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Universal Health Care process is before
the Illinois Senate this fall. A coalition based
in CU is a major activist group agitating for
its passage.
The Health Care Justice Act of 2003 initiates
a process to achieve universal health
care. It is not one specific plan to achieve
universal health care. It requires the creation
of a Bi-partisan Health Care Reform
Commission by September 1, 2003 to oversee
the gathering of public input and recommendations
for a universal access heath
care plan. The Commission and its operations
will operate under the Illinois
Department of Public Health. This Commission
will hold two sets of 10 public
hearings around the state seeking public
input on the development of the Health
Care Justice Act of 2003. Health care
providers, health care consumers and others
will assist in developing and proposing
several different plans ranging from singlepayer
plan to other ideas for Illinois to
implement.
The Public Health Department will task
the commission and a final report will be
presented to the Governor and General
Assembly in early 2005. This report will be
based upon the public meetings and
research and will include a comparative
analysis of the different proposals submitted
by interested parties to achieve universal
health care coverage. The bill provides
for further public discussion during the
spring through fall of 2005 with the Commission
presenting the options to the General
Assembly which is obliged to then pass
affordable and accessible health care for
Illinois.
HEALTH CARE JUSTICE’S LEGISLATIVE HISTORY
AND ITS FUTURE
The Health Care Justice Act of 2003 HB
2268 passed the House Health Committee
on March 11th with bipartisan support and
passed the full House (60 Yes, 45 No, 11
Present, 2 Present) . THe Health Care Justice
Act passed out of the Senate Health
Care Committee, but was stopped by the
insurance industry from having a full Senate
vote.When the House bill passed, it was
assigned to the Senate Insurance Committee
instead of the Health Care Committee
where it passed on April
29th. It stalled in the regular
session but the deadline for
Senate approval has been
extended until the end of this
year, which allows for it to be
passed during one of the two
short Fall Veto sessions.
These are November 4th to
6th and 18th to 20th. It is
extremely important that
State Senators be contacted regarding the
importance of this bill in this time period.
Should it have passed in the first days of the
month, calls should be made to the governor
for his quick signature and attention be
focused on how the process will be continued
and implemented.
HOW WRETCHED THE CURRENT CRISIS IS!
Our health care system is decomposing
at an accelerated rate. The central office of
the Campaign for Better health Care is in
Champaign, and there are also offices in
Chicago. CBHC is Illinois’ largest grassroots
health care coalition, representing
321 diverse organizations. Every component
of the health care system is in cardiac
arrest. A total meltdown will occur if President
Bush succeeds in forcing our parents
and people with disabilities into private
managed care plans in order to be able to
access prescription drugs. Bush’s backdoor
approach to block grants to the Medicaid
program will cause havoc for millions of
Illinoisans and bankrupt the state.
Health care costs are soaring at double digit
rates and it is projected that similar levels of
increases will continue for the rest of this
decade. In 2001 the United States spent
$1,424,000,000,000 on health
care, an increase of
$114,000,000,000 from 2000.
Conservative estimates for
2003 predict that our country
will spend $1,750,000,000,000.
This figure will represent per
capita spending of nearly
$5,500 per person. Of countries
with a universal health
care system, even those with
the highest expenditures are still only spending
$3,000 per person. And yet 45 million Americans
are uninsured and another 75 million are
underinsured.
Here in Illinois the health care crisis has
reached epidemic levels. As the economic
recession continues, more Illinoisans are
unemployed, thus becoming uninsured. For
many low income workers Medicaid is the
only answer. For others it is the emergency
room. This spring, CBHC released the most
extensive study ever in Illinois detailing the
number of uninsured. This report revealed
that 3.1 million Illinoisans were uninsured
at any given moment in 2001. The Health
Care Justice Act of 2003 commits the state
of Illinois to enact universal health care by
June of 2006. This proposal will force this
debate back on the political agenda.
Of those politicians, organizations and
policy makers who do support universal
health care, there is no agreement on what
approach should be taken. Those in support
must be more committed than was the case
in the early 1990s to move this fight forward.
This proposal is strategically designed, first,
to win the public and political battle to
make a commitment to implement universal
health care. Once we achieve this major
political hurdle (which will not be easy), we
can move to stage two: determining what
solution will work best. The first hurdle will
be a political battle that will be just as tough
as winning the type of health care system,
which would be fair and equitable.We must
win this debate first. If we do not take this
two-step approach, the forces opposing us
will succeed in implementing piecemeal
reforms and expand the stranglehold of the
medical industrial complex.
For more information about the Health
Care Justice Act please access CBHC’s website
at www.cbhconline.org, the Illinois
General Assembly’s web-site or call CBHC.
Call State Senator Winkel and tell him it is
time that he stands up for consumers and
businesses. The health care crisis is causing
havoc for employers and employees. Passage
of the Health Care Justice Act would
be the biggest economic stimulus plan for
our state. In addition to calling Winkel, call
Senator Obama and tell him that you are
behind his effort to call this bill during the
Fall Veto session and getting it passed out
of the Democratically controlled Senate.
The time is now, not next year.

Las personas de habla inglesa limitada deben recibir
servicios de interpretación de intérpretes calificados y
familiarizados con la terminología médica para así dar
la verdadera asistencia sanitaria al paciente.
Las leyes y las pautas federales requieren que todos
los proveedores de la asistencia sanitaria, que reciben el
financiamiento federal, proporcionen el acceso significativo
a los servicios de interpretación para las personas
de habla inglesa limitada.
¿Está Usted Recibiendo los Servicios de Interpretación
y los Servicios de Lenguaje que Necesita?
¿Ha Usted, o alguien que Usted conoce, necesitado
atención médica y:
¿No se le proporcionó un intérprete por parte del
proveedor de los servicios de asistencia sanitaria?
¿Se le proporcionó un intérprete inadecuado o sin el
entrenamiento adecuado?
¿Tuvo que depender de un miembro de su familia o
un menor como traductor?
¿Se le negó la asistencia médica porque no hablaba
bien el inglés?
¿Le trataron de forma descortés porque no hablaba
bien el inglés?
¿Sufrió una grave enfermedad o herida debido a las
barreras del idioma o a los errores de comunicación?
¡Si es así , o si Usted quiere apoyar el esfuerzo de
ofrecer más y mejores servicios de interpretación a
nuestro sistema local de asistencia sanitaria, necesitamos
que Usted ¡particípe en nuestros esfuerzos!
Para más información, para informarnos de un
incidente personal en que le ofrecieron a Usted un traductor
inadecuado u otros servicios de lenguaje en el
sistema local de asistencia sanitaria, o para participar
en los esfuerzos comunitarios para dirigir estos problemas,
llame al Champaign County Health Care Consumers
al (217) 352-6533 o por correo electrónico al.

