Americans Are DYING: Universal Health Care Should Be Something We Can All Agree On [View All]

[McCamy Taylor]

Divide and Conquer is the Republicans favorite tool. When you represent the financial interests of the top 0.5%, you have to have a lot of tricks up your sleeve to remain in power. One of the tried and true strategies is to throw the Democrats into an arena and pit them against each other like gladiators, and then pick off whatever is left standing.

Americans are dying in Iraq. Americans are dying from the effects of polluted water, air and bad food, drugs and toys. American infants are dying before they even have a chance to be born from rising infant mortality. And, according to this article from the New York Times, since 1980, when George Bush Sr. made his infamous hostages for votes deal to steal the election for Ronald Reagan, poor and minority Americans have been dying at an increased rate over their more affluent brothers and sisters.

http://www.nytimes.com/2008/03/23/us/23health.html?_r=1&oref=slogin

New government research has found “large and growing” disparities in life expectancy for richer and poorer Americans, paralleling the growth of income inequality in the last two decades.

Life expectancy for the nation as a whole has increased, the researchers said, but affluent people have experienced greater gains, and this, in turn, has caused a widening gap.

Snip

In 1980-82, Dr. Singh said, people in the most affluent group could expect to live 2.8 years longer than people in the most deprived group (75.8 versus 73 years). By 1998-2000, the difference in life expectancy had increased to 4.5 years (79.2 versus 74.7 years), and it continues to grow, he said.

After citing (and highlighting) the usual litany of “blame the victim” excuses such as poor lifestyle choices, the NYT considers another possibility:

Nancy Krieger, a professor at the Harvard School of Public Health, rejected that idea. Professor Krieger investigated changes in the rate of premature mortality (dying before the age of 65) and infant death from 1960 to 2002. She found that inequities shrank from 1966 to 1980, but then widened.
“The recent trend of growing disparities in health status is not inevitable,” she said. “From 1966 to 1980, socioeconomic disparities declined in tandem with a decline in mortality rates.”
The creation of Medicaid and Medicare, community health centers, the “war on poverty” and the Civil Rights Act of 1964 all probably contributed to the earlier narrowing of health disparities, Professor Krieger said.

The article also mentions several studies which show that Blacks and Whites treated under identical circumstances---for instances at the VA---will receive different care, with Whites more likely to receive preventive care or screening than Blacks which could contribute to longer survival.

First, I would like to address the issue of poor lifestyle choices. It is true that living under the burden of income disparity in an affluent society is linked to a variety of health problems including depression, suicide, domestic violence, alcoholism,, drug abuse, increased risk of death by homicide. However, if you go online to the CDC and look back at longevity rates in 1950---before medical science had any treatment for coronary artery disease and myocardial infarction, the big killers of Americans, you will see that Blacks and Whites at age 60 had almost identical life expectancies. (see page 193)

http://www.cdc.gov/nchs/data/hus/hus06.pdf#027

Now consider that African-Americans lived under even greater disadvantage in 1950, with more limited access to educational opportunity in many parts of the country, with restricted job and voting rights and diminished income earning potential compared to Whites. If income disparity and life style factors were the sole cause of the current discrepancies in life expectancy, you would expect that the problem would have been even more pronounced in 1950. However, a 65 year old Black man and a 65 year old White man in 1950 could both expect to live to be 78 years old. Something happened in the meantime. I believe that Krieger is right. What happened is that medicine found ways to treat heart disease and cut down on deaths from heart attack, but Blacks---and the poor---do not reap the same benefits from this medical technology that Whites---and more affluent Americans do. (As a side note, another possibility to consider, which I will not elaborate upon here, is that medical research, which has been proven to have a bias in favor of men over women, may also have a bias in favor of treatments that work better for people of European origin than African origin. There is no reason to assume that the mechanism of heart disease formation in people whose ancestors came from different geographic regions of the world is identical and that identical treatments work the same for them. Just as we are now learning that there are differences between the cardiac biology between men and women, we may find that there are subtle but important difference in the pathophysiology of heart disease of Asians and Native Americans and Europeans and Africans---including people from different parts of Africa.)

