Political Bargains

The February 2004 issue of Governing magazine, a periodical aimed at state and local government officials, carries a damning condemnation of the American health-care system. The information isn't surprising, just distressing. President John Kennedy said "When we got into office, the thing that surprised me the most was that things were as bad as we'd been saying they were." It turns out that when it comes to health care in the USA, the nattering nabobs of negativism were right on the money. The Governing article begins: Medicine in the US is enjoying a surge of innovation and creativity that promises continuing improvements in everyday life for millions of people -- but it is being thwarted by federal and state health care systems incapable of delivering those improvements fairly and consistently to much of the American public. To be blunt, Americans are living with first-rate medicine and a third-rate health care system. And the problem is getting worse instead of better.

No surprises there. When the UN measured the efficiency of health care distribution programs, the US finished behind Costa Rica, and in a statistical dead heat with Slovenia. While we're regularly treated to feel-good reports of children from poorer nations coming to the US for life-saving surgery, we fail to provide proper care for our own children. We can work miracles, one patient at a time, but when it comes to routine care of the general population, we fail.

Wealthy Canadians head for the US for medical treatment, since they can get needed care more quickly than if they wait for their national health service to get around to them &endash;- but Canadians can afford to wait, they live longer than the people of the US. As a nation, we have the greatest health care resources in the world, if you can just get to them. Most people can't.

According to PoliticalMoneyLine, in 2001-2002, insurance companies donated over $37 million to candidates, 69% for Republicans. With or without double coupons, the best bargain you can buy is an American politician. 

The sad fact is that about 50% of the money spent on health care is wasted. The money doesn't go to paying physicians and nurses, it doesn't go towards buying sophisticated diagnostic equipment, it's spent on the paperwork of submitting claims to hundreds of insurers, each with their own forms, each with their own rules, each with their own levels of inefficiency. It goes towards a system that requires health care providers to keep track of every syringe, pill, and bandage.

Meanwhile, those who can't afford to buy into the system, are increasingly subject to the sort of treatment that would give the sheriff of Nottingham a bad name. There's an almost tragic lack of awareness across economic classes in the US. The middle class, or what's left of it, is composed of good, generous people, who still believe in Norman Rockwell magazine covers and Hallmark cards. They believe, in all sincerity, that as a society we take care of our poor. Now and then, when things get tight, when the bills for college tuition come in, there's even a resentment of the poor, who seem to be getting a free ride in education, housing and health. They're not &endash; but the Neocons have done a great job of hiding the truth. To the extent that the Neocons are themselves middle-class, hard-working people, they've hidden the truth even from themselves.

The rich, who are getting the benefits, may know better, but with a few exceptions they're too far removed from the poor to be aware of hunger, ignorance and disease.

On Feb. 6, the Los Angeles Times reported that California is planning the shutdown of a program for treating low-income men with prostate cancer. There are 320 men now in the program, with another 20 on a waiting list. All have prostate cancer and an annual income of under $18,000. The day before, the Portland Oregonian reported that 58% of the voting population had rejected a proposal for an income tax increase needed to fund the Medicaid program. The tax would cost a family with an income of $41,000 a year about $36.

On Feb. 3, the New York Times reported on the "scores of companies" that have stopped providing medical coverage to their retirees. In some cases, this only applies to newly-hired personnel, who at least have fair warning, but in other cases the benefit is being withdrawn from people who depended on their company's good faith.

In Texas, a newborn infant must wait 90 days before being entered into the state's SCHIP program for medical care for poor children. This state dropped 54,000 children from health care coverage in the first 6 months of 2002. In 2001, North Carolina put 34,000 children on a waiting list for health coverage.

The Governing report is a clear indictment of our health care distribution system, and the section on coverage for pregnant women and children raises questions about our basic morality.

In its Feb. 9 issue, The New Yorker quoted Gov. Howard Dean as concluding one of his speeches, not with his usual "we want our country back", but with the words "The most important thing is the human soul and we want that back." Amen.

Sam Uretsky is a writer and pharmacist living on Long Island, N.Y.

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