.%    population and 11.1% of the Champaign
County population have Limited English Proficiency. This
means that a growing number of people in our community
face the danger of being unable to adequately communicate
with health care providers. Failure on the part of health care
facilities to provide interpreters and other language services
may result in an inability to access needed health
care, misdiagnosis, unnecessary or inappropriate
testing and treatment, less frequent use of primary
and preventive care services and more frequent visits
to the emergency room, and sometimes even death
from medical error and miscommunication.
Champaign County Health Care Consumers
(CCHCC) became concerned with the growing
number of calls to our Consumer Health Hotline from local
immigrants about inadequate interpreter services at local
health care facilities. We are aware that too many people in
our community have faced significant barriers to accessing
health care and have suffered injury, illness, and inappropriate
treatment as a result of inadequate language services at our
local hospitals and other major clinics.
In response, we have launched a new campaign for
improved hospital interpreter services. The campaign hopes to
identify major areas of concern for patients with Limited English
Proficiency, educate consumers about their right to language
services in health care facilities, and initiate collaboration
with local health care providers to improve these services.
As Alejandra Coronel, CCHCC volunteer and immigrant
from Venezuela, says: “Health care is a basic human right. It is
what maintains our life in times of injury and illness. When
we, as immigrants, cannot access health care because of language
barriers, we are made to feel less human, less deserving
of our lives and our wellness than non-immigrants, when we
contribute to and love this community as much as any other
people here.”
LEGAL MANDATE
Title VI of the Civil Rights Act of 1964 prohibits discrimination
based on race, color, or national origin by any person
or institution receiving federal funding for programs or activities.
The federal government and the courts have determined
that the prohibition of discrimination based on national origin
includes protections for people of different nationalities
who do not speak English well.
In health care settings, this means that providers who
receive federal funding (such as Medicare and Medicaid) must
work to ensure that patients with limited English skills have
meaningful access to any program services and benefits that
are offered to other patients. This includes virtually all hospitals,
clinics, doctor’s offices, nursing homes, managed care
organizations, state Medicaid agencies, and home health care
agencies. Further, the Title VI protections extend to all the
operations of the organization or business, not just those
departments or patients for which they receive federal funding.
More specifically, the Office of Civil Rights requires all
recipients of federal funding to:
1. Provide translation services at no cost to the Limited
English Proficient (LEP) individual.
2. Have written policies regarding language access services
and staff who are aware of the policies.
3. Determine the language needs of prospective patients at
the earliest possible opportunity.
4. Systematically track LEP clients and clients’ needs.
5. Identify a single individual or department charged with
ensuring the provision of language-accessible services.
6. Provide written notices to clients in their primary
language informing them of their right to receive
interpretive services.
7. Not use minors to translate.
8. Use family and friends as translators only as a last
resort and only with informed consent.
9. Ensure the availability of a sufficient number or
qualified interpreters on a 24-hour basis – including
telephone services.
10. Use only qualified and trained interpreters with
demonstrated proficiency in both English and the other language,
knowledge of specialized terms and concepts in both
languages, and the ethics of interpreting.
These services must be provided to all patients with Limited
English Proficiency, not just those patients who are recipients
of Medicare,Medicaid, and Kid Care.
Are YOU Getting the Interpreter and Language Services
You Need?
Have you, or someone you know, ever needed health care
and:
– Not been provided an interpreter by the health care provider?
– Been provided an inadequate or untrained interpreter?
– Had to rely on a family member or minor to interpret?
– Been denied care because you do not speak English well?
– Been treated rudely because you do not speak English well?
– Suffered greater illness or injury because of language barriers
or miscommunication?
If so, or if you want to support the effort to bring more and
higher quality interpreter services to our local health care system,
then we need you to get involved!
For more information, to report a personal account of
inadequate interpreter or other language services in the health
care system, or to get involved in community efforts to
address these problems, contact Champaign County Health
Care Consumers at (217) 352-6533 or at
cchcc@prairienet.org.

Brooke Anderson is a Community Organizer
for Champaign County Health Care
Consumers. Brooke was the lead organizer
on CCHCC’s recent statewide legislative
victory mandating contraceptive coverage
in all health insurance plans with prescription
coverage in the state of Illinois, and
now works on a variety of health care justice issues for CCHCC.

      
is dependent not just on health care, but also
on a decent standard of living –including
adequate food, clothing, housing, and social
services – and on a safe community. It is not
enough for people to have access to health
care once they are already ill or injured; our
community must also use a public health
perspective to prevent illness, injuries, and
deaths from occurring in the first place.
Right now, the health and wellbeing of our
communities are undermined by the epidemic
of gun-related injuries and deaths.Approximately
29,000 people in the United States
were killed by guns in 1999. Twice as many
people were treated in emergency rooms for
non-fatal gun-related injuries that year.
Many of these injuries and deaths are
preventable. Champaign County Health
Care Consumers (CCHCC) is working to
mobilize a local coalition to fight for more
sensible national policy on guns that emphasizes
consumer rights and public health.We
are working for federal legislation that
would regulate guns as a consumer product
and on legislation to re-authorize and
strengthen the federal Assault Weapons Ban.
REGULATING GUNS AS A CONSUMER PRODUCT
Guns – like prescription drugs, insecticides,
household chemicals, and many other
products found in American homes – are
inherently dangerous. Yet guns, unlike other
inherently dangerous products, and unlike
nearly all other consumer products in America,
are not regulated for health and safety.
The history of consumer product regulation
clearly demonstrates that a significant number
of illnesses, injuries, and deaths can be
prevented by health and safety regulation.
CCHCC has endorsed the
Firearms Safety and Consumer
Protection Act, which would
subject the gun industry to the
same health and safety regulations
as virtually all other products
sold in America. The bill
would give the Department of
Justice strong consumer protection
authority to regulate
the design, manufacture, and
distribution of firearms and
ammunition. This legislation would finally
end the gun industry’s deadly immunity
from regulation and make our communities
safer, but without limiting the public’s access
to guns for sporting and other legitimate
purposes, and without outright banning all
guns. For more information about the
Firearms Safety and Consumer Protection
Act, visit www.regulateguns.org.
RENEWING AND STRENGTHENING THE FEDERAL
ASSAULT WEAPONS BAN
CCHCC has also begun a campaign to
reauthorize and strengthen the federal
Assault Weapons Ban. Civilian assault
weapons are semi-automatic versions of military
weapons designed to rapidly lay down a
wide field of fire, often called “hosing down”
an area. This increased lethalness makes
them particularly dangerous in civilian use.
In 1994, Congress passed and President
Clinton signed a ban on the production of
certain semi-automatic assault
weapons and high-capacity
ammunition magazines. This
law banned a list of 19 specific
assault weapons and other
assault weapons incorporating
certain design characteristics.
The law is scheduled to sunset on
Sept. 13, 2004. If not reauthorized,
it will then be perfectly
legal for the gun industry to
begin mass-producing and marketing
semi-automatic military-style assault
weapons like AK-47s to civilians.
But it is important not just to re-authorize
the current law, but also to strengthen it.
Over the past decade, the gun industry has
circumvented the law, designing and marketing
“post-ban” assault weapons like the
Bushmaster XM15 — the rifle used by the
Washington, DC-area snipers — that incorporate
slight cosmetic modifications to
evade the ban. Therefore, the reauthorization
of the ban must include substantial
improvements to prevent the gun industry
from continuing to flood America’s streets
with these deadly weapons. CCHCC has
joined a broad coalition of more than 260
national, state, and local organizations
(including 20 other organizations in Illinois)
that is supporting the legislation to implement
a stronger, more effective assault
weapons ban.
Representatives Carolyn McCarthy (DNY)
and John Conyers (D-MI) have introduced
the Assault Weapons Ban and Law
Enforcement Protection Act of 2003 (H.R.
2038), which would significantly strengthen
current law to address limitations in the ban
that have allowed the gun industry to circumvent
it. H.R. 2038 currently has 100
cosponsors. A companion bill, S. 1431, has
been introduced in the Senate by Senators
Frank Lautenberg (D-NJ) and Jon Corzine
(D-NJ).
Over the next year, until the current
Assault Weapons Ban expires, Champaign
County Health Care Consumers will be
working to educate the community about
the need to renew and strengthen the Assault
Weapons Ban through video showings,
leafleting, letter writing, educational reports,
and other activities. CCHCC will also be
working to communicate the public support
for ban renewal to our area representatives
and Illinois Senators. For more information
on the Assault Weapons Ban, visit
www.banassaultweapons.org.
We are urging community members to
tell congress that our community’s safety
and wellbeing outweigh the gun industry’s
interest in increasing profits. If you are interested
in receiving more information, helping
with either of these two projects, or being
added to the gun regulation project mailing
list, please contact CCHCC at 352-6533.

