Nancy Spannaus

The current stalemate on healthcare in the Congress provides a perfect opportunity to "get it right," beginning with the approach represented in the legislation of "Medicare for all." The United States is faced with a health care emergency, and action to deal with the crisis by applying American System principles is needed immediately.

In his 1944 State of the Union address, President Franklin Roosevelt declared that the nation had basically accepted "a second Bill of Rights under which a new basis of security and prosperity can be established for all-regardless of station, race, or creed." Among them were "the right to adequate medical care and the opportunity to achieve and enjoy good health," and the "right to adequate protection from the economic fears of ... sickness...." As I outlined in the first article in this series. FDR was proceeding from his Constitutional commitment to provision for the General Welfare, which he had pursued throughout the New Deal. Having won the battle for Social Security and unemployment insurance, he was determined to build on his successes to provide prosperity for the entire population.Thanks to the effective counterattack against FDR's American System approach to the general welfare, ongoing now since FDR's death, this basic right has not yet been put into practice more than 70 years later.

But landmark progress has been made, especially with the establishment of Medicare and Medicaid. That historic accomplishment was signed into law by FDR Democrat Lyndon Baines Johnson on July 30, 1965. When the program actually went into effect July 1, 1966, approximately 19 million individuals were enrolled. As of 2015 (the latest official figures available), there were over 55 million individuals enrolled in Medicare, and over 74 million in Medicaid, or the associated Children's Health Program called CHIP. Altogether, that's more than one-third of the U.S. population-a giant step toward universal coverage, although with obvious inequities and problems.

Additionally important is the fact that Medicare serves as a kind of "proof of principle" (albeit flawed) of the kind of universal health care which FDR envisioned, and which John Conyers' H.R. 676 "Medicare for All" bill proposes. Like the general population, the Medicare population-the entire population over 65 years of age-varies widely in state of health, encompassing many healthy seniors as well as those beset by traditional diseases of old age. According to the Center for Economic and Policy Research, and several other sources, Medicare's overhead costs are about 2%, as compared to 12-15% spent by private insurers. And the Medicare total population (which also includes 9 million individuals with disability and overall amounts to about 18% of the U.S. total population) receives its care at the cost of 19% of national health care expenditures.

But when the battle was waged to establish Medicare, the U.S. population was not as obsessed with saving money on health care as today: the issue was providing desperately needed health services to those who could not afford it. That focus, in the midst of the current health care emergency, should be readopted today.

JFK's Fight

FDR Democrats took the lead in fighting for health care for senior citizens over the entire 20 years in which the battle was underway. President Harry Truman was the first to take up the issue, sending two special messages to Congress on the issue.His first, on November 19, 1945, called for universal medical insurance in order to fulfill FDR's goal in the Economic Bill of Rights. Truman outlined a five-point plan: 1) federal money for construction of additional facilities; 2) expanded public health services; 3) federal money for medical education and research; 4) "prepayment of medical costs" through expanding the wage-base insurance system (i.e. Social Security); and 5) benefits to protect against loss of wages from sickness and disability.

Truman was unable to pass his plan, despite considerable effort. What did pass was the Hill-Burton Act (1946), which mandated an inventory of existing hospitals, a survey of the need for more, and the development of programs for construction for "such public and other nonprofit hospitals as will, in conjunction with existing facilities, afford the necessary physical facilities for furnishing adequate hospital, clinic, and similar services" to all. It also set standards for the ratio of hospital bed per population and provided for hospital construction.

During the Eisenhower years, a number of Democrats kept up the fight, including Senator John F. Kennedy. As President, Kennedy took up the fight in earnest. One of his first acts as President-elect, on Nov. 8, 1960 was to set up a taskforce on health and social security for the American people. Its recommendations came in January 10, 1961, and were followed by the convening of a National Conference on the Aging, and a Presidential Health Message to Congress in February.

