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HEALTH HEALTH Health Policy Advisory Center Volume 13, Number 2 Environmental Hazards PAC BULLETIN Is It Wages VS. Health? SN Ss --/-- ~. "a a] 1? -- 4ye., ar ad Vb; 1 pfordresher Inside Interview with Tony Mazzocchi & P. 7 The Attack on Medicare and Medicaid P. 11 Rays * X - Exposed P. 19 Review Peer Health / PAC Bulletin March / April 1982 Board of Editors To the Editor: I've just read Louanne Ken- nedy's excellent article on vol- untary and proprietary hospi- tals in the November / Decem- ber Health PAC Bulletin. The irony of the situation you cover is that the voluntary hospitals could probably save themselves if they developed an alliance with labor and the poor and put Tony Bale Pamela Brier Robb Burlage Michael E. Clark Barbara Ehrenreich Louanne Kennedy David Kotelchuck Ronda Kotelchuck Arthur Levin Patricia Moccia Marilyn Norinsky Kate Pfordresher David Rosner Hal Strelnick Richard Younge Associates: Des Callan, Madge Cohen, Kathy Conway, Doug Dornan, Cindy Driver, Dan Feshbach, Marsha Hurst, Mark Kleiman, Thomas Leventhal, Alan Levine, Joanne Lukomnik, Peter Medoff, Robin Omata, Doreen Rap- paport, Susan Reverby, Len Rodberg, Alex Rosen, Ken Rosenberg, Gel together a decent regulatory Stevenson, Rick Surpin, Ann Umemoto. system based on prospective re- imbursement and utilization control. Such a system could Editor: Jon Steinberg Staff: Carl Blumenthal, Debra De Palma, Dana Hughes, easily be shaped to channel Ellen Kolber, Peter Medoff, Steven Meister, Loretta Wavra. money away from the propri- etaries and into the voluntaries and if it put Medicaid patients in the mainstream and provided for decent wages for hospital workers it might be politically MANUSCRIPTS, COMMENTS, LETTERS TO THE EDITOR AND SUBSCRIPTION ORDERS should be addressed to Health / PAC, 17 Murray St., New York, N.Y. 10007. Subscription rates are $ 15 for individuals, $ 30 for institu- tions. irresistible, even now. Apparently, however, the voluntaries are not going to take 1982 Health / PAC. The Health / PAC Bulletin is published bimonthly. Se- cond class postage paid at New York, N.Y. and at additional mailing offices. on the proprietaries, are going to persist in regarding labor Articles in the Bulletin are indexed in the Health Planning and Administration data base of the National Library of Medicine. and the poor as their enemies and are going to resist regula- tion to the end, as if, despite all the steel industry can all destroy Along with providing relief the evidence to the contrary, themselves why shouldn't the for farmers from cost pressures they still believe that public and voluntary hospitals do this, too. of petrochemically based fer- private money will flow their It does amaze me though that tilizers and pesticides, the bill way in unlimited quantities, as people can still believe in an would have pay - offs for envi- long as the hospitals demand it. economic theory that presup- ronmentally concerned citizens It's all so irrational. poses companies will act in and health conscious - consum- 4 I will be sorry to see voluntary their own best interests. ers as well. hospitals close. At their best they are concerned about the level of care their patients Sincerely, Stanton J. Price Santa Monica, CA Cong. Weaver plans an early May hearing on the bill and, if response to the bill is strong, receive. They do provide some hopes to get committee action free care, which is more than To the Editor: on it by early summer. can be said for the proprietar- On February 24th, Cong. Jim Interested supporters can ies. And in California at least Weaver of Oregon introduced help move the bill forward by they provide far more and far " The Organic Farming Act of writing their Representatives in better care to Medi - Cal recipi- 1982, " a bill which calls for re- Congress, asking him / her to co- ents than do the proprietaries. search and information on or- sponsor the bill. But they will be closing. It's ganic farming systems at six Sara Ebenreck, Director not so surprising, though. If the regional centers around the 2 railroads, the auto industry and country. Washington Office Rodale Press Health / PAC Bulletin Notes and Comment Hearing the words " philosophy " and " health " in the same sentence from a new en- trant into New York City's Health and Hospital Corporation revolving door management was a refreshing surprise. Mayor Koch has never been known to place health high on his priority list, let alone have a " philosophy " about it, and most of his appointees have been happy to discuss the city's health policy mostly in terms of savings - dollars rescued for " more impor- tant " services, i.e. Fire and Police. The sentence came from the mouth of Dr. David Sencer, the new Commissioner of Health, at the March forum of the Public Health Association of New York City. Many had awaited his arrival as head of the Department of Health. His reputation as a knowledgeable public health professional seemed to promise that he could revive his agency to its reasonably functional state of a decade ago. After opening his talk with a self effacing - " I just got here " disclaimer and the mandatory joke - - Sencer bears an uncanny resemblance to Bob Newhart in both looks and delivery - he set his audience straight. Public health began somewhere in the murky past, before 1959, he explained. In those hal- cyon days, urban public health departments had a properly modest view of their role: keep restaurants clean, give kids shots, and prevent the spread of VD. Then came the activism of the 60's. Everything began to get out of hand. People started confusing preventive medicine with curative medicine. Public health departments expanded to care for sick people, organizing and delivering ambulatory care about - which, Dr. Sencer implied, they knew nothing. Worse still, they were (and are) ill equipped to com- pete with larger, more powerful providers for funds and other resources necessary to deliver such services. The obvious conclusion, said Sencer, is to return as rapidly as possible to the good old days of narrow focus on preventive medicine and policing public sanitation. The latter, he suggested, might be expanded somewhat in ex- ceptional circumstances to include monitoring and regulating acute health care providers via the health department's " bureaucracy. " " I'm a great believer in bureaucracy, " he explained, " I believe public bureaucracy is the skeleton, to which must be joined the muscle of the com- munity and of the private sector. " Elaborating on this metaphor, he made it clear that the community muscle is found primarily in the city's major medical providers, i.e. teaching hospitals and medical schools. But without a skeleton it " merely quivers. " Sencer's dissection of the role of public health would be amusing if it were not for two somber realities. One is that far too many other- wise well informed - health professionals share the historical ignorance upon which it rests. The other is that the current realities of health and health care in New York and other cities are such that the Sencerian vision all too easily complements the fashionable Reaganesque shuffle of " letting the private sector do it. " Public health history did not begin in the 1950's. For more than a century debates have raged in this country, in Western Europe, and virtually everywhere else over which curative and preventive services should be the direct responsibility of the government. The variation in the scope and content of the services offered has been enormous in the United States, over time and from locality to locality. The debate has been particularly intense in the urban Northeast and, Dr. Sencer might be surprised to learn, in New York City most of all. As George Rosen pointed out in an essay in From Medical Police to Social Medicine writ- ten shortly before his death last year, New York City maintained an extensive network of dis- pensaries in the 1920's which were forced out of existence by the county medical societies. In- deed, as the Health / PAC report on the late 1970's demise of the Department shows, much of its history can be seen as a struggle between the (generally expansionist) views of those favoring " district services " and the (generally reductionist) perspective of those advocating more centralized, categorical administration. Sencer's sharp distinction between " preven- tive " and " curative " medicine can also be questioned - one prominent community health physician in the audience did just that. If the last 20 years of experimentation and innovation in ambulatory care have taught us nothing else, they have shown that attempting to separate routine services in these two areas seriously weakens the impact of both. This is the basis of the very concept of " primary care. " Health / PAC Bulletin i Sencerian revisionism is not an academic matter. One would have to be deaf and blind not to be aware that health services accessible to the particularly poor -- the uninsured poor or " medically indigent " -are extremely meager and under attack from all quarters in this coun- try. New York City, which contains the largest medically indigent population, simply cannot afford the Reaganomian pretense that minimal Medicaid and Medicare combined with the wis- dom and charity of the private sector will weave safety nets for all. New York health activists have recently cited at least two examples of how dangerous this ap- proach can be: 1. The Department of Health currently runs over 50 child health stations, including 27 Pediatric Treatment Centers which also deliver curative medicine. A proposal periodically surfaces to turn all 50 over to the Health and Hospitals Corporation. Would Dr. Sencer park his Mercedes in a used car lot for safekeeping? The HHC closed many of its own well baby - clinics in the late 1970's because they were costly and didn't generate sufficient Medicaid revenues or inpa- tient admissions. For the thousands of kids who use them- most of whom lack any health insurance - they are the only source of care. If the health depart- ment won't fight for these kids, who will? 2. The Department currently provides school health services. Suggestions have been raised to transfer this responsibility to the Board of Education or elsewhere. Would the new provider offer the same care? There's no guarantee. Of course, there is no guarantee that the health department will be providing even its current meager services either. The $ 1.5 million budget increase re- quested for School Health Services for next year is pathetically inadequate, as everyone in the Department is aware. Whoever is saving money at the expense of children's health ought to have a good reason. In both these cases, the Department of Health originally took responsibility for providing these services because no one else demonstrat- ed the capacity or commitment. If anything, re- cent and future cutbacks reinforce the need for this role of provider of last resort. New York City's Department of Health once was considered the finest in the country. It pioneered numerous forms of personal health services long before Dr. Sencer was born, in- cluding school health exams (1905); public health nursing (1902); well baby - clinics with milk (1908); and dental clinics in schools (1921). All of these services were available free of charge to the city's poor. If the current Department of Health reminds Dr. Sencer of a skeleton, it may be because it is being reduced to one by successive waves of administrators. And the muscle - bound state of the city's major hospitals owes much to public officials prepared to cheer them on and write them checks. The next time the new commissioner studies anatomy, he might take the time to notice that a healthy organism needs more than muscle and bone. It needs a head in touch with its environ- ment and able to cope with it. NEW YORK CITY DEPARTMENT OF HEALTH -The New York Work Group (The NYWG was established by Health / PAC to monitor government programs in New York. We hope to establish similar groups in other cities and states, and would appreciate hearing from any volunteers.) Health / PAC Bulletin Claims, " July August -, 1981, Vital Signs Bulletin). After six months of behind the scenes wrangling with the State Health Department and the Senators Alan Cranston and Hospital Association of New York State (dominated largely S.I. Hayakawa on behalf of their by small hospitals) over reim- local wine industry. bursement policies, the Council Senator Cranston, like many has come up with a compromise other members of the California proposal. The problem is, very Hold That