Tuesday, September 13, 2011

We have a choice

During the recent Republican debate, CNN's Wolf Blitzer asked Republican presidential candidate Ron Paul the following question:

"A healthy 30-year-old young man has a good job, makes a good living, but decides, you know what? I'm not going to spend $200 or $300 a month for health insurance because I'm healthy, I don't need it. But something terrible happens; all of a sudden he needs it.

"Who's going to pay if he goes into a coma, for example? Who pays for that?"

Paul, who is a physician, responded with this exchange:

PAUL: Well, in a society that you accept welfarism and socialism, he expects the government to take care of him.

BLITZER: Well, what do you want?

PAUL: But what he should do is whatever he wants to do, and assume responsibility for himself. My advice to him would have a major medical policy, but not be forced —

BLITZER: But he doesn't have that. He doesn't have it, and he needs intensive care for six months. Who pays?

PAUL: That's what freedom is all about, taking your own risks. This whole idea that you have to prepare and take care of everybody —


BLITZER: But Congressman, are you saying that society should just let him die?

Many in the audience yell “Yeah” or “Let him die.”

The exchange between Blitzer and Paul points out perhaps the greatest difference between the Tea Party dominated Republican Party and the Democrats.  The Tea Party/Republicans want to take us back to the late 1800s and early 1900s before progressives were able to pass legislation that set the federal government on the side of working men and women.  We forget what it was like back then and what our country would become if people like Paul and the other Republicans get their way.  Let me remind you.

I wrote about the plight of the average working American in the early 1900s in my book Getting Things Done in Washington.  Here is an excerpt.

If you worked in America in the late 1800s and early 1900s you suffered not only from near starvation wages but also from a range of medical ailments, many serious.  If you worked for long as a miner, stonecutter, textile worker, furrier, cap maker, baker or hairdresser, you almost certainly would develop bronchitis, asthma and very likely tuberculosis.  Regardless of occupation you worked long hours, with little time to rest or even seek fresh air.  You and your family lived in overcrowded and unsanitary tenement housing.  You were constantly under stress and exhausted.  You likely sought refuge in alcohol which soon ravaged your body.  If you were a woman and became pregnant, you worked as long as you could before giving birth and then, assuming you survived the delivery, returned to work as soon as possible since your family depended upon your wages.  Your child would very likely never live to reach the age of five.  Any bout of sickness for you or a family member had disastrous consequences even if the ill person recovered.  Your life would quickly spiral out of control as it did for Emil Bollhausen, a Germany immigrant and cabinet maker, one of several hundred cases reported in a study of New York City working families in a 1917 study by the Russell Sage Foundation.

Bollhausen had arrived in the United States in 1882.  He quickly found work in New York City’s furniture industry employing cabinet making skills he had been taught by his father in Berlin.  He married and had a son.  His wife worked as a janitress and the family, while not prosperous, could pay the bills.  They survived.  By 1915, at the age of fifty-four, Bollhausen had found better and higher paying employment working for an antique dealer doing fine finishing and repairs.  Then, Bollhausen had heart trouble.  He developed pleurisy and pneumonia and was hospitalized.  His income naturally stopped since there was no such thing at the time as paid sick leave.  Bollhausen and his family entered a downward spiral as described in a report at the time:
“[H]  ospital treatment, then a few day’s work, illness again, no money to pay the doctor, the use of patent medicines suggested by neighbors, the hospital again with some improvement followed by four weeks in the country…work again too hard for him, another illness, dispensary treatment…eight months of  sickness and treatment and still unable to undertake regular work.”

Bollhausen’s experience was typical of most workers who were unfortunate enough to become ill.  What little assistance workers could obtain for dealing with medical expenses came from fraternal organizations such as the Freemasons or Odd Fellows often in the way of a fraternal or “lodge” doctor who was paid by the association to treat members.  Most good doctors refused to take such patients because the payments were small.  Members might also receive a small cash benefit if they couldn’t work because of illness for a length of time, usually a week or more. Such benefits lasted only for a limited time and diminished over time.  For example, one association in New York paid $4.00 a week for the first six weeks then $2.00 a week for the next six weeks with nothing thereafter.

In 1916, about one quarter of unionized workers belonged to unions that provided some kind of sickness benefits to their members.  This was at a time when only a little over 5 percent of American workers were in labor unions so the coverage was available only to a small segment of the workforce. 

Most people got the little medical care they received through charities that operated free medical dispensaries (health clinics).  These were particularly popular in urban areas with large immigrant populations.  Dispensaries served not only the poor and unemployed but the working poor.  Many who might have had some limited access to assistance through an association or employer chose to go to a dispensary out of the belief (unfounded) that free care was superior to that they could obtain in doctor’s offices.  In reality, “dispensaries were not all well equipped, however.  In many cases, overcrowding, absentee doctors, haphazard care, and decaying facilities made dispensary treatment ad harrowing experience.”   Additionally, dispensaries were typically open for only a few hours a day or week and usually only during working hours so it was difficult for most working people to visit them without losing perhaps an entire day’s pay.  Those who did visit found the wait to see a doctor a long one and their visit with the doctor fleeting as he rushed on to another patient.  For example, two doctors in one New York dispensary one morning in 1914 reportedly saw a total of 162 patients in just four hours, a rate of more than 40 patients per hour. 

Some private physicians were willing to wave their fees for low-income patients.  Nurses and midwives, usually female, charged less.  Most of these options were available only to whites and only in urban areas.  If you were black or lived in a rural area, you had little medical care available either public or private.
Urban or rural the typical experience of the American worker of the time who became seriously ill was similar to that of a cook in New York in 1915.  He had held a number of good positions but lost work when he developed a cough because no one wanted to employ a cook with a serious cough.  He entered a hospital for treatment but was discharged homeless in a few days.  He eventually was able to obtain medication though a dispensary and found lodging at a home for destitute tuberculosis patients run by the Salvation Army.  Like most working poor who became seriously ill, the cook soon died and was buried in a pauper’s grave in potter’s field.    A person born in 1900 had a life expectancy of just 47 years. 

That’s the kind of world and kind of life for the average working man and woman that  Republicans seek to recreate by undoing more than a hundred years of progressive legislation.  They will accomplish their goal if we elect them in 2012.  It is our choice.  

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