By in Rhode Island’s Future
Way back in the Reagan years, in those
prosperous times when the social safety net was being shredded, experts talked
about triage.
Triage is a medical term for sorting
level of injury in a disaster, including putting a black tag on the living who
cannot be saved with present resources. Our economy was a disaster, they said.
The ship of state was loaded down with poor people. How could we afford this
burden?
Some writers pointed out it’s premature to throw people
overboard while there’s still steak and whiskey in first class. But enough
stayed comfortable that the cries of the excluded could be ignored and concentration
of wealth proceed.
Now the 0.1% are living in opulence
that makes steak and whiskey seem quaint, and our ship of state has been
hijacked by a corrupt billionaire and his pirate crew. It’s triage time again,
and the 20 million who recently got access to health care are about to be
tossed.
The president who must not be named
just signed an executive order that
undercuts the shaky stability of the Affordable Care Act with unclear language
about easing the burden of regulation. He has made it clear he intends to undo
the insurance reforms of the past 6 years.
Fundamentally, insurance is about
dividing up the risk. If our nation divided the risk among our 324,000,000 we
could have universal health care in return for our taxes.
We are decades behind the
rest of the developed world in constructing a national health program. What we
have now, the Affordable Care Act, should really be called the Achievable Care
Act, because it’s what survived the Congressional sausage-making factory.
We were supposed to have a Public Option, but that was
triaged out as the ACA passed by single digits in both houses. It was harsh, I
remember hearing Rep. Joe Wilson shout, “you lie” at
President Obama as he spoke to Congress. House majority leader, Rep. John
Boehner was emoting all over the place.
President Obama accomplished what a century of presidents attempted.
He got us started on a track to universal access to health care.
Rhode Island has built up a working
health benefits exchange that is a lifeline for many of us, middle class
included. Small business owners, people whose jobs do not provide insurance,
people who were hanging in there hoping to stay healthy until they qualified
for Medicare are some of the people who use Obamacare.
Workers don’t have to stay in jobs they hate just to have
access to insurance. Parents can decide to stay home if that’s best for their
family instead of working just for the coverage.
Most Americans have coverage in the
complicated system we’ve built since WWII. Most don’t fall through the holes. I
think the fact that we have emergency services creates an illusion that the
safety net is there when we need it. It’s true that by law no one who goes to a
hospital ER in an emergency is turned away. That seems so right, so American,
that most don’t know that law was only passed in 1986.
EDITOR'S NOTE: The promise to provide health care to all regardless of ability to pay pre-dated the 1986 law. The promise was a part of the 1946 Hill-Burton Act which spurred construction of health care facilities across the US. Any facility that received federal construction money had to make this pledge. But until the last 1970s, this promise was little known and had no enforcement mechanism.
Community organizations in Rhode Island were the first to organize uninsured workers to fight for this right. Among the lead organizers were George Nee, now head of the state AFL-CIO and the late social justice hero, Henry Shelton. I served as the campaign's strategic researcher. The RI Hill-Burton campaign spread across the US and led to the passage of the 1986 law. - W. Collette
Now we won’t die outside the hospital
door, but the most common cause of bankruptcy is
medical debt.
I got my first inside look at the
beast that is our health care ‘system’ when I answered a newspaper ad in 1985.
I was hired as a nurse’s aide at Wayland Health Center. That nursing home shut
down after a horrific incident where an aide put an elderly patient into a hot
tub without testing the water and burned her to death.
Subsequently the state
required all aides to be trained and certified. Darn those government
regulations. We can’t even tie confused people up in chairs all day like we did
back then.
As a minimum wage worker I was one of
those freeloaders in the 47% that
didn’t pay federal income taxes.
Every two weeks I would stare at my
paycheck for a few minutes, wondering how 40 hours of exhausting labor could
earn me so little. I worked close to where I lived because a car was
unaffordable.
I guess you could say I was one of the takers, contributing
nothing except Social Security and other deductions in my paycheck plus sales
taxes and the underpaid labor that made nursing homes lucrative for the job
creators.
I voted to maintain the highways I couldn’t afford to drive
on while seeing public transit cut year by year. I had health insurance by then
because I was legally married, but many of my co-workers were uninsured or
paying a big hunk of their wages to get on the company plan.
It’s risky to go without a medical
safety net. Things happen. A healthy woman may have a million dollar baby. And
that baby might need skilled care for many years. A car accident, an unexpected
health crisis will happen to someone.
Or yourself, if the dice roll that way.
But it’s midnight in America. Must we
toss some people overboard? Maybe not the grandmothers on Medicaid. They
babysit so their adult children can hold down a decent middle-class job. Maybe
not the disabled children, because they are innocent, unlike their exhausted
parents. But the Ladd School is closed and we need the caregivers. Maybe not
orphans who age out of the foster care system.
Maybe not anyone because people who
get sick for lack of care end up costing all of us at the ER or hospital.
Investing in health care for Rhode
Island has costs but also advantages.
Direct health care is a job creator,
one of the most labor-intensive classes of work and more needed as the
population ages. Health care workers don’t put their pay into offshore
accounts, they spend it locally.
During the Reagan years we heard
scandalous stories about six hundred dollar toilet seats ordered
for the military. During the Iraq War bundles of cash were
just lost. Contractors for Halliburton risked their lives driving empty trucks through a war zone because
they were paid by the run. Soldiers tried to improvise shielding on ‘thin skinned Humvees’ that
left them exposed to roadside bombs.
All these billions and all those lives
sacrificed to war. Why is investing in peace such a hard sell? If managed
right, money spent on health care can be a job creator.
We need a living wage for the women and men who provide
direct care for the elderly and disabled. Their wages for the most part will go
right in to our local economy. And health care is meaningful work with
opportunity for advancement. Workers who get more training and education can
gain certification and better pay.
Direct care workers have knowledge and
experience they can share with the community, helping to educate the public on
how to manage chronic diseases like diabetes and heart disease. That woman in
scrubs riding the bus is holding it all together and she deserves a raise.
The right is better than we are at
propaganda. Sneer at “government health care”, but don’t touch my Medicare.
Sarah Palin’s “death panels” lie had legs because Americans feel insecure.
For-profit corporations have too much power over what should be a public good.
But if you don’t want the system that neglected wellness to go into overdrive
when you are dying you better hope your doctor will make time to discuss an
Advance Directive even if she can’t bill for it.
One great benefit of the Affordable
Care Act is the provision that insurance companies can’t deny someone for a
‘pre-existing condition’.
This makes it harder for insurance companies to ‘cherry pick’ customers who will never make a claim. Republicans want to ease the pain to big insurance by dividing Americans into the healthy and a high risk pool forthose whom God has not blessed
This makes it harder for insurance companies to ‘cherry pick’ customers who will never make a claim. Republicans want to ease the pain to big insurance by dividing Americans into the healthy and a high risk pool for
I don’t know how to find a signal word
for the outrageousness of this. Maybe the word, ‘segregation’? We’ll hate on
people who make expensive claims and blame them for our lousy economy. They should
be grateful that they get second-class, high risk pool insurance. Segregation
worked just fine for the majority for about a hundred years, after all. Let’s
hear it for segregated health care.
Or we can recognize that we are a
great nation and we can take care of our own. Not with a ‘system’ that puts
profit ahead of the public good, but with effective, efficient and accountable
health care for all. We would not be the first country to get there, so what
are we waiting for? Now is the time.
Author Nancy Green is a Nurse, health care advocate,
Providence citizen
