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In Health Care, the Real Issue is Justice

Please note: This op/ed was written for distribution to national and local press during Health Care Justice Week (10/13-22/00). Local activists are welcome to revise the text for publication with locally relevant information and a local author.

by Kenneth Frisof, MD

What is the real issue in health care in 2000? Is it providing prescription drugs to Medicare beneficiaries? Is it adding more poor children to Medicaid? Is it protecting patients against harm from HMO's? No, the real issue is deeper than any of these: it is justice.

There are 43 million uninsured living in the world‚s richest national during its longest economic expansion in history. Millions more insecure about their coverage. Other millions, even with insurance, who don't receive needed care because they can‚t afford what their insurance doesn't cover. Why aren't the politicians talking about any of these issues?

A World Health Organization study released this summer ranked U.S. health care first in the world in expenditures and technical quality, 37th in effective utilization of its resources, and an abysmal 55th in fairness. Why isn't this finding quoted on the campaign trail?

The United States is the only advanced democracy to enter the 21st century without a system of universal coverage. The German parliament enacted it in 1883; the Swiss in 1911; the English in 1946; the Australians in 1964; even the South Africans in 1996, two years after the end of apartheid. Why can't it happen here?

This nation has tried. In 1948 and in 1994, national health insurance initiatives were proposed by the President, discussed in Congress and defeated by lobbyists without votes even being cast.

Why is America so different from the rest of the world? Don‚t we care about each other?

As individuals and families and communities, we do care about each other. But our political system doesn't care about caring; it cares about cash. Universal coverage wasn't defeated in 1994 because the American people didn't want it, but because, as the political scientists say, "concentrated" interests were more concerned about the potential effect of reform on their bottom lines than on the health of the nation. Money doesn't simply buy votes; even worse, it affects what comes up for votes and what doesn't.

Where, then, are the voices for justice? They are straining to be heard, above the din of the paid political advertisements. The U2K (Universal Health Care 2000) Campaign was created a year ago by the National Council of Churches, the Cleveland-based Universal Health Care Action Network and the Gray Panthers. National endorsers include the American Public Health Association; the American Nurses Association; the American Medical Student Association; the two unions with the most health care workers, AFSCME and SEIU. Voices of the medical profession are being heard through the parallel D2K (Decision 2000) Campaign of the American College of Physicians/American Society of Internal Medicine.

The minimally funded U2K Campaign has already made a difference. We have persuaded members of Congress to establish a Universal Health Care Task Force to develop principled and practical proposals to end health care injustice in America. We have created Health Care Justice Week, from October 13 through October 22, during which there will be dozens of public events to let the voice of the people be heard. In houses of worship and in union halls, on the streets and in candidate forums, we will be raising the real issues in health care, the issues of justice. We are encouraging candidates for Congress to sign up as "Leaders for Health Care Justice," to commit themselves to participating in the Task Force if elected. Information on events during the week can be found on the U2K website: <www.u2kcampaign.org>.

As other democracies have shown us, there are a number of paths to quality health care for all. But to get there, we have to think big. We have to think about caring for each other. We have to think about justice. We need representatives who will be leaders for health care justice. Then maybe in the next election, the candidates will discuss the real issues in health care.

Kenneth Frisof, MD, is a practicing family physician in Cleveland and Co-chair of the U2K Campaign.



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