5.2 - Bankrupt Families

Zach’s mom, Sharon, first had an inkling that something wasn’t quite right with her son when he was three months old. Zach got bronchiolitis, an upper respiratory tract infection that inflames the small passageways in the lungs. “It was so bad, and lasted for so long. I mean he was sick for months,” recalls Sharon.

But it wasn’t until Zach was seven years old—after six years of regular doctor visits, countless surgeries, IV antibiotics, and months and months of oral antibiotics, as well as intestinal problems that at one point had him waking up every night to throw up—that it really became clear what was going on with him.

During those first several years of his life, Zach often ended up in the doctor’s office at least once a week. Sharon and her family had health insurance that covered the entire family, but the co-pays, deductibles, and other costs added up. Sharon calculates that her family’s out-of-pocket medical expenses each year ranged from as low as $14,000 to as high as $23,000 in 2004.

Sharon explains how this happened even though they are covered by insurance, “If you go to the doctor once a week, and take seven different medicines a week, you can do the math and see that it costs more than a car payment each month. That’s not including if he needs a surgery, a chest X-ray, a CAT scan, or something else.” All of these medical issues involve co-pays, deductibles, and other costs that add up over time.

During Zach’s lengthy illnesses, Sharon’s husband, Arnold, kept requesting more and more hours at work to keep up with the constant flow of medical bills. Arnold works for a heating and electrical company located in the Indiana area where they live, and as Sharon says, works as much as possible, “They usually cut him off somewhere between seventy and eighty hours per week.” He was working hard to keep the family financially afloat, making about $65,000 per year. Sharon, a full-time mom, was busy at home caring for Zach and his two younger sisters, Dakota and Jessica.

Finally, about a year ago, Zach contracted a sinus infection that lasted from November through March, which left him on antibiotics for five full months. Because insurance balked at covering more antibiotics, the doctor administered the medication through an IV line just to get around insurance restrictions. Sharon recalls, “The doctors were talking about flushing Zach’s sinuses every time he had a sinus infection—and that involves surgery.” More costly procedures were adding up, and Zach wasn’t getting any better.

Sharon schedules Zach’s visits to medical specialists all on the same day to save trips to the hospital. On the day they received the news that the sinus infection was still raging, they also had a visit with Zach’s digestive specialist.

It had been a stressful day of CAT scans, IVs, and other procedures. By the time Zach and Sharon got to the digestive specialist’s office Sharon was overwhelmed, “The doctor asked, ‘How’s everything going?’ and I just lost it and started crying. I said, ‘He’s been sick for so long. I don’t see how he can keep going like this forever.’ The doctor responded, ‘It’s not my field, but it sounds like an immune problem to me.’

In the end, his digestive doctor is the one who figured out that Zach had an immune deficiency which caused him to get sick over and over again. The good news was that there was a treatment for this disease, once a month intravenous infusions of gamma globulin. The bad news was that after the insurance company paid what they cover, the medicine still costs $5,000 in of out-of-pocket expenses each year.

At this point, the family—fully insured, with Sharon’s husband basically working the equivalent of two full-time jobs— was losing the battle of the medical bills. “When Zach was diagnosed with a primary immune deficiency, we knew it wasn’t going to end,” Sharon recalls. “We already had remortgaged our house to pay for medical bills—so when we found out how much the new treatment was going to cost, we knew we couldn’t pay our higher mortgage payment, the cost of his medicines, and other costs every month.” That was the breaking point.

Sharon and Arnold finally waved the white flag of surrender when it became clear that there simply weren’t enough hours in the workweek to keep up with the constant incoming flow of bills. They made an appointment with an attorney to declare bankruptcy.

Their attorney’s office was in downtown Indianapolis. After checking in with the receptionist, Sharon and Arnold were ushered to a large conference room that had two walls of windows, and another wall with shelves of law books from floor to ceiling. They settled down into comfortable chairs around a conference table and told the attorney their story, sharing all their raw feelings of despair that came from working hard, having a sick child, and still losing everything, “The attorney cried when we told him what had been happening with us. My husband really needed that because when we went there it was just breaking him. His theory was that he could just keep working more.” But there weren’t any more hours in the week left to work.

Medical issues are a leading cause of bankruptcy in the United States. A February 2005 study published in the journal Health Affairs, authored by a well-respected team of experts that includes several Harvard University professors, found that families like Sharon’s are part of a growing trend of medical bankruptcies. ² In fact, half of all bankruptcy filings in 2001 were related to medical issues.

