(For previous posts on the issue of health care, see here.)

It is important to realize that in the single payer or socialized systems, everyone is covered and no one is denied coverage for lack of employment, pre-existing conditions and the like. Does that mean that one will be able to have any treatment that one desires whenever one desires it? Of course not. Whenever there is greater demand than resources available, there will always have to be decisions made as to how those resources are to be utilized, and invariably some treatments may be denied or delayed for some people.

The point is that this occurs even now in the private health insurance system that we have in the US. The difference, and it is a huge one, is that the private health insurance decisions about whom and what to treat are made by bean counters who are driven by the insatiable drive to make profits for their companies and who seek every means to deny treatment. There is almost nothing that ordinary people can do when they get shafted by the companies, because they are expert at giving you the run-around.

In single-payer and socialized medicine, decisions about how to allocate resources are made by collectively by physicians, other health professionals, and public policy makers who try to maximize the benefits of the system with the resources they have. There is usually some kind of board that is responsible for the workings of the system, but unlike the boards of directors of private, profit-seeking health insurance companies, they do not personally benefit financially by limiting treatment. And if we do not like how the system is run, then we have power to change things in that we can either vote to give the system more resources (the way we vote levies for schools and libraries) or we can vote for a government that will make the changes we desire. The public ultimately controls the health care system, which is as it should be.

It is also important to realize that in both single payer and socialized systems that are in existence in other countries, people still have the option to buy private health insurance if they want extra services, so those people who want premium services can still have them.

Those who think that they have good insurance now in the US from the profit-seeking private health insurance companies and resist change towards a single-payer or socialized system might be in for a nasty shock when they actually get ill because the health insurance industry has entire teams of people whose sole job is to find ingenious ways to deny coverage. The US health care system is truly wonderful as long as you do not get sick. Reporter Lisa Girion of the Los Angeles Times of June 17, 2009 reports on how the insurance companies cancel the medical coverage of sick people after they are diagnosed, a practice known as ‘rescission’.

An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant Inc. canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period.

It also found that policyholders with breast cancer, lymphoma and more than 1,000 other conditions were targeted for rescission and that employees were praised in performance reviews for terminating the policies of customers with expensive illnesses.

Denial of coverage is mostly done by using the infamous ‘pre-existing conditions’ loophole. Insurance companies will go to great lengths to dig up something, anything, that can be used to deny claims and cancel coverage altogether. “A Texas nurse said she lost her coverage, after she was diagnosed with aggressive breast cancer, for failing to disclose a visit to a dermatologist for acne… One employee, for instance, received a perfect 5 for “exceptional performance” on an evaluation that noted the employee’s role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care.”

Michael Moore’s film Sicko (see my review) interviewed people whose job was to do this and get rewarded for it by the insurance companies. This should be no surprise. After all, then president Richard Nixon approved of setting up the present employment based private health insurance system only after he was assured by his aide that “Edgar Kaiser is running his Permanente deal for profit… All the incentives are toward less medical care… the less care they give them, the more money they make… the incentives run the right way.” The present system is running exactly as they envisaged.

In May 2008 my younger daughter graduated from college so she immediately ceased to be on our health plan. But her job started only in August 2008 so we had to go through the dreary business of shopping around to get temporary coverage for the months of June and July before she got on her new company’s plan. That kind of irritation alone should be enough for people to want to ditch the present system in favor of one where coverage is decoupled from one’s employment status. For most people, the biggest nightmare about losing their job, or even changing it, is how to ensure health care for them and their families.

But that’s not all. When my daughter later went to the doctor for some minor treatment, the insurance company would not pay unless she could prove that it was not a ‘pre-existing condition’, which meant that we had to go back and get all the documentation about her two month temporary coverage. Even that was not enough and we had to get the paperwork of the coverage she had before that and submit that too. All this took a lot of time and the matter still has not been resolved. In the meantime she left that job and got a new one, so we don’t know what will happen now. But if she had not taken the precaution of getting temporary coverage for the two-month period of June and July 2008 (which happens to many people between jobs), and if we had not been conscientious about keeping all the paperwork, they would have simply denied her claims and she would have been on the hook for the entire amount. And there is nothing that we could have done about it.

