posted July 21, 2005
Medical Mt. St. Helens: Health Care Crisis in America

copyright 2005 by Jack Rasmus
“Z� Magazine, March 2005

In America, the richest county in the world, millions of workers and their children face the human and economic devastation that can accompany a serious illness; go without paying their rent, buying clothes for their kids, or even food on the table whenever a moderate illness strikes; face the prospect of a six to ten hour wait in a hospital emergency room for something as simple as a sprained ankle or common cold.

The official number of those without any health coverage in America today continues to grow, now exceeding 46 million—rising at a rate of more than 1.5 million each year from 2000 through 2002 and by 2.7 million more in the last 18 months.

During 2001-02 more than 75 million Americans—a third of the population under age 65, 80% of whom were working families, more than half of all Hispanic and 40% of all black Americans—went without health care coverage at some point.

Nor are the growing ranks of those without benefits simply the unemployed or even part-time employed. More than 22 million of that 46 million are employed in full time jobs. More than 10 of that 22 million work at companies with more than 500 employees. And more than a million a year with jobs are being added from households with incomes between $25,000 and $50,000 a year.

But the 46 million are only the missing face of the medical Mount St. Helens, the gaping hole of the millions without health care today. Beneath the surface the pressures build, the forces still gather. The mountain continues to rumble angrily, smolder, threatening to explode once again and reveal still further tectonic dimensions of the crisis.

Not just the 46 millions without benefits, but the rapidly accelerating costs of health care coverage for the rest desperately trying to hold onto benefits, the declining quality of that coverage and that care, the abandonment of retirees and their families, and the growing trend of companies rapidly shifting the costs of paying for health care to their workers—all are further ugly dimensions of the general health care crisis plaguing America.

Reality Beyond the Statistics

No where has the crisis for those struggling to maintain their health benefits been more evident on a human level than in the case of the current plight of grocery and hotel workers, increasingly being pushed to the wall and forced to strike or face company lockouts as they try desperately to defend their health care for themselves and their families.

Generally unknown to the public at large, grocery clerks and hotel workers typically earn from barely above the minimum hourly wage to a maximum of $12-$13 an hour in the higher cost of living, big cities. Equally important, at most neighborhood food chain stores and big city hotels, typically 70%-80% are employed only part time and 90% of them must work second jobs to make ends meet.

After management proposed a several hundred percent increase in their premiums and deductibles in union negotiations now underway in northern California, as one of 50,000 grocery clerks there, Esai Alday, interviewed by this reporter passionately put it: “We’re all in the lower pay brackets. We live in little rooms in the city. We can’t even dream about owning a house. And now they want us to pay more. I work two jobs now. How are we supposed to pay for healthcare—work three jobs? Why are they trying to put all the burden on us?�

No less poignant is the situation faced by 4000 hotel workers in San Francisco, presently locked out by the fourteen large international hotel chains in that city. Susan Donahue, a young cook of 15 years at one of the hotels, described the companies’ latest health care offer as proposing to eliminate health care insurance coverage for 1000 of the 4000 union workers plus offering to shift monthly costs for the rest up to $270 to $300 per employee. “If they treat us this way this year, how will it be five years from now?, Donahue said.

Or as Isaiah Galvez, another senior employee in the hotel industry in that city explained, if a retired union member makes more than a $1,000 a year the companies now want to reduce their benefits and raise their premiums. “They work so hard, and now they want to take it away�, Galvez added, “Our premiums will go to $300 or more. We fight for our family, for our benefits.�

The Real Health Care Spin—Costs Out of Control

A little more than a decade ago, during the initial years of President Clinton’s first term in office, an attempt was made to get a handle on the rising costs and declining availability of health care. A modest National Health Insurance plan was proposed. The corporate health care industry quickly gathered its lobbyists, however, and launched one of the most expensive lobbying campaigns in Congressional history to defeat the bill. The big insurance companies, the multinational pharmaceutical companies, the private hospital chains, and medical equipment providers all rallied with record big bucks behind conservatives and others more interested in their lucrative campaign contributions and defeated this last serious effort at health care reform. In place of a National Health Insurance plan was offered the stopgap measure at the time called ‘Managed Health Care’, which has since proved to be a debacle not only in terms of ensuring health care coverage but as a means to prevent runaway health care costs as well.

Despite ‘Managed Care’, costs since 1999 have consistently risen on average more than 10% each year. Premiums paid to health insurers have been rising even faster since Bush took office, in the double digit range every year, and in the last three years between 13%-14% each year on average.

Shifting the Costs of Monthly Premiums

With premiums rising faster than costs, it’s not surprising that health insurance companies have been benefiting greatly in recent years.

As the Vice-President of the Health Research Education Trust, Jon Gabel, pointed out, “Insurers are now adding to their profitability. In fact, I believe profitability is as high as it’s been since the mid-1990s�. One of the largest health insurers, Blue Cross-Blue Shield, which covers one of every three people with health insurance in the U.S., doubled its profits in 2003 with premium increases ranging from 10% to 16%, in the process increasing its surplus by $8 billion and reserves on hand another $32 billion.

Premium increases of 13-14% a year are, of course, at the low end, charged to the largest companies with some leverage to negotiate with insurance giants like Blue Cross-Blue Shield, Aetna, Cigna, and others. Smaller companies with 100 or even 200 employees often experience premium increases of 20%-25% a year. And the forecast for 2005 is for the largest companies to pass on yet another 13.7% increase in premiums.

The annual 10% health care costs and the 13%-14% for health insurance premiums dwarf the rate of inflation or the gains in workers’ earnings—both of which have been averaging barely 1%-3% the past four years. But despite minimal 1%-3% pay gains, the policy of many companies during the Bush years has been to shift the costs of the record, double-digit, increases in health insurance premiums to their workers.

As reported by the Kaiser Family Health Foundation, premiums for workers with families increased by 49% from 2001 through 2003, and for single workers by 52%. Translated into real dollars, a married worker with a family paid premiums amounting to $2,512 on average in 1988; a single worker $872 on average. However, by 2000 the cost of the family premium had risen to $6,438 and by 2003 to $9,068. For the single worker it was $2,471 and $3,383 respectively.

A recent survey by Fortis Health, a company that sells health savings plans, showed that an average employee’s share of rising premium costs has risen by more than $1,000 a year since 2000.

Shifting Costs: Co-Pays, Deductibles, Falling Ceilings, Collapsing Floors

Companies who forego shifting health care costs directly to workers in the form of higher premiums often use a more indirect approach to pass on the rise in costs to their employees. The favorite means are increasing co-pays, raising deductibles, hiking co-insurance charges for spouses and children, reducing ceilings on payments, or otherwise placing restrictions and limits on certain frequently used procedures. All examples of what experts call targeting “first dollar� health costs.

The preferred approach with regard to co-pays is to raise the employee’s share of a doctor or hospital visit from what was typically 10% or 20% in the past, to 25% or 50% today. Or raising the dollar ceiling of out of pocket expense before ‘major medical’ coverage kicks in, from the typical $5,000 in the past to $10,000 before co-pays are no longer required. Or, in another typical example, instead of paying a $10 co-pay for a drug prescription written by a doctor for a 6 month period, making the employee come in every month and pay the $10 for a month’s supply at a time over the six month period.

Among deductibles the trend of late has been to raise what was once a $100 per year deductible for employee and $150 or $250 deductible per year for dependents, to the now more typical $250 for employee and $500 for dependent.

The ‘ceilings and limits’ game often involves putting a money cap, or lowering the ceiling on a maximum annual payment, for a frequently used medical procedure. Typical are limits on payments for MRIs, CT scans, and blood tests. 57 million Americans, or one third of working age adults in the U.S., have some kind of long term illness such as heart disease, diabetes, asthma or other chronic condition requiring repeated medical procedures. And thousands die each year when employers agree to ceilings, or lower those payment ceilings for such procedures.

An increasingly favorite use of ‘ceilings’ is the case of retirees’ health benefits. Ceilings on retirees benefits first became popular in the early 1990s. Where ceilings on payments did not exist they are now being applied; where they did exist previously they are being lowered. Ceilings for retirees are particularly attractive for companies. They allow a company not simply to reduce spending but the amount saved, because of certain allowable corporate accounting practices, becomes ‘instant income’ added directly to the company’s bottom line.

Any combination of the above—higher premium payments, co-pays, deductibles, limits on procedures, ceilings—can and do quickly add up to a significant total shift of health care costs from employers to workers. Any one of the devices for shifting costs easily more than negate the annual average 2% increase in hourly earnings workers have been getting on average the past four years. The rising health care costs and premiums, and the various cost shifting practices, have easily wiped out whatever minimal gains in hourly earning workers have achieved the past four years.