Beer and congressional delegation, re- ceived hefty contributions from few people appear happy with it. Make It a Bier The two most common images of the John Wayne Real Ameri- can He man - have him lighting up a cigarette and wetting his lips on the hefty foam of a large beer. John Wayne, as we know, died of cancer. Oddly enough, both of these masculinity vali- dators have turned out to be the Wine Institute for his 1980 campaign. American politics appear to be on a downward trend: before decisions were made in back rooms; now they're made in cellars. Jon Steinberg Compromising Positions The Council wants to give the State Health Department au- thority over all third party payers. To make this more attractive to hospitals, the pro- posal offers a bad debt and charity pool funded by a three percent surcharge on all third party payers. AS carcinogens. The dangers of cigarettes are common knowledge, but thanks to the Reagan Administration As the United States moves into the era of limits with the hesitancy of a drunk entering a dark room, hospitals are among The state is offering the equivalent of a kiddie wading pool for a herd Americans will be able to drink their beer in peaceful ignor- ance. Last November the those tripping on the depres- sion glass. The small ones are falling away. The largest are of thirsty elephants. a Treasury Department rescinded regulations for labeling alco- growing larger, more sophisti- cated in their medical and reim- Despite this sweetener, the Council plan has attracted little holic beverages scheduled to bursement technology, and support among hospital admin- become effective next January. even more powerful politically. istrators. Public hospitals, par- Their foam enhancers, color- Often state governments are ticularly New York City's Health ings, flavorings, preservatives, caught in the middle, attempt- and Hospitals Corporation, anti oxidants - , and enzymes will ing to appease communities think the state is offering the continue to remain part of their uneasily aware that their hospit- equivalent of a kiddie wading mystery. als are turning into skeletons or pool for a herd of thirsty ele- Unless a suit filed this March by the Center for Science in the rubble while catering to the needs of the major teaching phants. The state pool is small to begin with, and public hospitals Public Interest is successful. hospitals. would be allotted less than a According to CSPI Legal Af- Because it contains the most quarter of it even though they fairs Director Bruce Silver- medical empires and large serve a disproportionate num- glade, " The Treasury Depart- numbers of small hospitals- ber of indigent patients. An ment had secretly agreed to though not nearly so many as a earlier version of the proposal repeal the ingredient labeling requirements several weeks decade ago New York repre- sents the most advanced form of doled out the money according to need, but this was withdrawn before it solicited comments on this conflict. In 1978 the state to assuage upstate and subur- its plans from the public as re- legislature set up the Council ban opposition. The needs of quired by law. " CSPI has ob- on Health Care Financing in the poor and the needs of state tained documents indicating response to cries for help from legislators don't always coin- that Treasury officials promised hospitals hard hit by the state's cide. the rescission in response to ob- rigid cost containment program Even so, the rest of the jections raised by California (see " A New Way to Stake hospital industry has not been 5 Health / PAC Bulletin won over. At a recent meeting, transportation of military pets tive care programs, the govern- Hospital Association members when personnel are trans- ment will increase government voted overwhelmingly to reject ferred. If the veterinary costs over the long term while the Council proposal. They benefits for military pets were hurting millions of children. were particularly put off by eliminated, 35,000 low income David Kotelchuck their profound distrust of the children could be immunized David Kotelchuck is on the State Health Department. Dur- instead... Health / PAC Board. ing the past six years the The State of Virginia has Department's Medicaid cost fewer than 160 full time home- containment program has pro- vided the final shove for many making aides serving more than 2,500 aged, blind, dis- Time Warp hospitals teetering on the edge of bankruptcy, and the surviv- abled persons and families with handicapped children at home. Under the heading " Red Tape Flap, " the Wall Street ing institutions see no reason to applaud a plan which gives it control over Medicare as well. State Health Department of- ficials profess to be insulted and hurt by this suspicion of their good intentions, but they will have a tough time pushing their plan through. On April 1 it was sent off to Washington for an okay. The next step is approval The Pentagon has 300 personal servants tending to fewer than 300 senior officers, none of whom reports himself seriously disabled. Virginia's program costs about $ 1 million a year. The Pentagon's program costs over $ 5 million a year. Presi- dent Reagan cut Virginia's pro- gram by more than a third; he increased the Pentagon's pro- Journal recently reported that the White House has asked OSHA to drop employers ' worker illness - injury logs to cut paper work. This certainly sounds like a worthy effort, since it is easy to imagine man- agers spending hours toiling at their desks recording every lit- tle scratch, allergy, and lost limb. by the state legislature, where it gram by 15 percent.... The Reagan Administration will encounter heavy opposition Secretary of Defense Wein- will be relieved, however, to with or without hospital industry berger has a private dining learn that the burden is not as support. room at the Pentagon at which great as it imagined. A new New York Work Group only about 100 persons are study by the Bureau of Labor eligible to dine. It has a staff of 19 and each meal served costs Statistics found that although previous estimates had calcu National Security The Children's Defense Fund has published " A Children's Defense Budget: An Analysis of the President's Budget and Children, " which makes some telling comments on the Reagan Administration the diner an average of $ 2.87 and the taxpayers an additional $ 12.06. President Reagan forced the low income - children of working mothers in child care centers to give up their mid morning - supplement of juice and crackers. Each time Secretary Weinberger or one of lated that it took four minutes to fill out the OSHA 200 form and 20 minutes for the OSHA 101 form, a BLS survey in three states found that the actual times are now 2.1 minutes and 5.9 minutes, respectively. Reagan OSHA administra- tors, who are firm believers in priorities. Here are a few excerpts: his select associates has lunch, 40 of those low income - children self reporting - by employers, might note that the earlier fig- President Reagan proposed must go without orange juice or milk. More than one million ures were obtained by asking management. This time, at least an additional $ 3 million cut in the childhood immunization mid morning - supplements for low income - children now to be two BLS representatives stood by with stopwatches. program for fiscal year 1982 which would eliminate immuni- lost each year could be restored if Secretary Weinberger and The BLS also asked the par- ticipants if they " perceived zations for 75,000 children at his colleagues ate in other recordkeeping as a burden, " risk. In fiscal year 1983 he plans Pentagon dining rooms, or con- and found that the answer was to cut $ 2 million more. The tracted with a private food com- generally " no "; the employers Defense Department spends pany to run his private dining said they would have to record $ 1.4 million on shots and other room on a self sustaining - basis. injuries and illnesses anyway veterinary services for the pets for insurance and other pur- of military personnel. Addi- The report goes on to point poses. 6 tional millions are spent on the out that by eliminating preven- Jon Steinberg Health / PAC Bulletin Health / PAC Interview A Talk With Tony Mazzocchi by Peter Medoff I had arranged to meet Tony Mazzocchi at the the President decides upon, the current policy office of the health and safety director of a New of dismantling will continue. For instance, York based - union. He had come in from his standard setting. That was always an oppor- new home in New Jersey. tunity for us in the labor movement to petition Until recently, he was the health and safety for promulgation of a particular standard, to director of the Oil, Chemical, and Atomic provide evidence on why we need it to best pro- Workers union OCAW () , based in Denver. Last tect workers at the point of production. Well, August he narrowly lost the election for the Auchter is just going to bury any petition that union presidency and was stripped of his posi- comes in. In effect, that's already been said. tion. His only OCAW post is international rep- " Of course, " he added quickly, " on top of resentative - without salary. However his repu- that you have an economic crisis in which fear tation as one of the most insightful analysts of is travelling through the workplaces. Even the occupational health and safety movement is where some of these problems are highly visi- not in danger. ble workers are reluctant to take an aggressive Dressed in a brown turtleneck, talking in his stance to deal with them. The preservation of customary informal manner, Mazzocchi posed jobs is foremost on everybody's minds. Legiti- a sharp contrast to the two coat - and - tie formal mately so and logically so. Environmental and union officials he was conversing with. economic blackmail is real. It's a very difficult " I'm sort of in limbo now, " he told me, " What time even to conduct a straight economic ac- I'll be doing will become clearer in the next few tion. I just do not see people going into the weeks. " About himself he would say no more. street over this issue. We're in a time of conces- He was quite voluble, however, on his fa- sions and very few unions are putting them- vorite topic. " The health and safety movement selves in a position where they can extract what is again under siege, " he began. " The Ad- is necessary. " ministration has cleverly, in my opinion, dis- mantled the operation in a not totally visible way. The Occupational Safety and Health Ad- ministration played a great role in dramatizing the issues. It provided a platform, a stage, for " We suspect that we live about seven years less than one would normally this drama to get played out on, in view of the total population. expect. " " As a result, many diverse actions occurred. Community groups such as Committees on Oc- He smiled with an energetic wave of his cupational Safety and Health were formed. A hand. " But of course we're a decade further lot of unions developed rather sophisticated down the line and we know a lot more. As I say, health and safety departments. " many unions built departments and they are His eyes, wide with enthusiasm as always going to proceed under their own steam. I think when he talked about the movement, abruptly many of the health and safety confrontations narrowed. " With Thorne Auchter leading the will be between a union and a specific industry show as OSHA director, or any other appointee without the government being involved. OSHA will maintain itself as an agency, make a few mild forays once in a while. That's been a tactic Peter Medoff is a member of the Health / PAC used by previous administrations to keep a staff. facade of protection. But it's not going to inter- 7 Health / PAC Bulletin fi Y' Peter Medof vene in any substantive way. " He paused for a moment, weighing the likely prospects. " The effects of working throughout the 1950's, 1960's, and 1970's are going to be more apparent in the 1980's. Birth defects and childhood cancer, for example, are going to be more visible. The responses are hard to predict. It's an issue that is not going to go away. Things are going to get worse as a result of the economic crunch. Cutbacks, lack of maintenance, speedups, drives for increased productivity will all make health and safety problems that much more severe. " When asked about state and local interven- tion, he smiled ironically. " That's taking us back before OSHA; the state and local govern- ments will be the graveyard of any hopes. A number of issues will be pushed in some states, but as the economic pressure grows it will be similar to other times I've lived through, even