Suzie Madrak relates an awful story about the hassle she went through when she injured her ankle. Because the injury occurred when she fell while getting down from a truck, her health insurance and auto insurance companies kept passing the buck to each other as being the party responsible for paying for treatment. This kind of thing simply would not happen in a single-payer or socialized system.

Anyone who has had to deal with the health insurance companies knows the aggravation that occurs routinely. The funny thing is that most Americans think this is normal because they have never known anything better. People in countries that have single-payer or socialized health systems never have to deal with an profit-making insurance bureaucracy that seeks to make money by denying treatment.

It is important to always bear in mind one undeniable fact: In the current system, it is that the primary mission of the private health insurance industry is to maximize the profits of their shareholders, not to provide good service to sick people.

The fact that finding ways to deny coverage is an important part of their profit-making strategy emerged once again when during congressional hearings last month, Rep. Bart Stupak, the chairman of the House Subcommittee on Oversight and Investigations asked each of the heads of the major health insurance companies whether he would at least commit his company to immediately stop rescissions except in cases where they could show intentional fraud. All of them said “No”, thus confirming that denying coverage to sick people by any means possible is a deliberate profit-seeking policy of these companies.

Unbelievable.

POST SCRIPT: Bill Maher makes a commercial for the American Medical Association

(For previous posts on the issue of health care, see here.)

In order to effectively combat the health industry propaganda that seeks to preserve the current terrible system, people need to have a clear idea of what the main issues are and get clear on what the various terms mean.

First of all, ‘universal’ coverage, by which is meant that everyone has access to some health care is not enough. It is possible to achieve this by demanding that everyone must purchase private health insurance (the way all drivers must purchase auto insurance) and then providing aid for those who cannot afford it. All this would do is put more victims in the clutches of the rapacious and inefficient private health insurance companies and increase their profits while not improving the system.
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(For previous posts on the issue of health care, see here.)

The late Walter Cronkite said, “America’s health care system is neither healthy, caring, nor a system.” And he was right. It is a rotten structure that has continued purely on the basis of its ability to fool people using smoke and mirrors into thinking it is better than it is. But the structure is so bad that the façade is crumbling and the need for reform cannot be hidden anymore.

As the health care reform debate gathers steam, those who benefit greatly from the current system (drug and health insurance companies, hospitals, and doctors) by making large amounts of money while delivering less than adequate care, and the members of Congress whom they effectively bribe to protect their interests, and the mainstream media which is always obsequious in advancing the interests of the business and political elite, are going flat out to preserve as much of their interests by either lying or fear-mongering or creating confusion. As all the various plans are debated, with their details, it is important to keep clear what the issues are, and the next series of posts will try to do that.
[Read more…]

I have said before that while I voted and supported Obama against McCain, he is firmly committed to following the policies of the pro-war/pro-business elites that govern this country. No politician can get elected to high office otherwise.

Perhaps nowhere is this clearer than his attitude to single-payer health care. I have written extensively about this in the past and it is clear that a system like that of France provides the most cost effective means of providing high-quality health care to everyone without the incredibly expensive, burdensome, and bureaucratic system that we have in the US.

But although Obama talked a lot about providing access to health care to everyone, when he called a summit to be held yesterday (March 5, 2009) to discuss this serious problem and said that he wanted wide-ranging views on how to solve it, he deliberately excluded those who wanted the single payer system as part of the discussion. His key people on health care reform are those with ties to the parasitic health insurance industry. Hillary Clinton did the same thing with her earlier ill-fated efforts to reform the health care system.

Politicians and the health insurance industry like to call for ‘universal’ health insurance as long as all it requires is that the government mandate that everyone have private health insurance, because that would hugely increase their profits. This is why it is important for people to realize that ‘universal’ health care and ‘government-run single payer’ health care systems are not the same thing. The latter is far, far, better.

