by Gilles d'Aymery
(Swans - June 15, 2009) I recall researching and writing a pretty depressing Scorecard for America in 2004 in which I compared among other issues the health care systems of four countries -- the U.S., Cuba, France, and Israel. Healthcare expenditures in the U.S. in the late 1990s were about 14 percent of GDP. They have now grown to almost 18 percent. In 2007, over 60 percent of personal bankruptcies were triggered by medical expenses that people could not cover. Uninsured or underinsured families are ballooning. Americans spend far more per capita than any other "advanced" country and yet the World Health Organization ranks the U.S. 37th in terms of health performance. Whether it is infant mortality, life expectancy, and all other measurements, the U.S. is far behind the rest of the Western world. While the Obama administration is trying to overhaul the health care delivery system, as President Clinton tried in 1993, we are once again being treated with commercials (remember Harry and Louise?) and rhetorical rants that depict any serious change to the status quo as a march toward dreaded socialism, long waiting lines, and rationed medicine. Public solutions are fought tooth and nail (and mucho greenbacks and lobbying) by entrenched for-profit interests -- the pharmaceutical industry, the insurance companies, the medical equipment suppliers, and a small slice of the medical profession that benefits from the fee-for-service payment model and is represented by the American Medical Association. That a plurality of the American polity, the medical doctors, and the nurses favors and asks for a single-payer system is snubbed by a majority of our lawmakers. Such a system is "off the table."
A single-payer system, it should be reminded, is an administrative approach to funding. It would replace the existing for-profit private insurance system by one big (or regionally, or state distributed) organization(s) in which all would be enrolled and pay into. Nothing more, nothing less. Care would be provided by the same health providers -- private and public -- as it presently is. Choice for patients would actually be enhanced because they would not depend on the whim of, and "packages" offered by, the many insurance companies. It would save the country between $300 and $400 billion a year, and everybody would be insured. Cheaper, with no change in the delivery of services (though fee-for-service treatments need to be abandoned or drastically altered), it's a proven system that would substantially improve both the health of the public and that of our economy. Health care costs and military spending are slowly asphyxiating the country. Those two items will bankrupt us as surely as the sun will rise tomorrow morning and the earth will long survive our consumerist orgies. Still, single payer is off the table. Why?
Mostly, the reasons are due to ideology, ignorance, and powerful financial forces in play. The ideology stance is the most laughable argument, since the side that is clamoring in favor of free markets is at a loss to explain why the costs are exorbitant and the results so wanting compared to other "advanced" nations. There is something truly ironic when the proponents of free-market, "competitive" solutions whine that "Forcing free market plans to compete with these government-run programs would create an unleveled playing field and inevitably doom true competition," as Republican members of the Senate Finance Committee wrote to President Obama last week. If free-market health care is so much more competitive than a governmental, not-for-profit plan, why should they worry? If a public plan would be, as they argue, so inefficient, why should they be concerned? Evidently, their approach should trounce the so-called bloated bureaucracy. Or are they afraid of something that is left untold? That a single-payer system is indeed more effective than their piggy banks? Again, check and analyze the costs and results of all the other "advanced" nations. Or you may rather listen to Rush Limbaugh...
Ignorance is a matter I would rather ignore (!) herein. How can you explain to people, for example, that Canada does not have a single-payer system per se, but a mix of federal/provincial/territorial systems that provide with various distinctions health care to their populations? The system in Quebec is slightly different from the one in British Colombia, or Ontario, etc. Germany too does not have a national single-payer system. However, what they do have in common is that they to do not treat health as a moneymaking venture, as we do in the U.S. Beliefs thrash facts in this country. So, how can one ask believers to study reality and eschew their beliefs? Waste of time...
But it's not a waste of time to bring a few facts to the reality-based, non-brainwashed, part of the polity. Money reigns.
