This year's commemoration of Martin Luther King, Jr. comes as the nation struggles with the issue of health reform. What would Dr. King have thought of the current proposal? While nobody would presume to speak for him, his writings and speeches leave us plenty of clues. How better to honor his memory than to apply his thinking to such an important issue?
We can be sure that Dr. King would demand action. "Of all the forms of inequality," he said, "injustice in health care is the most shocking and inhumane." It's disgraceful to allow 45,000 people to die each year because they don't have health insurance, and we can assume he would support any effort to lower that number.
But those deaths won't disappear altogether under the current proposal. The CBO estimates that 9 million people will remain uninsured, and they're awfully optimistic about the number of people who can pay staggeringly high premiums. The latest figures show that there are 46.3 million uninsured Americans. That means that even if the CBO is right, more than 8,700 people will still die each year from lack of insurance. The actual number could be much greater.
Nor will we have equal health care for all. The infant mortality rate for African American babies in the is 2.5 times greater than it is for non-Hispanic whites, according to data from the National Center for Health Statistics. That figure is likely to improve under reform, but not nearly enough. African-Americans die years earlier than whites at all income levels because, according to one study:
"... elderly black and Hispanic patients often received substandard care for common but serious conditions like heart attacks, congestive heart failure and pneumonia. esearchers say their data suggests that the nation's healthcare system is racially and ethnically segregated, not just for the elderly, but across the board."
These elderly patients have Medicare, and many higher-income minorities have employer coverage, so this is not an insurance issue. It's the product of an ongoing system - call it "healthcare apartheid" - that treats minority patients differently and less effectively than whites. In 2010, American healthcare is still "separate and unequal."
It's also worth considering what Dr. King might have thought of health reform that has jettisoned the public option, leaving for-profit insurance companies in sole command of most Americans' healthcare. We can't know his reaction, but we do know that he said "traditional capitalism" has "created conditions permitting necessities to be taken from the many to give luxuries to the few, and has encouraged smallhearted men to become cold and conscienceless ..."
Added Dr. King: "The profit motive, when it is the sole basis of an economic system, encourages a cutthroat competition and selfish ambition ..."
Will the coverage people receive tomorrow protect them in time of need? Reform will provide many people with health insurance - and will require many others to purchase it. But our current private-insurance system still leaves actual medical treatment out of many people's economic grasp, and often fails to protect them from financial ruin caused by illness or injury.
The problem's getting worse: "Insured people in poor or fair health experienced more than a 5 percentage point increase in unmet need (9.0% in 2003 vs. 14.2% in 2007)," a recent study concluded. These findings are consistent with a Gallup poll showing that three out of ten Americans, the vast majority of whom had health insurance, said they were forced to put off needed care.
People will have insurance, but not assurance, after reform passes. They will receive coverage but won't always receive care.
It's hard to imagine that Dr. King would be satisfied with mandating Americans to purchase inadequate insurance from for-profit companies, or with the Senate bill's harsh treatment of some Americans at the lowest end of the income scale. A family of three making $25,000 per year would pay $1,025 each year in premiums under the Senate bill, while under the House bill they would be covered by Medicaid with no premiums at all.
What about the so-called "Cadillac tax"? It's hard to believe Dr. King would support taxing costlier benefits, especially when "rich" benefits have very little influence on whether a benefit plan falls under the tax or not. The discriminatory effect of the tax , which cuts benefits because of forces outside people's control, seems hard to reconcile with Dr. King's philosophy.
Dr. King would probably be gratified that health reform will benefit many lower-income people. But it's hard to picture him supporting provisions which place heavy burdens on those who can ill afford it. Reform accomplishes some worthwhile things, but only at the cost of a massive transfer of wealth from the middle class to for-profit insurers.
Many people on the Left have been cheering for the Senate bill for weeks. They say that those noisy activists pressing for a better bill are too abrasive and too demanding, that they're making life too difficult for the President and Congress. For guidance on that, we'll have to turn to Dr. King's famous Letter From a Birmingham Jail:
"I must confess I am not afraid of the word 'tension.' I have earnestly opposed violent tension, but there is a type of constructive, nonviolent tension which is necessary for growth."
On this Martin Luther King Day, the struggle isn't over. There's still time to fight for the most just, wise, and equitable bill possible. And if there's a signing ceremony, the time to fight won't be over then either. The work, in fact, will have just begun.
Richard Eskow is currently working with the Campaign for America's Future to stop the health excise tax. He blogs at: