Business Sense, Common Sense and Health Care

By Morton Mintz

Sponsored by the Western Pennsylvania Coalition for Single-Payer Healthcare at Carnegie Mellon University, Pittsburgh, April 11, 2007

My thanks to all of you for coming here today. I'm honored to have the chance to be with you.

Laughs are in chronic short supply, so I hope to be forgiven for telling one of the worst jokes you've ever heard.

A church needed a bell-ringer. It put a help-wanted ad in the paper, but only one man responded. He had no arms. The priest said, gently, "Sir, um, with all due respect, would you, um, tell me how you could do the job?" The armless man replied, "Don't worry." The church, an equal-opportunity employer, hired him.

The armless man's technique was simple: running full speed into the bell. This worked once and, sort of, a second time. Each Sunday after that, for reasons you can imagine, the bell sounded more and more faintly. Finally came the morning when the valiant man sprinted as fast as he could toward the bell. But his vision no longer being the best, he missed it altogether, went out the belfry, and plunged to his death.

A crowd gathered. A police officer asked, "Can anyone identify this man?" A woman answered, "Well, I don't know his name, but his face sure rings a bell."

I have an excuse for telling this groaner. Think of the bell needing a ringer as universal health care. Think of the armless man charging at it as employment-based health care. Think of the plunge as employment-based health care in its death spiral.

Less than a month ago, on "60 Minutes," the head of the Government Accountability Office, David Walker, summed up our situation:

"On cost we're number one in the world. We spend 50 percent more of our economy on health care than any nation on earth.

"We have the largest uninsured population of any major industrialized nation. We have above average infant mortality, below average life expectancy, and much higher than average medical error rates for an industrialized nation....

"It's the number one fiscal challenge for the federal government, it's the number one fiscal challenge for state governments and it's the number one competitive challenge for American business. We're gonna have to dramatically and fundamentally reform our health care system in installments over the next 20 years.

"And if we don't, it could bankrupt America."

Mountains of data back up Walker. Consider the inflation-adjusted national health expenditures projected last month by the Centers for Medicare and Medicaid Services. In less than 10 years these outlays will more than double--from $912.6 billion in 2006 to $2.81 trillion in 2016.

The origins of the health-care death spiral are illuminated by a little-known correspondence between two long-gone titans of industry, Lammot duPont, president of E.I. duPont deNemours, and Alfred P. Sloan, Jr., president of General Motors.

By 1929, Ford cars had safety-glass windshields. GM, however, persisted in using plain flat glass for Chevrolet windshields. These were cheaper. But on impact, they broke into shards that slashed and killed.

For sound business reasons, Lammot duPont urged Alfred Sloan to adopt safety-glass windshields for Chevrolets. E.I. duPont would profit by selling GM safety-glass components.

Also for sound business reasons, Sloan refused. He did not believe that protecting his fellow Americans from easily preventable bloodshed and death would be good for GM's bottom line. "Accidents or no accidents, my concern in this matter is a matter of profit and loss," he wrote Lammot duPont. Ford's use of safety glass, he continued,

"is no reason why we should do so. I am trying to protect the stockholders of General Motors and the Corporation's operating position--it is not my responsibility to sell safety glass...You can say that I am selfish, but business is selfish. We are not a charitable institution--we are trying to make a profit for the stockholders."

Sloan's conscience was clear. He was violating no law. Indeed, he was true to the letter and spirit of the law. A corporate director, the Library of Congress's American Law Division told a Senate committee in 1968, must

"exercise his unbiased judgment, influenced only by consideration of what is best for the corporation. ... Many courts have spoken of the rule as being that a director owes a loyalty that is undivided and an allegiance that is influenced in action by no consideration other than the corporation's."

I did not come here to discuss whether undivided loyalty to the stockholders is a good or bad idea for the country. Rather, I came to make this argument: Loyalty to the stockholders--a conservative capitalist principle if I've ever heard one -- demands that corporate directors and officers try to get the health-care monkey -- or 800-pound gorilla--off the backs of their companies. Had Corporate America heeded the demand, when it was duty-bound to do so, its overwhelming political power--its proven ability to govern the government--would have brought us universal health care long ago.

