We’ve Been Trapped Inside a Bad Health Care System So Long, We Don’t Even Know How Much We’re Missing June 26, 2009Posted by rogerhollander in Canada, Health.
Tags: age, bankruptcy, Canada, canada health, canada healthcare, disability, education, health, health care, health care costs, health care plan, health care reform, health costs, health insurance, healthcare, healthcare costs, healthcare reform, insurance, national health, public option, roger hollander, sara robinson, savings, single payer, universal health
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Our current system has robbed us of the chance to save, educate ourselves, see the world and live to a robust old age.
Sometimes, when you’re up to your chin in alligators, it’s hard to focus on the fact that there’s a big, broad, alligator-free world waiting somewhere out there, beyond the edge of the swamp.
In this case, it’s hard for most Americans to even imagine that nobody in the rest of the developed world lives this way. We’ve been living inside the restrictions and making the trade-offs required to hang onto our all-important health care coverage for so long that we don’t even realize that we’re cutting those deals, or what we’re giving up, or how thoroughly those choices have come to dominate and limit our lives.
If you’re an American under 40, you can’t remember a time that the health care system didn’t work this way — or that keeping coverage wasn’t a dominant factor in making your life choices. If you’re older than that, the memory of another, happier era beyond the swamp is dim, and fading fast.
This was one of the things that struck me hardest when I arrived in Canada five years ago. The swamp-blindness was so dark and deep that it took a while to adjust to a world without alligators. It’s almost impossible to describe to folks back home how different life is when health insurance simply doesn’t factor at all into how you choose to live your life. There’s almost no language for it. Rather than even attempt it, I sometimes just ask my American friends and relatives to open up their imaginations, and answer the question for themselves:
- How would your life be different if you never had to worry about getting, keeping, or affording health care again?
- What other choices might you have made?
- Where else would you be right now?
- How would it change your plans for the future?
I’ve seen people reduced to tears of rage and frustration by these questions. When you really stop and think about it — pause for a few minutes to take it all in, past, present, and future — it becomes clear that the full absurdity and the sheer enormity of the sacrifices we have to make for an almighty health care card are the greatest obstacle to life, liberty and the pursuit of happiness that most of us are burdened with today.
Polls say most Americans who have health care are satisfied with it. But nobody ever asks them if they’re satisfied with what they’ve had to do to get it, keep it, or afford it.
What would you do differently? I watch my Canadian neighbors live their lives, and the world beyond the swamp comes into sharp and stunning focus.
My neighbors go to the doctor when they need to — and often, when they don’t. If they’re just feeling funky for a day or two, they go. If the splinter is too big to handle with a needle, they go. Anything goes a little bit sideways — they go.
By American standards, they’re probably overusing the system. (My husband once asked an employee who was nursing a cough, “Have you seen a doctor about that?” The guy just looked at him, confused. Of course he’d seen a doctor. Up here, only an American would ask such a stupid question.)
But the upshot is that the small symptoms of really big things — little lumps, creeping blood pressure, wounds that don’t heal right, coughs that don’t go away — are caught and diagnosed early in a GP’s office, instead of months or years down the road in a full-blown crisis at the ER, which is now the American way. And this is central to cost containment: getting emergent problems calmly headed off right away in a $30 office visit is a lot more cost-effective than having to deal with the full catastrophe later on in a $3,000 emergency-room drama scene. And it allows people to maintain their good health through the years, instead of delaying treatment until it’s too late to recover it and permanent damage is done.
My neighbors heal, recover, and go on with their lives. The U.S. disability rate last year was 19.1 percent, and rising fast. In Canada, it’s 14.3 percent — and Statistics Canada believes that the only reason their stats are creeping up these days is that people who once hid their disabilities are now more willing to admit them.
That disability rate affects the country’s economic competitiveness. Americans just don’t have the time or money to spend on a proper recovery after a major event, or get the full course of treatment that a chronic condition requires to be truly well-managed. Fearing for our income or our jobs, we hurry back to work too soon. Our insurance doesn’t cover necessary follow-up therapies, so things may not heal thoroughly or properly. We can’t afford the drugs, so we cut the pills in half, or stop taking them entirely.
The result is that too many of us end up far more impaired than we need to be — and may, in fact, never be quite right again. Deferred maintenance — which is what this is — takes a ferocious toll on the American workforce, which is now being forced to compete with workers around the world who get better care, make better recoveries, and are able to return to work at full strength.
