MARIN INDEPENDENT JOURNAL

Esther Wanning: Crushing burden of health care
Article Launched: 03/29/2007 11:05:01 PM PDT

EVERY HOLIDAY involves a time of reckoning. At Christmas, we look for goodness; on Martin Luther King for justice; on Memorial Day for self-sacrifice.

On April Fool's Day, we look for foolishness. This brings me to the American health-care system. We pay twice as much for health care ($7,129 per capita, 16 percent of the GNP ) as other developed countries do - and we get less and poorer health care.

There are no controls on the soaring costs. National health-care spending is expected to double over the next 10 years, while vast numbers remain uninsured and underinsured. Meanwhile, 40 percent of the time patients do not get recommended treatment, hospital infections are rife, mistakes are commonplace, patients are overtreated or undertreated, depending on their insurance policies, and doctors and nurses are quitting in disgust.

"The system is indefensible and unsustainable," a Wall Street Journal editorial said in December.

We could instead do as many other countries do: Provide health insurance for everybody under one public system, eliminating health-insurance companies and their massive paperwork and expensive overheads. Medical providers would remain private but would no longer need a phalanx of billing clerks.

All patients would be covered for all their medical needs, and all the funds would come from the same place.

There are many other reasons for such a "single-payer system." The health agency could direct funds where needed, preserving hospitals in poor areas. We could have a cooperative system instead of a competitive system. Health care is different from other consumer entities; the buyer has little bargaining power, while the supplier can operate like the mafia.

Competition in health care often drives prices up, while operators wrangle for dominant positions, overinvesting in expensive equipment, then creating the demand for it. One Medicare study reached this conclusion: "About a third of medical care is devoted to services that do not provide any detectable benefit."

Because there is no government entity setting standards, U.S. health providers are far behind other countries in computerization. Each separate entity limps along trying to invent its own system, with the result that rarely can one specialist call up the records of another. (Kaiser and the Veterans Administration single-payer systems are exceptions.)

Insurance companies have failed to keep costs down; it's not in their interest. They do want to minimize their own "medical losses," but their profits are a proportion of the whole, so the whole must be big. Where would the health-care industry be if everybody was healthy? Says medical ethicist Daniel Callahan: "The market is far better at meeting immediate short-term private interests than long-term collective needs."

The enormous lobby of the health-care profiteers, financed with the money we spend for health care, has succeeded in holding back reform. It greets any threat with the mantra, "Government can't do anything right."

You can't fool all of the people all of the time. We know that the best hospitals are public hospitals, that Medicare operates with a 3 percent overhead, that the National Institutes of Health produces the most important research. A well-designed and well-monitored public system could invest dollars far more wisely than insurance companies do, compensate providers fairly and equitably and plan for future needs.

The movement demanding such a system is growing by leaps and bounds. State Sen. Sheila Kuehl's single-payer bill for California passed the Legislature last year and was vetoed by the governor. Kuehl has reintroduced the bill. You can sign a petition endorsing it at www.onecarenow.org.

The OneCareNOW campaign is holding an event advocating for single-payer in a different city in California every day for 365 days in a row. On Sunday, the campaign comes to San Rafael with a "Health Care (for All) Fair." Seven major organizations will have booths, Barry Massie, MD, will speak, along with Assemblymen Jared Huffman and Mark Leno. There will be entertainment and song and lots of information about a single-payer system.

Only fools would continue to put up with our wasteful, tragic system. Come join us at 2:30 p.m. at the First Presbyterian Church of San Rafael at Fifth and E streets and learn about reforming our foolish health-care system.

Esther Wanning is the director of the Marin chapter of Health Care for All-CA. Call 479-7523 for more information about the April 1 event.

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