progressive times. You have an opportunity to do something progressive in one state, your laws get too tough and industry runs down South or someplace else, and that's going to overwhelm everybody. " In recent weeks, Mazzocchi had been work- ing on another tack, and his energy and enthu- siasm intensified as he launched into a discus- sion of the project. " I see more opportunity for alternative structures. For instance, where OSHA had a standard setting process that al- lowed us to get the story out in the open. I've been talking to a number of scientists, trade unionists and community types about creating a standard setting process that has a bias toward working people. The process would in- clude scientists and workers who really want to provide the ultimate in standard protection for workers. After all, OSHA and most Federal agencies have incorporated by reference stan- dards promulgated by consensus organizations. dominated by management. " So I think it's a time for a worker consensus to emerge. We'd provide a mechanism for re- ceiving information about substances and come up with recommended standards. Then we'd fight to have them incorporated by reference just like industry has. Over 90 per- cent of the standards in the Occupational Safe- ty and Health Act are industry promulgated. Health / PAC Bulletin " Another area, " he continued with an almost boyish delight, " is worker control over medical industrial - hygiene at the plant level. Even in this period of economic duress we ought to be setting up separate entities and have management contribute funding. A lot of it wouldn't even be new money since manage- ment is already spending on industrial hygiene. It's a fight over control, and I think it has to take place in this decade. And it can. " Record keeping would be centralized and confidential. The employer would see only what the union sees aggregate - data. We're capable of doing this overnight. " Unlike many specialists in occupational health and safety, Mazzocchi has always seen the issue in the context of a broader analysis of the work process and society itself, and has been outspoken in expressing his views. " My concept is that catastrophic diseases are built into the industrial process, " he said, " Cancer, birth defects, heart disease, are so built into the mode of production that unless we address how we do things and what we produce, we've got serious problems. When we address them in a way that gives people some power down below, we'll be on the way to dealing with ultimate remedies. " I think a lot of people don't understand the way the industrial process works and that has to come first. They think in terms of bad guys against good guys, not imperatives of produc- tion to maximize profit. " He smiled ironically. " The bosses are right in that respect. They say you have to disease peo- ple, that they can't afford better protection. Essentially, they're saying that working people have to give bosses a subsidy, using up their lives. Cost benefit - is true. " Birth defects and childhood cancer are going to be more visible. " " For instance, in the oil industry we've had a demand that we want to know how long we live. The industry has never told us; they have all the data. We suspect, based on pension data, that we live about seven years less than one would normally expect. That's a handsome subsidy. And then you take morbidity and the quality of life on top of that and you're dealing with ap- preciable subsidies. " Industry is one big welfare basket case, " he exploded with mock wonder, " If we took our subsidies back and said,'Let free enterprise work,'we'd find it isn't very free or very enter- prising. They wouldn't make it. " That seven years is a big piece of somebody's life. I can't say it's a loss of produc- tive life because there is always somebody from the army of unemployed to take your place. In real dollar terms it doesn't cost. But it's a sub- sidy that industry extracts, and it's worth a lot. You can work a person and expose him or her. If you had to develop an alternative, safer, method, you could produce less, no question about it. " Industry is one big welfare basket case.... It isn't very free or very enterprising. " " I never bought the argument that healthier places are more productive. I think that comes from people who don't understand the nature of the workplace. If you die young, you help them in a lot of ways. You enhance their pension plans and you probably subsidize the executive pension plans. " Although a strong advocate of building co- alitions beyond the trade unions, Mazzocchi was unenthusiastic when asked about com- munity - based alliances. " Broad coalitions around health and safety issues are always difficult, " he explained, " If a community is assaulted by a substance, people normally act to get rid of the plant, which of course creates divisions. I think the best oppor- tunity for a broad coalition is working with the health community. The models established by the COSH's have to be encouraged. There are alternatives like the standard setting organiza- tions I mentioned. That kind of worker control, to me, takes first priority because there is a chance to move on it. " If you try to establish local standards, it's easy for an industrial entity to say,'Hey, you priced us out of the market and we're going to move.'That type of thing could happen in a middle class community that really doesn't want industry around anyway, but I'm talking about industrial communities. Economic threats succeed. Where you have service cuts there are opportunities for coalitions. A subway can't up and run away to Mississippi. " And the whole question of our children can easily be developed into a coalition base. Health / PAC Bulletin Everybody is concerned about children. We shouldn't abandon all the good slogans to the right. The right to life'is a great slogan, but the real fight is over the rights of our kids to be born healthy and to survive. That's an issue that emanates from the workplace and can incor- porate broad sections of the population. Most workers feel that they're working at lousy jobs because they want to make it better for their kids. If they doom their kids by working at these jobs, they're going to be angry about it. And as I've said, the 1980's will be a time for genetic confrontation. It's going to be a visible issue, very visible. " A Labor Party? Playing for keeps After ten years of roaming around at odd jobs supervising - the Phoenix Program in a Vietnamese province, running a mail order - prayer service, assisting in tenant relocation for a condominium firm Milton - " Bear " Nuckles decided to go back to school and begin a career where he could earn a steady income. Now he describes his first year at the Hardnose School of Hospital Personnel Management in " the most engaging account of a strike- breaker's education , yet written. " -Nursing Grudges Quarterly At the August, 1981, OCAW convention, Mazzocchi introduced a resolution calling for a new national political party. It passed unani- mously. He has long been one of the leading advocates within the trade union movement of a " A candid, eloquent, and often moving account of how one man learns to prevent union trouble. " - Orderly Management " Bear " Nuckles can save national labor party. " I think that the opportunity for constructing a labor party is better than it has ever been, " he said emphatically, probing the air with his fore- finger. " And I also think it's a necessity - a par- ty that at least becomes a platform for coherent expression of the nature of what's occurring in this country. It would help draw people back across to this side of the spectrum. The right is just gobbling everybody up. Look at the responses to Reaganomics. The Democrats have been coming up with variations of the same dance. " There is a big third party out there, the par- ty of non voters - . It's enormous. I think that's an indication of people's cynicism toward the ex- isting political structures and choices. And for the labor movement, it means their only salva- tion is in a political context. It's the only way we're going to organize, the only way we're go- ing to mobilize. " He scowled with frustration. " Right now it's one big retreat. " Even in a one to one conversation, it was easy to see the dynamic labor leader capable of electrifying a large audience with direct sentences, delivered with extraordinary force and conviction. you a bed pan - full of money. " -Hospital -Hospital Handicapper MEAN, ROUGH, AND TOUGH A Touching Account of the First Year at the Hardnose School of Hospital Personnel Management by Milton " Bear " Nuckles $ 4.95 Turkey Paperback _Also available. CUT COSTS, CUT FLESH: A dynamic young admissions director relates his never- ending battle to keep profit margins up at Chicago's No. Mercy Hospital and Medical Center. Includes a special appendix: ten ways to stop the poor at the door. Bill M. Furst $ 4.95 Turkey Paperback For the best " In times of expansion it's certainly easier to build coalitions, " he concluded, " but in times of crisis it's necessary. The imperatives exist Lino osku pfpolry tshied eToulrogkye.y. now. There aren't any choices. We really have For the TURKEY catalogue of more than 50 books on how to get rich at the expense of the poor, send $ 10 to cover postage, 10 to resist what's happening, and begin to handling, and our lunch to Health / PAC, 17 Murray St., New York, develop offensive actions. " B N.Y. 10007. Health / PAC Bulletin subs are $ 15. Health / PAC Bulletin A Factory Life Is More Than A Living by Tony Bale and Barbara Ehrenreich The handmade sign on the side of the road says " WELCOME TO LONG ISLAND'S LOVE most paranoid environmentalist's suspicions. They revealed, for example, how Hooker had CANAL. " Its carefullly drawn skull and cleaned up for its 1980 open house: drums of crossbones reminds anyone who might have toxic waste were loaded into Purolator trucks forgotten what happened outside Niagara and driven around Long Island; at midnight the Falls. A second sign, more optimistic, says " HONK IF YOU SUPPORT THE STRIKING waste was returned to the plant. And they told how the company handled chemical spills: HOOKER CO. WORKERS. " A young couple when 2000 gallons of styrene spilled on the who look like they might be on their lunch ground outside the plant, management ordered break from one of the other factories nearby the workers to simply cover it with dirt. One hot slows their car, then honks in support. summer day the styrene burst into acrid, Picketers on the side of the road wave back smokey flames. solemnly. This is central Long Island, where Revelations such as these changed the tract houses press up against bleak acres of in- character of community protest at Hooker. dustrial parkland; no one here likes Hooker There were rallies, public meetings, and one Chemical Company. August evening an innovative protest: two The strike had support even before it started. dozen people, mostly. housewives trailing Hooker has been dumping toxic wastes in Long young children, marched from the main road Island since 1965. The Republican administra- over to Hooker's administration building, sang tion of Nassau County ignored a New York " This Land Is Made for You and Me, " and Public Interest Research Group report charg- quietly dumped their garbage out of plastic ing that much of the ground water in the area bags onto the neatly groomed lawn. had been contaminated, but sales of bottled water boomed in quiet suburban towns of Syosset, Bethpage, Islip, and Hicksville. A Hooker attempt to improve its public image in When we arrived Hooker's Hicksville the summer of 1980 backfired when local en- vironmental activists staged a die - in at the com- plant looked like an armed camp. pany open house to protest its best known - unadvertised by product - , cancer. Protests didn't really get off the ground, though, until the plant's 43 blue collar workers struck one year later over their own health and safety issues. From the collective security of the picket line, they were able to talk about what had gone on inside. Their stories surpassed the " I've been saving my garbage for a week for this, " said a woman who lives a few blocks from the plant, " I always wanted to dump on them. " The plant security guards were too stunned to call the police. " I loved it, " one of the picketing workers who had watched told us later, " I couldn't believe they actually did it. " When we arrived a few days before the Tony Bale and Barbara Ehrenreich are mem- " dump - in, " Hooker's Hicksville plant looked bers of the Health / PAC Editorial