Letter from the US

Is a new era of healthcare reform finally arriving in the US? That is certainly the conclusion reached by the mainstream media over the last months. Congress is poised to pass what is described as a 'sweeping reform measure', known as the Patients' Bill of Rights.

United Health Group, one of the biggest and most profitable healthcare companies, decided last week to stop denying payment for health procedures and 'to give decisions on care back to doctors', according to a New York Times headline. And even Bill Bradley, campaigning for the Democratic Party's presidential nomination, has introduced an 'ambitious and innovative' healthcare proposal that would cover all children and nearly all adults.

But a closer look at the substance of these measures shows that, rather than representing real reform, they are attempting to prevent it. The Patients' Bill of Rights passed by the House of Representatives last month would allow patients the 'right to sue their Health Maintenance Organisation (HMO) after they have been denied needed healthcare. By then they might well be dead or dying. Moreover, the version passed by the Senate last July, which is more likely to survive in Congress, doesn't even allow patients the right to sue and only applies to workers covered by federally regulated plans.

United Health Group's decision, upon closer examination, is filled with holes. It covers just 80 of the hundreds of medical procedures doctors prescribe. Furthermore, its motivations for the policy shift are far from humanitarian. Its management claims it will save $100 million in red tape on these 80 procedures--90 percent of which have been approved until now.

In addition, Bradley's proposal is no cause for celebration for the uninsured. He doesn't even call for universal health coverage, as Clinton did when campaigning for his failed plan in 1992. Bradley claims his plan will cover all children--not by providing healthcare directly, but by requiring parents by law to provide health insurance for their children! He proposes that those not insured through their employers be allowed to buy into the federal employees' health plan. A complex web of tax breaks and incentives would be provided on a sliding scale to help cover the costs. But, with the current monthly cost of a family health plan averaging between $497 and $531, Bradley's tax incentives are unlikely to make health coverage affordable for average working families. In Pennsylvania, for example, over 40 percent of uninsured children come from families earning more than $36,816 per year. Nationally, the amount deducted from parents' pay cheques for coverage tripled between 1987 and 1995.

Healthcare reform will not come about by these sorts of measures, which amount to little more than smoke and mirrors designed to leave intact the enormously profitable privatised healthcare system in the US. Profit making enterprises have overtaken the healthcare industry in the last decade. Between 1994 and 1997 nearly one in every three hospitals in the US was involved in a merger, and the pace has picked up since. For-profit healthcare giants do not even try to hide that they are designed to make profits by cutting costs. Without challenging this approach--which always places the need to cut costs over medical needs--patients will continue to suffer the consequences.

With a flood of publicity, the Clinton administration announced in 1998 that it was instituting a programme to enrol all eligible poor children into Medicaid. Yet last year total Medicaid enrolment dropped by 1.1 million--and 330,000 more children lost their health coverage. Most of the time, administrators do not tell poor families that they are eligible for Medicaid. As Gail Aska of the welfare rights organisation Community Voices Heard argued, 'The real information that people need isn't coming from the system. And why should it? The object of the game is to get as many people off welfare as possible.'

The healthcare crisis faces not only the 45 million people in the US who lack health coverage, but millions of others who are covered by plans which cost more each year and deliver less. In the last year alone, healthcare premiums rose 4.8 percent--for government workers they rose 10 percent. The average cost of a prescription drug has nearly doubled in the last six years. A minimum wage worker must pay a quarter of his or her income to cover the $200 monthly cost of blood pressure medication. Doctors report that many low income workers end up taking their medicine only every two or three days instead of daily to lower the cost.

Health insurers arbitrarily place spending 'caps' on treatments for life threatening illnesses such as cancer and heart transplants, leaving patients to choose between tens or hundreds of thousands of dollars in medical debt, or death. Time magazine summarised the problem last week in its article, appropriately entitled. 'HMO Hell':
'HMOs are only the most criticised part of a healthcare system caught in a weird paradox. America has perhaps the best doctors, the best hospitals and the best medical technology, and its health spending is the most lavish in the world.' Yet studies show that half or more of the eligible heart attack patients don't receive beta-blockers that could reduce the risk of another heart attack A 'substantial' number of cancer patients 'do not receive care known to be effective for their conditions,' says another study. And each year 106,000 hospital patients die from adverse drug reactions--wrong dose, wrong drug, wrong patient or wrong mix with other drugs.'

When deciding whether a patient needs hospitalisation, the slogan among managed care administrators is, 'When in doubt, carve it out,' said a former nurse at HMO giant Oxford Health Plans. Oxford gave its claims reviewers a cost saving goal of reducing hospital days by 1,000 in a given quarter--with the incentive of bonuses as high as 25 percent of workers' annual salaries if they reached the goal.

A 1997 annual report by the Kaulkin debt collection company bragged that healthcare collections make up the largest sector of revenues in the debt collection industry. Yet managed care executives are among the highest paid in the world, averaging $2 million per year in compensation and $12.6 million in stock options in 1997. These executives live in the lap of luxury from profits they make by denying needed medical care to millions of people and throwing millions more into debt. Real reform means people must be the priority, not profits. That can only happen when the very notion of making profits off medicine is challenged directly. Healthcare should be a right, not a privilege.