In the process, Corporate America would have lifted the gorilla off the backs of small businessmen, people who work for themselves, and solo practitioners (Disclosure: My architect son-in-law here in Pittsburgh is one of them.)

Instead, with big unions as collaborators, Corporate America opted for, and clung to, employment-based health coverage. It's a non-system, akin, says Dr. Deborah Richter,president of Vermont Health Care for All, to a business without a CEO, and without a budget, with a system that controls overall costs. It focuses excessively on payment for care of the sick, or, as Richter wryly calls it, "pay as you go."

The "nutshell problem" with this, Richter told me for my Nation article, is that it demands "a massive bureaucracy to limit individual utilization and to administer payments." Between 1970 and 2000, she pointed out, "[t[he number of healthcare administrators needed to limit individual utilization" increased 2,500 percent...while the number of doctors increased by only 150 percent. "Yet," Richter continued, "pay-as-you-go does not guarantee health care to each of us should we get sick or be injured, and "[p]eople who need disease management to avert, delay or moderate serious medical medical disorders don't get it."

Diabetics are an example. How can they get disease-management without health insurance? And how can they get that insurance when the game for insurers--which sure as hell are faithful to the shareholders--is to insure healthy people?

For a long time, employment-based health care, subsidized by a total tax exemption, worked--or seemed to work--tolerably well, as recalled just 10 days ago in the New York Times Magazine. Inevitably, though, it came more and more to resemble the battered armless man running at the bell. In the end, with Corporate America showing neither business sense, nor common sense, nor loyalty to the stockholders, employment-based health care plunged from the bell tower.

The consequences--the preventable consequences--have been horrendous, as you know. 47 million Americans without health insurance, more than one-third of them in households with family incomes of at least $40,000. In the past year, 29 of every 100 children with no coverage. Millions of people with inferior coverage. Millions more with shrinking coverage. An unending torrent of heartbreaking personal and family tragedies. More than half of all personal bankruptcies caused by sickness or unpaid medical bills. And terrible damage to U.S. competitiveness, the economy, and employment.

For some, though, the consequences have been just loverly. Take the top ten for-profit health insurers. The average annual pay of their top executives--way back in 2000--was $11.7 million, excluding unexercised stock options. And don't forget the long-term care providers who, as the Times reported recently, "have developed procedures that make it difficult--if not impossible--for thousands of policyholders to get paid before they die."

In my talk today, Alfred Sloan's iron dedication to the shareholders underpins a focus on three propositions that, I would argue, Sloan would accept.

ONE. It was in the enlightened self-interest of General Motors to embrace and advocate publicly-financed but privately-run health care, including free choice of physicians, for all Americans. By refusing for decades to do this, GM directors and officers, whatever their intentions were, have demonstrated a persisting disloyalty to GM stockholders. GM, Wal-Mart CEO H. Lee Scott Jr. said last year, "is no longer an automotive company. General Motors is a benefit company that sells cars to fund those benefits."

TWO. GM's efficiency-battering, bureaucracy-nurturing, self-destructive conduct, even if an extreme case, is nonetheless symbolic of Corporate America's conduct generally.

THREE. This conduct is a principal if neglected cause of America's health-care crisis.

In 2002, top executives of the Big Three automakers' Canadian divisions and the president of the Canadian Auto Workers union signed a "Joint Letter on Publicly Funded Health Care." "While providing "essential and affordable healthcare services for all," they wrote, single-payer "significantly reduces total labour costs...compared to the cost of equivalent private insurance services purchased by US-based automakers" and, in addition, "has been an important ingredient" in the success of Canada's "most important export industry."

The union compared the hourly labour costs of vehicle assembly in Canada and the United States. In U.S. dollars, the Canadian hourly rate--including wages, benefits and payroll taxes--was $29.90. The American rate was $45.60.

Of the nearly $16 difference, health care accounted for more than a quarter, saving Canadian employers, GM principally among them, $4 per hour per worker. Monthly health-coverage costs for Canadian employers average about $50, mostly for items such as eyeglasses and orthopedic shoes; For U.S. employers the same costs average $552, or 10 times as much, the Washington Post has reported.