Board. Tony is like an armed camp. The bare 12 acre grounds a sociologist specializing in occupational are surrounded by a six foot chain link fence health; he is currently teaching on Long Island topped by two feet of barbed wire. The regular at the State University of New York, Old security force had been augmented with 24 Westbury. Barbara lives on Long Island and is rented " professionals " from an international the mother of two young children. security agency. From the road that fronts the 11 Health / PAC Bulletin plant grounds we could see at least a dozen of them in their navy blue jump suits, high boots, and riot gear some - posted at intervals inside the fence, a cluster at the checkpoint that separates the parking lot from the plant, and two stationed on the plant roof. As we walked over to the picket line, one filmed us with a video camera. " Don't mind the storm troopers, " grinned Al (this and all other names have been changed), a short man in his early 30's wearing jeans and tee shirt with a button saying " Teamsters are beautiful. " The measures Hooker and its multi- national parent company, Occidental Petro- leum, were taking to intimidate 43 men who earned, on the average, $ 6 an hour, was a source of considerable amusement for the picketers. There were 20 of them when we ar- rived at mid - day, white, Black, and Hispanic in proportions representative of Long Island's labor force, if not its residential population. Most of them were sitting peaceably on lawn chairs under a large, makeshift tent, trying to keep cool. After a union organizer (Teamster Local 810) introduced us, four men offered to come over to a nearby coffee shop for an interview. By this time they had already talked about conditions inside Hooker to community groups and county health officials, but they welcomed the oppor- tunity to get as much as possible down on tape. " Hooker is very public relations conscious -, " Al explained, Once they were back at work anyone who talked to outsiders would be risk- ing a trip to the unemployment office. They told us that the Hicksville plant makes a variety of what the company calls " specialty chemicals "; it also makes its employees inter- mittently or chronically sick. " We always knew Swedn Now there were problems, " said Terry, " Things like rashes, headaches, coughing. We have one guy in his late 20's who coughs up blood.... There are two men under treatment for throat cancer. " He offered an explanation of how easi- ly disasters occurred: Four years ago when I was working with uredane I stuck my hand in a drum and pulled out two gaskets. The foreman told me to take ' out em.... Three days later the skin peeled off my hands. Something called DMF. That's a sol- vent used in uredane, the most powerful one they've got. One of the fellows exposed to it had lesions all over his body. Al described another section of the plant: By and by we would get fever. We get sick. Sometimes, I don't know, I begin to smell wrong and what the heck, I've got to go to the bathroom and take a shower right away and remove all my clothes....... We get the smell of that sticky stuff on our pants, the laundry won't remove it. Terry added, a.. * .. a a.... .. oe 8 # .. ~ - 6 .. . My nose bleeds and I cough up blood every time I load my reactor up. It's insufficient equipment. The mask they give up runs out in 9 minutes; and in the concentration we work in it takes 2 hours to load the reactor. We might just as well take the mask off and throw it away. " Al nodded in agreement. " I've walked into his plant when he's loading up the reactor and I walk out. I won't go up there. " Mike, who had been at Hooker longer than Swedn the others, told us that when the reactor is charged the TMA (trimalitic anhydride) con- Now centration in the air is " anywhere from 100 to 12 1000 times the OSHA limit. You get rashes, Health / PAC Bulletin Stirred by the news, 15 Hooker workers on Long Island met to discuss health and safety hazards at their own plant. They agreed to call the Burlington strike leader named in the paper and invite him out to Hicksville. Everyone pitched in $ 5 to pay for the gas. Two Burlington strikers and their wives agreed to drive up and address the Hicksville Hooker's first plant - wide, rank and file meeting on health and safety issues. After hearing the Burlington story and discussing their own situation, the aroused Hicksville workers Swedn decided to affiliate with Teamster Local 810, which had helped arrange the meeting and was Now willing to take health issues to the bargaining table. (Although the Burlington workers ultimately lost their strike, they had set a prece- dent for rank and file communication between nose bleeds... it does a job on your lungs, everything. " For years, there was good reason not to com- plain. According to Terry, management would respond, " Well, you have a respiratory or allergy problem. We'll give you a medical dis- charge. Goodbye. " " That means, " said Terry, " If you can't hack it, mister, get out. " " No one knew much about the possible long- term effects of the chemicals they were exposed to, and they assumed that management would let them know if there was anything to worry about. " I used to clean out drums containing PVC's with my bare hands, " said John, a thin, long haired - 29 year - - old, " If there were cuts on my hands they wouldn't heal...I didn't know any better. " John and the other Hicksville workers began to know better when the story of the Love Canal tragedy broke. Hooker, their employer, had created it, and for the first time they heard the chemicals they worked with linked to cancer, birth defects, and chromosome damage. " You started watching out for yourself, " said Terry, " because you realized the company's not watching out for you. " But apart from minor skirmishes with man- plants and across union jurisdictional lines.) Technically, the Hicksville strike was a lock- out. Management would not recognize the union and refused to discuss health and safety issues. This stance did not improve Hooker's image in the community or with its employees. In the early days of the strike, the picketers re- searched Hooker and Occidental Petroleum, learning a lot more about their holdings, prof- its, and dismal environmental and occupa- tional record around the country. On the basis of their own experience, no horror story else- where was difficult to believe. " Most of the older Hooker plants are me- chanical Frankensteins, " Mike told us, " They were not built or engineered to produce chem- ical products. Here, for example, Hooker bought the plant from Inland Rubber Corpora- tion and made a few modifications -'take this out, modify that, this pipe is still good - it's ready to fall off the ceiling but it's still hanging agement, nothing happened for several years- largely because there didn't seem to be much that anyone could do. But in March, 1981, the Hicksville workers read about a strike at the Hooker plant in Burlington, NJ. Five of the 350 blue collar workers there had died of cancer in the space of a few years. The company had shown no interest in finding out why or in cleaning up the plant. Finally, the angry workers walked out in a wildcat strike. Swedn Now 13 Health / PAC Bulletin there have been leaks of liquid 66. " " " You have to keep asking, " Terry said, " They have the safety data sheets that are put out by the manufacturers of these chemicals. But the attitude is that you can take a monkey and offer him a banana and he'll open a valve for you if he knows he's going to get that banana. They say,'Take this and pour it in.'I want to know what I'm pouring. To me this is just proper training, but there is no training here at all. " c0 J, al. Swedn Now He smiled grimly. You " want to know how well management knows the chemicals? We had one of the fellows mixing this stuff called TD - 80. He filled the drum up with water, cap- ped it, and walked away. It's a good thing he did, because the drum took off like a jet and went over the top of the plant.. It turns out TD - 80 reacts with water. " up there all we'll do is change this pump, put a new line in, and so forth. " " If workers complained, they could expect management to retaliate by choosing its own The consequent disasters are not surprising, Al noted. " Many of these products are trans- ferred at very high temperature because that's when they're in the most viscous state. They're blazing hot. Now the actual production kettles are old, overused. They weren't made for con- tinuous manufacture or for tremendous temper- ature changes, and we have a seven day a week production schedule, which they like because profits are at a maximum. The result is there are constantly leaks, constantly breaks. " " And when that happens, " Terry interjected, " somebody usually gets burned or you get a wide spill. It could be anything from a plasti- cizer to a polyester or alcohol. I've seen it all. " In the years leading up to the strike, there had been dozens of small confrontations over " safety " issues. Mike remarked that his super- visor's contribution to plant safety was writing him up for smoking in the boiler room. " Now there's nothing in the boiler room except con- crete, steel, and number six bunker oil, which takes a blow torch to ignite, but he caught me with a butt. " The next time Mike was written up because the boiler room was so steamy he had taken off his safety glasses to read the meters. We asked whether OSHA had been any help, and were answered with snorts. " The last time OSHA was here was in 1978, " Terry said, " Half the time when OSHA was down here we never even knew it. We were told the man was a salesman or somebody from the Jersey plant, or whatever. " Only a few weeks before our inter- view had they learned that they had a right to working conditions. Information was a major request OSHA inspections and to accompany issue; no one knew what he was being exposed to or what it might do to him. " I fought for years to get a listing of the chemicals we use and what their toxicity rating was, " Mike said. One fluid used as a heat transfer agent was an " F - 2. " Nobody worried about it until migratory birds in contact with local electric power lines containing the same chemical were found to be suffering lethal birth defects. Hooker then switched to a new agent which the employees knew only as " 66. " " We asked whether it's harmful, " related Phil, who had joined us in the coffee shop, " and they told us it's not unless the vapor is heated to about 720 , and here it gets up to 450-500 , so there shouldn't be any problem. But we don't know if that's true. " In the meantime, Mike put 14 it, the vapor gets into the plant atmosphere and al Swedn Now Health / PAC Bulletin 0000 0 000 110 \ 10 N Canadian Canadian Canadian Canadian Canadian Canadian Canadian Revolution Revolution Revolution Revolution Revolution L - Revolution Revolution the inspector around the plant. This April, months later, we asked Don It was time to return to the picket line. Phil Cierzniewski, former strike leader and current waved toward the desolate grounds sur- shop steward, how conditions had changed rounding Hooker's chemical fortress as we ap- since the strike. " It's a better atmosphere, " he proached it. " I've found dead birds outside the assured us, " Whatever happens - spills, any- plant. Not hurt, just dead. " We wanted to know thing like that they - have to call the environ- what these men thought about their own life ex- mental agencies. You can have all the safety pectancy after all they had learned, but it was equipment you want, and it's possible to find not a question to ask. out what every chemical you're working with is. " I think we're going to win, " Al prophesied, For example, we had a case where a man re- " Either that or we're going to drive these bas- fused to do a particular job because he didn't tards out of business. And when we get back in- know what the chemicals were. If that had hap- side it's going to be a whole other story. " pened before the strike he would have been A few days later, Hooker settled with the suspended. " striking workers. One of the provisions of the He paused for a moment, thinking of the best agreement was a mechanism for joint worker- way to describe the transformation. It's " a com- management surveillance of occupational plete turnaround, " he said, " We have power hazards. where before we had none. " | 15 Health / PAC Bulletin i Occupational Hazards 1 SAFETY $ 10 Now ALTH ( 8053 STRIKE Workers will no The Reagan Game Equipment Required 1 unloaded die 1 worker for each player money 1 sink ee Workers in your plant wildcat for better health and safety. Take another turn. The OSHA enforce- longer be guaran- teed " walkaround pay " from their employers while assisting an OSHA inspection. You lose an hour's pay ac- companying the in- spector (don't worry, he or she won't be back). Pay Boss $ 10. ment staff will be cut by over 40 per- Thorne Auchter, cent by 1983 from Reagan's new the 1,697 when OSHA Director, bans Rules: Each player is given 10 $ in cash. Each in turn throws the die and moves his or her Reagan took office. As Business Week OSHA publications and films deemed worker the number of spaces it indicates. wrote, " the typical " biased " in favor of The first player who reaches Retirement in labor or alarmist good health with more than $ 10 in his or her pocket wins. START business ment establish- OSHA will see an every inspector about 77 years , about workplace hazards. Complete game with one eye closed. , ii lose Haley's a as often Under a new " tar- geting " system, inspector waiting for fo t Comet while. " as OSHA will stop in- specting at least 75 2-77 plant Workers form in your percent of employers on - the basis of FILE one com it e of. Remove a safety their own reports of low rates of lost- time illness and in- jury. Your employer fudges the forms. AND From now on, throw die with only four RANK turn poisonous while. Lose a fingers. . the You iOnSgH An oi sn ecwo nsider- standards, health concentrating instead weakening the on the adequate ones few you are books. That on vat will remain cleaning wash your you three times. hands caps. your handi- The Administration sharply reduces funding funding for for grass- roots efforts of unions, COSH groups, and others to to promote health and safety. Pay Rank and File $ 3 toward your own health and safety group and eliminate one health problem. 