BILL MOYERS: We turn now to health care. You don't need me to tell you that 47 million Americans are uninsured, and it's not news to you that medical costs are increasing faster than the rate of inflation, or that more Americans than ever are afraid a single major illness could bankrupt them. It's little wonder that when the Gallup poll asked people on the eve of this election year to name the most important thing that can be done to cope with health care, 63% mentioned universal coverage — more than any other fix. Critics were quick to cry "Socialism! Socialism!", and even before Senator Hillary Clinton unveiled her healthcare plan, they attacked it, too, as "socialized medicine." It took the McClatchy News Service, which some of us consider the finest news organization still on its feet, to reach back into history for some context on this debate. McClatchy's Kevin G. Hall reminded us that Senator Clinton's "socialistic" plan bears a striking resemblance to changes proposed in 1974 by President Richard Nixon, who was, some will remember, a Republican. Here's what Nixon said in his final State of the Union address:
PRESIDENT RICHARD NIXON: I shall propose a sweeping new program that will assure comprehensive health-insurance protection to millions of Americans who cannot now obtain it or afford it, with vastly improved protection against catastrophic illnesses."
BILL MOYERS: Nixon's plans were foiled by the White House crimes known as Watergate, which forced his resignation.
Thirty-four years later, we're no closer to health care for everyone, despite the number of Americans who need it. But now, some very determined people are taking up the fight for universal health care. They're nurses, who day in and day out encounter the human consequences of a broken system. Here's our report, by Producer Peter Meryash and Correspondent Rick Karr.
RICK KARR: Let's consider a hypothetical cardiac patient: Male, sixty-seven years old, high-stress job, and a history of serious heart problems. And let's say, hypothetically, that he'll be changing jobs soon. Intensive care unit nurse Geri Jenkins says a patient like this might have a tough time getting new health insurance.
GERI JENKINS: He's had four major heart attacks. He's had a quadruple bypass. He's got an implantable defibrillator in his chest. He has atrial fibrillation. He gets cardio vertigo and his heart rhythm goes out of whack. He would be uninsurable for having a preexisting condition.
RICK KARR: That is, he'd be uninsurable if he were an average American. But this case actually isn't hypothetical: The patient is Richard Bruce "Dick" Cheney—the vice-president—and because he's a government employee, he can't be denied health insurance no matter how serious his heart condition is.
Last year, Cheney was rushed to the hospital with an irregular heartbeat—at least his fifth trip to the hospital since being in office—and the incident made national news.
NEWS REPORTER VOICE: This just in: We are told Vice President Dick Cheney has been diagnosed with an irregular heartbeat.
RICK KARR: It also caught the attention of a union called the California Nurses Association—or CNA—whose members see a sharp contrast between what they call the "Cadillac healthcare" the Vice President gets as a government official and what's available to most Americans.
ROSE ANN DEMORO: Dick Cheney can have the choice of doctors. He can go to any hospital. He can have excellent standard of care. And he's alive today because of it. And there are a lot of people who aren't.
RICK KARR: Rose Ann DeMoro is executive director of the CNA. Under her leadership, the union launched an ad campaign that's designed to shock: It claims that if Cheney were just a regular American, he'd probably be dead by now. The ad has run in newspapers across the country and on the internet and it calls for radical change in the country's healthcare system so that everyone can have access to the kind of care that saved the Vice President's life.
ROSE ANN DEMORO: What the nurses are saying is, there shouldn't be a double standard. There should be an excellence in care that applies to all people. We, as the public, pay for Dick Cheney's care. Why not—why is the government not providing the same type of care to all Americans?
RICK KARR: The Vice President isn't the only government employee who gets what the nurses call "Cadillac healthcare." It's all government employees—members of Congress, workers at the Justice Department, and Interior, and the EPA—a total of more that two million people on the federal payroll. Like Vice President Cheney, they get to choose from a wide selection of health plans—and you, the taxpayers, pay about seventy percent of their monthly premiums. Everyone within a plan—no matter how sick they are—is charged the same rate. There's no waiting period before coverage kicks in. And perhaps most importantly, no one can be denied coverage because of a pre-existing medical condition. Rose Ann DeMoro says compare that to the approximately forty-seven million Americans—that's one in six of us—who are uninsured or the ninety million with insurance who say they've had trouble getting the healthcare that they need.