And medical related bankruptcies are skyrocketing. There’s been a twenty-threefold (2,300 percent) increase in medical related bankruptcy filings between 1981, when only 8 percent of bankruptcies were medical related, and 2001.³ And, it turns out, these medical related bankruptcies look a lot like what Sharon’s family experienced—most of those who went bankrupt had health insurance (a full 76 percent had insurance when their illness started),⁴ and those filing for bankruptcy are “predominantly in the middle or working classes.”⁵ In other words, it’s mostly hard-working families with insurance that end up in bankruptcy as they deal with medical issues.

“Our study is frightening. Unless you’re Bill Gates, you’re just one serious illness away from bankruptcy,” notes Dr. David Himmelstein, the lead author of the study and an associate professor of medicine at Harvard in a Harvard Medical School Office of Public Affairs press release. “Most of the medically bankrupt were average Americans who happened to get sick. Health insurance offered little protection. Families with coverage faced unaffordable co-payments, deductibles, and bills for uncovered items like physical therapy, psychiatric care, and prescription drugs. And even the best job-based health insurance often vanished when prolonged illness caused job loss precisely when families needed it most. Too often, private health insurance is an umbrella that melts in the rain.”⁶

After Sharon, Arnold, and Zach’s story ran in the New York Times in October 2005,7 the drug company dropped the $5,000 annual bill for uncompensated costs, and other help came their way. They are still in danger of losing their house, which is in foreclosure due to the bankruptcy, but the family is starting to save money again. Sharon concludes, “I’m going to seriously knock on wood. I can’t imagine us being in the same situation now that our medical bills are covered.”

Making it to the front page of the newspaper is not a viable solution for the other two million debtors and their dependents that experienced bankruptcies related to medical problems in 2001.⁸ “Families with children were especially hard hit,” notes the news release about the study put out by the Harvard Medical School Office of Public Affairs.9 It continues, “—about 700,000 children lived in families that declared bankruptcy in the aftermath of serious medical problems.” Something has to give.

5.3 - The Melting Umbrella

The truth is that according to the World Health Organization, the United States spends more on healthcare per person than any other nation in the world,¹⁰ yet still was only tied for the twentyeighth highest life expectancy,¹¹ and ranked in at a low thirtyseventh for our mortality rate of children under five years old.¹² We aren’t getting much for the money we spend.

Some states are trying to do something about this. For example, there’s been a movement in California to get universal health coverage for kids, Maine is working on getting costs to businesses down while covering more people, and Vermont passed a bill that called for a publicly financed comprehensive healthcare system through the State House and State Senate in 2004 that was eventually vetoed by the Governor.

Dr. Deborah Richter, current Chair of Vermont healthcare For All, got tired of seeing her patients die from treatable diseases because they were uninsured and unable to pay for proper medical care. A few of her patients pushed her to activism: One situation involved a brother and sister who both had juvenile diabetes and didn’t have insurance. They came from a hardworking family that made just enough money so they weren’t eligible for Medicaid, but their jobs didn’t come linked with health insurance. When their health worsened, they weren’t able to take care of their health needs, leading to tragic consequences.

Like the siblings, many in our healthcare system are lost in the huge gaps in coverage, “Right now we have private insurance for most middle and upper income kids, and several low income coverage possibilities including Medicaid and SCHIP (State Children’s Health Insurance Program), but we still have nine million kids falling through the cracks,” notes Dr. Alison Buist, Health Policy Director for the Children’s Defense Fund.

Some coverage is available to low-income families, Buist explains how it works. Medicaid, a federal entitlement program, requires the federal government to provide support if a person meets their eligibility criteria. It currently covers more than forty million people, half of whom are children.¹³ SCHIP, a federal block grant program that provides funding to states, is essentially a state health insurance program that covers children from families with slightly higher incomes than Medicaid covers. Yet there are too many children and families who do not qualify for either program and are left without healthcare options.

