The Unhealth of Our Medical Sector
Navarro, Vincente
The U.S. health care non-system is inhuman and inefficient. Among major Western industrialized nations only the U.S. and South Africa do not uphold the principle that health is a human...
...Just one example: occupational medicine...
...There has been further growth of investor-owned hospitals (the hospitals with the highest profits), stimulated by new forms of federal payment...
...health care system needs profound changes...
...We need to give a major voice to the workers and their unions in the governance of their occupational health services...
...Nearly 11 percent of our GNP is spent on health services, making the health sector the third largest economic activity in the nation...
...We need to reverse this trend...
...Six hundred dollars for each car in Detroit is traceable to negotiated health benefits...
...They provide care that is believed by a majority of physicians (including a quarter of those working for them) to be inferior to care by nonprofit hospitals...
...13 percent of all hospitals are now investor-owned...
...For instance: • Infant mortality is no longer declining at the rate it had for the last twenty years...
...THE MAJOR POLITICAL AND MEDICAL ESTABLISHMENTS oppose a national health program on the grounds that it goes against the current political mood in the country...
...Fifty-nine percent of poor and near-poor blacks and 63 percent of Hispanics were uninsured for all or part of the year in 1984...
...Other countries offer more comprehensive and universal health care coverage and have better health indicators and more popular health services than ours, and cost much less than ours do...
...While Reagan plans to build 17,000 new nuclear weapons over this decade at an estimated cost of $71 billion, his budget only allows for a single month's stockpile of vaccination serum...
...The current Republican administration is crowded with individuals who worked for and were part of these interest groups...
...This is reprehensible...
...This branch of medicine is primarily controlled by management rather than labor...
...The gaps between black and white infant mortality rates and between low-income and high-income families are the largest since 1940...
...The solution has to be rooted in a substantial change in national priorities, with a large shift of resources from the military to the health sector...
...MOST OF THESE PROBLEMS ARE PREVENTABLE...
...said once, "A nation that continues year after year to spend more money on military defense than on programs of social benefit is approaching spiritual death...
...Vice-President Bush used to be a director of Lilly, one of the largest and most profitable drug and medical equipment companies...
...The greedy are indeed exploiting the needy...
...Most occupational doctors are paid by management, and their work shows it...
...The reasons for supporting a national health program are fairly straightforward: (1) it is the moral and principled thing to do—the U.S...
...We need to establish a national health program...
...Three million families were refused medical care in 1985 because they could not pay for it...
...The reason: fairness and solidarity...
...Why This Situation...
...The average out-of-pocket expenditures for the average American have increased...
...In other countries, health is a right that does not need to be bargained for and is provided by the government...
...Federal health expenditures have suffered unprecedented cuts...
...The number of people who do not have health coverage has increased from 1982 to 1984 by five million...
...The number of families who have been refused health care because they could not pay has increased from 1982 to 1985 by two million...
...THE ROOT OF THE PROBLEM IS THE PROFIT orientation of our health care system, the economic rationale that it sustains it, the entrenched interest groups that it reproduces, and the enormous waste that it generates...
...A child from a black or white low-income family has only half the chance of surviving the first year of life as a child from a higher income family...
...In 1983, for example, $15.6 billion were spent on insurance overhead, $26.9 billion on hospital administration, $4.1 billion on nursing home administration, $31.1 billion on physicians' overhead, $2 billion on marketing, and $38.2 billion on excessive physicians' income...
...The percentage of federal expenditures going to the care of the elderly and disabled has declined from 7.6 to 7.1 percent while the percentage for defense has increased from 22 to 26 percent...
...And the mortality rate of infants between 28 days and one year of age has increased...
...The system of payment based on general revenue dollars allows for better public accountability and the transfer of funds within the federal budget...
...population...
...The National Opinion Research Center reports that 78 percent of admitting physicians report that they have received pressure from their hospitals to discharge patients...
...This reversal has to be based on a popular mobilization stimulated by calls not only to compassion but also to solidarity and concern for social justice...
...has to join the rest of the civilized nations and recognize that health is a human right...
...As simple as that...
...Profits for the hospital industry have increased: 81 percent of hospitals realized profits in 1985, with an average profit margin of 14.12 percent, a margin several times higher than the 3.3 percent after tax margins reported by Business Week for the services industry as a whole...
...Today one child dies of poverty, hunger, and malnutrition on average every fifty minutes...
...In 1983, the profit in some areas of the health sector was as follows: for the drug industry, $5.6 billion...
...Principles of a National Health Program THE SOLUTION IS TO REVERSE the current situation that favors the greedy few over the many needy...
...But the problems of high cost of health care and limited health coverage of the poor are the exacerbated forms of problems faced by the majority of the U.S...