Go to page 197 of the CDC document, and you will see that Blacks and Whites had almost the same death rates from heart disease and cancer in 1950, but the rate of heart deaths for Whites has fallen more than it has for Blacks, and the rate of cancer deaths has risen more for Blacks than for Whites. The rate of respiratory (smoking related ) cancer deaths have risen at about the same rate, suggesting that there is not a significant difference in smoking related mortality.One possible cause for increased cancer deaths in Blacks is the tendency to build toxic waste dumps and factories near African-American communities. This article from Ms. magazine is just one of many that you can find online about the topic. If you are not familiar with the issue, I encourage you to read up on it.

http://www.msmagazine.com/spring2007/thedirtysaga.asp

Regarding causes of death that are related to the despair associated with income disparity, homicide death rates for Blacks first increased but then decreased over the last 50 years, consistent with an improvement in socioeconomic status with the passage of civil rights legislation in the 1960s. This improvement may also reflect improved legal status within the U.S. Death from MVAs (motor vehicle accidents) , a marker for “dangerous” or risky behavior like DWI, are the same for the two groups, suggesting that theories that Blacks have lower life expectancies because they do not value their lives or health are pure bullshit. Whites continue to have two and half times the suicide rate of Blacks at age 65 another sign that self destructive behaviors are not increased in the African-American community.

I think you can see where I am going with this. There has been a tremendous improvement in medical science since 1950. Back then, if you had a heart attack, you crossed your fingers and hoped that you survived with enough cardiac muscle left to keep you alive. Now, if you have blockage in your arteries, and you have insurance and a doctor who thinks to screen you, they can open those arteries with a balloon, get you on drugs to clean out the cholesterol deposits, lower your blood pressure and your heart’s work load, thin your blood to prevent clots, help you lose weight and exercise---and you will die of cancer or pneumonia at 80.

However, that will only happen if you have health insurance, and if your doctor thinks that you are a good candidate for preventive treatment. If you are one of the 40 plus million Americans without health insurance, you will show up at the emergency room after six hours of “indigestion”---at which point the cardiologist that they drag in will hope and pray that you have enough cardiac muscle left after this heart attack to keep you alive.

Two things have to happen to narrow the life expectancy gap. The first is a no-brainer. Everyone in the United States needs health insurance in order to get preventive health care before heart disease has a chance to develop . That means universal health care. If people wait for the first MI to sign up, people are going to die. (The second is much more difficult. The income disparity gap must be narrowed. The best way to accomplish that is through improvements in education. But, as I will discuss below, as long as states' budgets are consumed by health care spending, there will not be enough for education, which will keep the poor poor.)

However, the same insurance industry that fought tooth and nail in 1993-4 to save its empire is not going down without a fight this election season, either. Here is SourceWatch with a mini-summary just to remind those who have forgotten or those who are not old enough how the nation’s first efforts at universal health insurance were torpedoed by a slick propaganda campaign.

http://www.sourcewatch.org/index.php?title=Coalition_for_Health_Insurance_Choices

To drive home the message, CHIC sponsored a now-legendary TV spot called "Harry and Louise," which featured a middle-class married couple lamenting the complexity of Clinton's plan and the menace of a new "billion-dollar bureaucracy." The ad was produced by Goddard*Claussen/First Tuesday, a PR and election campaign management firm that has worked for liberal Democrats, including the presidential campaigns of Gary Hart, Bruce Babbitt and Jesse Jackson. According to Robin Toner, writing in the September 30, 1994, New York Times, "'Harry and Louise' symbolized everything that went wrong with the great health care struggle of 1994: A powerful advertising campaign, financed by the insurance industry, that played on people's fears and helped derail the process."

