The Campaign for Justice in Health Care (JHC)
In 1992, I had been working as a typesetter for the better part of a decade and a half, and yet another “minor” recession was eating away at the possibilities for economic self-sufficiency. The savings and loan debacle of the late 1980s is hardly remembered now, but it did extraordinary damage to the American economy, and the fact that very few of those responsible for that damage ever paid any social penalty for their role no doubt encouraged a new generation of economic plunderers during the first decade of the 21st century.
Four years earlier, I had actually done more than vote during the presidential campaign. I actually volunteered to work during Michael Dukakis’s campaign, and I put in enough hours to be offered tickets to a Dukakis rally at UCLA in the last ten or so days of the campaign. It was an inspiring rally, though it was too little, too late for Dukakis, who had squandered an early lead in the summer by heading home to Massachusetts right after the Democratic convention instead of hitting the campaign trail. At that point, campaigns were thought of as “fall” affairs, and Labor Day was the kick-off point. The first Bush knew better. Attack as soon as possible, and don’t let up. Dukakis never recovered from his failure to build on the momentum created by the Democratic national convention.
After three consecutive terms by Republican presidents, I was hungry for victory and looking for a candidate. Tom Harkin from Iowa struck me as a decent man and progressive enough that I see myself voting for him. I heard that he was going to appear at a gathering in West Hollywood. There were well over 100 people in the room as he gave his speech, which seemed spirited and upbeat until there was a pause for questions near the end. A voice from the back of the room shouted out, “What about AIDS, Senator Harkin? This is West Hollywood.” Harkin flinched slightly and then became slightly angry, not at the person who had asked the question, but at himself for having trusted those who arranged this event. I knew what he was thinking: “Why didn’t someone tell me in advance about my audience, so that I could emphasize my record here?” In point of fact, Harkin had done far more than others to push for the AIDS research, but he hadn’t seen that as a major part of his record. Unfortunately, the incompetence of his staff in not notifying him about the location of his event, and the importance of this issue to them, left him high and dry, and made him look as indifferent to an historical health crisis as the majority of politicians back then. It was a moment that taught me a great deal about the value of knowing where you are and understanding the groundswell of the times.
At this moment, there is a health care crisis that is only becoming worse by the day. I am hardly an economic expert or a recognized authority in the matter of public health care, and yet I remember enough about the depredations on the lives of working people during the past quarter century to believe that the AIDS crisis of the 1980s and 1990s is not unconnected with the Black Lives Matter movement. I offer the following five-part article on the need for justice in health care as my contribution to this ongoing discussion. Thank you for reading.
Part One: Memories of the Job Crisis and its Impact
on the Health Crisis to Come
In recent decades, the Republican party has succeeded in large part because it has manipulated the voters who support its candidates by making promises about social issues that it has only been able to deliver on an installment plan. Symbolic victory is more prevalent than any actual effacement of the gains made by women and people of color since 1950. Conservatives often feel disregarded by the party Elites except when it comes to voting in elections.
Not to be outdone in that kind of campaigning and underperformance, the Democratic party has often talked a good game, but delivered far less than its supporters have a right to expect. In the most recent debate (Sunday, January 17, 2016) involving the two leading candidates for the Democratic nomination for President, Hillary Clinton listed jobs as her first priority. Where have we heard this before? From her husband, Bill Clinton, who ran in 1992 as someone who told us that indeed jobs would be lost to technology, but that there would be job training. And he was right. Jobs were lost, but there was no job training available to those workers in any meaningful number of programs.
Hillary Clinton would like to forget that by 1995, three years after her husband took office, jobs were being lost at an extraordinary rate, and while one can argue that things briefly got better from 1997-1999, that was only after the havoc of much unnecessary turmoil in employment. The shedding of jobs – especially union jobs – helped out his corporate sponsors immensely and devastated the day-to-day lives of workers. Bill Clinton did not care about anything other than empowering Wall Street firms. Workers were last on his list of priorities.
