Page 2"*The Portland Observer—June 5,1991
Response to the "Opinion" Of the
Canadian Health Care System
O n May 29,1991 your new spaper
published an article under the weekly
colum n, “ Reinvestm ents in the C om
m u n ity " , subm itted by the A m alga
m ated Publishers, Inc. W hile the ar
tic le 's title suggests it would provide
facts to support its contention that the
Canadian health system wouldn’t work
here it instead decries the Canadian
health system with such weak asser
tions as, “ A m ericans are not C anadi
a n s” , that “ C anada is fairly hom oge
neous with only sm all, scattered eth
nic populations", and that "social vari
ances (in the U.S.) also account for
higher health care costs; teenage preg
nancy, poverty and violence - as well
as illness and injury related to alcohol
ism, drug abuse and cigarette sm ok
in g ” . This is deeply disturbing on
several levels, not the least o f w hich is
the lack o f adequate explanation given
for our runaway spending for bureauc
racy and expensive equipm ent as well
as the strong hint o f racism contained
in the article.
The US spends more money than
any other country in the world on health
care. Pooling public and private money,
in 1990 we spent $602 billion nation
ally; $6.5 billion in Oregon alone!
T hat is equivalent to $200 per person
per month. W hat does that money buy
us? W e have the highest infant death
rate am ong 20 industrialized nations
and the lowest life expectancy among
12. T hat $200 per person per month
buys us the 18th highest rate o f child
deaths, the 11th highest rate o f m ater
nal deaths in the world and a 21st
ranking in the rate o f infant im m uniza
tion against measles. Despite O regon's
$6.5 billion in health care spending in
1990 more than 400,000 Oregonians
w ere w ithout insurance, close to one in
5 o f our state’s population; 1/3 o f those
uninsured were children.
C loser exam ination of where the
U.S. places its health care priorities
dem onstrates it has little to do with our
rich diversity o f ethnic m inorities. IT
HAS EVERYTHING TO DO W ITH
the fact that our health care continues
to be dictated by a system that operates
for profit, not to be confused with a
health care system. Our escalating health
care costs are tied to hospitals which
average barely more than 50% room
occupancy overall yet purchase fan
cier and more expensive equipm ent to
com pete for an ever-decreasing pool
o f affluent patients. The rising costs
referred to in the API article are also
tied to the 1500 private insurance com
panies in the U.S. spending 20% o f our
total health care dollar on pushing
papers.
C loser to home, Portland has 13
Magnetic Resonance Images, (M RI’s),
more than the entire country o f C an
ada. These state-of-the-art m achines
cost $2 m illion each and return an in
credible profit to doctors and hospitals
who pass on their costs to us in higher
rates. Since Oregonians who possess
insurance often w on’t see the costs of
ordered testing, they may give little
thought to the fact that those MRI tests
can run as much as $400,-700, or that
ultimately insurance rates o r higher
premiums for uninsured, employers con
tinue to reduce their health benefits
contributions and more working fam i
lies are unable to purchase or maintain
their health insurance coverage.
Insured patients even pay for capi
tal improvem ents which can include
high-profit surgery centers or “ Hil
ton-like” m aternity centers for afflu
ent mothers-to-be, or even state-of-
the-art employee fitness centers, since
hospitals pay o ff their often unneces
sary expansions by raising our rates.
It is worth noting that 87% of
O regon’s hospitals are non-profit, yet
they netted $92 m illion in "E xcess
revenues” in 1989.
In the private, corporate world those
“ excess revenues” are called profits
which they, unlike our non-profit hos
pitals, would be required to pay taxes
on.
To claim that our health system
costs more because we have a greater
num ber o f m inorities ignores the fact
that the rate o f non-insured, even the
rate o f m aternal and child deaths, is for
minorities, on average, more than twice
that o f the population as a whole. To
suggest, as the API did, that we need to
spend more m oney on health care than
a country like Canada because we ha ve
greater num ber o f ethnic people is rac
is t
The health needs o f our minority
populations are no more expensive than
the population as a whole. Yet it is
precisely because minorities have in
adequate access to health care, that
they are disproportionaly shut out of
decent-paying em ploym ent that they
are more often underem ployed and un
em ployed, that they lack financial re
sources to purchase healthcare insur
ance, and that they must navigate the
racism , sexism and classism which
perm eates the fiber of America, in
cluding the health care industry, that
their quality o f health indicators are
much higher.
