Universal Health Care and Health Care for America Now (HCAN)

The urgency of rising health care costs in the US has become increasingly clear. Michael Moore's film Sicko, which revealed the cruelty of our health insurance that denies 50 million people access to basic medical treatment, struck a chord with many Americans. But besides the real moral and human cost of the US' lack of universal health care is the economic one.

A recent report by the Government Accountability Office (GAO), the investigative arm of Congress, entitled "Long Term Federal Fiscal Challenge Driven Primarily by Health Care" found that:

"Rapidly rising health-care costs are not simply a federal budget problem," said the report, prepared by Gene Dodaro, acting U.S. Comptroller General. "Growth in health-related spending is the primary driver of the fiscal challenges facing state and local governments as well."

"Unsustainable growth in health-care spending also threatens to erode the ability of employers to provide coverage to their workers and undercuts their ability to compete in a global marketplace."

"Health-care costs are growing much faster than the economy, and the nation's population is aging," the GAO report says. "These drivers will soon place unprecedented, growing and long-lasting stress on the federal budget. Absent action, debt held by the public will grow to unsustainable levels."

That need for health care reform has sparked a national coalition of over 100 national and local organisations representing labour unions, doctors, nurses, women, small businesses, religious groups, racial minorities, and think tanks called Health Care for America Now (HCAN). This group has launched a new campaign in 53 U.S. cities to demand quality, affordable health care for every United States citizen. They are advocating a multi-payer health care system which allows for both a private (with stiff regulations) and a public system through advertisement on corporate media outlets. Organized labor, despites its declining membership and clout, is a crucial part of this coalition with the lobbying capacity, funding capability and grassroots activity that outmatches any other public interest organization. As Professor Marie Gottschalk writes in Dissent magazine::

For well over a century now, labor has been instrumental in the development of the U.S. health system. It established some of the first prepaid group practices and health maintenance organizations, was the leading voice for national health insurance up until the mid-1970s, and was decisive in the establishment of Medicare and in the expansion of other major social programs, like Social Security and the Great Society. The employment-based system of health benefits is largely the product of a collective-bargaining regime established during and immediately after the Second World War. That system is under siege today. Without unions to act as a brake, today’s downward spiral in health benefits for union and nonunion workers would be even faster.

But organized labor itself is now divided over health care reform. Their position, especially that of the AFL-CIO and its "Medicare for all", reflect the "compromise" of HCAN to advocate a multi-payer plan rather than a single payer plan to create universal health care coverage. Andy Stern, president of SEIU, has been the leading proponent within organized labor, of a business friendly approach to health reform that stresses economic competitiveness. He has sought out partners in the business sector including "The Bully of Bentonville" Walmart, the Business Roundtable (who helped kill Clinton's health care initiative) and the AARP to promote this issue and rely on their willingness to cooperate. On the other hand, a growing number of national unions, locals, labor councils and rank and file members have endorsed the single payer solution, most notably the National Nurses Organizing Committee.

But the emphasis of economic competitiveness as an impetus for health reform, that GAO points out and Stern has championed, is overstated. Gottschalk points out that:

It is true that employer spending on health care, measured as a percentage of after-tax profits, did jump in the late 1990s. But the rise in health care costs as a percentage of profits was due partly to a drop overall in corporate profits as the dot-com and high technology sectors went bust in the late 1990s. Spending on health care measured as a percentage of after-tax corporate profits declined steadily from 1986 to 2004, except during the 1998–2001 period. More significantly, employer spending on wages and salaries and on total compensation as a percentage of after-tax profits has dropped precipitously since 1986, except during the 1998–2001 period. [1]
Marie Gottschalk, “Back to the Future? Health Benefits, Organized Labor, and Universal Health Care,” Journal of Health Politics, Policy and Law, 32 no. 5 (December 2007), pp. 946-47, Figures 1 and 2.

While health care costs continue to escalate, employers have had great success at squeezing wages and other forms of compensation and shifting more health care costs onto their employees. Wages and salaries make up the smallest portion of the country’s gross domestic product since the government began collecting such data in 1947. In 2006, on the eve of the subprime crisis and the recession, corporate profits were at their highest level in four decades.
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The fact is that many European and Japanese firms are highly competitive even though their workers enjoy more generous health, vacation, maternity, and other benefits.

In most other Western industrial democracies like Canada, they have a single payer universal health care system. The single payer term, according to Physicians for a National Health Program, refers to a particular financing system in which "one entity—a government run organization—would collect all health care fees, and pay out all health care costs" as opposed to the thousands of health care organizations that currently exist in the US which would reduce administrative costs which according to a 2003 study published in the New England Journal of Medicine, makes up 30 percent of American health care spending, about $294 billion. Under a single payer system, reducing such exhorbitant waste would be enough to fund universal health care without increasing costs Americans currently pay for insurance. Thus only a single payer system of universal health care can seriously tame and streamline spiraling costs in the US. Currently there is a bill proposed for such a single payer plan in Congress introduced by John Conyers and has 92 co-sponsors.

The moral necessity for universal health care done in the proper fashion through a single payer program cannot be understated though. If we are going to face down the combined lobbying forces of opposition from pharmaceutical and insurances, the push for such a plan has to be backed by a strong grassroots social movement. As Gottschalk points out:
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we need to resist the temptation to reduce this mainly to a question of dollars and cents. As Uwe Reinhardt recently said, the health care debate really boils down to one question: “Should the child of a gas station attendant have the same chance of staying healthy or getting cured, if sick, as the child of a corporate executive?” Reinhardt notes that it would cost about $100 billion in additional government spending to provide health care coverage for every man, woman, and child in the United States—or about what the country spends every nine months to fund the war in Iraq.

Successful reform movements in the United States—the abolitionist movement, the New Deal, the civil rights movement—have always had strong moral overtones. President Franklin D. Roosevelt did not invoke the dollars-and-cents language of an accountant to spur the country to support the landmark social insurance programs that became known as the second New Deal.

There is evidence that the moment is ripe for such a social movement with an increasingly economically populist sentiment spreading through the US as Gottschalk notes:

Recent public opinion data show strong public support for a government guarantee of health care. Moreover, a revealing new study of voter discontent by the Democracy Corps found the most commonly chosen phrase to characterize what’s wrong with the country was, “Big business gets whatever they want in Washington.” Instead of attempting to ride what New York Times columnist Paul Krugman has characterized as the “strong populist tide running in America right now,” [Andy] Stern is flying against it.