Obama initially did not want not even allow the views single payer advocates to be heard, even though one of the most senior members of his own party, Congressman John Conyers, has proposed House Bill 676 to establish just such a system. This is because almost the entire government is beholden to the health-drug-hospital lobbies and they are all fearful that when more people realize how much better a government-run single payer system is, they will demand it.
But the supporters of single-payer flooded the government with protests about this exclusion and at the very last minute, an invitation was extended to advocates of single payer. They invited Conyers and Dr. Oliver Fein, who is president of Physicians for a National Health Program, whose mission is to obtain a single payer system. As their site points out:

The U.S. spends twice as much as other industrialized nations on health care, $7,129 per capita. Yet our system performs poorly in comparison and still leaves 47 million without health coverage and millions more inadequately covered.

This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.

That illustrates why, as I said before, it is extremely important that the people who voted for Obama not cut him any slack at all and keep up the pressure on him, because the lobbies that dominate the government work 24/7 to keep the pressure on the politicians they buy so that they follow their dictates. Obama is no exception, however much his most ardent supporters might think he is different.

This success in gaining entry to the summit does not mean that single-payer is going to win out soon. The for-profit health care lobbies that make fortunes out of the sickness and misery of people have too much at stake and are still too powerful to be vanquished that easily. They are vampires, preying on people’s fears in order to preserve their profits, and it will take a lot to drive a stake through their hearts. What kind of mentality pays bonuses to employees if they can cancel the policies of sick people, and thus save the company money? And yet, in the for-profit health care system we have now, such a cruel policy is good business practice.

The present system has become so appalling that now even a majority of doctors want a single payer system, because they themselves are finding the current system dehumanizing, deprofessionalizing, and a bureaucratic nightmare.

The latest sign is a poll published recently in the Annals of Internal Medicine showing that 59 percent of U.S. doctors support a “single payer” plan that essentially eliminates the central role of private insurers. Most industrial societies — including nations as diverse as Taiwan, France, and Canada — have adopted universal health systems that provide health care to all citizens and permit them free choice of their doctors and hospitals. These plans are typically funded by a mix of general tax revenues and payroll taxes, and essential health-care is administered by nonprofit government agencies rather than private insurers.

There will be no real improvement in the health care system until the private, for-profit health insurance industries are removed from it. But the health insurance lobby is powerful and has huge access to the halls of government and the media. It will take a huge groundswell of popular sentiment to overcome it.

POST SCRIPT: How other countries did it

The US is the only major country without a government-run single-payer health system. Supporters of the present system self-servingly argue that switching over would cause huge disruptions and chaos. This article in the New Yorker describes how the single payer system was introduced in other industrialized countries, with minimal fuss and to great satisfaction.

The French health-care system has among the highest public-satisfaction levels of any major Western country; and, compared with Americans, the French have a higher life expectancy, lower infant mortality, more physicians, and lower costs. In 2000, the World Health Organization ranked it the best health-care system in the world. (The United States was ranked thirty-seventh.)

(For previous posts on the topic of health care, see here.)

Efforts are underway to try get a universal, single payer health care system in Ohio. The group behind it is the Single-Payer Action Network Ohio (SPAN Ohio), which is supporting legislation instituting such a plan. Their website provides more information about their initiatives and meetings.

The Health Care for All Ohioans Act has been introduced in the Ohio House (H. B. 186) and the Senate (S. B. 168).

The main points of the legislation can be seen here but here are the highlights:

• Patients get free choice of health care providers and hospitals.
• When you go to your own personal physician for visits, there are NO premiums, NO co-payments, NO deductibles, NO one excluded. You pay nothing.
• When you get your prescription filled by your pharmacist, there are NO premiums, NO co-payments, NO deductibles, NO one excluded. You pay nothing.
• If you need hospitalization, there are NO premiums, NO co-payments, NO deductibles, NO one excluded. You pay nothing.

In each case, the health care provider is reimbursed from the Ohio Health Care Fund.

