The following remarks by Dr. Claudia Fegan, past president of Physicians for a National Health Program, were delivered to the annual strategy conference of Healthcare-Now! on Jan. 28 in Houston.
By Claudia Fegan, M.D.
Dr. Claudia Fegan
On Jan. 19, Sarah Burke, a Canadian treasure, a pioneer in the sport of freeskiing who was instrumental in getting that sport added to the next Winter Olympics, died at the age of 29.
Sarah, a resident of British Columbia, died from injuries sustained in a fall on Jan.10 at the end of a practice run in Salt Lake City, Utah.
Sarah Burke was a phenomenal skier, immensely talented and tremendously enthusiastic about her sport. If you want to see grace in motion you should search Sarah Burke’s name on YouTube. She soared like an eagle and glided through the air effortlessly.
Immediately following her death her young husband and parents were presented with a bill for $550,000.
While she is Canadian and had cradle-to-grave coverage by Canadian medicare, she did not have coverage for this accident which occurred in the United States. She was covered by her professional skiing organization when she participated in sanctioned events; however, her training run in Salt Lake City was not a part of a sanctioned event.
Now it is true Canadians were stunned by the bill she had racked up during her 10-day ICU stay. However, they were shocked to learn that how much you are billed depends upon your insurance status. They were even more appalled to discover that being uninsured would result in being charged more for health care than if you were insured.
Sarah’s friends took to the Internet and have already raised $294,200 toward her outstanding bills. Unfortunately, most of the 50 million people who are uninsured in the United States today aren’t lucky enough to have a following to raise money to pay their medical bills.
That brings me to why I am here today. I would like to do five things this evening, although my English teacher husband tells me I should never to try to do more than three. So here goes:
1. I want to tell you what I do
2. Tell you why I do what I do
3. Tell you what Barack Obama did
4. Tell you why you must do why you must do what I do
5. Tell you how you can do it
What I do
So I am the Chief Medical Officer for the John H. Stroger Jr. Hospital of Cook County, or as most people outside of Chicago know us, Cook County Hospital. We are unusual among the public hospitals that remain open in the United States today because we still take care of everyone who comes to our door, regardless of their ability to pay.
That means last year 80 percent of the outpatients we saw were uninsured. Fifty-six percent of the patients we admitted were uninsured. The variance is because almost a quarter of those we admitted were able to get insurance once they were in the hospital and we had a chance to apply for coverage on their behalf.
Over the years I have spoken a lot about health care and I usually speak about my patients.
I remember at the Democratic National Convention in 2008 I talked about my patient Nina, who was a hairdresser who had no insurance. When she found a lump in her breast she was afraid to come to the hospital. When her daughter finally brought her in both breasts were rock hard and the tumor had begun to drain from one of the breasts.
Camille had been diagnosed with breast cancer when she was employed and was initially cared for at the University of Chicago where got excellent care. A couple of years later, after she had been laid off, she began to have problems again. Her surgical oncologist wouldn’t return her phone calls and her oncologist told her she couldn’t see her without insurance. So she came to County, where we took care of her.
I have talked about my 63-year-old patient Delois who needed a hip replacement because her joint had been destroyed by arthritis and she had bone grinding on bone. At County we don’t do joint replacements because we can’t afford the prosthetics. All we can do is give those patients pain medication, try to get them disability coverage so they can go somewhere else or wait for them to turn 65.
Then there is my patient Joan, who after a career as a bookkeeper thought she could contribute more to society by teaching music to children. She was frugal with her funds, purchased a small studio and some instruments. She hired instructors, most of them part-time. It means most of the instructors are musicians or schoolteachers whose available time coincides with when there is the most demand for lessons.
For years Joan was able to provide affordable lessons for students and sometimes free instruments for students who couldn’t afford them. She never made much money, but it gives her great joy to bring music to children. Joan does this work because she says it makes us a better society.
In the last three years the number of parents bringing their children for lessons has decreased, the expenses for the studio have increased and Joan has struggled to make ends meet.
For years I have managed Joan’s blood pressure and that has been a cost-saving to her because in the Cook County Health and Hospital System we charge patients based on their ability to pay. So last winter when she fell from her bicycle in Chicago snow and broke her ankle, there was no one to raise money for the surgery she would need to put it back together. With a broken ankle she couldn’t even climb the stairs to her second-floor studio.
Joan did the only thing she knew to do — she dragged herself with her broken ankle to our emergency room, where she knew she would be treated with dignity and respect and where she knew she would not receive a bigger bill because she was uninsured. Surgery went well and Joan has not traded her bike for a car; she has splurged on a three-wheeler instead.
So what I do is advocate for the 50 million uninsured in this country who seek nothing more than Health Care Justice. Yes, I personally take care of the Ninas, Deloises, Camilles and Joans who come to our doors, but in my spare time I fight for social justice.
Why do I do what I do?
Martin Luther King said, “The time is always right to do what’s right.” Well it is not right to punish people who don’t hav
e health insurance. We live in one of the wealthiest, most powerful nations in the world. We have no problems marching all over this world to tell developing nations how they should treat their citizens and yet we don’t have the common decency to provide for our own.
We are an arrogant lot, we Americans. We always think we know what is best for everyone else, but we refuse to look in the mirror and see the indignity and humiliation we impose on those of who do not have health insurance in this country.
We allow the health insurance industry and the pharmaceutical industry to profit tremendously on the misfortunes of many. Most pharmaceutical companies today are multinational entities that sell the same medications in the U.S. as they sell elsewhere in the world, but in the U.S. they are able to sell these medications for twice, three times and sometimes 10 times as much as they sell them elsewhere. That is because the U.S. allows them to sell medications for whatever the market will bear and most of the rest of the world regulates the cost of medications.