Hillary Clinton’s reiteration of jobs as her first priority deserves more than just the skepticism rightfully generated by the memory of her spouse’s betrayal of working people in the 1990s. One only has to look at the woeful incompetence of the Democratic party in handling the job crisis of 2007-2010 to estimate the likelihood of Hillary Clinton being a “jobs President.” Let us go back eight years and take a look at how well President Obama handled the crisis. Here is the policy statement that explains the plan:
http://otrans.3cdn.net/45593e8ecbd339d074_l3m6bt1te.pdf
“A key goal enunciated by the President-Elect concerning the American Recovery and Reinvestment Plan is that it should save or create at least 3 million jobs by the end of 2010. …. We expect the plan to more than meet the goal of creating or saving 3 million
jobs by 2010Q4. There are two important points to note, however: First, the likely scale of employment loss is extremely large. The U.S. economy has already lost
nearly 2.6 million jobs since the business cycle peak in December 2007. In the absence of stimulus, the economy could lose another 3 to 4 million more. Thus, we are working to counter a potential total job loss of at least 5 million. As Figure 1 shows, even with the large prototypical package, the unemployment rate in 2010Q4 is predicted to be approximately 7.0%, which is well below the approximately 8.8% that would result in the absence of a plan.”
(policy document dated: January 10, 2009)
That was the plan that President Obama and his team of advisors from Wall Street came up with to meet the crisis of massive unemployment. The actual outcome is that the plan did not begin to ameliorate the damage done to the economic lives of working people. By the end of 2010, the unemployment rate was 9.3 percent, not 7 percent. (http://data.bls.gov/timeseries/LNS14000000 )
The shortfall, as stunning as it is, hardly represents the real evil at work here. How could anyone think that the goal of resolving this crisis should be 7 seven percent unemployment? That aspiration is in and of itself a hideous, reprehensible failure of social imagination on the part of Obama and his co-conspirators from Wall Street. Of course, that Democrats would put forward a plan that they had to know in their muscle-bound brains would be completely inadequate would not be surprising to anyone who remembered Bill Clinton’s inability to deliver on job training in the 1990s. As with Bill Clinton, Obama and his cohort merely went through the motions of alleviating the catastrophic distress of working people. Nor did things get better in 2011. In September, 2011, the unemployment rate was 9 percent. The prolongation of the crisis and its cantilevering on the backs of working people reveals exactly how little those in the professional ranks of politics and social and economic policy understand ground-level existence.
And does anyone care to remember that this figure of nine percent unemployment in 2010-2011 is totally manipulated? Anyone who had despaired of finding work by the summer of 2011 was not counted. You were not unemployed, these statistics insisted. And the nightmare was only worse under the surface. How many hundreds and hundreds of thousands of people found that their unemployment benefits were insufficient and found themselves depending on relatives and friends who could barely sustain themselves? The damage done to working people during that period is at a level that those who hold positions of authority cannot imagine. They do not have enough intelligence to make that kind of empathic leap.
Bernie Sanders at least has the common sense not to make jobs his first priority. It is too late to redeem that tragic implosion. While he listed “jobs” in third place in his list of priorities, he knows that the coming crisis involves health care and that the only way to address the onslaught of health care needs of the baby boomer generation is the single-payer system. “Medicare for All,” he calls it, and in making this his anthem he brings to a complete stop a system in which generations exploit each other.
It should be noted that the baby boomer generation has subsided Medicare for the population born between 1910 and 1935. This rather large cluster of people paid very little into the Medicare system and reaped continuous coverage. By the end of this decade, it will be the turn of those born between 1946 and 1955 to receive the same benefits that their hard work provided to their elders. But will that promise be kept? Why should it be kept, especially when there are fewer people paying into it, all the while suspecting that it will not be there for them when it is their turn? I can hardly blame Gen X and the succeeding generations from being cynical. There is a tsunami of unfunded health benefits about to come due, and they are being asked to let themselves be drowned by a health care system dominated by corporate culture.
So Sanders wisely sees that the only way – the only fair way – to make sure that the promise made to the baby boom generation is kept is to provide the same level of access and care to everyone, and to provide this health care as a right. The pursuit of health is the foundation of whatever happiness we are fortunate enough to share with others. It is an inalienable right, and those who are 35 or 45 years old have as much right to it as those who are 70 or 75 years old. Health care is one of the essential critical fulfillments of social cohesion and requital. To diminish its status is to guarantee a debilitated social economy. If Sanders’s plan seems radical and daunting in its unfamiliarity to Americans, then they need to remember how badly both Democrats and Republicans handled the job crisis. They will do no better with their current plans (including Obamacare) to resolve the coming health crisis. Millions of economic lives would have been saved if Obama had acted with the boldness required in 2009. Millions of lives – literal lives, this time – are at stake, if we do not act with similar boldness in altering the health care system in the next four years.
