California residents are facing a medical
emergency, caused by the greed and anarchy of capitalism in health care.
There is a
dangerous shortage of emergency and critical care beds because of massive
closings of hospitals over the last five years. These
hospital closings, job eliminations, and patient care cuts were deliberately
done to increase profits. The cuts
have produced untold misery for patients
and healthcare workers. They have
also produced obscene profits for health maintenance
is no longer profitable. Capitalist healthcare has produced
its own downfall. Hospital closings, job eliminations, and
patient care cuts are one-time-only savings that cannot be repeated, and
other healthcare costs have continued to rise. At the same time,
the HMOs are in a dog-eat-dog struggle to steal each other's members, so
they have kept their premiums down to undercut each other. The result is
that after six years of record-breaking profits, HMOs have had two years
of huge losses.
immediate solution will be simply to raise premiums, but this is already
causing a crisis. HMOs and employers are refusing to
pay hospitals higher rates, and hospitals are refusing to cover patients
without the higher rates. The health industry's
long-term solutions will be more consolidations, a new round of massive
hospital closings, a whole new form of managed care with more "teeth"
to severely ration patient care, and abandoning the poor and the old.
As international financial crisis spreads
and worsens, and as war over oil and world resources approaches, a
major battle over healthcare is developing between two groups of capitalists.
Some capitalists in private healthcare want
to renew their profits by cutting their own costs more. But the more dominant
capitalists have a more long- term outlook, and are more concerned with
reasserting the US as a world power. These capitalists need overall
health care drastically curtailed "in the national interest," and don't
trust the marketplace to do this.
Hard as this may be to believe, it
is quite possible that the rulers of this country will move healthcare
away from the for-profit HMOs, and turn it over to "non-profit" health
care like Kaiser, which will become centralized and quasi-governmental.
This sounds progressive, but it is not. "Removing profit from health
care" will mean the rulers have decided real healthcare is too expensive
and should be abandoned so they can make greater profits elsewhere or rebuild
their factories and military. "Single-payer" will mean the rulers
have decided to use the government to enforce healthcare rationing.
Like so many of the "reforms"
offered by capitalism in crisis, this restructuring
of health care will actually be fascism with a liberal cover.
Any attempt to make meaningful improvements in healthcare directly challenges
the needs late-20th century capitalism. Capitalist healthcare
cannot be "fixed" without challenging capitalism itself and finally smashing
LABOR PARTY envisions a communist future where workers control society.
We would work to supply each other's
needs, not to make profits for an elite. Health care
will exist to improve the quality of our lives rather than making money.
This would make our work and our lives much richer and more integrated.
There would be no reason for the horrors of racism, sexism, poverty, or
managed care. Our fights against our downward spiraling wages, working
conditions and standard of living can develop into a movement to unite,
to act, and take power as a class. That is the purpose of PLP.
Read our newspaper CHALLENGE/DESAFIO
about the day-to-day struggles to make this dream a reality.
a dangerous shortage of emergency and
critical care beds ...
In January, 1998, it became
obvious that there is a healthcare emergency in California. The shortage
of beds in Emergency Rooms and Critical Care units threatens everyone,
whether they have medical coverage or not.
to top of document.
In the second week of January,
there were times when no critical care beds were available from San Francisco
through San Jose. The shortage of pediatric critical care beds was so severe
that one Oakland hospital prepared backup plans to transport pediatric
patients to Los Angeles. (personal communications)
At San Francisco General Hospital
(SFGH), the Nursery was closed to new patients for the first time in years.
Non-emergency surgery was canceled because no beds were available for recovering
patients. (Personal communication) Severely ill patients could spend 12-24
hrs in the Emergency Department, waiting for critical care beds. Emergency
Room (ER) workers were having to care for both gunshot or heart attack
victims and critical care patients waiting for beds. In the first two weeks
of December '97, SFGH diverted critical ambulance patients to other hospitals
56% of the time. (SF Examiner, 12-17-97)
For half of the month of January
'98, city officials in San Francisco told Emergency Rooms that, no matter
how busy they were, they could not divert new patients to other ERs, because
all the other ERs in the city were just as busy. (SF Examiner, 1-27-98)
In the last year, diversions were suspended in four of the last 12 months,
more than in the last 10 years. (SF Examiner, 12-16-97)
Kaiser Richmond's stand-by emergency
department had thirteen-hour delays in transferring critically ill patients;
a patient died there waiting for a critical care bed. At Kaiser Walnut
Creek's ER, a child with extreme fatigue and shortness of breath waited
more than 5 hrs to be seen. "I saw people lying on the floor in the emergency
room; it was disgusting," the child’s mother said. (SF Examiner, 1-27-98)
Kaiser was giving its ER patients fliers saying they would wait an average
of six hours. (California Nursing Association,CNA, press
For the first two weeks in January,
Washington Hospital in Fremont pitched a tent outside the ER for families
of patients waiting for treatment. (SF Examiner, 1-27-98)
Los Angeles County already is
facing a serious undersupply of ER capacity, which will worsen by 2005.
According to a May 1997 report by the National Health Foundation. In the
mid-1980s there were 102 acute-care hospitals with basic ERs. Now there
are 81 basic emergency rooms, and not all of those provide the full range
of services for ambulances responding to 911 calls. (Modern
The San Francisco Emergency
Services administrator said hospital and ER patients are 25-50 percent
above projections. (SF Examiner, 1-27-98) Kaiser is seeing 10 percent
more ER patients than this time last year. Davies Medical Center is seeing
25 percent more. (SF Examiner,12-16-97) This
increase in ER visits is a reflection of fewer people having medical coverage.
Emergency Room patients are
much sicker than before. Thousands of people have lost medical coverage.
30% of San Francisco residents who were eligible for Medi-Cal managed care
a year ago are no longer on the rolls, either because of intimidation of
legal immigrants or because of losing welfare. (SF Chronicle, 11-18-97)
Those who have lost Medi-Cal now have no coverage at all. They must use
county hospital ERs when they get so sick they can no longer postpone care.
By then, they are seriously ill, and often come into emergency rooms needing
This crisis is the result
of a policy of increasing profits by closing beds, units, and entire
hospitals, and by laying off thousands of hospital workers.
cuts deliberately done to increase profits ...
to top of document.
In Contra Costa County, Kaiser
refused to open an ICU in their newly built hospital in Richmond.
In February 1997, woman with chest pains drove there, was transferred
to Kaiser Oakland, which had no free beds because it was being closed,
and died in transit to a third hospital. (Modern Healthcare, 7-20-98)
Kaiser also closed its emergency room (ER) and critical care beds in Martinez
in late January 1998, and plans to close its standby ER in Richmond in
April 1998. (CNA, 1-8-98) All Contra Costa Kaiser patients
will be diverted to Kaiser Walnut Creek, whose ER can already barely handle
its patients. An 84- year-old man died there on December 30. He had come
to the hospital with shortness of breath and was not seen until almost
4 hours later, when he stopped breathing completely. (SF Chronicle, 1-10-98)
In late May 1997, 12% of Walnut Creek ER patients left without being seen.
Kaiser Pamphlet) Walnut Creek Kaiser’s 24-bed critical care unit is
already operating at capacity. (SF Chronicle, 1-10-98) At Kaiser Martinez
a man waited in the emergency room for eight hours, untreated, after suffering
a stroke because the hospital’s CT scan was broken. Emergency room waits
were so long that at one point, 19% of registered patients left without
being seen. (CNA Kaiser Pamphlet) Contra Costa County lost
282 beds between 1994 and 1996, while the population grew. (SF Examiner,
1-27-98) Contra Costa County, in particular, has some of the
lowest per-capita rates of health resources of any state. The U.S.
average is 3.0 acute-care beds per thousand residents, Contra Costa's is
1.7, the third lowest in the US. Where the U.S. has 3.4 hospital-based
registered nurses per thousand, Contra Costa has 2.1. Where the U.S. has
13.7 hospital employees per thousand, Contra Costa has 8.1. (Modern
In Alameda County, Kaiser plans
to close its 167,000 member Oakland Hospital this year; it saw 61,000 ER
patients per year. (SF Chronicle, 1-10-98) Kaiser is also investigating
transferring hospitalized patients at Kaiser's Redwood City and Santa Clara
hospitals to a rented floor at Stanford University Medical Center. It is
investigating similar arrangements for Kaiser Hayward and Kaiser Fremont.
(SF Chronicle, 12-15-95, 1-25-96, 2-12-96) Planned closings of Oakland,
Richmond, and Sacramento Kaisers, plus the Martinez closing, means 9,880
licensed beds closed. (CNA
webpage, "Empty by Design")
Kaiser Permanente eliminated
1,600 RN positions (14% of the total) in Northern California over the past
three years and is pushing to eliminate one in eight physicians. (California
Nurses Association, "Medical
Strip-mining and the New Nursing Shortage") Between 1991 and 1994,
Kaiser reduced its overall hospitalization rate by 25%. Kaiser Hawaii reduced
its average length of hospitalization by a full day within a single year.
(SF Chronicle, 2-15-96) Kaiser's 1994-1997 Southern California business
plan called for a 30% decrease in days of hospitalization per member. (The
Link, CNA Kaiser Interfacility Newsletter, 9-95)
In San Francisco, Kaiser and
French merged, and then French closed. Garden-Sullivan, Pacific Presbyterian
and SF Children's were merged into CPMC, which closed Garden-Sullivan and
three ERs. (SF Examiner, 12-16-97) Letterman also closed. UCSF and Mount
Zion merged closing the Mt Zion nursery. UCSF and Stanford have merged,
probably leading to closings in pediatrics, OB, and radiology. In addition,
UCSF and CPMC merged their OB-GYN, pediatrics and radiology services.
California hospital closings
reflect a pattern of racism and anti-working class bias that the California
Nurses Association aptly calls "Medical Redlining," which it defines as
"abandoning communities where ill people are concentrated in favor of
communities where healthy
people predominate, with a goal of increasing overall profits and revenues."
(see the CNA Kaiser
Pamphlet for really excellent documentation)
In the San Francisco Bay
Area, Kaiser's new Richmond hospital, where the ICU was never opened and
where the ER was recently closed, is located in a predominantly black industrial
city, with four times the poverty rate of Walnut Creek, where Kaiser is
keeping its hospital open. The now-closed Martinez facility,
where the stroke victim waited eight hours because of a broken CAT machine,
is in a working-class part of Contra Costa County with 1.5 times the poverty
rate of Walnut Creek. The flagship hospital in Oakland targeted for
closing is in the middle of a majority black city with low average family
incomes and four times the poverty rate of Walnut Creek.
In Los Angeles County, the
May 1997 report on emergency room access by the National Health Foundation
divided the county into 10 hospital regions. It found a shortage of emergency
capacity in seven regions largely working-class and minority. It found
a surplus in middle-class San Fernando, and Glendale areas and the wealthy
West Side. (Modern Healthcare, 7-20-98)
According to SF Emergency Medical
Services Quality Control officer Mark Forrett, " We have discovered that
staffing for critical care beds is the major determinant factor when hospitals
go on critical care diversion." (internet news group letter) SFGH is short
13 critical care RNs and the three Catholic Hospital West hospitals in
San Francisco are short 32 ER and critical care RNs by their own admission.
(SF Examiner, 12-16-97)
New York City Hospitals closed
1,000 beds and got rid of 5,000 workers in 1995. (NY Times, 10-26-95) At
least a dozen New York City hospitals closed during the 1970's.
At Los Angeles in May 1966,
after the federal "bailout" of the county healthcare system, 6 county
clinics had already been privatized, 20 county clinics were being privatized,
2,400 health workers were already laid off, 3,500 positions were being
cut, and officials were in the process of closing 1700 County beds, a one-third
reduction. (LA Times, Modern Healthcare, 10-2-95)
In November 1997, the LA
County Supervisors voted to decrease County-USC Medical Center from
960 beds to 600 beds. County-USC Medical Center is the biggest public
hospital in the US, in the midst of the biggest unsured population in the
US, 2.8 million and expected to grow by 25,000 per year. Nearly
a third of the population under age 65 is uninsured. (LA Times, 10-30-97)
The former head of the LA County medical Association said "They are going
to be dying in the hallways, dying waiting to get into the operating room."
(LA Times, 11-13-97) A family practice doctor predicted that private
hospitals in the vicinity of County-USC would close their own ERs, rather
than risk begin "stuck" with indigent patients who could not be transferred
out because County-USC had no room to accept them. (LA Times, 11-12-97)
Nationally, hospitals are still
operating at 60 percent of capacity, but many of the unused beds are "mothballed,"
adding little to costs, so most hospitals have been able to generate profits
or, in the case of nonprofit hospitals, surpluses. (NY Times, 1-5-98) Kaiser
Permanente has about 2,000 licensed but unstaffed beds in California. (CNA
webpage, "Empty by Design"
untold misery for patients
and healthcare workers ...
The effects of these hospital
closings, job eliminations, and patient care cuts have been catastrophic.
They have produced untold misery for patients and healthcare workers.
to top of document.
The US has the worst infant
mortality, highest percentage of low-birthweight babies, shortest male
life-span, second-shortest female life-span, and second-lowest visits to
doctors per person of all industrialized countries.
41 million of us across the
country have no health coverage (17%), including 6.5 million of us in California.
(SEIU Unity, Feb./March 95) Over 100,000 people die yearly in the US from
lack of health insurance, 11 per hour. (Vincent Navarro, 1993, quoted in
Don DeMoro, Restructuring Health Care, SEIU 250 publication, J-3) An additional
29 million people with private insurance are underinsured, "risking out-of-pocket
expenses in excess of 10 percent of family income in the event of a catastrophic
illness." (SF Examiner, 10-25-95) Medicaid covers only about 47 percent
of the poverty population. (Nation, 1-9-95)
Most people without medical
insurance have jobs. Nationally, 40% of jobs have no health benefits, including
one of three healthcare workers. The General Accounting Office says of
the 9.3 million children lacking health insurance during 1993, 89% had
at least one parent working full-time. (Don DeMoro, Restructuring Health
Care, SEIU 250 publication, p. I-3) 80% of the 2.6 million medically
uninsured in Los Angeles either have jobs or are dependents of someone
with a job. (L A Times, 10-30-95)
Institutional racism has made
these cuts particularly devastating to minorities. New York City's black
and Latino communities have five times the national average number of TB
cases, and comprise 80 % of cases in the state. (Nation 2-28-94) Survival
rates among blacks for several common cancer are half those of whites,
also from lack of early detection. The leading causes of death among black
women 15 to 50 years old are breast and cervical cancer, mainly for want
of early detection. Only 22 percent of women diagnosed with breast cancer
at Harlem Hospital live five years, compared with 76 percent of white women
and 64 percent of black women nationwide. Between 1989 and 1993, black
women in their fifties had only one ninth the drop in breast cancer death
rates as their white counterparts. (SF Chronicle 5-8-96) A recent DPH study
in San Francisco showed that in Bayview-Hunters Point, the rates of cervical
cancer and breast cancer for women under 50 are twice that of San Francisco
as a whole, due to lack of gynecological care and pap smears. (SF Examiner
8-18-95, SF Chronicle 9-22-95) Black infant mortality is twice as high
as white infant mortality, largely due to premature birth and low birth
weight, which are largely preventable by pre-natal care. Low-birth weight
infants are known to have forty times the risk of dying in the first month
of life. (NY Times, 1995) Blacks have proportionately fewer heart bypasses
even though heart disease is the main killer of black Americans.
Figures of Latinos are similar.
Over one-third of Mexican-Americans under age 65 lack health insurance.
Latinos represent half of California's approximately 6.4 million uninsured.
Stillbirths among California Latinos increased by 45 percent between 1987
and 1989 while infant mortality rate improved in the state as a whole.
The average waiting period to obtain a prenatal appointment in a Los Angeles
County clinic is more than 16 weeks, past the critical first trimester
. The average life expectancy of Latino farm workers in the U.S. is 49
years, compared with a national average of 75 years for non-Latinos.
Beyond race, the disparity of
health between rich and poor is appalling: A recent report from the National
Center for Health Statistics shows people with less money and less education
die younger and suffer more from virtually every health problem.
For people of the same race and gender, lack of money or education was
associated with: a seven-year gap in life expectancy, 2.4-fold more
babies dying in their first year, a 5-fold increase in teen-age pregnancy,
a 6-fold increase in toxic blood-levels of lead, and a greater probability
of dying from heart disease (2.5X), lung cancer (2.4X), diabetes
(3.0X), and suicide (3.7X). (LA Times, 7-29-98 and 7-30-98)
These statistics are a mirror of a society where the current disparity
of wealth is greater than ever recorded starting in the early 1930s,
and the richest 1% has more wealth than the poorest 90% combined.
profits for health maintenance organizations ...
The cuts have also produced
obscene profits for health maintenance organizations.
to top of document
From 1989-1995, healthcare was
the most profitable industry in the US. (NY Newsday 4-17 95)
The profits of the 7 largest
providers jumped 700% in one year. (California Nurse, 5-96)
In 1994, the top 21 HMOs, hospital
chains, and long-term care providers made over $3 billion profits (LA Times,
5-4-95) and California's six biggest HMOs made $1.13 billion. (SF Examiner,
3-10-96) Northern California Kaiser alone made over $813 million. (SF Chronicle,
Kaiser’s 1993 profits were so
high that dozens of pages of memos were exchanged between high-level administrators
discussing how to explain these profits to its workers whose jobs were
being cut, and to its patients whose hospitals were being closed. One sample:
"As much as possible, present 1993 financial results in context so that
they don’t conflict with current budget/layoff imperatives." (California
The CEOs of the 7 largest HMOs
earned an average of $7 million in 1994. (California Nurse, 6-95) The stock
holdings of CEOs of the top ten are worth $2.4 billion. (Ralph Nader, speech
to SF conference on managed care, 8-95) Columbia/HCA’s CEO owns $249 million
in stock. The CEO of PacifiCare, SFGH’s one-time HMO partner, owns $35
million in stock in addition to $1.2 million salary. (California Nurse,
3-96) The value of stock owned by just the top 25 health care executives
by itself could provide medical insurance to 14% of the nation’s uninsured.
(California Nurse, 3-96) With the merger of US Healthcare and Aetna, among
the largest HMOs and insurance companies, US Healthcare’s CEO Leonard Abramson
received a cash and stock bonus of $929 million, more than enough to fund
LA County’s 1996 healthcare budget deficit (California Nurse, August 1996)
healthcare is no longer profitable..
Those glory days of gigantic profits
are gone with the wind. Having gutted health care, the financial
geniuses of the "health industry" are looking around in disbelief, wondering
where their profits went. "I don't think anyone knows where we are going,"
said Marilyn Moon, a health economist at the Urban Institute in Washington.
"This is a wacky period in health care." (NY Times, 1-5-98)
With all respect to Ms Moon, it's not
"the period" that's wacky. It's the greed and anarchy of capitalism that's
wacky. The savings from hospital closings, job eliminations, and patient
care cuts, are one-time-only savings that cannot be repeated, meanwhile
healthcare costs continue to rise, particularly pharmaceuticals. At the
same time, HMOs have been in a dog-eat-dog struggle to capture each other's
members, and have had to keep their premiums down to undercut each other.
The result is that after six years of record-breaking profits, HMOs have
lost large amounts of money for the last two years.
The tendency to self-destruct is built
into capitalism; there is no way it can escape. On one hand, capitalists
must expand their business and get more customers, because if they do not,
their competitors will force them out the market: it's grow or die. On
the other hand, in order to grow, capitalists, must sink more and more
money into buildings and machinery, and interest on the necessary loans,
so their profits-per-dollar-invested decrease. Inevitably, the system crashes.
Because workers are enmeshed in capitalism's machinery, our lives become
part of the wreckage. What's happened to healthcare is an illustration
to top of document.
Kaiser Foundation Health Plan,
the biggest HMO in the country, lost $270 million in 1997, its first loss
in its 50 years. Only last year its profits were $265 million. Its first
quarter 1998 losses were $92 million. (SF Chronicle, 5-2-98) Kaiser traces
its problems to its own success in attracting new members in California.
Kaiser was then unprepared to handle additional members and had to pay
to have them treated elsewhere. Standard & Poor's credit-rating
service placed Kaiser's debt on "credit watch with negative implications."
