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October 7, 1997

Cameos for Universal Health Care

by Townsend Walker

Money, as ever, will be a big factor in the next round of health-care reform: a shortage of it among advocates of universal health care (UHC); an abundance of it among those who want, for whatever reason, to maintain the status quo; the temptation to sell out to monied interests by those who know in their hearts that UHC is the only rational answer to the nation health care debacle but can't say "no" to circles of power and influence. Perhaps the largest, and certainly the most insidious because they dispense their money in the name of good works and selflessness, are the foundations whose devious intentions are masked by the word "philanthropy."

Millions of television viewers witnessed a classic case of philanthropic skullduggery in 1994 when the Robert Wood Johnson Foundation (RWJF), with assets today in excess of $5 billion, paid NBC television $2.5 million, plus $1 million for publicity, to produce a commercial-free program examining health-care reform. The typical viewer probably saw the program as a noble gesture toward helping Americans understand health-care reform in terms of its "complexity" -- and who can quarrel with that? What the typical viewer did not know then, and does not know now, was that the vast fortune of the RWJF derives from the tax- free dollars of the world's largest health and medical products conglomerate -- and that huge chunks of that fortune go to influencing the formulation of public policy affecting the delivery of health care in the U.S. The NBC television program served that purpose very well. It was no accident that "single payer," as we called universal health care then, was pushed to the side and was hardly noticed during the two-hour program. Doubters of my broad generalization here will find confirmation of my thesis, and much else besides, in The Foundation Center's 1997 edition of its National Guide to Funding in Health.

The Robert Wood Johnson Foundation is only one among many bloated "philanthropies" standing by to spend any amount of tax-free money to stop the movement for universal health care in its tracks. No strategy is too devious for their purposes. They will use their Trojan horse to infiltrate and subvert the movement for universal health care at every turn. And they will succeed once again if we fail to devise a strategy that fashions a mighty army out of the U.S.'s working class.

Like health, having health care is no problem till we don't have it -- and need it -- as in the fable where the grasshopper hops his way through a pleasant summer to a cold death in winter. Or as in the old proverb, which admonishes us to consider the ways of the lowly ant and understand the need to act now to avoid disaster later. Consider two people cited in the September 1 issue of U.S. News and World Report as victims of the "managed competition" approach to health care -- two women who discovered that, instead of the charm of health-care protection, they had hanging around their necks the stinking corpse of a rotting albatross.

Or consider the case of Henry O. Forgy, Jr., a retired and respected business, who writes me from Jackson, Tennessee, sympathizing with the views expressed in New Vision/New Voices and lamenting the erosion of Medicare benefits. "...[M]y clinic asked me to sign a 'Medicare Advance Benefits Notice' in connection with a test...done to verify platelet count in an effort to diagnose a pulmonary count which began on Christmas Eve. The provider anticipates no payment from Medicare and as a consequence...none from my medical insurance. The determination of what is 'allowable' is a complete mystery...My supplementary coverage now exceeds $1,200 per year."

Harsher consequences of "managed competition" could be cited, but I cite these three cases here because of their timeliness and because I enjoy a warm friendship with Mr. Forgy dating back to our university days together in the 1940's. May the sad experiences of these three, however mild in relation to others, be a constant reminder of the vigilance and action required of all.

Alert!! Read this if your health insurance protection comes from your employer. "Eroding employer financial support for providing health insurance to employees' families has contributed to the overall decline in private health insurance coverage. Each year between the late 1980s and 1994, increases in employers' costs to provide health insurance to their employees and their families outpaced inflation -- with cost growth of 18 percent one year. As health insurance reached 10 percent of employees' payroll costs, many employers began to reconsider the amount of support they would provide to employees, particularly for family coverage.

Acquiring or maintaining health insurance has become more difficult for some families because of changes that some employers made to their firms' health coverage. Some employers -- particularly smaller employers -- dropped coverages altogether. In 1993, more than 29 million employees -- almost one-fourth of the workforce -- were employed by firms that did not offer group health insurance for employees' families. Most employers continued to offer coverage, but many raised employees' premium contributions significantly -- especially for family coverage. Some employers have used other mechanisms that could discourage employees from two-worker families from purchasing family coverage from them. Children experienced the greatest loss of private coverage. Over six years, the percentage of children younger than 18 years old with private health insurance decreased from more than 73 percent to 66 percent.

For the benefit of readers under Medicare or who expect some day to receive their health care through Medicare, I quote the following from the August 11/18 issue of The Nation:

"The crisis in Medicare is not its purported impending bankruptcy. The real crisis is the Gringrich-Lott-Archer plan to privatize the best government program in American history. One-sixth of Medicare beneficiaries -- generally the healthiest and youngest -- are currently enrolled in heath maintain organizations (HMOs), run mostly by private insurance companies. Several hundred thousand more Medicare patients belong to provider service organizations (PSOs), managed care network typically owned and managed by physicians.

"The most expensive 10 percent of Medicare beneficiaries cost the government an average of $37,000 per person per year. The other 90 percent of beneficiaries cost Medicare about $1,400 per year. The government pays managed care companies about $4,500 for each Medicare beneficiary they enroll. At $4,500 each, managed care companies can shower their members with eyeglasses, prescription drugs and in some cases even health club memberships. And there are piles of money left over -- for huge profits, exorbitant executive salaries and sophisticated lobbying and marketing campaigns...Managed care companies have recently launched extravagantly expensive campaign to urge the healthiest people to reject traditional fee-for-service Medicare and join them. [These] companies spend attract the most affluent, the healthiest and the youngest seniors. Some companies sponsor recruiting dances and locate their offices on the second floor of elevatorless buildings in order to discourage the less able- bodied.

[Then] "a funny thing happens...Obstacles erected to deny and discourage care push them back into traditional fee-for-service Medicare, effectively disenrolling them from the managed care plan..."

The disaster that lies ahead for Medicare patients as they age and their infirmities multiply should be made an inducement for the elderly to throw their collective weight behind the next phase of the movement for universal health care. But that will only happen when the memberships of organizations like the American Association of Retired Persons force a cessation of the practice of profiteering from the sale of health insurance -- and a return to representing the real and long-term interests of the elderly.

Townsend Walker of Huntsville, Alabama has been an activist for universal health care since his retirement twenty-two years ago, and now edits New Vision/New Voices in that connection.

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