Happy birthday, Medicare!

July 30, 1965: President Lyndon Baines Johnson signs Medicare into law. Also seated is President Harry Truman, recipient of the first Medicare card.

July 30, 1965: President Lyndon Baines Johnson signs Medicare into law. Also seated is President Harry Truman, recipient of the first Medicare card.

Medicare turns 44 years old today. It’s in good health.

The program remains efficient — Medicare’s administrative costs are about three percent, much less than that of employer-based private insurance (five to ten percent of premiums for large companies, 25 to 27 percent for small ones) or individual private insurance (40 percent of premiums). Medicare, of course, doesn’t devote administrative dollars to denying coverage or claims on a case-by-case basis. Also, unlike the private insurance industry, it doesn’t seek out profits.

And Medicare remains popular, so much so that weakening it is a legislative third rail that health care reformers are finding they have to avoid at any cost. That’s true even if some of its biggest fans are confused about how it works:

At a recent town-hall meeting in suburban Simpsonville, a man stood up and told  Rep. Robert Inglis (R-S.C.) to “keep your government hands off my Medicare.”

“I had to politely explain that, ‘Actually, sir, your health care is being provided by the government,'” Inglis recalled. “But he wasn’t having any of it.”

Actually, Inglis doesn’t have it right either: Medicare is national government financing for health care, not government provision of health care. Medicare-financed health care is provided by private doctors, clinics and hospitals. Medicare is an example of what journalist T. R. Reid calls the National Health Insurance model, like the health care systems of Canada, Taiwan and South Korea. Canada, in fact, calls its system “Medicare” too.

Here in the United States, Medicare is a model for treating health care as a public good rather than a commodity: a system in which benefits and contributions are fairly shared, one that works for everybody, rather than one in which health care is something to be bought and sold — and tough luck for those who can’t afford it. Medicare is like a fire department that protects everyone’s house — like the fire departments we actually have in this country. The private parts of our health care financing system are like fire departments that only protect the houses of people who can afford to pay.

The current health care reform process offers an opportunity to move towards establishing health care in this country as a public good and a human right. A key step is establishing a new Medicare-like public health care plan that guarantees access for all, something we’re calling on Senate leaders to do.

The Senate is the key battleground now. Of all the Congressional committees with health care jurisdiction, the Senate Finance Committee is least hospitable to a public plan, and has yet to pass a bill. The eventual Finance Committee bill faces a bruising reconciliation with the Health, Education, Labor and Pensions Committee bill that’s already passed. And there will be a further fight when the full Senate debates and votes on the merged bill. In honor of Medicare’s birthday, tell Senators Baucus (chair of the Finance Committee), Dodd (HELP vice chair, running the committee with chair Ted Kennedy ill) and Reid (majority leader) to ensure the final Senate bill provides a Medicare-like public health care plan for all.

Over the looming August recess — the Senate is scheduled to adjourn next Friday, August 7 — everyone with a vested interest in keeping health care a commodity will be working as hard as possible to close the window on a new Medicare-like public plan. Which makes the delaying tactics we’re seeing on the Hill that much more galling. Health care legislation doesn’t have to take this long. In 1965, after all, in the first year of Johnson’s second term, Congress passed Medicare in late spring, in time for the president to sign it into law on July 30 — 44 years ago today.

Happy World Health Day!

Today is the 60th World Health Day, which the World Health Organization uses to highlight a different health theme each year. Today it’s making hospitals safe in emergencies, which WHO Director-General Margaret Chan promoted at an event in China, nearly a year after the Chengdu earthquake. The WHO’s activities to mark the anniversary of the disaster seem to have been warmly received, unlike those of environmental activist Tan Zuoren, who last week was detained by the police in Chengdu, apparently because he planned to publish a list of children who died and a report on the role corruption played in the schools that collapsed. He’s currently at risk of torture.

Here in the United States, particular hospitals are vulnerable to disasters like Hurricane Ike — and our health care system as a whole is facing a slow-motion emergency. The figure you often hear of one in six people in the United States lacking health insurance is just the tip of the iceberg — one in three non-elderly Americans was uninsured at some point in the last two years (as Families USA recently reported).

Our health outcomes are a cause for shame: on women’s lifetime risk of dying in pregnancy or childbirth, the United States ranks 41st in the world, and black women have three times the maternal mortality rate of white women (as AIUSA is currently investigating).  