Over the course of his short presidency, Kennedy sent three special messages to Congress on health care. He acted from the standpoint, as he said in his Feb. 27, 1962 message, that: "The basic resource of a nation is its people. Its strength can be no greater than the health and vitality of its population. Preventable sickness, disability and physical or mental incapacity are matters of both individual and national concern." His proposals in that speech ranged from health insurance for the aged, to expanded support for training medical personnel, to mass immunization, and attacks on environmental pollution which affected health.

In May of that same year, the President took a more high-profile approach, when he went to a New York rally for his program of medical care for the aged in Madison Square Garden. That rally, as Kennedy stressed, was one of 33 which occurred around the country on May 20, 1962, and was geared to supporting the bill which had been introduced by Reps. Aime Forand of Rhode Island, and Cecil R. King of California. That bill was now limited to providing care for the elderly, and called for employee contributions through their paychecks to a program which would pay a large portion of the cost of hospitalization should that occur; in other words, Medicare's Part A, as we know it today.

While he concentrated on personalizing the consequences of the bill by talking about how it would affect individuals, and on refuting those who would accuse the bill of "socializing" medicine, Kennedy also directly took on the question of the government's responsibility for the health of its citizens. "This bill serves the public interest," he argued. "It involves the Government because it involves the public welfare. The Constitution of the United States did not make the President or the Congress powerless. It gave them definite responsibilities to advance the general welfare-and that is what we're attempting to do."
Read entire article here:
https://americansystemnow.com/the-american-system-in-healthcare-the-path-to-medicare/

Congress Need Only Go to American System Principles to Solve the Health Care Crisis

July 11, 2017-As the U.S. Senate takes up the question of repealing Obamacare again this week, Americans can expect to be inundated with waves of facts, figures, and moralisms that will accelerate the conflict over this issue, but which provide no clear pathway to a solution to what is a genuinely catastrophic health care crisis in the United States. The first step to resolving the deadlock in Congress is a return to the principles of the American System, as defined particularly by Alexander Hamilton and President Franklin D. Roosevelt.

This article will be a preliminary approach to the healthcare question from that standpoint, not a prescription. But the first place to start is with a clear-eyed view of the problem as a whole.

A National State of Emergency

The United States population faces a health crisis unprecedented in the nation's history. This is demonstrated by the fact that life expectancy in the United States is actually decreasing in significant geographical areas and sections of the population-a situation not even experienced during the nation's worst depression, that of the 1930s. A study on mortality rates released in December 2016 by the National Center for Health Statistics showed that Americans could expect to live for 78.8 years in 2015, a decrease of 0.1 from the year before. The overall death rate increased 1.2 percent, fed by the fact that the mortality rate is increasing among white (non-Hispanic) middle-aged women, particularly in rural areas. The causes of the increase in the death rate is being attributed to what are called "diseases of despair"-alcoholism, drug use, and obesity.

A related aspect of the crisis is the opioid epidemic, which is gathering steam. A recent New York Times study, based on government statistics, estimated the rate of overdose deaths from opioids at approximately 100 per day, and projected the total deaths from this source in 2016 to be 59,000 or more (final statistics will be released by the CDC in December of this year.) Detailed studies have been released on the specific causes (see Dreamland-The True Tale of America's Opiate Epidemic), but every indication is that the problem is increasing (an estimated 19% rise from 2015 to 2016!), despite crackdowns on over-prescription of painkillers and the like.
This rise in mortality, documented by Brookings scholars in 2017, highlights the severity of the healthcare crisis.

The third aspect of the crisis is the horrifying scarcity of means to provide medical care to deal with these conditions. The shortfall ranges from a drastic decline in the availability of medical facilities, to the skyrocketing price of medication and medical care for vulnerable parts of the population, to the shocking dearth of investment in advanced medical science.

