by Dr. John Battista, M.D.
September, 2000
As many of you are aware, health care is the number one concern of the American public in this presidential election. And for good reason. Health care expenses are the number 1 cause of bankruptcy in the United States.
This is not surprising since 17% of our population are without health insurance, and any person short of the super rich would be bankrupted by a major illness or serious accident. It is less well known that 25% of the individuals with insurance are underinsured to the point that they would be bankrupted by a major medical illness. Nearly one half of our population are at risk of bankruptcy due to medical expenses.
Some of the awful truth about our American health care system is revealed when we look at the people who are the uninsured in the United States. 80% of the uninsured are members of working families. The less money you make the greater the odds you won't have health insurance. The uninsured are predominantly hourly workers at jobs that offer no insurance benefits, or hourly workers who can not afford to pay for the benefits offered. Imagine that you work for $10 an hour, make $1600 a month to support your family, and the cost of health insurance is over $500/month. No way you can afford to be insured.
Uninsured, working Americans are single women. Single women have twice the rate of uninsurance of married women. The uninsured are people of color. African Americans have twice the uninsurance rates as whites. Hispanics have three times the uninsurance rates as whites.
The uninsured have poorer health, more trouble accessing health care, and a higher likelihood of dying than the insured. As a result, our health care system is literally killing the working class, killing single women and their children-- killing people of color. As Martin Luther King put it so well "Of all the types of inequality in our country, inequality in health care is the most shocking and inhumane." Our country puts profits before people. We must stop this. We must put people before profits.
The awful truth of putting profits before people is equally apparent when we consider the health care available to the 45% of Americans who access health care through their employer's insurance plans. About 15 years ago corporations began to complain to politicians about the high cost of providing health care benefits to their employees. Our politicians listened. As part of the "Corporate Contract On America," politicians decided to limit the costs of health care to corporations by turning over the access to health care to for-profit health insurance companies and shifting the cost of health care to workers. Their money saving and profit enhancing strategy has been a success. The cost of health care to corporations has decreased and the cost to workers has increased.
As a direct consequence of this corporate savings project, worker's health care has been injured. It has been injured by forcing health care givers to breach the worker's confidentiality in order to get pre-approval for medical treatment. The result is that the worker's sexual history, drug history, and health care status have become available for sale by the insurance industry, and on many occasions these data have been given back to employers so they can target medically expensive worker's for firing.
The health care of workers has been injured by forcing workers to find new health care givers when their employer negotiates a better deal with a new insurance provider to which their health care provider does not belong. Too bad for you that you have to start a new relationship with a new health care provider-that's just the cost worker's have to pay in order for the company to maximize profits.
Finally, workers are injured when needed health care is denied to them as the result of having health care decisions being pre-approved by insurers whose motivation is to maximize profits. And too bad if you die. You can't sue your insurer for killing you. They were just managing your health care benefits, they weren't treating you.
Our health care system puts profits before health. We must stop this. We must put health before profits.
The same awful consequences of putting profits over people is apparent when we look at the health care available to the poor through publicly financed health insurance programs. Millions of women and children lost their health care benefits when the Republicans and Democrats banned together to "end welfare as we know it." In addition, the rates paid to providers for people on welfare have been reduced to the point that hospitals and health care practitioners lose money by treating people on welfare. As a result health care givers have increasingly refused to see people on welfare. Hospitals have had to cut staff in order to try and make ends meet. The result is poorer hospital care for all Americans, and terrible problems accessing adequate health care for the poor.
The poor and the wealthy must have the same access to the same health care system. This is the meaning of social justice in health care. This is what the green party stands for.
Our American health care system takes care of the wealthy and takes it out on the poor, the working class, the elderly and the disabled. We spend the most money per capita on health care of any society on the face of the earth and yet our overall health is around 22nd in the world. How can it be that we have an oversupply of physicians, hospital beds, diagnostic equipment, have the best trained health care providers in the world, spend more money per capita than any other country yet have infant mortality rates worse than Trinidad, have a life expectancy less than the Dominican Republic, and have immunization rates worse than Botswana?
The answer is inefficiency. According to the World Health Organization the United States ranks 77th in the world in terms of the impact of our spending on the health of our people. Why is the American health care system is so inefficient? How is it that we succeed in spending more than twice the money other industrialized countries spend on health care per capita and yet rank below them on overall health care statistics?
