We are a great nation and we can take care of our own

With health care, it’s midnight in America

By Nancy Green 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 for those whom God has not blessed people with pre-existing conditions.

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