Julio M. Velasquez
Jared Grogan
English 1020
11 December 13
Where We’ve Been; Where We Are
What is the difference between the United States of America and Canada? The United States and the United Kingdom? France? Spain, Germany, and Norway? Not much. All are developed countries that have relatively high quality of living. They all have cars to drive, food to eat, public safety officials; the normal amenities one would expect from countries of their stature. However, one of the countries is lacking in a singular department: healthcare. Out of the world’s thirty three developed nations1, seven which are listed above, the United States is the only country that lacks a structured, government run healthcare system1. The problem with America’s healthcare is quite discombobulating. It is also a very old one. Throughout America’s history, the topic of health insurance has been time and time again subject to the reprioritization of the quality of life and the importance of health during wartime, has taken the backseat to economic and unemployment concerns, and has fallen victim to acrid politics.
The subject has been over complicated and blown out of proportion. Insurance in itself is a simplexity. Simple because all insurance can be stripped to a basic process: Money is continuously paid to an organization by an individual, that organization ensures that as long as payments are made the individual is protected against the entire cost of medical bills if the need for medical attention arises. The money that is not used toward the individuals medical expenses can be applied to the medical expenses of another paying individual, however the original payer is still entitled to coverage. The process resembles the way banks use funds once it is deposited. Your money still belongs to and is available to its owner, but the cash is being used by someone else. This process has been used in private and public health insurances in America, however in a very different way. Private insurance companies have the goal of earning a profit while still providing coverage to their customers. The private insurance system is highly unregulated and subject to greed and mishandling.
Private insurance is available to those who can afford the monthly premiums by many different companies. Public insurance is also available, but to a more specific demographic. The public health insurance in America is offered by Medicaid and Medicare, both organizations of The Department of Health and Human Services, a governmental entity with the responsibility of “…protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves.”3 Medicaid is an insurance program available any person who is considered low income or is disabled. In 1998, Medicaid covered 12% of Americans4. Medicare is offered to Americans ages 65 and older. Medicare covers “…about 14 percent of Americans and nearly every senior...”5.Medicare and Medicaid, created by the same Act in 1965, are the safety net that is in place for every American in their time of need5.
America’s apparent obsession with privately run healthcare is one that seems to go along with the economic system, capitalism, where goods and services, in this case, a service, is bought and sold for a profit. This is very easy to assume because of the tense politics as of late. Although there are small exceptions, this ideology is nothing but a false front for what has historically happened to health care reform legislation. Records of struggles to find a way to pay for health care can be found dating as far back as 19006. In about 1920, the need for a health insurance started to become more and more urgent as medical science and research breakthroughs started to drive up the cost of treatment. This was felt heavily by the middle class; the people who had enough money to afford insurance, but not enough money to be able to pay high premiums. Around the same time, coincidentally, physicians’ incomes began in increase and prestige in the field was established. Into the 1930s, the strive for heath insurance was caught in a tough battle with the dwindling state of the economy. As the Depression set in, emphasis was transferred from healthcare being available and affordable for every American to healthcare being affordable to the unemployed and elderly. With the passing of the Social Security Act, the need for health insurance is all but eliminated. Those who could afford insurance bought it, those who could not and qualified for Social Security assistance were caught by the safety net. When the economy began to bounce back, more and more people found themselves in need of insurance. In response, Blue Cross, now known as Blue Cross Blue Shield, against the advice of insurance professionals, began offering private insurance for hospital care in many states across America.
The 1940s were a rough time for the fight for universal healthcare. It saw the emergence of ‘prepaid group healthcare’ insurance which was widely viewed as a radical entity. There was a rise in employer-based health benefit systems, the same system that is used by millions of qualifying employees today. Pres. Roosevelt requested that congress pass an ‘Economic Bill of Rights’. This bill of rights, in relation to healthcare, would give every American: “The right to adequate medical care and the opportunity to achieve and enjoy good health” and “the right to adequate protection from the economic fears of old age, sickness, accident, and unemployment”6. Although Pres. Roosevelt contributed greatly to the effort to implement these rights, the effort was stunted by his death in 1945. Many aspects of the Economic Bill of Rights have been “...incorporated into the Universal Declaration of Human Rights, which was adopted by the United Nations in 1948. These rights were then expanded further by The International Covenant on Economic, Social, and Cultural Rights, which was ratified by 142 nations as of 2003”7. Although it is mainly where many aspects originated, the United States has not signed the Covenant. Pres. Roosevelt’s successor, Pres. Truman, proposed a health plan that would cover all of American society. Many aspects of the proposal were focused on children, the scarcity of medical facilities across America, and the need for more healthcare professionals. The actual health insurance proposal came under great scrutiny. This early in America’s history as a developed nation is when politics begins to play a key role in healthcare decisions.
