Magazine" -- --
For Joel Segal, it was the day he was kicked out of
George Washington Hospital, still on an IV after knee
surgery, without insurance, and with $100,000 in medical
debt. For Kiki Peppard, it was having to postpone needed
surgery until she could find a job with insurance -- it
took her two years. People all over the United States
are waking up to the fact that our system of providing
health care is a disaster.
An estimated 50 million
Americans lack medical insurance, and a similar and
rapidly growing number are underinsured. The uninsured
are excluded from services, charged more for services,
and die when medical care could save them -- an
estimated 18,000 die each year because they lack medical
But it's not only the uninsured who suffer. Of the
more than 1.5 million bankruptcies filed in the U.S.
each year, about half are a result of medical bills; of
those, three-quarters of filers had health insurance.
Businesses are suffering too. Insurance premiums
increased 73 percent between 2000 and 2005, and per
capita costs are expected to keep rising. The National
Coalition on Health Care (NCHC) estimates that, without
reform, national health care spending will double over
the next 10 years. The NCHC is not some fringe advocacy
group -- its co-chairs are Congressmen Robert D. Ray
(R-IA) and Paul G. Rogers (D-FL), and it counts General
Electric and Verizon among its members.
Employers who want to offer employee health care
benefits can't compete with low-road employers who offer
none. Nor can they compete with companies located in
countries that offer national health insurance.
The shocking facts about health care in the United
States are well known. There's little argument that the
system is broken. What's not well known is that the
dialogue about fixing the health care system is just as
Among politicians and pundits, a universal, publicly
funded system is off the table. But Americans in
increasing numbers know what their leaders seem not to
-- that the United States is the only industrialized
nation where such stories as Joel's and Kiki's can
And most Americans know why: the United States leaves
the health of its citizens at the mercy of an expensive,
patchwork system where some get great care while others
get none at all.
The overwhelming majority -- 75 percent, according to
an October 2005 Harris Poll -- want what people in other
wealthy countries have: the peace of mind of universal
A wild experiment?
Which makes the discussion all the stranger. The
public debate around universal health care proceeds as
if it were a wild, untested experiment -- as if the
United States would be doing something never done
Yet universal health care is in place throughout the
industrialized world. In most cases, doctors and
hospitals operate as private businesses. But government
pays the bills, which reduces paperwork costs to a
fraction of the American level. It also cuts out
expensive insurance corporations and HMO's, with their
multimillion-dollar CEO compensation packages, and
billions in profit. Small wonder "single payer" systems
can cover their entire populations at half the per
capita cost. In the United States, people without
insurance may live with debilitating disease or pain,
with conditions that prevent them from getting jobs or
decent pay, putting many on a permanent poverty track.
They have more difficulty managing chronic conditions --
only two in five have a regular doctor -- leading to
poorer health and greater cost. The uninsured are far
more likely to wait to seek treatment for acute problems
until they become severe.
Even those who have insurance may not find out until
it's too late that exclusions, deductibles, co-payments,
and annual limits leave them bankrupt when a family
member gets seriously ill.
In 2005, more than a quarter of insured Americans
didn't fill prescriptions, skipped recommended
treatment, or didn't see a doctor when sick, according
to the Commonwealth Fund's 2005 Biennial Health
People stay in jobs they hate -- for the insurance.
Small business owners are unable to offer insurance
coverage for employees or themselves. Large businesses
avoid setting up shops in the United States -- Toyota
just chose to build a plant in Canada to escape the
skyrocketing costs of U.S. health care.
All of this adds up to a less healthy society, more
families suffering the double whammy of financial and
health crises, and more people forced to go on
disability. But the public dialogue proceeds as if
little can be done beyond a bit of tinkering around the
edges. More involvement by government would create an
unwieldy bureaucracy, they say, and surely bankrupt us
all. The evidence points to the opposite conclusion.
The United States spends by far the most on health
care per person -- more than twice as much as Europe,
Canada, and Japan which all have some version of
national health insurance. Yet we are near the bottom in
nearly every measure of our health.
The World Health Organization (WHO) ranks the U.S.
health care system 37th of 190 countries, well below
most of Europe, and trailing Chile and Costa Rica. The
United States does even worse in the WHO rankings of
performance on level of health -- a stunning 72nd. Life
expectancy in the U.S. is shorter than in 27 other
countries; the U.S. ties with Hungary, Malta, Poland,
and Slovakia for infant mortality -- ahead of only
Latvia among industrialized nations.
The cost of corporate bureaucracy
Where is the money going? An estimated 15 cents of
each private U.S. health care dollar goes simply to
shuffling the paperwork. The administrative costs for
our patched-together system of HMO's, insurance
companies, pharmaceutical manufacturers, hospitals, and
government programs are nearly double those for
single-payer Canada. It's not because Americans are
inherently less efficient than Canadians -- our publicly
funded Medicare system spends under five cents per
budget dollar on administrative overhead. And the
Veterans Administration, which functions like Britain's
socialized medical system, spends less per patient but
consistently outranks private providers in patient
satisfaction and quality of care.
But in the private sector, profits and excessive CEO
pay are added to the paperwork and bureaucracy. The U.S.
pharmaceutical industry averages a 17 percent profit
margin, against three percent for all other businesses.
In the health care industry, million-dollar CEO pay
packages are the rule, with some executives pulling down
more than $30 million a year in salary and amassing
billion-dollar stock option packages.
Do those costs really make the difference?
Studies conducted by the General Accounting Office,
the Congressional Budget Office, and various states have
concluded that a universal, single-payer health care
system would cover everyone -- including the millions
currently without insurance -- and still save billions.
