by AFT President Sandra Feldman
March 1999

When the cure
is worse than
the disease.

At long last, Congress is turning its attention to real issues, such as health care and education. That's good. But there is also a lot at risk as they do. Take, for example, the calls for privatizing Social Security, education, and health care, including Medicare. Those efforts could really do harm.

In health care, for example, many companies are in financial trouble, and investors are abandoning their stocks. It's no wonder. The belt-tightening that initially brought big returns has lost patients and caused doctors to quit and nurses to strike. Now, health care costs have begun to rise again. Prescription drugs and procedures using new medical technologies have gone through the roof, and there is no sign that these increases will slow down. But the big losers are not the investors in health care stocks. They're the ordinary people who have to spend more money to get less care--if they can get it at all.

There is no question that the health care system in this country needed reform. People with plenty of money have always been able to get the best, but many Americans have never been able to afford decent medical care. Really poor people are shielded by Medicaid and the elderly by Medicare (though these programs are increasingly under attack). The truly disadvantaged are the working poor--people who have low-paying jobs that don't offer health insurance or offer it at rates they can't afford--and the children of these people. In 1997, 11.3 million children in the U.S.--approximately 15 percent--had no coverage for doctors or hospital care. And as costs continue to rise, more and more working people will be forced to abandon their coverage.

But coverage is not enough to insure good health care in the new world of market-driven medicine. There are no mechanisms to protect sick people if a company puts the financial bottom line ahead of patient care. That's why, if they choose, HMOs can forbid doctors to tell their patients about any treatment that the company considers too expensive and why they can prescribe exactly how long a doctor can spend with a patient. (One West Coast outfit limits office visits to 7 ½ minutes.) Some even offer bonuses to doctors who cut corners in the treatments they prescribe. Hospitals can also be guilty of paying more attention to the bottom line than to the welfare of their patients. One big cost-cutting measure has been to reduce the nursing staff and hire people with no special qualifications to do the work of skilled professionals. Yet, no one I know would want to recuperate in a surgical unit where untrained aides change patients' dressings or monitor their progress, or where nurses have too many patients to give proper care.

There are parallels here with education--in efforts to privatize or introduce so-called market reforms. We already know, from several ongoing voucher programs, that this approach does not improve student achievement--or save money.

Just as vouchers are a program for a few that threatens the education of all children, especially the neediest, the trend toward hospital takeovers and for profit managed care has resulted in strong incentives to keep out people who are sick or who need care the most. Now, there are proposals to turn Medicare into a voucher program, which surely would disadvantage those same people.

Despite how well it usually works, the free-market model is not a good fit for health care or education. Like Social Security, these require responsible government programs.

There is a temptation to make discussions about issues like health care and education into political battles. Now, as members of Congress emerge from a bruising and often partisan battle, they can show their determination to put all that behind them by leading us in a nonpartisan discussion of these important issues. When talking about education and health, people shouldn't think conservative or liberal, Republican or Democrat. Yes, there will be differences of opinion, but the government has a responsibility to help us make sure that every citizen - especially every child in America - has access to good health care and good schools. That's where the bottom line should be for those elected to serve the public good.