The Deteriorating Quality of American Health Care

Given the double digit increases every year in the cost of health care in the U.S. since 2000, and the even faster rise in out of pocket expenses by workers for that care, one might presume the quality of that health care has improved several fold as well over recent years. Unfortunately, the old American saying “you get what you pay for� doesn’t apply any more. In America today the national motto is “you pay more for less�—less not only in terms of health care coverage but in health care quality as well.

In 2004 the total bill for health care is estimated to cost $1.79 trillion. The United States spends more than 15% of its Gross Domestic Product on health care, more than any other industrialized country. Switzerland and Germany spend less than 11%. Canada and France less than 10%. The average is 8%.

A study that appeared in the Journal o the American Medical Association in the summer of 2000 reported that “Of thirteen countries in a recent comparison, the U.S. ranks on average 12th out of 13 for sixteen available health indicators�. Among just some of the indicators, the U.S. was 13th in years of potential life lost; 11th in life expectancy for females; 12th in life expectancy for males; and 13th in infant mortality. According to the study’s author, Dr. Barbara Starfield of Johns Hopkins School of Medicine, by 2004 “It’s getting worse� and, as she put it, “The findings are so robust that I think they’re probably incontrovertible�.

A more recent study in October 2004 ranked the U.S. tied for 36 out of 52 countries in the category of infant mortality, with Cuba and Slovakia, and below Malaysia. Another study done in 2003, based on data from a survey of 513 health care plans covering 71 million Americans by the National Committee for Quality Assurance, found that “More than 57,000 Americans die each year due to lack of health care�. Still other studies estimate as many as 98,000 die each year due to medical errors.

The list of respected sources and scientific results could go on, but they tell the same story: the quality of health care provided is deteriorating seriously while the cost, shifted more and more to employees, go through the roof. Given that dual reality it is not surprising that many workers and companies are increasingly being forces to withdraw from the health care insurance system altogether in the U.S., facing the choice of health care insurance or food, health care or paying the rent, health care or being able to pay for gas or public transport to get to a job.

Declining Coverage for the Employed and the Retired

Companies not willing to absorb the cost of accelerating health care premiums—or unwilling to bother to play the shell game of raising co-pays, deductibles, lowering ceilings, etc.—are choosing simply to stop providing coverage as a way to cut costs.

More workers, for example, are being required in recent years to pick up the entire cost of their dependents’ coverage. Or in cases where there is no union contract, companies are simply choosing to give the employee a lump sum monthly payment equivalent to the health insurance premium it once paid, and then let the employee go and find his or her own health insurance. The cost in terms of health premium payments is thus ‘frozen’ for the company at that last level. The worker assumes all future premium cost increases.

Another significant area of declining health care coverage involves retirees. This particular trend is taking place predominantly within larger corporations, those with more than 200 employees. In 1988, roughly 66% of large companies provided health coverage to retirees; by 1996 only 46%; by 2000 39%; and in 2002 the percentage declined to only 34%. In smaller companies, with fewer than 200 workers, the coverage for retires fell by 2002 to only 5%.
Where employer-provided retiree coverage still remains, companies are drastically reducing or even eliminating coverage for retirees’, such as recently announced in September by the telecom equipment giant, Lucent Corp, and by major airlines like United, Delta, and US Airways, by IBM, and soon by other major corporations like AT&T.

The number of retirees and their dependents thus losing, or about to lose, coverage is likely in the tens of thousands. Moreover, the pace of lost coverage for retirees is likely to quicken. Hidden deep within the nearly 700 page Corporate Tax Cut bill recently passed by Congress this past October, 2004, are provisions for incentives that encourage large corporations like Lucent and others to cut retirees benefits and coverage even more. The unilateral corporate cutting of retirees’ and their dependents’ health care coverage will almost certainly accelerate in the period ahead.

The declining coverage problem is no less dramatic for workers still on the job, not yet retired. From 1993 to 2003 the percentage of full time workers in the U.S. covered by an employer provided medical care plan declined by 17 percentage points, from 73% to 56%. Only 36% of full time workers in companies of less than 100 employees had any medical coverage by 2003. And only 9% of the more than 30 million part time workers in the U.S. had any medical coverage.

Expressed in non-percentage terms, for the period since George Bush took office, between 5 and 6 million workers lost their employer provided health insurance. Of this total, approximately 3.4 to 4.0 million still had jobs and either lost health coverage due to employer initiated action, or else they dropped it themselves because of the inability to afford the rapidly rising costs being shifted to them.