A minority of our fellow citizens, however, would prefer to benefit from the unequal distribution of “health wealth.” This fraction of business as usual administrators has a vested interest in a system in which HMOs become “too big to fail.” Anyone can see what such a system has in mind: public money subsidizing private profits. Wall Street’s health is the only check-up they need to have an annual report on.
PART TWO: “Mega-mergers” versus Obamacare paranoia
The obsession of the right-wing with Obamacare and how the Federal government might “socialize” medicine is a long-standing resentment. One of the most popular programs administered on a national level is Medicare, but it was strongly opposed in its original formation by the Republican party and its more extreme sympathizers.
The fear of centralized control of such an intimate matter as one’s individual health has some reasonable basis. Anyone who works at a large institution knows the enormous discrepancy between the ideological claims of those who administer the institution’s programs and the actual delivery of those services. “Student success” is the mantra in higher education, but I have seen first hand how students needing classes and registered for those classes are left empty-handed. And I myself, at a critical moment in my health care between July and November, 2010, nearly died because of the bureaucratic ineptitude and indifference of my HMO medical plan; indeed, I have seen this personal experience replicated several times in the past decade and a half in my first-hand network of friends and family. The difference between the level of care announced in HMO press releases and the dilatory delivery of that care when it is needed is enough to make one highly suspicious of claims that urgent medical attention, under the thumb of HMO financial expediency, will be superior to the care that a single-payer system will deliver.
The part that I don’t understand about people’s fear of Obamacare, or a single-payer system administered by the federal government, is their concern about the centralization of medical power. Hey, folks – it’s already happening. All you have to do is look at the articles in newspapers about the mergers of various HMOs to understand that massive mergers of health insurers have already created a vortex of centralization that has the profit-motive as its primary engine: your health is merely an inconvenient obstacle to the maximization of that overriding urgency.
The issue of “mega-mergers” was recently the subject of a very fine article by Chad Terhune, an award-winning journalist, in the Los Angeles Times.
http://www.latimes.com/business/la-fi-agenda-health-mergers-20160111-story.html
This article is dated January 11, 2016, and it is merely the latest installment by a reporter with an impressive backlog of articles on the health industry crisis. It appears, however, that this will be his last article as a reporter for the Los Angeles Times. I heard recently that David Ulin is no longer with the LA Times, and I note with dismay on the bio page for Chad Terhune that “he left the Times in January 2016.” If so, the departure of two writers of the caliber of Ulin and Terhune is not a good sign for the future of that newspaper. I am deeply concerned about how the Times plans to cover the current debate on health care. To whom will this crucial assignment be given? I have substantial doubts that someone of Terhune’s exceptional caliber will replace him.
In the meantime, the question I have for conservatives who fulminate about Obamacare’s centralized control of medical plans is why the same vigorous disdain is not brought to bear on these mega-mergers. It seems, quite frankly, hypocritical to lambast Obama’s program on one hand, and then to shrug one’s shoulders with a “business-as-usual” slouch as companies interweave with one another in a winner-take-as-much-as-possible competition.
For Terhune’s biography, see:
http://www.latimes.com/la-bio-chad-terhune-staff.html?page=2&#
PART THREE: Healthy Black Lives Matter, Too: Race and the Single-Payer System
Physicians for a National Health Program (PNHP) has a website I would urge all of you to take a look at. In addressing “Frequently Asked Questions” about single-payer health systems, one word that scarcely appears, however, is “race.” How would a single-payer system affect the dynamics of social stratification of race? How would the hierarchy of white privilege fare under single-payer? The answer to this is the slogan that Bernie Sanders should have adopted over a year ago:
Healthy Black Lives Matter
In the single-payer system the phrase “all are equal in the eyes of the law” extends firmly into the world of health care. I suspect, however, that the possibility that African-Americans and Latin@s would have equal access to high quality medical diagnosis and treatment is precisely the factor that makes the single-payer system unacceptable to many people who vote in a conservative pattern.