Many of those are Americans who hold jobs without health insurance coverage. These workers make too much money to qualify for any state or federal medical assistance, yet the high cost of private insurance makes it out of reach, particularly for those holding low-income jobs (which are the jobs least likely to have job-linked health coverage). In fact, working families make up 81 percent of uninsured people.¹⁴

Patricia Schoeni, Executive Director of National Coalition on healthcare, notes, “Lots of people think that when you’re talking about the uninsured, you’re talking about poor people. But the majority of uninsured work; and a large number of them are middle class Americans. They are uninsured either because they work for an employer who doesn’t provide health insurance and going out onto the open market to buy an individual insurance policy is prohibitively expensive; or they are uninsured because they are unemployed, or because employers are passing along the cost increases to them and they drop the coverage.”

Not to give the wrong impression: People in poverty are also doing without healthcare in our nation. Right now, the Kaiser Family Foundation reports, “Low-income Americans with family incomes below 200 percent of the poverty level run the highest risk of being uninsured. Over a third of the poor and nearly 30 percent of the near-poor lack health insurance.”¹⁵ And again, these statistics are only those without health insurance, and don’t include the significant number of Americans whose healthcare coverage would not carry them through a serious or long-term illness. Essentially, as Dr. Himmelstein, associate professor at Harvard, noted, unless you are Bill Gates and can pay unlimited sums out-of-pocket, you can’t count on coverage in this country when the chips are down.

This crisis is only deepening, with the number of uninsured Americans rising quickly. Between 2000 and 2004 alone, the number of uninsured people under sixty-five years old increased by six million.¹⁶ In that same time period, job-linked coverage dropped by 5 percent.¹⁷

The 5 percent drop in job-linked coverage is nothing to be glossed over. Frankly, the cost of employer-sponsored health insurance is going through the roof. Businesses are also struggling with the rising costs of healthcare. Many businesses are stretched to the limits of profitability just because of the escalating premiums for employees. There was an 11 percent increase in premium costs in the one year between 2003 and 2004. By 2004 the average cost of a premium for family coverage was $9,950.¹⁸ The Kaiser Family Foundation finds, “Premiums for employersponsored health insurance rose at about five times the rate of inflation and workers earnings.”¹⁹ And it further notes, “Since 2000, premiums for family coverage have risen 59 percent.”²⁰

In this current situation of increasingly expensive healthcare coverage, the impacts are also seen in the way we work. Joan Williams, Professor of Law at the University of California, Hastings, and Director of the Center for WorkLife Law, comments, “Healthcare is a huge reason why people overwork in the United States. One of the reasons people strive so hard to get ‘good jobs’ is because otherwise they wouldn’t have health insurance. In the U.S. we tend to have bad twenty to twentyfive hour per week jobs without benefits, and good forty to sixty hour per week jobs with benefits. A lot of the reason people are willing to work such long hours is not that they prefer to do so, but because they have no other choice since we deliver healthcare through a job link.

“This has direct implications for moms,” explains Williams, “because it pushes families into a format where one person has an all consuming job with healthcare, which means mothers get pushed into marginalized jobs or out of the labor force. Also, the lack of socially provided healthcare makes it very difficult for proportional pay and equity for part-time work because it’s so expensive for an employer.” She concludes, “Europe has a guarantee of part-time equity in their laws, and one of the reasons is healthcare. The lack of socially provided healthcare in the United States plays a major role in the fact that we work longer hours than virtually any industrialized country.” These long hours, in turn, allow little time for raising a family.

The astronomical cost of healthcare coverage is not only changing the way we work, but has also caused a drop in job-linked healthcare coverage altogether. Many employers are simply unable to afford the sky-rocketing costs of health coverage Healthcare for All Kids 131 for their employees, leading to an increasing number of uninsured Americans.

5.4 - Uninsured Complications and the Ultimate Cost

There were forty-six million uninsured Americans in 2004.²¹ Forty-six million Americans like Dr. Richter’s patients, the uninsured siblings with juvenile diabetes who were unable to afford proper medication and treatment for a treatable condition. “I took care of them for years. When George was twenty-one years- old, he essentially died from complications of diabetes. At the same time his sister, Tina, was five months pregnant and had a premature baby that didn’t survive, mainly because the mother was a poor candidate for pregnancy after years of untreated diabetes. Then a year later, at twenty-five years old, Tina had a heart attack, ended up needing bypass surgery and died on the table. And this was just one family, but it became routine. These were people who didn’t need to live this way.”