Allison Jones is a part
time staff member at
CCHCC and a student
at the University
of Illinois. Some of
her projects at
CCHCC include work on the Women’s
Health Task Force, the Gun Regulation
Project, and the Medical Debt Coalition.

    of Champaign County
residents (led by Mike Doyle), concerned
about the lack of citizen/consumer representation
on the local health planning board,
formed Champaign County Health Care
Consumers (CCHCC).
In the 1970s, the federal government
required the formation of local health planning
boards in order for communities to
make decisions about how to allocate
resources and federal funding for health care
at the local levels.
The federal government required that a
certain percentage of the members of each
local health planning board be made up of
“consumers” in order to ensure that the interests
of the people who use the health care system
be represented in the local decision-making
process. “Consumers” are distinguished
from health care “providers” (such as physicians,
hospital administrators, etc.).
This is where the Champaign County
Health Care Consumers got its name, and the
word “Consumers” refers to this federal government
distinction. CCHCC does not use
the name “Consumers” in a capitalistic sense
– this is not a reference to “purchasers” of
health care. In fact, it is CCHCC’s view that
health care is an essential service and should
not be a service left up to the “free market.”
“Consumers” is a statement
of the interests represented
by CCHCC, and those are
the interests of the people
who are supposed to be
served by the health care system.
At the time that CCHCC
got started, the “consumers”
on the local health planning
board were not truly representing
the interests of the
community, and especially
not the interests of lowincome
Champaign County
residents who had limited
access to health care as a
result of Medicaid discrimination or inability
to pay.
CCHCC struggled to make the community
aware of the local health planning board
and its role in the allocation of resources in
Champaign County, and to get real consumer
representatives elected to the Board. Shortly
after this struggle, CCHCC moved on to its
fight against Medicaid discrimination.
From its inception, CCHCC has organized
to increase the influence of consumers who
have traditionally been excluded from the
health care decision-making process. Twentysix
years and many victories later, CCHCC is
still empowering consumers to fight for quality,
affordable health care for all.
CCHCC is a non-profit, grassroots, citizen-
action organization
founded on the belief that
access to quality, affordable
health care is a basic human
right. Through CCHCC’s
community campaigns, people
realize that they can make
changes in the systems that
shape their lives. CCHCC has
over 6000 members who have
dedicated themselves to fighting
for justice in the health
care system. By engaging and
empowering consumers in the
struggle for improving health
care – at the local, state, and
national levels – CCHCC
works to better the day-to-day lives of people
in Champaign County and beyond.
CCHCC’s efforts have created the Consumer
Health Hotline, established a countywide
public health department, expanded
dental access for people with low incomes,
changed illegal and harmful medical billing
and debt collection practices, implemented
contraceptive coverage for women in
employee health coverage plans, and made
the local health care system more responsive
to consumer needs.
Throughout the years, CCHCC’s grassroots
work has received national attention,
and CCHCC is increasingly becoming a
national resource for other consumer advocacy
organizations. In addition, hospital executives
from around the country, government
officials, and policy makers frequently consult
with CCHCC on issues of medical debt
and collections, and other access-related
issues.
In September 2002, CCHCC was awarded
the Robert Wood Johnson Foundation’s
Community Health Leadership Award, a
prestigious national honor. In 2003, CCHCC
was featured in the July/August issue of Lifetime
Magazine, and quoted in an August
issue of The Nation. Most recently, CCHCC’s
work resulted in a front page article of the
October 30, 2003 Wall Street Journal, which
focused on the use of “body attachments”
(warrants for arrest) and incarceration of
low-income people by local hospitals in their
collection efforts. This national story
revealed to the nation that a debtors’ prison
does indeed exist for people who owe money
for hospital bills.
Claudia will be giving a presentation at
6:30pm on November 15th in the Wisegarver
Lounge of the IDF building, corner of Sprignfield
and Wright in Champaign.