The largest-selling drug in the world, Lipitor (atorvastatin), is produced in Ireland by the giant pharmaceutical conglomerate Pfizer. According to the Lipitor Web site, "One in 5 adults has high cholesterol. High cholesterol is a leading risk factor for heart disease -- the #1 health problem in the United States." Atorvastatin is the drug par excellence to treat high-cholesterol patients (diet notwithstanding), but it is a very expensive drug, at least in the U.S. Why?
For years, a few lawmakers in the US Congress have been trying to change legislation regarding the cost of drugs and to allow Americans to buy their medicines from the famed "free-market" in other countries that happen, irony of all ironies, to practice a non-for-profit health care system. Here is Senator Dorgan (D - ND) speaking on the floor of the senate on June 08, 2009:
This is Lipitor, produced in Ireland by the same company, shipped in two different directions. Even the bottle is identical, except one has a blue label and one has a red label. One of these went to Canada and one of them went to the United States. The American people get the pleasure of paying twice the price for Lipitor than the Canadians do. But it is not just Canada, it is virtually every other industrialized country that is able to pay a fraction of the price for prescription drugs our consumers are required to pay. Why? Because there is a law in our country that says the only entity that can import prescription drugs is the manufacturer of the drug itself.
This is not a Democratic concern. Here is Senator McCain (R - AR) on the same day:
[McCain explaining lobbying...] Just a few years ago, before Democrats took control of Congress, the pharmaceutical industry was busy funneling millions to Republican candidates, at times giving the GOP three dollars for every one headed to Democrats.
Over the last two cycles, though, drug makers have been much more generous with the other party. In the 2008 cycle, pharmaceutical companies gave the two parties about $14.5 million each, and this year the industry has given $714,000 to Republicans and $721,000 to Democrats.
[McCain explaining the fleecing of the American people] The Fraser Institute found in 2008 that Canadians paid on average 53 percent less than Americans for identical brand-name drugs. Specifically, the institute found that the most commonly prescribed brand-name drug, Lipitor, is 40 percent less in Canada, Crestor is 57 percent less in Canada, and the popular arthritis drug Celebrex is 62 percent less expensive in Canada. Americans would love a 60-percent off coupon for prescription drugs and deserve such a discount now more than ever.
A recent study shows that the country is wasting about $700 billion, or about 30 percent of all sick care costs, in unnecessary procedures created by fee-for-service specialists who not only are paid to provide the services, but create the services in the first place. Not surprisingly, these specialists are by-and-large members of the American Medical Association, which has come out against any kind of public-financing system.
They, and the paid-for ideological whores in the commentariat, wail against public financing and finger out Canada as the evil incarnate lurching to bring socialism to our beloved freedom-loving country. (Can you imagine socialism coming to this country? It's getting so darn close that we need the NRA to rush to the defense of our national parks!) Even Nicholas Kristof of The New York Times, and a gatekeeper of the citadel, can't stomach this baloney. In his June 11 Op-Ed, "This Time, We Won't Scare," Kristof takes on the fear brigade and puts forward the belief (yet another one) that this time around -- not like in 1993 -- the usual scare tactics won't work and the American people won't be swiftboated. For Kristof, "the bottom line is that America's health care system spends nearly twice as much per person as Canada's. . . . Yet our infant mortality rate is 40 percent higher than Canada's, and American mothers are 57 percent more likely to die in childbirth than Canadian ones." Comments to his article were overwhelmingly in favor of a single-payer system with testimonies on the benefits of single-payer systems from Canada and Europe. Here is just one example from an American expat in Saumur, France (comment #13):
All expats, like us, shake our heads in dismay when we read about US "health scare" politics.
My wife gave birth to a beautiful child in January. We received only one bill: 101 Euros (less than $150). And that's because we chose to pay for the private room instead of the free double. Standard length of stay after child delivery: 3 days.
All the ObGyn visits, all the blood tests, all the postnatal visits: covered.
