A HEALTHCARE SYSTEM THAT WORKS FOR ALL BY 2025

WHEREAS, the current healthcare system lacks accountability for patient outcomes and the ability to prioritize the health of people in normal times, as evidenced by the United States falling behind our industrialized nation peers in areas like life expectancy and avoidable hospitalizations in patients with chronic disease, and as tragically evidenced by the growing number of casualties and the inability to manage in a pandemic; and

WHEREAS, COVID-19 has laid bare the structural racism in our healthcare system and resultant inequitable health outcomes in the United States, revealing and deepening disproportionately inferior healthcare access and health outcomes for Black and brown people, who are disproportionately represented in essential service jobs, experience higher rates of poverty and low wages, and have higher uninsured rates than white people; and

WHEREAS, undeniable disparities in access and health outcomes persist within our healthcare system for other vulnerable populations, including but not limited to Native American communities, LGBTQ people and those with disabilities; and

WHEREAS, hospitals are important centers of rural communities, often being the largest employer and the only source of care in often geographically isolated communities that experience high rates of factors that impact health, like poverty, income and access to healthy food; and

WHEREAS, food supply, poverty, housing, transportation and other social determinants of health not only drive inequities in health status, but also perpetuate disparities in economic status, and the lack of investment in these and other social determinants is a primary contributor to inferior health outcomes overall in the United States compared with other developed nations; and

WHEREAS, more than 100 million people remain uninsured or underinsured, numbers that will continue to grow because of the high unemployment rate during the current economic crisis in the United States. And many with employer-sponsored coverage experience such high out-of-pocket costs, due to factors like high premiums, deductibles and deceptive billing practices, that they forgo needed care and are effectively uninsured; and

WHEREAS, the United States remains the only industrialized country without a universal healthcare system, despite spending the most on healthcare among developed nations. Americans pay more than twice as much as other developed countries on total healthcare spending and prescription drugs; and

WHEREAS, the delivery system is comprised of highly profitable tax-exempt corporations led by executives making on average $3.5 million per year, by highly profitable publicly traded companies, and by private equity firms that together comprise an industry that accounts for 18 percent of the gross domestic product and is a major driver of the national debt; this is an industry structure that has resulted in a power dynamic that puts patients, healthcare workers and taxpayers at a disadvantage in advocating for a system prioritizing investment in factors that influence health, economic standing and the ability to flourish in American society; and

WHEREAS, the current economic crisis leaves many institutions and care models vulnerable to acquisition by large publicly traded companies or private equity funds. As the focus of these financial interests shifts, new practices and care models will change how care is delivered and will be prioritized on the basis of maximizing revenue; and

WHEREAS, the pandemic has hastened the imminent evolution of care delivery toward broader use of technology, artificial intelligence, and moving the locus of care, all of which drive critical workforce changes that will affect those who work in healthcare and could undermine standards, working conditions and voice of healthcare workers in the delivery of care; and

WHEREAS, we can no longer avoid confrontation with the costs of healthcare, the substandard patient care outcomes, or the inequities perpetuated by the healthcare system. The current transition of our healthcare system will be on a trajectory of ruin for patients if we do not advance a system centered on the health and well-being of all people, with healthcare as a basic human right, guaranteeing every person can access the care they need when they need it; and

WHEREAS, the post-pandemic status of our healthcare delivery system presents an opportunity to transition a model of healthcare driven by high-value, universal access; sustainable cost; accountability for outcomes; and choice; and actions taken coming out of the pandemic are critical to break the pattern of continued support of the existing system that is fiscally unsustainable and leaves tens of millions of Americans behind:

RESOLVED, that the American Federation of Teachers will work to achieve universal coverage by the year 2025, whether through single payer or private insurance with a public option, so that all patients have coverage for timely access to the care they need, treating healthcare as a public good, and will consider a different payment system model that promotes value and coordination in care delivery; and

RESOLVED, that the AFT’s interim efforts will comprise a glide path toward 2025 that addresses the structure of our healthcare delivery system by working toward:

• banning or limiting the growth of for-profit hospitals;
• banning or limiting the growth of private equity, and regulating the access and services provided by for-profit and nonprofit hospitals alike;
• restricting the further consolidation and privatization of hospitals and healthcare systems;
• enforcing the community benefit standard for nonprofits so that it means something, or review the charitable status of nonprofit hospitals so that they are paying taxes to support public infrastructure;
• a model of coverage that uses existing public financing mechanisms, like Medicaid, to build a foundational model that addresses cost, access, choice and outcomes; and

RESOLVED, that the AFT will work vigorously to ensure massive investment in our public health infrastructure in a way that permits robust programming aimed at prevention, maintenance and disease surveillance to collect critical data about community-specific health needs that inform appropriate programming, as well as resources to develop and provide timely and relevant programming responsive to community health needs; and

RESOLVED, that the AFT will advocate for programming, funding, research and public investments that address health disparities, social determinants and unacceptable healthcare outcomes among Black Americans, other communities of color, LGBTQ people and other vulnerable populations. Specifically, we oppose any health policy initiatives that have any racist impact;

RESOLVED, that the AFT will advocate for programming, funding and policy solutions to address the crisis-level challenges faced by patients in rural communities involving threats of hospital closures and addressing social determinants of health; and

RESOLVED, that the AFT will play a role in shaping the future of the healthcare workforce. We must ensure that workforce changes do not happen to our members but happen collaboratively with them, thus allowing care to be delivered in new and creative ways that maintain the standards that we have bargained to establish and that improve patient outcomes.