CLASS STRUGGLE

Special from Global Labor Strategies [print_link]

Normally the GLS Blog writes about issues that have a global dimension. But GLS staff regularly work on national and local issues as well.  We wanted to give our readers a window into some of this work, so below is a newly released pamphlet, entitled DOCTOR WALL STREET: How the American Health Care System Got So Sick, prepared by GLS staff member Jeremy Brecher and first published in Z Magazine.  An abstract and the pamphlet’s introduction are below. Download the full pamphlet here.

ABSTRACT: DOCTOR WALL STREET: How the American Health Care System Got So Sick

Few people know the real truth about how the American healthcare system came to be the way it is.  They know the system has a lot of problems, but they feel it must be the way it is for good reasons.  They are wary of reform because they fear attempts to fix the system might put what they already have in jeopardy.  DOCTOR WALL STREET: How the American Health Care System Got So Sick is a short (3200 word) easy-to-read pamphlet providing a unique historical account, based on recent scholarship, of how the American healthcare system got the way it is.  It’s a story of private interests – ranging from colonial era physicians to today’s drug corporations and private hospital chains – who shaped the system to serve their own greed and self-interest, not just patients’ health. But it also shows that, when people have spoken up forcefully, they have forced the system to provide healthcare to wider and wider circles of Americans.  This pamphlet provides knowledge that will arm Americans in their contemporary struggle to provide good healthcare to all.

Introduction

When ordinary Americans seek care for their health, they come up against a most peculiar system.

The U.S. has some of the most advanced medical science in the world.  It spends more of its resources on health care than any other country in the world.   Yet Americans’ health is rated near the bottom of developed countries.  In some of the poorest countries in the world people live longer, and fewer die in infancy, than in the U.S.  Americans spend nearly twice as much as Japanese on health care, but Japanese live on average four years longer.

The American health care system spends one-third of its cost on paperwork, waste, and profit over and above the cost of actually providing health care.  Yet nearly one-third of Americans are without health insurance over the course of a year.   In all other developed countries, more than 85% of citizens have health coverage under public programs.

The American health care system is so complex that even experts – let alone ordinary people trying to find care for themselves and their loved ones — are unable to fully understand it.  It is highly bureaucratic.  This “system” is balkanized into medical fiefdoms, making it difficult to access the care and caregivers you want and to maintain continuity of care.  People who have good health benefits in one company or state are afraid to change jobs or locations because they will lose their health benefits.

The American health care system is full of inequalities.  People who work for one company may have high quality insurance while those who work for a similar company have none.  People who would have Medicaid insurance in one state are denied it in another.  While on average 70 percent of Americans have private health coverage, 50 percent of African Americans and 60 percent of Hispanics don’t.

The quality of care provided by the system is uneven.  While health care personnel are often regarded as excellent both by patients and by independent evaluators, they are subject to constant pressure and speedup.  And people are often refused treatment they need by managed care officials who are not even doctors.

Despite its high cost to individuals, employers, and society, this system leaves many people feeling desperately insecure.  They worry: What will happen to me if I get sick?

This pamphlet tries to answer the question: How did the American health care system get the way it is?  It aims to makes the work of scholars who have studied the system’s history accessible for ordinary people who are trying to navigate the health care system – and to fix it.

The American health care system is incompressible if we try to understand it as a way to meet Americans’ need for health care.  But it becomes easier to understand when we recognize that it was not designed primarily by or for the people who were likely to need health care.  Rather it was constructed by private interests who aimed to shape the system for their own benefit.  At various times those interests include employers, doctors and other medical professionals, insurance companies, unions, and profit and non-profit health service providers.  The peculiar system we inherit today reflects their struggles with each other and with the public interest.

But if private interests have shaped the health care system, why does it protect ordinary people at all?  In the background of this story is a hidden reality.  For a century, the American people have increasingly believed that health care should be should be guaranteed as a basic human right and demanded that it be available for all Americans.  Doctors, employers, and politicians have all had to pursue their interests by tacking against this powerful wind.

When the people have spoken up forcefully, the health care system has been pushed toward better meeting their needs.  It has happened before and it can happen again.

Download the full pamphlet here.