Fixing an ailing healthcare system

By Edward J. McElroy
AFT President

Without major reform, more Americans will end up uninsured or underinsured; the lack of preventive care will result in serious, costly illnesses; and skyrocketing healthcare costs will be passed on to the insured. 

Since 1994, when the Clinton administration's attempt to fix the U.S healthcare system was rejected, well over 1,000 bills relating to healthcare reform have been introduced in Congress. Yet very little has been accomplished. In fact, the number of uninsured and underinsured Americans has continued to grow—as have healthcare costs. The most recent failure came in October with President Bush's veto of a bill that would have extended health insurance to millions of low-income children.

With 47 million Americans uninsured, including 9 million children, and many millions more underinsured, action is long overdue. The AFT's endorsed candidate in the Democratic primary for president, Hillary Clinton, has made universal, affordable healthcare one of her top priorities. Most of the other major presidential candidates in both parties also have proposals to change our healthcare system, ranging from comprehensive approaches like Sen. Clinton's to plans that would further undermine healthcare security in America. The fact that the candidates are talking about it—and that public opinion polls list healthcare re-form as a top domestic priority—gives me hope this country will get serious about transforming the critically ill healthcare system.

Why is this issue so important to the AFT? After all, most AFT members
have health insurance, and the coverage often is superior to that of non-
unionized workers. But those of us with good healthcare coverage will not remain as islands of privilege. Without major reform, more Americans will end up uninsured or underinsured; the lack of preventive care will result in serious, costly illnesses; and skyrocketing healthcare costs will be passed on to the in-sured. As healthcare costs rise, so will the number of uninsured Americans. The longer this trend continues, the more likely it is that healthcare benefits effec-tively will become an "extra," rather than a right. We cannot ignore this dangerous race to the bottom.

But our concern about health reform is not purely out of self-interest. Our members say it is one of the most important domestic priorities.

As citizens and members of your communities, you know that there is a human cost to the healthcare crisis. You also know that, as healthcare costs increase, other domestic priorities are shortchanged. And our members who work in education know that children must be healthy to reach their full potential.

The country learned a lot in the past 15 years about what the American people will and won't embrace with regard to healthcare reform. Those lessons should drive our efforts now. Here are some basic principles that should be in any healthcare reform plan:

• First do no harm. Those with good health plans should be able to maintain at least the same level of coverage, and to choose their own doctors and providers.
• Cover everyone and end insurance discrimination. Nobody should be denied healthcare or charged exorbitant premiums because of age, gender, health status or pre-existing conditions.
• Expand access to high-quality preventive care. Prevention pays, saving lives and bringing down costs for everyone.
• Emphasize shared responsibility. Employers, individuals, government and healthcare providers all should contribute to managing risks and costs.
• Offer affordable choices. Individuals should be able to choose from an array of high-quality healthcare options, with subsidies to assist low-income Americans.
• Control costs. Strategies may include eliminating administrative waste; emphasizing early prevention, detection and management of illnesses; and using technology to coordinate high-quality care.

Comprehensive change may not come in one fell swoop, which is why we should look to states' experiences with healthcare reform. States can be useful laboratories for experimentation on new approaches to reform. This is also a good way to ensure a plan is politically palatable. If the proposal goes beyond what the American people are prepared to accept, it will never have a chance to achieve even the most noble of goals.

As the classic Sam Cooke song says, "A change is gonna come." Change in the healthcare arena is inevitable-for better or worse. Do we want change to happen to us? Or do we want to shape change? Collective bargaining gives us the chance to be change agents, and a number of AFT locals are working to find solutions in this arena. (See feature story.)

Reforming the U.S. healthcare system is a daunting-but not an impossible-task. The AFT will continue our work with elected leaders and other partners in the effort to reform the healthcare system. Healthcare reform might seem like a Herculean task, but it is possible. We can wait no longer.