Other tactics used by shills like Rush---people were told they would be jailed if they tried to see a doctor of their choice. If they called 1-800 numbers for “information” they were forwarded to their representatives office and encouraged to tell their reps to vote “no” on Clinton health care. Focus groups liked the Clinton plan if it was described to them but when it was presented as the “Clinton plan” they said it would never work, because the media had told them over and over that it would never work and would lead to health care disaster.

And of course, the classic strategy that the right wing uses when battling any attempt to alleviate disparity in this country is to tell those in the middle class that they will be forced to do without so that someone poorer than them can get something they do not deserve. The Reagan “welfare queen” strategy. See, here she is in New Orleans, surrounded by her "attendants", the quintessential American welfare queen, White, elderly and disabled with a police escort, because she is such a menace to society.




This is Divide and Conquer at its worst. People with insurance obtained through their jobs were (and still are) told that they will lose this “free” benefit and be forced to pay higher taxes to get substandard insurance for themselves----and to pay for insurance for dead beats.


In Who Really Pays for Health Care? The Myth of “Shared Responsibility” by Ezeckiel J. Emanuel MD, PhD and Victor R. Fuch, PhD in the March 5, 2008 issue of JAMA ]The authors argue that employers do not pay for health insurance and employees do not get “free” health insurances benefits---no matter what their employers or unions tell them. They analyze wages and insurance costs in the U.S. and show that as insurance premiums have risen, wages have fallen. When employers no longer pay insurance premiums, wages rise. Employers have enjoyed increased profit per employee over the last 30 years, even as health insurance premiums have risen, but at the same time, employees real wages have declined----because employees are paying for their own risen health care costs, not their employers.

The authors go on to talk about the cost to state governments , where health expenditures are typically the largest single factor contributing to rising taxes and deficits which make it difficult for states to adequately fund education systems. Since Medicaid, SCHIPS and state funded public hospitals and clinics are supposed to be the safety net for those who do not have “employer sponsored health insurance”, the current system is exacting a heavy toll on states and hurting our children’s future.

In addition, by giving people with employer sponsored health insurance the illusion that they are getting something for “free”, it creates a powerful disincentive for them to support a national universal health care program that would relieve their states from their current burden and insure the 40 million who lack insurance and set up a health system based upon prevention. “Getting Americans invested in cost control will require that they realize that they pay the price, not just for the deductibles and copayments, but for the full insurance premiums, too.”


We see the same thing happening again this year. The economy is at the top of American’s lists of concerns, and health care is right up there with mortgages and jobs. Every Democrat has a health care plan, but instead of banding together to tell the country why its needs universal health care, the two remaining Democratic candidates are trying to scare America. “Don’t choose my opponent’s plan. That one will send you to jail” (Shades of Rush Limbaugh!) “If my opponent really believed in universal health insurance, he would make it required, like Social Security. Maybe he doesn’t really believe in Social Security.”(Who’s a better Democrat? The one who doesn’t ask who’s a better Democrat).

Imagine the health insurance industry’s delight. They do not have to run Harry and Louise ads. The Democratic campaigns will do it for them. They do not have to make universal health insurance controversial. The primary has already accomplished that goal.

And who pays for a few votes for one candidate in one primary or a few more caucus goers for the other? Millions of people, mostly hard working but middle and lower middle class Americans, lots of them White but a disproportionate number of them Black and Latino and unmarried mothers with small children who were so sure that they would get health care in 2009 or 2010 and who now have to wonder if it will be 2012. Or maybe never, because who knows how long Democratic control of Congress will last?

It is OK for Democrats to argue like a pack of rabid hyenas during the primary. It is what they do. Yeah, we know that Karl Rove and the MSM are baiting us and that DU is filled with Freeper trolls lighting fires, but the Party will survive. But can we please agree that some things are too important to trash? Like health care for all Americans? Because we are dying without it.