This was originally published in New Ground 103, November — December, 2005.
by Bob Roman
In contrast to some previous years, the Campaign for Better Health Care’s (CBHC) annual meeting was a robust affair. Held at the Holiday Inn Mart Plaza in Chicago this past November 10, it brought together nearly 400 participants from around the state. While there was some mainstream press coverage, it was mostly in the context of the keynote speaker, Governor Rod Blagojevich, and his “Kids Care” program and his administration’s suspect hiring and contracting practices.
The reason for the increased interest by health care activists and the reason for journalistic neglect is fairly similar: the Health Care Justice Act. To recap, the Health Care Justice Act sets up the “Adequate Health Care Task Force” that will draft legislation dealing with the health care crisis for the state legislature to consider next year, the goal being to have the legislation in effect by 2007. Depending upon what the task force recommends, this may (or may not) be a major, radical change in health care in Illinois.
So why is Kids Care a story and Health Care Justice not? Part of it is that anything talked up by a bunch of politicians is considered news. Then too, Kids Care comes in the context of conflict: a looming election contest, threatening criminal prosecutions. But while the implications of the Health Care Justice Act could be radical, no one really knows at this point. It’s all just possibilities; it’s all just complicated ambiguities. Nobody knows who the winners and losers will be. Thus there is no overt conflict thus no drama thus no story.
“Everybody In! Nobody Out!” the crowd at the meeting enthusiastically chanted in a ritual not unlike singing “Solidarity Forever” at union events. But if the actual implications of the Health Care Justice Act are presently ambiguous, this year’s CBHC annual meeting was also a study in ambiguity. The meeting was a careful balancing act between maintaining interest and enthusiasm for the process of the Health Care Justice Act and a studied openness as to the specifics of the Task Force’s product. After all, if no one knows who the winners and losers will be, it’s hard to organize opposition to the process.
For example, one of the major presentations at the meeting was by Larry Boress of the Midwest Business Group on Health. It was a Power Point slide show entitled “Affordable, Accessible Health Care: A Smart Business Decision”. Much of this dealt with educating “consumers” about health issues and providing what might be called “transparency” regarding the quality and price of the services available. Some of this would be of interest in any health care system. But the thrust of this presentation was to explore ways of making health care an interchangeable commodity, a necessity if “consumer based” (which is to say “free market”) approaches to health care have any chance at universal application.
Boress’ presentation was politely received.
The CBHC also included, in the meeting packet, an answer to Boress’ presentation in the form of a reprint of a New Yorker article from August 29, 2005. “The Moral-Hazard Myth: The Bad Idea Behind Our Failed Health-Care System” by Malcolm Galdwell examines the assumptions made by ideologues obsessed with supply and demand curves and the gruesome consequences in real life.
Another major part of the program was a reprise of last year’s panel discussion about the Health Care Justice Act. This year the panelists included Mark Blum (Executive Director, America’s Agenda), Kao-Ping Chua (Jack Rutledge Fellow, American Medical Students Association), Rachel Rosen DeGolia (Operations & Organizing Director, UHCAN), and Steve Scheer (Principal, Health Management Associates). The panel’s topic was to be rather broader, but moderator Elizabeth Brackett (The News Hour with Jim Lehrer) found the process and the prospects of the Health Care Justice Act to be more interesting. While Mark Blum had a great deal to contribute, Steve Scheer was perhaps more interesting. Evidently a long-time campaigner for universal health care, he has reached the point where he has become a somewhat dogmatic advocate of incremental reforms. In light of the long and disappointing history of efforts toward universal health care in this country, Scheer’s attitude is understandable. But such a promiscuous love of tinkering is unwarranted. There are worthy incremental reforms that make significant improvements to the lives of a large constituency, such as Medicare and (to a lesser extent) Medicaid. Then there are reforms that are… incremental?
The keynote address by Governor Rod Blagojevich largely concerned his new Kids Care program. Quite possibly this program qualifies as a worthy incremental reform; it covers a significant constituency for whom it will make a real difference. On the other hand, it is to be paid for, in part, by placing Medicaid recipients into “managed care” programs. In the context of private, for-profit insurance, “managed care” becomes shorthand for rationed care with an additional cut removed for profits. Does this “incremental reform” amount to spreading thin services even thinner? One has to sympathize with Republican whining about vagueness.
Blagojevich, or his speechwriters, have apparently been reading Jim Wallis and listening (though not too closely) to George Lakoff. The Governor spent much of his speech proclaiming his budget as a “moral document”, a testament to family values, etc. All of which might sound convincing if Blagojevich had taken any risks in the budget’s composition.
The lack of overt, active opposition to the Health Care Justice Act process does not preclude the possibility of sabotage. Or is it incompetence? The past President of the United Food and Commercial Workers Union, Doug Dority, spoke to the meeting, briefly, in his capacity as the President of America’s Agenda. He condemned the performance of the Illinois Department of Public Health in arranging the hearings mandated under the Health Care Justice Act. The first hearing at Trinity UCC Church in Chicago was well attended. (The UofC Young Democratic Socialists worked with other campus groups to bring students to the hearing. Over 500 people attended.) But the venues for subsequent hearings were finalized at the last minute, often with no more than a week’s advance notice. Chicago DSA has been sending postcards advertising the hearings and the opportunity to testify to our database in the zip code(s) surrounding the hearing sites, but it’s not clear how useful this is if recipients only get three or four days notice.
It is possible to submit comments (that is, to testify) by mail and email. You can mail your written testimony (typed, double-spaced, 8.5″ x 11″ paper) to Tracy Morgan, Illinois Department of Public Health, Division of Health Policy, 525 W. Jefferson St., Springfield, IL 62761. Or you can email your comments to firstname.lastname@example.org. For more information, go to http://www.idph.state.il.us/hcja/
CBHC is also working on getting legislators in the Illinois House and Senate to endorse health care reform. Among other things, the pledge insists “that efforts cannot stop with covering all children in Illinois we must cover all Illinoisans!” and commits the individual to attending a public hearing of the Adequate Health Care Task Force. For more information, call the CBHC at 312.913.9559 or go to http://www.cbhconline.org/HCJC/index.htm.
These are interesting times for health care politics in Illinois. The coming year will be when we decide if it is a time of meaningful change or meaningless hot air. CBHC has drafted a set of criteria by which to judge whatever the Adequate Health Care Task Force produces. Viewed through ideological eyes, it’s easy to imagine that only a universal (“single payer”) solution would adequately address the criteria. But in fact, they are mostly vague enough to encompass any number of approaches. And the criteria are broad enough that any given solution to health care in Illinois is likely to shortchange some aspect of them. The criteria are not useless as a tool for judgement, but the range of possible solutions makes it likely CBHC will be in trouble with some part of its constituency when it has to decide.
Post Script: My table at this event was in an obscure corner of the hall, a sort of alcove actually. Blagojevich’s speech was at the end of the event. When he concluded, he was surrounded by well-wishers and lobbyists demanding his attention. Nobody at my table joined the scrum. We stood there in deep conversation when suddenly an outstretched hand appeared before me. It was the Governor, on his way out of the hall, demanding a handshake. I obliged. He was so needy.