Health Crisis in Louisville's West End

There is a solution, experts tell forum
By Anne Braden
The Louisville Defender
(Special to The Defender)
Thursday, September 8, 2005

Millions of people across the U.S. are in poor health, and many are dying of diseases and conditions that could have been cured. Thousands of these people live in Louisville --- the largest number in the West End. This is a tragedy and it does not have to be that way.

That is the message brought to a recent community forum sponsored by the Kentucky Alliance Against Racist & Political Repression at its headquarters on Broadway by Dr. Adewale Troutman, director of the Louisville Metro Health Department and two other panelists.

“This is a matter of social justice and human rights,” Troutman said. “We are told that in this country we are guaranteed ‘life, liberty and the pursuit of happiness.’ But we can’t have any of these unless we have health care.”

There are a number of reasons why so many Americans die when they don’t have to, and the principal one is that people do not get preventive care, the panelists told the forum. “They do not go to a doctor or clinic for regular check-ups, so by the time they are diagnosed, it is too late,” said another panelist, Dr. Garrett Adams, a distinguished local physician.

And they don’t go for check-ups because they don’t have health insurance, the panelists told the forum. (A recent Census Bureau report based on Year 2000 figures, stated that 45.8 million people in the U.S, have no insurance at all, and 530,000 of them live in Kentucky, about, 85,000 of them in Louisville. And that many more are under-insured, some say as many as 80 million.)

There is an answer to this crisis, Dr. Troutman said. It’s Single-Payer National Health Insurance.

Most people --- including the people who need it most – don’t know what that term means. The name is not very descriptive.

Panelists at the forum put it simply. “It’s a system like Medicare,” said Dr. Adams “But it’s not just for people over 65, it’s for everybody, and it covers all medical conditions.”  

If it’s so simple, then why don’t we have it?

Dr. Adams put that simply too. “The block is the insurance industry,” he said. “The insurance companies are parasites feeding off the medical system. They are the middle-man, and Single Payer would cut them out.” And they spend some of their huge profits, Adams said, to use their connections to mass communication systems to tell people Single Payer would be a calamity and would be bad for them.

But today there is hope that this powerful force can be overcome, said the third panelist, Kay Tillow, a coordinator of a broad local coalition, Kentuckians for Single Payer Healthcare. Rep. John Conyers (D-Mich.) has introduced a bill in Congress to implement Single Payer, HR 676. It is called the Expanded and Improved Medicare for All Bill. And a mass movement in support of it is spreading like wildfire all across the country.

Dr. Troutman, who is recognized nationally as an authority on health care conditions in African American communities, also stressed the wide gap that exists between health conditions in the white and Black communities. If you are Black, statistically you are 2-1/2 times more likely than whites to die in infancy, and your life span will be 10 years shorter than that of whites. African Americans are 12 percent of the U.S. population but 27 percent of the uninsured.

The Facts & the Figures

All the panelists peppered their presentations with statistics and factual information. Dr. Adams showed slides with charts demonstrating the rising numbers of uninsured people and the growing number of administrators of health care services.

Dr. Troutman noted that much of his academic training and experience has been in research and statistics. “Anything I tell you is backed up by statistics and facts,” he said. “We do not have a health care system in the U.S. We have a fragmented program to manage sickness.”

For example, the panelists presented these facts:

• This is the only industrialized country in the world that does not have a guaranteed health plan for all of its people.

• The U.S. spends an average of about $5,000 per patient on health care. Other countries, which have national health programs, spend between $2,000 and $3,000. But, according to the World Health Organization, the U.S. is 37th in the world in efficiency of health care delivery.

• 18,000 people in the U.S. die each year for lack of health insurance. That’s six times the number that were killed in the 9/11 attack on the World Trade Center.

• Between 80 and 85 percent of the people without insurance in the U.S. are employed. They just can’t afford rapidly rising insurance premiums, which have increased by double digits each year since 2001.

• Drug company profits average four times those of other Fortune 500 companies.

How It Would Work

About 35 people attended the forum. They were very diverse, racially and age-wise, and came from many sections of the community. They were full of questions to the panelists.

First of all, they wanted to know exactly how Single-Payer would work. Dr. Adams explained it, step by step. Every person in the country could apply for and receive a National Health Insurance Card. When they needed treatment or a diagnosis, of just a check-up, they would go to the doctor, clinic or hospital of their choice. That health provider would send the bill direct to a special agency created for this purpose. It would pay the bill direct to the provider. The patient would owe nothing. There would be no deductibles or co-pays.