Why do I do what I do? Because my parents taught me right from wrong and they taught me to fight for what is right. What we do to people in this country without health insurance is wrong. Single-Payer National Health Insurance would provide our country with health care justice and that is right.
What did Barack Obama do?
Barack Obama pushed for and passed the Patient Protection and Affordable Care Act. Now let’s be clear, I’m a big fan of Barack Obama. His home in Chicago is less than two blocks from mine, he was my state representative before he was my senator and he is a very smart man.
But at the end of the day, he is a politician and I am a physician. I think our values are different, not right or wrong, just different. I think he is the best president we have had in a generation, but it is the job of a politician to compromise and I happen to disagree with where he has chosen to compromise. Passing the Patient Protection and Affordable Care Act was nothing short of miraculous — every single president since Franklin Roosevelt attempted to pass legislation for national health insurance, and not one before Obama had succeeded.
In the book “The Heart of Power,” David Blumenthal chronicles the efforts of presidents from Franklin Roosevelt through George W. Bush to achieve access to health care for the American public. He writes, “Major health reform is virtually impossible: difficult to understand, swarming with interests, powered by money, and resonating with popular anxiety.”
Blumenthal quotes congressional veteran and co-chair of the 9/11 Commission, Lee Hamilton: “Health care is so difficult because Congress is an incremental body and health care is a non-incremental issue.”
PPACA, or the Affordable Care Act as it is commonly called today¸ is badly flawed. It has no cost containment and will not address the issues of cost, access and quality. Single payer will.
Why must you do what I do?
The Affordable Care Act, once fully implemented, will leave 23 million people uninsured. About 45,000 people die each year as a result of not having health insurance, which means 180,000 more people will die before full implementation of the Affordable Care Act.
Single payer will cover everyone.
Barack Obama worked hard and maneuvered a massive piece of legislation through an intellectually constipated Congress, but he did not get us what we need. We need health care justice for this country.
He and others might argue that we did not make him fight for single payer. We weren’t marching up the front lawn of Congress or the White House shouting for it, or not shouting loudly enough, so there was no incentive for those on the inside to fight for it.
We didn’t lose the war to gain access to health care for all Americans. We got battered in an ugly skirmish, but we’re not done.
It is time to change our tactics
The opportunity for change is still ahead of us. The Affordable Care Act has not made health care a right.
Access to care in this country a profit center controlled by the insurance industry. We pay them to limit access to care. We spend more per capita on health care than any country in the world more than $7,500 per person and yet we are ranked only 37th in the world by the World Health Organization for the care we provide.
What we have done now is required everyone to purchase insurance. For those who can’t afford it, we’ve required states to either cover them under Medicaid or we’ve provided federal subsidies so they can purchase private insurance.
This is an industry that has a history of profiteering by retroactively denying coverage to people with illnesses. So now we are requiring everyone to buy coverage and, yes, we have told the insurance companies they can’t deny coverage to those with illnesses.
My question is this: Why can’t we just pay for care without having to go through the insurance industry?
We spend enough money on health care in this country. We just let too many people who aren’t involved in providing care take profit from it.
This is about justice. Health care should be a right to which everyone is entitled.
Remember we live in the wealthiest country in the world. We spend more on health care than any other country; it is time we got our money’s worth. It is time we got the health care we deserve, not the care the insurance industry is willing to let us have. It is time we made health care a right and not a privilege.
How can you do it?
You have to speak up. You have to speak loudly. You have to make your voices heard. The Affordable Care Act is an opportunity. It is not going to work!
You have to remind the people that there is still a simpler, easier solution. People want to know, they have questions. They will ask, is the new health law the answer? Will this work? Will this solve the problem? The answer is NO, the answer is NO!
The Affordable Care Act didn’t go too far, it didn’t go far enough and we can’t be afraid to say that. You have to tell the truth, you have to fight for what is right. You can’t be afraid to tell our representatives who are under attack from the right that what they have done in not enough and there are important points on which they cannot compromise. They need us to demand single payer, they need us to make them do it.
Being right is not enough; you have to fight and you have to fight hard to win the hearts and minds of th
e American public.
I keep reminding you that this is an issue of social justice and issues of social justice require struggle and tenacity because there are always reactionary forces ready and willing to push back against change. There are always people who benefit from the status quo. They will resist the change that will provide more for the many and instead want to retain the most for a few. We have to fight that.
My father was a labor union organizer, but he loved literature. He taught me a poem by Langston Hughes that I think applies to our current struggle. It is called “Mother to Son.”
Mother to Son
Well, son, I’ll tell you:
Life for me ain’t been no crystal stair.
It’s had tacks in it,
And splinters,
And boards torn up,
And places with no carpet on the floor —
Bare.
But all the time
I’se been a-climbin’ on,
And reachin’ landin’s,
And turnin’ corners,
And sometimes goin’ in the dark
Where there ain’t been no light.
So, boy, don’t you turn back.
Don’t you set down on the steps.
‘Cause you finds it’s kinder hard.
Don’t you fall now —
For I’se still goin’, honey,
I’se still climbin’,
And life for me ain’t been no crystal stair.
You are going to spend some time tonight and tomorrow discussing strategy, it is important that strategy be about getting the politicians to do what is right and not about compromising on the basic principle of single payer: Everybody in and nobody out! Everybody in and nobody out!