So how does the Ohio Health Care Fund get its money? Under the proposed plan, people who earn less than the Social Security tax cap (currently $97,500 per year) pay no additional taxes. The money to fund the system comes from a variety of sources: up to 3.85% payroll tax paid by employers; up to 3% gross receipts tax paid by businesses; 6.2% tax on individual compensation in excess of the Social Security tax cap; 5% surtax on adjusted gross income over $200,000; funds from other government sources. Remember that currently employers that provide private health insurance have to pay for it. That money can now be directed to the Ohio Health Care Fund instead.

An Ohio health care agency runs the program and its governing board consists of the state director of health and fourteen other members, two from each of the seven regions that make up the state. The two members are elected for two-year terms by a regional health advisory committee, which in turn is elected by a meeting convened of the county and city health commissioners of each region.

Since there are many misconceptions (often deliberately perpetrated by the health care industry and its allies in the media) about what a single payer system involves, here is a handy document that compares the myths with the realities.

One of the big distortions that will be perpetrated by the health insurance and drug industries and politicians is to treat ‘universal’ and ‘single-payer’ as if they are synonymous terms. They are not and people should be vigilant when that sleight-of-hand is attempted. ‘Universal’ refers to the fact that every person should be covered, with no exceptions. ‘Single payer’ refers to the mechanism by which the health care system is financed and health care providers reimbursed.

It is not difficult to provide ‘universal’ private health insurance coverage, if that coverage is bad. All one needs to do to achieve that is to compel everyone to purchase some kind of health insurance, like the way people are compelled to buy auto insurance in order to drive, and some states have gone that route. But all that achieves is people or their employers being forced to purchase high-deductible, low-treatment coverage. Such policies will not result in better and more accessible treatment for more people or reduce the frustrating bureaucracy that we all encounter now. In fact, it will be a profit windfall for the private insurance companies as they get even more people into their nets. Such ‘universal’ programs would not be an improvement on the current system, though it will be touted as such by the health-care industry and their apologists.

‘Single-payer’ means something different, that there should be just one single entity, preferably run by the government or at the very least a non-profit publicly accountable board, that collects the money and spends it on the health care system. The single payer plan calls for the complete elimination of profit-driven private health insurance companies from the health care system, and has to be an essential component of any meaningful health care reform. As Sicko pointed out, the introduction of profit-making bodies between the patient and the doctor is the single feature that has resulted in the health care system in the US being so inferior to its peer countries.

Candidates should not be able to evade the issue by saying they support universal health-care. The question that should be asked is whether they support single-payer universal health care. Of all the presidential candidates in both parties, only Dennis Kucinich is calling for such a universal single-payer system, although many of the other Democratic candidates have signed onto the vague ‘universal’ health care part.

A petition has also been started by SPAN Ohio to gather signatures to put the legislation onto the statewide ballot. This petition contains the officially approved summary of what the legislation contains, as well as the full text of the bill. It is a parallel track strategy to the bills in the state legislature to get the same results.

I am collecting petition signatures so if anyone wants to sign it, or collect signatures as well, please contact me or SPAN Ohio. My petition form is limited to those who reside in Cuyahoga County.

The Cleveland branch of SPAN Ohio meets at 7:00pm on the first Monday of each month at the ACLU building, 4506 Chester Avenue. Other branch locations and meeting times can be found on their website.

POST SCRIPT: Handy guide to candidates

With so many people running for president, it is hard to compare their stands on the various issues. One enterprising website has done us all a favor by preparing a table that gives capsule summaries of their views. Of course, you will need to look elsewhere for more details and nuances.

When all their other arguments about the advantages of the current US health care system compared to universal, single-payer systems in France, Canada, England, Germany, etc. are shown to be false, apologists for the US health care system turn to their trump card: alleging that wait times to see a doctor in those countries is longer than it is in the US. This statement by the lobbying group America’s Health Insurance Plans is typical: “The American people do not support a government takeover of the entire health-care system because they know that means long waits for rationed care.”

The problem with this type of allegation is that the US does not systematically collect data on wait times, whereas the other countries do collect the data and make them public. The assumption seems to be that in the US, if there is no data, then the wait times must be zero. No data, no problem!