Coverage would be comprehensive for all medically necessary care, including home health, nursing homes, dental, vision, mental health, hospitals, office visits, physicians, laboratory tests, medicines, and rehabilitation. Thus, like Medicare, the program would be “publicly funded and privately delivered.”

And where would the money to finance the program come from? From a modest payroll tax on employers and employees --- less than employers pay now to private insurers if they provide coverage to their employees, and less than employees pay private companies if they can afford insurance at all. In addition, there would be a tax on corporate profits and higher rates for people whose income is over $250,000 a year. A subsidy from the Federal Government would be much less than it now puts into health care because the huge administrative costs of private insurers would be eliminated.

But what about employees of insurance companies who would lose their jobs? The Conyers bill provides a cushion for these people, Dr. Adams said, as any humane government should, when progress inflicts suffering on some individuals. In a program something like the GI Bill after World War 11, displaced workers would be subsidized for several years while they returned to school, entered training programs to learn new skills and professions, or established diverse businesses of their own.

Countering the Arguments of Opponents

And what, members of the audience wanted to know, should they say to counter the arguments of those who say Single Payer would destroy the so-called “health system” and them?

All of this, Dr. Troutman said, is a web of myths, circulated by those who control the channels of mass communication and the economy, and it’s an old pattern. In the 1920s for example, the scare word was “Bolshevik,” and the American Medical Association turned people away from the simple reform of health clinics in poor communities by giving them that label. Later, in the mid-20th Century they called universal health care “socialized medicine,” and today, they still use that term. They also say Single Payer would lower the quality of health care, drive young people away from seeking medical careers and experienced doctors out of the country or out of the profession, would mean waits for months or even years to get service at hospitals, and would bankrupt the country.

None of this, Dr. Troutman and Dr. Adams said, is true. Single-payer is not “socialized medicine,” in which the government would run health care. Rather it is like the Canadian system in which patients choose the provider they want and a public agency pays for it --- a system that is “publicly financed but privately delivered.” The tales of long waits in Canada are greatly exaggerated, but where they happen it is because the Canadian program is under-funded. If Canada spent anywhere near as high a percentage of its Gross National Product on health care as the U.S. does, there would be no waits.

They said some high-priced specialists might flee the profession, but Cuba, which has a socialized system and has the best health delivery system in the world, according to researchers, recruits more youth into the profession than it needs and exports doctors to other health-starved countries. The volume of paperwork in Canada is much smaller than the amount required by private insurers in the U.S. And the cost to the government of a Single Payer plan would be much lower than the amount it now pays to states and health providers.

Journeys to Commitment

The recent forum was moderated by Alice Wade, Organizer/Coordinator of the Kentucky Alliance. The introduction of the panelists included brief summaries of their unique life stories, and each one opened their presentation by telling about their own journey to a commitment to Single Payer. Dr. Troutman grew in the South Bronx when that area was predominantly African- American and in an advanced state of decay. He was the son of a single mother who worked at low-paying jobs to support her children, and he lived on the streets. Most of his close friends are now either dead (one in the East River), on drugs living the life of a dealer, or in prison. He says he often wonders why his position is totally different and concludes that it must be the work of a Divine Providence and God must have a purpose for his life. Something in Troutman turned him in the direction of service to others very early. As a student, working his way through City College of New York, he became a part of the Black Liberation Movement of the 60s in New York and organized the first Black Student Union in New York’s university system. He went on to earn a medical degree and a Master’s in both public health and Black Studies in distinguished universities. When he came out of school, he had already decided to use his education and skills to improve the lives of Black and poor people. Since then, he has held high positions in both public agencies and private health care facilities, and in research institutions and has used all of them to pursue his purpose of helping the people he left behind in poverty and isolation. (He worked with Former U.S. Surgeon General Dr. David Satcher on a widely-acclaimed study of the Black/white health gap and co-authored a recent highly-publicized article based on this study entitled “What If We Were Equal?”)

Since becoming Louisville Metro Health Department’s first African American director in January 2004, his primary objective has been to make that agency’s services and information more readily available to poor communities, and he has already accomplished a series of reforms. He has come to believe that real health care requires more than physical care. He said it must also address the mental, psychological and spiritual needs of people. And he believes bringing real health reform will require taking on the host of evils that plague health-starved communities --- for example, lack of jobs and educational opportunity and hopelessness.

