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Rose Ann DeMoro Executive Director, CNA/NNOC Whose Life Doesn't Count? Settling for gradual healthcare reforms won't get us anywhere. listening to all the purveyors of conventional wisdom, you might well think only a slow step-bystep approach on healthcare reform is possible. The most comprehensive reform is HR 676 in Congress and SB 840 in California. Those bills would provide guaranteed healthcare as an expanded and improved Medicare for all. But, the pundits claim, this genuine reform is not politically feasible so let's settle for what we can get. Lower expectations and turn down the public heat, they advise. Turn out the lights on a lot of patients too, they ought to add. Gradualism—extending health coverage to some—is the mantra of the day, fawned over by some politicians and advocacy groups alike. The appearance of "bipartisanship" or the staging of "strange bedfellows" is often the only purpose of grand pronouncements of support for universal healthcare. Whether the proposals actually solve the healthcare crisis is irrelevant or secondary to the hype. The greater danger, we're told, is doing nothing. But what are we getting done? Virtually all the gradual reforms being touted would reinforce a multi-tiered healthcare system with as many standards of care as there are dollars to purchase them, and further lock us into a private insurancebased model that holds our health hostage to the HMOs and big insurance companies for years to come. As California State Sen. Sheila Kuehl, author of SB 840, noted in a hearing on her bill, of which CNA is the principal sponsor, "There is no limit to the number of market reforms that would be needed to force the insurance companies to do the right thing." It's apparent the public is ahead of the politicians and policy wonks. A New York Times/CBS poll in March found that 64 percent said the government should guarantee health insurance for all, 55 percent identified it as the top domestic priority for Congress and the president. APRIL 2007 Who will be left behind while we wait and wait and wait? Every year, lack of health insurance causes 18,000 unnecessary deaths, the equivalent of six times the number who died in the September 11 attacks. Among those without insurance, lung cancer patients are less likely to receive surgery, chemotherapy, or radiation treatment; heart attack victims are less likely to receive angioplasty; people with pneumonia are less likely to receive X-rays or consultations; and people with colorectal cancer are 70 percent more likely to die within three years than people with health coverage. The uninsured receive less preventive care, are diagnosed at more advanced disease stages, and receive less therapeutic care. Not only do they incur greater pain and suffering down the road, they also face increased cost, at a time when medical bills already account for half of all personal bankruptcies and onethird of credit card debt. With public frustration over the collapse of our healthcare system mounting, we have the greatest opportunity in years to achieve fundamental reform. Yet the gradualist approaches would undercut the momentum and squander that opening. Our most successful national health program, Medicare, also provides one of the best arguments against incremental steps. When Medicare was enacted 40 years ago, many contended that the dream of a full national health system was right around the corner. Four decades later, Medicare has not been expanded. Most of the changes have been contractions—higher out-of-pocket costs for beneficiaries and repeated attempts at privatization by the healthcare industry and its champions in the White House and Congress. Similarly, incremental healthcare reforms in a number of states including Maine, Massachusetts, Minnesota, Washington, Vermont, and Tennessee that were supposed to lead to universal coverage failed to produce any real reduction in the number of uninsured. Incremental changes create the illusion that the problem has been solved and push W W W. C A L N U R S E S . O R G the day of real reform further away. That is particularly disastrous when those "reforms" pour hundreds of millions more into the coffers of the HMOs and insurance giants by, for example, forcing everyone to buy junk insurance as in the Massachusetts law and Gov. Arnold Schwarzenegger's scheme. Both the Massachusetts law and the Schwarzenegger proposal lock people into high-deductible plans at a time of widespread reports that people with such plans self-ration and avoid needed care due to cost—ultimately exacerbating their threat of financial ruin or health risks. Women face a disproportionate burden under these plans, according to recent reports by Harvard Medical School researchers cited in the Journal of General Internal Medicine, and by the Commonwealth Fund. The Commonwealth Fund report found that more women did not fill prescriptions, skipped tests, avoided specialists, and failed to seek needed treatment due to costs. The Harvard study noted that women need more routine medical visits than men, and found that they typically have double the out-ofpocket medical expenses of men. Children also bear the consequences. In its March journal, the American Academy of Pediatrics cited risks that include "lower rates of preventive care and immunizations, less compliance with recommended treatment, less continuity of care, and lower use of acute and chronic care" when families with such plans skip medical services due to cost. It's time to stop promoting inferior approaches that aggravate the healthcare crisis and insist on real reform. American history is filled with examples of fundamental, democratic change brought about by mass action and public pressure against the counseling of the go slow crowd. We can and must achieve that in healthcare as well. I Rose Ann DeMoro is executive director of CNA/NNOC. REGISTERED NURSE 11