Forty-six million Americans are like another of Dr. Richter’s patients, a woman in her late fifties with post-menopausal bleeding. “She came to me because her family was begging her to see a doctor. She had obvious signs of cancer and I said, ‘Look, here are the things we need to do.’ And she said, ‘I just can’t afford it right now.’ And she kept waiting. Then she had a pulmonary embolism and died, which is a sign of cancer. She just kept delaying and ignoring signs for at least a year and a half. She didn’t do anything because she was afraid of the costs, but then she died.” This woman paid the ultimate price with her life. People without insurance are right to fear high medical costs, but they shouldn’t have to pay with their lives.

Ironically medical procedures and treatments often cost more for people who are uninsured, than for people who are insured. A study prepared by the Hospital Accountability Project of the Service Employees International Union investigated this issue and found: “While insurance companies and other third-party payers have aggressively negotiated discounts for their health plan participants, the uninsured have been left behind. Without any bargaining power of their own, uninsured ‘self-pay’ hospital patients are expected to pay non-discount ‘gross charges.’ ” The study further found, “. . . patients who pay full gross charges—typically the working poor who earn too much to qualify for Medicaid or charity care but are not covered by insurance—generally pay twice as much as the payment received for insured inpatients.”²² People without insurance, and those with inadequate private insurance, are on the front lines of our medical crisis.

5.5 - Taking Action

After finishing her medical residency years ago, Dr. Richter worked in the inner city helping low income patients, but after six months she realized she could help more patients by working to reform health coverage in order to stop the medical crisis at the source. This decision came to her as she dealt with big issues, like the unnecessary deaths of her patients, and with the smaller issues, such as, “I would prescribe medicine. Then the patient would come back six months later and still not be better because they couldn’t afford to fill their prescriptions.”

So she started working part-time as a doctor and part-time as an advocate. Dr. Richter’s resolve was strengthened as she compared her experiences with doctors in other countries. Once, when speaking in Canada where for more than three decades all citizens have been covered through a single-payer health plan (a system where the government pays the healthcare costs of citizens to independent, privately run hospitals, doctors, and other health services), she shared a story about how one of her uninsured patients died due to lack of care. “People in Canada asked, ‘Did the newspapers cover it?’ ” Dr. Richter responded, “No, this was just one case of dozens and dozens I saw in my practice alone. Think about this magnified across our country.”

As medical costs and the number of uninsured rise at an alarming rate, people are becoming ever more aware of America’s healthcare crisis. “The current patchwork system we have isn’t working,” notes Buist. “We’re trying to move toward a world in which children have access to all the advantages that we can easily give them if we just had good policy.” Buist joins Dr. Richter and others who are educating policy makers and organizing communities around the country to demand the good health policies our children deserve. “The fight we’re fighting now,” says Buist, “is to make sure all children have healthcare coverage. How you get there is the question.”

5.6 - World Comparisons

The rest of the world is way ahead of us. “The United States remains the only Western nation without universal health insurance coverage,” writes Rick Mayes in his book, Universal Coverage: The Elusive Quest for National Health Insurance. Two-thirds of the 191 countries tracked by the World Health Organization pay a higher percentage of their citizen’s total healthcare costs than the U.S. does.²³

Yet we, as a country, spend more on healthcare than any other nation in the world, a whopping $5,274 on average per capita,²⁴ and we don’t have the best health outcomes, not even close. In fact, countries with the same mortality rate the United States has for children under five, spend a fraction of what the U.S. spends per person each year: Estonia ($263 per person); Slovakia ($265 per person); Poland ($303 per person); the UAE ($802 per person); and, the United States ($5,274).²⁵

Our lack of complete healthcare coverage, coupled with these high costs has many shaking their heads in confusion. More money should equal more coverage and better care, right?

Not so. One big difference between the United States and other nations is that we are spending our health dollars mainly through prepaid private sector health insurance plans (In 2002, 65.7 percent of health expenditures came from private prepaid plans in the United States).²⁶ Few countries have such a high percentage of health expenditures through private prepaid plans. In fact, only seven other countries in the world had more than 50 percent of their health expenditures through private prepaid plans in 2002: the Bahamas, Chile, France, Nambia, the Netherlands, Slovenia, and South Africa.²⁷

Private healthcare plans are notoriously inefficient with dollars, particularly since, more often than not, different prices are set for the same procedures and care based on what has been negotiated with various private health insurance coverage plans. The administrative effort it takes just to keep up with billing and accounting (since, for example, there can be a veritable multiple choice of prices for each medical procedure) adds significantly to the total healthcare cost. Not to mention the fact that it’s quite difficult for a healthcare consumer to do “comparative shopping” when the prices aren’t set.