In 2003 GM said that building a mid-sized car in the United States costs $1,400 more than than building the identical car in Canada. No mystery about this. GM covers health-care costs--costs not borne by foreign competitors--for a startling 1.1 million Americans.

The bill for this is awesome. In 2004 it was $4.8 billion--$1 billion more than earnings. In the same year, GM projected its costs for providing health-care benefits to current and future retirees at $63 billion.

In 2005, when GM lost $10.5 billion, health-care costs were adding $1,500 to the price of every GM vehicle--but only about $200 to the cost of every Toyota.

Ford's case is similar. In 2003, its health-coverage bill for 560,000 employees and their dependents and surviving spouses was $3.2 billion--more than six times net profits of $495 million.

CEO William Clay Ford was publicly upset. "Health care is out of control--it's a system that's broken," he said. He urged a national solution and directed vice chairman Allan Gilmour to craft a proposal.

Gilmour crafted mush. "We're going to have to have a national solution," he said. "That national solution does not mean, necessarily, national health care." Why not? Gilmour didn't say.

Two years later, GM chairman and chief executive G. Richard Wagoner Jr. became publicly upset, too. He delivered a stern warning:

"Failing to address the health care crisis would be the worst kind of procrastination, the kind that places our children and our grandchildren at risk and threatens the health and global competitiveness of our nation's economy."

Wagoner called on corporate and government leaders to find "some serious medicine." What would he ave them prescribe? He didn't say. He was re-heating the mush served up by William Ford and Allan Gilmour.

Wagoner wouldn't let the phrase single-payer escape his lips. Notably, however, it had escaped the lips of Jack Smith, who sat in his chair a decade earlier, and who, as a former president and general manager of GM Canada, had personally experienced the benefits of single-payer. A 1994 Times ad bought by single-payer advocates quoted Smith: "I personally favor single-payer."

It gets more embarrassing. At a press conference announcing the 2002 Canadian "Joint Letter," Michael Grimaldi, Smith's successor at GM Canada and a vice president of the parent corporation, hailed single-payer as "a strategic advantage for Canada."

The questions raised by all of this were glaringly obvious. Over many months in 2004, I put them repeatedly to a GM spokesperson. She provided no answers, refusing even to tell me how to contact Smith. (I located him but to no avail.). GM "does not support" single-payer, she told me. Why not? Because, she said, "[m]uch has changed in health care since Smith...made statements about universal, single-payer healthcare." What's changed? She wouldn't say. But hey, Ford's spokesperson didn't respond at all.

By contrast, Chrysler -- and DaimlerChrysler after the merger -- has regularly endorsed single-payer. It has done so since 1990, in a letter appended to its contracts with the United Automobile Workers. "A lot of people think a single-payer system is better," vice president Thomas Hadrych told the Washington Post.

A lot of people indeed. Two out of three Americans surveyed on a recent New York Times/CBS News poll said that all of us should have government-guaranteed health coverage. To get that coverage half would willingly accept a tax increase of $500, or more. They've met a tax increase they like.

What explains GM and Ford publicly hugging single-payer north of the border while fleeing from it south of the border? More fundamentally: What explains the stubborn, prolonged, and self-destructive refusal of most of Corporate America to demonstrate the leadership, business sense, common sense, and loyalty to stockholders that had the potential to prevent the health-care debacle?

I will offer some explanations, or partial explanations, I believe to be plausible. One is, or was, a political climate, which I'll summarize in three sentences: While Republicans controlled Congress, single-payer could not have been enacted. So long as they control the White House it cannot be enacted. Even a rapturous kiss by Rick Wagoner, William Clay Ford, and other corporate leaders would not have led, and would not lead, to its enactment before 2009.

I say this mainly for an unsurprising reason: The health-insurance, health-provider, pharmaceutical, and medical-device industries are always ready, able and willing to invest whatever it takes in lobbyists and campaign contributions to work their will in Washington and state capitols.

In 2003 alone, the Center for Public Integrity has reported, "298 pharmaceutical and health-industry groups spent $114 million lobbying the federal government [and] employed 1,274 professional lobbyists." That's nearly 2.4 lobbyists for every member of Congress. Many are former Senators or Representatives, as "60 Minutes" brought out in an excellent piece on April 1.