“The most controversial aspect of the plan was the proposed national health insurance plan. In his November 19, 1945 address, President Truman called for the creation of a national health insurance fund to be run by the federal government. This fund would be open to all Americans, but would remain optional. Participants would pay monthly fees into the plan, which would cover the cost of any and all medical expenses that arose in a time of need. The government would pay for the cost of services rendered by any doctor who chose to join the program. In addition, the insurance plan would give a cash balance to the policy holder to replace wages lost due to illness or injury.
President Truman's health proposals finally came to Congress in the form of a Social Security expansion bill, co-sponsored in Congress by Senators Robert Wagner (D-NY) and James Murray (D-MT), along with Representative John Dingell (D-MI). For this reason, the bill was known popularly as the W-M-D bill. The American Medical Association (AMA) launched a spirited attack against the bill, capitalizing on fears of Communism in the public mind. The AMA characterized the bill as "socialized medicine", and in a forerunner to the rhetoric of the McCarthy era, called Truman White House staffers "followers of the Moscow party line".* Organized labor, the main public advocate of the bill, had lost much of its goodwill from the American people in a series of unpopular strikes. Following the outbreak of the Korean War, President Truman was finally forced to abandon the W-M-D Bill…”8
The 1950s were a major time for defeat in the fight for universal healthcare. The Korean War had begun and as the price of healthcare doubled, attention was once again diverted from healthcare and focused on defense. Many proposals were made in congress for different strategies and approaches to hospital insurance, but to no avail. The societal responsibly for caring for the sick poor has been transferred to government. It is accepted socially that welfare services will be the insurance provider for the poor and a private insurance system for those who can afford it.
By the ‘60s, the private insurance industry was booming exponentially. There were well over seven hundred private insurance companies selling insurance across the country. In a rather self-serving fashion, major medical insurance companies endorse what came to be known as ‘high cost medicine’. The only win for the side of universal healthcare is the signing into law of Medicare and Medicaid by Pres. Johnson.
In the ‘70s, Pres. Nixon, unlike many of the presidents who acted on healthcare before him, sided with private insurance. He renamed ‘prepaid group healthcare’ plans as ‘health maintenance organizations, or HMOs. Along with HMOs cam legislation that provides a federal endorsement, assistance, and certification. The cost of healthcare was also rising rapidly. The increase was partially due to the rapid inflation of the economy, expanses of hospital expenses and profits, and changes in medical care. It was at this point that Pres. Nixon, having experienced poverty himself, proposed a plan for national health insurance9. The insurance was to be an employer mandate to provide universal insurance. However, it was seen as inadequate by congressional democrats and faced powerful opposition by the AFL-CIO and the UAW. The legislation was defeated. Edward Kennedy was preparing to work with Pres. Nixon, but yet again, healthcare was dropped from national priorities, this time due to the Watergate scandal. The state of America’s healthcare system became known as a crisis.
By the 1980s, corporations began to infiltrate the healthcare systems. Corporations began buying hospitals, medical billing offices, and pharmacies, to name a few. Under Pres. Reagan, Medicare and private insurance plans shifted from paying doctors by treatment to paying by diagnosis.
The state of healthcare in America was, once again, looking bleak. By the ‘90s healthcare costs rose at double the rate of inflation. In 1993, Pres. Clinton proposed a comprehensive plan to provide universal healthcare to all Americans. The plan was to mandate that employers to provide health insurance coverage to all of their employees through HMOs. It was highly opposed by conservatives, libertarians, and the health insurance industry. To make matters worse for the plan, fellow Democrats offered competing plans instead of uniting behind Pres. Clinton’s plan. The bill was announced ‘dead’ by Senate Majority Leader George Mitchell.