Dr. Adams was born in Nashville and recently retired from the full-time faculty of the U of L School of Medicine where he was Chief of Pediatric Infectious Diseases and Medical Director of Communicable Diseases at the Metro Health Department. He holds an M.D. and Master’s degrees in Public Health from a series of top-ranked universities. For many years, he was on the staff of Kosair Children’s Hospital and says that despite its valiant efforts to meet the needs of struggling parents and their children he saw the deterioration in health care access and delivery throughout the U.S.

He says he first heard of Single Payer insurance from a medical journal article he read when he was working at the Metro Health Department two years ago. His curiosity was aroused, and he looked at the web site of the Physicians for a National Health Program ( He endorsed the Physicians Proposal for a National Health Program, and he soon found he was not alone. He said when he signed on in August 2003, there were 8,000 doctors across the country who had done the same thing. By last January, he said, this number had increased to 13,000. The American Medical Association, which only represents 25 per cent of American physicians, still opposes Single Payer, but many primary care physicians --- frustrated by worsening life conditions in low-income communities and the inability of health care agencies to meet their needs --- are organizing rapidly everywhere for Single Payer.

Kay Tillow is a native of Western Kentucky and --- like Dr. Troutman --- came to maturity in the 1960s. She became an organizer and worked first with miners in Eastern Kentucky where the miners’ union was under massive attack, was losing members as union mines shut down and was being forced to close its network of hospitals in the mountains. Later she moved to Pittsburgh and worked many years on the staff of the union that represented hospital workers there and fought not just for their rights but also for better health care for patients. About 15 years ago, she returned to Kentucky, and began organizing hospital workers first in Western Kentucky and then in Louisville. She now serves as staff of the Nurse’s Professional Organization (NPO), the union which represents local hospital workers. It has carried on a long struggle with the Norton hospital system, and has recruited a majority of the workers in one of its hospitals. But it has been unable to get a contract because Norton has steadily refused to negotiate, despite several decisions from the National Labor Relations Board ordering it to do so.

Tillow still works as staff for NPO while she helps organize Kentuckians for Single Payer Healthcare. She says the local group is part of a burgeoning national movement to pass the Conyers bill. Fifty members of Congress have joined Conyers as co-sponsors of the bill. “But there are over 400 members, so we have a long way to go,” Tillow said. “But we are growing fast.” She said that nationally scores of religious institutions, civil-rights organizations and unions have endorsed the bill, and the local coalition is also growing. It will soon begin to work to get the state legislature to enact a Single Payer plan for Kentucky. Tillow was a key organizer of a coalition seeking a Kentucky Single Payer plan over a decade ago, and she recalled that the recently deceased Leonard Gray, who was then a state legislator, introduced a bill to enact a state plan. It did not get out of committee, but meantime the coalition supporting it did extensive research and proved that such a plan would be much less costly to the state than its current levels of subsidy to health institutions.

A Personal Experience

Dr. Troutman ended his presentation to the forum with another personal story. He said he recently had occasion to be hospitalized himself--- for a minor condition that needed official diagnosis. He said he got into a local hospital immediately and got thorough and skilled attention from doctors and staff. He said he realized this was because he is a doctor himself and has good insurance. But then he added:

“I stayed one night, they gave me one pill, did a cardiogram, stress test and one other test and three (not so good) meals.” When I left, they gave me a copy of my bill on which the balance due was zero because my insurance was paying it. When I got home and looked at it, the total was over $12,000. I thought to myself, ‘If I didn’t have insurance, what would I do?’ I would have to take bankruptcy and would probably lose my home. I realized that this is what happens to millions of people in the U.S. --- studies show that 51 percent of bankruptcies result from medical crises.”

Dr. Adams said the experience had strengthened his determination that this experience not happen to any more people in Louisville.

Dr. Troutman is eager to speak to more community groups about Single Payer and the Black-white health gap. If your church or neighborhood group or union local would like to have him, call the Alliance at 778-8130 and they will tell you how to contact those responsible for his schedule. Tillow and Dr. Adams said their organizations also are eager to provide speakers.

Contact Kentuckians for Single Payer Healthcare at 459-3393, Also everyone is welcome at regular meetings of the Coalition. They meet on the third Thursday of each month, 5:30 to 7 p.m. at Central Presbyterian Church, Fourth & Kentucky.