RICK KARR: The California Nurses Association is one of the few union success stories these days. It's been growing: It now represents some eighty thousand members in all fifty states, not just California. Like other unions, it fights for better wages and benefits and working conditions. But its members don't think the union's mission stops there: They believe it's their duty to fight for better health care for all Americans, which means that along the way, they've picked fights with some huge corporations, and powerful politicians, like they did with their ad about Vice President Cheney.
His office slammed the "CheneyCare" ad with a no-comment comment, saying, "Something this outrageous does not warrant a response." But Rose Ann DeMoro says the ad represents exactly the kind of political advocacy that a nurses' union should be doing.
ROSE ANN DEMORO: Every registered nurse in this country advocates for her patient at the bedside. She's there. She's the last line of defense for the patients. She fights for the patients against hospital corporations, often putting her own job in jeopardy. And you can't fight for your patient without changing the social structure in which that care is delivered. So, registered nurses, organized by us, have become a pretty dramatic force in this country to change the healthcare system.
RICK KARR: DeMoro says that CNA members see every day on the job how the current system works, and they've decided that it's badly broken.
ROSE ANN DEMORO: If you look at healthcare in America, there is no healthcare system. There's a healthcare industry that's major objective is profit-making. Which means not providing the patient all of the care that they need, discharging patients early, patients without insurance being treated differently than wealthy people, frankly. And that is the healthcare system in America. Those who can afford it get to live and those who can't suffer needlessly.
RICK KARR: It's a strong indictment, but it's backed up by the numbers: The US has more preventable deaths than any other industrialized nation. And in fact, more than twenty thousand Americans die needlessly every year, according to a recent report, because they don't have health insurance.
But the CNA's "CheneyCare" campaign isn't just about the uninsured. The union says that even those of us who do have insurance face potentially fatal problems with the system. That's because insurance companies, driven by profits, are the ones deciding which medical treatments are paid for—and which aren't.
For example, the CNA took up the cause of seventeen-year-old Nataline Sarkisyan. She suffered from leukemia, and chemotherapy had destroyed her liver. Intensive care unit nurse Geri Jenkins—who's also one of four co-presidents of the CNA—says Sarkisyan's doctors thought that she needed a liver transplant.
GERI JENKINS: Her doctors felt she had a 65 percent chance of survival at six months. And who's better to make that decision? A pediatric transplant specialist? Or an insurance company who's not actively involved in the case and knows the nuances of her care? We think it's much better to let the actual healthcare provider who has all that knowledge make the decision.
RICK KARR: The insurance company—Cigna —said, "no," that it wouldn't approve paying the hundreds of thousands of dollars that a liver transplant could've cost. So the CNA set up protests to call attention to Nataline Sarkisyan's plight—and even marched right into Cigna's lobby. During the protest, the insurer reversed its position and agreed to pay for the liver transplant. But that didn't help Nataline Sarkisyan: She died that night.
GERI JENKINS: It was too late. And we think that's just a classic example of what happens. And it happens hundreds, if not thousands of times a day all across America, with people who think they have insurance, but when the crunch happens, someone denies them what they need.
RICK KARR: The nurses launched their "CheneyCare" campaign in part to uncover more stories like Nataline Sarkisyan's. The union set up a web site that asks Americans to write in with their own health-care horror stories.
ROSE ANN DEMORO: It's a war on our soil against the American people, what's going on with the insurance industry. And the Dick Cheneys and all of the politicians who get the healthcare that the public provides, we're saying, "Why are Americans not worthy of the same type of care that you have?"
RICK KARR: When it comes to this kind of high-profile political battle over health-care policy, the CNA has a pretty good track record. Take the fight that the nurses had with California's governor: A few years before Arnold Schwarzenegger took office in two thousand three, the state had passed a new law that set strict limits on the number of patients a nurse could take care of at any one time. Schwarzenegger, once he was in office, moved to scale back the nurse-to-patient ratio. At the time, his approval rating was over sixty percent, but the CNA decided to take him on, anyway.
GERI JENKINS: And we just were there. Everywhere he went, we were there. We were like the bad penny you couldn't get rid of. We were there, at every event he went to, every time he showed up in public, every time he went to a fundraiser trying to solicit huge amounts of money from his corporate donors. We were there.