The answer is not that we pay our health care providers more than other nations. Our reimbursement of health care providers, with the exception of surgeons, is similar to other industrialized countries.
The answer is not that we utilize more health care than other nations. Other industrialized countries have more doctor visits, and more hospital days than the United States.
There are three awful answers to American health care inefficiency. The first is we spend at least twice as much money on administration than other industrialized countries. The number of administrators in our health care system has increased by 2500% relative to the number of nurses and physicians in this country since 1970. The reason our administrative expenses are so high is that we have multiple insurers with multiple protocols and multiple procedures to deal with, and that the for-profit insurers are totally inefficient in providing health care relative to public and not for profit insurers. For-profit administrative expenses are five to ten times the public sector, and two to four times as much as the not for profit health care sector.
The second awful reason that our health care system is so inefficient is that we spend twice as much for medications as other industrialized countries. They buy their medications in bulk from pharmaceutical companies getting average savings in the area of 30 to 50%. Instead, the United States protects and subsidizes the pharmaceutical industry even though it has the highest return on investment of any industry in the world.
The third awful reason our system is so inefficient is our failure to emphasize preventive health care, which is the direct result of our failure to provide universal access to health care as a right of citizenship. As a result, diseases that could be prevented must be treated. Also, when our people do seek treatment their diseases are more advanced, more difficult to treat, and more expensive to treat.
High administrative costs, failure to limit drug costs, and failure to emphasize preventive health care are the three reasons why our health care system is so ineffective, inefficient and costly relative to other countries. Each of these inefficiencies is the direct result of putting profits over people and failing to insure health care as a right of citizenship.
The Green Party not only believes, but can show, that when you put people over profits, and guarantee access to health care as a right of citizenship, the health of our nation will improve and the cost of our health care will decrease.
The Green Party proposes that all citizens of the United States have access to comprehensive health care as a right of citizenship. We propose that all citizens have the right to choose any licensed health care provider and that decisions about health care be made by health care providers without pre-certification. We believe our universal health care system should be administered on the state, rather than federal level. We believe our health care system should be directly under the control of citizens and health care providers, not the government or corporations.
Greens thus propose a publicly financed, publicly controlled, comprehensive, single payer, not for profit, health care system that is administered at the state level. All benefits will be paid through a single insurer in each state. All individuals will have the same health care benefits, and be in the same health care system.
How will this system resolve the problems of access, cost, and quality of care that plague our current system?
First, all citizens will have access to the same comprehensive health care, no matter what their economic status. There will be no uninsured.
Second, this system will cost less than our current health care system despite increasing benefits and extending them to the entire population. This is due to administrative savings that come from have a single insurance system to which everyone belongs, and having this public insurer negotiate decreased prices for medications with the pharmaceutical industry.
Studies on single payer, universal health care from the General Accounting Office and the Congressional Budget Office both predict savings of 100 to 200 billion dollars a year if this system were enacted in the United States. These studies did not even consider additional savings from stopping corporate health care fraud which is estimated to be in the neighborhood of another 100 billion dollars a year. States such as Connecticut and Massachusetts which have studied bringing this type of health care system to their states have predicted savings in the neighborhood of 1 to 3 billion dollars per state per year. There are no studies-none- which show increased costs as a result of single payer universal health care in the United States. All evidence from other countries shows that we can increase our health care benefits, and cover the entire population, with better health care outcomes than we currently have, for less money than we currently are spending.
In addition, future savings would occur through increased preventive care which would naturally result from increasing access to health care. Greens believe that our health care system should emphasize preventive health care. Not just prenatal care, pap smears, breast exams, and cancer screenings. Preventive care in terms of stopping the environmental causes of disease created by the unregulated, industrial pollutants. We are opposed to nuclear energy, because nuclear power plants cause cancer in the people who live near them. We oppose the use of pesticides in the production of foods, because pesticides cause cancers. We favor cleaning up energy production facilities, like the filthy five in Connecticut, because their pollutants cause asthma, chronic obstructive pulmonary disease and contribute to lung cancer.
What about quality of care? All international studies comparing health care outcomes under single payer systems and the current multipayer system of the United States show comparable or better outcomes from single payer health care systems despite lowered costs. In the United States when you compare the quality of care in not for profit health care organizations, which is essentially what we propose, and for profit, managed care systems, which is what we predominantly have, you find that not for profit health care systems do better than for profit health care systems on every quality of care indicator.