16 BOSS Health / PAC Bulletin A comprehensive Union petitions for emergency tempo- rary standards are denied for two new- ly discovered can- cer threats, ethylene Your union decides to support worker health and safety committees in each plant. Take $ 2 from Rank and File. plan to streamline the regulation of carcinogens, devel- oped after 2 years of study, is sus- pended while " sci- entific and techno- oxide and ethylene dibromide, affecting health care workers and workers handl- ing pesticide- sprayed fruit, respectively. Your life expectancy declines. On your next turn, throw die OSHA is trying a " pilot program " in two regions under which employers are asked to grade logical develop- ments " and " cost- effectiveness " are examined for two or three years. You take leave of absence for chemo- therapy. Lose your next turn. and move back- wards. --- Declaring that for- maldehyde is " not RETIREMENT inspectors on " cour- tesy, competence, impartiality, etc. " Your inspector is fired for discourtesy after he cites an employer for a gap- ing hole in the plant floor. You lose one You and fellow workers demand better goggles and get them. Pay Rank and File $ 5 and re- move one handicap. a aa ripe for regulation, " OSHA withdraws its name from a joint statement with the leg. eR aT National Institute for Occupational Safety and Health warning that " for- maldehyde (should) be handled as a potential occupa- tional carcinogen and that ap- propriate controls be used to reduce worker exposure. " You inhale while in- sulating walls. Sick with worry that it will cause cancer in You refuse to enter a room filled with noxious fumes your boss says are Reagan OSHA- approved and are suspended. Pay Boss $ 5 but remove (.; a . Your supervisor catches you inspect- ing your machine and accuses you of malingering. Pay Boss $ 5. ten years, you miss one handicap. your next turn. other The Administration cancels a rule that would have guaran- teed workers access to the chemical con- tents of trade name - substances they are exposed to on the - 16 Z job. Your right hand is burnt by Z 16 -, a mysterious new wonder chemical compound you are asked to pour. Throw die with your left hand from now on. and three sue man- failing You workercso rargeemcetn t efxoirs ta ehda zwahrdCa.ot l- to it lect knew double have to con- Rank Bos. Pereira you tributed File from and Andrea 17 Health / PAC Bulletin HEALTH PAC BULLETIN THE HEALTH CARE HIERARCHY The Health / PAC Bulletin doesn't have to boast that it's better than the competition; there is no competition. No one else offers independent analysis of health policy issues from prenatal care to hospices for the dying; covers medical carelessness for women and on the job poisoning; offers incisive international reports and lively briefs on domestic health developments. If you already know all this and have a subscription, why not do a friend a favor and fill in his or her name on the form below before you run out of 20 stamps? Remember, nine out of ten radical doctors recommend the Health / PAC Bulletin for fast relief of health care policy mystification. Please enter. Check: Y' Individuals $ 15.00 Y' Institutions $ 30.00 _subscription (s) for the Health / PAC Bulletin (six issues) Name Address City State_ Zip. Y' Bill me (plus postage and handling) Y' Charge: Y' Visa Y' Master Expiration date No. Signature Send your check or money order to Health / PAC Bulletin, 17 Murray St., New York, N. Y. 10007 18 Health / PAC Bulletin Killing Us Softly by Mark Kleiman Last year the Reaganoids'all out - assault on social programs nearly ground to a halt on the Medicare. This is a nationwide health insurance pro- Medicare and Medicaid front. We all may gram for nearly all the aged and certain dis- claim some credit, but entrenched health in- abled individuals. " Part A " is hospital in- dustry lobbyists provided most of the heavy surance free to everyone eligible. This is the mortar. Hospitals have learned how to defend most rapidly growing segment of the Federal their own Federal subsidies while decrying health budget, up 40 percent over the past two " handouts " to others. years to $ 33.3 billion. This year the White House strategists have After a Medicare beneficiary pays a deduct- chosen a new approach, sniping at the margins ible (204 $ in 1981), the government foots all ad- of Medicare, underfunding the payment sys- ditional " reasonable costs " under Part A. tem, and offering states " incentives " to cut Because they cannot charge Medicare patients Medicaid. the difference between these payments and A budgetary siege is planned to starve out their normal (unconscionably inflated) charges, more determined resistance. Last year hospital hospitals " shift " the burden by charging com- costs shot up 17.5 percent. Overall medical mercially insured patients even higher rates. costs climbed 15 percent, bringing a two year But public hospitals and community hospitals jump of 31 percent at a time when consumer in poor neighborhoods have few if any private- prices in general were rising " only " 20 per- ly insured patients, so any cuts in Medicare cent. The elderly population is growing at a reimbursement hit them hardest. Unless they rate of 3.5 percent. Millions of newly unem- receive additional local aid, an unlikely pros- ployed workers and their families need substi- pect in the current political and economic cli- tutes for health insurance plans lost with their mate, these institutions will be compelled to jobs. Thus if the Reagan Administration suc reduce services or close entirely. ceeds in holding expenditures at current levels The supplementary medical insurance por- or severely restricting increases, by the time tion of Medicare, known as Part B, is available we're ready to elect a new president Medicare to the same population for an annual premium and Medicaid will be a pathetic remnant of (132 $ in 1982). For the services covered under what they are now which - is far from perfect. this program, Medicare now pays 85 percent of Pious statements that the Medicare budget is the " reasonable charges " after the beneficiary up $ 5.8 billion over last year conceal a 5.4 per- covers the first $ 60. cent cut in real dollars. Similarly, the seeming- Because Medicare benefits have not kept up ly small cuts in Medicaid mean dramatic reduc- with health care inflation and most doctors are tions in services - the proposed cut of $ 2.2 unwilling to accept payment levels slightly less. billion in the new budget on top of the previous lavish than their other clients cough up, Part B year's $ 1.8 billion reduction constitute a 23 is currently paying only 38 percent of the out- percent cutback after inflation in just two short patient bills of the 20 million Americans en- and painful years. rolled in it. Doctors can hand patients any bill For the concerned and the sadistic, a more they please, so reducing the Federal payments detailed preview of this horror show follows. only compels these consumers to pay more out of pocket. This is exactly what the Reagan Ad- Mark Kleiman is Executive Director of the Con- ministration intends to do. sumer Coalition for Health in Washington, D.C. In another carefully targeted move to shift 19 Health / PAC Bulletin  A mother with two children would be ineligible for welfare (and Medicaid) if she earned more than $ 130 a month in Alabama, or $ 126 a month in Texas. costs to the elderly, the Administration wants to delay eligibility for new Medicare beneficiaries for up to a month and force automatic increases in Part B deductible payments. When the elderly are staggering from these blows, they may have trouble finding a physi- cian. By dropping a five percent ceiling on the overall rate increase doctors may charge Medicare and delaying any new charge levels three months, the budget proposal would discourage them from accepting Medicare " assignment. " If they don't accept it, the Feds don't have to pay them. The patient pays, in health or in cash, but that's not the Reagan Ad- ministration's concern. The most massive attack on hospital pay- ments is the move to cut two percent from the " reasonable costs " hospitals can charge for treating Medicare patients. This " saving " was suggested by the profit making - hospitals through their Federation of American Hospi- tals in a successful effort to ward off more re- strictive Federal regulation. The voluntary hos- pitals, organized in the American Hospital Association, aren't happy about this part of the Reagan budget at all. This disagreement is the first significant rift between the two hospital groups since they formed a coalition to oppose Federal cost containment legislation four years ago. The voluntaries are convinced that any across the board reduction will hit them harder, since they have less privately insured patients than the for profits - and few of them possess as much sophisticated computer technology which can ferret out the most profitable rate structures. Needless to say, if this meataxe passes it will hit the public hospitals right in the neck, since they depend almost entirely on Medicare and Medicaid and also must cope with many uninsured patients. Medicaid Although it is billed as the poor people's medical program, only 53 percent of the coun- try's indigent citizens (as opposed to all the un- documented aliens) are eligible for it. The Fed- eral government pays 50-78 percent of the cost of a state's state's program, but each of them has broad discretion in deciding who is eligible, and for what benefits. states All except Arizona are re- quired to enroll the " categorically needy " - those persons receiving Aid to Families with Dependent Children and some persons who are disabled. Twenty states refuse to cover any per- sons they are not required to under Federal law, effectively excluding the working poor. States also can (and do) limit eligibility by set- ting income standards extremely low. Some, mainly in the South, use so many exclusionary criteria that only 25-30 percent of those poor by Federal definition are covered. States may also cover the " medically needy -those " earning slightly above the state eligibility ceiling whose medical expenses are so high that they would sink into poverty paying them. To understand the Medicaid program it is im- portant to know how low the actual poverty levels may be set. It would be nice to think that Reaganoid congresspersons who have com- plained about the difficulties of living on 62,000 tax dollars per year might feel a little less ex- ploited if they knew that a mother with two AsetesioesepnusseasnsrUisennedts a UOSEREEEEATAE TASES UTERSUHCASUSOEEOREERETLSASTESUOREROANUCOSIOSEOUCONUGUULOOEUOOERUELSOUHELOATELUHOOLUGHEORAOERONOUSHGOCHOELNNORSOOON Important news for 10 million Americans Fed level 1980 = 8,414 0 no Health Protection for Operators of VDTs CRTs / Find out the dangers eyestrain - , muscle pain, indigestion, stress - and some simple ways to minimize them in this booklet produced by the New York Committee for Occupational Safety and Health. Available from Health / PAC, 17 Murray St., New York, N.Y. 10007, for $ 1 plus 25 postage for in- dividuals and $ 3 plus 25 for institutions and corporations. 