My neighbors start small businesses. Americans routinely stay chained to jobs they hate because they can’t afford to lose coverage. Canada has an exuberant entrepreneurial culture, fueled by favorable tax structures for small business and a preference for Main Streets over malls. Canadians may bet the house and the kids’ college funds on a new venture; but they never think twice about whether or not they can afford to leave BigCo because they’ll lose their insurance, or what will happen to the new business if they get hit by a delivery truck, or how they’ll afford some kind of minimal coverage for their new employees. Unburdened by health care costs or concerns, their ventures are far more likely to thrive.
My neighbors go back to school. Low-cost government-subsidized universities combined with assured health care make it easy for people to make mid-course career adjustments, pursue their passions, and expand their horizons. The upshot is a better-educated, more capable workforce that’s constantly improving its skills.
My neighbors quit jobs they hate. “Take this job and shove it” is a lot easier — and sweeter — when your boss isn’t holding an almighty health care card over your head. Bosses know this, too, and working conditions are often better as a result.
My neighbors stay home with their kids. They can afford to do that, because they’re not wholly dependent on whichever breadwinner can manage to find a job with a decent health care plan.
My neighbors invest. They’ve got stable household budgets that aren’t being thrown off by surprise health events. Because Canada doesn’t have a mortgage interest deduction, most Canadians reduce interest costs by taking out 10- or 15-year mortgages. The payments really squeeze the family budget for that decade — but by their 40s a lot of them own their homes outright, something most Americans will never achieve. Home ownership, college savings and retirement funds are all big-money investments that you simply can’t commit to if you’re liable to be hit with five-figure medical bills at any moment.
My neighbors travel. Americans don’t get vacation time; and when they do get it, they tend to stay in-country. A lot of Canadians take three weeks off in the winter to go somewhere fabulous and warm (understandable, given the climate). The sheer variety of these escapes boggles me yet: They fly off to build schools in Guatemala, or take holiday jobs in New Zealand, or learn French in Morocco. Even the guy who paints my house can afford to do this, because he’s not spending half his annual income on health care premiums. That $15K-a-year savings will buy a whole lot of margaritas in Cancun.
The result is a population with broad global awareness, and extensive global ties — a necessary thing for a country whose economy depends completely on trade. And it may be an important factor in keeping Canada progressive. According to Diana Kerry, who ran her brother John’s overseas campaign in 2004, Americans who own passports vote Democratic three to one. So travel makes you liberal. Who knew?
My neighbors seldom go bankrupt. The Canadian bankruptcy rate has soared in the past year to 4.3 per thousand. In the U.S., it’s 11.1 per thousand. The entire difference between these two figures is accounted for by the fact that 62 percent of all U.S. bankruptcies were driven at least in part by medical expenses.
But tidy numbers like this elide a harder reality: Bankruptcy doesn’t just cost us financially. It also destroys the foundations of our social capital. When the house, the dreams, and the future are gone, very often the marriage is the next thing that goes, too. Bankruptcy travels in close company with domestic trouble, divorce, drug use, homelessness, and broken families. (After medical-bill refugees, the second most common people in bankruptcy courts are recently divorced women.) If, as conservatives like to remind us, the family is the basic unit of civilization, then our health care system is directly making its profits by pulling down our social foundations — and ultimately undermining our ability to hold our civilization together.
My neighbors have never seen anyone die because they didn’t have health care. With 22,000 Americans dying every year due to a lack of health insurance — that’s one every 24 minutes — there aren’t many of us who don’t know someone who lost a loved one because they couldn’t get the treatment they needed. (For me, it was my father.)
But when I share this factoid with Canadians, they invariably do a long double take. They lean back, squint, stare, and pause to reassess my credibility (if not my sanity). It’s literally unbelievable. They can’t even process it. I must be making it up, or at least exaggerating. It’s just beyond the realm of imagining that a rich nation like America would let that kind of thing happen — let alone let it happen sixty times a day, for years on end.
And yet, they know things are bad down here, because everybody who goes South buys travel insurance before they cross the border. Everybody has heard scary stories about people who got sick or hurt and ended up in an American ER with a five-figure bill to pay. It’s just a stupid risk, and they’re not willing to take it.
What would you have done differently if you’d never had to worry about health insurance? How would life be different now? How would it change your plans for the future?
Go ahead. Think about it. Let yourself get good and angry. The current system has robbed an entire generation of Americans of their full potential. It has made us serfs. It has narrowed our horizons. It has undermined our families and communities. It has deprived us of the chance to save, to own a home, to educate ourselves and our children, to see the world, to retire in comfort, and to live to a healthy and robust old age.