If we focused the money w e now
spend on health care on satisfying the
basic health needs o f our entire popu
lation, and aim ed at providing a basic
level o f service which stresses preven
tion, encourages patient participation
and responsibility, and prom otes cul
tural sensitivity and appreciation as
well as equitable access, we could guar
antee, like Canada has, equal access to
the best health possible for our entire
nation. Holding our physicians to a
higher standard of accountability, and
the checking and review that the API
article briefly passed over is not the
primary contributor to many o f run
aw ay costs o f our health care industry.
The Canadian system is not feder
ally run. It is provincially-based. Within
broad criteria each providence defines
w hat their health package w ill be and
funding mechanisms. Our closest C a
nadian neighbor, British Colum bia,
spends about 35% less per person on
health than Oregon. Yet all of its resi
dents are provided with equal access to
com prehensive, affordable, quality
health care. No, they d o n ’t get every
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thing they may want nor do doctors gel
to prescribe every expensive procedure
that m ight make a difference. Yes, long
term care and prescription drugs and
m ental health are included without a
deductible. The system in British C o
lumbia does not allow for a different,
inferior level o f care for M edicaid re
cipients; all are treated equally. Every
one may have to wait but Americans are
also accustom ed to waits, delays, can
cellations and rescheduling.
W e Americans are misled if we
assume we have a health care ’system*.
W e have good service and access to
those who can afford medicaid for some
low-income, poor people; M edicare for
people over 65, and self-treatm ent or
em ergency rooms for the uninsured.
We have physicians who are increas
ingly opting out o f provision o f service
to M edicaid and Medicare payments
because the reimburscmenrs are too low.
We have physicians who treat Blue
Cross and Blue Shield patients with
respect not accorded to M edicaid or
M edicare patients.
The O regon Health Services Com
mission was created by the legislature
to develop a listing of ranked health
services both responsive to public val
ues and incorporating experience-based
information on treatm enteffectiveness.
These were prioritized in declining value
from the m ost to the least important -
which would provide the greatest bene
fits in im proving and maintaining the
health o f previously-uninsured O rego
nians. W hile the effort has been a con
troversial one, this pioneering effort has
drawn attention from around the world
for its efforts to grapple with the com
plex issues of investing in and respond
ing to the needs o f both our society and
the individual in guaranteeing a level of
health and wellness to all citizens.
Many other states are now engaged
in grappling with escalating costs, spi
raling rates and inadequate health serv
ices for their citizenry. It is a problem
which w on’t go away simply because
we ignore it or attempt to shove it aside
by claiming more pressing national
interests. Oregon’s bold effort, to tackle,
in the open, what had previously been a
closed discussion, must be applauded
and an im portant, significant beginning
if we are going to truly develop a health
system that is available and account
able to all Americans. W hile it is not
necessarily the final word, it certainly is
a start.
It should be noted that the only
source citedi n the API article is a member
o f the American Society o f Internal
Medicine. Over the years, the biggest
opponents to proposals for national and
state health plans are mem bers o f the
American Medical Association. That
body opposed Medicare, they opposed
M edicaid, they even opposed expan
sion of pre-natal care as interfering with
the doctor/patient relationship. O ur
country’s health care statistics show we
have nothing to lose and everything to
gain from studying the efforts o f other,
more-enlightened countries, like C an
ada. No, their system is not perfect,
without flaws or serious disputes. It is,
however, a real system that is achieving
quality o f life indicators with much less
money than the United States.
Finally, I am personally em bar
rassed that the only other industrialized
country that fails to provide all o f its
com m unities with quality health care
besides the U.S. is South Africa. That
certainly isn ’t company that I’d choose
to keep. Perhaps the greatest invest
ment we could make in our community
is to create a health system that gives
everyone equal access and affordable,
com prehensive services. Yes, it will
cost us plenty. But w e’ve been paying
that a long time with nothing much to
show for it..o th e r than increasingly-
poor health and death rates for our chil
dren, and their mothers.