But using the scant data that is available, BusinessWeek points out that except in a few selected, non-emergency situations, even this charge is false: “In reality, both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems.”

As Paul Krugman points out in his New York Times July 16, 2007 column:

[B]y and large, opponents of universal health care paint a glowing portrait of the American system that bears as little resemblance to reality as the scare stories they tell about health care in France, Britain, and Canada.

The claim that the uninsured can get all the care they need in emergency rooms is just the beginning. Beyond that is the myth that Americans who are lucky enough to have insurance never face long waits for medical care.
. . .
[N]ot all medical delays are created equal. In Canada and Britain, delays are caused by doctors trying to devote limited medical resources to the most urgent cases. In the United States, they’re often caused by insurance companies trying to save money.

This can lead to ordeals like the one recently described by Mark Kleiman, a professor at U.C.L.A., who nearly died of cancer because his insurer kept delaying approval for a necessary biopsy. ”It was only later,” writes Mr. Kleiman on his blog, ”that I discovered why the insurance company was stalling; I had an option, which I didn’t know I had, to avoid all the approvals by going to ‘Tier II,’ which would have meant higher co-payments.”

He adds, ”I don’t know how many people my insurance company waited to death that year, but I’m certain the number wasn’t zero.”

(You can read about Kleiman’s plight here, which occurred despite having what he calls “fancy-dancy health insurance through my employer, which as it happens also owns one of the world’s dozen best medical centers”.)

And what about that favorite of US health care apologists, the waiting time for hip replacements? Krugman looked at that too:

On the other hand, it’s true that Americans get hip replacements faster than Canadians. But there’s a funny thing about that example, which is used constantly as an argument for the superiority of private health insurance over a government-run system: the large majority of hip replacements in the United States are paid for by, um, Medicare.

That’s right: the hip-replacement gap is actually a comparison of two government health insurance systems. American Medicare has shorter waits than Canadian Medicare (yes, that’s what they call their system) because it has more lavish funding — end of story. The alleged virtues of private insurance have nothing to do with it.

Krugman’s conclusion is right on target:

The bottom line is that the opponents of universal health care appear to have run out of honest arguments. All they have left are fantasies: horror fiction about health care in other countries, and fairy tales about health care here in America.

POST SCRIPT: Déjà vu

As usual, cartoonist Tom Tomorrow succinctly captures how the media is colluding with the administration in fanning the flames for war with Iran, exactly the way it did with Iraq.

(For previous posts on the topic of health care, see here.)

In my previous posts following on the film Sicko (Haven’t seen the film yet? It is well worth it.) I have been focusing on the tangible costs and benefits of the US health care system compared to those of other developed countries, and showing why the US system comes out badly in comparison. The chief culprit is the insertion of profit-making private health insurance companies between the patient and health care providers, creating an immediate trade-off between profit and providing care that is detrimental to the latter.

But there are several intangibles that are also important. The main one is that having one’s health insurance tied to one’s place of employment highly distorts the basis on which people make important life decisions. Right now, many people make decisions of what job to take and where to live based on the health care provided by employers. People with families and young children are especially caught in a bind. Some people spend their entire lives in dead-end jobs that they hate, trapped because of the fact that they cannot afford to leave and lose the health benefits. This is especially so if they or a member of their family has a health problem that becomes a non-covered ‘pre-existing condition’ in their new workplace, and thus denied coverage, at least for a limited time.

What is the cost of this? For one thing, it discourages entrepreneurs and freelancers. A person who wants to quit his or her job to start their own business or implement an innovative idea is strongly discouraged from doing so, especially if they have families. Not only is the cost of purchasing private insurance for themselves prohibitive, so is the cost for providing it for their employees. In 2004, the average cost of health insurance for family coverage was $9,950, which means that it is likely to be around $12,000 in 2007. This is close to the amount earned annually by a full-time minimum wage worker. How many business ideas have never seen the light of day, how many jobs never created, because potential innovators just could not bring themselves to risk the health of their families by leaving their jobs?