...Health costs are the major cause of personal bankruptcy...
...In the U.S., we spend almost double (10.8 percent of the GNP) what Great Britain does, but still 16 percent of our population doesn't have any form of health coverage and the majority of our citizens still pay directly for large amounts of their health bills...
...The political and medical establishments ignore this reality or put it aside as a problem of certain small sectors of the population...
...On average, a worker is killed or dies because of work-related conditions every five minutes...
...Both arguments are wrong...
...for medical and equipment suppliers, $1.8 billion...
...Fifty-one percent of hospital funds and 83 percent of nursing home funds are already tax funds, but the boards of trustees—the top authority in each institution— are highly unrepresentative of the population they serve...
...149 • Federal interventions have stimulated hospitals to discharge unprofitable cases...
...Workers pay far more attention to their health and safety than bosses do...
...and (3) people want it...
...The problem is clearly not lack of resources...
...There is a perverse quota system in which the trustees come only from the top 5 percent (in income) of our population...
...These are but a few examples of an unacceptable reality...
...Some examples: • From 1980 to 1985, more U.S...
...Great Britain, for example, with 5.6 percent of its GNP spent on health services, offers comprehensive and universal health coverage, with 85 percent of the British people pleased with their National Health Service...
...The current system relies heavily on payroll taxes, fees, premiums, and direct payments—all highly regressive...
...Under the Current Administration THE HEALTH SITUATION HAS WORSENED DURING the Reagan administration...
...4) A major change is needed in the orientation of the health system with priorities shifted to give greater emphasis to preventive, community, environmental, and occupational and social care...
...The interest groups that benefit from such greed and waste will oppose changes...
...A basic and principled commitment cannot be abandoned because of political expediency...
...Not surprisingly, 72 percent of our population feel that the U.S...
...148 • Twenty years after the establishment of Medicare (the insurance program for the elderly) senior citizens still have to pay on average 22 percent of their health care bills out of their own pockets...
...It also includes the enormous apparatus needed to sustain those profits and the interest groups they benefit...
...A migrant farm worker is likely to live slightly more than one-half the number of years that a corporate executive lives...
...and South Africa do not uphold the principle that health is a human right...
...What this argument ignores is that we already spend more on health care than any other nation on earth...
...A somewhat similar situation exists in Canada...
...2) it makes sense...
...In spite of these enormous expenditures, we still have problems with our health care system, problems unmatched by any other country in the West: wrong priorities, high costs, and poor health care...
...It is not only the interest groups of the militaryindustrial complex that rule this federal administration, but the interests of the medical-industrial complex...
...Because of this reading of the popular mood the Democratic Party Platform in 1984 150 abandoned the party's commitment to a national health program...
...For example, Medicare, which represents 7 percent of all federal health expenditures, has received 12 percent of all federal cuts...
...A lot of profit and obscenely high salaries are being made from sick people...
...Much of these profits and expenditures is both unnecessary and harmful...
...children died because of poverty, hunger, and malnutrition than the total number of American battle deaths in the Vietnam War...
...for insurance and other financial institutions, $2.1 billion, and for health institutions (including hospitals), $2.8 billion...
...1) A national health program should be based on general revenues coming from income taxes rather than fees, premiums, and payroll taxes...
...As Reverend Martin Luther King, Jr...
...Thirty-eight million people do not have any form of health insurance coverage, public or private...
...These are not only minority problems—they are majority problems...
...36 percent of them are children...
...Starting from the top: President Reagan used to work for General Electric—a major hospital supplier —appearing in ads opposing Medicare, the program that has been responsible for a decline of 2 percent per year in the mortality rate among our senior citizens...
...Moreover, when health benefits are paid by payroll funds, the size of those benefits may hinder the competitiveness of U.S...
...The major political and medical establishments say we have neither the resources nor the popular will to make the commitment to health a human right...
...And 62 percent favor a national health program, even if the establishment of this program would call for higher taxes (which it would not...
...industry...
...3) The health institutions (e.g., hospitals and nursing homes) that are funded primarily through tax funds should be governed by boards of trustees that are publicly accountable, and representative of the communities they serve...
...And their political influence is enormous...
...This shifting of priorities will require a combination of government interventions with popular participation in which the populations affected by the health programs should play a major role in their governance...
...Many liberals have abandoned their commitment to a national health program because of what is presented as an antigovernment mood in the country...
...But the problem is not only profits...
...2) The policy priorities should be established at the level of the federal government with the states exercising a planning authority (under federal guidelines) and the local government exercising an administrative authority (also under federal guidelines...
...Meanwhile half of all black preschool children are not immunized against diphtheria, whooping cough, tetanus, and polio...
Vol. 34 • April 1987 • No. 2