This increased administrative spending through private insurers can be seen by comparing the administrative costs between public and private ventures right here in our own country: 12 percent of money spent by private insurers is spent on administrative efforts, while only 4 percent of money spent by Medicare (a public program) goes to administrative efforts.²⁸ Management salaries in private insurance firms have become more and more inflated, and profit may also have a hand in the difference. Many of the top CEOs from non-governmental, private health insurance companies are making tens of million dollars per year. For example, in 2004 the CEO of Aetna, Inc., a large health insurance company, brought home $10,119,290 in compensation including stock option grants. This particular CEO has another $164,722,382 in unexercised stock options.²⁹

Canada offers a good example in how administrative costs differ between private and universal plans. Canada’s national healthcare system offers universal health coverage paid by the government, as a single-payer; while the doctors, hospitals, and other medical service providers are still independent from the government (much as if our Medicare was expanded to cover our entire population). In 1999, on average, each person in the United States racked up $1,059 in administrative costs related to healthcare, while an average Canadian incurred $307 in administrative costs.³⁰ Australia, Denmark, Finland, Iceland, Sweden, and Taiwan have similar single-payer health plans.³¹ It’s important to note this coverage is not linked to a citizen’s employer, as private coverage often is in the United States.

A 2004 study in the International Journal of Health Sciences found that such healthcare systems are significantly more efficient. “Our data help explain why Canadians spend 40 percent less on healthcare, yet receive more hospital care and make more doctor’s visits and enjoy better access to care. Trimming U.S. administrative costs to Canadian levels would save at least $209 billion annually, enough to cover the uninsured and improve coverage for the tens of millions who are currently underinsured.” The study also concludes that such reductions would be, “. . . enough to fund universal coverage.”³²

While many point to the Canadian single-payer system as a template for solutions to our healthcare problems, there isn’t a consensus as to what is the best healthcare solution for the United States at this time. To be perfectly clear, while we are advocating for universal coverage (particularly for children), we are not endorsing one healthcare solution, such as a single-payer system, over another. However, comparing Canada’s healthcare system to our own is useful. Canada is a nation with a similar standard of living that enjoys a healthcare system that is serving its citizens more effectively by objective measures.

Dr. Reichter points out, “We can pick and choose features from around the world, it doesn’t have to be Canada—we can pick the prevention and public health structure from Japan, or the primary care choices in England and Sweden. The thing people have to recognize is that a universal healthcare system is inevitable. There is no other way out of the crisis than to have a universal healthcare system that includes everyone, contains costs, and is publicly financed.” Clearly, when the time comes for change, there will be no lack of ideas for solutions.

5.7 - The Will to Change

There is growing consensus that we have a problem. Then why, if there are so many possible solutions, are we stuck with this failing healthcare system? The answer: We have an entrenched and complex healthcare system that is hugely difficult to change. Historically, there has not been sufficient political capacity to create a plan and implement needed changes. Patricia Schoeni, Executive Director of National Coalition on Healthcare, agrees and points out, “There is no will to fix the problem right now. It is basically a lack of leadership in all levels of government and on Capitol Hill, and an unwillingness of elected representatives, the majority of them at least, to come to grips with the fact that we have a problem and we have to deal with it.”

If individual tragedies like those shared by Dr. Richter don’t provide impetus for change, maybe the business sector can. More and more business leaders are recognizing that the high cost of healthcare coverage is a major disadvantage that cuts into their ability to compete in a global market. Consequently, some business leaders are helping ignite the political will for addressing the healthcare issue with solid solutions. During the 2004 drive for comprehensive health coverage in Vermont, many businesses signed on to the effort and put signs in their windows that said, “This Business Supports Universal Healthcare.” One such business, based out of Waitsfield, Vermont, is Small Dog Electronics. Small Dog Electronics, one of the larger Apple computer resellers in the United States, sells new, refurbished, and used Macintosh computer products, as well as other related products like iPods.

Each fall, beautiful crimson maple trees frame the entrance to the Small Dog offices and warehouse. Dogs are allowed at work, and every day about fifteen of them clock in with their owners. Don Mayer, CEO, brings his bulldog named Hammerhead and his pomeranian named Fantail Shrimp to work with him each day, “The dogs are a sort of reminder to keep my business small and friendly. That’s why we named it Small Dog. I’ve been in business a long time and found that I always have less stress, more fun, and make more money when my business is small.”

