Beyond the flawed Obama health care reform    

The time is always right to do what's right': Dr. King and health reform



By Claudia Fegan, M.D.

It is indeed an honor and a privilege for me to stand here today
celebrating the life and work of Dr. Martin Luther King Jr.

Dr. Garrett Adams, who gave me such a kind introduction, recently
learned that my father was the photographer who took the picture of
Emmett Till's body the night his mother requested the casket be
opened so that the public could see what they had done to her baby.
That photo became an icon of the civil rights movement.

I was only 7 years old the day my daddy stood behind Dr. King's
right shoulder and photographed the crowd that stood before him on
the Washington Mall as he gave his "I Have a Dream" speech. My
father, a steelworker, was also a documentary photographer. I
brought one of his photographs of Dr. King at that historic rally
with me today.

We learned much from Dr. King, even though he was taken from us too
soon. He taught us that "the time is /always/ right to do what's
right."

As we stand here today, there are 50 million Americans who are
uninsured. African Americans are represented disproportionately
among the uninsured. I am referring to the fact that while we
represent only 12 percent of the population, we are 20 percent of
the uninsured. /This is our issue./

As a result of not having insurance, we have decreased access to the
preventive services that would allow us to live longer, healthier,
richer lives. We pay a tremendous price for this.

Our infant mortality rate is about 2.5 times that of whites, our
rates of death from heart disease and cancer are 1.5 times that of
whites, our rate of death from diabetes is almost 2.5 times that of
whites and our rate of death from HIV is 5 times that of whites.
African American patients on dialysis are less likely to be referred
for evaluation for kidney transplant and therefore, not
surprisingly, we are far less likely to get a kidney transplant. /
This is our issue./

The Institute of Medicine in its 2004 study on "The Consequences of
Uninsurance" estimated over 18,000 people a year die as a result of
not having access to health insurance:

* Uninsured adults receive fewer and less timely preventive and
screening services
* Uninsured cancer patients die sooner due to delayed diagnosis
* The uninsured receive less chronic illness care, poorer hospital
care and are more likely to die in the hospital.
* The risk of premature death among uninsured Americans is 25
percent higher than among Americans with health insurance.

This is our reality, the reality of health care for African
Americans in this country. We will never get more until we demand
more. /This is our issue./

Physicians for a National Health Program, PNHP, is an organization
of 18,000 physicians. Since 1986 we have been trying to convince
physicians, patients and politicians that if we tossed out the
private insurance industry and made the government the single payer
for health care in this country, we could provide coverage for
everyone with same money we are using now to cover only two-thirds
of the country poorly.

I have a patient who is 63 years old. Ms. Lenoir has worked all her
life, she is active in her church, she cares for her elderly mother
and together she and her husband have raised their children to be
self-sufficient members of society. Ms. Lenoir does not have health
insurance because her employer has never provided that benefit.

The problem is Ms. Lenoir needs a new hip. After more than 20 years
of arthritis in her hip, the joint is destroyed. She has bone
grinding on bone. No amount of anti-inflammatory medication will
relieve her pain. I had to plead with her to consider taking a
narcotic to relieve her pain so that maybe she could get a good
night's sleep.

I sent Ms. Lenoir to a pain specialist who injected the joint to
provide her with temporary relief and who then called me and said,
"This woman needs a new hip." I told her, I know that, but have you
got one you can give her? No one will pay for a hip for her until
she turns 65 and Medicare will provide her with coverage.

I wish you could look into this woman's eyes each time she comes to
see me and feel her pain. Will the legislation passed last year
provide her with a new hip before she turns 65 in 2013? No probably
not. /This is our issue./

In the book "The Heart of Power," David Blumenthal chronicles the
efforts of presidents from Franklin Roosevelt through George W. Bush
to achieve access to health care for the American public. "Major
health reform is virtually impossible: difficult to understand,
swarming with interests, powered by money, and resonating with
popular anxiety," he writes.

The congressional veteran and co-chair of the 9/11 Commission, Lee
Hamilton, said, "Health care is so difficult because Congress is an
incremental body and health care is a non-incremental issue."

What Barack Obama did with the passage of the Patient Protection and
Affordable Care Act (ACA) was nothing short of miraculous, but it
was not enough and it will not solve our problems.

Going forward there will not be a fair, open or honest discourse
about this legislation. It is a fact that ACA will do nothing to
control costs. That is the major flaw of the legislation.

Why are we still talking about single payer? Because single payer
will address the issues of /cost, access/ and /quality./

Dr. King taught us being right is not enough. We have to win the
hearts of the American public.

We didn't lose the war to gain access to health care for all
Americans. We got battered in an ugly skirmish, but we're not done.

It is time to change our tactics. The opportunity for change is
still ahead of us. More recent studies have taught us that actually
45,000 people die each year as a result of not having health
insurance which means 180,000 more people will die before
implementation of the majority of the ACA legislation. If everything
goes exactly as planned, there will still be at least 23 million
uninsured once all the changes have taken effect. /This is our issue./

Camille Rucks was a security guard for a small company on the South
Side of Chicago. In the spring of 2008 she developed breast cancer.
She received outstanding care at the University of Chicago and did
well. However, in November 2008, which we now know was the beginning
of the recession, when her company began to struggle, she was laid
off. She thought she was targeted because she had been out sick so
much when she was receiving chemo, but it doesn't matter.

In January 2009, when she had some blood-streaked sputum, her
primary care physician (PCP) ordered a chest X-ray that showed a
spot that raised the question of maybe her cancer had returned. Her
oncologist told her she couldn't see her because she was no longer
insured. Her surgeon never returned her phone calls.

