"Change" you say?

Part 8: Healthcare William C. Shelton (The opinions and views expressed in the commentaries of The Somerville News belong solely to the authors of those commentaries and do not reflect the views or opinions of The Somerville News, its staff or publishers.) Every humane society in the world today with the means to do so provides healthcare to all of its citizens, except for the United States of America. And "if we had set out to design the worst system that we could imagine, we couldn't have imagined one as bad as we have," says Marcia Angell, former editor-in-chief of the New England Journal of Medicine. The U.S. health care system is the most expensive in the world on both a per-person basis-$7-8,000-and as a percentage of the total economy-15-16%. Switzerland's, the next-most-expensive system's, per-person costs are 56% of ours. Canada's are 44%; Great Britain's, 22%. Yet 47 million U.S. residents have no health insurance, and the numbers keep growing. Back in the economy's boom days, more than half of all personal bankruptcies were the result of medical emergencies. While American healthcare is the most costly, its outcomes are shameful. The United Nations ranks U.S. life expectancy at 29th in the world and our infant mortality rate at 33rd. Our own CIA puts these rankings at 45th, and 42nd respectively. The World Health Organization ranks the U.S. 37th in health system performance, between Costa Rica and Slovenia. Our system's staffing levels are low, and it lacks safety controls, putting staff and patients at risk. Estimates of annual deaths resulting from medical errors range from 48,000 to 98,000. Virtually every analyst who studies the entire system from a perspective free of self-interest and ideological presuppositions concludes that a single-payer healthcare system is the best solution. In such a system, the government negotiates contracts with doctors and hospitals and pays their bills. Citizens pay for healthcare through the kind of payroll tax that now funds Medicare. Propagandists and fools call this "socialized medicine," but that would be a system that is owned by the government and employs the doctors. The Veterans Administration is socialized medicine. A single-payer system is not. From statistics already cited, it should be clear that single-payer systems produce better health outcomes. By covering everyone and emphasizing preventative care, many health problems never arise, while those that do can be identified at an early stage, where treatment is more effective and less expensive. Single-payer plans can also disseminate and encourage best practices. Mitchell Selzer, a leading hospital consultant studied the practice profiles of 24,000 physicians treating 1.5 million patients. He found that a subgroup of those doctors studied consistently admitted, diagnosed, and treated patients using 20-to-30% fewer resources and incurring correspondingly lower costs than the average doctor studied. Yet this group produced better care-fewer errors, shorter stays, fewer infections, fewer readmissions, fewer deaths. Preventative care and best practices are not the only reasons why single-payer is less expensive. A landmark Harvard Medical School study determined that some 30% of healthcare dollars go to administrative costs. Health insurance companies dispute this figure, citing an industry-average administrative expense of 15 percent. But they don't acknowledge that healthcare practitioners absorb the expenses required to deal with insurance companies. By comparison, Medicare's administrative costs are 1%. And insurance companies don't have the will or bargaining power to negotiate the kind of prices that send Americans to Canada to purchase their prescription drugs. Single payer is a fiscally conservative solution. Between decreased healthcare costs and increased taxes, Americans would spend less. And American businesses would be more competitive. General Motors' healthcare costs are $1,500 for every car that it manufactures. I began this series during the elections, when the word most often on presidential candidates' lips was "change." My intent was to show that in every policy area, a fundamental transformation of our economic and political institutions would be required to achieve the basic conditions that all Americans should expect. Single-payer healthcare is an excellent example in that its implementation would not require such fundamental change. But apparently, its adoption would. Instead, policy makers support piecemeal solutions that add large costs, reward those responsible for the mess, and do not solve the problem. The prescription drug benefit passed in 2003 comes to mind. A CBS News/New York Times poll published in February reported that 59% of Americans say the government should provide national health insurance. Other polls put this figure as high as 70%. Meanwhile, 59% was also the portion of doctors who told researchers for an Annals of Internal Medicine study that they support legislation to establish national health insurance. Opposing these citizens and doctors are lobbyists and publicists, well paid by the multibillion-dollar health insurance industry. In addition to broadcasting falsehoods that single-payer healthcare is a "socialized" system that would be more expensive and less effective, they say that consumers would have fewer choices. The reverse is true. Freed of restrictions imposed by their current medical plans, consumers could choose any doctor or hospital that they wanted, increasing competition. Politicians who posture as defenders of the people's interests quail in response to forces mobilized by health insurers. It's not just the huge campaign contributions that insurers can invest. Once something is considered to be politically unfeasible, it's suicidal for a politician, no matter how well established, to keep advocating it. He or she is considered to be hopelessly unrealistic and disloyal to the party. Journalists focus on politics rather than substance. They reflect opinion rather than inform it. They confuse objectivity with impartiality, uncritically quoting both sides of an issue and thereby passing along myths and lies. Forceful and consistent presidential leadership that continually points to hard evidence and poll results could defeat the health insurers, for-profit hospital chains, and right-wing ideologues. Instead, we are moving toward another piecemeal policy. In Canada, politicians had the courage and vision to say to health insurers, "you're out of business. You have a much better chance to find new work than citizens have to improve their health under the current system." In the United States, we allow an industry with 140,000 agents to kill policies that would benefit 250 million Americans.