Occupying the health care industry

By Jordan Green
Yes! Weekly (Greensboro, N.C.), Dec. 7, 2011

The Cone Health Family Medicine Center on North Church Street in Greensboro might seem an unlikely place for a revolt to stir, but that’s exactly what was happening as Health Care for All North Carolina gathered for its annual meeting on a recent Saturday afternoon.

At the 1 p.m., about nine people — mostly physicians — had assembled.

Their number more than doubled when organization president Dr. Jonathan Kotch escorted Dr. Steve Auerbach, the keynote speaker, into the room. They were running late because Auerbach’s meeting with Occupy Durham had run over.

Auerbach fiddled with an overhead projector and showed some footage of New York City health care workers marching with Occupy Wall Street, but couldn’t get the audio to work, so he went right to his slide show.

“It’s really, really bad right now,” said Auerbach, a pediatrician who is a member of the N.Y. board of directors of Physicians for a National Health Program. “Also, it’s gotten worse. It’s gotten worse for awhile, and in the past couple of years it’s been getting worse a lot faster. It used to be better, which suggests it doesn’t have to be this way.”

Auerbach, who wore a blue dress shirt, tie and blue jeans, spoke in a raspy, direct manner, conveying by turns outrage, compassion and flashes of black humor with wit and occasional profanity, in contrast to the more reserved docs from North Carolina.

“What’s the it?” he asked. “Anything you want: Income, income inequality … hollowing out of the middle class….”

Auerbach has been presenting a slide show about single-payer health care to Occupy groups. Explicit in Health Care for All NC’s name is advocacy for the idea that “health care is an essential safeguard of human life and dignity,” and that the state has an obligation to ensure that everyone has access to it. This audience was already pretty well versed in the fine points of single-payer, so Auerbach focused his remarks on income inequality.

The tea party pinpoints the historical moment when everything went wrong to 1913, when Congress ratified the 16th Amendment, allowing the federal government to collect income tax.

For Auerbach, it goes back to 1971, when the so-called “Powell Memo” was drafted. Charting economic history, Auerbach told the North Carolina physicians that prior to his confirmation to the U.S. Supreme Court, a corporate lawyer who worked for the tobacco industry named Lewis Powell drafted a secret memo to the U.S. Chamber of Commerce arguing for an aggressive effort to shape public opinion to counteract mainstream support for regulation.

Auerbach displayed a line graph representing the share of national income commanded by the wealthiest 10 percent beginning in 1917. The line lurched upward through the 1920s. “We still have the gilded era,” Auerbach said, noting that the wealthiest 10 percent received more than 50 percent of income at that time. Then, around the time of World War II, the line plunged into the 30s – “the great moderation,” as Auerbach described it – where it remained through the 1960s.

“Starting in the early ’70s, we go right back up to the gilded era – plutocracy,” he said. Now, based on widely published statistics, wealth distribution is back to 1920s levels, with the richest 10 percent earning almost half of the national income.

Among the policy decisions of the past 30 years cited by Auerbach and other progressives as responsible for the widening income gap are deregulation, reductions of the effective tax rate on the wealthy including capital gains and attacks on unionization.

“If you want to talk about a sin, it’s a sin that you work for minimum wage, and you do all the right things, and you still can’t make ends meet,” Auerbach said. “That doesn’t even include waitresses and farm workers, who are exempt from minimum wage. You know, you have to earn at least $12 per hour to live above the official poverty level.”

Auerbach, who describes himself as part of the “2 percent,” told his fellow physicians, “We’re doctors; we make a lot of money.”

For Auerbach, that means a home in the Upper West Side of Manhattan with ample square footage. It means his kids are enrolled in good schools, and “a certain high lifestyle.” He added that he makes his money through earned income, and his earnings are taxed at 33 percent of his income, as opposed to those whose income from capital gains is taxed at 15 percent.

Auerbach’s animated presence conveyed a conviction that not only is change desirable but also attainable as a matter of citizens taking responsibility for shaping the course of human events. And he seemed pretty confident in sizing up the opposition.

“I think this is where the anger of the pretty well to do is coming from,” he said. “That may be where the anger of the tea party is coming from, to the extent that it’s not a phony, cooked-up thing completely.”

Tax policy is not typically the domain of the medical establishment, but Wayne A. Hale, coordinator of geriatrics at Cone Health’s family medicine residency program, seemed willing to grapple with it.

“This reminds me of the obesity epidemic,” Hale said. “We’re trying to change individual behavior, but we have so much advertising money stacked against us.”

Auerbach presented a set of statistics indicating that poor people pay a higher share of their income to health care than other cohorts and that the portion of their income eaten up by sickness and disease is creeping up.

“Before the 2007 meltdown, 62 percent of personal bankruptcies were due to medical causes,” Auerbach told me after his presentation. “Of those, 78 percent had medical insurance but they ran into trouble because of high co-pays and benefit caps. That doesn’t happen in other countries. It’s unimaginable. It can’t happen.”

As evidence that income inequality is affecting health, Auerbach told me the greatest predictor of health is family income and wealth, followed by race. Poor people are sicker, he said, and they have less money to pay for it.

“As a physician, I have an oath to do no harm,” Auerbach said. “Corporations are doing harm. My patients are people. Corporations are not people. My duty is to my patients.”