Universal Health Care – Everybody In, Nobody Out

Injustice in Current Health Care

Current Health Care

QUESTION: Even if everyone in the country isn’t covered medically at present, isn’t it an exaggeration to talk about this as a great social injustice?

Is it less of an injustice than excluding an ethnic minority from half the pharmacies in town, or from using a public water fountain, as in the South during segregation? The poor access of ethnic minorities to health care facilities is suggested by the very large differences in basic health statistics such as infant mortality. Part of this difference in access is the much greater rate of uninsured workers (and their families) among ethnic minorities. The consequences are at least as dire for members of these communities as being excluded from pharmacies and water fountains. Consider for example the much lower chances that an African American child will even survive infancy.

In fact, according to a report in the American Medical News (published by the AMA) of late 2004 entitled, “The Health Impact of Resolving Racial Disparities: An Analysis of U.S. Mortality Data” resolving racial disparities in health care could save fives times as many lives as the number saved by technological advances made in improving drugs, devices and medical procedures. Comparing mortality data of whites and African-Americans between 1991 and 2000, (the researchers found). Technological advances averted 176,633 deaths between 1991 and 2000, while eliminating racial health care disparities could have averted 886,202 deaths.

What kind of a democracy could remain fixated on the loss of 3000 lives (Sept 11 2001) on a single occassion and remain so unconcerned about the loss of nearly 300 times as many lives every ten years, just because the lives lost are of ethnic minority and largely low-income? Even if you are fixated on “security issues”, how could you not be concerned about the hundreds of thousands of veterans of the Afghanistan and Iraq wars who have been shut off from veteran benefits?

QUESTION: But isn’t it possible that some of these ethnic communities simply don’t put the same value on participation in the modern health care system?

Consider physicians, for example, who are certainly people who have chosen to fully participate in the present modern system. African-american and hispanic physicians see as patients a much larger percentage of indigent, uninsured and low-income than do their caucasian counterparts. They thereby demonstrate a GREATER concern for delivering health care broadly than do those counterparts, on the whole. Yet, despite a stated desire by government and the health care professional associations to increase health access to the underserved communities of our nation, the percentages of African-Americans entering medical school (who could be counted on to deliver such care) have not significantly increased during recent years.

QUESTION: Don’t minorities just get more care than white people from the public safety net systems to compensate for lower rates of insurance?

Actually, even among medicare beneficiaries, it was found that black beneficiaries in particular underutilized available services, even though these were services were deemed medically necessary. The lowest utilization occurred among low-income blacks. So, no African Americans actually tend to use available state programs less than their white counterparts.*1

Furthermore, the issue of injustice is by no mean s concerned with ethnic minorities alone and justice for them exclusively. It also turns out that we are generally condemning our unborn children to lives of limited capability and restrictd opportunities both physically and mentally, for example with our terrible record in consistent provision of pre-natal care. In so doing, we are selling off cheaply our nation’s future. Meanwhile what the GW Bush administration has focused on very successfully (2000-8) is to come up with creative new ways to come up with new savings and tax-loop schemes for the wealthiest Americans and disguise them as new health care access programs.

QUESTION: People are just rewarded for what they earn through labor or investment risk. Isn’t health care security just one of the many incentives to work hard and invest wisely?

The first problem with this is that people with few resources have no or insignificant money to invest (and need to invest at lower risk). Considering that in 1998 the wealthiest 20% of Americans had more than 5 times the household wealth than the other 80% (combined not per capita), it is obvious that most working Americans have little chance to gain health care security through the wall street lottery, much less through their insecure jobs and pensions. Also what of the American workers who once sick are dropped by the insurers AFTER they take ill on the basis of undotted “i’s” and uncrossed “t’s” on the original policies. How more responsible can we get? Working hard and even working within a relatively privileged sector of the economy with “good health benefits” does not mean that a seriously illness would not still bankrupt your family, pretty much the same as an uninsured family would be affected. The ONLY reason this faith in private insurance persists is that so few of us have tested our insurance with serious illness.

And the spread in wealth is even more extreme if we look at a smaller percentage of wealthy Americans. So that just the wealthiest 5% of households have 3.5 times the wealth as the combined 80% less wealthy Americans. Also during the 15 years before the 1998 data was collected the gap in wealth between the wealthiest 20% and the rest of us increased by more than 15%. *2

QUESTION: This is just more leftist, slamming of the wealthy. The most successful Ameicans are already paying more than their fair share in supporting less fortunate, why should you abuse them?

