniqueness of a national health service strategic direction is that this form of socialism can and does take place within the capitalist system. The NHS in the United Kingdom remains the jewel of health services despite its underfunding problems. Raising the banner of socialized medicine sends the kind of message that a Party of Socialism needs to communicate. Also, this demand with its logic and realism is the kind of anti-monopoly program that can combine with other peoples’ struggles such as increased public housing, jobs, etc.

Key elements of a national health service include, but are not limited to:

1. the elimination of profit from all aspects of health care and public health measures;
   
2. payment for all health care including true public health measures from steeply progressive taxes;
   
3. the delivery of all health care and public health services from publicly owned hospitals and community health facilities federally financed via global budgeting;
   
4. the delivery of all health care and public health services by salaried public health care providers and workers, who earn a living wage, have job security and full benefits and who have the right to organize;
   
5. the elimination of all financial barriers to access to health care;
   
6. a tiered and publicly system of governance relying on local, regional, and national elected boards;
   
7. a national system of quality assurance and guaranteed services;
   
8. a regionally based system of publicly owned health care worker education and research facilities which have no financial barriers to access and no ties to corporations.