Will health care reform fix these problems? That’s up in the air right now. But the starting points for that process are cause for despair: What can get past a filibuster? What will entrenched interests sign off on?

Human rights give us a fundamentally different place to begin. As the WHO’s constitution says,

The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.

A health care debate that takes human rights seriously starts where the WHO’s constitution does: every human being has the human right to health care. That’s exactly where AIUSA’s new statement of health care principles begins: for a health care system to fulfill the human right to health care, it must be universal — as well as equitable and accountable.

Do you agree that health care is a human right? Then celebrate World Health Day by adding your name to AIUSA’s petition. Join us in bringing human rights to the health care debate!

AIUSA has joined with the National Economic and Social Rights Initiative, the National Health Law Program, and the Opportunity Agenda to form the Health Care is a Human Right Coalition. Don’t miss NESRI and NHeLP’s ten human rights principles for financing health care (long version, short version, press release), and OA’s State of Opportunity in America, 2009, which assesses the current state of health care as well as income, education, poverty and incarceration.

Report on Palestinian Health Care released

Lancet, a British public health journal, released yesterday a series of reports entitled Health in the Occupied Palestinian Territories which examine the health situation in the West Bank and Gaza. The five reports cover the status of health in the OPT, maternal and pediatric health, common diseases, health as a security issue, and a health-care system assessment for the occupied Palestinian territories and take into consideration issues such as security, the availability of resources, the various conflicts between Israel and Palestinian organizations, the blockade of Gaza, and the occupation of Israeli troops. The series was compiled as a joint effort by health scientists in the OPT, together with help from WHO, associated UN agencies, and academic institutions in the USA, UK, Norway, and France.

It makes claim that the security threats to the region originate, at least partially, in constraints imposed by Israel such as checkpoints and border closings which prevent access for patients and medics, create a shortage of medical supplies, and “affect every aspect of Palestinian life, such as the ability to travel, work, marry, study, worship, and be with family…[thereby] compromis[ing] the social determinants of health by increasing social exclusion, unemployment, and creating barriers to food, social support and transport.

The reports also discuss how the armed conflicts in the area have negative mental health impacts in children. Studies done even before the recent conflict illustrated the traumatic effects that witnessing brutally violent acts can have on children, resulting in “behavioral problems, fears, speech difficulties, anxiety, anger, sleeping difficulties, lack of concentration at school, and difficulties in completing homework. In order to solve the health crisis in the region, the series calls for a just political and economic solution, claiming that if international laws were respected and enforced, they could “protect Palestinians from insecurity

The full series can be found at www.thelancet.com(free registration is required).

Gaza By The Numbers

A snapshot of Gaza by the numbers:

Humanitarian Assistance

  • Movement in and out of Gaza is all but impossible and supplies of food, water, sewage treatment, basic health care have been drastically affected by the blockade of aid. Food prices are rising and wheat, flour, baby milk, and rose 34%, 30%, and 20.5% respectively during the period May-June 2007 alone.
  • Prior to the blockade (implemented after Hamas took over total adminstration over Gaza in June 2007), around 250 trucks carrying aid entered Gaza each day.
  • As of March 2008, that number was reduced to 45.
  • According to UN figures reported in the Guardian, that number dropped to just 5 in December.
  • Most recently, the Israeli government prevented a Libyan ship carrying 3000 tons of aid from entering Gaza.

Poverty and Dependency on Food Aid

  • Number of people living in absolute poverty in Gaza in 2008: 80%
  • Number of people living in absolute poverty in Gaza in 2006: 63%
  • In 2007, households were spending 62% of their income on food.
  • In 2004, households were spending 37% of their income on food.
  • As of March 2008, there were over 1.1 million people—three quarters of Gaza—who are dependent on food aid. In less than ten years, the numbers of families who depending on UNRWA food aid has increased ten-fold


  • In June 2005, there were 3,900 factories in Gaza employing 35,000 people.
  • In December 2007, there were just 195, employing only 1,700.
  • Unemployment is close to 40%.
  • 40,000 agriculture works who depend on cash crops now have no income.
  • In September 2000, 24,000 Gazans crossed into Israel to seek cheap labor. Now that number is zero.