EINO does agree that it is relevant to bring in discussion of “fair share” and who is paying for what. There are three major sources of federal revenue: personal income tax, corporate income tax and payroll tax. Since 1977 personal income tax has held steady at about 44.5% of total federal revenue, while the corporate tax share has fallen steadily from 14.4% to 7.4% (in 2003) and the payroll tax has grown from 29.9% to 40.0% according to data from the official US Budget (GPO, 2004). The payroll taxes surplus collected since 1983 (being more than the payout for Social Security and Medicare each year) were spent to offset general budget deficits, or the cost of reducing corporate taxes by half through 2003. Browse through some of these studies HERE.

Payroll taxes are poorly understood by most Americans. Payroll taxes are regressive, the greater your income the less you pay as a percentage. A household earning $270,000 per year pays the same payroll tax (or 1/3 the rate) as a household with an income of $90,000 a year, while someone earning $2.7 MIL pays about 3.3% of the rate paid by the $90,000/ yr family. Furthermore, its a myth that employers are paying half of the payroll tax. Employers consider the total cost of hiring (or retaining) each worker and that includes ALL taxes, if the share the federal government collected directly from them were much less that money would go towards other aspects of salary and benefits. Essentially, corporations collect any payroll taxes they must pay by reducing worker pay by the same amount.

Reagan’s 1981 tax cuts amounted to $600 BIL in personal income tax cuts which have been accruing to the wealthiest 5% of taxpaying Americans. From the Reagan tax cut the 60% of all taxpayers with annual incomes less than $20,000 actually had tax increases. The steady 44.5% share of federal revenue paid through personal income tax is very misleading. From 1965 to 2002 the effective federal tax rate nearly tripled for the US Median Income Family while it fell by 69% of its 1965 rate for the top 1% of earners by the year 2002. (US Treasury CBO and Erasmus book pg. 101)

Prior to 2001 the Estate Tax applied to only 2% (52,000) of the 2.5 million “head of households” who died that year -the other 98% of Americans had already been exempted from any such tax. Even for the 2% to whom the tax applied in 200 there was a $1.35 MIL exemption before the tax kicked in for the remaining inheritance. Under the current (2001) revisions by 2009 the exemption will rise again to $7 MIL and only some 2,400 Americans will be subject to any estate tax. Nonetheless, Bush and the GOP congress are campaigning heartily in 2006 to save these 24,000 loyal subjects to the throne further expenditures. Thirty or forty years ago we could have argued about the wealthy paying their fair share (although compared internationally the US has always been “a nation of low taxes”) but today? After the burden has been so heavily shifted to the lowest-incomed Ameicans?

But it’s not just who is paying taxes that makes are system so unjust. Low-income people with a greater likelihood of being uninsured, are disproportionately people of color also are charged more for the same care than are higher income people. Why should any low income category pay 2 to 3 times what better off, insured people are charged?

QUESTION: Isn’t it just that Latinos and African Americans are more frequently low-income and that people with less resources are disadvantaged for health care, as they are for almost everything?

It is true that ethnic minorities are disadvantaged in many areas in our “great democracy” and also that probably the most fundamental way in which they are kept disempowered and disadvantaged is through mechanisms and history which leaves them with less economic resource and little opportunity. But this is all the more reason that (if we were serious about a functional democracy) we would show commitment and dedication to the concept of a fundamental right to health care -just like we have for primary and secondary education. A real democracy would require that minorities not be excluded from being full participants in our country’s and in their own future, merely because of assigned status at birth. Health care is no less necessary to have a genuine, functioning democracy than is education. It’s absolutely necessary to being included in a society like ours. READ MORE about democracy and health care from our document (PDF) or by visiting the relevant section of “Right To Health Care . org “.

We do not recognize that there is any more justice in our country or in the health care system owing to the fact that exclusion from resources might be largely predictable based on socio-economic status. We are aware of studies such as the one appearing in late 2004 which detailed the consequences of lower socioeconomic status in terms of disparity and scarcity of health care and access to health care resources. READ MORE about one such study and get the citation to the peer-reviewed article. It should be kept in mind that even being among the poorest in Canada you would likely fare better than the average citizen of the USA, suggesting the sort of difference universal care would bring.

QUESTION: Most Americans these days are concerned with the threats to our very existence, like terrorism -that’s our major collective social concern. Can’t you see that individual or human rights are secondary?

