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California Nurses Association
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May 9, 2008

In this weeks BILL MOYERS JOURNAL, Rose Ann Demaro, the Executive Director of the California Nurses Association, argued that calling America's approach to health care a "system" is innaccurate.
If you look at health care in America, there is no health care "system." There's a health care industry thats major objective is profit-making — which means not providing the patient all of the care that they need, discharging patients early, patients without insurance being treated differently than wealthy people, frankly. And that is the health care "system" in America. Those who can afford it get to live and those who can't suffer needlessly.

According to the U.S. Census, 47 million Americans don't have health insurance. In a 2005 article in the NEW YORKER, Malcolm Gladwell enummerated some of the consequences of being uninsured:

The leading cause of personal bankruptcy in the United States is unpaid medical bills. Half of the uninsured owe money to hospitals, and a third are being pursued by collection agencies. Children without health insurance are less likely to receive medical attention for serious injuries, for recurrent ear infections, or for asthma. Lung-cancer patients without insurance are less likely to receive surgery, chemotherapy, or radiation treatment. Heart-attack victims without health insurance are less likely to receive angioplasty. People with pneumonia who don't have health insurance are less likely to receive X rays or consultations. The death rate in any given year for someone without health insurance is twenty-five per cent higher than for someone with insurance. Because the uninsured are sicker than the rest of us, they can't get better jobs, and because they can't get better jobs they can't afford health insurance, and because they can't afford health insurance they get even sicker.

Preventable Deaths
Preventable deaths A recent Urban Institute study attributes as many as 20,000 deaths in the United States each year to lack of health insurance coverage and another study, conducted by Ellen Nolte and Martin McKee at the London School of Hygiene and Tropical Medicine, found that the United States leads nineteen top industrialized nations in overall preventable deaths, with 109.7 deaths for 100,000 people (between 75,000 and 100,000 deaths annually).

An Election Year Issue
Such grim statistics have made health care reform one of the top issues in the 2008 presidential campaign. But voters pondering health insurance plans are confronted with a forest of buzzwords and minutiae. Drew Atkins, the president of the Kaiser Family Foundation, encourages voters to seperate out the big differences between each candidates approach to reform before getting lost in the details. As he points out in a recent article:
[T]he real health care debate has been delayed by the focus in the primaries on the differences on health between candidates in each party, especially the differences between the plans put forward by the leading Democratic candidates. While the differences between the candidates' plans can mean a lot to experts, they mean much less to voters.
He explains that Obama and Clinton have broadly similar plans and highlights what he sees as three key differences between the Democratic and Republican approaches to health care this year:
  • Both Democrats cite guaranteeing universal or near-universal insurance as being the end goal. McCain, in adopting a plan similar to Bush's, focuses more on bringing down the cost of insurance for those who want to purchase it.
  • The Democratic plans seek to build on the existing employer-based system, whereas McCain's plan restructures tax laws to encourage individuals to purchase insurance on the open market.
  • McCain's plan favors high-deductibles on the front-end (routine medical visits, vaccinations, et cetera) with catastrophic coverage on the back-end, and using tax-favored savings accounts to pay for routine care, whereas Obama and Clinton's plans are more comprehensive with front-end protection and a focus on preventative care.

>>Learn more about the presidential candidates's health care plans.

The California Nurses Association and CheneyCare
The California Nurses Association (CNA) thinks neither of these approaches will go far enough to guarantee coverage and lower the cost of health care. They've come out with an attention-grabbing advertising campaign dubbed "CheneyCare" that contrasts the coverage afforded elected officials and government employees to that of many Americans. The ad describes Vice President Dick Cheney's ongoing health problems:

The patient's history and prognosis were grim: four heart attacks, quadruple bypass surgery, angioplasty, an implanted defibrillator and now an emergency procedure to treat an irregular heartbeat. For millions of Americans this would be a death sentence. For millions of Americans, this might be a death sentence. For the vice president, it was just another medical treatment. And it cost him very little.

Cheney is eligible, along with 2 million other Federal employees, for the Federal Employee Health Benefits Program. According to their Web site, those eligible for the FEHB Program "enjoy the widest selection of health plans in the country." And the CNA points out the FEHB Program has some very important benefits:

  • Everyone is charged the same rate
  • There is no waiting period for coverage
  • No one is denied coverage
The CNA argues that all Americans should be covered under a similar, government administered plan, and is backing HR 676 — commonly known as the "Medicare-for-All Act" — to expand and modify Medicare. This type of plan, in which one non-profit organization pays all medical bills, is often called "single payer." Proponents of a single payer system argue that by putting everyone into one big pool, a non-profit plan can achieve the three benefits enummerated above as well as cut down on administrative costs, balance risk and ultimately cost less than what they refer to as the United States current "corporate bureaucracy". The CNA summarizes their arguments for a single payer system here.

Critics of single payer plans often dislike increasing government involvement and point to shortcomings in national health care systems in other nations, such as Canada and Britain, arguing that a single payer system in the United States would lead to long waits and reduced care, extravagant costs and loss of liberty. The Heritage Foundation has a report arguing against instituting a single payer program here.

The California Nurses Association
The California Nurses Association and its national arm, the National Nurses Organizing Committee, is one the fastest growing health care organizations in the United States, with 80,000 members in 50 states. They represent nurses in collective bargaining agreements as well as advocate for health care policy reforms such as a federal single payer system for the United States and requiring minimum RN-to-patient ratios. Published May 9, 2008.
Related Media:
Andy Stern
The President of Service Employees International Union, the fastest growing union in the nation, weighs in on the growing economic gap between average families and the wealthiest Americans.

OBarbara Ehrenreich
Bill Moyers talks with author Barbara Ehrenreich about inequality in America.

OKathrine Newman
Sociologist Katherine Newman on the global markets' effect on kitchen table issues.

References and Reading:
US Census: Health Insurance Coverage: 2006
The U.S. Census bureau's official statistics on health insurance coverage in the United States.

U.S. Office of Personal Management: Federal Employees Health Benefits Program
The FEHB Program covers over 4 million Federal employees, retirees and family members. The president, vice president, and members of Congress are all eligible.

Cover The Uninsured
Official site of the Robert Wood Johnson Foundation project.

"Cheney Has Another Heart Problem"
by John D. McKinnon, the WALL STREET JOURNAL. November 26, 2007.

Guaranteed healthcare
The California Nurses Association Web site associated with the CheneyCare campaign collects stories of patients denied care by health insurance companies.

Nataline Sarkisyan
More information on the 17-year-old who died awaiting a liver transplant initially denied by the health insurance corporation CIGNA.

California Nurses Association
Official Web site of the California Nurses Association.

The Moral-Hazard Myth
Malcolm Gladwell takes on one the most influential arguments in the health care debate.

The S-CHIP Debate
A summary of the debate over S-CHIP, a program that provides health insurance the children of America's poor.

Pulling it together
Drew Altman, the president and CEO of the Kaiser Family Foundation writes about the general differences between the Democratic and Republican approaches to health care reform.

Also This Week:

The California Nurses Association proposes "CheneyCare" for what ails America.

The rivalry between two fast-growing unions.

British law professor Philippe Sands, author of TORTURE TEAM, talks about the approval of coercive interrogation by high-level American officials.

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