By Dave Lindorff

If you want to fix the disaster that is called the American
healthcare system, the first thing to do is to clearly point out what
its major failings are, and there are two of these.

The first is cost. America is one of the or possibly the most
expensive places in the world to get sick or injured. The corollary of
that is that it is one of the best places to make a killing if you are
in the medical business, whether as a doctor, a hospital company, a
pharmaceutical firm or a nursing home owner.

The second is access. One in six Americans—a total of 50 million
people at latest count—have no way to pay for that care. Too young for
Medicare, too “well off” for Medicaid, but too poor to buy private
health insurance or too sick to be admitted into a plan, or employed by
a company that doesn’t provide health benefits, these people get no
medical care until they get so sick that they are brought into a
hospital emergency room where they get treated (often too late) at
public expense, or at the hospital’s expense, with the cost shifted
onto taxpayers or onto insured patients’ premiums.

Any reform of this atrocious “system” must address these two major failings or it is no reform at all.

And that’s where all the various versions of Obamacare fall flat.

Simply put, you cannot solve either of these problems by leaving
the payment system for medical care in the hands of the private
insurance industry, since the whole paradigm of insurance is to make
money by keeping high-risk people out of the insured pool, and by
keeping reimbursements and coverage for premium payers as low as
possible.

Having a so-called “public option” plan working in competition with
private insurance plans will not solve this problem. Either the public
option will become like the private options—trimming benefits and
rejecting some applicants—or it will become a dumping ground for all
the high-cost, high-risk people that the private sector insurance
industry doesn’t want. At that point, the public plan will become a
huge cost burden on the taxpayer, who will begin demanding that it cut
back in the benefits it provides, taking us right back to where we
started.

The fact that the Obama administration and the Democratic Congress
are both raising the issue of the high cost of health care “reform,”
and are talking about ways to raise revenues to pay for it
tells us all we need to know about the alleged “reform” schemes they
are contemplating. They are doomed and, even if implemented, will not
work.

Real reform of the American health care system would not cost money. It would save money.

There is a level of dishonesty in what passes for the debate over
health care “reform” in both Congress and the media that is stunning in
its brazenness and/or venality.
Of course real reform would cost more in government spending. But that
is because real reform would remove the cost of medical care from both
employers and from workers (who over the last 20 years have been
shouldering an increasing share of their own medical care). And that
shift would mean more profits for US companies, which would free up
more money for wages, and it would mean less money deducted from
paychecks, meaning higher incomes for workers.

If President Obama had any political courage at all, he’d simply
get on TV and say this: I will create a plan that will cover everyone,
lift the burden of paying for healthcare from individuals and
employers, and have the government pay for it all. You the taxpayer
will pay for this plan with higher taxes, but you will no longer have
any significant medical bills, you will no longer have health insurance
premiums deducted from your paycheck, your employer will no longer be
paying for employee medical coverage, and you will never have to worry
about losing health benefits again, even if you are laid off.
(Incidentally, eliminating employer-funded health insurance would go a
long way towards allowing workers to fight to unions, and to strike for
contracts, by ending the threat that they would lose their benefits.)

Of course, to do that the president would have to be talking about
what is variously known as national health care or a single-payer plan,
in which the government is the insurer of health care for all.

This option isn’t even being discussed in this so-called debate. As
I’ve written earlier, even though there is an excellent single-payer
system in place that has been running for a third of a century just to
the north in Canada—a system where patients have absolute freedom to
choose their doctor, get instant access to a hospital and to expert
specialist care in emergencies, and have a healthier society by every
statistical measure—all at a fraction of the staggering cost of
healthcare in the US, not one Canadian expert working in that system
has been invited down to discuss its workings with the White House or
with members of Congress.

There has been a lot of negative propaganda spread about Canada’s
single-payer system, by right wing, business-funded “no-think” tanks,
and by medical industry lobbies from the American Medical Assn. to the
pharmaceutical industry, but no government committee or agency has
bothered, or dared, to bring in Canadian experts to respond to and
debunk that propaganda. The corporate liars talk about waiting lists
and lack of access to CAT-scan or MRI machines. But all we really need
to know about the Canadian, and other similar single-payer systems, is
that nowhere that they have been instituted have they been later
terminated, even when, as in Canada, right-wing governments have been
elected to power. The public, whether in Canada, or France, or England,
or Taiwan or elsewhere, loves their public health insurance system,
whatever flaws or problems with underfunding those systems may have at
certain times. Trying ot eliminate such systems would be political
suicide for a conservative government, as even arch-free-marketer
British Prime Minister Margaret Thatcher, who never me a government
activity that she didn’t want to privatize, learned.

Right now, with half of all Americans reportedly fearing that they
could lose their jobs, and with one in five Americans reportedly either
unemployed, or involuntarily working part-time, we have a situation
where a majority of Americans either have no health insurance, have
lost their health insurance, or are in danger of losing their
employer-funded health insurance. It is a unique moment when a bold
president and Congress could act to end private health insurance and
establish a public single-payer insurance plan to insure and provide
access to affordable medical care to all Americans.

Instead of this, we are being offered half measures or no measures
at all by leaders who are shamelessly in hock to the health care
industry or who are afraid of its power.

17 years ago, the Clintons had a similar opportunity to grab the
health care industry by the neck, strangle it, and produce a
single-payer alternative. They blew that chance by trying to keep the
health care greed-heads happy. Now, almost a generation later, we have
another shot at it, and Obama and his Democratic Congress are doing the
same thing again. There is a strong likelihood that they will fail,
like the Clintons before them. If they succeed in coming up with some
kind of hybrid public-private Frankenstein of a system that includes a
public insurance option, it will simply delay the inevitable disaster,
as medical costs, already 20 percent of GDP—the highest share of any
economy in the world—continue to soar, and as the cost of the public
plan, which will inevitably become a dumping ground for high-cost
patients, becomes politically untenable. In the end, we will have even
more expensive and inaccessible healthcare than we have today.

It doesn’t have to be this way, but only if Americans rip their
eyes away from their crisp new digital-image TV screens and start
demanding real health care reform will we get honest reform. A good
place to begin would be to start writing and phoning your local media
outlets to ask why they are not reporting on single-payer, and in
particular on the single-payer bill sponsored by Rep. John Conyers
(D-MI), which is being silently blocked and killed by his colleagues in
the Democratic congressional leadership and by the White House. A good
place to begin would also be to start calling your elected
representatives to demand that they support Rep. Conyers’ single-payer
bill.

___________________
DAVE LINDORFF is a Philadelphia-based journalist. His is author of
the critically acclaimed book “Marketplace Medicine: The Rise of the
For-Profit Hospital Companies” (Bantam Books, 1992). His latest book is
“The Case for Impeachment” (St. Martin’s Press, 2006). His work can be
found at www.thiscantbehappening.net