He comments, “We take our dogs very seriously, and we have every kind of dog you can imagine. We have some small dogs, we have mixed breeds, huskies, two black labs, a golden, a yellow lab, and eskies.” There are dog bowls, toys, and dog beds throughout the offices and warehouse.

Small Dog Electronics, which prides itself in taking care of employees, currently covers all employees and their families with health insurance. This is beginning to be a problem. When Mayer started in business thirty years ago he notes, “The cost for a family healthcare premium was about $1,500 per year. Now it’s approximately $11,000 for each family’s coverage. This can amount to almost 50 percent of an entry level employee’s salary.” In fact, the cost of healthcare coverage is becoming a big factor in business decisions for Mayer, “No longer do I consider growth and opportunity as the criteria for expanding my staff. I have to consider the astronomical cost of healthcare as part of that equation as well. This makes the healthcare crisis an impediment to economic growth, which can be further illustrated by the number of labor actions and strife with healthcare as the primary element of dispute.”

From his perspective, supporting comprehensive coverage “was a fairly easy decision for us,” says Mayer. “The healthcare system as it’s currently configured is a mishmash that basically represents an accident of history.” Sharing his understanding, Mayer continues, “This employer based healthcare system is completely faulty. It was instituted in the 1940s as a way to get around the wage price controls from WWII and after so employers could offer health insurance as an incentive to retain key employees. It kind of stuck over the years to the point where we are now, which is a healthcare system on the verge of collapse.”

It’s not just small businesses that are starting to take serious notice of the implications of our healthcare system. In 2005, Toyota announced it is planning to build a second plant in Ontario that will hire about 1,300 workers and make 100,000 cars each year starting in 2008. The Canadian location was chosen over cities in the United States despite the fact that several U.S. states offered “hundreds of millions of dollars in subsidies,” as reported by CBC News.³³ The CBC News article noted, “In addition to lower training costs, Canadian workers are also $4 to $5 cheaper to employ partly thanks to the taxpayer-funded health-care system in Canada, said federal Industry Minister David Emmerson. ‘Most people don’t think of our health-care system as being a competitive advantage,’ he said.” Some executives of big businesses, particularly those from the vehicle manufacturing industry like General Motors, Ford, and in particular DaimlerChrysler, are starting to bring up the fact that another type of healthcare system might be better for business.³⁴

There still isn’t a full-fledged push for change from corporate America at this time. This boils down, in part, to a philosophical issue since many in big businesses are opposed to increased federal government involvement as a rule, and addressing comprehensive health coverage certainly entails more federal government involvement. However, as American healthcare costs continue to streak upward at an incredible pace, there’s no question that leaving our healthcare linked to employers is going to hurt our competitive advantage in a global economy. Our economy, our businesses, and our citizens are struggling. It’s long past time for a change.

5.8 - The Big Picture

Our healthcare system is in crisis. Year after year the cost of healthcare rises at a multiple of the inflation rate. Every year fewer businesses provide healthcare for employees. Every year the number of Americans who have healthcare coverage has declined. Because of this, more and more people find themselves without health insurance, without access to preventative care, and without access to any healthcare at all save the emergency room.

These emergency rooms visits are often for illnesses that need never have become so severe, and for illnesses that would regularly be treated by a primary care physician much less expensively. This also puts added pressure on the ability of emergency rooms to properly care for patients, not only because they end up being a place of last resort for those without funds to pay for services (and often end up stuck with the bill), but also because the added numbers of those without insurance or other healthcare options often fill emergency rooms to capacity, making them unavailable for other critical emergency services.

It has become conventional wisdom that patients in emergency rooms and hospitals need a relative or friend that can stay with them in order to advocate on their behalf as they negotiate chaotically overcrowded emergency rooms and understaffed hospitals. “Hundreds of thousands of people die each year from medical errors, and millions are injured by poor quality care and accidents that shouldn’t be happening,” says Patricia Schoeni, Executive Director of National Coalition on healthcare. Schoeni notes that the three main drivers in our current healthcare crisis are cost, coverage, and quality of care—and that all must be addressed as we form healthcare solutions.