Taking The Next Step
This most recent series o f articles
has dealt with the preparation of A fri
can American youth for success in a
culture increasingly driven by science
and technology. This approach has
necessarily evaluated the current proc
esses o f education, community support
and parental involvem ent And consis
tently I ’ve addressed that “ gap’ ’ I cited
last week - “ between ‘our’ knowledge
o f the world around us and realities o f
the workplace and infrastructure.”
Accompanying my experience-
based effort to bring about effective
change has been a réévaluation o f 'm y
ow n’ contributions. As you well know,
this is not an easy task and my first
assessm ent-that the record looks pretty
solid-could well be a cause for alarm.
On the one hand I look at a 25 year
collection o f aw ards, plaques, ac
knowledgements and media accounts,
but on the other hand, there is always
that great secret betw een the doer and
his maker; W H A T WAS THE REAL
GOAL? And in any case, why question
success?
I did not have to seek very far to
find the source o f my unease. In the
very areas in which I believed my ef
forts and innovations would make the
difference (as vain as that may sound),
we find the greatest gulf between A fri
can American aspirations and achieve
ments. Particularly, I have had to look
at my successful (temporarily) innova
tions in education; the design, dem on
stration and im plementation o f aw ard
winning techniques in developing cur
riculum and classroom procedures for
teaching science, mathem atics and
technology at all grades. But what has
happened? M illions o f dollars are allo
cated fora galloping horde o f unproven
experiments to ‘build the wheel all
over again ’, am id a shrill cacaphony o f
rhetoric and poloemics: “ Year 2000,
im port E uropean g en iu s” . M ost
w ouldn’t know a radical from a natural
log.
A second area that has demanded
another look is where there was pio
neering in the incorporation o f Black
History and the reclaim ing o f ‘roots’
into a pardigm for academic m otiva
tion and achievement. This is espe
cially true of my eleven years o f related
teaching and course developm ent at
Portland State University. A prime
example is a three quarter course I
developed, “ Black Economic Experi
ence” ; (three credit hours). So success
fully did this section integrate the ele
ments above, but also a frame o f refer
ence for the student to comprehend
(and function in) the economic and
cultural dynamics o f the innercity, that
the university took the unprecedented
step o f GRANTING CREDITS IN
FOUR SEPARATE DEPARTMENTS:
SOCIOLOGY, BUSINESS, URBAN
STUDIES AND BLACK STUDIES!
Back to that business o f the
“ workplace and the infrastructure”
mentioned earlier. I was so certain when
this course drew many scores of full
time students (black and white)-as well
as m anagers and other personnel from
urban programs and other public sec-
tors-that I had managed to tailor what
would prove to continue as a viable and
broadly accepted methodology for
com prehending our urban trauma. To
this day, I am meeting public sector
officials and professors who took that
course and the comments are pretty
much standard: “ That sure was a neat
session-we really need something like
that now , I’d send my entire staff-do
you ever think about doing something
in ‘Continuing Education’? so what
dropped out?
Then, too, there was the com m u
nity interface developed in conjunction
with the pioneering university courses.
A prim e exam ple here is my technique
o f structuring ‘real tim e’ community
developm ent projects right into the
classroom curriculum. For instance the
students participated as I designed a
short letter to accompany proposals to
foundations requesting that they FU R
NISH FUNDS FO R THE PURCHASE
OF REAL PROPERTY TO SITE
CERTAIN NORTHEAST ED U CA
TION AND SOCIAL PROGRAMS.
The particular technique w orked like
a charm , though the w ritten policy di-
rectives o f the foundation said this
would never be done. So right there in
the classroom students saw how a com
prehension o f the relationship between
the goals o f a foundation and the goals/
track record o f TH E BLACK E D U
CATION CEN TER (in the particular
case, and com m unity program s in
general) could be related in a fashion
o f immense economic benefit to a
community (1974).
Two o f the students used the tech
nique to acquire a perm anent dom icile
for the mental health program for which
they worked. Both organizations still
own the properties acquired (I be
lieve). However, and this is one source
of my “ unease” , neither these nor
several other organizations followed
through with the NEXT STEP I devel
oped through a concurrent academic
course sited right in the com m unity:”
Minority Business Operations” . I knew
from a long past experience as a real
estate broker that acquiring property
is one thing-but keeping, managing
and developing it is quite another. In
these dynamic situations the needed
“ next step” , not taken, was to de
velop the parcels and move to acquire
the then-cheap adjacent properties for
additional ‘program -sustaining’ in
come.