The crisis in Flint, Michigan regarding the lead poisoning of its population should be monitored under many different rubrics, but the quality of health care that the afflicted residents receive should be given particular attention. If “Black Lives Matter,” it is not simply that they should be free of antagonistic treatment by police, but that these lives should be as healthy as possible.
In this regard, one of the most important FAQs (Frequently Asked Questions) on the PNHP website is: “Why shouldn’t we let people buy better health care if they can afford it?” PNHP responds by saying that “If the wealthy are forced to rely on the same health system as the poor, they will use their political power to assure that the health system is well funded. Conversely, programs for the poor become poor programs. For instance, because Medicaid doesn’t serve the wealthy, the payment rates are low and many physicians refuse to see Medicaid patients. Calls to improve Medicaid fall on deaf ears because the beneficiaries are not considered politically important.”
This answer could be thought of as the equivalent of everyone having to drink the same water. If the families of high level automobile manufacturing executives had had to drink the same water as the families in Flint, Michigan, do you not think that more care would have been taken to monitor the quality of water? Health care, like drinking water, is a fundamental human right. “Healthy Black Lives Matter” should become one of the primary demands — perhaps the primary demand — for those of us who want to see a fundamental change in the distribution of medical knowledge and resources.
PART FOUR: Dignified Black Deaths Matter, Too
In the past decade, one of the most important civil rights battles has involved the ability of an individual to put an end to useless suffering when confronted with the checkmate of mortality. Conservative factions insist that self-determination should be insisted upon when it comes to economic matters, yet the same groups will all too often call for their moral choices to be imposed upon others in the realm of health care. The West Coast of the United States has been leading the way in promoting the right of an individual to give herself or himself the same degree of compassion that we would give to any terminally suffering animal, and the recently passed legislation in California will no doubt cause the smug self-righteousness of conservative institutions, such as hospitals run by the Catholic church.
Regardless of whether a single-payer system is put into place in the near future, the sobering fact remains that the access that individuals will have to the “right to die” under this new law is a matter yet to be determined. Michael Hiltzik in the Los Angeles Times has written recently of the problems that patients have incurred at Catholic hospitals when a woman wants a tubal ligation. One of the questions that the PNHP website does not address is how to integrate an institution that is ideologically hostile to the needs of the population it would serve under a single-payer system. What will happen, for instance, when a terminally ill patient — who is trapped in a Catholic hospital designated as the only provider by her HMO — is not interested in being starved to death in a hospice, but instead adds her voice to the chorus of Kurt Vonnegut’s poignant question as he neared the end: “Can I go home now?”
(Let me be clear about one point: hospice care would claim that pain-killing drugs enable people to have all nutrition cut off and yet experience no suffering. Unfortunately, the accuracy of medical claims falls far short of the guarantee needed in such an intimate matter, and skepticism in regards to this claim by hospice organizations and their advocates is utterly justified.)
In enforcing the right of individuals to terminate their lives when pain approaches the point of intolerable duress, I can easily see a crisis looming for the baby boom generation. A lot of people are going to die in the next 15 years, and some of them will passionately yearn for release from their protracted suffering. What is completely predictable is that Catholic hospitals and the hospices under their control will refuse to allow doctors in residence to grant the legal wishes of their patients.
In countering this obstreperousness, one point to keep in mind is the all important exchange of money for services and where that money comes from. If Catholic hospitals accept any tax money whatsoever, then they need to bow to the rights guaranteed by law to all who have contributed to that tax system. In point of fact, this is one of the things that brought the integration of schools to a flashpoint at mid-20th century. School districts would accept federal money, for instance, that was given to them to sustain the education of the offspring of military personnel stationed in their districts. Often these areas loved the presence of the military, since their payrolls contributed to the local economy. The edge of that sword, however, was less welcome. If a school district accepted funds from the government to educate the children of military personnel, it could not then turn around and say that the African-American children of these soldiers and sailors could not then attend the same public schools as the children of white soldiers and sailors. In a similar manner, Catholic hospitals will have to get used to the idea that they cannot be exceptions to the rule of law and they will have to integrate their services with the rights of those who want to end their suffering.