We don’t need to read statistics about how poorly our medical system compares to other industrialized countries. It’s a reality we all understand. “We do more research than any other country, the problem is we don’t have the ability or facilities to put what we know how to do best into actual practice on a broad scale,” Schoeni explains. In other words, while we have some of the best healthcare technology in the world, very few people get access to those services.

The crisis of our medical system not only brings the loss of a secure medical safety net for American citizens, the cost of this failing system is also undermining our economy. As car manufacturers and other large companies make decisions about where to locate their manufacturing centers, the U.S. will continue to lose when competing with lower associated healthcare costs. Businesses in the U.S. are fundamentally at a competitive disadvantage in the global economy because of the cost of healthcare.

Our economy is suffering in yet another respect due to the exorbitant cost of healthcare. The fact that medical costs have become a primary cause of bankruptcy is really only the canary in the coal mine. American families have less disposable income and more debt due to the skyrocketing costs of medical care. This depresses the overall economy just like high oil prices do when the high cost of gasoline eats up a family’s budget.

The costs of medical benefits are also distorting the way businesses structure the workplace. Why do you think businesses are willing to pay overtime rather than hire additional workers, even though overworked employees are more likely to make mistakes and be less productive? The costs of benefits have become so burdensome that many employers bend over backwards to avoid hiring additional full-time workers. Some employers “specialize” in hiring part-time workers to avoid paying benefits altogether. One consequence of this trend is that a substantial portion of the working poor have two or three part-time jobs, none with benefits. These hardworking people are just an illness away from financial ruin. Many employers are also having financial difficulty with high premiums and are passing along the increased costs to their employees, making healthcare benefits one of the main issues of contention when unions strike. The fact is that employers and employees are both experiencing huge difficulty due to our healthcare crisis. This situation has to change.

5.9 - Steps for Change

There are certain steps that must be taken to address this crisis. To start, all children in the United States must have health coverage. As terrible as the lack of healthcare coverage is for adults, it’s unconscionable not to protect our children, and it is extremely short-sighted to leave children without medical coverage. Plainly said, providing easily accessed healthcare to children will save us medical costs in the short and long term. It will also enable those children to learn and grow into the citizens that are going to be supporting us as we retire in the future. As Buist points out, “Covering kids is not just about health. Getting children access to healthcare has ramifications in almost every area of their lives, and the lives of their families.”

The Motherhood Manifesto promotes basic, highly interrelated steps to better support parents and children. Healthcare is a core part of this support. The fact of the matter is that motherfriendly work would be more available if we had some kind of universal healthcare. Our childcare providers would be better able to stay working at the jobs they love if they had healthcare. Minimum wage workers would not be quite so vulnerable if they had healthcare. Finally, every child’s parent also needs access to healthcare. As the flight attendants always reminds us right before an airplane takes off, “In the event of a loss of pressure, place the oxygen mask securely over your own face before assisting your child.” Point being, it is hard to take care of our children if we are incapacitated.

Why do we first call for universal healthcare for all children, and not for all Americans? Restructuring our healthcare system is a monumental task. There will be major conflicting powers involved in creating this 336, and so far all efforts have stalled out. Taking care of kids is something we must do today. We should work with whatever systems we have to give all children access to healthcare immediately. Then hopefully we can celebrate the transition to universal healthcare for all citizens in the not so distant future.

Keeping our children healthy and protecting them from injury or illness should never be left to chance; healthcare for children should not be a privilege in America but a right. Simply put, the time has come for all children to have access to healthcare.

5.10 - Manifesto Point 'H'

ACTION: While our leaders come to grips with the healthcare emergency facing the nation, mothers want

1. Congress to immediately enact universal coverage for all American children.

• The United States spends more on healthcare per person than any other nation in the world.ⁱ
• Was tied for the 28th highest life expectancy.ⁱⁱ
• Ranked a low 37th for our mortality rate of children under five years old.ⁱⁱⁱ
• Two-thirds of the 191 countries tracked by the World Health Organization pay a higher percentage of their citizen’s total health care costs than the U.S. does.^iv
• As a country, United States citizens spend more on health care than any other nation in the world, a whopping $5,274 on average per capita.^v
• Countries with the same mortality rate as the United States has for children under five, spend a fraction of what U.S. citizens spend per person each year: Estonia ($263 per person); Slovakia ($265 per person); Poland ($303 per person); the UAE ($802 per person); and, the United States ($5,274).^vi

Chapter Five Notes