(LA Times 2-14-98) Kaiser had a 20% growth in membership last year. It
has 8.9 million members nationally, including 1/3 of Northern California
residents with coverage. It has $12 billion in assets. (SF Chronicle, 2-14-98)
"HMO (patient) ranks continue
to grow, while profits continue to sink. ... Profits at the nation's HMOs
fell 60 percent last year, from $1.8 billion in 1995 to $700 million in
1996," according to a recent report by Weiss Ratings Inc. in Palm Beach
Gardens. The rating agency looked at 344 managed care companies nationwide,
which insure nine out of 10 HMO members. "This was the second year of declining
profits after six years of steady profit growth," said Martin Weiss, the
agency's chairman. "The reason is health care expenses went up, but HMOs
were unable to raise premiums accordingly, due to increasing competition
in the managed care industry." As a result, Weiss believes that HMOs now
are under pressure to either raise rates, cut services or do both. (South
Florida Business Journal, 9-1-97)
"Many other health care organizations
and major insurance companies like Aetna, the Cigna Corporation and the
Prudential Insurance Company of America are suffering losses this year
or acute erosions of their profits." (NY Times, 10-19-97)
"Despite a 3.2 percent increase
in enrollment during the second quarter, overall profits for Florida's
health maintenance organizations plummeted by 72 percent, with more than
half of the health plans losing money." (Orlando Business Journal, 9-23-96)
"Combined first-quarter net
income for the 10 health plans with the largest local enrollment was down
21 percent from the first quarter last year. PacifiCare Health Systems
saw its stock tumble in June after preliminary reports that second-quarter
earnings will come in far below initial projections." (Sacramento Business
Journal, 7-21-97) PacifiCare's fourth quarter 1997 profits dropped 53%
from a year before. PacifiCare blamed losses in the Utah operations of
FHP International, which PacifiCare acquired last year. PacifiCare said
it would close the Utah operations down if it could not sell it. (LA Times,
"Shares of Oxford, the biggest
health maintenance organization in the New York area, fell 62.4 percent
in Nasdaq trading. Oxford's announcement was only the latest in a string
of disastrous financial reports in the managed health care industry, as
Aetna, Cigna and other companies said that higher costs would reduce their
profits, too." (NY Times, 10-28-97)
"Six of the seven largest HMOs
in Georgia saw their profits plunge in the first half of 1996. The six
companies' net incomes dropped anywhere from 28% to 95%. Three of the seven
-- Cigna, United and U.S. Healthcare of Georgia Inc., registered losses
in the second quarter, according to the filings." (Atlanta Business Chronicle,
Some critics of managed care
say the savings from restrictions like limiting access to specialists and
tests can be realized only once. "We may have squeezed what we can out
of the health care system," said Assemblyman Alexander B. Grannis, a Manhattan
Democrat who is chairman of the Insurance Committee. (NY Times, 1-11-98)
"Many analysts in New York state
say the primary reason (for HMO losses) is that managed care companies
had kept prices artificially low for years to encourage reluctant New Yorkers
to sign up and are only now coming to terms with the actual cost of care."
(NY Times, 1-11-98)
"The competitive landscape has
shifted. There are a lot of HMOs competing for a finite amount of business.
The upshot has been that HMOs have not been able to raise premiums like
they used to." (CNN financial services 1-17-97)
HMOs are complaining that Kaiser
deliberately undercut rivals' prices to grab market share, then found itself
unable to make money on the new business. California Nurses Association
Executive Director Rose Ann DeMoro claimed that Kaiser has diverted funds
from patient care to pay for advertising and marketing, management consultants
and mergers and acquisitions "for the sole purpose of dominating the HMO
market." (LA Times, 2-14-98)
Stuart H. Altman, a Brandeis
University professor who is chairman of a council studying changes in the
health system for the Robert Wood Johnson Foundation said it all: "In the
early days, the HMOs extracted fairly substantial profits. Those days are
over." (NY Times, 1-5-98)
The immediate solution
will be simply to raise premiums 5-15%, but this is already causing a crisis.
Health insurance buyers and employers are refusing to pay higher rates,
and hospitals are refusing to cover patients unless the rates are raised.
HMOs' immediate solution will be simply to raise premiums. ...
to top of document.
Increases in health premiums
are endangering employee's medical coverage. A law firm with 20 employees
in Kenilworth, NJ, was recently notified by Aetna U.S. Healthcare that
monthly premiums would rise 19 percent for single employees and 28 percent
for families with children. Benefits experts expect big employers to see
rate increases of 9 percent to 14 percent in most parts of the country.
(NY Times, 4-24-98) Kaiser won 12-14% rate increases from the Health Insurance
Plan of California, which purchases health insurance for about 8,000 California
companies with fewer than 50 workers. (LA Times, 4-25-98) Kaiser, has demanded
a 12% 1998 rate hike from CalPERS, the nation's second largest purchaser
of employee health benefits, which purchases health benefits for more than
1 million state and local public employees. (CalPERS press statement: April
14, 1998) CalPERS members on Kaiser's Medicare plan would have a 27% increase.
(LA Times, 4-15-98) Sources familiar with the negotiations say Kaiser may
try to phase in rate increases of up to 30 percent over the next three
years. (SF Business Times 3-27-98) CalPERS has warned Kaiser that it may
freeze further enrollment unless it cuts its rate request by half. Kaiser
has warned CalPERS that it may withdraw from the state health plan entirely
if it doesn't get what it wants. (LA Times, 4-15-98) 340,000 CalPERS members
belong to Kaiser.
Sutter Health, with 26 hospitals
in Northern California, planned to cancel its $60 million contract with
California Blue Cross, which refused the rate increases Sutter demanded.
180,000 Blue Cross enrollees would have been without non-emergency
care. Blue Cross covers 4.4 million in California, and its CaliforniaCare
has contracts to cover Medi-Cal recipients in several counties. (SF Chronicle,
5-16-98, Modern Healthcare, 5-18-98) After a three week standoff,
Blue Cross relented, agreeing to Sutter's increases. (SF Examiner, 6-6-98)
In the wake of Blue Cross's
capitulation to Sutter, Catholic Healthcare West, with 30 hospitals in
California, has cancelled its contract with Blue Cross as of July 7 1998,
over clashes on reimbursement rates. No new non-emergency
care will be available for Blue Cross members. (SF Bay Guardian,
the HMOs' long-term solution will be more consolidations and ...
The long-term solutions
will have to be more consolidations, a new round of massive hospital closings,
and a whole new form of managed care with more "teeth" to drastically restrict
patient care. This will include abandoning Medicaid and Medicare
coverage for expensive or unprofitable paitents such as the poor and the
elderly. The devastation of health care over the last five years
is not enough!
to top of document.
There will be even more hospital
consolidations as bigger HMOs with more cash reserves can hold out and
undercut smaller HMOs and then raise rates higher than the smaller HMOs
did. "The fierce competition for customers has driven out some contenders,
leaving those remaining freer to seek higher rates. For very small programs
with disproportionately high numbers of chronically sick members, increases
of over 30 percent are expected." (NY Times, 10-19-97) Robert Hoehn of
Salomon Brothers said half of the HMOs in the country aren't viable. While
many will be acquired, others will disappear. In Dallas, for example,
recent mergers, plus one in the works, will eliminate four of the nine
biggest health plans, which cover 80 percent of the patients. After
a merger in western Pennsylvania, Highmark Blue Cross and Blue Shield provides
coverage for more than 60 percent of the population of Pittsburgh and 29
surrounding counties. (NY Times, 6-29-98)
There will be a faster pace
of hospital or bed closings as HMOs that develop monopolies in their areas
will now be free to close "excess capacity." "It's clear we have overcapacity,"
said Thomas H. Crenshaw, senior vice president for strategic planning for
Health Midwest, the largest hospital chain in the area. "This continued
building is counterintuitive from a community-need perspective." (NY Times,
"In general we have probably
twice as many physicians as we need," said Kathryn A. Paul, president of
the Rocky Mountain Division of Kaiser Permanente, which oversees the big
health maintenance group's Kansas City services. The surplus, Ms. Paul
said, generates excess demand, with underemployed doctors hustling for
patients. (NY Times, 11-22-97) People are dying in Kaiser's Emergency Rooms,
and 100,000 people a year die from lack of health insurance, and yet health
care capitalists say there are twice as many doctors as we need!
There will be a tougher form
of managed care than in the past, one which will directly restrict patient
care as opposed to the "failed" managed care which was a mixture of restricting
patient care and holding down premiums.
Standard and Poor's Financial
service said of Kaiser: "More conservative financial practices, strategic
and operational restructuring initiatives, and higher premiums are expected
to yield improved earnings by 2000. Lasting prosperity, however will
depend on the unified efforts of management and their independent Permanente
Medical Group partners (the doctors) to align the system's capacity with
demand and effectively manage costs." (S&P Creditwire, 6-24-97)
As HMOs are realizing they cannot
make profits off elderly, sick, or poor patients, they are dropping their
Medicaid and Medicare plans. "Market woes are so severe that
experts wonder if any MediCare HMO can prosper indefinitely" (NY Times,
9-9-98) The July 6th
New York Times says: "Citing losses and cuts in government payments,
the nation's biggest health maintenance organizations are quitting managed
care programs for the poor and elderly ... advocates for patients say they
fear the retreat will bean a return to crowded Medicaid mill clinics delivering
inferior care." Managed care organizations like Aetna U.S. Healthcare,
Pacificare, Oxford Health Plans, Kaiser Permanente and Blue Cross and Blue
Shield Associations have shut down some of their Medicaid (Medi-Cal) services
in at least 12 states, including New York, New Jersey, Florida, Massachusetts
and Connecticut. (Also see NY Times, 9-9-98) The withdrawals
have spread to Medicare managed programs for the elderly, primarily in
rural communities with few patients and where clinics and doctors
are scarce. In May, Anthem Blue Cross and Blue Shield said it was pulling
out of Medicare plans in 19 Ohio counties. Last month, Health Net, a large
California HMO, said it would end its Medicare service in 10 counties.
Part of this is due to government
cutbacks to Medicaid and Medi-Care. The 1997 Balanced Budget Act
reduces federal Medi-Care spending by $115 billion over the next five years.