In the current sociopolitical climate, the outlook is brighter than ever before for healthcare reform, but still very unstable. The election of Pres. Obama brought the promise of healthcare reform. He was able to pass a version of his healthcare package, but not one that would cover as comprehensively as previously hoped. In Pres. Obama’s healthcare legislation, the Affordable Care Act, many major concerns from the past century were addressed. The type of system America now has is an Insurance Mandate system. Every American is mandated to have health insurance, either by a private insurance company, or by a low cost public option. Because every American is mandated to have coverage no one can be denied access to care if they have a preexisting condition and no one can be dropped from insurance policies if they get sick. Preventative care is free; No copay, no deductible. Woman will be able to visit and OB-GYN without an insurance companies permission. Small businesses will get a tax cut to help pay for their employees insurance. There will be no lifetime limit on coverage, and if there is a denial of coverage, the insurance company must allow an appeal and get provide an independent review of the case.
Where to Next
When the constitution was written, the main discourse was the infringement of what we have come to know as rights and civil liberties. These rights are mostly political and religious in nature. This is why we have such great freedoms to worship and vote as we do. The problem we run into is that the concept of healthcare, let alone universal and single payer healthcare, was not a topic at the dawn of our country. Because our country was built upon political and religious freedoms, we have no specifically social and economic rights; rights that would not only allow for a universal healthcare system, but encourage it.
The United States has a strong cultural aversion to social and economic rights. In order to move toward a more stable and humanitarian state, we must shed the inadvertent schism that has been caused by the lack of documented social rights. America must continue the work of Pres. Roosevelt and implement the ‘Economic Bill of Rights’. Under the entire Economic (Second) Bill of Rights, every American would enjoy:
- “The right to earn enough to provide adequate food and clothing and recreation;
- The right of every farmer to raise and sell his products at a return which will give him and his family a decent living;
- The right of every businessman, large and small, to trade in an atmosphere of freedom from unfair competition and domination by monopolies at home or abroad;
- The right of every family to a decent home;
- The right to adequate medical care and the opportunity to achieve and enjoy good health;
- The right to adequate protection from the economic fears of old age, sickness, accident, and unemployment;
- The right to a good education.”6
America is able to move toward a more socially and equally just future. It has been proven time and time again by the Supreme Court.
“U.S. Supreme Court decisions that pointed towards implementation of a Second Bill of Rights included: the right to defense counsel in criminal cases (Gideon v. Wainwright, 1963); the abolishment of poll taxes for voting in 1964 and 1966; the striking down of a California law that required a one year waiting period for new arrivals attempting to obtain welfare benefits (Shapiro v. Thompson); the striking down of an Arizona law requiring a one year’s residence in a county prior to being eligible for receiving free non-emergency medical care (Memorial Hospital v. Maricopa County); and, a finding that welfare recipients could not be removed from welfare roles without a hearing (Goldberg v. Kelly, 1970).”7
In order to fulfill the work of Pres. Roosevelt and ensure a safe and stable social and economic future, we must act in to our own benefit. No one is looking out for the people anymore. We must be our own lobbyists. We must picket injustice. We must boycott greed. We must vote for politicians who have not been already bought to serve special interests. We must use the civil liberties that we have in order to gain the social rights we deserve as human beings.
Works Cited:
1 . "True Cost – Analyzing our economy, government policy, and society through the lens of cost-benefit." True Cost. WordPress, 09 08 2009. Web. 1 Dec 2011. <http://truecostblog.com/2009/08/09/countries-with-universal-healthcare-by-date/>.
3 Longley, Robert. "Is the US Really That Uninsured?." About.com. about.com, n.d. Web. 1 Dec 2011. <http://usgovinfo.about.com/od/medicarehealthinsurance/a/insurancestats.htm>.
4 . "Medicaid: A Program Overview." Almanac of Policy Issues. Almanac of Policy Issues, 00 09 2009. Web. 2 Dec 2011. <http://www.policyalmanac.org/health/archive/hhs_medicaid.shtml>.
5 . "Medicre." Almanac of Policy Issues. Almanac of Policy Issues, 00 09 2009. Web. 2 Dec 2011. <http://www.policyalmanac.org/health/medicare.shtml>.
6 . "The Economic Bill of Rights." ushistory.org. us.history.com, n.d. Web. 5 Dec 2011. <http://www.ushistory.org/documents/economic_bill_of_rights.htm>.
7 . "FDR's Unfinished "Second Bill of Rights" - and why we need it now." DEMOCRATICUNDERGROUND.COM. Democratic Underground, 02 12 2006. Web. 13 Dec 2011. <http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=364x2848856>.
8 . "Harry S. Truman Library and Museum." This Day in Truman History November 19, 1945 President Truman's Proposed Health Program . Harry S. Truman Library and Museum, n.d. Web. 03 Dec 2011. <http://www.trumanlibrary.org/anniversaries/healthprogram.htm>.
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