How to Fix Our Health Care Mess


How messed up is America's health care system? Consider the case of the Leavitts. Anne and her husband Dixie, both in their 70s, got frazzled trying to work their way through the maddening maze of George W's new prescription drug program, which compels seniors to choose among 1,400 competing drug-insurance schemes offered by 80 corporations. Each plan in this baffling "marketplace" offers different coverage, is frustratingly complex and is filled with fine print. The Leavitts had to call on their son to help them select a company to cover their meds.

But -- oops! -- even with hands-on help, Anne and Dixie made a bad choice that almost cost them their entire medical coverage. They rushed to drop that plan and were lucky to find another at the last minute to avert a family disaster.

What makes the Leavitts' story unique among the millions of seniors who've been similarly discombobulated by Bush's convoluted prescription plan (including 15 million who've been left with no drug coverage) is that their helpful son is none other than Mike Leavitt. Yes, the head honcho of Bush's Health and Human Services Department! One more twist: Dixie Leavitt made his fortune in the insurance business.

If someone who's an insurance professional and is personally advised by the government's top health official still gets flummoxed -- that's a clue that the Powers That Be have saddled us with a truly lousy program.

The health-industrial complex

There's no legitimate excuse for this mess. A program to provide medicines for every single senior could and should be simpler and far less expensive than Bush's $1.2 trillion scam. Medicare, with its extremely low overhead and an efficient payment system already in place, is the logical conduit for such a program. It could negotiate with drug makers on behalf of every senior to get low prices on all medicines, then pay pharmacists directly for the total cost of prescriptions they fill.

Instead, Bush and Congress put the new drug benefit in the hands of the corporate bureaucracies that separate us patients from our medical professionals. All seniors are on their own to purchase one of the confusing myriad of drug cards from HMOs and insurance companies. These middlemen then bill Medicare for whatever medications the seniors get and put no lid on the prices of the drugs.

Thus, rather than being a straightforward benefit for people in need, Bush's program has become a boondoggle benefit for America's bureaucratic, wasteful, fraud-ridden health-industrial complex. Such giants as UnitedHealth, Humana, and WellPoint (which have already scarfed up more than half of the new drug program's market) are given both a new source of monthly premiums and a generous federal subsidy to provide prescription coverage.

Not to be left out of the financial fun, the drug barons have obtained a green light to bloat their profits (already the highest of any industry) with overpriced pills that ultimately are paid for by Medicare dollars taken out of all of our paychecks. WARNING: The following fact could make your eyeballs explode: Bush demanded and got a provision in his new program that specifically prohibits Medicare officials from negotiating with drug corporations to lower the prices they charge. If only this were a bad horror movie! Alas, it's the core reality of America's sick health care system. Wait, you say. We've got the top technology and medical know-how in the whole freakin' world. America is No. 1! We have the healthiest people, and we get the best quality health care there is, bar none. USA! USA! USA!

Well, that's the rah-rah myth we're fed by the industry, the media and most politicians, but it's not true. Still, if you insist that the United States simply must be No.1, it is true that ours is by far the most expensive health care system on the globe. Go, USA! In 2004, spending averaged $6,280 for each man, woman, and child in America -- more than double the average ($2,307 per capita) spent in all other industrial countries.

Over 16 percent of our economy ($1.9 trillion last year) goes into our corporatized system -- 50 percent more than Switzerland's universal system, which ranks second in spending per person. Not only does the United States drastically outspend everyone else, but it does so while leaving tens of millions of Americans outside the system. In contrast, Canada puts only 10 percent of its economy into health care, Australia 9 percent, and England 7 percent, and these countries manage to provide care for every one of their people.

While we Americans pay much more, we get far less. The World Health Organization's latest survey ranks the quality of U.S. health care at -- cue the trumpets -- 37th in the world. Ta-da! Not only is our system's performance beneath Canada, Japan and all of Europe, but it's also beneath such powerhouses as Malta, Colombia, Morocco, Chile and Dominica. We're only one notch above Slovenia, for godssake!