RICK KARR: When Schwarzenegger addressed a women's conference in Long Beach, local TV news showed members of the CNA marching outside the convention center while inside, some union members unfurled a banner protesting the Governor's opposition to nurse-to-patient ratios. That's when Schwarzenegger lashed out at the nurses.
GOV. ARNOLD SCHWARZENEGGER: Pay no attention to those voices over there, by the way. Those are the special interests. If you know what I mean. The special interests just don't like me in Sacramento because I am always kicking their butts. That's why they don't like me. Laughs.
ROSE ANN DEMORO: He was so cocky and confident and so above it all in terms of decorum that he thought that he could say whatever he wanted. Well, I swear I was outside and the press-- the media came. It was like paparazzi running out of the building. And they're saying, "Did you hear what he said? Did you hear what he said?" And you knew at that moment, it was kind of stunning actually that it was a seminal turning point in his career in California, and perhaps his political ambition. And that just unfurled. That galvanized all of the nurses in California.
RICK KARR: Within a few months, Schwarzenegger had backed off his bid to rescind the nurse-to-patient ratios. Meanwhile, his approval rating fell to around forty percent.
ROSE ANN DEMORO: And at that point in time, he said nothing more about registered nurses. And he kept very quiet in California about the California Nurses Association. I think that the nurses, you know, the shoe was on the other foot, frankly, in terms of who kicked who's butt. And he knew it.
RICK KARR: Since then, the CNA has taken the fight to other states, pushing for a similar cap on nurse-to-patient ratios in half a dozen, most recently in Arizona.
It's been organizing across the country, and it hasn't been timid about opposing other unions. In March, for example, when the Service Employees International Union, or SEIU, tried to organize more than eight thousand hospital workers in Ohio the CNA moved in to stop the vote. The Service Employees charge that the CNA's opposition is really union-busting and even launched a web-site called ShameOnCNA [dot] com. But DeMoro says the SEIU is too willing to compromise with health-care conglomerates and that the CNA would be a better representative for Ohio nurses.
The CNA's been critical of the three remaining presidential candidates, too. It's bought TV ads in primary states: the nurses say that none of the remaining candidates are pushing for true reform because all of them would keep the big insurance companies in the picture. Instead, the nurses want what they call "Medicare for all"—a single, government-run system that would provide every American with the same coverage that Vice President Cheney has—and get the insurance companies out of the way.
GERI JENKINS: I think when you interject into the middle of the delivery of healthcare an entity whose sole purpose is to make a profit, it totally skews the whole intent of what insurance is supposed to be, or what care is supposed to be.
RICK KARR: The nurses base their argument on a surprising fact: From every dollar that insured Americans spend on health care, insurance companies keep thirty cents, none of which goes to actual health care. Instead, it pays for executive salaries, shareholder dividends, advertising and marketing, and other "overhead." And that's before a penny flows to the for-profit hospital conglomerates that look out for their own bottom lines—and run most of the country's health-care system.
GERI JENKINS: When you have 60 percent of the healthcare in this country being delivered by for-profit corporate entities, whose major focus is their bottom line, then you better hope there's a nurse there to make sure you're okay and to look out for you and advocate for you when you're at that—those most vulnerable moments in your life.
ROSE ANN DEMORO: Since nurses are in every community across the country, and since they're such a trusted profession, we think we're structurally situated to actually change this hit system systemically for once and for all. And we're not gonna stop until that happens.
BILL MOYERS: Those California Nurses are a combative lot—and not just in their fight for universal health coverage. They're also in that fierce battle with a rival employee's union—the SEIU—over organizing new members. The competition has led to some heated confrontations in meetings and the courtroom, creating a distraction from the hopes of other labor leaders for a united front in the political campaigns this fall. That's a story for another day, but we've posted some information about it on our web site at pbs.org.
Next week, we'll look at another battle affecting your health—this one about what's driving the high cost of the daily meds so many of us depend on.
ANNOUNCER: With one little pill, taken just once a day, people with allergic reactions...
MELODY PETERSEN: The drug industry is driven by marketing and profits which is fine if you're selling cold cuts or computers, or something like that, but it's definitely not alright with medicines. That's the problem with the industry.
BILL MOYERS: We hope you'll join us next week. I'm Bill Moyers.