Here we go unraveling . . . .

Inspired by Paul Krugman's column today and events of the last week(s), I thought I would revisit the perennial favorite health advocate's topic: health care for all.

According to Krugman,

Health care seems to be heading back to the top of the political agenda, and not a moment too soon. Employer-based health insurance is unraveling, Medicaid is under severe pressure, and vast Medicare costs loom on the horizon. Something must be done.

This has been one of those periods in which the cost of paying for health benefits for workers and retirees threatens to shut down corporations and municipalities. In my most optimistic periods I think that this "unraveling" of our expensive, inefficient, inadequate and patchwork system will finally push us toward a national solution. Yet somehow the system must still be working, at least for the private sector, since we are not seeing big business rise up to demand that health benefits become a public, not a private responsibility. We can only assume that as long as workers are willing to "take the hit" and pay an increasing amount of the costs of their care, employers will continue to see employer-base health insurance to be working to their advantage.

Thus it was with pride--at least in being a New Yorker--that we watched Roger Toussaint refuse to agree to the kind of two-tiered contract that workers around the country have been accepting in order to keep their benefits. Many in New York, including those who consider themselves supporters of labor, bristled at the refusal of the transit workers to accept even a 1% contribution--and that only for future employees--to their health benefits. After all, most of us who are private sector employees have been contributing far more than that for over a decade.

Toussaint's stand, however, had that wonderful ring of American ideals (dare we remember the Dennis Rivera of old).

"We will not sell out the unborn," Mr. Toussaint said in refusing to agree to lower benefit levels for future employees than for current employees. "We believe that future generations of transit workers should be better off than us, just as we are better off than past generations of transit workers" (New York Times, December 19, 2005). (Since there is no contract yet, it is still possible that Toussaint will end up holding firm on pensions but giving "a little" on a two-tiered plan for health benefits, according to Stanley Aronowitz, a City University of NY Sociologist quoted in the December 24th New York Times.)

But clearly the only sensible answer to the problem of rising costs of covering health care--and to the growing problem of retiree benefits that are threatening to become extinct in the private sector and to bankrupt local governments--is a national health program. I suggest you revisit the Physicians for the National Health Program web site and read (or reread) the "Proposal of the Physicians' Working Group for Single-Payer National Health Insurance" published in JAMA in August 2003.

A more recent cause for some optimism is the Emily's List fall survey, which showed that healthcare was a particularly important concern for women, and could impact how they vote in the midterm elections in 2006. The findings, among other things, noted that health care and health care costs are "winning issues" for Democratic candidates and that "Independent women, a key swing group, are looking for action and seeking a voice and leadership on the health care issue."

So, as a health advocate, my New Year's wish is that the bumper sticker, "Our National Health Plan: Don't Get Sick" (featured in my young friends' very funny and wise collection, Actions Speak Louder Than Bumper Stickers) will no longer be humorous because it is true. I guess that's a lot to wish for, so let's just hope that as the current system unravels we can take effective action toward an alternative that will acknowledge our public responsibility to truly provide health care for all at a cost that society can afford.