Beyond the flawed Obama health care reform

The following remarks were delivered by Dr. Claudia Fegan, past president of Physicians for a National Health Program, to the Louisville (Ky.) Urban League on Jan. 15. 2011

The time is always right to do what’s right: Dr. King and health reform

By Claudia Fegan, M.D.

It is indeed an honor and a privilege for me to stand here today celebrating the life and work of Dr. Martin Luther King Jr.

Dr. Garrett Adams, who gave me such a kind introduction, recently learned that my father was the photographer who took the picture of Emmett Till’s body the night his mother requested the casket be opened so that the public could see what they had done to her baby. That photo became an icon of the civil rights movement.

I was only 7 years old the day my daddy stood behind Dr. King’s right shoulder and photographed the crowd that stood before him on the Washington Mall as he gave his “I Have a Dream” speech. My father, a steelworker, was also a documentary photographer. I brought one of his photographs of Dr. King at that historic rally
with me today.

We learned much from Dr. King, even though he was taken from us too soon. He taught us that “the time is always right to do what’s right.”

As we stand here today, there are 50 million Americans who are uninsured. African Americans are represented disproportionately among the uninsured. I am referring to the fact that while we represent only 12 percent of the population, we are 20 percent of the uninsured. This is our issue.

As a result of not having insurance, we have decreased access to the preventive services that would allow us to live longer, healthier, richer lives. We pay a tremendous price for this.

Our infant mortality rate is about 2.5 times that of whites, our rates of death from heart disease and cancer are 1.5 times that of whites, our rate of death from diabetes is almost 2.5 times that of whites and our rate of death from HIV is 5 times that of whites. African American patients on dialysis are less likely to be referred for evaluation for kidney transplant and therefore, not surprisingly, we are far less likely to get a kidney transplant. This is our issue.

The Institute of Medicine in its 2004 study on “The Consequences of Uninsurance” estimated over 18,000 people a year die as a result of not having access to health insurance:

* Uninsured adults receive fewer and less timely preventive and screening services
* Uninsured cancer patients die sooner due to delayed diagnosis
* The uninsured receive less chronic illness care, poorer hospital care and are more likely to die in the hospital.
* The risk of premature death among uninsured Americans is 25 percent higher than among Americans with health insurance.

This is our reality, the reality of health care for African Americans in this country. We will never get more until we demand more. This is our issue.

Physicians for a National Health Program, PNHP, is an organization of 18,000 physicians. Since 1986 we have been trying to convince physicians, patients and politicians that if we tossed out the private insurance industry and made the government the single payer for health care in this country, we could provide coverage for everyone with same money we are using now to cover only two-thirds of the country poorly.

I have a patient who is 63 years old. Ms. Lenoir has worked all her life, she is active in her church, she cares for her elderly mother and together she and her husband have raised their children to be self-sufficient members of society. Ms. Lenoir does not have health insurance because her employer has never provided that benefit.

The problem is Ms. Lenoir needs a new hip. After more than 20 years of arthritis in her hip, the joint is destroyed. She has bone grinding on bone. No amount of anti-inflammatory medication will relieve her pain. I had to plead with her to consider taking a narcotic to relieve her pain so that maybe she could get a good night’s sleep.

I sent Ms. Lenoir to a pain specialist who injected the joint to provide her with temporary relief and who then called me and said, “This woman needs a new hip.” I told her, I know that, but have you got one you can give her? No one will pay for a hip for her until she turns 65 and Medicare will provide her with coverage.

I wish you could look into this woman’s eyes each time she comes to see me and feel her pain. Will the legislation passed last year provide her with a new hip before she turns 65 in 2013? No probably not. This is our issue.

In the book “The Heart of Power,” David Blumenthal chronicles the efforts of presidents from Franklin Roosevelt through George W. Bush to achieve access to health care for the American public. “Major health reform is virtually impossible: difficult to understand, swarming with interests, powered by money, and resonating with popular anxiety,” he writes.

The congressional veteran and co-chair of the 9/11 Commission, Lee Hamilton, said, “Health care is so difficult because Congress is an incremental body and health care is a non-incremental issue.”

What Barack Obama did with the passage of the Patient Protection and Affordable Care Act (ACA) was nothing short of miraculous, but it was not enough and it will not solve our problems.

Going forward there will not be a fair, open or honest discourse about this legislation. It is a fact that ACA will do nothing to control costs. That is the major flaw of the legislation.

Why are we still talking about single payer? Because single payer will address the issues of cost, access and quality.

Dr. King taught us being right is not enough. We have to win the hearts of the American public.

We didn’t lose the war to gain access to health care for all Americans. We got battered in an ugly skirmish, but we’re not done.

It is time to change our tactics. The opportunity for change is still ahead of us. More recent studies have taught us that actually 45,000 people die each year as a result of not having health insurance which means 180,000 more people will die before implementation of the majority of the ACA legislation. If everything goes exactly as planned, there will still be at least 23 million uninsured once all the changes have taken effect. This is our issue.