Claudia Lennhoff is the
Executive Director of the
Champaign County Health
Care Consumers (CCHCC).
She has worked as a community
organizer for
CCHCC for 7 years, and has been Executive
Director since 1999. In 2002, Claudia and
CCHCC received the Robert Wood Johnson
Community Health Leadership award for community
organizing efforts to increase access to
health care in Champaign County.

     contributing
a personal anecdote on health care I was
immediately inspired to write about my
mother.My mother’s “missed” diagnosis,
her unnecessary surgery, her fight for life
after the surgery, the month in the hospital
that ended in her death, the cancer
that would have killed her regardless,
points in her life that possibly contributed
to her disease and definitely
contributed to her lack of health, and so
much more. As I started to write, I realized
I was peeling back the layers of an
onion that needs to be written for my
own health, but is not ready for public
viewing.Also, as with an onion, I was too
sensitive to the affects of the vapor to
write an article without a lot of tears.
Thus, I decided to distill my many different
experiences with health care and
hospitalization, in particular, and write
some tips.
These tips are primarily based on
three major health care events in my life
within a six month period: the surgery
and month of hospitalization of my
mother (in her late 50s) resulting in her
death, the weeks of hospitalization of my
paternal grandfather (in his 90s) resulting
in his death, and the major surgery
performed on my son (then 2 years old)
who is still alive. These events happened
in three different hospitals in the central
Illinois area. I am not a paid health care
provider, a trained medical practitioner,
nor do I play one on TV. I’m sure most of
you out there could add some suggestions
of your own and I hope that you
do. The “tips” are in no particular order.
TIPS FOR THOSE UNDERGOING TREATMENT
OR FOR THEIR CLOSE LOVED ONES:
1. Take Charge of Your Own Health.
I cannot emphasize this enough and this
really encompasses a lot of the other suggestions.
2. Ask Questions. You cannot ask too
many questions. Ask questions of your
physician, ask question of yourself,
research, talk to others, call the
nurses/doctors and double check your
understanding of medical advice, know
your medication/know your doses (okay
I got this one from the movie 12 Monkeys,
but seriously it is very important),
read books, surf the internet, try to
understand what is going on with your
body. If you do not feel up to this task,
please, please, ask someone close to you
to research for you. Which leads me to
my next suggestion.
3. Whenever Possible Have Someone
With You. Take along an advocate. I
am talking about the simple doctor’s
checkup to the stay in the hospital. It is
always good to have a second set of ears.
Your partner may think of a question
that never occurred to you. It also gives
another perspective on the event. I
accompanied my father to a cardiologist
appointment recently. My father and I
came away with completely different
perspectives on his health. After discussing
the appointment, we both came
to some middle ground. If I had not
been at that appointment, it is likely that
my father’s view of his own health would
still be based on the obviously very sick
person he saw exit the examining room
prior to his visit with the doctor. Comparatively,
my dad was feeling great.
4. Never Leave Someone Overnight
in the Hospital Alone. Really. If there is
any way to avoid leaving a loved one in
the hospital alone, please be with them.
If you are the one being hospitalized, ask
someone to come and stay with you. I
know we are all busy, but this is really
important. We all know the amount of
things that are done out-patient these
days, so when you have to spend the
night in the hospital then it is pretty serious.
I heard a nurse from a national
nurses organization say they had
arranged a buddy system for nurses who
have to spend time as patients in the
hospital. Even the nurses, maybe especially
the nurses, realize how important
it is to have an advocate with you while
in the hospital. This is especially important
if the hospitalized person is being
medicated. Let’s face it, being in the hospital
is stressful; when you are medicated
and/or stressed you cannot be expected
to make the best decisions for yourself
and your health. My family ended up
being with my mom around the clock
and oh how I wish we had planned this
from the beginning.We took shifts and it
was tough, but it was worth it. Unfortunately,
we did not do this for my grandfather
and I regret it. I discussed with the
original surgeon staying in the OR with
my son during his surgery. The surgeon
was open to this and I watched tapes of
open heart surgery to prepare me for the
event. The last thing I wanted to do was
cause problems in the OR and I trusted
the staff (obviously, with my son’s life),
but I also knew the risks and I wanted to
be there. Against my better judgment,
my husband convinced me to go with
the older, more experienced surgeon
who was not open to my being in the
OR. I did, however, stay with my son
until he was anesthetized and I was in
the room as he woke up.Other than that,
a loved one was always at my son’s side.
5. If It is Important to You, Ask for
It. My sister was spending nights with
my mother and sleeping on a very
uncomfortable chair, we asked for a
couch and received it. Since family was
with my mom as much as possible, we
quickly took over bedpan duties.. This
made my mom more comfortable,
helped out the overworked nursing staff,
and made us feel like we were doing
something. Eventually, the staff was
comfortable with our collecting linens
from the hospital supply closet so the
messy jobs didn’t have to wait for available
hospital staff. For my son, it was
important to me to sleep next to him
since I knew he wouldn’t be able to get
up right away. I demanded a regular
sized hospital bed and I was in bed with
him as he was waking up post-op until
we left the hospital. Some of the hospital
staff was supportive, some were not, but
I stood my ground. It made a difference
to me and my son and I believe it aided
in the healing process. Even during my
son’s birth, I wanted to keep my own
special nightgown on.. The nurses said
“no” for whatever wonderful hospital
protocol. Luckily, I had my doula (again,
an advocate) who could talk to the staff
while I was concentrating on my contractions
and explain that in the case of
an emergency they could tear the thing
to shreds. I birthed my son in my own
warm nightgown. Maybe not as important
as the other situations I noted, but it
meant something to me.
6. You Deserve to Be Treated with
Respect. After a particularly tough day
at the hospital with my mom, I came
home with my little 2-year-old son and
made signs for my mom’s room.Most of
the signs were these tips or variations of
them. The next day I took them into my
mom’s room, read them to her, and posted
them on the walls. They were for her,
but also for the hospital staff. I wrote
them in first person as though she was
telling herself and the staff, “I deserve to
be treated with respect at all times,” and
everyone read them. I received a lot of
comments. During her month in the
hospital, mom was not always treated
with respect, not even close. Some people
on the staff were kind, some were
clueless, some seemed to hate their jobs
and take it out on the patients, and some
seemed to border on sadistic.When people
(and there were so many people)
who cared for my mom would ask what
they could do, she would answer, “Bake
something for the hospital staff ” and
they did. I watched some of the nurses,
who had complained in front of my
coherent mother how heavy she was and
how much they didn’t want to move her
to change the sheets, eat the baked goods
and I would almost wretch. I would listen
to my mom tell her primary care
physician (who happens to have also
been her surgeon) how he was “the best
doctor in the world” (okay she was on
morphine that day, but still) and I would
feel so ill. Sure, treat the staff well, they
do deserve it, even the most clueless
among them. Caring for people is tough,
especially in our current health care system.
But, please don’t forget that you
deserve to be treated with respect at all
times. If this respect is not automatically
shown, demand it!
7. Listen to Your Body. You know
your body better than anyone else in the
world. Listen to it. Your body tells you
when something goes wrong. There are
all sorts of clues to your health communicated
to you through your amazing
body. Listen. Then, if something feels
wrong, let your loved ones and your
health care providers know. If those
around you are not listening or minimize
your feeling, talk to someone else.
Get another physician. Now you are listening
to your body, and you deserve to
have someone listen to you.
8. Get a Second (Third, Fourth, etc.)
Opinion. Do not be afraid to get a second
opinion. I kept asking my mom to
get a second opinion prior to her
surgery, but she eventually confided to
me that she was “too tired”. Bells and
whistles should have been going off for
both of us, but I didn’t push enough or
listen enough or take her to another doctor
myself. In the end, she still would
have died. The difference might have
been that she died more comfortably at
home without enduring some of the
unnecessary pain. Maybe it wouldn’t
have changed a thing. I will never know.
When my son’s pediatric cardiologist
suggested open heart surgery for a child
who was showing no symptoms of hiscongenital
heart defect, you better
believe we got a second, third, and
fourth opinion. It wasn’t a matter of
trust, I really have liked most of the
medical staff who have worked with my
son, but a matter of taking charge of
one’s health. Obviously, we went ahead
with the surgery, but after traveling to
different hospitals around the state we
were better equipped to make educated
decisions on where, who, how, when,
and why the surgery would be performed.
9. Always Get a Copy of Medical
Records and Test Results. I cannot tell
you how often I have seen patients carry
their medical records around the hospital
to another doctor and say something
about wanting to take a peak at them.Most of the time they are all sealed up
and the adults look down at the package
with a guilty look on their face when
they say they would like to read the “forbidden”
information within. Reality
check. This is your life, your information,
your records and you are entitled to
read them. In fact, I would say it is your
duty to read them. Ask for a copy of your
medical records and always get a copy of
test results. This is information that
helps you take charge of your health. Yes,
they may charge you a copying fee or
threaten to charge you. Yes, the information
quite often sounds like someone
writes them just for the court to read in a
malpractice suit. Yes, some of the information
will make little sense to you. You
will, however, learn quite a bit, you will
have a reference to refer back to, you
might notice that you understood something
differently than the doctor worded
it in her/his notes. Quite often I will read
the records and ask a question of my
physician based on these records and
this leads to better communication and
understanding on both sides. With the
small amount of time allotted to physicians
to spend with their patients these
days, it is not surprising there may be
misunderstandings or lack of communication.
10.Have Someone Keep Track of the
Bills. Heath care can be very costly.
Some of the suggestions I make here
could sound even more costly. Many
people don’t seek a second opinion due
to finances. Many people stay with a
doctor who doesn’t listen to them due to
the HMO coverage. You are busy trying
to heal yourself or looking out for your
loved one so assign one of those wellmeaning
“what can I do for you” people
to researching financial aid, or talking
with your insurance company, or looking
into alternative options for longterm
care, or whatever it is that you
think might help. Sure, the insurance
company may only speak to a family
member, but friends can do some leg
work for you. Looking at an itemized bill
of a month stay in the hospital makes
you think about taking your own tissues
with you during your next hospital stay.
Nothing is worse than “sticker shock”
after a loved one dies. We actually had
staff sit the family down and say how
hard they were working with the insurance
company to “let”my mother stay at
the hospital when I was fighting as hard
as I could to take her home. It was, to say
the least, surreal.
A FEW TIPS FOR THOSE FRIENDS OR
ACQUAINTANCES OF PEOPLE WHO ARE
HOSPITALIZED:
1. Do Something. I know, we all have
been through that feeling of “What
could I do?” but just do something. Ask
what you can do, but if told nothing, do
something anyway.Anything. Just do it! I
cannot tell you the loneliness I felt during
my mother’s hospitalization. I would
drive to the hospital every day and think
about all these people driving to their
destinations and they had no idea that
the most incredible person was lying in
an inadequate bed dying while I felt
alone and helpless to do anything to ease
her transition. I would drive home and
once in a while I would find on my
doorstep a wonderful home-cooked
meal. I have to say this person is not a
long-time friend or someone I even see
very often, she is not someone who
cooks often, and my family could be
considered hard to cook for due to our
dietary/life choices which do not match
those of my friend. The friend who left
these occasional meals brought indescribable
light into a very dark time in
my life. I am so grateful to her and I love
her so much for “just doing”. So many
people in our lives stayed away and didn’t
know what to do. I don’t fault them, I
did fault them, but now I understand. It
is tough. My friend with those quiet
meals left on the doorstep with no question
or fanfare, she is compassion.
2. Send the Card. Go ahead, pick up a
card and send it to the hospital, to the
home, to the family, to the person
undergoing health care. It will make a
difference to someone. We wallpapered
my mother’s hospital room with cards
from literally hundreds of people. We
kept the cards. Sorry, I didn’t get thank
you cards out to all of you like I had
envisioned. I love you all, especially
those of you I never knew who chose the
perfect card. My son still looks at the
cards he received. My grandfather never
received one.
3. Talk About It. If people are fine,
there is a hospitalization, or if they die.
Talk about it. Don’t pretend the entire
thing didn’t happen. I love the kids who
came up to my son and asked about his
scar (he is fond of going topless). I
explained that a hole in his heart was
patched by the same material their raincoats
are made out of and they nodded
their heads as if this is the most logical
thing in the world, they showed off their
scars from skinned knees and went
about their happy play. The adults were
hanging on every word, but they didn’t
have what it took to ask about it themselves.
We have so much to learn from
children.
For all those skeptics out there: Yes, I
am available to accompany you to your
doctor’s visit, call me if you want me to
spend the night in the hospital with you,
let me at your health care bills, and I’m
sure I can whip up a hot meal. Even if
you just want to talk about it. Drop me a
line.
linda.evans@erols.com