America's "CorporateCare" system fails on the most basic measures of health. For example, babies born in impoverished Cuba have a better chance of survival than babies born here. On average, 77 babies die every day in the United States -- an infant mortality rate that, according to the CIA World Factbook, ranks us way down at No. 42. At the other end of life's span, our people can expect to die younger than those in 34 other countries -- including Cuba, Andorra, Luxembourg, San Marino and, yes, Slovenia.

Rationing care

Universal health care is not an economic issue -- our country is the richest in the history of the world, and we already throw more money into the health care trough than any other nation in history. Nor is health care even a health issue -- our doctors, nurses, technicians, nutritionists, pharmacists and others are phenomenally skilled, having both the intellectual and technical capability to meet the health needs of everyone in our land.

Universal care is a moral issue -- and that's where our country has gone all slippery. Notice that the CEO class and political elites all are rolling along in the Rolls Royce of health plans, courtesy of generous subsidies from us taxpayers. These are the very people who control policymaking in Washington, and they have shown no ethical qualms about taking good care of themselves while watching the majority of their fellow citizens trying to go down life's bumpy health care road in a sputtering Yugo -- or, worse, on bare feet.

It's well-known that our system coldly leaves more than 46 million of us without any health coverage. That's one in every six Americans, including 8.3 million children. If you're keeping political score, the number of uninsured has jumped by six million under the Bushites' five-year reign in Washington. More than half of America's low-wage workers (those paid $20,000 a year or less by such outfits as Wal-Mart, Tyson or McDonald's) are not covered -- and more than half of them are having problems with their families' medical expenses. Quite a few are paying a heavier price -- some 18,000 Americans die unnecessarily each year due to lack of health insurance, roughly the same number who die of stroke, HIV or homicide. Less well-known, however, is the costly burden on millions more who supposedly are "covered" but may suddenly find themselves on the hook for thousands of dollars if they get seriously sick. Here's how it can happen:

  • A 20 percent co-pay can quickly become a problem for middle-class workers who, for example, need cancer medicines running $12,000 per month.
  • A trip to the hospital can leave you with a sickening side effect: having to pay $10,000 or more for treatments that were quietly excluded in your policy's fine print.
  • Of the 29 million Americans now in medical debt, 70 percent were insured when their medical bills put them in this situation.
  • Medical bills help drive about a million people into bankruptcy each year -- 68 percent of them had health insurance when they filed.

The fix

The system is so obviously messed up that even the Bushites know that something must be done. Predictably, their "fix" is corporate-driven and doomed to be an expensive failure. Just as he'd like to do with Social Security (Lowdown, March and April 2005), George wants to privatize Medicare and Medicaid, and also leave all other Americans at the mercy of "marketplace care" -- controlled by the usual suspects of the health-industrial complex. His lure is to offer health-savings accounts (HSA), "allowing" people to put a few thousand dollars into these tax-free schemes. We are all then to draw from HSAs to cover routine medical expenses and to buy high-deductible insurance policies (there's those middlemen again) for our catastrophic expenses. What if your savings and insurance policies are inadequate? Well, tough luck, sucker.

The insidious ethic behind Bush's fix is that health care is just another product to be purchased in the "free" marketplace, no different than buying a car or an electronic gadget. The Bushites view health as a consumer good, not as a part of the common good. In this view, people who need care are not "patients" but "customers," and it's up to individuals to become smart shoppers when buying the health care they need.

Excuse me, but while "consumer driven" makes a slick sound bite for George W, purchasing health care is not at all like picking out a new refrigerator. Start with the obvious fact that we're not all doctors or medical technicians. How do we know whether we need this test or that one, whether it's cough syrup we need or a cancer treatment? If you become seriously ill, are you really in a position to go comparison shopping for the cheapest hospital and specialists? And do you really want the cheapest? Health care is not a market, it's a human need. Yeah, yeah, say the Bush ideologues, but you mooches will overuse the system if it's not your own money you're spending. First of all, it is our money -- either in the form of insurance premiums or taxes. Second, even the best-insured people rarely get a colonoscopy or amputation just because it's covered. Going to the doctor is hardly something that people do for enjoyment.

A moral choice

Years ago, Martin Luther King Jr. said, "Of all the forms of inequalities, injustice in health care is the most shocking and inhumane."