Since 1998, the Center also found, these groups had "lobbied on more than 1,400 congressional bills...and spent a whopping $612 million," while "the insurance industry...spent $543 million...and employed just over 2,000 lobbyists." For the drug and insurance industries, the stakes are so enormous that the dollar figure the Center called "whopping" is chicken feed.

In the last four election cycles, the same groups' campaign contributions--or, more accurately, investments--totaled $93,460,125, For the insurance industry the total was $146,374,074. Of the combined total of $239,834,199, the Center for Responsive Politics found, about two-thirds--between 64 and 74 percent--went to Republicans.

Walter Maher is a former vice president for public policy of DaimlerChrysler. In an interview for The Nation article, he made two related points.

The first was that any industry subject to government regulation "has got to be concerned about irritating the regulator." The Bush Administration is not distinguished by a reluctance to retaliate.

Maher's second point concerned the Buddy System.

The Business Roundtable is an association of 150 CEOs of the country's biggest corporations, which have combined annual revenues of $4.5 trillion. Among these corporations are, by my count, seven major pharmaceutical manufacturers and maybe a dozen health insurers and health-care providers.

"It's definitely fair to say that CEOs are very reluctant to take unpopular positions against their colleagues in the BRT," Maher told me. "If a huge majority of them are staunch conservatives who have no interest in health reform, or in using the government to control costs, or to expand coverage, or even to moderate health costs using regulatory tools, it'll be a rare CEO who will want to take on his CEO buddies. That's absolutely true." He went on to say: "It will be a cold day in hell when the BRT leads the charge for universal health coverage in the United States."

Prescription drugs open a window on the Buddy System as it involves General Motors. For many years, drugs have been a staggering, and the fastest-growing, share of GM's health-care costs. In 2000 the bill was $1.1 billion; one year later it was up approximately 22 percent.

In 2000, GM's spent $52 million just for Prilosec, a brand-name ulcer medicine. "That is millions more than GM executives believe they should have spent," Newsweek reported. "They blame much of the extra cost on savvy marketing by Prilosec's maker AstraZeneca," and are fighting back with an "aggressive plan to curb drug spending." The article continued: "Point man" James Cubbin "has been taking his case to senior executives at some of the nation's largest drug makers, including AstraZeneca."

What Newsweek missed was this: In 1996, GM had installed a new director. He was the chairman of that very same AstraZeneca. And, like Rick Wagoner, he was a member of the Business Roundtable.

A year later, deciding that two drug-company directors were better than one, GM added a Pfizer executive vice president. Mysteriously, though, soaring drug prices continued to plague GM. By 2003, prescription medicines were accounting for more than 25 percent of its total medical spending.

Universal-coverage countries aren't co-opted by pharmaceutical executives. They use price controls to cap prescription-drug prices. The benefits for GM Canada are reflected in assembly costs stunningly lower than in the U.S., and they flow into the treasury of its corporate parent. Despite this, GM Detroit gives no public indication that it's learned anything. Instead, while the noses of AstraZenca--the drug company that made it see "red"--and Pfizer remain inside it's tent, it pleads for mercy from price-gouging pharmaceutical manufacturers, .

Rick Wagoner, in the speech cited earlier, worried that in the U.S., GM would be spending $1.9 billion on prescription drugs in 2005--up $800 million from 2001. What did he expect?

Then there's the purportedly conservative, free-enterprise ideology that condemns single-payer as socialism, or improper government interference in the marketplace, etc. For a GM that loves single-payer in Canada, to invoke this ideology would be, needless to say, a non-starter. For other corporations, though, it's been a guiding light.

Raymond W. Werntz learned this to his sorrow. For nearly 30 years, he'd run health-care programs for Whitman Corporation, a Chicago-based multinational holding company. Then, in 1999, he moved to Washington to become the first president of the Consumer Health Education Council, a program of the nonprofit, nonpartisan Employee Benefit Research Institute.

Werntz saw it as his mission to try to persuade employers to face the "huge, huge" issue of the uninsured because, he told me, "business has to be involved with the solution." The problem that emerged was its "unwillingness to even think about a solution." Its "unwillingness to even think about a solution." "My life for four years was trying to get business people in a room with single-payer people," Werntz told me. "I couldn't do it."