So, what is it I have been saying
here? Is it ju st how great it all could
have been had I achieved the full prom
ise o f those “ goals” ? Am I caring
about what ‘o ther’ people should have
done? Not at all, I’m sim ply getting
ready for the next phase o f my ‘retire
m ent’. I’ve given serious thought to
mama’s advice of fifty years ago; “ Quit
complaining Junior. If you’re not sat
isfied that it’s being done right, do it
yourself!” So now it is a case o f how
much I want to do-or interest others in
doing-as I get very favorable responses
from foundations, industries and the
public sectors offering to support “ those
NEW, forw ard-looking programs
you’ve designed Mr. B urt!” Please!
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Are • The • Proud • Sponsors • Of
Reinvestments
BY: ULLYSSES TUCKER, JR.
Accepting advice or suggestions
from people close to your life can be
extremely difficult, especially when you
already have your mind made up. How
many times did your parents, or some
one you respected, tell you that “ if you
play with fire, you will get burned?”
How many times did you do it anyway?
My grandmother used to say,
"Junior, I’m going to tell you about a
lot of things that arc right in this world,
but you arc still going to do wrong.
Despite her wisdom and insight, I had
to team life’s lessons the hard way. I
could have saved myself some pain,
conflicts, and adversity had I paid more
attention to her. Though I failed to
listen or take heed, I experienced a
great deal of growth and stronger ap
preciation for my grandmother. Why
arc people so hard-headed? Sure, I
knew that fire would burn if I played
with it. Ouch! There’s something to be
said about feeling the pain o f fire or
seeing the terrible bum on your finger
tips. Believe me, I learned something
in the process even though I knew the
outcome before it happened. Adversity
builds character and as the old saying
goes, no pain, no gain.
In my opinion, there is no right
or wrong time to take advice from
others. It’s strictly a judgement call or
it might boil down to the level of re
h I
Community
spect one has for the person presenting
the advice. Then again, I had great
respect for my grandmother, but 1 acted
foolishly anyway. First of all, every
human being has experienced a differ
ent reality and a unique perspective.
No one is totally correct with their
advice. It’s valid according to their
perception. Everyone has positive in
tentions when attempting to provide
others with advice, for the sake of argu
ment, but what is relevant to your life?
People must choose wisely or listen
carefully to those offering advice be
cause not everyone has positive mo
tives. In thecascof doctors,lawyers, or
economic advisors, we pay for con
structive results or sound advice. I,
though do confess not to know it all,
have enough experience to trust my
own judgement and make decisions
that will enhance my life. Sure, I listen
to what others have to say, but most of
the lime I file it away for future use.
Listening is important because at some
poinL the advice someone is trying to
give may eventually come in handy.
Some of the advice will, more than
likely, never be utilized, but it’s always
there in my subconscious, wailing to
hopefully make my life better or stop it
from taking a bad turn. People can
sometimes give advice based on their
perception of where they think you that
arc. My grandmother thinks that I
should be married with children. 1 say
that she is wrong and furthermore, I’m
not ready. Is this bad advice?
In high school, I was advised by
my academic counselor to join the armed
forces or to study a trade because I
wasn’t college material. Yes, my GPA
was less than 2.0 overall and yes, I
scored less than 500 on my SAT tcsL
Still, had I taken her advice, I would not
have a Master’s degree today. My 3.45
GPA (senior year) was more indicative
of my potential as a college student, not
my past academic history. Ironically,
that same counselor presented me with
an award (1985) honoring me as one of
the “ Most Outstanding Alumnus of the
Decade” from my high school. I told
the story to her, but she could not recall
it and that was the turning point in my
life. How many others did she discour
age with her advice?
Common sense is important, too.
Now, if someone advises you that if
you jump off a 2,000-foot cliff, you’re
going to die...lake heed! Some things,
like playing with fire, arc just facts of
life. Some advice is concrete and real.
Other advice is based on individual ex
periences. The only true advice that I
can give about taking advice from oth
ers is simple, be man or woman enough
to admit it when the “ advisor’ ’ is right,
regardless ofwhcthcr it hurts your pride
or noL It’s a sign of growth and matur
ity.
"Reinvestments in the Community" is a weekly column appearing
in API publications throughout the USA.