Linda Evans is a Champaign
native. She lived in
the Washington DC area
for several years before
serendipitously moving
back to the C-U area two
years prior to her mom’s
hospitalization. She is a
‘retired’ computer consultant.
Currently, she is a full-time homeschooling
mom/volunteer/activist.

After deciding upon the theme of “health care” for our November issue, the Public i editorial collective asked fellow community members to share their personal experiences with the health care system, whether positive or negative (we anticipated more of the latter). The responses we received – limited but thoughtful – appear on this page.

A Journey Home

This is an account of our journey back to our home. It is one of the paths that has led away from institutional and corporate control of our family, to a more natural and satisfying life. We have learned that being a so-called expert does not make a person ‘correct’ and it is a mistake to always give up control to such ‘experts’. We’ve learned it is important to take complete responsibility for your life. This includes nutrition, finances, education, and health. Officially sanctioned experts (i.e. not self taught) and institutions always believe they know what’s best for you, whether or not it is really best for you or anyone, and corporations are always first interested in quarterly profits.

My partner and I are expecting a child soon. This will be our fourth. As with all major life experiences, we have learned much from each birth. Our oldest daughter was born at Covenant Hospital. We chose a doctor because she was a woman with children and because of her relatively low Cesarean rate (she had the official credentials).We were new to this situation, received no good advice from our parents or childless friends, but wanted as natural an experience as possible. A natural experience is not what we received. We sat in clinic waiting rooms for hours during the pregnancy. Every visit would require an unnecessary internal exam. We were encouraged to take useless, painful and potentially harmful tests like amniocentesis (It primarily detects Down Syndrome, to allow time for an abortion of, what some people call, a ‘defective fetus’ – pretty vile).