20 CQUDUOESEOLGEOLOUALSEQEREGESIONROLIASSU0TN000L20000R1S0K2020QE9000 D2NNSUIN090SU50000T0RE009E0900000090S00000DENSUET0N0Q0N0GNIAONEOEONNGUDSOUGTONENINOSRERREONTDSONCHONCOESESNORER EEN MpoROneRTOReTeses Ege Health / PAC Bulletin children would be ineligible for welfare (and Medicaid) if she earned more than $ 130 a ' month in Alabama, or $ 126 a month in Texas. Over ten million of the nation's 22 million Medicaid beneficiaries are poor children. Another three million are low income senior citizens who rely on the program for much of their treatment not covered by Medicare. Another four million are blind or totally dis- abled. All of these people, truly the truly needy, are hurt by proposed cutbacks. There appears to be no idea so attractive to the Reaganoids as one which has failed while increasing the suffering of the poor. The Administration proposes to allow states to ex- tract copayments " of a few dollars each from Medicaid beneficiaries. When Reagan tried this approach as governor of California, Medicaid outpatient costs dropped a gratifying eight percent, but inpatient costs quickly * leaped 17 percent as people who delayed seek- ... - ing needed care became more seriously ill and required hospitalization. What seems a " reasonable " copayment to a Reaganoid will not seem so reasonable to a mother trying to raise two children on total AFDC payments of only $ 60 a month - the 99 cents per day which the state of Mississippi gives poor families. Federal Medicaid legislation once required states to cover basic inpatient and outpatient hospital services, skilled nursing homes, and physician services. Optional services each state could sign up for included drugs, eye- glasses, dental care, dentures, and prosthetic devices. Last year Congress succumbed to the Reagan offensive against the working poor by allowing states to pick and choose which of the medically needy, if any, would be covered. States were also allowed to withhold hospital coverage from medically needy beneficiaries. This year the attack continues with a proposal to reduce the share of the tab the Feds pick up for states'medically needy Medicaid benefici- aries. States would also be deterred from covering any of the " optional " services by a three percent cut in Federal payments for such " options " as insulin for diabetics and crutches for the disabled. THE " TRULY WLEDY ' i" aa aw ar Tas 4 Kate Pfordresher 21 Health / PAC Bulletin Following its general human disservices pat- tern, the Reagan Administration strategy for Medicaid is to avoid direct cuts for which it must take responsibility, shifting the onus to the financially strapped states. White House staf- fers also hope that by raising the political cost of the Medicaid program, they can increase governors'interest in a " swap " which would give them responsibility for programs such as food stamps and take Medicaid off their hands. Fortunately this fabled swap has gone to an ear- ly death this year, but we shouldn't underesti- mate the Reagan Administration's capacity to resurrect mistakes. Opposition Bedfellows The structure of the Congressional budget reconciliation process creates the potential for a broad, if short lived -, alliance between low- income advocates who care about care and private hospitals and doctors worried about their profits. Medicaid foots the bill for nearly 60 percent of nursing home costs and 12 per- cent of all hospital costs. Last year's coalition will re form - around the same broad agreement to keep the budget " mark, " or spending target, for Medicaid as high as possible. Once Con- gress establishes the spending level, the coali- tion will once again shatter as each interest group seeks to avoid cuts to its institutions. Hospitals will stress limits on ambulatory care and may support copayments. Primary care providers and nursing homes will (privately) grouse about hospital inflation. Consumers will try to single out particularly flagrant provider fraud and urge more stringent controls as an alternative to benefit and eligibility cuts. Although the current budget revolt offers some hope of relief, there is a strong likelihood that repeals of corporate tax breaks and cuts in military spending will be used to reduce the deficit before the money trickles down to social programs. Democratic congressional staffers recognize they will probably have to produce some set of reductions which add up to what- ever money the House Budget Committee decrees health programs must surrender. Liberals and progressives are formulating. their own triage strategy. Medicare's Part A program of hospital insurance will probably be their primary candidate for cost cutting - . They will also renew last year's efforts to give states incentives for rational cost containment mea- sures. Bloated payments for profit making - renal dialysis dialysis firms are another target. Some health advocates are pushing for Federal controls on the reimbursement of hospital - based physicians such as anesthesiol- ogists, radiologists, and pathologists. A 1981 report from the Inspector General of the De- partment of Health and Human Services re- vealed a variance of as much as 95 percent in payments for the same kinds of specialists in hospitals of the same size in the same geo- graphic area, concluding that there was " no ra- tional basis " for the differences. The fee for- - service and commission arrangements for these doctors provide incentives to charge as much and do as much as possible, costing Medicare alone over $ 1.1 billion in 1981. Although prospects are dim for even these minimal reforms, they will be effective weapons to defend programs. Even though the health system is in many ways in worse shape than it has been since the Depression, very few ad- vocates are actively working for comprehen- sive solutions which would provide decent, effi- cient, and accessible health care. Cautious after severe losses and grimly determined to preserve what benefits they can for poor and working people, most activists have felt a need to devote their best energies to defending the limited gains and token concessions of the 1960's and 1970's. " It's rather sad, " mused one organizer, " So "T many of us who fought for social change now | fight so hard to defend the status quo. " a - DOOOOOQODOOHDDODOODOODOODDHDOODODODOQODOODGDOOODOOOGDHDODOODODODOD GWOOQOQDHDOODOOOOOOOS Watching the Reagan Reaction Health / PAC is compiling a list of all projects monitoring the effects of the Reagan cutbacks. If you are part of or know of any either locally or on the national level, please let us know. 22 DODOOOODOOOQHDDDODOGDOHODOPDODOOOOHDOOQODOOOHOOOODOOOOSO OODODOOOOODOOGOODOOOOOOD@OOOOSO Health / PAC Bulletin Changing the View from the Mystic River Bridge By Matthew P. Dumont, M.D. During the summer of 1980, drivers crossing the Mystic River Bridge were greeted by a large red and yellow sign reading; " Warning! I did have some knowledge about lead poisoning. An estimated 90 percent of the houses in Chelsea have lead on their interior Bridge Cleaning ahead. Close your windows. " surfaces. Herbert Needleman's classic studies Thick plumes rose from the surface as workers of the effects of low levels of body lead burden blasted away in preparation for repainting. on childhood school behavior and intellectual Although the Massachusetts Port Authority performance were done in part in Chelsea. He was thoughtful in warning motorists crossing found that current " safe " levels of exposure are New England's largest bridge, they appeared entirely arbitrary, because there is no evident to have forgotten about the residents of Boston's minimum level below which lead does no Charlestown section and of Chelsea at either damage to the behavior and learning end. Living in substandard housing in the capacities of children. Lead at any level is toxic shadows of the bridge, the predominantly and just does not belong in the human Hispanic population of the low income in- dustrial city of Chelsea was unwittingly taking a organism. They then insisted that there was no cause for perilous gamble with poison. alarm; the material coming off the bridge, In 1976 I had participated in an expression of felicitously called " Black Beauty, " was " 9912 concern about flakes from the lead based paint percent safe. " I said that may sound like a good on the bridge. Soil concentration of lead score, but one part lead in 200 is a disastrously beneath it were then dangerously high, be- high level. After asking what business of mine tween three and four thousand parts per million this was anyway, they gave me a more or less -only a few parts per million is considered tox- polite brushoff. ic. At the time, Massport minimized the risks of exposure but agreed to stop using lead based ee paint. Now, four years later, it was blithely I wondered how much of the blasting away at 25 years of regular paintings, creating a visible aerosol of lead dust. When I spoke to them, Massport officials ex- madness and fury I saw every day was generated by lead poisoning. pressed annoyance. My inquiry, they felt, questioned the responsibility and expertise of their highly paid engineers. They informed me Several years before, I had become aware of that enclosures around the blasting sites had the psychological effects of marginal elevations been designed only after a fact finding - visit to of blood lead in adults. A 44 year old woman study techniques used at the Golden Gate receiving treatment from me was suffering from Bridge in San Francisco. I sympathized with a " classic case " of involutional melancholia. the bother this trip had entailed, but pointed She had a hand wringing - agitated depression out that their cautionary signs for motorists with insomnia, appetite loss, thoughts of death would seem to indicate a certain laxity in the and delusions that her body was rotting away. design. The poor woman went through six months of psychiatric purgatory on top of her illness. I Matthew Dumont, M.D. is a Boston - area tried a succession of drugs. Eventually, when psychiatrist and health activist. she was hospitalized and no longer my patient, 23 Health / PAC Bulletin It was not that " evil " people became " good, " but that the bureaucrats were forced to redraw their frame of reference. she was given a course of electroconvulsive behavior of public officials. A revelation seem- treatments by a shock mill up the river. Nothing ed to hit many of them that they could not rely worked and she ended up back with me. One on agencies designed to protect their health, day we were talking about anger (I am a that their government lies. psychiatrist after all) and she described how Massport was getting bad press and the flak- she was furious at her husband because she catchers who were sent to meeting after meet- couldn't stand the fumes and dust he was ing were showing signs of weariness. At one creating by using a blow torch to blister and scrape paint off the walls of their house. Of public gathering a woman carrying a baby broke down in tears while describing the re- course it turned out to be lead. peated injections of chelating agents her There is a lot of violence in Chelsea, wife daughter had to endure. When a Massport beating, child abuse, adolescent mayhem. The nutrition of the people is appalling. Their spokesman implied that her own negligence had caused the child's intoxication a man al- calcium and iron deficient diets make them most took a swing at him. particularly vulnerable to the effects of lead. I wondered how much of the madness and fury I Massport, D.E.Q.E. and state health officials wanted to stop the noise. By the time the Feder- saw every day was generated by its poison and al Center for Disease Control came out with a began routine blood lead and erythrocyte pro- toporphyrin tests on all our clients. Almost everyone was in the elevated but " toxic non - " report concluding that the blasting procedures 4 were not safe, the Director of Massport was prepared to sign a statement agreeing to all the range. conditions set by the citizen's negotiation If you exclude perinatal complications and group which had been organized by Fair overt trauma or infection, it is possible that a Share. Massport acknowledged that its proce- major portion of the hyperactivity and mental dures might