Camille Rucks was a security guard for a small company on the South Side of Chicago. In the spring of 2008 she developed breast cancer. She received outstanding care at the University of Chicago and did well. However, in November 2008, which we now know was the beginning of the recession, when her company began to struggle, she was laid off. She thought she was targeted because she had been out sick so much when she was receiving chemo, but it doesn’t matter.

In January 2009, when she had some blood-streaked sputum, her primary care physician (PCP) ordered a chest X-ray that showed a spot that raised the question of maybe her cancer had returned. Her oncologist told her she couldn’t see her because she was no longer insured. Her surgeon never returned her phone calls.

Her PCP called me because she was not able to get the necessary tests done for Camille because she was no longer insured. I told her PCP to have Camille come see me the next day.

I said, sure, of course, this is what we do; we’re the County Hospital. In less than a week she had a CT of her chest, and within two weeks she had been seen by pulmonary and oncology. She did have metastatic cancer and we took care of her. I wish I could tell you this story had a happy ending, but it doesn’t. Camille died last
year, but she told me she had no regrets. We treated her with dignity and respect.

My question is this: Who doesn’t deserve dignity and respect? Why should you have to pass a wallet biopsy before a health care provider determines she can talk to you, order a test, figure out what is wrong or decide how to treat you? This is our issue.

The Affordable Care Act has not made health care a right. Access to care is a profit center controlled by the insurance industry. We pay them to limit access to care. We spend more per capita on healthcare than any country in the world — more than $8,000 per person — and yet we are ranked only 36th in the world by the World Health Organization for the care we provide.

Under the ACA, everyone will be required to carry or purchase private insurance. For those who can’t afford it, we’re requiring states to either cover them under Medicaid or to provide supplements so they can purchase private insurance. This is an industry that has a history of profiteering by retroactively denying coverage to people with illnesses. So now we’re requiring everyone to buy coverage, and yes, we have told the insurance companies they can’t deny coverage to those with illnesses.

My question is why can’t we just pay for the care without having to go through the insurance industry? They are not to be trusted. Ask the state of Massachusetts how it has worked out for them with mandating insurance coverage and paying for those who can’t afford it. The cost of premiums has gone up so high so fast in the first year the governor met with the major companies to request they hold off on their premium increases because the costs had exceeded three times the original projections. The state now teeters on insolvency. This is our issue.

We spend enough money on health care in this country. We just let too many people who aren’t involved in providing care take profit from it.

This is about justice. Health care should be a right to which everyone is entitled. Remember we live in the wealthiest country in the world. We spend more on health care than any other country. It is time we got our money’s worth. It is time we got the health care we deserve, not the care the insurance industry is willing to let us have. It is time we made health care a right and not a privilege.

We have to speak up. We have to speak loudly. We have to make our voices heard.

The Affordable Care Act is an opportunity: It is not going to work!

We have to remind the people — there is still a simpler, easier solution. People want to know, they have questions. They will ask, is this the answer? Will this work? Will this solve the problem?

Multinational Big Pharma charges the American public the highest pharmaceutical prices in the world, while it sells the very same drugs all over the world at prices one-half, one-third or even one-tenth of the price they charge in the United States. They do this because in the rest of the industrialized world, there is legislation that limits profits for medications, while the U.S. allows these companies to charge whatever the market will bear. The Affordable Care Act does not address this issue. This is our issue.

Dr. King said, “When people get caught up with that which is right and they are willing to sacrifice for it, there is no stopping point short of victory.” The Affordable Care Act was not victory. We now have a House of Representatives that thinks the American public will be appeased by political theater instead of substance. They had planned to spent time reading the Constitution omitting the parts about Blacks being only three-fifths of a person, or the prohibition of alcohol; revisionist history at best, trying not to acknowledge the Constitution has been changed repeatedly throughout history.

They had planned to spend time voting to repeal the law when they knew it was an empty gesture. The shootings in Arizona at least gave them pause for that.

What the American public wants is not so different from what African Americans want and deserve. We want guaranteed access to care, freedom of choice of provider, quality health care and two words you don’t hear in association with health care very much anymore: trust and respect.

We know it can be done because every other industrialized country in the world has figured how to do this. Most of them spend less than half what we do and they have better outcomes with more satisfaction.

It is not so complicated what we want: we want a health care system that takes everybody in and leaves nobody out. It is only the phony solutions they are attempting to confuse us with, that are complicated, just so we don’t notice they fail to expand coverage to those who need it and deserve it. That’s why this will be the civil rights struggle of the 21st century, and this is our issue.

I understand people are reluctant to criticize the ACA because our president is under assault from the right and he needs our support. I think Dr. King would tell us it is important to tell the truth. “The time is always right to do what’s right.”

When I think about this struggle I think about a poem my father taught me as a child. It was written by Langston Hughes and is called “Mother to Son.”