Her PCP called me because she was not able to get the necessary
tests done for Camille because she was no longer insured. I told her
PCP to have Camille come see me the next day.

I said, sure, of course, this is what we do; we're the County
Hospital. In less than a week she had a CT of her chest, and within
two weeks she had been seen by pulmonary and oncology. She did have
metastatic cancer and we took care of her. I wish I could tell you
this story had a happy ending, but it doesn't. Camille died last
year, but she told me she had no regrets. We treated her with
dignity and respect.

My question is this: Who doesn't deserve dignity and respect? Why
should you have to pass a wallet biopsy before a health care
provider determines she can talk to you, order a test, figure out
what is wrong or decide how to treat you? /This is our issue./

The Affordable Care Act has not made health care a right. Access to
care is a profit center controlled by the insurance industry. We pay
them to limit access to care. We spend more per capita on health
care than any country in the world -- more than $8,000 per person --
and yet we are ranked only 36th in the world by the World Health
Organization for the care we provide.

Under the ACA, everyone will be required to carry or purchase
private insurance. For those who can't afford it, we're requiring
states to either cover them under Medicaid or to provide supplements
so they can purchase private insurance. This is an industry that has
a history of profiteering by retroactively denying coverage to
people with illnesses. So now we're requiring everyone to buy
coverage, and yes, we have told the insurance companies they can't
deny coverage to those with illnesses.

My question is why can't we just pay for the care without having to
go through the insurance industry? They are not to be trusted. Ask
the state of Massachusetts how it has worked out for them with
mandating insurance coverage and paying for those who can't afford
it. The cost of premiums has gone up so high so fast in the first
year the governor met with the major companies to request they hold
off on their premium increases because the costs had exceeded three
times the original projections. The state now teeters on
insolvency. /This is our issue./

We spend enough money on health care in this country. We just let
too many people who aren't involved in providing care take profit
from it.

This is about justice. Health care should be a right to which
everyone is entitled. Remember we live in the wealthiest country in
the world. We spend more on health care than any other country. It
is time we got our money's worth. It is time we got the health care
we deserve, not the care the insurance industry is willing to let us
have. It is time we made health care a right and not a privilege.

We have to speak up. We have to speak loudly. We have to make our
voices heard.

The Affordable Care Act is an /opportunity/: It is not going to work!

We have to remind the people -- there is still a simpler, easier
solution. People want to know, they have questions. They will ask,
is this the answer? Will this work? Will this solve the problem?

Multinational Big Pharma charges the American public the highest
pharmaceutical prices in the world, while it sells the very same
drugs all over the world at prices one-half, one-third or even one-
tenth of the price they charge in the United States. They do this
because in the rest of the industrialized world, there is
legislation that limits profits for medications, while the U.S.
allows these companies to charge whatever the market will bear. The
Affordable Care Act does not address this issue. /This is our issue./

Dr. King said, "When people get caught up with that which is right
and they are willing to sacrifice for it, there is no stopping point
short of victory." The Affordable Care Act was /not/ victory. We now
have a House of Representatives that thinks the American public will
be appeased by political theater instead of substance. They had
planned to spent time reading the Constitution omitting the parts
about Blacks being only three-fifths of a person, or the prohibition
of alcohol; revisionist history at best, trying not to acknowledge
the Constitution has been changed repeatedly throughout history.

They had planned to spend time voting to repeal the law when they
knew it was an empty gesture. The shootings in Arizona at least gave
them pause for that.

What the American public wants is not so different from what African
Americans want and deserve. We want guaranteed access to care,
freedom of choice of provider, quality health care and two words you
don't hear in association with health care very much anymore: trust
and respect.

We know it can be done because every other industrialized country in
the world has figured how to do this. Most of them spend less than
half what we do and they have better outcomes with more satisfaction.

It is not so complicated what we want: we want a health care system
that takes everybody in and leaves nobody out. It is only the phony
solutions they are attempting to confuse us with, that are
complicated, just so we don't notice they fail to expand coverage to
those who need it and deserve it. That's why this will be the civil
rights struggle of the 21st century, and /this is our issue./

I understand people are reluctant to criticize the ACA because our
president is under assault from the right and he needs our support.
I think Dr. King would tell us it is important to tell the truth.
"The time is always right to do what's right."

When I think about this struggle I think about a poem my father
taught me as a child. It was written by Langston Hughes and is
called "Mother to Son."

*Mother to Son*

Well, son, I'll tell you:
Life for me ain't been no crystal stair.
It's had tacks in it,
And splinters,
And boards torn up,
And places with no carpet on the floor --
Bare.
But all the time
I'se been a-climbin' on,
And reachin' landin's,
And turnin' corners,
And sometimes goin' in the dark
Where there ain't been no light.
So, boy, don't you turn back.
Don't you set down on the steps.
'Cause you finds it's kinder hard.
Don't you fall now  --
For I'se still goin', honey,
I'se still climbin',
And life for me ain't been no crystal stair.

The issue of guaranteeing access to care for everyone is an issue of
social justice. Battles for social justice are never over, because
there will always be reactionary forces waiting in the wings to turn
back the clock. There are no easy solutions. We have to be willing
to fight for what we believe in and keep fighting.

The night before he was assassinated Martin Luther King said: "Let
us stand with greater determination. And let us move in these
powerful days, these days of challenge to make America what it ought
to be. We have an opportunity to make America a better nation."

I hope you will join me in saying what we expect from any health
care program any politician will offer us:

Everybody in, Nobody out!
Everybody in, Nobody out!
Everybody in, Nobody out!

Thank you.