How much do we pay in health care per year (a family of 6)? A little under $1000. We chose our own doctors - any doctors. When someone is sick, we call our doctor and are seen usually within 2 hours.
When one of our children suffered seizures a few years back she was flown by helicopter to a University hospital 80 miles away. I fainted when I received the bill: $0. Including 2 days at the hospital for observation.
After years of Florida hanging chads, WMDs, swiftboat veterans, Katrina, default swaps and Palin-craze, it's so depressing to read about the return of Harry and Louise. (Where's my glass of Bordeaux?)
Perhaps the biggest hogwash of all that needs to be swiftly dispelled is the argument made by the opponents of a single-payer system that it would significantly increase taxes. How people can repeat this humbug with a straight face is beyond comprehension. If you are self-employed and buy your own insurance or you get your insurance through your employer, premiums are paid to the for-profit insurance companies. With a single payer-system these premiums -- while about 30 percent lower -- would be paid to, say Medicare. They are not taxes, even if collected through Payroll. They are premiums -- with lower or no deductibles and co-pays, and much cheaper prescription drugs.
So a far more efficient and economical national health care system that insures everybody and produces much better results should be a no-brainer, yet we cannot get it on the table. Forget about it, says Montana Senator Max Baucus (paid for and financed by the for-profit industry), who heads the US Senate Committee on Finance in charge of the current health care reform. For Baucus "We are Americans. We are different. We do things differently. The fact is single-payer is off the table." (I paraphrase.)
Differences do matter indeed. So do facts. One senator who gets his facts right is Bernie Sanders (I - VT), whose remarks on the floor of the Senate on June 08, 2009, are worth quoting in full (Page: S6240 of the congressional record):
Mr. President, let me be very clear. Our health care system is disintegrating. Today, 46 million Americans have no health insurance and even more are underinsured with high deductibles and copayments. At a time when 60 million people, including many with insurance, do not have access to a doctor of their own, over 18,000 Americans die every year from preventable illnesses because they do not get the medical care they should. This is six times the number of people who died at the tragedy of 9/11, but this occurs every single year, year after year. In the midst of this horrendous lack of coverage, the United States spends far more per capita on health care than any other Nation, and health care costs continue to soar. At $2.4 trillion and 18 percent of our GDP, the skyrocketing cost of health care in this country is unsustainable, both from a personal and macroeconomic perspective.
At the individual level, the average American spends about $7,900 per year on health care -- $7,900 per individual every year. Despite that huge outlay, a recent study found that medical problems contributed to 62 percent of all bankruptcies in 2007. From a business perspective, General Motors spends more on health care per automobile than on steel--more on health care than on steel -- while small business owners are forced to divert hard-earned profits into health coverage for their employees rather than new business investments. Because of rising health care costs, many businesses are cutting back drastically on their level of health care coverage or they are doing away with it entirely.
Further, despite the fact that we spend almost twice as much per person on health care as any other Nation, our health care outcomes lag behind many other countries. We get poor value for what we spend. According to the World Health Organization, the United States ranks 37th--37th--in terms of health system performance, and we are far behind many other countries in terms of such important indices as infant mortality, life expectancy, and preventable deaths. In other words, we are spending huge amounts of money, but what we are getting for that investment does not compare well to many other countries that spend a lot less than we do.
As the health care debate heats up in Washington, we as a nation have to answer two fundamental questions.
First, should all Americans be entitled to health care as a right and not a privilege? That is the way every other major country treats health care and the way we respond to such other basic needs as education, police, and fire protection. One hundred or more years ago, this country decided that every young person, regardless of income, is going to get a primary and secondary education because that is the right thing to do and good for the country. But unlike every other major industrialized Nation, we have not come to that same conclusion that health care is a right.
Second, if we are to provide quality health care to all, the next question is, how do we accomplish that in the most cost-effective way possible? We can provide health care to all people in a lot of ways, but some of those ways will essentially bankrupt this country. What is the most cost-effective way to provide quality health care to every man, woman, and child in this country?