Thus, to summarize, the Green Party proposes that we have a publicly funded, publicly controlled, locally administered, comprehensive, universal health care system which emphasizes preventive health care. This system can be reasonably expected to resolve the access to health care problem in our country, lower health care costs, and improve quality of care.
This is the Green Party national health care platform. This is what Ralph Nader wants to bring to the United States. This is what the Connecticut Green Party wants to bring to the State of Connecticut.
And what is the response from our lawmakers, media, and health care industry spokespeople to this proposal. Silence. Don't talk about this. And whatever you do, Don't let Nader in the debates. Instead we'll ask the Green Party why they want to spoil our great health care system, our great democratic system, with their idealistic, unrealistic, socialistic poppycock.
In 1999, when the Connecticut Green Party, as part of a coalition of health care activists, succeeded in getting a single payer, universal health care bill passed out of legislative committee against all odds, we were met with thunderous silence. The insurance industry made no comment.
When we arranged for a debate between ourselves and the insurance industry to be broadcast on every cable station in the state. They refused to debate us. Why? They knew that the data support what we propose, and that if the people got educated about the truth they would demand passage of single payer, universal health care. This is the same reason Bush and Gore don't want to debate Nader on health care.
But of course that didn't stop the insurance industry from lobbying. No, insurance lobbyists had a banner year when our bill got out of committee. Just as they did when a single payer universal health care bill, the Mc Dermitt Bill, came to the US Congress. That year, the insurance and pharmaceutical industry spent more money lobbying congress than was spent by the Republican and Democratic parties combined in the 1992 presidential election. That's who we are up against. The biggest and deepest pockets in the world.
When you can get Republicans and Democrats, the insurance industry, and the pharmaceutical industry to come out and talk about single payer, universal health care what do these bell ringers of democracy have to say?
Their first argument, put to us by Mary Eberle, Democrat, and Co-chair of the Health Care Committee of Connecticut, is that the United States has the best health care system in the world so there is no need to change it. Her evidence for claiming that the United States has the best health care system in the world is that the Queen of England, the Shah of Iran, and the Prime Minister of Canada came to the United States to get health care. Damn the fact that we rank 22nd in the world in health care statistics. Damn the fact that the World Health Organization ranks our health care system 35th in the world overall. So what if people are dying unnecessarily. We have the best health care system in the world, the Queen tells us so.
The second argument you hear is that we can't afford it. As you already know this is complete baloney. This has the same political truth as "Bush the Compassionate", and "Gore The Populist." Single payer, universal health care won't cost money. It will save money. Only the Republican and Democratic incrementalist health care plans will cost more money. What we can't afford, is the costly, ill conceived, corporate kowtowing, Republican and Democratic health care policies. What we can't afford not to do, is implement the Green Party's universal health care policies.
The third argument you hear is that what the Greens propose is socialized medicine. This is ridiculous. The system we propose is not socialized medicine. Under the proposed system, health care providers will not be employees of the state, they will be in good old fee for service, competitive, free market medicine. It is corporate medicine, not single payer medicine, that is socialistic, in the sense that it restricts choice, interferes with decision making, and tries to make health care providers the indentured handmaidens of the corporatized state. The big boys don't like single payer, universal health care because it takes power away from big government and big corporations, the twin tyrants of the democratic and republican parties. They don't like it because it returns power to the people, where it belongs, and where the constitution puts it.
The fourth myth you hear is that single payer, universal health care will result in lines like Canada. The reason there are waiting lines in Canada is not single payer, universal health care, it is the fact that Canada has a shortage of medical infrastructure due to lack of funding. This is not true of the United States. We have a 35% oversupply of providers and infrastructure. Although single payer health would increase demand in the United States by 15% it would not create lines, because the increased demand would not come close to exhausting our oversupply of health care givers, diagnostic equipment, hospital beds, and surgical suites.
The fifth myth you here is that single payer universal health care means inefficient big government. This is doubly wrong. First, single payer universal health care does not mean big government. The green party does not propose a government controlled system such as Medicare administered at the federal level. We propose a system under the control of health care advocates and health care providers administered at the state level.