(NY Times, 9-9-98) "The economics of serving people on Medicare make
it virtually impossible to make money," said Karen Korn, a health care
services analyst at Putnam Investments in Boston. "The government has approved
rate increases for Medicare managed programs of about 2 percent while medical
costs are rising at 4 percent or higher. "There's no way that translates
into OK margins," Ms. Korn said. (NY Times, 7-6-8)
Meanwhile, Washington is still pushing to force even more Medicaid and
Medi-Care recipients into managed care plans. (NY Times, 9-9-98)
Most of the withdrawals from
Medicaid care have come in the most populous states with large pockets
of urban poverty. The Massachusetts Blue Cross and Blue Shield Association
and the Tufts Health Plan dropped out dropped out of the Massachusetts
Medicaid program. (NY Times, 7-6-8) Oxford Health Plans has
canceled its contract to cover 33,000 Medicaid managed care recipients
in Connecticut, raising questions about its commitment to cover 42,220
more in New York City. In early February 1998, U S Healthcare withdrew
from the New York City Medicaid managed care program, where it was to cover
24,000 recipients. In August 1998, U S Healthcare announced that it was
absorbing a $900 million charge to be able to back out of Medicare
plans in 35 counties, an announcement that made Wall Street wonder whether
any profits could be made off Medicare patients. (NY
Times, 8-7-98) Over the past year, eight organizations, including
Aetna U.S. Healthcare and Prudential, have dropped Medicaid programs
in New York state. Both states have cut back their Medicaid reimbursement
to participating HMOs. (NY Times, 2-26-98) In March,
Kaiser Permanente, the biggest HMO, quit Medicaid care in Charlotte,
N.C., and last year Humana did so in St. Louis. Pacificare, the nation's
third largest HMO and which was supposed to have been SFGH's partner in
Medi-Cal managed care, has decided to drop all Medicaid services,
closing programs in California, Oregon and Utah. In California, Blue Cross,
the designated private HMO for half of the Medi-Cal managed care population
in San Francisco and Contra Costa counties, does not want the business
any more, since California's Medi-Cal rolls have been greatly reduced.
(SF Chronicle, 11-18-97)
In a similar way, economic
pressures force HMOs out of Medi-Care markets where old and sick
people are concentrated. On the average, managed care
companies get $5,700 per year per Medi-Care patient. 90% of these
patients are healthy and cost about $1,200 per year. 10% are not
healthy and cost about $37,000 per year. This should make it easy
to make profits, but the problem is that healthy patients live in non-urban
areas where there are fewer hospitals, and therefore less incentive for
hospitals to cut rates they charge to the managed care companies.
(NY Times, 9-9-98) The only HMOs that have made money from Medi-Care
are PacifiCare and Humana, which pay doctors a fixed amount of money per
month per patient (physician payment on a capitation basis), thus
passing the financial risk onto the individual provider. (NY Times,
9-9-98, LA Times, 8-12-98) Despite this, even Humana is dropping
some it its Medi-Care markets. (LA Times, 9-16-98)
Instead, public and county
hospitals are taking over Medicaid and Medi-Care patients. This is
a recipe for disaster. On one hand, federal and state reimbursement
for these patients is dropping, up to 20% since the mid-90s. On the
other hand, public and county hospitals are already drained by serving
indigent patients, and have no rich patients to shift Medi-Cal/Medicare
patients’ costs onto. As the Times says, "Advocates for patients
say they fear the retreat will mean a return to crowded 'Medicaid mill'
clinics delivering inferior care." (NY Times, 7-6-98)
major battle over healthcare is developing between two groups of capitalists.
In respnse to this crisis
in healthcare, an intense struggle between two different modes of
managed care has developed.
In one corner are the free-market,
for-profit HMOs, typified by the giant hospital chain Columbia/HCA.
In the other corner are
the giant "non-profit" HMOs with their own chains of hospitals and doctors,
typified by Kaiser-Permanente.
One sign of the struggle between
the giant for-profit HMOs and the giant non-profit HMOs is their
positions on federal regulation of HMOs. Let's
be clear on this: neither the Democrat or the Republican plans
challenge the basic premise
that the rich and powerful have the right to
restrict our medical care.
All of these plans are
restricted to workers with health benefits
from their jobs, an estimated 168 million. But 40% of jobs has no
health coverage; these workers are excluded. Medicare and Medicaid
(Medi-Cal) recipeints are excluded. Indigent people with no coverage
at all are excluded. The Senate Republican plan is further limited to workers
in companies that self-insure their employees, an extimated 48 million.
(SF Examiner, 7-20-98)
In fact, as we saw above, both
for-profit and non-profit HMOs
are abandoning care of Medicare and Medicaid patients.
As Bill Clinton says, "Our job
... is not to abolish managed care.
Our job is to restore managed care to its proper role
in American life, which is to give us the most efficient and cost-effective
systems possible," (LA Times, 7-16-98)
Nevertheless, the non-profit
HMOs and for-profit HMOs still have radically different outlooks about
The non-profit HMOs are
for government HMO regulation: Approximately 18 Kaiser HMOs and HMOs
and Kaiser affiliates (9 million covered) and an equal number of other
HMOs that are also non-profit and have their own hospitals and staffs of
doctors have formed THE HMO GROUP to lobby and promote their interests.
This group is pushing to have
HMOs governed by all of the federal regulations proposed by the Clinton
and the Democrats, with the important exception of allowing HMOs to be
sued. (See below.) (NY Times, 7-14-98) In
fact, as we will see, the non-profits helped draft the regulations.
What are these plans for HMO
The for-profit HMOs are
vehemently against government regulation: Eight of the largest for-profit
HMOs, many offshoots of insurance companies, have united with business
lobbiests like the US Chamber of Commerce, the National Federation of independent
Business, and the National Association of Manufacturers to form the Health
Benefits Coalition. The HMOs are Blue Cross/Blue
Shield Assn (18 million), United Healthcare/Humana (10 million), Cigna
(6million), Aetna-USHealthcare (5 million), New York Life/NYLHealthCARE,
Premier, and Prudential HealthCare. Other members are The American
Association of Health Plans (1000 managed care companies, 140 million covered)
and Health Insurance Association (commercial health insurers).
(HBC webpage) (Coverage figures from Modern Healthcare, 6-1-98) The
Health Benefits Coalition is pushing to have no federal regualtion of HMOs
at all. (NY Times, 7-14-98, SF Examinier, 7-13-98)
As of mid-July 1998, there
are three major legislative HMO reform plans: a Democrat Senate/House proposal
(Kennedy,Mass/Dingell, Mich), a Republican House proposal, (Gingrich, GA),
and Republican Senate proposal. These are the highlights:
Part of this struggle between
the for-profits and the non-profits is a simple dogfight between two competing
groups of capitalists. But this is not simply a struggle over immediate
profits. These two competing groups of capitalists have completely different
sources of money and power, and completely different national agendas and
needs. Increasingly, they cannot co-exist.
Health plan liability in
case of death or injury:
DEMOCRATS: Allows plan members
to sue under state malpractice laws by removing ERISA shield.
HOUSE REPUBLICANS: Expands
penalties for health plans for inferior care, $250,000 cap on medical malpractice
SENATE REPUBLICANS: No provisions
Appeals process for patients
denied particular care by an HMO:
DEMOCRATS: Requires an internal
appeals process and a government-certified company for external.
HOUSE REPUBLICANS: Requires
internal appeals process through HMO-appointed arbitrator, non-binding.
SENATE REPUBLICANS: Requires
internal appeals process and external appeals board selected by the health
plan, for "medically necessary" procedures over $1000..
Patients' access to specialists:
DEMOCRATS: Allows the chronically
ill to consult specialists to get adequate care. Allows women to choose
an OB/GYN as primary care provider.
HOUSE REPUBLICANS: Allows
children to choose a pediatrician and women to choose an OB/GYN as primary
SENATE REPUBLICANS: Allows
women to choose an OB/GYN as primary care provider and children to see
a pediatrician without a referral
Continuity of care if patient
or doctor is dropped from health plan:
DEMOCRATS: Requires up to
90 days of coverage after primary care doctor is dropped from plan or coverage
HOUSE REPUBLICANS: No provisions.
SENATE REPUBLICANS: Similar
to Democrats' plan
Coverage of services by
Emergency Rooms not part of patient's HMO:
ALL PLANS: Must be covered
if a reasonable person would have concluded such care was needed.
Doctors right to discuss treatments
not covered by HMO ("gag rule")
ALL PLANS: gag rules prohibited
Length of hospital stay following
DEMOCRATS: Allows 48-hour
HOUSE REPUBLICANS: No provision.
SENATE REPUBLICANS: No provision.
Medical Savings Account
DEMOCRATS: No provision.
HOUSE REPUBLICANS: Some
expansion of medical savings accounts.
SENATE REPUBLICANS: Vast
expansion. Allows tax-deductible contributions to medical savings accounts
instead of comprehensive insurance.
Disclosure of information to
patients and potential patients:
DEMOCRATS: includes drugs
covered and patient outcome/satisfaction information
REPUBLICANS: limited to
what is covered and appeals process.
(data from LA Times, 7-15-98,
7-16-98, SF Examinier, 7-13-98, SF Examiner, 7-20-98)
Columbia/HCA is controlled by
a newly-rich group of Texas capitalists. Richard L. Scott started Columbia/HCA
in 1987 by buying two El Paso hospitals with Richard Rainwater, a Texas
investor with big holdings in Texas natural gas, oil drilling, Marathon
and Texaco oil companies, Texas real estate, and Walt Disney. This money
has fueled the growth of the Columbia/HCA empire. At its height, Columbia/HCA
controlled 340 hospitals, nearly half of the for-profit hospital beds in
the country, 200 home health care agencies, and 135 outpatient-surgery
offices. It was the nation's 10th largest employer, with 240,000 employees.
Columbia acquired in-trouble hospitals at the lowest possible cost, closed
or consolidated facilities which duplicated services, and cut staff. At
one point, it was acquiring a new hospital every ten days. (texasmonthly.website,
Modern Healthcare, 5-15-96)
Kaiser, on the other hand, was
founded as a health plan for workers in Kaiser steel, cement, and shipbuilding
industries during WWII. These industries are financially tied to older
Rockefeller money and the corporate banking system of the US, particularly
The "new-money", "oil patch"
Texas capitalists tied to Columbia/HCA get their money from domestic oil
production and high-tech industries. They do not have the interest or the
money to compete in the world-wide market, particularly in foreign oil.
Their interest is in amassing as much money as possible, as quickly as
possible, domestically. They do not want to pay taxes to support world-wide
armies to dominate other countries. They therefore are associated with
isolationism, anti-NAFTA, anti-taxation, anti-government rhetoric, and
highly speculative financial dealings for quick profits. They are generally
portrayed as "reactionary," and are tied to the militias, the Promise Keepers,
and the anti-abortion movement. They are not as rich and as powerful as
the "old-money" Rockefeller capitalists, but in the last three decades
their position has risen enough that they now challenge the "old-money"
For example, in healthcare,
the Health Benefits Coalition (see above), representing the largest for-profit
HMOs and insurance company related HMOs, also contains Citizens for a Sound
Economy (CSE), which called managed care reform "the road to socialized
medicine." (American Federation of State, County, and Municipal Employees,
AFSCME, bulletin, 1-23-98)
Citizens for a Sound Economy
is associated with Congressman Dick Armey, who promotes Steve Forbes' flat
tax, and with Congressman BillyTauzin, who promotes a national sales tax.
