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Health Care In Crisis
Guerilla News
GNN Staff
July 22, 2004

In one of the most memorable scenes in Bowling for Columbine, Michael Moore travels to Canada where walks up to people's houses, opens their unlocked front doors without knocking and rambles into their living rooms. The Canadians greet the controversial director with little more than polite, if only slightly startled, Hello, what can I do for you?

For most Americans, the scenes were shockers. Why didn't they shoot him? While Canada and the U.S. have much in common - Wal-Mart, hockey, the North American landmass - the two countries are different in many ways. Gun laws are one, how we care for our sick is another.

In Canada, all citizens have basic health care provided for them by the state. The Canadian system isn't perfect. Dental work, and many procedures aren't covered, but every Canadian (and many non-citizens living in Canada) can go to sleep at night knowing they can visit a doctor for a simple check-up without being hit with a bill that will set them back a paycheck, and, most importantly, they won't be saddled with astronomic debt if they were to need a major operation or develop a serious illness. It's no different in every other western democracy, and even many developing countries around the world. Yet here in the U.S., the world's richest and most powerful nation, 44 million of us (including 8.5 million children) have no health coverage whatsoever, which means many don't get the preventive care they need, and when they do get sick, they risk losing everything they have to pay for treatment.

A nation of haves and have-nots

Last month, tens of thousands of Americans took to the streets for a Health Care National Day of Action. Marches took place in 19 cities across America, with the theme, "Bridging the Gap for Health Care." The event was sponsored by Americans for Health Care (a project of the Service Employees International Union (SEIU) the nation's largest health care union, representing over 755,000 health care professionals), Jobs With Justice, Rock the Vote.

The organizers put health care squarely into the realm of social justice, emphasizing how the gap between the "haves" and "have nots" is growing. According to a recent study requested by Congress by the Institute of Medicine distinct and glaring disparities exist in health care offered minority communities and whites.

"Disparities in the health care delivered to racial and ethnic minorities are real and are associated with worse outcomes in many cases, which is unacceptable," Dr. Alan Nelson, chairman of the Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, told CNN.

The report concludes that not only is there overwhelming evidence that blacks get second-class care, but that treatment leads to higher death rates in African-Americans when it comes to HIV/AIDS, cancer and heart disease.

It's no surprise that health care has become one of the hottest topics in the presidential race. Last year's passage of a watered-down prescription drug bill, which provides government drug benefits for seniors, did little to ameliorate the challenges the uninsured face when trying to get health care. Presumptive Democratic candidate John Kerry has made health care reform one of his key campaign issues (read Kerry's health plan here). In the last 60 seconds five more people will have lost their health insurance, by this time tomorrow 7,000 will lose theirs. That's a lot of votes.

What we all want

The irony is health care is an issue that almost everyone agrees needs attention. The public's growing unease with the current health care system has meant that more and more Americans support a more towards universal coverage and rule changes governing how Americans buy their drugs.

In a recent poll by ABC News and the Washington Post, a sizable majority, 70 percent, said it should be legal for Americans to buy prescription drugs outside the United States. One in eight respondents said they or someone in their home already does it.

The October 2003 poll found that more than half of Americans, 54 percent, are dissatisfied with the overall quality of health care in the United States while 44 percent are satisfied. Dissatisfaction with our health care system is growing, it's more than 10% higher than in 2000 and higher than it has been in the past decade when compared with earlier surveys.

Those polled said they worried about future costs, declining coverage and the problems of people who lack insurance. The poll found that six in 10 people surveyed say they are worried about being able to afford health insurance in the future. More than one in six said they have no insurance.

GNN recently traveled to three cities in the U.S. and Canada to talk to young people about their concerns, and found similar responses.

As 24-year old New York City resident Rosemary told us, many Americans don't worry about health care until it's too late, "We have other priorities in our country. Most people don't think about it. The people who have health care and are covered by it, don't think twice about the issue. They just take it for granted that they can get medical attention whenever they need it. And then those who aren't covered, they don't even realize that they could have the same opportunity."

System run amok

Even more troublesome, the uninsured are being gouged. Hospitals are increasingly charging uninsured patients more than what they bill those with insurance. A recent Mother Jones magazine investigation analyzed the costs of an appendectomy in the Detroit area. An uninsured patient was charged $15,0711, while Blue Cross HMO was only charged $5,193. If that patient had simply traveled across the water to Windsor, Canada, it would have only cost them $1,970.

In the end, most uninsured simply don't pay - they can't afford it. American patients without insurance failed to pay roughly two-thirds of the $60 billion in bills they racked up in 2001, meaning the hospitals get stuck with debt.