Second, it is a delusion to continue to assert that corporations are more efficient than governments in administering health care. Yet, this is the delusion our media pumps into the public. In 1999 while campaigning for our single payer bill here in Connecticut, I asked two hundred people who is the more efficient provider of health care, Medicare or Cigna. All answered Cigna. All were wrong. Medicare spends 3% on Administration. Cigna consumes 33% of its insurance premiums on administration and profit and is the single most inefficient provider of health care in the world. They consume more in overhead and profits than they pay out to health care providers. For-profits are so inefficient that Governor Rowland had to give the for-profit Medicaid managed health care industries in Connecticut a 10.5 million dollar corporate welfare tax credit this year to convince them to stay open. They could not compete with not-for-profit and fee-for-service delivery systems. They are less efficient. They are inefficient because they pay obscenely high salaries to their CEO's, they consume vast amounts of money managing care, marketing themselves, and making profit for their stockholders.
All publicly administered health care programs are more efficient than any for-profit health care programs. It's high time we start to get the facts straight, and start to speak truth to power.
The final myth that you hear is that people don't want single payer, universal health care. However, in 1998 when the Harris Poll asked people do you want publicly funded, publicly administered, universal health care in the United States 77% of Americans answered yes. The vast majority of polls have consistently shown one half to three quarters of Americans favor single payer, universal health care.
So why don't we have it? Why is single payer so ignored or abused by politicians and the press? The answer is money.
Politicians are elected by money. 91% of the time the politician who spends the most money gets elected. 85% of the money that goes to politicians comes from the top one tenth of one percent of the American population. These are CEO's. These are people who fly in corporate jets and use corporate yachts. Money talks and politicians listen. The wealthy elite of this country who pay for political campaigns don't want universal health care because it will hurt the profits of the health care and pharmaceutical industries. The rest of the corporations go along with this because they know that if the myth of the efficiency of the corporations is broken in health care, it will be called into question in their industry. They have succeeded in getting their corporate philosophy to be the dominant philosophy of the media, because they now own the major TV stations, where most people get their "disinformation."
As a result we have a conspiracy of silence, myths and lies. The awful truth is that the majority of our politicians would rather have Americans die than lose their elections fighting for your health. They know that if they support single payer, universal health care, they will get no money from the big spenders and the overwhelming odds are that they will be marginalized, mistreated in the press and lose their election.
So what can you do. The first thing you can do is vote green. In particular, I am talking to the conscientious objector majority of you who refuse to vote. We need to have you vote and we need to have you vote green. Ralph Nader and the Green Party are candidates you can vote for without having to hold your nose in the voting booth. Win or lose your vote counts. It is a wake-up call, a voter Molotov cocktail to the powers that be. It allows the Green movement to grow, and win in the future. It gives people hope, and allows us to get 13 million dollars in federal matching funds. That's 10 times more than we are spending this year. Don't waste your vote, vote Green.
The second thing you can do is to join the green party of Connecticut. The Green Party of Connecticut needs you. We are political activists who seek to educate the public, mobilize the public, pass progressive legislation in our state, and win elections at the town, city and state levels. We are very interested in local issues. We want the green party to grow from the bottom up-- by electing green party people to local boards, and councils where they will work for the good of the average citizen. We need you to run in these elections where you can win. We need you to mobilize for our state candidates and state legislation, which includes passing universal health care legislation in CT in 2001.
The third thing you can do is to give the Green Party money. We are being outspent in every race. Often by 100s of dollars to one. Nader has raised a million dollars. The Republicans and Democrats are investing 100's of millions of dollars in their run to control the White House, to control your minds, and control your lives. Money talks and we need money so we can talk to more of you.
The fourth thing you can do is to reach out to the Green Party of Connecticut. Invite Green Party people to come and talk to the groups that you belong to -- faith communities, labor organizations, student groups, and social justice groups. When you are involved in a fight for social justice and economic rights, turn to us. We will be there for you. We fought to stop the stadium, we are fighting to stop the mall in New Haven. We are fighting to close Millstone. We are fighting to get back the billion dollars of taxpayers money being spent to bail out Northeast Utilities for their nuclear energy fiasco. We are fighting to win a livable wage for all citizens of Connecticut. We are fighting to end child poverty in the state. We are fighting to let local communities preserve open space, and fight back developers.
I guarantee you, that if each of you will do these things-vote Green, give money, join the CT Green Party, and reach out to the Green Party for help, then we will create a party of the people, by the people, and for the people-we will be joined in a party that stands for truth, justice and liberty for all.
This essay was originally written to be the keynote speech at the New Haven Be Green Party on the New Haven Green.