CSE received $9.3 million
from foundations of the Koch family, the largest family owned business
in the US, from domestic oil, gas, coal, and chemicals. The Koch foundations
considered CSE "an important weapon in the assault on government interference
in business." (Nation, 8-26-96, and the CSE webpage)
The more dominant "old-money"
Rockefeller interests tied to Kaiser get their profits from foreign countries,
chiefly oil from the Mid-East. Their interest is in trying to maintain
the US's weakening hold on the rest of the world, because capitalists in
Germany, France, Russia, and even China are threatening this domination.
Therefore the Rockefeller interests are in maintaining a strong US military
force, pursuing an aggressive foreign policy to maintain US interests abroad,
and building up the World Bank and International Monetary Fund to promote
world-wide financial stability. The "old money" also wants to regain the
loyalty of a bitterly cynical working class, particularly minorities, so
they will fight in foreign wars to regain US domination abroad. They therefore
are associated with internationalism, a longer-term national outlook, and
are pro-taxation and pro-central authority. They are generally portrayed
as "liberals," and support affirmative action, abortion, and unions, if
kept sufficiently subservient. This is the group that is leading the US
into war in the Mid-east and eventually into world war.
For example, in healthcare,
The HMO Group (THMOG), representing non-profit HMOs with their own hospitals
and staffs of doctors, has as a goal "to coordinate national health priorities
through collaboration between public agencies and private sector HMOs,"
THMOG has close ties with the Robert Wood Johnson Foundation, the largest
US think tank and philanthropy devoted to health care issues. Much
of the Johnson Foundation's work has been helping states get "waivers"
from the federal government, excusing states from federal requirements
of providing medical and welfare assistance to poor people. Even
before the Clinton/Gingrich welfare reform program, Clinton's Health
and Human Services Department granted waivers to 2/3 of the states in the
country. Many of the Medicaid waivers put together by the Johnson
Foundation involved public/private partnerships in the sense of forcing
Medicaid recipients into private HMOs.
THMOG recently received a
5 year multi-million dollar contract from the federal Centers for Disease
Control and Prevention's National Centers for Chronic Disease Prevention
and Health Promotion (NCCDPHP) to assess the linkage between private
providers of health care services and the CDC and other Public Health Service
agencies. According to THMOG;s press release, "The HMO Group shares CDC's
vision of fostering bridges between public and private health partners
that benefit the entire community."
In fact, both groups of capitalists
are equally workers' enemies. The agenda of the dominant "Rockefeller"
capitalists calls for extracting gigantic sums of money to rebuild the
US manufacturing base and infrastructure, and re-arm the military for war.
This is why the "liberal" Clinton passed "Workfare" (Welfare Reform), forcing
welfare recipients to work and replace millions of "regular" workers who
will go on workfare themselves, tremendously lowering all worker's wages.
For more information on the
struggle between the the dominant "Rockerfeller" capitalists and the "new-money"
domestic oil-based capitalists, see the Progressive Labor Party article
Fascists," in the January, 1998 issue of Communist.
The Rockefeller agenda of
extracting billions for rebuilding the manufacturing base and the army
means limiting the profits of their domestic rivals, and severely limiting
the amount of money that workers get for healthcare. The Rockefeller capitalists
cannot afford to spend as much heath care money as the for-profit HMOs
use, and they cannot afford to let profits go to their "new money" rivals.
The stakes are huge, health spending accounts for one-seventh of gross
domestic product. As international financial crisis worsens and as war
over oil and world resources approaches, many economists are deciding health
care costs must be drastically slashed "in the national interest," and
free-market economics cannot be depended on to do this.
to top of document.
"Some economists have begun
to question whether, over the longer term, health maintenance organizations
can deliver on their promise of keeping health costs under control. "Oxford
joined the long list of HMOs that lost control over costs," said Kenneth
S. Abramowitz, an analyst at Sanford C. Bernstein & Co." (NY Times,
"As for the HMO's, their job
is getting more difficult," said Mr. Altman, consultant for the Robert
Wood Johnson Foundation. "They have to push harder on one side, against
doctors and hospitals. On the other side, buyers are more demanding; they
want higher quality, lower prices, greater access and more choice of doctors
and hospitals." (NY Times, 1-5-98)
"United Healthcare's woes also
raise the question of whether managed care works as a model for the future
of health care in keeping costs under control. While the company's difficulties
are limited to caring for the elderly, it is unclear how successful any
managed-care company will be once it covers more people. The backlash from
consumers, who are increasingly demanding more from their plans and want
more choice of doctors and hospitals, adds to the difficulty of containing
costs. 'You can't make huge margins in this business long term,' Feinberg
argued." (NY Times, 8-7-98)
rulers of this country may well move healthcare away from the for-profit
Hard as this may be to
believe, it is quite possible that the dominant capitalists of this country
will move health care away from the for-profit sector, and turn it over
to "non-profits" like Kaiser, which will become quasi-governmental. They
will probably use people's anger at for-profit health care as an opportunity
to make this move in the guise of reform. To many, this move will look
progressive, but it is not.
A recent NY Times article (6-1-98) shows
how trying to reform healthcare through the proposed Patients' Bills of
Rights will strongly favor large HMOs with their own doctors, so-called
Group Practice HMOs, like Kaiser. The reform legislation mandates
that HMOs must publish extensive and detailed statistics about their quality
of care. In theory, the patient can then choose HMOs
and doctors with good statistics. But this theory ignores the reality
of who controls health care. Only the large HMOs with their own doctors
charting on their centralized computer patient records will be able
to meet the requirements of the reform legislation. In this
way, patients' justifiable demand for accountability will speed
up the monopolization of hospitals and insurers, and open up patients
to more coercion and worse medical care in the future. In more detail,
the article says:
"But the experts also
know something the politicians won't say. These bills of rights, the product
of a consumer backlash against restrictions imposed by the HMOs, are almost
certain to do the opposite of what consumers say they want. Rather than
expand consumer options, they will drive patients into restrictive types
of HMOs that limit patients to a small roster of doctors. The bills could
also wipe out old-fashioned fee-for-service health insurance, which puts
medical choices completely in the hands of doctors and patients."
Patients' rights have broad
support among health policy experts who say they will make insurance companies
accountable for the quality of care they provide. The idea is that if every
plan reports clear data on mortality, morbidity and patient satisfaction,
consumers can reward the best plans with their business.
The patients' rights bills
would demand substantial record-keeping. how many of its youngsters receive
vaccinations,... how many diabetics are checked for high blood pressure
and how many coronary patients take beta blockers ...How many of the plan's
asthmatics return to normal work schedules without repeated visits to hospital
emergency rooms?... How many of the plan's diabetics successfully control
their blood pressure?
HMOs can handle demands
for extensive data collection, typically by steering patients to a small
roster of doctors and by using "gatekeepers" to intervene between patients
and specialists. They also provide the plan a single place to find any
patient's complete medical record. That makes tracking outcomes possible.
By comparison, looser forms of managed care, like Preferred Provider Organizations,
allow patients to see nearly any doctor, but require them to pay more for
those who are not members of the plan. There is no one place to find a
patient's complete record so plans must sift through claims submissions
to figure out which treatments their patients received.
The bills would tighten
the grip of managed care because they impose elaborate record-keeping requirements
on the health plans, aimed at making them publicly accountable for how
well they prevent, treat and cure illness. What the politicians won't yet
admit is that accountability clashes with something else something else
patients prize: choice.
restructuring of health care will actually be fascism with a liberal cover
When we talk about turning
health care over to quasi-governmental "non-profits" for a much tighter,
more centralized rationing of patient care, we are talking abut fascism.
Fascism can exist years before
world war, or concentration camps. Capitalism inevitably leads to periodic
crises of decreased profits. And when this happens capitalism switches
from "democratic" mode to fascist mode to regain its profitability at any
"Removing profit from
health care" will mean the rulers have decided real healthcare is too expensive
and should be abandoned so they can use the money saved to make greater
profits elsewhere or rebuild their factories and military. "Single-payer"
will mean the rulers have decided to use the government to enforce healthcare
Fascism involves (among other
things) three elements, all of which can be seen in the US and US healthcare:
Fascism is collaboration
of unions with the dominant capitalists, and the co-optation of
unions and opposing groups to confuse and then obliterate class consciousness
Fascism is increased
monopolization of the economy to capture profits for the dominant capitalists,
and the merging of business
and government to assure that business and government serve the dominant
capitalists. (The merging of government and business is an attempt to rebuild
the decaying factory system and infrastructure and prepare for war to regain
Let's try to look at these elements
For the past twenty years,
the rulers of the US have been setting the stage for using force and threat
of economic ruination to extract more profits from workers, through huge
cuts in wages and services, especially health.
is using force and threat of economic ruination to wring more profits from
In the mid-1970s, US rulers
realized that their defeat in Vietnam had broken the US stranglehold on
the world's economy. They realized there would be serious problems for
US capitalists in the coming decades, and that they would have to greatly
reduce the living standards of the working class. Business Week (10-12-75)
wrote :"Yet it will be a hard pill for many Americans to swallow ---
the idea of doing with less so that big business can have more. ... Nothing
that this nation or any other nation has done in modern history compares
to the selling job that now must be done to make people accept the new
reality. And there are grave doubts about whether the job can be done at
all. Historian Arnold Toynbee, filled with years of compassion, laments
that democracy will be unable to cope with approaching economic problems
--- and that totalitarianism will take its place" (Setting the stage
for using force to impoverish workers and enrich the capitalists.)
In the same period, a
leading hospital management magazine wrote, "Though some corporations
make money as (health care) costs increase, the majority (of corporations)
lose money because costs for health benefits, which they share with employees
and unions, cut into their profits. Given the competition for markets with
foreign firms, US corporations can no longer afford to leave health care
politics to the usual participants -- professors, bureaucrats, physicians,
and hospitals. .... Whether or not a hospital cost control bill is passed,
or is passed but found inadequate, the big corporations are here to stay.
They will work for federal and state attempts to control costs, preferably
keeping the impetus in the private sector, but controlling costs by all
means, at all costs. (Hospital Progress, 12-77 p 49-50). (Setting the
stage for major cuts in health care, possibly using the government. Also
setting the stage for increased monopolization, by suppressing health-care
corporations whose interests conflict with the dominant corporate interests
of the US.)