subject citizens to " undue " lead retardation of children in older urban areas exposure. (They would not accept the word may be related to low level lead intoxication. " poison ".) It agreed to canvass every house And along with the whirlpool of stresses of low and factory within a hundred feet of exposure. income life, lead would have to be implicated It promised to arrange and pay for baseline as a source of the unusually high rates of hyper- blood lead determinations for each of them, tension, coronary heart disease, and renal fail- and monthly redeterminations for everyone ure among the urban poor. So I got angry. Maybe I was lead poisoned under age 17. It would identify and relocate pregnant women during the blasting periods. It too. I began to have midnight fantasies of put- would place air monitors at various points near ting on a black sweater and sabotaging the blasting equipment. Instead, however, I de- cided to find some way of working with the peo- ple of Chelsea so that they could protect themselves from the bureaucrats who were the bridge to measure the concentration of air- born lead. An independent industrial hygienist would be empowered to suspend the blasting if air concentrations or blood lead samples reached elevations determined as hazardous threatening their children. by an independent body of experts. Needless to Fair Share, a citizen organizing group in Massachusetts, agreed to organize some public say, the fancy San Francisco enclosures would be re designed - to contain as much of the blast meetings and the Greater Boston Legal Serv- ices program initiated a class action suit. The material as technically possible. One conclusion which can be drawn from suit was dismissed when the City of Boston Lead this experience is that a physician's anger and Poison Prevention Program testified that the blasting procedure was " safe ". (Politics has a frustration can be directed away from his or her own stress receptors through collective action noble tradition in our state.) But a lot of publi- which, incidentally, can be more effective in city was generated. The people of Charlestown preventing lead poisoning than any profession- 24 and Chelsea grew increasingly angry at the al activity. Health / PAC Bulletin Massport More interesting is the change which took low income - and powerless people found them- place in the bureaucrats ministering to a large selves increasingly sophisticated in their un- public authority. As time went on the agency derstanding of a specific health problem men- became less defensive in confrontations with acing themselves and their children. They the community group and more prepared to learned that they could not rely on the sup- incorporate the concerns of the people into posed protections of official agencies, that they their own cost benefit - accounting. It was not had to assume responsibility themselves. When that " evil " people became " good " but that the their meetings and confrontations resulted in bureaucrats were forced to redraw their frame accommodation, they experienced a sense of of reference to include previously ignored sec- exhiliration, a feeling of control over events in ond order effects. The prevention of lead poi- their lives. They did not see their activism in soning became a technical problem of as much radical political terms, but this victory could interest to them as preserving their bridge and not help but give them an awareness of how col- moving traffic across it. (Maybe the inattention lective action can affect important issues; an to second order effects is the contemporary in- awareness with revolutionary implications. OE carnation of evil, but it does not help to think in those terms. In this case, officials of the agency 1. Deficits in Psychologic and Classroom Performance of Children seemed to turn around when a parent said to them, " I really don't think you want to go to bed with Elevated Dentine Lead Levels. Needleman, H. et al. New Eng. J. of Med., 300 (13) March 29, 1979. 2. Lead Poisoning in Clinical Psychiatry. Dumont, M. Practical at night thinking that you may have poisoned a Reviews in Psychiatry. 3 9 (), Dec. 1978. child "). Even more important is the effect of these ex- 3. Lead and Hyperactivity. Oliver, D. et al. The Lancet. Oct. 28, 1972. 4. Health Hazard Evaluation Report TA80-099-859; W.I.O.S.H., periences on the people of Chelsea. A group of C.D.C., U.S.P.H.S. 25 Health / PAC Bulletin 1 The Bulletin Board Fallout Question Marx The Last Epidemic: The Medical Conse- quences of Nuclear Weapons and Nuclear War is a 36 minute videotape of a conference of Physicians for Social Responsibility held in San Francisco in the fall of 1980. It features Dr H. Jack Geiger, professor of community medicine at the City College of New York. Sixteen millimeter film is also available from the Re- source Center for Nonviolence, PO Box 2324, Santa Cruz, CA 95063. A transcript of the sym- posium can be obtained for $ 5.45 from Physi- cians for Social Responsibility, P.O. Box 144, Watertown, MA 02172 Having seen the film and read the book, you can go to the rally and march for disarmament at Central Park on June 12, during the U.N. Special Session on Disarmament. For more in- formation, contact the June 12 Committee, 853 Broadway, room 2109, New York, NY 10003, 212-460-8980 The Summer Institute for Popular Economics will be offering four one week - sessions this summer at Hampshire College. This intensive course for minority, women, environmental, labor, and other activists will cover unemploy- ment, inflation, the tax revolt, unions, sexism, racism, occupational health and safety, and many other economic topics. Complete cost is $ 200 for low income people and $ 300-400 for others. Scholarships are available. For additional information and ap- plications, write the Center for Popular Economics, P.O. Box 785, Amherst, MA 01004. Silent Summer Poisons and Peripheral People is a series of ar- ticles on the problems created by toxic substances for ethnic minorities and tribal societies in the Third World. Published in the Last Hired, First Expired Occupational Disease Among Black Workers: An Annotated Bibliography, by Morris Davis and Andrew Roland, is one of the latest prod- ucts of the Labor Occupational Health Pro- gram, 2521 Channing Way, University of California, Berkeley, CA 94720. Send $ 7 for this summary of several hundred books and ar- ticles on the subject. last three newsletters of Cultural Survival, Inc. (11 Divinity Avenue, Cambridge, MA 02138), it describes the effects of pesticides, medicinal drugs, and industrial and mining wastes. Cultural Survival is an interdisciplinary group of academics working for the rights of in- digenous peoples, mainly in South America. Deformities of the Back Thousands of Remarkable Cases Flesh and Bone China The Harvard School of Public Health and the U.S. China - Peoples Friendship Association are sponsoring a field study in the People's Republic of China, July 3-22, on " Problems of Modernization and Occupational Health. " The tour includes stops in five cities and an ex- change conference with Chinese experts. For more information, write the Association, 720 Massachusetts Avenue, Cambridge, MA 26 02139. An old lady, 72 years of age, who suffered for many 4 years and was absolutely help- less, found relief. A man who was helpless, unable to rise from his chair, was riding horseback and playing tennis within a year. A little child, paralyzed, was playing about the house after wearing a Philo Burt Appliance three weeks. We have successfully treated more than 50,000 cases the past 20years. 30 Days'Trial Free Send For Our Free Book. ald If yuous w ililn d esgcirivbei tnhge deyfionuit e dcaesfe iitn iintfoer- iwinllf ionrfo-r- mation mation at once. PHILO BURT MFG. CO 96-17 Odd Fellows Temple JAMESTOWN, N. Y. Health / PAC Bulletin This concept of what is called Body English mote cancer. The debate is over the degree of risk and how it might be quantified. a linear, non threshold - dose- effect relationship (the less rays you're hit with, the less your risk, but you never get down to no risk) generates one of the hottest current debates in scien- Unlike many medical tech- tific literature. It was examined nologies whose risks are not dis- covered until years after their extensively in a series of reports from the National Academy of invention and application, the Science's Committee on the Understanding Over exposure - harmful side effects of non- natural radiation exposure were all too evident almost immedi- Biological Effects of Ionizing Radiation (-commonly BEIR) known as BEIR - I (1972), BEIR - II by Arthur A. Levin ately after W.K. Rontgen devel- oped the process in 1895. Tran- (1977) and BEIR - III (1979). " In brief, " a review of BEIR- One out of two Americans sitory injuries such as blistering III's findings in the May 18, says " cheese " and poses for at least one medical or dental x ray - annually. In 1978 an esti- mated 278,000,000 radiograph- ic examinations were given - a lot of snapshots for a national album. of the skin appeared within hours of exposure. In less than a decade, researchers saw the connection between radiation and subsequent cancers. These pioneers in radiology were often the early victims in the 1979, issue of Science stated, " the majority's report says that weak radiation, in the most pes- simistic estimate, is unlikely to produce effects any worse than one would expect if one simply extrapolated downward from Although they have little nos- talgic value, these pictures offer significant diagnostic bene- fits - or at least some of them do. They also represent 80 per- cent of all exposure to human- made radiation. Estimates of how many of these pictures are medically " necessary " range from 90 percent (American Col- years before adequate safety standards were developed. However because the radiation- associated cancers were almost always preceded by progres- sive skin damage, it was as- sumed that radiation was the culprit only when people were bombarded with doses large enough to cause gross injury. the known effects of severe radi- ation. The effects decrease in proportion as dose decreases, right down to the smallest level of exposure. This means that even a minuscule release of radioactivity in a populated area has a negative effect on public health. " This moderate report was lege of Radiology) to 70 percent sandwiched between conclu- (The Bureau of Radiological sions of a BEIR - III group which Health - BRH) to 50 percent " Even a minuscule found it too alarmist because (Ralph Nader). Taking the BRH middle ground, this means at least $ 1.5 billion could be saved release of radioactivity has a negative effect on hazards in their opinion de- crease very rapidly at low levels, and those of another every year by tightening up medical and dental radiological public health. " minority which believes the linear dose effect - hypothesis practices. underestimates low dose - risk. If there were no health risks It wasn't until 1950 that a Because radiation - induced in low level - radiation exposure, scientist at Caltech, E.B. Lewis, cancers have no unique fea- the only concern about " unnec- suggested a more troubling tures, the relationship between essary " x rays - might be their possibility. Citing the height- cause and effect is hard to pin- cost, but as an article in this ened frequency of leukemia in point even though it is general- February's Scientific American Japanese atomic bomb survi- ly agreed that exposure in- indicates, few knowledgeable vors and in certain populations creases the frequency of most people deny there is some risk of patients who had been (but not all) types of cancer. that they either cause or pro- treated with radiation for non- There are other problematic cancerous conditions, he ar- aspects, not the least of which is Arthur A. Levin is a member gued that no dose of radiation is the interval between exposure of the Health / PAC Editorial completely free of carcinogenic and the onset of cancer, often Board risk. 15 to 20 years. 