When the baby failed to make her appearance on time, the doctor told us the baby was not in the right position. We had numerous sonograms and a personal visit to the doctor’s office for a talk on how horrible a birth like that could be. Since it was two weeks past the due date, she asked us if we wanted an immediate C-Section. We scheduled one for the following Monday.

We did our own research and discovered a book that said if a woman lies on her back with her pelvis raised, an engaged baby often can change positions. Fortunately, we did this (the doctor never heard of this special positioning). Arriving at the hospital on Monday (before the doctor’s office hours), we were told that since we were already there, we should induce labor. We were very happy to hear this, since, to us, induced labor is better than surgery.While it is better than surgery, it is not very pleasant. My partner was strongly urged to lie in bed for the birth, something she detested. She was also constantly hooked up to the fetal monitor, which she also detested. Eight hours later (after the doctor’s office hours), our daughter was born.

The new responsibility of a child is something that makes you forget other worries, so it was not until our second child was expected that we thought about the bad experience in detail and looked for ways to minimize the problems. My partner refused to return to the first doctor after it became evident that the doctor did not remember (or review) anything of the first experience. Our records were listed as having a C-Section. I called around and found out that one doctor in town would do a water birth. After watching a truly wonderful video on water births, we decided this option was for us. Water birth also had the advantage that no one can make you lie down or strap electronic equipment to you while you’re in the water.

We took our time getting to the hospital, rather then rushing in at the first contraction. We walked around the Engineering Quad until the contractions were intense and then went into the hospital.We timed it well, our son was born less than 1 hour after we checked in. It was a much better birth experience, they let us hold him for a couple of hours before they took him away to be worked on. We had taken charge of the situation and were better off.

Our second experience was bad after the birth. We didn’t want to hang around a hospital, we wanted to go home the next morning. The nurse wouldn’t check us out because our son ‘looked slightly jaundiced’ and they needed to wait for the results of some test. I was scolded for carrying my son around. We spent most of a day trying to get out, and finally got home for a late dinner. We were not in control in the hospital and were frustrated by not being able to do what we knew was right for us. We still listened to authority figures, so called experts, at that time.

Nurses now had different advice for us than the first time. This time my partner was to nurse the baby until he was done, not 15 minutes on each side (as they insisted with the first baby). This time we didn’t have to have ‘security photos’, which we were told would identify our daughter if she was kidnapped. (Too many people complained about this racket.)

Upon learning we were expecting for the third time, we were determined to have a truly good birth experience. We had spoken with a number of women in our homeschooling group who had birthed at home. They recommended midwives and we met with one. We had never met a person we felt was so relaxed and confident in what she did. We now know this is a sign of a competent individual who’s secure in their role.

Let me mention that the midwife I’m talking about is not a medical doctor. She does not practice medicine, which is illegal in Illinois if you are not licensed. She does not dispense drugs or do internal exams. She has no medical degree. She is not affiliated with a hospital or clinic. My insurance won’t pay for her. What are her credentials? She has helped deliver hundreds of babies. She worked as an apprentice for years before setting out on her own and she has her own apprentices.

Beyond that, she treated us like people. A typical pre-natal visit would involve taking blood pressure, taking my partner’s and the baby’s heart rate, feeling for the position of the baby and a couple of tape measurements. Then our family would sit and talk with her about babies and whatever else. Often we would have a meal together. We shared hugs when she arrived and left. She doesn’t hurry in, glance at a chart and hurry on to the next patient.

When talking about this with family and coworkers, we received comments about homebirth similar to those that we got about homeschooling and veganism. People are afraid that unless you use society’s ‘approved’ methods, things will go wrong. “You can bleed to death in 1 minute from a hemorrhage.” “What if the cord is wrapped around the baby’s neck?” are reminiscent of “How will your child be socialized?” and “What about calcium?” We discussed all these possibilities with the midwife and were satisfied. The midwife recognizes there are birth complications that do require medical intervention.

She is very frank about what is not within her capacity or function as a midwife. These complications are not commonplace as many people are led to believe. Giving birth is a natural experience that has been happening for millions of years, and does not generally require massive amounts of computer technology, Doppler radar and biochemical engineering. Medical science, like schooling, spends too much time matching people to ‘standardized’ results and not enough time dealing with people as unique individuals.

Our second daughter’s birth involved my partner and I walking around our neighborhood park until it was too difficult to walk, then going into our house. About 2 hours later, we had a new daughter. She was not subjected to the medical procedures hospitals perform on newborns. She just stayed with her mother for the first weeks of life. No painful blood tests, no eye drops, just comfort from mom. When our homeopath and a friend showed up the next day, they were surprised and delighted to see a newborn. Now that we’re expecting again, we have our visits with our midwife. Our oldest daughter is very interested in what is happening and spends time talking with the midwife. This is a terrific homeschooling experience and allows for countless educational opportunities to present themselves. It is a family event that we can all share: no clinic waiting rooms, no painful exams, only relaxed and friendly conversation. It is not institutionalized; it is real and natural. If you want more details of the birth experience, you’ll really need to talk to my partner. She’ll be happy to talk about it. I can tell you it was painful. Allopathic medicine does have a place, but read those forms they have you sign at the hospital. One said, “I understand that the practice of medicine is an art,” protecting so-called experts from malpractice lawsuits. Also remember that hospitals are for sick people and, despite insurance form claims, pregnancy is not a disease. We understand that things out of our control may happen and all we can be sure of is that we will continue to learn from our experiences. We are learning on our own, in our home, with our family. Addendum: Our fourth child, a son, Emerson Quinn Urban, was born at home on Sunday, October 26th. The midwife came over to our house at about 4:30am and stayed until everything was finished, around 3:00 in the afternoon. She encouraged us, gave us positive suggestions, but mostly left us to our own devices during the earlier stages of labor. In discussing our birth the next day when she stopped by for baby and mom checkup, she mentioned that Emerson’s shoulder had been stuck, but she quickly and gently dislodged him. We didn’t know this had happened at the time. I can imagine what would happen at the hospital.

-Ken Urban

Fractures in the System
I had a bike accident (ok, that’s overly-dramatic; I fell off my bike when it was hardly moving at all) and had a compound fracture of my radius. I had to have surgery to put a metal plate in my arm. The insurance company refused to cover the plate, calling it “a prosthetic.” In fact, of the $15,000 bill, they ended up covering about half. In addition, I was laid off that month, and only the initial hospital visit was covered, so all the castings and x-rays afterwards were not. I ended up with a very large hospital and clinic bill, on unemployment. Two months later they sent the bill to a collection agency. I then found out that because of my income level, I was eligible to have some of my bill waived…if I had asked. They aren’t required to tell you about it. And since they had already sent it to the collection agency,when I finally did ask, it was too late. This collection went on my credit report, and although it was paid in a timely fashion, my credit rating went down and it was difficult a few years later to buy a house. Lesson learned: insurance doesn’t mean anything if it’s not from a company that your clinic is in bed with, becausethere is no such thing as a “customary charge.”