The head of the Robert Wood
Johnson Foundation, the most powerful medical think-tank in the US, is
Steven Schroeder. In 1890, as a member of the UCSF Health Policy Group,
Schroeder organized a Cost Containment Conference, where he said "the main
culprit in the high cost of medical care is our current inability to make
and enforce decisions about what medical services we need and can
afford." (Personal observation) Schroeder popularized the notion that "low-cost,
high-utilization technologies such as lab testing create more of a regulatory
problem than do the ‘high-fliers’ (high-tech CAT scans etc.)." He deplored
the increased use of lab tests in maternity care, and in diagnosis of appendicitis,
breast cancer, and heart attack at the Palo Alto Clinic, a primary-care
based clinic serving the East Palo Alto ghetto as well as Palo Alto. He
also deplored an increase in lab tests among a New Mexico Medicaid population.
(Address to Sun Valley Forum). (Setting the stage for enforcing the rationing
of healthcare, particularly healthcare of the poor.)
Another speaker at the
same 1980 Cost Containment Conference described a 3-year program at UCSF
to discourage residents (doctors-in-training) from ordering mechanized
blood tests, blood clotting time tests, stat orders, X-rays, vital signs,
weights, fluid Intake-and-Output tracking, and medicines administered four
times daily. He advised doctors not to worry about malpractice suits, because
residents, as students, were not legally liable. When asked why the program
trained residents instead of doctors, he explained that there are two levels
of healthcare. There is private health care, used by the wealthy, where
decisions are made by doctors, and there is public health care, used by
the poor, where decisions are made by the residents. "Therefore, it is
the residents who need to be taught cost-containment, not the doctors."
(Personal observation) (Again, enforcing the rationing of healthcare, particularly
healthcare of the poor. Also justifying inequities in healthcare)
"Persons will be recognized
as in need of, and then denied, benefits that the medical care provision
system is capable of providing. ... These decisions (to withhold treatment)
are likely to be made when any of the following conditions are met:
(1) the treatment is determined to be futile, (2) the patient declines
treatment, (3) the quality of the patient’s life is unacceptable, or (4)
the cost of providing care is too great. ... Only when society
is fully able to come to grips with death and dying is it likely that policies
and procedures for decisions not to treat will not only will be formulated,
but will also be followed. This period is likely to be hastened as financial
constraints force the issue." (Health Care Technology and the Inevitability
of Resource Allocation and Rationing Decisions, Journal of the American
Medical Association 4-22-83 p 2208)
A cost-benefit analysis
showing that care of very low birthweight babies is not economically justified,
based on the expected lifetime earnings of the infant. ("Economic evaluation
of neonatal intensive care of very-low-birth-weight infants", New England
Journal of Medicine 308:1330-1337, 1983) (Setting the stage for denying
care to those who are not "economically productive.")
A survey of patient deaths
in Seattle extended care facilities, showing that doctors were willing
to withhold antibiotics to 40% of patients with fever, the majority of
whom died. "Physicians have been accused of prolonging life at any cost.
However, surveys of health professionals have found that many (50 to 70
per cent) are disposed to withdraw or withhold life-prolonging treatment."
The question of whether the patient expressed a desire to continue living
is never even mentioned in the article. ("Nontreatment of Fever in Extended-Care
Facilities, New England Journal of Medicine, 5-31-1979, p 1246 (Popularizing
the idea of killing unproductive people who might use up resources.)
A prominent British neurologist
wrote in 1975 that "no person with severe handicaps is likely to be able
to earn his living in competitive employment, unless his IQ is at least
100." He developed a set of rigid criteria to determine which newborns
with spina bifida should receive aggressive therapy. These criteria include
consideration of the infant’s "social condition" (economic resources of
the parents.) (J Roy Coll Phys, 10:47, 1975) (Popularizing the idea of
letting economically unproductive people die without treatment.)
Medical journals started publishing
items like these:
At Children's Hospital
of Oklahoma, secret "quality-of-life" experiments on children born with
spina bifida were conducted between 1977 and 1982. Twenty-five parents
were advised by doctors not to have their babies treated; 24 of these babies
died. 36 parents were advised by doctors to have their babies fully treated;
all 36 lived. The decision to advise for or against treatment was based
on a formula devised by the doctors, involving the baby’s functionality,
the parent’s financial resources and education, and how little public resources
would have to be used for treatment and rehabilitation. The US Supreme
Court refused to hear a lawsuit filed by the parents of children who were
allowed to die. (Progressive, 10-94)
More recently, in 1995, the
Pew Health Professions Commission at UCSF, one of the most influential
medical think tanks in the US, issued a report advocating closing 60% of
the beds in the nation, half the hospitals, and 20% of the medical schools
in the nation. It predicted "surpluses" of 100,000 doctors and 200,000
nurses by the year 2000. (NY Times 11-17-95) The San Francisco-based Pew
Commission includes former government officials, medical educators including
University of California San Francisco (UCSF), public health professionals
and insurance company executives. The commission is headed by Richard Lamm,
former governor of Colorado, who became notorious for speeches in 1984
declaring that old people had the DUTY to die and free up scarce national
resources. (SF Chronicle, 3-29-84, NY Times, 11-17-95, and SF Examiner,
Return to "fascism".
Very recently, many economists
are deciding that the marketplace cannot be depended on to adequately ration
health care. "The HMO industry has lost a lot of clout," said Uwe Reinhardt,
an economist at Princeton University. (NY Times, 10-28-97) "Managed care
companies do not manage care," said Kenneth E. Raske, president of the
Greater New York Hospital Association, a trade group. "Instead they manage
price, the prices they pay to providers. There are really few good examples
of any sound managed care in New York." "Medical costs are going up," an
HMO representative said. "Utilization is going up. They are not managing
care." (NY Times, 1-11-98) (Calling for more severe rationing of care.
This passage also sets the stage for increased monopolization, by suppressing
health-care corporations whose interests conflict with the dominant corporate
interests of the US.) This bring us to the next characteristic of fascism:
is increased monopolization of the economy ...
The federal government has
allowed, and even encouraged, monopolization on the part of "non-profits,"
particularly Kaiser, which are associated with the dominant Rockefeller-based
capitalists. It has allowed them to form bigger and bigger conglomerates.
At the same time, the government has attacked for-profit HMO conglomerates
associated with the "new" capitalists, forcing them to break up.
So-called "non-profits" especially
Kaiser, have been allowed to swallow up each other rapidly. In the third
quarter of 1996, 95% of all acquired hospitals were non-profits, and 80%
of the buyers were non-profits as well. From late 1996 to September
1997, Kaiser acquired or merged with: (1) Group Health Cooperative of Puget
Sound (675,000 members), the largest membership-run non-profit HMO in the
US, (2) Health Insurance Plan of Greater New York: (1,100,000 members)
originally a state-run health plan for New York State employees, (3) Community
Health Plan (350,000 members, and (4) Humana Group Health Plan (118,000
members) (CNA Kaiser Pamphlet, available on the CNA website) In June,
1998, Kaiser announced an alliance with AvMed, Florida's largest non-profit,
with 400,000 members. (CNA communication) What is important
is not only the size and pace of the acquisitions, but also that they were
non-profit, with a tradition of membership service and/or involvement.
Kaiser wants a patient base more involved with its HMO, more likely to
identify with it, and more willing to accept its cuts.
Return to "fascism".
On the other hand, Columbia/HCA
has come under huge attack from the government, allegedly for Medi-Care
fraud. Federal agents seized thousands of documents, have indicted high-ranking
officials, and have forced a complete reorganization of Columbia/HCA in
which they are losing a third of their hospitals and their entire home
care operation. No one doubts that Columbia/HCA committed massive fraud,
but Medicare fraud is very widespread, practically built into the system.
(NY Times, 12-18-97) What's behind the attack on Columbia/HCA is an attack
on new money. (Direct attack of the upstart capitalists by the dominant
capitalists, which will lead to more monopolization.)
is merging business and government ...
Kaiser and other "non-profits"
have made moves to integrate themselves with government-supplied health
care. They have involved themselves in movements to federally regulate
healthcare delivery by HMOs, and in a federal initiative to extend healthcare
to more children. The money for these "non-profits" comes largely
from bonds issued by state health facilities financing authorities, which
charge no interest to the HMOs.
In September, 1997 Kaiser's
three non-profit arms (Kaiser itself, Group Health Co-operative of Puget
Sound, and Health Insurance Plan of New York) announced an agreement with
the American Association of Retired People (AARP) and Families USA (a health
reform advocacy agency) on instituting standards in 18 areas of health
consumer concern. According to Kaiser's 9-24-97 Press release, "the (joint)
group will urge policymakers and President Clinton's Advisory Commission
on Consumer Protection and Quality in the Health Care Industry to consider
the 18 principles for national standards in their recommendations."
In a letter to be sent to
the Presidential Advisory Commission, the health plans and consumer organizations
say they are advocating legally enforceable standards to protect consumers
and to achieve fair, consistent and efficient regulation, and greater accountability
by health plans." Remember, this is the same Kaiser whose members
are dying in its Emergency Rooms waiting to be seen! Non-profits
calling for federal regulation is a turnaround: Kaiser and
Health Insurance Plan of NY were two of the most prominent HMOs that pressured
the federal Health Care Financing Administration (HCFA) to abandon similar
federal regulations for HMOs receiving Medicaid (Medi-Cal) and Medicare
in July, 1996. (NY Times, 7-8-96) (Movement toward merging business and
government; and co-optation of opposing groups.)
The Presidential Advisory
Commission itself was tilted toward non-profit HMOs including representatives
from Service Employees International Union (SEIU) and the AFL-CIO, which
have entered into a partnership agreement with Kaiser (see below), Henry
Ford Health Systems (another non-profit HMO on the Kaiser model with its
own hospitals), and Families USA.
Many of the same Presidential
Advisory Commission members are forming a pubic/private coordinating group
charged with "ensur[ing] that consumers have a consistent set of standards
so they can choose health plans based on quality--not just cost", according
to vice-President Gore. (LA Times, 6-18-98) Several of the HMO reform
bills being debated require HMOs to divulge detailed information on their
programs of patient care. (NY Times, 6-3-98)
Another Kaiser move toward becoming
a government-mandated managed care provider is its initiative to subsidize
health coverage for children from low-income families in California.
It doesn't begin to solve the problem, paying an average of only 50% of
Kaiser's premium for only 50,000 children in California. (An estimated
1.8 million California children lack health insurance. The overwhelming
majority are in working families whose employers either have plans the
parents can't afford or do not have health coverage at all.)
But if Kaiser's children's
healthcare initiative is only a token remedy, it is a significant foot
in the door to becoming an official provider of health care. Kaiser is
pushing legislation to increase coverage of children by Medi-Cal and simplify
enrollment. It plans to work with schools to identify 630,000 children
presently eligible for Medi-Cal, but not enrolled. It also plans to work
with schools and the California Managed Risk Medical Insurance Board to
identify uninsured children. It plans to form a coalition with other health
care providers, insurance plans, and employers get them to make financial
contributions. (Kaiser press release, 6-23-97 and SF Chronicle 6-24-97)
Kaiser plans to have its initiative go nation-wide in 1999.