*Mother to Son*

Well, son, I’ll tell you:
Life for me ain’t been no crystal stair.
It’s had tacks in it,
And splinters,
And boards torn up,
And places with no carpet on the floor —
Bare.
But all the time
I’se been a-climbin’ on,
And reachin’ landin’s,
And turnin’ corners,
And sometimes goin’ in the dark
Where there ain’t been no light.
So, boy, don’t you turn back.
Don’t you set down on the steps.
‘Cause you finds it’s kinder hard.
Don’t you fall now —
For I’se still goin’, honey,
I’se still climbin’,
And life for me ain’t been no crystal stair.

The issue of guaranteeing access to care for everyone is an issue of social justice. Battles for social justice are never over, because there will always be reactionary forces waiting in the wings to turn back the clock. There are no easy solutions. We have to be willing to fight for what we believe in and keep fighting.

The night before he was assassinated Martin Luther King said: “Let us stand with greater determination. And let us move in these powerful days, these days of challenge to make America what it ought to be. We have an opportunity to make America a better nation.”

I hope you will join me in saying what we expect from any health care program any politician will offer us:

Everybody in, Nobody out!
Everybody in, Nobody out!
Everybody in, Nobody out!

Thank you.

1 Comment

  1. Ned Yellig on February 10, 2011 at 8:55 pm

    8,000 patients dumped in the street

    “8,000 patients left in the lurch” read the headline in Saturday’s N&O. The stunning announcement that the health insurance contract between Aetna and UNC Health Care expired suddenly on February 5 was a surprise to many, but such occurrences are no longer an uncommon event in employer-based health insurance benefit programs.

    These 8,000 anxious patients must now quickly find a new physician or clinic along with switching to a different insurance provider with new rules, limits to care, and pharmaceutical formularies.

    Jennifer Marks, the pregnant patient mentioned in the article and one of the many dropped by Aetna, is described as worried and angry. She has a right to be. This business/insurance glitch is just one of the too many glaring reasons why Americans should be up in arms about health care insurance reform.

    It is unconscionable that this country with our wealth, knowledge, expertise, and innovation should be putting its citizens in harm’s way through this kind of brutal abandonment, hassle, and anxiety.

    We have been reading about the costs of our health care going through the roof and quickly heading for the limits of sustainability. While U.S. health care costs, as a percentage of the GDP, are about twice the average of other major industrialized nations, we are sinking into mediocrity in terms of quality measures as well as length of life and patient satisfaction.

    The Commonwealth Fund, a research group, reports that our country now ranks last out of 19 countries on a measure of “mortality amenable to medical care,” i.e. deaths that should not occur in the presence of timely health care. The study showed that approximately 100,000 fewer people would die annually in the U.S. if they had the kind of access to quality care that persons in other developed nations have.

    The reasons for this predicament are many; however, the most salient reason is that our system of private health insurance is based on profits, with tacit but obvious approval of our government. The American people are a commodity in this system, so why shouldn’t a private insurance company dump 8,000 of us when the numbers for profit don’t add up? As for profits, Aetna reported a 215 million dollar profit for the last quarter of 2010 and stock earnings for 2011 look very favorable according to their projections. So how much profit do you need, really?

    The larger question then becomes: Why do we tolerate this kind of abuse, and where is the outrage?

    It’s time that we reconfigure this discussion. High-quality health care in our country should be a right of every citizen.

    It took 80 years for women to achieve the right to vote in 1920. It took over 100 years after the Emancipation Proclamation for African Americans to achieve true legal status with the Civil Rights Act of 1968. Recently, there has been more support for the rights of Americans to carry a gun into Starbucks than there is currently for quality health care. Stop for just one moment and think about that.

    Equal access for all Americans to quality health care must become our newest civil right, right now!

    We simply mustn’t tolerate having Aetna or other insurance companies like it turning around and dumping 8,000 of us into the street.

    The most important and effective solution for us is to demand universal, comprehensive national health insurance like Medicare – but in a new, improved 21st century model that would cover everyone. Such a system would also give us powerful cost-control tools, like the ability to negotiate for services, medications, and supplies.

    The nonprofit Physicians for a National Health Program with a membership of 18,000, has been pushing for this change since its foundation in 1987, 24 years ago.

    Though Rep. John Conyers Jr. of Michigan has formulated most of these ideas into his “Expanded and Improved Medicare for All Act,” H.R. 676, and though the bill had 87 co-sponsors in the last congressional session, it never made it out of committee. Needless to say, it faced stiff opposition from the for-profit private health insurance industry, a formidable lobbying force.

    However, the bill will likely be reintroduced into the 112th Congress later this month, and I believe that we are on the threshold of the best opportunity to demand and fight for equal access to health care for all of us. Please call you congressman today and ask that he or she sponsor and support this important bill.

    Otherwise, what are you willing to do to make this happen in your lifetime?

    Ned Yellig, M.D., is a retired internist, a former hospice medical director, and a member of Physicians for a National Health Program. (www.pnhp.org).

    Ned Yellig, MD
    2514 White Oak Rd.
    Raleigh, NC 27609
    919-606-4129
    ebyellig@gmail.com