He said he knows U.S. business leaders who worship marketplace ideology "almost like religion." With them, he said, "it's emotional." But few of their counterparts in other developed nations share that alleged ideology. They've seen single-payer give free enterprise a helping hand.

Single-payer is "an economic asset, not a burden," A. Charles Baillie, who was chairman and CEO of Toronto Dominion Bank, one of Canada's six largest, told the Vancouver Board of Trade in 1999. "In an era of globalization," he said, "we need every competitive and comparative advantage we have. And the fundamentals of our health care system are one of those advantages."

Baillie emphasized an insufficiently understood reality. "The fact is, the free market...cannot work in the context of universal health care. While health care could be purchased like any other form of insurance...the risk and resource equation will always be such that, in some cases, demand will not be matched by supply. In other words, some people will always be left out."

Indeed, a World Bank report ranked so-called welfare states like Denmark, Finland and Sweden high in international competitiveness. "Social protection," an author of the study said, "is good for business, it takes the burden off of businesses for health-care costs."

Bill Clinton, you'll recall, came up with a Rube Goldberg universal health-care plan. It would have mandated a payroll tax to finance coverage of part-time as well as full-time employees, thus letting no employers escape paying their fair share. It won the endorsement of the U.S. Chamber of Commerce and the National Association of Manufacturers. Even the Business Roundtable resigned itself to not fighting it

Behind the scenes, however, fierce counter-pressures were quickly brought to bear. By CEOs of enterprises that profit--or profiteer--from the status quo and who twisted the arms of fellow CEOs By fast-food chains that mostly hired young people, worked them less than full-time, paid them little, and provided scant if any health coverage. By insurers. By Republicans choking on the idea of supporting a plan brought forth by Bill and Hillary.

The counter-pressures were stunningly successful, leading to what Maher labeled as a "startling flip-flop." The Chamber, pressured by the National Federation of Independent Businesses, "suddenly reversed course and totally rejected the Clinton Plan," he has written. The Chamber may also have been pressured from within. Many members, a former employee told me, "buy their health insurance through the Chamber. And many Chamber sales people make substantial incomes from the sale of those health plans."

The "NAM abruptly withdrew its endorsement six weeks after granting it," Maher wrote. What of the Business Roundtable, where Clinton's plan got one vote--Chrysler's?

After his bill died, David S. Broder and Haynes Johnson recalled in their book The System: The American Way of Politics at the Breaking Point, Senator Jay Rockefeller said, "'There's a special place in hell waiting for Bob Winters.'" Robert C. Winters was chairman of Prudential Insurance. At on at one and the same time he was head of the Roundtable's health-care policy task force.

Business Groups "effectively killed the bill," Maher wrote.

How can the flip-flopping Chamber and NAM, the Roundtable good 'ol boys, and the rest claim to have an ideology, or principles, or a philosophy, that would pass the laugh test?

In my interview with Ray Werntz, in 2004, he said that single-payer is "one and the same thing" as Medicare for everybody. Does the Corporate America that accepts Medicare understand this? I asked him "It's a dialogue that hasn't happened yet," he replied.

CEOs of large corporations, Werntz went on to say, see single-payer as something "that smacks of socialism," as "heresy." The real heretics, I believe, put the Buddy System and an ideology that accepts Medicare but rejects single-payer ahead of the best interests of their stockholders and of the American people. They are the self-described conservatives who rant about government bureaucracy but turn a blind eye to a bureaucracy that spends of 31 cents of every health-care dollar on administrative costs, while Medicare--which doesn't advertise or pay commissions--pays two or three cents.

Medicare is run by public servants subject to congressional oversight, not by the likes of UnitedHealth Group CEO William W. McGuire. In 2005 he was paid $124.8 million. At the end of that year, according to UnitedHealth's proxy statement, his unexercised stock options were worth, on paper, $1,776,547,635.

"The United States wastes more on health-care bureaucracy than it would cost to provide health care to all its uninsured," a comprehensive study in the International Journal of Health Services found in 2004. The authors went on to write:

"Administrative expenses will consume at least $399.4 billion of a total health expenditure of $1,660.5 billion in 2003. Streamlining administrative overhead to Canadian levels would save approximately $286 billion in 2002, $6,940 for each of the 41.2 million Americans who were uninsured as of 2001. This is substantially more than would be needed to provide full insurance coverage."