The Kaiser initiative is
part of a network of public-private partnerships to provide children's
health insurance coverage. The largest is the Caring Program for Children,
which operates in twenty-six states and pools Blue Cross and Blue Shield
administrative services and matching funds with private and philanthropic
donations. The Colorado Child Health Plan receives funding through corporations,
pharmaceutical companies, private donations, and Medicaid teaching funds
to the University of Colorado Hospital. (National Governors' Association
Fact Sheet, on world wide web) These three-way partnerships between
non-profit HMOs, state governments, and corporate donors are the mainstay
of many state's plans for extending children's' healthcare.(Movement toward
merging business and government.)
Kaiser's financing is largely
governmental. It currently has almost $1.5 billion outstanding debt
to various state and municipal agencies, such as health facility finance
authorites, community development authorites, state departments of budget
and finance, etc. The money from these bond issues is interest-free
to Kaiser, and the interest to the bondholders is paid from taxes.
(PRNewswire, 6-24-98) This includes a recent $400 million bond issue
by the California Health Facilities Financing Authority, their largest
ever to a health facility, a week after Kaiser forced a ten percent rate
increase for California Public Employes Retirement System (CalPERS) members.
(California State Controller's office press release, 6-25-98)
These public/private partnerships
are almost like a flip-flop optical illusion. If you look at the
partnerships one way it's privatization, because corporate donors finance
children's healthcare, and "non-profit" HMOs co-administer it.
But if you look at the partnerships the other way, it's "socialization":
because there is a federal initiative for children's healthcare, and state
governments are co-administering it. This simultaneous nationalization
and turning national programs over to corporations is what the Nazis called
national socialism, a term they devised in an attempt to get workers
to support it.
Robert Kuttner, of the Economic
Policy Institute (EPI), attacked profit-making ventures in healthcare,
and called Kaiser itself and Kaiser affiliates Group Health Cooperative
of Puget Sound and HIP of New York, "the most consumer-oriented nonprofit
plans," praising them for supporting mandated health consumer rights. Single-payer
healthcare is one of EPI's programs. (http://epn.org/kuttner/bk971126.html)
The Economic Policy Institute is a Massachusetts think-tank behind the
Richard-Gephardt-for-president campaign, and calls for a strategy of forming
alliances with unions to regain the loyalty of workers. Gephardt: says
"If you don’t temper capitalism, it’s a race to the bottom. Capitalism
left alone will defeat itself…" (Boston Globe, 12-5-97). EPI's "anti-capitalist"
funders are the Rockefeller Foundation, the C.S. Mott Foundation (General
Motors money), and the Russell Sage Foundation (Cabot gas and banking money).
Gephardt himself is a strong supporter of the "old money" strategy of getting
money from international domination. He backed Clinton’s invasion of Haiti.
In 1995, he voted to keep U.S. troops in South Korea and Japan. Last year,
he voted for a $245 billion 1997 military budget—$10.6 billion more than
Clinton had requested. (Challenge, 1-7-98, at http://www.plp.org)
In addition, Gephardt is the leading member of Congress pushing for $18
billion for the International Monetary Fund (IMF) to bail out crashing
economies in Asia. (NY Times, 4-5-98) Gephardt's ally Defense Secretary
Cohen emphasized that American economic and security goals are interlocking,
especially in countries like Thailand and South Korea: "We need to move
on the IMF funds as quickly as possible." (NY Times, 3-19-98) (Merging
of business and government, and a realization that free-market capitalism
cannot be left to its own devices. Also, capitalists posing as anti-capitalists,
trying to obliterate class-consciousness of workers.)
Return to "fascism".
is collaboration of unions and co-optation of opposition groups ...
The third hallmark of fascism,
particularly in its early stages, are collaboration between unions and
the dominant capitalists, co-optation of opposing groups, and manipulating
things to confuse and obliterate class consciousness of workers.
Kaiser and the AFL-CIO leadership
have recently concluded a partnership agreement, which stipulates
that AFL-CIO officials will participate in all levels of Kaiser's strategic
decision-making, including hospital closings, hospital and clinic downsizing,
restructuring the workforce, and policy questions on the quality of patient
care. Kaiser agrees to co-operate with AFL-CIO (chiefly SEIU) in areas
where its employees are already unionized, and to co-operate with AFL-CIO
moves to unionize Kaiser employees in hospitals Kaiser plans to take over.
AFL-CIO agrees to market Kaiser as a health plan to all union members nationally.
As part of their marketing obligation, the signers accept a pledge not
to engage in activities that might damage Kaiser's image or reputation.
The agreement contains a "confidentiality" gag clause, requiring the unions
to remain silent about information on Kaiser's plans obtained through Partnership
activities. Unions will have to conceal adverse data about Kaiser's poor
record on patient care and treatment of employees while promoting Kaiser
as the union health care plan. (CNA letter to international union presidents)
(Collaboration between unions and rulers, Also confusing and obliterating
class consciousness of workers by getting them to identify with Kaiser
as a "non-profit" so they will sacrifice their jobs and living standards
" ... as beds empty,
private hospitals are competing head-on with public hospitals for privately-insured
patients and even Medicaid (Medi-Cal) patients. ... The SEIU Research Department
has identified the key conditions for keeping these institutions competitive:
strong political and community support, stable funding, a well-developed
clinic structure, recognized specialties, and a competitive cost structure.
It's clear that keeping costs competitive will be key to the survival of
public hospitals. For SEIU healthcare workers, this means working with
management to address the future of public hospitals -- while defending
worker's rights and protecting the quality of care."
And just in case anyone doesn't
understand what "competitive cost structure" and "working with management"
means, SEIU spells it out in Findings About Healthcare Industry Restructuring
and Implications for Our Union:
SEIU has been preparing
for this partnership for years. Years ago, SEIU International wrote in
its pamphlet Keeping Public Hospitals Competitive:
"In order to maintain a
patient base, public hospitals will be forced to compete with private hospitals.
... Implication: Many public hospitals will need to change to survive/prosper
in the new marketplace. These changes will involve cost cutting often in
the staffing area ..."
Kaiser wrote in its Southern
California Regional Business Plan for 1995-1997, which calls for massive
layoffs, deskilling and job restructuring that it intends to "mitigate
any potential harmful actions on the part of the labor unions" by continuing
to develop "strong relationships with its union leadership." (The Link,
CNA Kaiser Interfacility Newsletter, 9-95) (#3, Collaboration between unions
SEIU told its members
to cross the picket lines of northern California RNs who are striking against
patient care cutbacks and hospital closings. Kaiser's position is that
it will "bargain" with AFL-CIO unions over patient-care-quality issues,
but not with the California Nurses Association. (#3, union-boss collaboration,
obliterating class consciousness)
At a time when San Francisco
General Hospital was faced big cuts, SEIU brought the leadership of their
Local 285 to San Francisco, to explain how Local 285 accepted the idea
of the merger and the privatization of Boston City Hospital and supposedly
made it work for them. The Boston local did a monumental job of mobilizing
the people of Boston to vote for a Public Health Commission to direct the
merged hospitals and insure that they fulfill their public health mission.
Labor was guaranteed a seat on the seven-seat Commission. However the final
contract that emerged called for cutting 1,200 workers (31% of the staff),
and closing half the beds, and even this plan was dependent on attracting
new business from community health centers and private insurers. (Boston
Globe 6-30-96 and 4-21-96)
To appreciate just how close
SEIU's leadership is allied to old money and its global oil companies,
consider a recent article on Nigeria from the SF Bay Guardian (7-8-98).
Nigeria's economy is based
on oil; it is one of the richest deposits in the world, producing $12 billion/year,
40% of which goes to the US. Five companies rule the roost: Shell
(Dutch), AGIP (Italian), Elf-Aquitaine (French), and Mobil and Chevron
(old-money US, aligned with Citibank and Bank of America.) The country
has been ruled by a succession of military dictatorships for 28 years,
which gets half the oil profits in the guise of the state-run Nigerian
National Petroleum Company.
In 1994 Nigeria's two oil
workers unions led a strike trying to force the military to recognize an
election the year before. The strike paralyzed the oil industry, and the
leaders of the unions were arrested. There were worldwide protests, emphasizing
the collaboration of the US with the military dictatorship.
At Mobil's May 98 annual
meeting, the Oil, Chemical, and Atomic Workers union (OCAW) forced a resolution
onto the floor demanding Mobile review its investments in Nigeria.
The resolution was quashed by institutional shareholders Franklin Research
and Development, New York City Pension Fund, and SEIU.
We can see the effect of the
Kaiser-SEIU partnership agreement already:
On February 5, 1995 the San
Francisco Chronicle ran an article claiming that CNA claims of deteriorating
patient care at Kaiser were false, citing figures from a liberal business
think-tank which purported to show that Kaiser nursing care was actually
improving. (Kaiser has repeatedly refused to show patient care statistics
to the CNA.) The Chronicle writer, Carl T. Hall, is an AFL-CIO shop steward
on his job. (personal communication) (#3, union-boss collaboration, confusing
the class consciousness of workers.)
Kaiser has already opened
a hospital in the Los Angeles suburb of Baldwin Park where the entire theme
of the hospital is physician-union co-operation. "Kaiser said the opening
will involve an unusual degree of union-management cooperation. Nursing,
technical, maintenance and other employees will be closely involved in
the planning." (personal communication and LA Times, 2-6-98)
Northern California Kaiser
is planning to open its long-vacant Roseville Hospital in Fall '98, with
SEIU Local 250 and 535 participation in planning of staffing models, health
care delivery and other aspects of hospital operation. (union-corporation
collaboration)(from SEIU Local 250 press releases, 3-5-98 and 3-23-98)
(Kaiser seems to have changed its mind and decided not to close all its
The main body of physician
opposition to managed care is now taking the position that for-profit HMOs
are the enemy, not managed care itself. Describing The Ad-Hoc-Committee
to Defend Health Care, composed of some of the leading critics of managed
care in the past, Managed Care Magazine (8-29-97) says: "The physicians
are not anti-managed care per se, but critical of what they view as undue
corporate influence in medical care. Their most specific goal is a moratorium
on for-profit takeovers of hospitals, insurance plans and physician practices."