-Clint Popetz

Discriminatory Pricing

I had a bike accident (ok, that’s overly-dramatic; I fell off my bike when it was hardly moving at all) and had a compound fracture of my radius. I had to have surgery to put a metal plate in my arm. The insurance company refused to cover the plate, calling it “a prosthetic.” In fact, of the $15,000 bill, they ended up covering about half. In addition, I was laid off that month, and only the initial hospital visit was covered, so all the castings and x-rays afterwards were not. I ended up with a very large hospital and clinic bill, on unemployment. Two months later they sent the bill to a collection agency. I then found out that because of my income level, I was eligible to have some of my bill waived…if I had asked. They aren’t required to tell you about it. And since they had already sent it to the collection agency,when I finally did ask, it was too late. This collection went on my credit report, and although it was paid in a timely fashion, my credit rating went down and it was difficult a few years later to buy a house. Lesson learned: insurance doesn’t mean anything if it’s not from a company that your clinic is in bed with, because there is no such thing as a “customary charge.”

-Anonymous

Few would dispute the assertion that the United States
health care system is in deep crisis. Health care spending
for 2001 was more than $1.4 trillion, or 14.1% of the GDP.
This comes to spending per person of $4,631, compared to
an average of $1,983 per person in other industrial
nations. Premiums for employer-sponsored health insurance
plans are currently rising more than 10% per year.
And data just released from the Census Bureau reveal that
43.6 million persons—one out of seven in the population—
were uninsured in 2002; indeed the number of
uninsured increased by 2.4 million from 2001 to 2002.
In a recent survey aired on NPR one in five Americans
thought health care was one of the two most important
issues to be addressed by the government—only the economy
and war were mentioned more frequently. Furthermore,
at least half of respondents expressed concern about
their ability to afford health care or the adequacy of their
current insurance coverage. With the 2004 presidential
campaign now getting underway, candidates will soon be
vying for public support for their various plans for health
care reform. Typically, however, such plans are characterized
by technical or vague language. In order to facilitate
public discussion, simple explanations of the various
issues at stake are badly needed.
THE UNINSURED
In addition to having the most expensive health care
system in the world, the United States remains the only
major developed nation not to offer some form of universal
health coverage for all its citizens. The reasons for this
are complex and include both residual cold war fears
about “communism” and business interests. These interests
are extensive, since 56% of health care spending in the
United States is privatized. This number is approximately
twice that of most other developed nations.
The lack of health care insurance is a serious problem,
particularly for the poor. Those earning less than $28,256
for a family of three (known technically as “200% of the
federal poverty level”) make up the majority of the uninsured.
The situation is even more desperate in rural areas;
in a few states, such as Maine and Montana, over 70% of
the uninsured are from rural areas. Since the majority of
health insurance in the United States is provided through
programs offered by employers, a popular stereotype of
the poor is that they do not have insurance because they
do not work. In reality, however, only 18% of uninsured
persons do not work—in fact, 70% have at least one fulltime
worker per family.
More typically, especially in rural areas, uninsured persons
are likely to be employed by small companies that do
not offer health insurance plans. And the crisis is even
extending to those who work for companies that do provide
insurance. For instance, work-based health care premiums
rose 14% last year. This means that the average
employee is expected to contribute $2,400 per year to their
insurance premium, a number which could easily be 10 or
20% of a poor family’s annual income. As evidence of the
scope of this problem of affordability, a report released
just this month shows that the number of employees of
large companies—which have traditionally had the best
rates of insurance coverage—who lack insurance
increased by 7% in recent years.
MEDICARE
Founded in 1965, Medicare became the second major
piece of health insurance legislation in the country after
worker’s compensation. Currently,Medicare provides limited
coverage for 35 million elderly adults over the age of
65 and 6 million permanently disabled younger adults.
Medicare has two parts. The first (“Part A”) covers
acute care, such as illnesses requiring hospitalization,
is automatic for all eligible citizens—generally
meaning those over 65 years of age—and is entirely
paid for by Social Security. The second (“Part
B”) covers non-acute care, such as office visits and
health screening procedures, and is paid for in
part by high co-payments. There are many
health care needs that are not met by either part
of Medicare, and so many individuals also purchase
some form of supplemental insurance
(known cleverly as MediGap insurance),
which may include continuing to buy into
work-based plans. Since at least 40% of those
who receive Medicare benefits subsist near
the poverty level, these co-payments and
supplemental programs often pose significant
financial difficulty. For instance, outof-
pocket health expenses for individuals
on Medicare averaged
$3,757 in 2002—a number
which may easily
represent more
than 20% of
the annual
income of
the poorest
among them.
PRESCRIPTION DRUGS
One specific item not covered by
Medicare that has received a great deal of attention in
recent years is the cost of outpatient prescription drugs. In
1999, 40% of the elderly were unable to afford “MediGap”
insurance and, therefore, had no prescription drug coverage.
Prescription drug spending is currently the fastestgrowing
component of the health care system—for
instance, in 2001, drug costs increased 16%, compared to
an 8% increase for hospital expenses. Many factors have
contributed to the rapid growth of this problem, including
rising manufacturing costs, increasing use of expensive
patented drugs, and the complicated health problems
of the elderly which often require them to take many
drugs at the same time. The bottom line is that Medicare
recipients are under ever greater financial pressure, and
their average personal spending for drugs has increased
50% in the last three years.
Under pressure from the Bush administration, Congress
is currently attempting to draft some form of
Medicare reform legislation to improve prescription drug
coverage. Although draft measures for $400 billion in
assistance over 10 years were passed in both House and
Senate in June, significant differences exist between the
two plans, and so it remains to be seen whether this legislation
will be implemented anytime soon. However, some
general observations can be made.
First, and most importantly, both plans would not
expand current traditional Medicare coverage. Rather,
they would create an expanded role for private insurance
firms in the Medicare population. Individuals on
Medicare would be encouraged to drop their enrollment
in traditional Medicare and, with limited financial assistance
from the federal government, purchase instead a
comprehensive private plan with prescription drug coverage.
Those who chose to remain within the traditional
Medicare structure would have the option of purchasing
the drug plan as a stand-alone option. In real terms, however,
this second option means that many individuals
would be simultaneously enrolled in three plans—
Medicare, a “MediGap” program, and also a drug plan.
This is a confusing arrangement designed to encourage
a switch to a private plan. Also, the stand-alone drug
plan would be partially paid for by increased co-payments
for other traditionally affordable Medicare
services such as home care.
The likely result of such a “market-based
reform” of Medicare would be that wealthy individuals
and those with relatively good health
(who would be offered lower premiums by private
companies) would move toward private