Following the 2004 elections the situation for active employees also promises to worsen. Since the last decade there has been a rule in effect which allowed corporations to arbitrarily and unilaterally transfer funds from their employee pension plans and use those funds to pay for health care, in effect partially absorbing their rising health care costs. While these transfers often served to undermine the financial stability of employees’ pension plans, they were successful softening for a time the impact of rising health care costs for many companies. However, the rule has limits. Companies can only transfer funds to cover up to 20% of rising health care costs, and once a transfer is made they have to wait 5 years before making another transfer. Many companies thus exhausted this 20% transfer rule during Bush’s first term, 2001-04. And with this accounting loophole now no longer available to them to partially offset health care cost increases, the pressure to transfer health care costs to workers and/or cut their benefits will now grow even more intense in the years immediately ahead.

According to Hewitt Associates, a leading health care and human resources consultant group, employee contributions to their health insurance plans are projected to increase by 15% across all plans, HMO or PPO. And as even the Wall St. Journal recently admitted, for the year ahead, 2005, “employers concede that they are shifting more health care costs to workers and there is little letup in sight�.

Solutions to the Crisis: Far Right, Centrist, and Real

The picture that clearly emerges is a health care system in which the number of Americans without benefits of any kind will soon exceed 50 million. A system where health care costs consistently rise 13-15% a year and threaten to double the cost of health care in general every 5 to 7 years. Where premiums rise even faster than costs, making big insurance companies, hospital chains and drug companies super profits, outstripping workers’ ability to pay by wide margins as employers duck the crisis by shifting those rising costs onto their employees’ backs. A health care system in which workers are asked to pay more and more for less and less—both in terms of coverage as well as in the quality of the health care delivered. A system of health care where even those with jobs are forced, either by their employer or by their own desperate choice, to drop out in millions because they can no longer afford to make that choice between food and health care, housing and health care, or education for their children and health care.

The Bush Solution

George Bush, who ran for office four years ago under the oxymoronic title of ‘compassionate conservative’, has chosen essentially to ignore the various and multiplying dimensions of the health care problem in the U.S. described above.

His answer to rising health care costs is that ‘frivolous lawsuits’ by consumers of health care services are the primary culprit behind rising health care costs. The answer, therefore, is to reduce medical malpractice suits. The implied, erroneous assumption is that health insurance companies, hospitals, and pharmaceuticals will then pass on their cost savings in lower prices to consumers and not simply continue raising prices and pocketing the profits, which will likely be the case.

In addition, Bush wants to people to set up individual Medical Savings Accounts (MSAs) with which to buy health care services—in effect allowing another big ‘middleman’, in this case the banks, the opportunity to swill at the health care trough—as if there weren’t too many ‘middlemen’ driving up costs and prices already.

MSAs are in one of many Bush recent initiatives designed to divert workers’ pay to banks, Wall St., and other financial institutions that manage such accounts, skimming lucrative fees and other charges off the top for their services. MSAs are the forerunner to recent Bush initiatives to set up similar Retirement Savings Accounts (RSAs) to siphon off social security payroll taxes to the benefit of those same financial institutions. Both MSAs and RSAs represent the on-going Bush-Corporate offensive to privatize both Medicare and Social Security.

Whether in the form of so-called frivolous lawsuits or MSAs, the Bush approach blames the health care consumer for the crisis in healthcare costs. A ‘blame the victim’ diversion from addressing and discussing the real source.

An example of how ridiculous the Bush blame the victim strategy can get was expressed by Bush’s Treasury Secretary, John Snow, who recently stated the problem with rising health care costs is that people ‘eat and drink too much’, thus causing excessive health problems and costs. For Snow the problem of health care and its costs is not that workers and consumers are required to bear more and more of the burden of rapidly rising costs, or to deal with declining availability and quality of services. The problem is consumer behavior that cuts into healthcare insurance, for-profit hospital chains, and pharmaceutical company business profitability, which ‘forces’ the latter to raise prices.
For the Bush team the problem is not the price-gouging insurance companies, greedy pharmaceutical companies with expensive bloated lobbies, or the often corrupt for-profit hospital chains like Tenet Healthcare or Health South, whose senior executives and ex-CEOs are currently facing charges of kickbacks and fraud. The problem is the worker, the consumer of health care services, who still has it too good, who has too much health care and is still not paying high enough premiums.