Actually it is easily argued that without ability to maintain our health with access to regular appropriate health care, without high quality education for all our children and such fundamental social support, that the “American way of life” we are concerned with protecting will be itself terribly deteriorated. Enjoying a “functional democracy” and an “American way of life” are agreed by virtually all Americans to involve certain rights, certain assured benefits which will accrue to all hard-working, sacrificing Americans. Just as we all acknowledge that all such Americans deserve to know that their children can get a decent education, at least K-12, the majority of Americans also agree that dedicated, responsible, hard-working Americans ought to be able to get the health care needs of their families met. A unified strong democracy is our strongest asset and this will require an inclusive nature and embracing our diversity. Meanwhile destruction of innocent human lives (unnecessary and untimely death) goes on quietly with a nod from the few “major news outlets” (i.e. television networks). Where should we look for an explanation of how health care costs could be skyrocketing, fewer Americans holding private insurance and public funds expenditures on health care also increasing in 2000-2005?

And while we are on the topic of Bush’s invoking the terrorist threat and his $2 TRIL war to bring Iraq a new political system (including universal health care for all Iraqis by the way), we note that the tax cuts instituted by GW Bush since 2001 totaled in excess $4 TRIL by the end of 2005 (in both personal and corporate tax cuts). Meanwhile the new Iraqi constitution which so many young Americans have died, guarantees the “Right to Health Care” for all Iraqis (nice, huh)? Additional cuts that GW is seeking for 2006, including the repeal of the Estate Tax, will throw in an additional $11.6 TRIL . The alleged shortfall in Social Security funding which GW worked so hard to promote around the country as a major security threat, is about a third of this cut, which he is trying to save from the federal coffers and keep in the deep pockets of the richest 20% of Americans (80% of it, at least). This post 2005 additional tax cut that GWB is so certain the nation can afford could not only reverse the deficit of Social Security, but could resolve the shortfalls in Medicare and still have enough left to provide free prescription drugs for all Americans (not just partial coverage, of certain prescriptions, for just elderly Americans).

QUESTION: Is there any evidence that a government program that was inclusive would have any impact on racial disparities in health care?

Yes! There is great evidence that universal health care would be highly effective in erasing all disparities in access to health care.Medicare’s leverage was demonstrated in 1966, the year of it’s inception, when hospitals desegregated as a condition for receiving Medicare reimbursement. Since then, Medicare has contributed to dramatic improvement in the health of the elderly and disabled minority population. From birth to age 65, racial and ethnic minorities are much less likely than whites to have health insurance. Upon reaching age 65, virtually all Americans are eligible for Medicare, and minorities constitute a disproportionate share of those who qualify for Medicare on the basis of long-term disabilities. Medicare also provides the same benefit package to all beneficiaries rich and poor; minority and white. While marked disparities persist, they are far less than those minorities experience before becoming entitled to Medicare. *REF-3

You want stunning statistics? In an early 2005 report when treatments for cancer were controlled for cancer site and stage, late-Medicaid enrollees were found to have 2 to 3 times more likely to have died than people enrolled in the federal program at the time of diagnosis. *REF-4 Federal programs which have made enormous gains in reducing racial disparities are highly effective in improving treatment outcomes.

QUESTION: Isn’t it appropriate that the hardest-working Americans, who have been rewarded with greatest accumulation of wealth should also enjoy the greatest security for themselves and their families, in health care, education and in all other benefits?

Project EINO understands that this point of view is attractive to many conservative Americans and we appreciate that it has some logic, but it misses the mark wide in a couple of very crucial respects. First of all, the hardest-working Americans, in general, are not those of the richest 10% of US families, most of whom, as never before in our history, are reaping enormous benefits from our nation with nominal to non-existent support of our institutions through taxes, while the tax burden on the families working the hardest has escalated in unprecedented fashion. Furthermore, the richest few families are, as never before, passing their wealth and domination down to their children and grandchildren, who will likely not be hard working or sacrificing at all.

Second, some basic issues of security and opportunity must be available to all americans, no matter what their economic status, if we are to claim that we are a functional (fully participatory) democracy and that all Americans have a decent chance to improve themselves, their families and their communities through hard, dedicated, self-sacrificing labor. If only the wealthiest 10% of families have children who can get a decent education (K-12) or who have a chance for higher education (even if outstandingly brilliant) then how can anyone argue that full participation in our society (running businesses, exerting political influence for example, founding associations to represent their community’s interests) is open to all? That would be nonsense, even for the most conservative individualistic self-reliant among us.

Similarly, although the right to health care has not yet been established, it is nonsense to claim that low-income hard-working (often at two jobs per adult) families who suffer uninsurance give their children the same opportunities in life as upper income families. Medical bankruptcy has grown tremendously and is well-documented. Losing one’s home, one’s small business, the ability of both one’s parents to go to work and be fully productive and to be able to afford resources for preschool education in the home, possibly pre-school out of the home; these are disadvantages which will handicap that child through the rest of their life, no matter how hard-working, dedicated and family-oriented the parents are.

 

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