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Health Care Today: Separate Is Not Equal

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Dr. Martin Luther King Jr. claimed that "segregation is the adultery of an illicit intercourse between injustice and immorality." As often was the case with Dr. King, his language was far more eloquent than our government officials deserve. July 30th, a massive march took place in Washington, DC to commemorate the 44th anniversary of the Medicare Act and push for health care reform today. The march, rally, and following press conference were organized by Public Citizen, Physicians for a National Health Plan and Health Care Now. According to a press release, their specific objectives included the following:

  1. Mandate congress to co-sponsor single-payer legislation (H.R. 676 "Expanded & Improved Medicare for All" for House Reps, and S.703 "American Health Security Act" for Senators
  2. Ask the Congressional Budget Office (CBO) to score single-payer legislation in terms of 'cost-benefit analysis; (past CBO ratings have documented a cost neutrality for single-payer programs which translates into no extra cost)
  3. Vote for H.R. 676 or S. 703 (single-payer legislation), or lose your jobs at midterm elections
  4. Refuse to accept campaign contributions from the very health care industries you are allegedly regulating. Instead, support publicly funded elections.

Their ultimate goal is to end the de facto segregation of health care we have now under private insurers and replace it with mandated single-payer health care for all Americans. Just as the case Brown v. the Board of Education denounced the doctrine of "separate but equal" as inherently unequal, so the Health Care Now press conference denounced our segregated, dysfunctional health care system of 'haves' (pharmaceutical companies, health insurers), and 'have nots.' Make no mistake: this is the civil rights issue of our day. It is literally a life or death situation.

A featured speaker at the Health Care Now press conference, held at the National Press Club, is then-Senator Obama's former physician from 1987 to 2009, Dr. David Scheiner.

Dr. Scheiner repeatedly spoke to the dire need for single-payer health care, or Medicare for all. Dr. Scheiner's rebuttal of those who fear "rationing" under a single-payer, Medicare-for-All system:

In the 40 years I have been practicing under Medicare, I have never encountered an instance where Medicare has prevented proper medical care. On the other hand, [private] insurance companies frequently interfere and block appropriate treatment.

To those congressmen who lack a moral compass Dr. Scheiner added, "Our nation is at a crossroads. We must not give in to the insurance and drug companies and instead do what is right for all Americans," urging both his former patient President Obama and Congress to adopt a single-payer plan.

By now, the public is certainly confused by the terms "public option," "private health insurance," and "single-payer." Opponents of single-payer health care have benefited from that confusion. I found that the California chapter of the National Organization for Women succinctly defined these terms in plain language.

Under the single-payer plan, all Americans would pay into the system through our taxes, with no one exempt. The collective risk and subsequent costs would be distributed across our entire population. Patients could go anywhere for care and retain full choice of doctors, with medical need as the sole consideration. No one would be denied coverage or denied care due to pre-existing conditions. In terms of pricing, the single-payer system would have more negotiating power because of sheer volume -- our entire population. It should be noted that as of this writing, even China is considering a single-payer system. As a US Senator, President Obama supported single-payer.

Now, as President, Obama favors an anemic version of what's known as the "public option." The public option would not be mandatory for all, and consequently would not have the same bargaining power as single-payer. Discrimination against pre-existing conditions could still occur -- covertly, via pricing which would be unaffordable for most. Like the doctrine of "separate but equal" carefully crafted in the Supreme Court case Plessy v. Ferguson, health care would continue to be delivered in a discriminatory manner, based not on medical need but on the ability to pay. We would maintain "separate but equal" systems of the healthiest and wealthiest, versus the sickest and poorest -- a prejudice based on economic caste.

Why is it that our government has no outrage towards this insidious form of segregation, while the same principle applied to public education or fire protection services would be decried as evil? What is it about health care that makes the term 'single-payer' taboo?

Earlier this season, doctors from the group Physicians for a National Health Program, (of which Dr. Scheiner is a member), interrupted the Senate Finance Committee when it became clear that single-payer was never going to be on the table. Several doctors and other single-payer activists interrupted Senator Baucus's committee and asked why single-payer was automatically off the table and and why it was that all the experts on the panel from the insurance and pharmaceutical industries.

For their efforts, one by one, each of the protestors was handcuffed and arrested. The July 30th march, rally and press conference was the collective response of doctors, nurses, clergy and ordinary citizens to the doctors' moral act of civil disobedience.