Health insurance tied to businesses also discourages the creative arts. Painters, writers, sculptors, poets, actors, dancers, and musicians are people who add enormously to the quality of life of a community. A community that has a vibrant arts community is one that is lively and healthy. Most artists do not go into it for the money (although they have dreams of their work becoming widely recognized someday) but because they really love what they do and are willing to suffer some hardship for it. They are willing to forego luxuries and live fairly Spartan lives with respect to housing, food, clothing and the like, just to have the opportunity to create art. Many are willing to take part-time jobs to cover life’s essentials so that they have the time and freedom to devote to their passion. But the biggest single expense for such people is the cost of buying health insurance as private individuals. Many simply do not do so, gambling that they will not get very sick.

Then we have young people, straight out of high school or college who may want to experience a carefree life for at least a short time before settling down, and maybe travel around this vast country doing various jobs, seeing new things, meeting new people, and learning about the various communities they pass through. Maybe they want to work in underprivileged areas. Right now, the only way to safely do that is to do it through an organization that provides health insurance. If they go on their own, they have to buy expensive private health insurance or take the risk that they will not need health care. Even for the volunteer organizations that provide health insurance, providing it is a big headache and expense.

Then there is the problem of transitioning between jobs and between school and jobs. There are often gaps between the times when students leave college and start their first jobs. Because they have left school, they no longer are covered by their family or school health insurance policies. They have to shop around for some coverage for the transition period until they get their first job. People who have a gap when they move from one job to another can sometimes use COBRA coverage during the transition.

Even people who like their jobs and have health insurance plans to choose from (the so called ‘lucky ones’) face all kinds of irritations. The family may select an insurance plan and from it choose pediatricians for their children, an internist for the parents and a gynecologist for the mother, all within that one plan. The next year, they are likely to find that some of the physicians are now on different plans. So you have to repeat the process of comparing health care plans, weighing the costs and benefits, comparing physician lists, and trying to figure out who and what to keep and to jettison. This has to be done every year. And then you have to keep track of all the paperwork and receipts and co-payments. I think people have got so beaten down that they simply do not realize how much time goes into taking care of all these details. It is only when they get drawn into the bureaucratic nightmare that results when coverage is denied or some major illness strikes that they realize what a crazy system they are in.

Why have people in the US become so numb and accepting of this state of affairs? In surveying the responses to the film Sicko, James Clay Fuller makes a good point:

Not one mentions the comments by Tony Benn, a former member of Britain’s Parliament. Yet Benn’s statements probably are the most profound element of the film.

He notes, as other good people often do, that “if we have the money to kill (in war), we’ve got the money to help people.”

But, more importantly, Benn tells Moore, that all of Europe and many other places have good health care systems while the United States lacks such a basic service because in Europe and elsewhere, “the politicians are afraid of the people” when the people get angry and demand some action. In the United States, he observes, “the people are afraid of those in power” because they fear losing their jobs, fear being cut off from health care or other services if they speak up and make demands.

“How do you control people?” Benn asks, and he answers: “Through fear and debt.”

His point is that in the United States we have a great overabundance of both.

When are people going to get angry enough to say “We’re mad as hell and we’re not going to take it anymore”?

POST SCRIPT: The invertebrate Congress

On Bill Moyers’ show, Conservative Bruce Fein argues why Bush should be impeached and criticizes a spineless Congress for not doing so, and John Nichols (author of the book The Genius of Impeachment) agrees.

Here is a transcript.

Another conservative Paul Craig Roberts (Assistant Secretary of the Treasury in the Reagan administration and former Associate Editor of the Wall Street Journal editorial page and Contributing Editor of National Review) has also called for the immediate impeachment of both Bush and Cheney.

The idea of impeachment was inserted into the US constitution as a vital check against the president assuming dictatorial powers akin to those of a king. It was almost tailor-made to deal with situations like that which currently exists. But the Democratic Party leadership seems unwilling to do this.

(For previous posts on the topic of health care, see here.)