Schools, Electricity, Medical Supplies

  • In January 2008, UNICEF reported that schools in Gaza had been cancelling classes that required high energy consumption like IT, science lab, and extra-curricular classes.
  • Hospitals cannot generate electricity to keep lifesaving equipment working or to generate oxygen, while 40-50 million liters of sewage continues to pour into the sea daily.
  • Hospitals are currently experiencing power cuts lasting for 8-12 hours a day.
  • There is currently a 60-70 percent shortage reported in the diesel required for hospital power generators.
  • According to the World Health Organization, the proportion of patients given permits to exit Gaza for medical care dropped from 89.3% in January 2007 to 64.3% in December 2007.
  • Many of those who are given permits are blocked at the crossing itself. In October 2007 alone, the WHO confirmed that 20 patients died because they were denied access to refereal services. Five of these deaths were children.

In speaking about the current wave of violence, Israel’s ambassador to the United Nations, Gabriela Shalev pledged that Israel will “destroy completely” the “terrorist gang.”

But the facts show that much more than a “terrorist gang” is being destroyed in Gaza.

(Unless otherwise indicated, all facts in this post are from the report “The Gaza Strip: A Humanitarian implosion” co-authored by Amnesty International, Oxfam, Medcins de Monde UK, CAFOD, Save the Children UK, TroCAIRE, CARE, and Christian Aid).

Roads to Single-Payer

Commenting on Vienna’s post on universal health care, J writes:

Health Care for America Now (HCAN) does not support single-payer healthcare. They support Obama’s mixed public/private insurance plan.

It’s true that HCAN supports a choice of private or public plans. Which means they don’t support single-payer right away. That doesn’t mean that what they’re proposing won’t lead to single-payer eventually.

Look at HCAN’s list of congressional supporters. It includes Barack Obama (and Joe Biden). But it also includes … John Conyers (who introduced H. R. 676, the single-payer bill Vienna was writing about).

Single-payer advocates who sign on to Obama/HCAN-style mixed public/private plans will have to push for certain key elements to make it into the final legislation, like (for example) a public option (“Medicare for anyone who wants it”) and strong regulation on private insurers prohibiting discrimination based on pre-existing conditions.

For better or for worse, the mixed plans have a lot of momentum right now. The biggest domestic health care event of the week was Senate Finance Chair Max Baucus unveiling his new white paper. He isn’t an HCAN supporter, but  his plan is in the Obama/HCAN vein. Very roughly, it’s Obama plus an individual mandate.

For more healthcare activism, check out Families USA’s Stand Up for Healthcare, including their excellent blog, and long-time single-payer advocates Physicians for a National Health Program, which Lynn Moses Yellott was right to highlight.

What's So Funny About Universal Healthcare?

Yesterday someone emailed me a link to a mock NYT article, National Health Insurance Act Passes.  I’m embarrassed to confess: I fell for it, hook, line and sinker. I believe that universal health care is one of the most important issues of our time, so, for a minute, as I read the first few paragraphs, I was elated. And then I noticed the date: July 4, 2009.

The United States National Health Insurance Act really does exist. Representative John Conyers first introduced the bill (H.R. 676) in 2003. Today there are 93 cosponsors. The bill would create a publicly financed, privately delivered health care system for all, essentially expanding the U.S. Medicare program.   It would be what is described as a “single payer” system.

Polls show that some sixty-four percent of Americans want the U.S. to adopt universal health insurance. Fifty-four percent support a single payer system, as do 6 in 10 physicians. President-elect Obama has said that he would  consider a single payer health care system if he were designing a system from scratch.

So why does the idea of “Medicare for all” seem so far-fetched?  Is it really on “that’ll never happen” par with Donald Rumsfeld tearfully admitting on “The View” that “the whole torture thing wasn’t such a good idea” (as reported in another mock NYT article)?

Are we intimidated by the prospect of confronting a powerful insurance lobby? Is the stumbling block the “socialized medicine” label that opponents are quick to throw around?

I’ll confess one other thing: the article left me feeling energized in a surprising way.  For a moment, I felt what it would be like to learn that Congress had taken a genuinely groundbreaking step to ensure that no one falls between the cracks. That the right to health care would finally be something people enjoy and not just hear about in debates. That 18,000 people wouldn’t die that year because they couldn’t afford care. That hundreds of billions of dollars wouldn’t be diverted from health care to administration while policymakers talk about having to make hard choices about who can be covered. And that hundreds of thousands of people wouldn’t be forced into bankruptcy or homelessness by crushing medical bills.

So what do you think? Can we make universal healthcare a reality in the United States?

Learn more about what activists in the U.S. are doing to bring about universal healthcare:


Health Care for America Now


Human Right to Health Care