As in most cases of Bush ideology, reality is thus forced to stand on its head and that inverted reality is thereby simply defined as the truth.

The story is similar in the related case of prescription drugs. Bush continues to ‘study’ the problem of ensuring safety for the consumer—as he has done for four years now—when in reality these are drugs manufactured in America, already proven safe, then exported to Canada where they are sold for half the cost across the border compared to their price here in the U.S. While not all the drugs imported from abroad are originally manufactured in the U.S., in terms of their overall dollar value the majority are from north of the border. Those products could, and should, be allowed for purchase in the U.S. American consumers thus want simply to re-import (not import) back into the U.S. those drugs already proven safe when manufactured originally here in the U.S.

As Bush’s Economic Report to the Congress earlier this year declared, the problem of rising health care costs and premiums in America today is that workers ‘have too much insurance’, not too little, and that they ‘should be encouraged to enroll in personal health care savings accounts’ with even higher deductibles that would promote less unnecessary use of the healthcare system.

The Centrist Solution

The centrist solution, unlike Bush’s, addresses the problem—but only at the periphery. Centrists—i.e. DLC-type Democrats—propose government assume some of the costs of catastrophic care, a move which will provide immediate windfall profits for health care insurers who will be left with the least costly subscribers with the more minimal claims. Catastrophic coverage will also likely encourage health care insurers and providers to actually raise prices in the transition period to his plan if there are no adequate price controls, which Centrist’s adamantly refuses to consider.

Centrists would also subsidize the problem, not resolve the crisis, by including subsidized health care coverage for children, thus rewarding price-gouging insurers, providers and manufacturers with underwriting and government guarantees at the taxpayer expense for their continued excessive pricing practices. Like Bush, Centrists also take the position that malpractice is a major contributor to the crisis, although they admit at the same time that malpractice accounts for only one-half of one percent of the annual cost increases for health care.

To their credit, and unlike Bush, Centrists generally agree to allow consumers access to Canada for lower cost brand drugs—at last allowing the rest of us to engage in ‘Free Trade’—just as the U.S. government has assisted corporations doing for so many years throughout virtually every industry in America with great financial gain for those industries. The issue and controversy surrounding the importation of prescription drugs from Canada thus clearly reveals that all the talk for years about the benefits of ‘Free Trade’ for all America has been really ‘Free Trade’ for the benefit of corporate America, and not for American consumers and workers.

But neither the Centrist or the Bush proposals address the fundamental problem of the health care crisis in America: the levels upon levels of monopoly-like pricing behavior by insurance companies, health care providers, pharmaceutical companies and for profit hospital chains who continually gouge the public today and get away with it because Congress looks the other way. Not to mention those companies working overtime to find ways to continually shift the burden of out-of- control health care costs onto the backs of their own employees.

At the core of the crisis are the Corporate power centers in America with enough money, lobbying and campaign contribution resources to get Congress, the Executive, and the Courts to conveniently ignore the crisis while it progressively deepens. And instead of addressing the fundamental causes of the crisis and those originating it, the policies being proposed both by Bush and Centrists either ignore it or find ways to pay for the worst abuses by shifting the costs ultimately to taxpayers from the perpetrators.

Financing a Real Solution to the Crisis

If the U.S. today spends $1.79 trillion a year, or 15% of its GDP, on health care but countries like Canada, Germany, and others with ‘single payer’ universal health care systems spend only 8%-11%, the U.S. should and could be able to reduce its current $1.79 trillion cost by at least a third, from 15% to 10%, by moving to a single payer system as well. That’s $600 billion a year, a savings of a third, from eliminating the ‘middlemen’ and layers of unnecessary administrative costs and profit gouging now plaguing the system.

The remaining $1.2 trillion a year could be raised in the following ways:

Restore the Stolen Social Security Surplus

Twenty years ago working Americans were burdened with the 12.4% payroll tax on their incomes, plus the prospect that the income base on which that 12.4% applies would rise annually to some indeterminate level. Today that base is nearly $90,000 a year and still rising. The promise at the time was that this tax, earmarked to save Social Security, would guarantee Social Security until at lease mid-next century for them and their children.