In terms of the first question I asked: Should all Americans be entitled to health care as a right, I think the answer to that question is pretty clear and is, in fact, one of the reasons Barack Obama was elected President of the United States. Most Americans do believe all of us should have health care coverage and that nobody should be left out of the system. The real debate is how we accomplish that goal in an affordable and sustainable way. In that regard, I think the evidence is overwhelming that we must end the private insurance company domination of health care in our country and move toward a publicly funded, single-payer, Medicare-for-all approach.
Our current private health insurance system is the most costly, wasteful, complicated, and bureaucratic in the world. Its function is not to provide quality health care for all of our people but to make huge profits for the people who own the companies. That is what private health insurance is about. With thousands of different health benefit programs designed to maximize profits, private health insurance companies spend an incredible 30 percent of each health care dollar on administration and billing. Thirty cents of every dollar is not going to doctors, nurses, medicine, medical personnel; it is going to bureaucracy and administration. Included in that spending are not only general administration and billing but exorbitant CEO compensation packages, advertising, lobbying, and campaign contributions. Public programs such as Medicare, Medicaid, and the VA are administered for far less money.
In recent years, while we have experienced an acute shortage of primary health care doctors as well as nurses, as well as dentists, and many other health care personnel, we are paying for a huge increase in health care bureaucrats and bill collectors. Over the last three decades, the number of administrative personnel has grown by 25 times the number of physicians. Instead of investing in primary health care, instead of investing in doctors, instead of addressing the nursing shortage, where our health care dollars are going is to health insurance bureaucrats who spend half their lives on the telephone telling us we are not covered for the procedures we thought we had paid for. That is a dumb way to spend health care dollars.
Further, and not surprisingly, while health care costs are soaring, so are the profits of private health insurance companies. From 2003 to 2007, the combined profits of the Nation's major health insurance companies increased by 170 percent. Health care costs are soaring; people can't afford health insurance. Yet the profits of the private health insurance companies have gone up by 170 percent from 2003 to 2007. While more and more Americans are losing their jobs and their health insurance, the top executives in the industry are receiving lavish compensation packages. It is not just William McGuire, the former head of United Health, who several years ago accumulated stock options worth an estimated $1.6 billion, or CIGNA CEO Edward Hanway, who made more than $120 million in the last 5 years. It is not just them. It is the reality that CEO compensation for the top seven health insurance companies now averages $14.2 million. Forty-six million Americans have no health insurance, more are underinsured, and we apparently have the money to pay exorbitant compensation packages to the heads of private health insurance companies.
Moving toward a national health insurance program, which provides cost-effective, universal, comprehensive, and quality health care for all, will not be easy. That is an understatement. It will not be easy. The powerful special interests, the insurance companies, the drug companies, and the medical equipment suppliers, among others, will wage an all-out fight to make sure we maintain the current system which enables them to make billions and billions of dollars every year in profits.
In recent years, these special interests have spent hundreds of millions of dollars on lobbying, on campaign contributions, and advertising, and with unlimited resources. They can make out a check as big as they need. They will continue to spend as much as they need in order to preserve this dysfunctional health care system from which they profit so much.
But at the end of the day, as difficult as it may be, the fight for a national health care program will prevail. Like the civil rights movement, the struggle for women's rights, and other grassroots efforts, justice in this country is often delayed, but it will not be denied. We shall overcome.
Mr. President, I yield the floor and suggest the absence of a quorum.
Please, don't get bamboozled once again. Contact your House representative and your two senators. Tell them you want a single-payer national health care system once and for all or, at the very least, that we all be provided with the option to enroll in Medicare. Give us choice, real choice!
Rep. John Coyers's informative health care pages (includes an excellent FAQ as well as the text of H. R. 675, and its supporters)
hr676.org: The Citizens Alliance for National Health Insurance
If you find Gilles d'Aymery's work valuable, please consider