As former health care industry reporter Jedd Seltzer told us, "We have high malpractice rates that have physicians running scared from state to state. We have prescription drugs rising at a higher rate than any other medical cost even though we haven't had any huge innovation in the last 10 years or so. We have people who are uninsured into hospitals, basically given charity care so that the hospitals take on more and more bad debt, they take on more and more of the burden, they don't have the resources for other things, like to invest in advanced medical technology. So we may have come full circle that the system is about to run amok."

Critics of Bush's Medicare revision argue that the plan does little to alleviate the biggest problems in the health care system. Most of the reforms don't kick in until 2006. As of June, seniors can now buy prescription discount cards that Bush says will save them 10 to 25%. But experts say the lower figure will be closer to reality. In 2006 patients will pay a $35 monthly premium and a yearly deductible of $250. This will cover 75% of the cost of drugs, up to $2,250 a year. (Thus a sizable chunk will come from the patient.) "Then comes the 'doughnut hole,'" writes Sam Newlund, a retired reporter for the Minneapolis Star-Tribune. "Above the $2,250, Medicare pays nothing until the patient has forked over $3,600 out of pocket. At that point Medicare pays 95%."

The New York Times says a person with $5,000 in yearly drug expenses at current prices will pay 70 percent of the cost.

Many argue the only solution has to be drastic.

Newlund writes, "What we need is a universal single-payer system, low-income people no longer would have to resort to high-cost emergency rooms for non-emergency treatment financed by the rest of us. We would minimize the time and waste of computer-punching and paper-rattling created by a dizzying maze of providers, each with complex and conflicting requirements and benefits. Think of the effort and expense each doctor's office is saddled with because of this mess."

The high costs are being passed down to employers, who are increasingly unable, or simply unwilling to foot the bill - more and more Americans who once relied on their job to cover their health insurance are finding out the benefits are not being offered.

GNN talked with several leading organizers who are doing inspirational work on the issue. Read our interviews with Jobs for Justice organizer Rand Wilson, Laurie Martinelli, a lawyer for Health Law Advocates, and Joe Duffett, the Executive Director of the Illinois-based Campaign for Better Health Care.

GNN also traveled to Los Angeles to learn about one hip company that is bucking the trends.

American Apparel: A case study

American Apparel is a forward thinking clothing manufacturing company that has recently exploded onto the scene through hip marketing, unique positioning and a politically correct ethos. Run by the charismatic mile-a-minute-talkin' t-shirt evangelist, Dov Charney, American Apparel makes for an interesting case study because of its huge 0-60 success, sweatshop-free branding, and leading edge practice of paying a fair wage to its workers (go figure!) while providing affordable health care and other benefits nearly unheard of in the industry.

While most apparel companies like the Gap manufacture their goods in countries like China and El Salvador, where labor can be as cheap as 50 cents an hour, American Apparel shop employees regularly make over $10 an hour and more. This apparent disadvantage hasn't slowed them down. In fact, in the past three years, American Apparel has doubled business every year, according to Charney. Last year he did $82 million in sales. In terms of employees, the company is now the largest domestic apparel manufacturer in the United States. American Apparel's first retail store opened in Echo Park, Los Angeles in October 2003. Now there's stores around the world, including Montreal, New York City, Toronto, Germany and England.

"We're committed to sustainability and are emphasizing living wages as a way of ensuring the continuity within the workplace...", says Charney. "We feel the health and welfare of our workers pays off because we're able to really create a special environment and if the workers get passionate about making the very best product, that's going to come across in the manufacturing."

"We have waiting lists for people who want to work in our factories. It's a coveted job, almost nobody leaves the company. Our turnover rate is basically nil."

One of the reasons for that is the company's health insurance program. According to Roan Atwood, coordinator of American Apparel's community relations and organic programs, the company has three different programs for its employees. Shop floor employees have their insurance subsidized at a higher rate than office workers, and even are offered a program called Salud Con Health Net. Especially designed for Spanish-speaking residents of southern California, the program even allows them access to medical facilities in Mexico, where many American Apparel employees have family.

The health plans end up costing each employee an average of $32 a month, with the company chipping in more than double that to cover the difference.

"It's important for two reasons," says Atwood. "We really see the employee as a long term investment. From a business perspective, a healthy employee is a loyal and positive worker. From a humanistic perspective I don't think anyone can argue with doing the right thing, treating other people with the same level of dignity and respect."

Atwood says that by providing full health care for their employees they don't see as many absentees as other apparel manufacturers do. Less people coming to work sick means less employees are getting sick.

"We feel the strain from domestic production and the increase in health care costs, but we're not willing to compromise our baseline commitment to having the most progressive mission of any company in the United States. Our health care policy is a central part of that."

This report was funded by a grant from the Nathan Cummings Foundation. Campaign for Better Health Care, Health Law Advocates and Jobs With Justice are also grantees.