In 1992 politicians promised once again, as revenues and huge surpluses began to appear from the payroll tax, that there would be a ‘lock box’ on these revenues to ensure their use only for Social Security and not for other uses by the federal government. Once again, in 2000, Presidential candidates Bush and Gore swore to the American public the surplus generated by the payroll tax would be locked away solely for uses related to Social Security. But as they spoke both candidates knew, as did members of Congress since the early 1990s when they first promised the ‘lock box’, that the surplus from the payroll tax was being permanently ‘borrowed’ every year and that the $1.4 trillion surplus was being spent annually to pay for a growing defense budget and tax cuts for corporations and high income individuals.

Were the $1.4 trillion restored to the Social Security fund, as originally intended by law, roughly $100 billion a year of earned interest could be earmarked for financing single payer health care for every American. All that is required is for the US government to issue bonds in the amount of the $1.4 trillion and place that amount in a special fund within Social Security dedicated to universal health care services.

Payroll Tax for Annual Incomes Over $90,000

An additional $350 billion a year in revenue could be raised by requiring the wealthiest 10% of taxpayers, the 11.3 million who now earn more than $103,000 a year, and the millions more earning between $90,000 and $103,000, to pay the same 12.4% payroll tax on all their gross income—just like the more than 100 million taxpaying household now earning less than $90,000 a year pay on virtually all their incomes. If more than 100 million working Americans today who earn virtually all their income from wages and salaries now pay a 12.4% payroll tax on all their incomes, why shouldn’t the top 10% income bracket, the 11.3 million, or the top 1%, the richest who earn more than $384,000 on average, also pay the same? If all Americans paid 12.4% another $350 billion a year could be raised, and dedicated to a special universal health services fund within Social Security.

And were those with earnings over $90,000 also required to pay the Medicare tax on all their gross incomes, as the average working American must do, the 12.4% payroll tax figure would increase to 15.3%, and provide an additional $75 billion a year in dedicated revenue.

Tax Loopholes, Shelters, and Corporate Tax Rates

In addition to the above $525 billion a year that could be raised by reforming the payroll tax system by making everyone pay the same percent of their income, and from restoring the $1.4 trillion Social Security surplus, another $275 billion a year could be raised by closing corporate tax loopholes, restoring historical rates on corporate and wealth taxes, eliminating current corporate and individual tax shelters, and for the first time strictly enforcing the foreign profits tax that US companies are required by law to pay, but do not, on earnings from offshore operations.
Various independent sources estimate changes in these areas would conservatively generate another $275 billion a year. And since all that $275 billion would be spent annually in the US economy (whereas much of it is not at present and is held offshore or held back by corporations from committing to business spending), the fiscal boost to the economy from $275 billion in additional spending would have a definite positive impact on a struggling US economic recovery.

Single payer, universal health care should not necessarily mean government payments for any and all services without reasonable controls. There is thus a role for reasonable deductibles, co-pays, and similar cost control measures in a Universal Singe Payer plan. The problem today is that such measures are not being employed primarily for cost control, but as means to shift costs and subsidize corporate profits performance at the expense of employees.

Another $400 billion a year would therefore be raised by maintaining, at much reduced levels, reasonable deductibles, co-pays and other cost control measures to ensure unnecessary wasteful use of the system’s services did not occur. However, monetary cost controls would not be allowed to escalate unreasonably, far outpacing normal income gains by health care consumers, as is the case today. These measures would be benchmarked strictly to the needs of financing the program, and severed from any corporate practices that seek to exploit health care as a means to subsidize profits, as unfortunately all too often has been the case.

The health care crisis has reached dimensions today that cannot be ignored or solved by tinkering at the margins. The crisis has attained a scope and magnitude such that it is feeding off itself. Slippage is occurring along multiple fault lines, well underground, not readily visible, but with each fault provoking movement in the other. Pressures build and an ultimate release is inevitable.

Bush’s current proposals will do nothing to change the magnitude, scope or pace of the crisis. Centrist proposals will only slowdown the process somewhat and only temporarily. The crisis is now too deep and too fundamental to address with smoke and mirrors or half-measures any longer. We are talking about literally the lives of millions of Americans and their families, and about untold physical, emotional, and financial suffering.

Health care in America today is a landscape of devastation and barrenness not dissimilar to that gray, desolate, ashen-covered mountainside laid bare by the eruption of Mount St. Helens in Washington State twenty four years ago. Except now it is not millions of trees that have been torn up, flattened and scattered. It is the lives of tens of millions of American workers and their families. The magma rises. The mountain groans and shakes, awaiting the next inevitable eruption.

Jack Rasmus, National Writers Union, UAW 1981

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