Samuel Uretsky

Bad Penny

You can't copyright titles. That's why it's okay to call the History of the Bush Administration "When Bad Things Happen to Good People." You could also use "An American Tragedy." Of course Fyodor Dostoevsky had a good title too, but it doesn't pay to get personal.

On Jan. 20, 2007, President Bush began his weekly radio address to the nation saying "Americans are fortunate to have the best health care system in the world. The government has an important role to play in our system. We have an obligation to provide care for the most vulnerable members of our society -- the elderly, the disabled, and poor children and their parents. We are meeting this responsibility through Medicare, Medicaid, and the State Children's Health Insurance Program. We must strengthen these vital programs so that they are around when future generations need them."

This statement alone would cement the president's reputation for living in a bubble. In a World Health Organization study of the comparative efficiency of health care distribution in 191 countries, the United States managed to rank 72nd, comfortably in the fourth tier. Among the nations that made a better showing were Iran and Bosnia. Admittedly these results may be out of date, they were based on data from 1993 to 1997, but this was the period when President Clinton's efforts to develop a universal health care system were blocked through the combined efforts of politicians who don't believe in universal health care and insurance companies who don't believe in reduced profit margins. The one area of health care where the US can proudly say "we're number 1" is cost. By any measure, in absolute dollars as a percentage of the national economy, the US spends twice as much on health care as any other nation.

One of the most dramatic indictments of the US health care distribution system was published by BMJ, formerly the British Medical Journal, and compared health inequality in the US and Canada. This study, too, used pre-Bush data, but since the Bush administration has overseen increasing income inequality and cutbacks in availability of health care, it seems safe to assume that things haven't improved. In the US, mortality rates were closely linked to income, particularly among the urban working poor. The study concluded that a 1% increase in income among this population would reduce the death rate by 21 for every 100,000 people. In Canada, a first-tier nation, there was no comparable link between life span and income. It's true that money can't buy good health, but it can buy a healthful diet. A male born in the US in 1993 can expect to survive to the age of 73. If he had just managed to make it across the border, his projected lifespan would have been 76 years &endash; and of course, these are averages, calculated as the mean. Any Canadian male could expect to make it to 76 &endash; in the US the rich live longer.

The US health system has been in disrepair for decades, and it has finally become a crisis situation. Does President Bush have a solution? Unfortunately, he does. In part, the president has revived his plan to reduce medical malpractice awards. He has also proposed: "We need to fix these problems, and one way to do so is to treat health insurance more like home ownership. The current tax code encourages home ownership by allowing you to deduct the interest on your mortgage from your taxes. We can reform the tax code, so that it provides a similar incentive for you to buy health insurance." Translation: make health insurance premiums deductible. This will certainly benefit people who are already paying for health insurance, but it's not going to make health insurance affordable to those who don't have it now. The 40+ million Americans without health insurance are, for the most part, citizens with full-time jobs, sometimes two full-time jobs, so that they're not poor enough for Medicaid, but not rich enough for private insurance. For the most part, these are people who lack the education needed to get jobs that provide health benefits.

As the Wall Street Journal has famously noted, the poor are Lucky Ducks who have avoided paying taxes by the simple device of not having money. The rich have to hire lawyers and accountants to avoid paying taxes &endash; the poor get these benefits for free. Making health premiums deductible will be a nice break for a few people, but for the 40+ million this won't help. It will maintain our current system of health care financing, making it just a little bit harder to convert to the kind of centralized single-payer system used by real first-world nations.

You could make a top 10 list of possible titles for a history of the Bush years. Alan Paton's Cry the Beloved Country, and then there's the 1979 Steve Martin movie &endash; but it doesn't pay to get personal.

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

From The Progressive Populist, March 1, 2007

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