I think almost everyone across the political spectrum would concede the fact that the fifty million Americans currently without health insurance would definitely benefit from the adoption of a universal, government-run, single-payer health care system. The reason that it has not been adopted is that many of the remaining 250 million have been frightened into thinking that their medical coverage would decline from what they have now.
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(For previous posts on Sicko and the merits of a government-run, universal, single payer health care system, see here and here.)

Michael Moore’s excellent film Sicko has cinematically exposed the deep flaws of the US health system. His film scarcely touches on the awful plight of the 50 million people who have no insurance at all. That would have been bad enough but instead he sought to highlight the plight of those who do have health insurance and think they are secure, but discover to their horror that their insurance companies let them down in their moments of greatest need.

He emphasizes the fact that when you introduce profit-making entities in between the patient and the health care providers, you have guaranteed that attempts will be made to deny health care as much as possible. The insurance companies actually have employees whose task is to dig deep into your past to see if they can find anything, anything at all, that would enable them to invoke the fine print in their policies and deny coverage. Hence many people receive nasty shocks that they are not covered just as they are reeling from the discovery that they have a serious illness.

And this is why in the US you have a system in which the minority who are rich and powerful and influential have access to very good health care because they are in a position to create trouble for the insurance companies, while the vast majority are vulnerable to finding out that getting ill can mean ruin.

One of the curious things about the health care debate in the US is that the opponents of a government-run, single payer, universal health care system try to portray it as this mysterious, unknown, complicated, untried, massively bureaucratic, expensive system that one should not experiment with.

This is ridiculous. It is the system in the US that is mysterious, complicated, massively bureaucratic, and expensive. Government-run, universal, single payer systems are the norm in the developed world and in many countries of the third world. There are any number of working models that have been in existence for over half a century for which cost-benefit analyses exist and the operating structures are well known. It is the US, almost in isolation, that has a bizarre, labyrinthine, bureaucratic, and expensive system.

The basic concept of how single payer health care works is very easy to understand as this wonderful little animation illustrates. What is needed is to select the model that might adapt best to the US and modify it to meet our needs. The only difficulty to doing that would be to combat the vested interests of the health insurance and drug interests who will fight tooth and nail to keep making massive profits off the sickness of people.

Even magazines like BusinessWeek concede that the French system is superior to the US:

In fact, the French system is similar enough to the U.S. model that reforms based on France’s experience might work in America. The French can choose their doctors and see any specialist they want. Doctors in France, many of whom are self- employed, are free to prescribe any care they deem medically necessary. “The French approach suggests it is possible to solve the problem of financing universal coverage…[without] reorganizing the entire system,” says Victor G. Rodwin, professor of health policy and management at New York University.
. . .
France also demonstrates that you can deliver stellar results with this mix of public and private financing. In a recent World Health Organization health-care ranking, France came in first, while the U.S. scored 37th, slightly better than Cuba and one notch above Slovenia. France’s infant death rate is 3.9 per 1,000 live births, compared with 7 in the U.S., and average life expectancy is 79.4 years, two years more than in the U.S. The country has far more hospital beds and doctors per capita than America, and far lower rates of death from diabetes and heart disease. The difference in deaths from respiratory disease, an often preventable form of mortality, is particularly striking: 31.2 per 100,000 people in France, vs. 61.5 per 100,000 in the U.S.

There will still be some bureaucracy because it will be needed to do all the paperwork to run the health care system. But the point is that this bureaucracy is invisible to the patients. As far as the patient is concerned, you go to the doctor and you get treated. That’s it. You do not have to fill in any forms. The paperwork goes on behind the scenes between the government, the drug companies, hospitals, and the health professionals. Even for the doctors the paperwork is simplified because they are now dealing with just a single payer of their services and don’t have to keep track of multiple health insurance companies, each of which has different rules for what they can and cannot do. This is why the entire health system in Canada has fewer workers (scroll down) to serve its population of 27 million than Blue Cross requires to service less than one-tenth that population in New England alone.