27 Health / PAC Bulletin Epidemiological studies are therefore the basis for establish- ing the cause - effect relation- ship. In addition to the two populations studied by Lewis, workers exposed to radiation in their jobs have been examined. The greatest amount of evi- dence has been found by look- ing at leukemia and breast cancer in women. For all types of leukemia save one, incidence increases as dose exposure in- creases. Not only has risk from high exposure levels been iden- tified in breast cancer, there is evidence that small doses re- ceived over time have a cumu- lative effect on breast tissue. Other data have been obtained from studies of thyroid cancer following radiation therapy, and of the link between prenatal exposure and childhood can- cer. In workers, links have been found between exposure and leukemia; lung, skin, bone, and brain cancer; and lymphomas. Despite this clear evidence that a causal relationship exists between exposure to human- made radiation and cancer, as the 1979 Science article points out, public perceptions of various risks generally under- estimate the actual danger. In rating the risk of death from 30 varied items, members of three groups surveyed placed x rays - 22nd, 17th, and 24th; their ac- tual U.S. rank among the 30 is 9th. The public still has to learn that x rays - can be unnecessarily dangerous to your health- even when the button is being pushed by a health provider. OE The next Body English col- umn will examine medical and dental x rays - and what can be done to reduce their number and improve their quality. Books Received Barrett, Diana, Multihospital Systems (Cam- bridge, MA: Oelgeschlager, Gunn & Hain, Publishers, Inc., 1981) McDonald, Marian (Ed.), For Ourselves, Our Families, and Our Future (Boston: Red Sun Press, 1981) $ 4.95 Blum, Henrik L., M.D., Planning for Health (New York: Human Sciences Press, 1981) $ 29.95 Peschel, Enid Rhodes (Ed.), Medicine and Literature (New York: Neale Watson Academic Publications, Inc., 1980) Bradford, David, V.D. in Australia (Forest Grove, OR: International Scholarly Book Ser- vices, Inc. 1981) Dally, Peter, and Joan Gomez, Obesity and Anorexia Nervosa (Boston, MA: Faber and Faber, 1980) $ 6.95 Power, Paul W. and Arthur E. Dell Orto (Eds.), Role of the Family in the Rehabilitation of the Physically Disabled (Baltimore: University Park Press, 1980) Russianoff, P., Ph.D. (Ed.), Women in Crisis (New York: Human Sciences Press, 1981) Geist, Harold, Ph.D., The Psychological Aspects of the Aging Process (Huntington, NY: Robert E. Krieger Publishing Company, 1981) Gersuny, Carl, Work Hazards and Industrial Conflict (Hanover, NH: University Press of New England, 1981) Hamilton, Michael and Helen Reid (Eds.), A Hospice Handbook (Grand Rapids, MI: William B. Eerdmans Publishing Company, 1980) Stinnett, Nick, Barbara Chesser and John DeFrain (Eds.), Building Family Strengths (Lincoln, NE: University of Nebraska Press, 1979) Thompson, Frank J., Health Policy and the Bureaucracy, (Cambridge, MA: The MIT Press, 1981) $ 25.00 Vallance, Theodore R. and Ru M. Sabre, Men- tal Health Services in Transition (New York: Human Sciences Press, 1981) $ 29.95 Hoffman, William and Jerry Shields, Doctors on the New Frontier: Breaking Through the Barriers of Modern Medicine (New York, NY: Wells, Thelma, R.N., Ph.D., Aging and Health Promotion (Rockville, M.D.: Aspen Systems Corporation, 1982) MacMillan Publishing Company, Inc., 1981) Zander, Alvin, Groups at Work (San Fran- 28 $ 12.95 cisco: Jossey - Bass, Inc., Publishers, 1981) Health / PAC Bulletin 1 Media Scan One rationalization was that the men in the experiment were no worse off than if they had been left to the care of the viction that Blacks were inher- ently inferior. When scientific medicine emerged in the early part of this century, researchers believed they had the tools to study " differences " between Blacks and whites. Discussions private health care system. This is a reasonable indictment of a market - based health care system which tends to neglect groups such as poor rural Blacks, but it is hardly a justification for delib- erately withholding treatment. Bad Blood. The Tuskegee Syphilis Experiment by James Jones, New York: MacMillan, 1981. $ 14.95. In 1966, a Public Health Ser- vice employee came across reprints of articles published by the Federal government's Cen- ter for Disease Control in At- lanta. He found them disturbing. They described what became known as the Tuskegee Experi- ment. Black men with syphilis were being studied by the CDC without receiving any treatment. The employee asked his su- periors if this was an ethical medical study. Apparently the CDC still thought it was, be- cause the experiment continued for another six years. It wasn't until 1972 that an expose in the Washington Star provoked an investigation by an ad hoc advi- sory panel, congressional hear- ings, and a national outcry which compelled its termina- tion. Only then did the men and their surviving family members receive treatment and some fi- nancial compensation. An experiment such as this of different susceptibility, im- munological responsiveness, and other physiological com- parisons offered a scientific gloss for what more emotional observers might call blatant racist prejudice: characteriza- tions of Blacks as innately lazy, intellectually inferior, and lack- ing in moral integrity. The Tuskegee investigators ostensibly hoped to demonstrate differences in the epidemiology of syphilis in Blacks and whites. The popular view among whites at that time considered Blacks more likely to contract syphilis because of their supposed sex- ual promiscuity. As objective scientists, the Tuskegee re- search team considered them- selves above such racist thoughts. However both the mo- tivation of their study by race and its design belie this self- evaluation. Fe The investigators did not see the immorality of their experiment because they were blinded by the values of the health care system. Besides, the book demolishes this argument by revealing that the experimenters intervened to prevent some of the men from being treated when private phy- sicians or other public VD treat- ment programs discovered they had syphilis. Jones develops a cogent argu- ment that the Tuskegee investi- gators did not see the immorality of their experiment because they were blinded by the values of the health care system in which they worked. Beginning in the early part of this century, the physi- cian professional was endowed with an aura of possessing a spe- cial body of knowledge. Science was the hope of the future, open- ing the way to answering all questions. Few were prepared to challenge the physician's right to pursue truth through experi- mentation - even if the subjects were deprived of their health and wellbeing in the process. Readers must decide for them- selves if this tragedy perpetrated from 1935 to 1972 could happen today. We certainly know that women, working class people, and racial minorities continue to be denied access to adequate health care as surely as the men in the Tuskegee study were. Richard Younge conducted for 35 years cannot be assumed to be a fluke. It was not. As the opening chapters of Jones examines in detail how individuals and a government (Richard Younge is a family phy- Bad Blood document, in the late agency supposedly committed to sician at a Federally - funded * 19th century white physicians the treatment of disease could community health center and a and white society were very blindly continue a project which member of the Health / PAC Edi- eager to find proof for their con- so contradicted this mission. torial Board.) 29 Health / PAC Bulletin INDEX TO VOLUME 12 (September - October 1980- November - December 1981) A Agent Orange. .no.1 * American Medical Association.. no.2. * Fitchburg, Massachusetts . no.3 Formaldehyde. .no.4 * Nuclear Hazards. .no.2 Nursing .no.3.no.3, no.8 * Asbestos..no.4.no.4 B Benzene. .no.1.no.1 Beta Blockers - .no.8.no.8 H Health and Hospitals Corporation. .no.3 no.6, -_ Health Charities Reform Project... no.8 * Health Maintenance Block Grants .no.7.no.7 Organizations .no.6.no.6 Boston, Massachusetts Heritage Foundation no.1 ..................... no.4 * Obstetrics ..........0. 0000000 no.4 Occupational Health .no.1, no.4, no.7 *, no.8 * Occupational Safety and Health Administration (OSHA)... no.1, no.4, no.7 *, no.8 * Brenner, Harvey .no.3.no.3 Bronx Municipal Hospital .no.1.no.1 Brown Lung... no.6..no.6 * Budget Cuts .no.1 no.4, *, no.5, no.7, no.8 C California. .no.2 no.3, *, no.8 Hospital Corporation of America.. no.8.no.8 Hospital Closings. . no. 1, no.2, no.3, no.7, no.8 House, Jonathan ..no.6..no.6 Hypertension. .no.7 no.8, I Office of Economic Opportunity (OEO).. .no.1 no.2, P Pennsylvania .no.4 Pesticides... .no.2 Pharmaceuticals no.2.. *, no.4 *, no.8 Profits in Health Care... see Cesarean Birth ......... ..no.6..no.6 Coal Mine0r . cs ee ..n o.4.no.4 Committee of Interns and International Health .no.2 K corporatization Public Hospitals. .no.1, no.2, no.3, no.6 Residents ..no.6..no.6 Ku Klan Klux. .no.1 * Community Health Centers n0.1 no.2, Competition Model for Health Care 2... cee .. no.5 Consumers. .no.1 no.4, L Lacey, Diane .no.3 Love Canal ................005 no.2 * R Radiation. .no.2.no.2 Reagan, Ronald no.3.. , no.4 *, no.5, no.7, no.8 Coordinating Committee on Pesticides.. .no.2 Corporatization .no.2.no.2 *, no.5 * M Medi - Cal .no.8.no.8 Reproductive Hazards. .no.6.no.6 * Right - to - know Legislation .no.4.no.4 no.7, no.8 Medicaid .no.2.no.2, no.7, no.8 S COSH Groups .no.4.no.4 Medical Empires .no.3 *, no.7 Medical Markets .no.1 no.5 *, San Francisco Interns and Residents Assoc .. 6. .no.3.no.3 * D Medical Schools ..no.3..no.3 * Social Security .no.7.no.7 * Mental Health .no.3.no.3, no.6 Stockman, David.. .no.5 Deinstitutionalization .no.6.no.6 Midwifery. .no.5 Delaware .no.40....n coec.e 4ee.en o.4 = Minorities and Health . no.3 * Depo Prevera.. .no.8 * Detroit, Michigan.. .no.1 no.2, *, no. 3 *, no.7 * N Sydenham Hospital. .no.3 T Toxic Chemicals .no.2.no.2 *, no.7 * Drummond, Dr. Hugh .no.7.no.7 Nashville, Tennessee .no.8.no.8 U DuPo0n ...t ee. e e. ee .no.4.no.4 E = National Coalition to Save Public Ulcers.. 0.0... eee .no.2.no.2 * Hospitals.. .nUon.1e, mnop.2l oyment and Health ..no.3..no.3 National Health Insurance..no.3..no.3 * Unions healthcare () .. no.3, no.6 El Salvador .no.2.no.2 National Women's Health Enthoven, Alan. .no.5 Network .no.8.no.8 * W Eugenics ..no.1..no.1 * F Federal Regulation .. no.2 *, no.4, no.6, no.8 * Neighborhood Health Centers... see Community Health Centers New York Committee on Occupational Safety and Health (NYCOSH).. .no.7 * | Women's Health... .no.3, no.4, no.5, no.6, no.8 * Workers'Compensation... .no.4 * Short item 3300 Health / PAC Bulletin REAGAN CUTBACK SERIES SURVIVAL OF THE FITTEST: The Competition Model for Health Care. The new look in national health programs. 24 pp. $ 2.00. -- REAGAN HEALTH CARE CUTBACKS: A Packet of Materials on New York State and New York City. 25 pp. $ 2.50. --- THEIR GUNS, OUR BUTTER: An anthology on Reagan Social and Health Policy. 45 pp. 3.00 $. - THE RAW DEAL: A Packet of Fact Sheets on the Reagan Health Care Cutbacks. 16 pp. $ 1.50. --= ") PAMPHLETS PACKETS Collected back issues of the Health / PAC Bulletin covering specific topic areas. $ 6.00 each. Federal Health Policy National Health Insurance The Demise of Public Hospitals The Political Economy of Health Community Health Care The Health Work Force Medical Education Mental Health Minorities and Health Care Occupational Health New York City Special Consumers and Health Planning The History of the American Health System Ideology of Health Women's Health THE PROFIT IN NON PROFIT - HOSPITALS. Illustrated pamphlet describing how profits are generated in these ostensibly non profit - institutions. 12 pp. 75 . ae THE MYTH OF REVERSE DISCRIMINATION: Declining Minority Enrollment in New York City's Medical Schools. A Health / PAC study of the falling minority enrollment in NYC's six medical schools. 24 pp. 2.50 $. --- CONEY ISLAND HOSPITAL: A Case Study in the Politics of Health. How one hospital is governed and how it relates to the health care needs of the community surrounding it. 16 pp. 75 . -- A COLLECTION OF DRAWINGS BY BILL PLYMPTON. American medical care as satirized by Bill Plympton in the Health / PAC Bulletin. 30 drawings, 8 " by 11'5.00 $. - HEALTH CARE IS FOR PEOPLE. NOT FOR PROFIT. A 17 " by 22 " poster by illustrator Bill Plympton. Brown letters on beige paper overlaid on an orange fist dollars - full - of - caduceus. See front cover. $ 2.50. meee TOTAL PURCHASE $ POSTAGE AND HANDLING || (Add 15% of total purchase.) TOTAL ORDER $ Individual Back Issues. 2.50 $ each. Send for an index. Health / PAC Occasional Papers. Review articles on specific subjects. Send for an additional list. Please fill in name and address on reverse side. All orders must be prepaid. Bulk rates available. Allow four weeks for delivery. We will send orders marked " rush " by United Parcel Service and bill you for the charge. 31 Health / PAC Bulletin HEALTH / PAC HEALTH POLICY ADVISORY CENTER 17 MURRAY STREET NEW YORK, NEW YORK 10007 2nd Class Postage Paid at New York, N.Y: 3 1