Enormous amounts of money are changing hands in the
health-industrial complex, but little is going to the
front line providers -- nurses, nurse practitioners, and
home health care workers who put in long shifts for low
pay. Many even find they must fight to get access to the
very health facilities they serve.
Doctors complain of burnout as patient loads
increase. They spend less time with each patient as they
spend more time doing insurance company mandated
paperwork and arguing with insurance company bureaucrats
over treatments and coverage.
Americans know what they want
In polls, surveys, town meetings, and letters, large
majorities of Americans say they have had it with a
system that is clearly broken and they are demanding
universal health care. Many businesses -- despite a
distaste for government involvement -- are coming to the
same view. Doctors, nurses, not-for-profit hospitals,
and clinics are joining the call, many specifically
saying we need a single-payer system like the system in
Canada. And while we hear complaints about Canada's
system, a study of 10 years of Canadian opinion polling
showed that Canadians are more satisfied with their
health care than Americans.
Holly Dressel's article on Cada's system shows why.
Although you'd never know it from the American media,
the number of Canadians who would trade their system for
a U.S.-style health care system is just eight percent.
Again, the public dialogue proceeds from a perplexing
place. Dissatisfied Canadians or Britons are much talked
about. But there's little mention of the satisfaction
level of Americans. The Commonwealth Fund's survey, for
instance, shows that, in 2005, 42 percent of Americans
doubted whether they could get quality health care. At a
series of town hall meetings in Maine, facilitators
asked participants to discuss dozens of complex health
care policies but excluded single-payer as an option.
Tish Tanski's article about health insurance in
Maine) Only after repeated demands by participants was
the approach that cuts out the corporate middle-men
allowed on the list.
The same story played out across the country at town
meetings convened by the congressionally mandated
Citizens' Health Care Working Group. In Los Angeles, New
York, and Hartford, participants simply refused to
consider the questions they were given about tradeoffs
between cost, quality, and accessibility. They insisted
that there's already enough money being spent to pay for
publicly funded universal health care.
But it's not only about the money. Comments from
participants in the town meetings, from Fargo to
Memphis, from Los Angeles to Providence, revealed an
understanding that this is about a deeper question. It
is an issue of the sort of society we want to be -- one
in which we all are left to sink or swim on our own or
one in which we recognize that the whole society
benefits when we each can get access to the help we
Likewise, when we asked readers of the YES! email
newsletter what would make you healthier, nearly all
answered in terms of "we." Any one of us could get sick
or be injured. Any one could lose a job and with it
insurance. Our best security, they said, is coverage for
What form might this take?
As elections near and the issue of health care tops
opinion polls as the most pressing domestic issue,
various proposals for universal health care are
circulating. The bipartisan NCHC looked at four options:
employer mandates, extending existing federal programs
like Medicaid to all those uninsured, creating a new
federal program for the uninsured, and single-payer
national health insurance. All the options saved
billions of dollars compared to the current system, but
single payer was by far the winner, saving more than
$100 billion a year.
Meanwhile, the Citizens' Health Care Working Group,
which held those town meetings around the country, has
issued interim recommendations. They state the values
participants expressed: All Americans should have
affordable health care, and assuring that they do is a
shared social responsibility. Sadly, that bold statement
is followed by inconclusive recommendations: more study,
no preference for public funding, and a strong
commitment to get everybody covered by 2012--but with no
means to do it. The commission will make final
recommendations to the president and Congress, and is
accepting public comment through the end of August.
What is the obstacle?
With all the support and all the good reasons to
adopt universal health care, why don't we have it yet?
Why do politicians refuse to talk about the solution
people want? It could be the fact that the health care
industry, the top spender on Capitol Hill, spent $183.3
million on lobbying just in the second half of 2005,
according to PoliticalMoneyLine. com. And in the
2003-2004 election cycle, they spent $123.7 million on
election campaigns, according to the Center for
Politicians dread the propaganda barrage and
political fallout that surrounded the failed Clinton
health care plan. But in the years since, health care
costs have outpaced growth in wages and inflation by
huge margins, Americans have joined the ranks of the
uninsured at the rate of 2 million each year, and
businesses are taking a major competitiveness hit as
they struggle to pay rising premiums.
Healthcare-Now is holding town hall meetings
throughout the United States (they've held 93 so far),
and people are pressing their representatives to take
action. Over 150 unions have called for action on
universal health care, and polls show overwhelming
majorities of Americans feel the same way.
Some political leaders are pressing for universal
health care. Remember Joel, who was kicked out of the
hospital with $100,000 in medical debt? He started
giving speeches about the catastrophe of our health care
system, and eventually got hired by Rep. John Conyers
(D-MI) to head his universal single payer health care
effort. Conyers' "Medicare for All" bill now has 72
co-sponsors. Rep. Jim McDermott's (D-WA) Health Security
Act has 62.
Around the United States, state and local campaigns
for universal health care are making progress. (See
Rev. Linda Walling's update).
One of these days, the lobbyists and their clients in
government may have to get out of the way and let
Americans join the rest of the developed world in the
security, efficiency, and quality that comes with health
care for all.
Health Care Options at a Glance chart comparing
Socialized vs Single-Payer vs Nonprofit Multi-Payer vs
Corporate Health Care.
Reprinted from "Health Care For All," the Fall 2006
YES! Magazine, PO Box 10818, Bainbridge Island, WA
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Sarah van Gelder is Executive Editor of YES!
Magazine. Doug Pibel is Managing Editor of YES!