|Michael Hogue / KRT|
In the U.S. people struggle to pay for needed prescription drugs while pharmaceutical companies post record profits. People die prematurely because they cannot get the care they need while hospital beds remain empty and medical equipment sits idle. We watch lawmakers rebuff health care reform efforts while they themselves enjoy the best of health care benefits. Such dismal truths can make the problems of the U.S. health care system seem too overwhelming and complicated to solve. Yet, for the first time in over a decade, people all over the country are finding reasons to be hopeful. Why? After struggling for nearly 100 years to make health care for all a reality in the U.S., what is different about this moment that suggests a new day is dawning?
The short answer is that the escalating crisis is forcing us to take action. The longer answer points to our understanding of how successful social change happens. Consider the major social reforms of the last century of civil rights, women’s rights, and environmental protections. In each of these, our country went through a process in which our cultural understanding of the issue evolved, our institutions were transformed, and laws were written that redefined our rights and responsibilities. The parallels we see as we confront our health care crisis suggest that significant change is beginning once again.
Our cultural understanding on the issue of health care is changing as frustration with the status quo builds. Even opponents of government intervention in health care are beginning to express concern about the cost of doing nothing.
While there is not consensus on how to make it happen, opinion polls overwhelmingly show that we as a society do believe everyone should receive the health care they need. What was once lip service from a few is now a chorus of voices calling for reform.
Many of our institutions, often opponents of reform, are changing as they recognize how the health care crisis affects their ability to fulfill their mission. Business leaders acknowledge that the way we structure our health care system puts them at an economic disadvantage in the global market because they must compete with companies that are not burdened with the costs of employment-based benefits. Health care institutions are searching for greater efficiencies and ways to provide more health care for our money.
Governments struggle to provide insurance for those not covered through their work. Schools acknowledge that health insurance costs for faculty and staff erode classroom resources, and union leaders recognize that protecting expensive health care benefits ultimately undermines job security and cuts into salary increases and pension benefits.
Our laws are changing to reflect this new understanding and redefine our rights and responsibilities in making health care more accessible and affordable. Even though legislators differ in their solutions and sincerity, few dare say that health care doesn’t need to be reformed. While there has never been a vote on universal health care in Congress, state and local governments are moving forward to cover more of their residents. Were seeing additional progress, as well, in state legislation that makes prescription drugs more affordable for more people.
States take the lead
Historically, in the absence of federal action, state actions have become the catalysts for social change. In response to the passage of health care reform legislation in Massachusetts and Vermont, a Boston Globe editorial noted, “The states are the laboratories of democracy, as Supreme Court Justice. Louis Brandeis once said, and the test tubes are bubbling (May 21, 2006).
Within those laboratories are scores of grassroots activists testing the waters.Health care justice groups are becoming re-energized; faith communities are reclaiming this issue; labor groups are committing financial resources to work on health care for all; social service organizations are reporting on how the health care crisis hinders their efforts to help low-income people; and numerous other organizations are adding health care reform to their priorities. Their work is seen in a number of state efforts emerging around the country; six have actually passed meaningful legislation"
- In 2003, California passed a bill requiring businesses with 50-plus workers to either provide coverage for their own workers or pay into a fund that would cover the uninsured. Although the law was narrowly repealed a year later, citizen support for reform increased thanks largely to grassroots supporters who fought against the big businesses that outspent them eight to one. Energized activists continue to raise the issue throughout the state and, in response, the mayor of San Francisco unveiled a proposal this summer to achieve universal health care access for the people of the city.
- Also in 2003, Maine passed its Dirigo Health Reform Act on a bill that sets a 2009 goal to achieve health care for all. The plan began in January 2005 and now covers over 10,000 previously uninsured state residents. Particularly notable is that this plan was passed by a legislature in which over half had been elected under the state’s new clean election laws, thus freeing them from dependence on special interest funds. Citizen activists continue working to maintain support for the plan in the face of opposition funded by groups outside the state.
- The Health Care Justice Act of 2004 in Illinois did not propose a particular plan for reform, but rather a state-wide process to gather citizen input to generate several proposals for reform. That process will conclude this fall when the legislature selects from the proposals one plan that will be implemented in mid-2007. In the midst of this process, the statewide public hearings generated a consensus about the importance of covering children and, as a result, the legislature adopted the Illinois Health Care for All Children law in 2005.
- Maryland enacted a more limited health reform bill when the Democratic legislature passed the Fair Share Health Care Act of 2006, overriding the Republican governor’s veto, in large measure because of the efforts of health care justice, labor, and faith coalitions in the state. Requiring employers with 10,000-plus workers, such as Wal-Marts, to designate a specified portion of their payroll expenses for health care benefits, the bill saw widespread citizen support. Part of a multi-state campaign to force large employers to accept responsibility for health care, the Maryland success has energized activists in numerous other states where similar bills have been introduced.