An examination of the Senate Finance Committee may provide some answers. According to information published at the Sunlight Foundation, members of the Senate Finance committee from both parties have accepted sizeable donations to their campaigns from a variety of health insurance and pharmaceutical companies. First, here is the breakdown of those contributions for every member of this committee:

Senator Health Sector Insurance Sector
  2008 Career 2008 Career
Baucus 1,148,775 2,797381 285,850 1,170,313
Rockefeller 515,150 1,674,229 107,874 394,074
Conrad 117,350 1,331,363 56,650 821,187
Kerry 289,430 8,145,141 90,250 1,397,367
Lincoln 226,753 1,281,608 49,500 440,033
Wyden 96,925 1,161,488 45,999 229,173
Schumer 10,000 1,402,358 3,000 946,400
Stabenow 239,018 1,188,186 40,800 246,750
Cantwell 48,951 573,076 12,300 80,850
Nelson 60,015 1,163,210 22,500 520,016
Menendez 81,650 1,216,476 67,450 458,679
Carper 15,450 452,000 28,700 447,984

These were the Democrats on the committee.

Now, here are the Republicans on the committee:

Senator Health Sector Insurance Sector
  2008 Career 2008 Career
Grassley 334,237 1,876,479 72,200 858,224
Hatch 122,300 2, 311, 744 24,880 659,307
Snowe 6,000 744, 640 5,000 408,490
Kyl 68,550 1, 971, 968 2,000 533,044
Bunning 40,450 1, 045, 687 45,100 769,016
Crapo 92,000 549, 192 63,750 360,932
Roberts 657,749 903,337 157,900 296,342
Ensign 16,550 1,795,899 19,150 580,690
Enzi 287,549 612,715 84,250 240,953
Cornyn 950,669 1,994,353 289,069 568,253

All campaign contribution records were found courtesy of non-partisan watchdog group the Sunlight Foundation, from their "Healthcare Lobbyist Complex" investigation.

Secondly, legislators who oppose a single-payer system often claim it would be fiscally unsound. Keep in mind that while the Senate HELP (Health, Education, Labor & Pensions) committee studies these issues, it is the Senate finance committee that looks at the bottom line. They base these objections on dated rough estimates from the Congressional Budget Office (CBO), and have not run new numbers especially in light of different economic scenarios.

The CBO estimates that the price tag of Obama's plan could end up costing as much as one trillion dollars. But, as the National Priorities Project reports, the cost of the wars in Iraq and Afghanistan is already at $915.1 billion. If we add in Obama's new $130 billion supplemental war spending request for fiscal 2010, then the amount spent for wars in Iraq and Afghanistan is that much, too -- one trillion dollars.

The wars in Iraq and Afghanistan will keep sending our country further into deficit. Ending these wars of empire is not only the morally right thing to do, but is more fiscally responsible, as the transfer of monies from military privateers to health care will more than offset any estimated cost overrun. Additionally, businesses no longer saddled with the cost of health care will be better able to afford employees, who will in turn spend money locally and help revive our damaged economy.

Real and perceived conflicts of interest cannot go unaddressed. Historically speaking, many pharmaceutical and insurance corporations donate money to candidates and campaigns whose policies will be more favorable to their corporate 'bottom line.' No one can fault businesses for protecting their interests in most concerns, however we are not talking about producing 'widgets,' or pushing Beyonce CD's -- we're talking about issues of life and death. Single-payer health care is the only system which is financially feasible, politically equitable and morally mandated.

As the nation learns that Senator Chris Dodd's prostate cancer is likely treatable -- with treatments paid for by his federal employee health plan -- a neighbor of mine is losing the use of the left side of her body due to a malfunctioning shunt designed to alleviate the damage done by hydrocephaly she has had from birth. She has no insurance so she is denied further care.

As we collectively mourn for Senator Ted Kennedy's poor cancer prognosis, indigent cancer patients in Las Vegas were turned away to a certain death sentence, as the one remaining public hospital treatment center was closed due to budget problems.

Again, separate but equal is not equal.

Dr. Scheiner is correct: as a nation, we are at a crossroads. Do we continue to place corporate profits above people? Will we continue to relegate the basic human right of equal health care to the political "back of the bus"? If, as Dr. King said, "The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy," when will we demand to know where our Senators stand at this moral crossroads?