It has left us in this swamp, chin-deep in alligators. And the first step in getting back out is getting very clear in our own minds that there are other places where people don’t live this way — and then angry enough to lean on our leaders, and make it just as clear to them that we don’t intend to live like this any more, either.
Because your future is still out there — and the most important thing you need to get there is a health care plan nobody can ever take away.
Sara Robinson is a Fellow at the Campaign for America’s Future, and a consulting partner with the Cognitive Policy Works in Seattle. One of the few trained social futurists in North America, she has blogged on authoritarian and extremist movements at Orcinus since 2006, and is a founding member of Group News Blog.
Cutting Wages Won’t Solve Detroit Three’s Crisis December 9, 2008Posted by rogerhollander in Economic Crisis, Labor.
Tags: auto workers, automakers, automobile industry, bailout, bankers, bankruptcy, benefits, big three, bonuses, chevrolet, chrysler, concessions, congress, detroit, Economic Crisis, environment, executive salaries, ford, foreclosure, gas, general motors, global warming, healthcare, homeowners, insurance, jane slaughter, japan, jobs, labor, labor costs, labour, mark brenner, medicare, motor city, oil, pension, petroleum, roger hollander, steel, sticker price, suv, taxpayers, toyota, uaw, unemployment, uninsured, unions, wages, Wall Street, workers
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Automakers have blamed workers for the financial collapse of the Detroit auto industry. (Photo: motortrend.com)
Thursday 04 December 2008, www.truthout.org
by: Mark Brenner and Jane Slaughter, The Detroit News
In the 1980s, Chevrolet proclaimed itself the “Heartbeat of America,” but today the American auto industry barely registers a pulse. As Washington considers Detroit’s plea for life support, the only place where pundits, politicians and Big Three executives seem to agree is that auto workers must make do with less or watch their jobs disappear.
Some lawmakers have complained that unions are the source of the problem, but they fail to understand some inconvenient truths. According to the latest figures from the U.S. Commerce Department, every worker in Big Three factories could work for free and only shave 5 percent off the cost of their cars. The auto companies pay as much for hubcaps and fenders as they do in wages.
Data from the Harbour Report – the industry’s gold standard – reveal that even including their benefits, labor costs in the Big Three’s plants account for less than 10 percent of the sticker price.
No matter how you cut the numbers, demolishing auto workers’ living standards will not transform the industry. The Big Three have been trying for years. They have slashed at least 200,000 jobs since 2004, and last year they wrung billions of dollars in concessions from the United Auto Workers. The union instituted a second-tier wage of $14.50 an hour for new hires, lower than pay in the nonunion, foreign-owned auto companies in the South.
The impact is all too apparent in auto communities across the Midwest. Forty thousand Detroit homeowners are in foreclosure, and the unemployment rate has hit double digits in many auto towns. That suffering will multiply if one of the Big Three collapses, or if retired auto workers are punished for decisions they had no hand in.
Automakers’ decisions have been disastrous. While competitors developed gasoline-electric hybrids, Detroit mined the gas-guzzling truck and SUV market, making $104 billion in profits between 1994 and 2003. Wall Street and Congress weren’t calling for more research and development or curbing the company’s dividend payments and high-flying executive salaries back then.
Pundits crow for us to “Dump Detroit,” but they don’t advertise that through a bailout or the bankruptcy courts taxpayers will shoulder the burden of the automakers’ colossal missteps.
Washington shouldn’t back into a bailout – it should jump in feet-first. What’s needed is not a half-measure, a cash infusion in exchange for selling the corporate jets. Now is the time to take a sweeping look at the country’s needs.
Our first steps should confront global warming and oil dependence through a comprehensive overhaul of the transportation system. Federal policy hasn’t changed since the 1950s, when gas was a nickel a gallon.
Detroit, the Arsenal of Democracy, retooled in a matter of weeks when we needed tanks, not cars, in 1941. We could produce this century’s answer to the interstate highway system and build mass transit and high-speed trains.
That same sense of urgency is needed for vehicles that don’t run on petroleum. If American engineers can build satellites that read your license plate from outer space, they can develop an alternative to the gasoline engine.
Automakers need direction as much as financial support from Washington, just as Japan’s government molded Toyota into a world-class performer.
In every other industrialized nation, government has stepped in and given their auto companies a significant edge. Most important, they all adopted national health care and pension systems decades ago.
General Motors alone provides health coverage to a million people – workers, retirees and families. The annual price tag is about $5 billion, which, as CEO Rick Wagoner is fond of pointing out, is more than GM spends on steel.
That burden could be lifted, to the benefit of 47 million uninsured Americans, by adopting a Medicare-style program for everyone. It would save the nation as much as $350 billion per year now spent for insurance companies to shuffle paper and deny claims.