This is exactly the same
rationalization the AFL-CIO uses to justify its partnership deal with Kaiser:
we must help "non-profit" healthcare against for-profit healthcare. Promoting
the "non-profits" by saying "Pursuit of corporate profit and personal fortune
have no place in caregiving, " sounds good, but it ignores the fact that
as capitalism goes further into crisis, its government will use "non-profit"
health providers to severely restrict the flow of health care and make
much greater profits for the class that runs the government. Whatever its
intent, this babble about eliminating profit from healthcare has the effect
of spreading passivity and setting us up for the kill. There is no way
to escape profits under capitalism; only communism can give us life without
Return to "fascism".
LABOR PARTY: a communist future where workers control society.
While acknowledging that,
in practice, there often is little difference between not-for-profit and
for-profit organizations and hospitals, Steffie Woolhandler, M.D., one
of the physicians spearheading the group, said, "The problem is profit-driven
health care." Woolhandler said non-profits are forced to compete with,
and behave like, for-profit companies. (Ad Hoc Committee's state in JAMA,
12-3-97) (#3, co-optation of opposing groups and confusing the class consciousness
What does Progressive
Labor Party mean by communism?
Our vision is a society
run by the working class, with no profits, and no money. We produce the
things we need and give them to each other. With no economic basis for
racism, sexism, or elitism, we could struggle to develop our real human
Under capitalism, the 1%
that rules society has more wealth than the rest of us put together . They
have built an entire apparatus to legitimatize, legalize, and secure this
system of theft. This apparatus includes the government, the schools, the
media, the universities, and the police and prisons. You can add many more
parts yourself. Communists call this apparatus "the state".
These capitalists are not
about to hand us control of society on a silver platter. Quite the contrary,
the disaster of capitalist healthcare is a reflection of the entire economy.
Capitalism is now in a world-wide crisis of inability to sell its goods;
its high-flying global economy is rapidly crashing into depression and
conflicts of major capitalists over markets, cheap labor, and raw materials,
chiefly oil. The fascism we see being imposed on us in health care, the
murder and massive jailing of our youth by the "justice" system, the forced
labor of welfare recipients and prisoners, all this is being imposed to
force more work out of us for less money, to take away our services, and
to gear up to fight in world war. We seem very weak.
the other hand, the rulers’ hospitals, factories, schools, and armies are
all staffed by workers like us. We have no interest in killing ourselves
for our bosses on the job or in battle. And we have every interest in overthrowing
our bosses. We believe that inspired by a vision of a communist future,
we can fight all the aspects of fascism in a way to develop our ability
to unite, to act together, and to forcibly take power as a class.
That is the purpose of Progressive Labor Party.
What would healthcare be like
in a communist society? Here is some of what we want:
Healthcare would exist to
improve the quality of life, not make profits. This
means we, the working class, would make healthcare decisions based on OUR
needs. For example:
WE will decide how many
hospitals and clinics were enough in our city or area.
WE will decide when our patients
need to see specialty doctors.
WE will decide our staffing
WE will decide when our patients
are ready to go home.
WE will decide how much training
was necessary for our different activities.
WE will decide whether it's
better to treat a particular condition at home.
But would "WE" always agree
with each other on what's best for all of us?
Probably not! Our existence
has both collectivity and individuality; we all have our individual strengths
and weaknesses to contribute. What's important is that the basis for
making decisions would be our collective good, and that a mass communist
party would exist as a framework to discuss questions and carry out our
For example, in the mid-60's,
when millions had communist aspirations in China, some providers and patients
preferred traditional medicine while others preferred western medicine.
People argued over which form should be the medicine of the new society,
until they realized there weren't enough practitioners of either type,
and they needed to use everyone that was available. The communist party
developed a plan to integrate the two disciplines. Traditional and western
providers worked together in each clinic and hospital, discussed patients
together to make sure all were getting the best care possible, learned
from each other, and often devised new treatments based on both methods.
(Joshua Horne, Away with All Pests)
There would be equality .
No one owning hospitals, food stores, or housing, to enrich themselves.
No one to force sending patients
home or onto the streets while they’re still sick.
No one with power over us who
would try to bribe us to scrimp on patient care.
We wouldn't all have the same
tastes, and people's needs would be different, but
we would all have the same standard of living.
At times this would mean sharing
adversity, too. For example, as the working class begins to win in armed
revolution, we can be sure the present rulers will try to destroy the nation's
infrastructure, including hospitals, rather than let us take possession
of it. During the rebuilding phase, there's no doubt about it: things will
be difficult. We believe in an environment of collectivity and equality,
people's best aspects will come forth. Even under capitalism the spark
of this spirit flashes: In the huge 1993 Mississippi River flooding when
urban black prisoners from Chicago prisons were sent into rural white downstate
Illinois towns to repair levees and save towns, strong suspicions and antagonisms
melted away, and strong attachments developed in many cases. (NPR news
Mental and manual labor would
not be separated as they are now. Each person's work would involve both
mental and manual labor. Elitist stratification would not be allowed.
During the mid-60s striving
for true communism in China, a local reporter looked for the captain of
a Chinese ship docked in Canada. The captain was found setting tables in
the dining room. The reporter asked the captain why he was setting tables.
The captain said, yes, it is true he had navigational and nautical skills
and was the leader while the ship was at sea, but those skills were no
longer needed in port so he was just like everyone else.
During this same period in China,
huge resources were put into healing workers injured during the rapid industrialization.
Huge advances were made in microsurgery, and surgeons from many countries
came to study the new techniques of repairing hand trauma. These advances
were the logical outgrowth of striving for communism, which values manual
labor as much as mental labor, and makes each nourish the other.
Communist merging of mental
and manual work can make healthcare work a smooth continuum of skills where
everyone can develop their potential. Think
about the awkward working relationship between nurses and new medical residents:
As doctors-in-training, the residents are supposed to give the orders,
but the nurses have to prompt the new residents on what orders to give.
It's not the new residents' fault, they've had very little patient contact.
Think how much easier it would be to learn to be a doctor, if you'd already
been a nurse for years, and an aide for years before that. Better yet,
think of how these jobs could be combined, so clinicians could smoothly
increase their skills, instead of hitting barriers where you can't get
a "better" job, or the only "better" jobs are management, so you become
clinically useless. The only reason for the capitalist boundaries between
Aides, Nurses, and Doctors is to enforce aclass-based pecking order.
We would be able to prevent
and treat disease in entirely new ways if people's work involved both manual
and mental labor, and both are given respect and validity. Once again in
mid-60's China, liver cancer was very common in a large area where there
was lots of hepatitis because of frequent fecal contamination of water
supplies by flooding rivers. From the village level up there was huge campaign
to drill thousands of wells each day to provide safe drinking water. Hepatitis
was drastically reduced, very quickly. Cancer scientists said, "Now in
20 years, we'll know whether hepatitis causes liver cancer." Combining
mental and manual labor, combining theory and practice, gives "epidemiology"
a whole new outlook. (report of Stanford Medical School dean returning
from China, early 1970s) Contrast this with capitalist cancer research,
where it is almost impossible to use population studies to tell whether
a substance causes cancer, because nothing has been done to eliminate the
known carcinogens like cigarettes and industrial pollution. Cancers from
known carcinogens swamp out cancers from the substance you would like to
We would do our work for free,
and get our needs free also.
If you were to ask nurses,
or other health workers what we would really like, the vast majority of
us would say we want to be able to provide good health care for our patients
without interference from the hospital, and we want to know we will have
food, shelter, medical care, education, and free time for our families
and our friends.
So the time we're conscious
that we need money isn't while we're working, it's when we need food, shelter,
clothing, transportation, etc. We need the money because the bosses who
own the farms, the apartments, the clothing factory, the bus line, etc
have stolen what "their" workers have produced, and we need money to buy
it back from those bosses.
A hospital worker wrote up an
experience on the question on money and wages:
I went into an operating
room in our hospital to adjust some equipment.
The room was filled with
stainless steel and hard tile, but the nurses
had dimmed the lights, and
were moving quietly and speaking in soft voices.
A delivery was in progress.
"When you feel a contraction
coming, press against my hand."
"That’s good. Now breathe
deeply, and let’s get ready for the next one."
Each time, you’re opening up a little more."
What quiet intensity!
What incredible focus!
What a privilege to work
where life is being born!
No matter how much they
try to make us forget it,
WE ARE THE ONES WHO HELP
The administrators, with
their power suits and spreadsheets and efficiency reports,
are completely foreign.
They haven’t a clue. They’re just feeding off us.
My friend works at
a different hospital.
She nursed a preemie as
small as a Cornish game hen into a thriving baby.
She worked with the whole
Later, she called the parents
at home to see how the baby was doing.
They read her the letter
they’d sent the hospital about her.
It was very touching.
Later, my friend got
a letter at work on midnight blue stationery with gold stars:
"Thank you for co-operating
with our Customer Relations program."
"Please accept this coupon
for a free yogurt in our cafeteria."
How dare these parasites
think they can bribe us with yogurt!
Plying us with trinkets
for what comes from our best nature!
But isn’t the whole wage
system like the yogurt?
No amount of money can equal
the work we do,
whether it’s resuscitating
or stopping the spread of
disease by collecting infectious waste.
As far as we’re concerned,
we work for each other.
Finally, we would like to include
a letter from Progressive Labor Party's newspaper, Challenge. It
is the grandmother of a baby who was born at the hospital where a reader
The nurses don’t pay me
to fix their machines.
The parents don’t pay the
nurses for delivering their babies.
Why can’t we run all of
society like this?
"She is the lay-midwife
in a village near Guadalajara Mexico. She told the Labor and Delivery nurses
how she takes women into her house for three days, delivers their babies,
feeds them, does their laundry, takes care of the baby, helps the mom with
breast-feeding, collects baby clothes from neighbors if the mom has none,
and often treats them with medicines she makes from barks and leaves, or
if necessary transports them to the hospital, about ninety minutes away.
Her small house has two beds; if more than one woman is in labor, she and
her husband sleep on the floor. She has been doing this for about twenty
years, having learned from giving birth to fourteen children herself, taking
a month's formal training, and continued reading.
Her "fee" is the
equivalent of three dollars, if people have it, or a chicken or a promise
of some favor if they don't. Several times, she emphasized, "The money
means nothing, it's all for love!" When asked if this was common in her
village, she said "Of course, nobody has any money. We just help each other."
The nurses and I were moved and inspired to hear health care described
in such a completely different light.
At first it seemed an amazing
co-incidence that we met this woman the same week as Challenge published
an article on how humanity worked for free for much
of history. But as an earlier article had pointed out, examples of working-class
heroism are all around us. We have good reason to trust that our class
can create a society where money means nothing, it's all for love.
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