- The Massachusetts health reform package passed last April was a landmark event because it was a compromise between a Democratic legislature and a Republican governor who agreed on the goal of health care for all. While not perfect, the reform package does represent what can happen in a politically divided environment when all the stakeholders can at least agree on the goal. It offers hope in the midst of the political partisanship that immobilizes reform efforts. That hope was brought closer to reality by an active faith network that helped build the bridges necessary to make compromise possible.
- Vermont, inspired by Massachusetts, revived a previous effort and passed its Health Care Affordability Act of 2006. Frustrated by rising health care costs and an increasing number of uninsured, in 2005 a group of labor, business, health, and government leaders developed key principles for reform, wrote a bill and got it passed in the Democratic legislature. When the bill was vetoed by the Republican governor, the largest coalition in the state’s history was formed. The bill was reintroduced, and it passed last May.
All of this activity in the states, coupled with decades of debates, provides valuable insights into the challenges ahead and what will be needed to move the health care agenda forward. The first challenge is the perceived contradiction between the dual goals of reform to improve access or to contain costs while maintaining quality. Legislative efforts usually have focused on one or the other. The truth is, however, that we must take on all the goals. Successful efforts will concurrently address how to increase access, reduce costs, and improve quality.
At the heart of the debate is the second challenge: Am I my brother’s or sister’s keeper? Some say no and promote individual responsibility. Others see health care as a shared responsibility that includes everyone.Successful reform will embrace both. Individuals will be called to make healthier lifestyle choices and society will be called to care for those unable to care for themselves. In addition, all players in U.S. health care individuals, governments, health care providers, insurers, and employers will be called to accept the shared responsibility of making health care affordable and accessible to everyone. As seen in several successful state efforts, the faith community, through their moral message, can play a critical role in bridging the political divide. The moral dilemma informs the third challenge determining whether human needs are better served by markets, individual ownership, competition and profits, or by governments and laws that ensure access and the fair distribution of costs? Again, instead of reducing the discussion to polarized stances, we should find solutions that promote a creative mix of effective government regulation and financing with fair market incentives.
The fourth and perhaps most daunting challenge is the economic self- interest of key health care stakeholders. While almost everyone in the United States would benefit from health care reform, a number of well-financed, tightly organized special interests, such as pharmaceutical and insurance companies and some big businesses, fear they would lose out. For example, in 2003, the year the Medicare prescription drug benefit was passed, there were 637 registered pharmaceutical industry lobbyists—' 1.5 for every member of Congress.
These lobbyists succeeded in adding the provision in the Medicare package that prohibits the federal government from negotiating Medicare drug discounts, despite the fact that it successfully negotiates Medicaid and veterans drugdiscounts. Strong public demands for change and lawmaker accountability are necessary to prevent special interests from blocking progress toward reform. Active, well-organized grassroots advocacy over an extended period of time is needed to promote reform, to prevent special interests from blocking progress, and to help sustain and protect reform once it is enacted. In addition, at least some of the key wealthy and influential stakeholders must be convinced to put the larger public interest above their own short-term, narrow economic self-interest.
Will Washington, D.C. get on board?
Sustainable statewide reform that can resist well-financed and powerful opposition will require federal action. Several federal efforts reflect a range of perspectives on how to make reform happen. One approach is the comprehensive reform packages such as The U.S. National Health Insurance Act, HR 676, introduced by Michigan Representative John Conyers. Modeled around U.S. Medicare and the Canadian single-payer system, it seeks to enact change with a single piece of legislation.
Another set of proposals cover particular populations such as children, or those with chronic diseases such as diabetes.
A third approach sets up processes to engage the various health care players in dialogue about what kind of reform would work for all of us. The Citizens Health Care Working Group is seeking public input for recommendations it will submit to the president and Congress this fall. In addition, the bipartisan Senate Bill S.2007, would establish a commission to examine the circumstances that contribute to problems in health care in order to develop public and private policies to address rising costs and the number of uninsured.
Perhaps the most promising of these process proposals Perhaps most promising of these process proposals is the Health Partnership Act (S.2772). This bipartisan Senate bill involves the federal and state governments, private payers, and health care providers in developing approaches for reform on a state-by-state basis. It provides federal grants and support to states that commit to specific reductions in the numbers of uninsured, and to specific measures to reduce costs and improve the quality of health care. The benefit of this proposal is that creative thinking is encouraged and funded, federal financial incentives help block opposition from well-funded special interest groups, and the will of the people can be implemented with federal support that is not hampered by federal political deadlock.
In the immediate days ahead, we must work to protect the people in Medicare and Medicaid and those in veterans’ health care programs. Losing ground in any of these programs will compromise the goal of affordable health care for everyone.
Meanwhile, concerned citizens are making a difference, generating pressure to move the issue forward. There are important legislative opportunities both in the states and at the federal level. These simultaneous efforts are moving us from despair to the hope that we can in the next decade achieve the dream of 100 years — affordable health care for all!