It’s 2003 and healthcare’s in crisis. Are workers and business in this together?

The following is a leaflet distributed at the American Public Health Association convention in the fall of 2003, six years ago.  It seems  pretty relevant today, given the current health reform legislation, with its emphasis on cost reduction for business and government, its incentives to make us pay more for less healthcare while securing sustained profits for insurers, drug companies and hospital chains, and its reliance on cuts to Medicare to fund the whole plan.


Obviously, healthcare is in crisis, but really there are two parallel health care crises.

For us, patients and providers, the health crisis is: 43 million uninsured, “patient driven” insurance that shifts costs to patients through high co-pays and inadequate benefits, a safety-net in tatters, a critical shortage of health workers, a hospital system rife with dangerous mistakes, and the worst health indicators in the industrialized world.  It’s clear to us that something must be done.

Business has a completely different health crisis: falling HMO and health insurance profits, rising and uncontrollable health costs, strikes and near-strikes over cuts in employee coverage, millions of ageing baby boomers with expensive diseases on the horizon, an uncertain recovery, huge federal and state budget deficits, and costly open-ended war ahead.  From their viewpoint, too, something must be done.

We need high-quality, comprehensive, single-tier, universal, government-financed healthcare.  Business needs to lower its operating costs as much as possible. We believe these are conflicting imperatives, which do not point to the same solutions.

Obviously, a huge segment of the corporate world wants to keep health insurance and high-priced drugs as part of the health delivery system because it’s a profitable commodity.  That sector is busy planning multi-tier “universal health coverage” where the uninsured get vouchers to buy new stripped-down health plans that could be profitable.  This plan was advocated in a recent NY Times Op-Ed piece (11-18-03), a SF Chronicle interview with Kaiser’s CEO (11-16-03), and is a plan proposed by California Blue Shield, which has hired hundreds of workers to handle anticipated new policy holders.

But what about the rest of the corporate world, businesses whose profits are reduced by bloated healthcare profits?  Could they help get single payer?  Some single-payer advocates say cracks are forming in the wall of corporate resistance. High costs and strikes are making some think twice about single payer. There are even policy-makers who worry that the dominance of the health and drug industries weakens the manufacturing sector, which could compromise national defense in time of major war.  Does all this make those businesses our ally?

We think not. For this sector of the economy, workers’ healthcare is a cost of doing business, like maintaining the machinery. Business will try to reduce health costs whether they are paid as direct benefits or as taxes under single payer.  They certainly have tried to reduce other tax-supported health programs like Medicare and Medicaid.  It should not stretch the imagination to foresee how business could turn the intense centralization of universal single-payer health care to their own advantage, and make it a mechanism for severe rationing of healthcare.  For example, the stripped-down “basic coverage” schemes that the insurance industry is presently designing for the uninsured will require standardization and government approval.  Once that happens, business will push to have “basic coverage” be the standard for patients under single payer.

For years, business hasn’t given a damn about people not having medical insurance.  Since the early 1980s they’ve laid tens of millions of us off, cut millions of current workers and retirees off medical benefits, and made their coverage so expensive that millions cannot afford it even when it is offered.  So you’ve got to suspect something is fishy when they start being so concerned about whether we have medical insurance.  We saw what happened when they were concerned with seniors not having prescription coverage.  They bundled in a plan to dismantle Medicare!

Our healthcare should be neither a commodity nor a cost of doing business.  This is a period of tremendous collision of people’s needs and aspirations versus corporate needs and demands.  The movement to end this disgraceful situation will involve a tremendous fight.   As Quentin Young said, getting good healthcare will be as big a struggle as civil rights.   Civil rights, Medicare, and Medicaid were all won by people who worked, their families, and people who would have worked if they could.  Their actions on the job, in their schools, organizations, churches, in the streets, and in the military challenged the US’s ability to govern and made the government produce the “Great Society” programs.  Although many of these gains have been erased in the intervening forty years, millions of lives were improved and the struggle remains as an inspiration and example of what is needed for deep reform of society.

We deserve nothing less than high-quality, comprehensive, single-tier, universal,  government-financed healthcare.  We have to be clear on what it will take to get it and who our allies are.

Concerned members of APHA

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