Double-digit increases in health-care costs do terrible things to the economy. Henry Simmons, president of the National Coalition on Health Care, an alliance of groups working for healthcare reform, has summed them up. They "slow the rate of job growth," "suppress wage increases for current workers," "undercut the viability of pension funds," "put American firms at a steep disadvantage in world markets" and produce "severe long-term budgetary problems" for the federal and state governments.

At the opposite end of the spectrum from the Buddy System and opportunistic ideologues is Deborah Richter. For eight years now, she has fought for universal access to affordable, high-quality health care. She sees it "as a public good, as are roads, education, and police and fire protection." It would replace the non-system with a system that standardizes reimbursements and benefits, and has the same rules for everybody. Richter calls it the "'investment model,' in which the whole society invests in a public good that we all may need but cannot provide for." The GI Bill after World War II built on that model.

Grown-ups do not hold out single-payer as perfect. It could not be a blank check. It would require what Richter calls "egalitarian rationing," meaning decisions designed to meet everyone's basic needs while denying some things to some. It would not be immune from the ills inherent in all large human endeavors, including tough tradeoffs, foolishness, and bad judgments.

But single-payer would do truly wonderful things.

It would reverse policies lacking in human decency, such as providing health insurance to a wage-earner and his family until his job is outsourced to China. Or giving him basic care when he's old or in prison, but not when he's a child or an under-65 adult. Or covering a diabetic for an amputation but not for the preventive tools that would have averted the amputation.

It would fuel the economy by transferring the hundreds of billions of dollars wasted on administrative costs to the pockets of consumers, enabling them to buy goods and services they now cannot afford.

It would cost employers far less in taxes than they pay for insurance.

It would stop forcing employers to pay for medical care under workers' compensation, which cost them more than $38 billion in 2002 alone.

It would narrow the wide gap in operating costs between unionized and nonunion competitors, particularly Wal-Mart.

You may remember the four-month strike against supermarket chains in Southern California--the longest in the industry's history. It left about 60,000 union workers jobless, and it seriously hurt the owners as well. The central issue was the chains' demand that members of the United Food and Commercial Workers union pay much more for health benefits. The settlement, reached in February 2004, sent a grim message to grocery workers everywhere.

Single-payer would defuse embittered labor relations. The supermarket strike "would not have occurred if we had a system of universal health-care coverage," Greg Denier, assistant to the international president of the UFCW, told me. "All of our strikes in the past decade have occurred because of the absence of universal health care."

In the Washington, D.C., region, lawyer Harry Burton, who represented Safeway and Giant Food in subsequent negotiations with the UFCW, essentially agreed with Denier. Universal health insurance would have "a profound effect...on nearly all collective bargaining," he told me, speaking "as an individual." Nonunion companies "virtually never" provide healthcare of the same quality as that provided by unionized competitors, thus creating "a vast disparity in costs," Burton said. That's why a tax-supported national system would result in "a leveling of the playing field."

Unlike GM, Greg Denier, and Harry Burton, spokespersons for Safeway, Kroger and Albertsons joined Ford's in not returning my calls.

Fairness requires a few deservedly unkind words for other major players.

First, leading U.S. news organizations. They have persistently made the dead-wrong assumption that Canada's experience with single-payer doesn't deserve in-depth, Journalism-101 coverage. Instead, they've mostly sniped, ignoring major positives and the system's huge popularity. They've also let candidates sail through entire political campaigns, and presidents sail through eight years in office, without asking them whether Americans have a right to basic health care. National health care is not some new, radical idea in the United States. It was a plank in Theodore Roosevelt's platform in his losing presidential campaign nearly a century ago, in 1912. Harry Truman urged it after World War II.