plans. Only the sickest and poorest individuals
would be “stuck” in the traditional Medicare
program. The House version of the plan calls
for a cap on government contributions to
Medicare to take effect in 2010. This
means that the vulnerable clients still
enrolled in traditional
Medicare would face
steadily increasing
co-paym
e n t s .
Although
this reform is
being billed as a
consumer- f riendl y
option which allows patients
more flexibility, bargaining power
in the private market would really be
restricted to the wealthy and the healthy. The longterm
outcome may be to limit participation in and undermine
the viability of traditional Medicare.
In addition to these market reform provisions, both
House and Senate versions of the legislation do provide
some additional direct drug benefits for the poorest individuals.
However, both allow critical gaps in these benefits.
For instance, the House plan would provide financial
assistance for drug costs up to $2000, but no assistance for
costs between $2000 and a “catastrophic” limit of about
$5000. Because of this the financial assistance percentage
for an individual with $4000 in drug costs would be less
than for someone with $2000.Another alarming feature of
both plans is that they require individuals to submit to
asset-testing to determine poverty level in order to be eligible;
until now, the great strength of MedMEDICAID
Enacted as companion legislation to Medicare,Medicaid
is the largest public health program in the nation
with more than $200 billion in annual spending. Currently,
it finances health care for nearly 50 million individuals.
In order to qualify for Medicaid, individuals
must meet financial criteria, meaning that all individuals
on Medicaid are among the very poor. It is the only form
of health insurance available for one in four children and
also many low-income parents. Additionally, it covers the
health care needs of more than 60% of nursing home
patients.Medicaid functions as a state-administered program
that is partially funded from federal sources, and it
generally ranks after education as the second-largest state
budget item.
Medicaid and the supplementary State Children’s
Health Insurance Program (SCHIP) serve as a critical
safety-net for low income families. For instance,
although work-based insurance coverage has been
decreasing in recent years, they have been able partially to
offset this crisis. In 2002, the uninsured population grew
by 2.4 million, but this number would have been much
worse had not Medicaid maintained the coverage of children
from affected families and also added 1.6 million
poor parents to the program.
Because Medicaid is a state-administered program,
the current nation-wide state budget crises are alarming.
In 2002, average state income fell by 5.6%—the first
decrease in recent years. Consequently, although demand
for Medicaid services increased 13% over the same period,
all states have had to impose “cost-containment
strategies” such as controlling drug costs and freezing
payments to participating physicians. Additionally, over
thirty states have had to restrict eligibility, reduce benefits,
or increase co-payments.
PERSPECTIVES
Although the crisis and inefficiency of the United
State’s health care system is readily apparent to any critical
observer, it is difficult to pinpoint any single factor as
the primary culprit. Consequently, any solution will need
to address many issues and carefully thought out. Only
one Democratic presidential candidate, Dennis Kucinich,
has elaborated a cogent universal health care platform.
Such a universal single-payer plan—that is, an entirely
publicly-funded system which covers everyone—is often
advanced as a progressive way to solve the nation’s health
care woes.However, this type of broad reform is opposed
by the majority of Americans, and, in light of the heavy
investment of private capital in health care, it is difficult
to envision its implementation in the near future.
Historically, universal plans have emerged in other
countries only slowly or in response to financial instability
in the private sector. In Canada, for instance, the
national program began as a proof-of-concept program
in the single province of Saskatchewan in 1947; this was
followed by nationalization of hospital care in 1957 and
physician services in 1971. In Great Britain, a national
program emerged as a response to a post-war financial
crisis among private hospitals.
In our view, therefore, a national health plan in the
United States is not yet a viable option because the necessary
grass roots organizing has not occurred, nor is the
financial situation of the private health care market dire
enough. However, individuals and community groups
can still promote health care change in significant ways.
First, through letter-writing and other more cohesive
lobbying efforts, they can advocate at the state level for
pilot health care projects and incremental near-universal
coverage programs. For instance, state governments
could be prompted to expand the eligibility and reduce
the restrictiveness of financial criteria for Medicaid and
SCHIP. Additionally, nearly all states sponsor other small
health care initiatives—such as vaccination clinics, drug
assistance programs, and child and pregnancy welfare
programs—which might be expanded.
Secondly, since a critical limiting factor for reform is
the lack of public interest or awareness, groups can begin
to initiate dialogue in their communities about efficiency,
innovation, and the universal right to health care.
Such efforts should also strive to increase the dialogue
between physicians and patients and to view physicians,
nurses, hospitals, and other professionals as potential
allies in the fight to improve health care. As evidence that
such measures can have perceptible effects, initiation of
public discourse and moderate health care reform in Vermont,
under the tenure of Governor Howard Dean, succeeded
in extending health care eligibility to 99% and
enrollment to 96% of the population.
Blind optimism in the ability of the market to reform
health care spending should be treated with a healthy
dose of skepticism. Although rhetoric about the efficiency
of private insurance is regularly touted by the current
administration, the facts are to the contrary. In 2002, the
United States spent $112 billion on health administration
costs. The administrative costs of private insurers averaged
12% of total spending—on the other hand, publicly
administered programs like Medicare averaged only
4.6%.What’s more, the administrative costs of the United
States’ largely privatized health care system is 6 times
that of Canada’s nationalized system.
Another major strategic approach to health care
reform is to reduce the profitability of medical industrial
enterprises. For instance, in 2001 the average profit margin
for pharmaceutical companies was 18.5%, compared
to 3.3% for all Fortune 500 firms. At the same time,
direct-to-consumer marketing expenditures by pharmaceutical
companies has nearly doubled since 1996, indicating
that this is an expanding market. Community
groups, therefore, can lend their support to innovative
measures to reduce this profit. As just one example, Governor
Blagojevich’s recent call for the FDA to allow the
state of Illinois to purchase all their drugs from the Canadian
market—where the same drugs often sell for half
the price—is an interesting development.
Finally, it must be emphasized that the push for better
health care is not just about policy, legislation, and community
dialogue. It is also, proverbially, a matter of
“putting one’s money where one’s mouth is”. Champaign-
Urbana has many excellent community- and charity-
based organizations working hard to address the special
needs of the homeless, migrant workers, the elderly,
ethnic minorities, and other at-risk populations. These
programs include the Crisis Nursery Center, the Francis
Nelson Health Clinic, the Greater Champaign AIDS, Project,
A Woman’s Place, El Centro por los Trabajadores,
The Center for Women in Transition, and the St. Jude
Catholic Worker House, to name just a few. Nearly all of
these organizations are chronically under-staffed and
under-funded. Champaign-Urbana citizens can make an
immediate difference for the health of our community by
volunterring weekly at or donating money to these and
other like organizations.