With active support from groups and individuals such as the California Teachers Association, the California Nurses Association, the California Physicians Alliance, State Treasurer Phil Angelides, the California Conference of the United Methodist Church and others, a universal healthcare bill continues to progress through the California legislature. SB 840, "The California Health Insurance Reliability Act," sponsored by Sen. Sheila Kuehl, has passed through the Senate and the Health Committee in the Assembly.
Grassroots lobbying is going on in more than a dozen other states to effect fundamental healthcare reform. It's clear that no progressive healthcare legislation that benefits working- and middle-class America is likely to emanate from special-interest-dominated Washington, D.C. under the Bush administration. While corporate healthcare interests reign supreme, larger economic forces at work in the global economy are beginning to reshape the debate regarding American health care. States must lead the way in defining the issue, educating the public, building coalitions, forging solutions and passing the legislation. Only then will Washington be forced to act.
There are four key points to consider when framing the issue:
• In 1980, healthcare costs consumed 9.1% of our gross domestic product. In 1993, the percentage rose to 13.8% of GDP. Today, healthcare costs consume 16% of GDP, or $2 trillion. Without reform, healthcare costs will consume 20% of GDP by 2015 and the 46 million now uninsured will grow to 54 million, with no end in sight.
• Of the total workforce in America, union representation has dropped to 8-9% for private sector workers, rising to about 12% if you include state and federal employees -- the lowest level in decades. This is important because union jobs are historically associated with providing decent wages, pensions and healthcare benefits.
• New York Times columnist Thomas Friedman and many others make the point that the post-WW2 economy is over. The global economy is here to stay, where pretty much any job, manufacturing process or capital investment can be outsourced at a moment's notice.
• Wages for most workers these past 30 years have been flat or stagnant. For some sectors of the economy they have actually declined, and purchasing power has not kept pace with rising costs in energy, education, housing and especially health care. This increased spending on health care alone means fewer dollars spent or invested elsewhere.
We're told repeatedly that we have the best healthcare system in the world, but this is patently not true. While no system is perfect, we are living with fragmented policies and plans that leave more people uninsured or underinsured each year. We spend twice as much as any other advanced industrialized nation, yet we don't even make the top 20 in terms of overall outcome (US ranked 37th overall according to the World Health Organization). The present system benefits vested healthcare interests but makes it increasingly difficult, if not sometimes impossible, for average Americans to find and fund coverage, not to mention the decreasing ability of businesses to provide insurance for their employees.
It is time to rebuild and broaden the definition of American infrastructure to include basic health care as a fundamental right. Past rigid adherence to laissez-faire economic and libertarian ideologies have not provided and are unlikely to provide solutions to the healthcare issue.
I believe that it is in our personal and national interest to seek a universal healthcare model in which everyone is covered and substantial savings are realized through negotiated prescription drug pricing, preventive care and streamlined funding for administration. It is in the interest of every family, every Democrat and Republican, and every business owner, from Fortune 500 companies to small- and mid-size enterprises. Skyrocketing medical costs also threaten county, state and federal budgets.
In the new global economy, Americans are competing with hundreds of millions of workers from other countries in both skilled and unskilled labor and we are more likely to experience economic uncertainty in the future. Without reform, cost shifting along the Wal-Mart business model will continue and the number of uninsured will grow. That will adversely affect wage growth, living standards, job creation, viability of pensions, competitiveness of American firms and ultimately the American middle class. Declining productivity will be only one of many casualties.
In 1972, having received orders for Vietnam, a group of us were sent to a holding company awaiting transport. A returning veteran passed by, offering this advice: "Hope you boys have good insurance." The remark stuck with me because of the obvious implications. Imagine the military, or public safety officers, for that matter, attempting to do their job with no assurance that they would receive care after engaging in combat.
Our nation is, in effect, asking its citizens to work in an increasingly competitive/combative global economic environment while increasing numbers go without health insurance. Not providing the necessary infrastructure behind our workforce may benefit the healthcare sector in the short term, but will have long-term economic consequences for the United States.
Ultimately, the American people will have to make a "business decision" regarding our access to health care. The decision will likely be some form of universal coverage. In the end, we are unlikely to sacrifice our families' access to secure, affordable health care to administrative overhead, exorbitant CEO salaries or inflated prescription costs associated with the parochial interests of today's healthcare industry.
How many uninsured Americans it will take before change occurs is an open question. Fortunately, in California and other states we have universal healthcare legislation pending. We hope our California 'Health Care' Dreaming will become a reality. Health care as a fundamental right? It's up to us.
Lee Guelff (email guelff@charter.net) is co-chair, San Luis Obispo County Chapter, Health Care for All (healthcareforall.org).