Allocating health care according to the size of your bank account or to your privileged position in society is fundamentally (even biblically) immoral. It's also a shameful embarrassment for any wealthy nation. A strong, fair, affordable choice is readily available -- and it's time to fight for it. Americans can keep wasting hundreds of billions of dollars a year on the handful of bureaucratic corporate profiteers that make up the health-industry complex, or we can put that money into a single-payer system that will deliver quality care to everyone. Despite relentless ideological assaults on the idea of universal, government-financed systems by cult-of-the-market dogmatists and right-wing blowhards, the untold truth is that such systems work.

Let's refute a few of the Big Lies that have kept a national, single-payer health plan from even being considered.

IT'S SOCIALIZED MEDICINE.Wrong, Limbaugh-breath. Like Medicare, government doesn't deliver the health care under a single-payer system (SPS) -- you still go to your choice of doctors and hospitals. SPS, as the name suggests, is merely a government-run payment system. Instead of you and me paying inflated premiums to profit-seeking insurance giants which then pay our medical bills, SPS eliminates the rip-off overhead of the middleman and pays all of our bills directly to the providers.

PRIVATE IS ALWAYS BETTER THAN PUBLIC. Not at performing truly public functions, such as assuring health care for all. Presently, up to a third of the health premiums we pay to insurance corporations go not to health care but to their profits, marketing campaigns, CEO pay packages, posh headquarters, lobbying firms, and -- most damning -- massive bureaucracies whose sole purpose is to try to deny coverage for our medical treatments. With SPS, all of these costs are eliminated -- Medicare, for example, spends only 2 percent of its revenues on administrative costs.

WE CAN'T AFFORD TO COVER EVERYONE. We can't afford NOT to have universal care. When today's uninsured millions get sick, they end up at the ER -- the most expensive care there is. Also, they get no preventative care, which is far cheaper than paying for the serious illnesses that they later develop. A decade ago, Taiwan switched from a U.S.-style corporatized system to a Canadian-style SPS. It quickly went from 60 percent of its people covered to practically all -- with virtually zero increase in overall health spending.

THERE'LL BE WAITING LISTS. Hello! Have you ever tried to get a quick appointment with your family doctor -- especially at night or on weekends? Only a third of Americans have same-day access to their own doctor. It takes days, even if you have insurance -- ask an uninsured American about waiting lists! And forget about trying to see a specialist within a month of calling. No country with SPS has a waiting list for emergency care and few have them for primary care. Waits for other procedures are almost always for elective surgeries (liposuction, face lifts, tennis elbow, nonessential MRIs, etc.).

Why not now?

The American people overwhelmingly support a major, progressive shift from corporatized "care" to universal care. Recent polls show consistent agreement on the need for real action:

  • Everyone has the right to quality, affordable care (90 percent) -- Lake Research poll of U.S. Women, 12/05
  • Average Americans spend too much on health care (65 percent); government spends too little (70 percent) -- Pew poll, 3/06.
  • Our current system has so much wrong with it that either "fundamental changes" are needed (56 percent) or we must "completely rebuild it" (34 percent) -- CBS/New York Times poll, 1/06.
  • Government should guarantee health coverage for every American "even if it means raising taxes" (65 percent) -- Pew poll, 5/05. Likewise, 64 percent of doctors favor a single-payer health plan, according to a 2004 Harvard Medical School survey of Massachusetts physicians. Even corporate executives -- from General Motors to Wal-Mart -- are publicly wailing about the high cost and low coverage of America's current system (though none are providing the leadership to put America on the right track to a national plan of universal coverage).

A single-payer system is the answer. An unusually strong editorial in March by the St. Louis Post Dispatch expressed the benefits succinctly: "Employers would no longer be saddled with health care. Workers would no longer worry about health care for themselves or their children. And we could toss the disgraceful private health insurance industry, with its wasteful bureaucracy and inscrutable coverage rules, into the dumpster."

Many good grassroots groups are pushing this fundamentally moral issue into the elections of '06, '08 and beyond, confronting Republican lawmakers on their shameful fealty to corporate greed, and Democrats on their appalling wimpiness. We can achieve the goal of good-quality health care for all -- and advance America toward the greatness of its democratic potential.

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