The fate of the Motor City captivates us because it speaks to our future. For 30 years, politicians have bowed to Wall Street, sitting by while wages for most workers stagnated. Big Three workers have maintained their living standards better than most, in no small part because they have a union. In a country where investment bankers gave themselves $30 billion in bonuses last Christmas, have we reached a point where $58,000 a year with benefits is too much to ask?
We once promised the pursuit of happiness to all, including the workers who make our factories run, not just those who trade credit default swaps. Now more than ever, we need to recapture that spirit with a thoroughgoing plan to rescue the environment, care for the sick and transform transportation.
Mark Brenner and Jane Slaughter work for Labor Notes, an independent monthly labor magazine in Detroit. It receives no support from the United Auto Workers.
Unions Aren’t the Problem December 9, 2008Posted by rogerhollander in Economic Crisis, Labor.
Tags: anti-unionism, auto industry, bailout, banks, benefits, capitalists, cars, congress, credit crisis, deregulation, detroit, Economic Crisis, economy, energy, income, insurance, labor, labour, main street, marie cocco, middle class, money, roger hollander, taxpayer, trickle down, unions, wages, Wall Street, workers
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Posted on Dec 9, 2008
By Marie Cocco
As Congress and the White House lurch toward possible approval of a loan package for the crippled auto industry, we are undoubtedly in store for more union-bashing. Note well that we did not hear any such tirades when vastly larger sums of taxpayer money—with fewer strings attached—were lavished upon the banks and financial industry wizards who created the credit crisis.
Put aside for a moment the misinformation and outright untruths that characterize conservative attacks on the autoworkers’ unions. No one should be allowed to cast blame on workers who want nothing more than to maintain a middle-class life.
Unions aren’t the problem. They are the solution.
Creating a viable middle class has been the goal of organized labor since labor first became organized. And it is this goal that was abandoned outright by American political and business leaders as they did all they could over the past three decades to encourage a relentless race to the bottom in wages and benefits.
Strip away the financial mumbo jumbo and the credit crisis comes down to this: For decades, as wages and benefits for working and middle-class people stagnated or fell, the only way for them to purchase the goods that make the economy hum was through credit. This was true whether the item purchased was a home, a car—or all the unnecessary gizmos that retailers have been more than happy to tell consumers were the must-haves of the day. Until we understand that we are in the midst of two crises—one the short-term credit crisis and one the longer-term crisis in the failure to pay workers what they need to sustain themselves—we are doomed to repeat this horror.
“If you are a man with only a high school education … your chances of making a wage or salary as good as what your father was making in the late 1970s are not good,” says Gary Gerstle, a Vanderbilt University historian. “We are looking at a deterioration in their life opportunities and living standards, at the same time that an enormous amount of wealth has accumulated at the top of the income ladder.”
It is true that some individuals were reckless in taking on debt. But it is equally valid that American workers simply haven’t been paid what it takes for them to spend enough to keep the American economy growing. “The economy needed levels of expenditure and consumption that most Americans literally could not afford,” Gerstle says.
What do unions have to do with this? To start with, unionized workers make about $200 more per week than do nonunion workers, according to the Bureau of Labor Statistics. The great expansion of the American middle class and an unprecedented rise in living standards occurred between the end of World War II and the 1970s—when unions were far more common and powerful than they are today. Beginning in the 1980s, an ideology of deregulation and anti-unionism took hold, with free-market capitalists arguing that no intervention in the markets—including labor’s intervention—was ever beneficial.
“The promise of deregulation was that this would create so much energy and dynamism at the top that it would all trickle down,” Gerstle says. “Not only would people on Wall Street make all kinds of money, but people on Main Street would find that there would be more dynamism in their lives, more opportunity, more wages.”
Well, people on Wall Street did make all kinds of money. People on Main Street got depressed wages, the demise of guaranteed pensions and 401(k)s that crashed with the stock market. They got health insurance that is barely affordable, if they’ve got insurance at all.
We are engulfed by an economic morass that holds the prospect of being the deepest and broadest downturn of the post-World War II era. It is no coincidence that the percentage of private-sector workers in unions—about 7 percent—is roughly the same as what it was before the Great Depression. Historically, Gerstle says, social movements have needed direct and often unsettling action to capture the public’s imagination and take hold.
This is why we can only hope that events such as the unfolding peaceful occupation of a Chicago window factory by its newly laid-off workers is the start of something much, much bigger.
Marie Cocco’s e-mail address is mariecocco(at)washpost.com.