Finally, my most profound concern about the enforcement of right to die legislation is how it might play out along racial lines. Given the disparity in treatment of African-American citizens by police forces in this country, one would be naïve to believe that such discrimination stops there. Hospitals run by the Catholic Church do not tend to be much different than most urban police forces: the hierarchy in the work force is largely white at the top and in the middle. As such, one is not unreasonably nervous in anticipating that white people in charge of caring for dying African-Americans might take it upon themselves to subject their patients to one final jolt of contempt and humiliation. (The presence of crucifixes throughout Catholic hospitals should suffice to remind us that Catholic hospitals fester with an ideology that valorizes suffering as a necessary component for so-called eternal salvation.) When baby boomer African-Americans, who somehow survived the gauntlet of random gunfire from any number of sources over the past several decades, finally arrive at the waiting area of personal embarkation, they deserve equal access to the “right to die” law. To assume that equal access to the right to die will of course be granted to African-Americans is as foolish as assuming that every African-African is treated by police officers with the same respect as Caucasian citizens. Black Lives Matter. Healthy Black Lives Matter. And Dignity in Death matters for Black lives, too.
PART V: The AIDS crisis as a Forecast of Baby Boomer Amnesia
I have been reading Queers in Space: Communities/Public Places/Sites of Resistance (Seattle, Washington: Bay Press; 1997) the past few days, and in particular want to recommend Ty Geltmaker’s chapter, “The Queer Nation Acts Up: Health Care, Politics, and Sexual Diversity in the County of Angels, 1990-92.” The years cited in the title are slightly deceptive, since Geltmaker does an excellent job at compressing the sordid history of how little effort was made by elected politicians in Los Angeles to deliver even a minimal level of health care to those subjected to the ravages of HIV. In reading his article, I was struck by how vividly he made the first full decade of the epidemic come back in memory, and I was also struck by a contemporary disparity in awareness of how the pandemic altered the development of Gay consciousness.
In fact, I often wonder how much knowledge young people (those born after 1990) have of the AIDS crisis. What percentage of them know how many tens of thousands of people in the United States died from the debilitating onslaught of HIV between 1980 and 2000? How many died in Africa? In Europe? In Asia? In Latin America? And it’s just the millennials that I suspect of wearing hip-boots of ignorance as they wade through that roll-call. At this point, I am not even certain that most baby boomers are cognizant of the enormous number of deaths exacted in the aftermath of officially sanctioned neglect of AIDS patients. It is all too easy at this point to imagine that life has become “normal” again in the United States; in fact, with the majority approval of gay marriage, it would seem that the nightmare of AIDS, at least in the United States, can be said to be rapidly receding as a tragedy that will mainly stay present as a dramatic element of novels and poems and the occasional screenplay.
What needs to be asked, though, for those who want to press the issue of the single-payer system, however, is to demand a thorough analytical report of how the crisis would have been handled, had a single-payer system been in place in 1980. That difference will tell us how urgent it is to depart from the care system currently in place, which hardly differs from the one in operation thirty years ago. Stop deceiving yourself, my fellow citizens. If you think that AIDS is the last massive attack virus that will hit this country for the remainder of its history, then you are living in a fantasy. It is crucial to apply proposed models of health care to a representative crisis in the recent past if we are to resolve a future crisis with minimum casualties.
As I close this extended commentary on health care, I wish to circle back to the beginning, at which I talked about the crisis of jobs within the default systems of economic collapse. Consider this: if President Obama had truly looked at how other such periods of turbulence had been handled, he would have seen without any doubt whatsoever the scale of job programs needed to save the lives of working people. In the mid-1970s, even a Republican president signed off on CETA (the Comprehensive Employment Training Act), and Gerald Ford did so when unemployment was far less than was happening in Obama’s first months as president. At this point, we need to study how effective a single-payer system would have been in meeting the AIDS epidemic of the 1980s. If that study shows – and I suspect it would – that a single payer system would have obviated the need for gay people to resort to ACT UP in order to get the level of medical and social care that should have been their fuckin’ birthright, then it is time to move towards a single-payer system now, and to send the system that made gay people’s lives and deaths a living hell to the perdition it so richly deserves.
About Bill Mohr