Take the availability of hospital facilities. An estimated 57 million people in rural areas (whatever their insurance and income status is or is not) are experiencing, or threatened with, a lack of medical care, from the absence of medical infrastructure. One-third of all rural community hospitals, some 670, are currently at risk of closing. Over the period 2010-2016, there were 80 rural hospitals shut.

Nationwide, over the 20 years of 1993-2013, the total number of community hospitals in the U.S. dropped from 5,261 to 4,974 (of those, 3,003 were urban, and 1,971 were rural, as of 2013). The total number of community hospital beds fell from 917,847 in 1993 to 795,603 in 2013. Accordingly, the national beds per 1,000 population ratio fell from 3.56 in 1993, down to 2.52 in 2013.

So far, every proposal to "reform" health care fails short, usually because they focus more on reducing the cost of care (to the individual, the government, or both), rather than increasing its availability overall. The Medicare-for-all bill (H.R. 676) put forward by Rep. John Conyers (D-MI) goes the farthest to addressing the crisis in provision of affordable care, and represents a feasible and necessary first step. It has 114 sponsors. If combined with the overall restoration of American System policies of banking and investment (Glass-Steagall, national credit system for infrastructure, et al.), including in woefully inadequate medical facilities, it can begin to solve the crisis.

Taken as a whole, the United States faces a medical state of emergency, and must act immediately.

The Principles Required

General Welfare: The first step is to define the principles for approaching the problem. It begins with the principle of the General Welfare which was defined by Treasury Secretary Alexander Hamilton, and can be found in both the document he is heavily responsible for bringing into being-the U.S. Constitution-and his four major reports, especially the Report on Manufactures.

The U.S. Constitution twice cites the responsibility of the Federal government to provide for the General Welfare of the population, first in the Preamble and then in Title I, Section 8, the enumeration of the powers and responsibilities of Congress. Then, in the Report on Manufactures, Hamilton elaborates:

Alexander Hamilton

"The terms "general Welfare" were doubtless intended to signify more than was expressed or imported in those [matters] which Preceded [in Section 8]; otherwise, numerous exigencies incident to the affairs of a nation would have been left without a provision. The phrase is as comprehensive as any that could have been used; because it was not fit that the constitutional authority of the Union to appropriate its revenues should have been restricted within narrower limits than the "General Welfare" and because this necessarily embraces a vast variety of particulars, which are susceptible neither of specification or of definition.

"It is therefore of necessity left to the discretion of the national Legislature, to pronounce upon the objects, which concern the general Welfare, and for which under that description, an appropriation of money is requisite and proper...

"The only qualification of the generality of the Phrase in question, which seems to be admissible, is this-that the object to which an appropriation of money is to be made be General, and not local; its operation extending in fact, or by possibility, throughout the Union, and not being confined to a particular spot."

Increase the Productive Powers of Labor: Alexander Hamilton also outlined the necessarily related American System principle for dealing with national crises-the Federal government's fostering of the productive power of the economy. As also elaborated in the Report on Manufactures, the economic health of the nation depends upon investments that improve productivity. These include material investments, such as the development of new technologies and infrastructure-both specified in the Report on Manufactures-but also obviously extend to the physical and mental state of the labor force itself. That means the Federal government must assume responsibility for ensuring the health and welfare of the population-although not necessarily paying for it directly.

But the necessity of providing the growth of the economy is relevant in another respect: Without a rising productivity, a nation doesn't have the resources readily available to invest adequately in social services like health care! We can't just reshuffle present monies (especially when so much of our money is backed by the equivalent of digital hot air, and our actual physical productivity is abysmal). We have to create new wealth, at higher levels of technology, to do what Hamilton understood as producing a more efficient economy, with a surplus to take on further advances in the future. Such an economic program will also create millions of new, decent-paying jobs and a sense of hope in the population once again-a crucial feature of turning around the "diseases of despair."
Read full article here:
https://americansystemnow.com/congress-need-only-go-to-american-system-principles-to-solve-the-health-care-crisis/

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