National Nurses United

C A L I F O R N I A N U R S E W W W . C A L N U R S E S . O R G M A R C H 2 0 0 6 7 I n the opening pages of Critical Con- dition, their brilliant indictment of the healthcare industry, authors Donald Barlett and James Steele describe a series of heartrending scenes that tell you all you need to know about the state of healthcare in the U.S. today. An auction of livestock, and three tons of hay in Simms, Mont. to pay the medical expenses of a horse trainer who was para- lyzed after being thrown through the wind- shield of his truck. A spaghetti dinner at an American Legion post in Omaha for a kid- ney transplant for a 15-year-old boy. A bar- becue and auction in central Texas for a high school footballer who broke his neck while making a tackle. Car washes, pie socials, church suppers, bingo games, raffles, those slices of Americana once reserved for social club functions have become a significant means for devastated families facing massive med- ical bills. Medical debt now accounts for half of all personal bankruptcies, and 40 per- cent of all Americans under 65 cite prob- lems with paying health bills. The increasing despair and fear so many now have is the backdrop of sudden empha- sis placed by President Bush on healthcare in his State of the Union speech in January. However, like his systemically-flawed Medicare prescription drug plan, the President's proposals will only exacerbate the problem and look more like an effort to further enrich his corporate donors in the healthcare industry. At the center of his plan is a scheme called Health Savings Accounts. The basic idea is to use tax cuts to impel uninsured consumers or those facing cuts in employ- er-based plans to put money into a tax- deductible HSA so they can buy insurance coverage out of their pocket, a dismal alter- native to a single-payer approach to assure universal access based on a single standard of care for all. Many people, of course, have little resources left to put into such an account, especially as more employers slash pension and health benefits. San Francisco Chronicle columnist David Lazarus noted that the day before the President unveiled "Bush-Care" (a term favored by the Foundation for Taxpayer and Consumer Rights), the Commerce Department report- ed the savings rate had fallen to 0.5 percent last year, meaning that far too many are not saving at all but continually dipping into what little they have in the bank. In addition to the cost of the coverage itself, the goal is to couple these plans with high deductibles, intended to discipline con- sumers by making them pay more for health coverage, but use less services, under the neoconservative theory that the problem with our healthcare system is patients demanding care when they are sick. Not surprisingly, the HMOs love this idea, and some big businesses are already looking at HSAs as a way of reducing or eliminating employer-paid coverage, but it doesn't work so well for everyone else. As even the market-oriented magazine The Economist noted in critiquing the Bush plan, most health spending is on people with chronic conditions, such as diabetes or high blood pressure, and other long-term care, and the cost will rapidly outpace the deductibles—impoverishing anyone in these categories who has to rely on an HSA. Further, the increased out-of-pocket cost will deter many from seeking preventive care, pushing more people, especially the low income, into utilizing emergency rooms or overburdened public health hospitals or clinics as their point of entry into the med- ical system, escalating costs for everyone. Overall, the Bush ideology, said the Economist, comes "at the price of greater inequality. The burden of health spending will be shifted on to those who are sick"— and the disparities in our current two-tier system will grow. Physicians for a National Health Plan offers the most detailed analysis of what is wrong with HSAs. The accounts do not con- trol costs, produce worse health outcomes, increase administrative costs, leave patients exposed to massive debt, and consumers who have experience with HSAs can't stand them. A study from the avidly pro-HSA, man- agement consulting firm McKinsey & Co. found that 56 percent of those with HSAs wish they had their previous health plan. Ultimately, the Economist rightly con- cludes, "the Bush agenda may speed the reform of American healthcare, but only by hastening the day the current system falls apart." For far too many, we should add, it already has. ■ Rose Ann DeMoro is executive director of the California Nurses Association and National Nurses Organizing Committee. Rose Ann DeMoro CNA/NNOC Executive Director Don't Get Sick in America Why Bush's plan for health savings accounts won't help those who actually need healthcare By Rose Ann DeMoro The accounts do not control costs, produce worse health outcomes, increase administrative costs, leave patients exposed to massive debt, and consumers who have experience with HSAs can't stand them. A study from a pro-HSA consulting firm found that 56 percent of those with HSAs wish they had their previous health plan.

• Cover