But while the surface debate is about policy, the deeper debate is about a fundamental difference in philosophy

At one extreme, there are those who take the view that it is up to each one of us to look after our own interests and feel perfectly comfortable ignoring the needs of others. Such people take the point of view that each person is responsible for their health care. The ‘free market’ should operate and people should shop around for what works for them. If they do not have the means to do so, then that is their own fault or their own tough luck. They have failed to provide for themselves and cannot expect the rest of society to look after them, except for what private charities might provide.

At the other end (which is where I am) are those who feel that when it comes to basic issues like health care, it is the responsibility of every one to look after everyone else. Decent health care is not a commodity like toothpaste to be bought and sold on the market. It is a fundamental right that everyone (especially children and the elderly) is entitled to, irrespective of their ability to pay, and should be seen as a collective social obligation. Most such systems are based on spreading risk over a large number of people and because of that principle, while there are options for people to buy supplemental insurance on the private market, there cannot be an opt out provision, just as there is no opt out for police or fire systems or trash collection or libraries or parks or all the other similar collective systems that we currently have in place.

Those who oppose single payer health care systems try to frighten people with all kinds of bogeymen. The extent to which they are willing to go sometimes reaches levels of downright lunacy. In the wake of the release of Sicko, some have even said, if you can believe it, that adopting a single payer system could result in more terrorism! There are no depths of fear-mongering to which they will not sink.

But the tried and true standby to try and frighten people is the charge that single payer systems equate to ‘socialized medicine’, as if that is an automatic disqualifier.

It is a tribute to the success of the propaganda model that simply the word ‘socialism’ strikes such fear in so many people in the US. But the fact is that the word is ill-defined in this context. There are some health care systems where the hospitals are actually run by the government, and the health care professionals are government employees. This is perhaps closest to what might be meant by ‘socialized medicine’ and is close to what England has with its National Health Service. Then there is the French system where things are a mix of public and private, and the government mainly acts as the sole entity financing the system, collecting money in the form of taxes and using that to pay for services.

If the scaremongers want to invoke the word ‘socialized’ so broadly as to mean the spreading of the risk across the whole population, then that is no strange concept to the US because then socialism is already rampant in the US.

Sometimes US ‘socialism’ occurs a highly distorted form, where the risks are spread around to everyone but the benefits accrue to a wealthy few. Consider for example the FDIC insurance that banks carry. Every person is underwriting that insurance through our taxes, but it benefits the banks and those who have money to deposit. The past US government bailouts of the auto and airline industries when they were in trouble are examples where the costs and risks are borne by all of us, but the benefits accrued to a select few. The savings and loan debacle of the 1980s was again an instance of the risks and costs being ‘socialized’ (i.e., spread over the entire population), irrespective of whether people had money in the savings and loans institutions or not.

The better form of ‘socialized’ services is where everyone pays for services and everyone also benefits, such as is currently the case in the US with ‘socialized’ fire departments, ‘socialized’ police departments, ‘socialized’ parks, ‘socialized’ libraries, ‘socialized’ trash collection, ‘socialized’ hurricane and weather forecasting, ‘socialized’ air traffic control, ‘socialized’ roads, the list goes on endlessly. All these function on the assumption that there are certain things which are a collective good, and that we all should contribute to their maintenance so that we benefit as needed. ‘Socialized’ medicine should be seen as a natural addition to such existing ‘socialized’ public services, not some strange alien concept.

No health system is perfect. There will always be people who suffer and die because of the lack of equipment or drugs or incompetence. But no one should suffer and die because of the lack of ability to pay or because of bureaucratic hurdles erected in their path in order that some people can make a profit.

In the next post in this series on Thursday, I will look at the “But I’m ok, aren’t I?” attitude that opposes change in the health care system because the speaker thinks that he or she is secure now.

POST SCRIPT: Health care industry contributions to candidates

Michael Moore is helping us keep tabs on how the health care industry is contributing money to presidential candidates of both parties.

Of course, the industry is doing this purely out of a sense of public service and for the sake of supporting democracy, and not to bribe the candidates to make sure that a government run, single payer, health care system is never seriously considered, whoever happens to win.