Second, Congress. In the dark of night 3 1/2 years ago, it enacted a Republican prescription-drug bill that had Adam Smith rolling in his grave. It prohibited the government that negotiates drug prices for the Veterans Administration from negotiating drug prices for Medicare. Yet Medicare beneficiaries pay 58 percent more than the VA does. For a year's supply of the cholesterol drug Zocor, as was reported on "60 Minutes," the best Medicare price is $1,485, nearly 12 times the $127 paid by the VA. Would Congress have committed this atrocity, this waste of taxpayer dollars, if the lobbying and campaign-finance laws didn't legalize bribery?

Third, George W. Bush. In the second presidential debate in 2004, he said: "[L]iberals...create government-sponsored health care. Maybe you think that makes sense. I don't." Thus was Medicare implicitly dismissed as senseless by the president who had pushed hard for the sell-out bill prohibiting Medicare from negotiating drug prices. John F. Kerry could have pointed this out. He didn't.

I don't pretend to be an expert on health-insurance proposals advanced by Governors Rendell, Schwarzenegger and Romney, but I'll venture a couple of comments.

Their common vice is that they preserve the waste and greed of for-profit health insurance. Their common virtue is that they would mitigate or even solve some health-care problems by, for example, penalizing employers who don't offer insurance. But by putting such Band-Aids on wounds that require a tourniquet, they would likely delay progress toward efficient, tax-supported universal health care.

The California and Massachusetts plans, like the national plans of President Bush and Senator Ron Wyden, would go on throwing money at private insurers while calling for high, out-of-pocket deductibles. These would produce another major vice: discrimination against women.

Women spend far more than men on health care. In the 18-64 age bracket, two long-time fighters for single payer, Harvard Medical School's Steffie Woolhandler and David Himmelstein, show in a new study, women's median health-care costs in 2006 were more than double men's ($1,844 vs. $847). In the 18-44 bracket they were nearly three times higher ($1,266 vs. $463). "High deductible plans punish women for having breasts and uteruses," Woolhandler said.

A question for the governors is, What stopped you from proposing and fighting to enact single-payer or a universal-coverage plan? Did the money that health-related industries spent, and could spend, influence your decision?

Wyden's proposal, detailed in the Times Magazine article, is ambitious, comprehensive, and far-reaching. Being these things, it would on enactment become, and likely long remain, a nearly insurmountable barrier to the clean, simple solution of single-payer.

The tectonic plates under health care are shifting in a constantly changing political climate. We see new evidence of this almost daily.

Here's Howard H. Baker Jr., the Republican former Senate Majority Leader, last November: "I think if anything, though, there is a recognition that at least a basic level of primary health care must be afforded to everyone."

Here's the March Times / CBS News Poll on the "[d]omestic policy most important for the President and Congress to concentrate on right now." Fifty-five percent of those polled chose health care for all.

Here's a quote from a recent AARP Bulletin: "As unlikely as it seems, big business could emerge as the force that finally brings about universal health insurance." I confess I wouldn't be amazed if the same Buddy System that held back progress toward single-payer will one day unleash it. That is to say, corporate leaders may come to accept as fact the headline on my Nation article: "Single-Payer: Good for Business".

I will end by asking and answering three questions, followed by two sentences:

First, does it make business sense or common sense for Congress to enact Ron Wyden's patchwork 17 months before voters may well choose a president, and a Congress, ready, willing, and eager to enact single-payer, or, at minimum, to gradually expand Medicare toward single-payer? I think not.

Second, can the country afford single-payer? Yes, it can. "The top 300,000 Americans collectively enjoyed almost as much income as the bottom 150 million Americans," the Times reported recently. We can pay for single-payer by closing the gaping loopholes in the tax system, and by adjusting the rates that further enrich the top one percent, and the top one-tenth of one percent, at the expense of most everybody else. Take into account, too, that the federal tax exemption for employment-based health insurance alone costs an estimated $200 billion a year.

Third, can the country not afford single-payer? Remember the warning of David Walker, the Comptroller General of the United States: Failing to fundamentally reform our health-care system could bankrupt America.

Single-payer would fundamentally reform health care. To make it happen business leaders should prepare and organize to seize the supreme opportunity to do well by doing good that will likely be bestowed by the 2008 elections.

Thanks for listening.

Morton Mintz covered the Supreme Court for The Washington Post from 1964 to 1965 and again from 1977 to 1980. He is a former chair of the Fund for Investigative Journalism.

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