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Who's killing health care in America?

June 22, 2007 | Pages 4 and 5

NANCY WELCH looks at the causes of the health care crisis depicted in Michael Moore's Sicko.

AS MICHAEL Moore's Sicko hits theaters, the simmering health care crisis appears headed for a boil.

The number of Americans without coverage has soared from 40 million in 2000 to upwards of 50 million today. Plus, researchers estimate that a further one-fifth of those who are insured don't have the coverage they need for a chronic condition or catastrophic illness, according to the Kaiser Family Foundation.

In other words, for every member of the U.S. Senate enjoying full government-administered health coverage, 1 million Americans go entirely or mostly without.

A total of 27 corporations, classified as health care and pharmaceutical companies, rank in the Fortune 500 list of big U.S. corporations, with total revenues of more than $600 billion among them.

And that's not counting mega-corporations like General Electric, which counts diagnostic equipment and medical financial-management systems among its many holdings--or insurance giants such as Prudential and Metlife, which peddle Medicare supplements and disability insurance among their other "products."

What else to read

The Physicians for a National Health Program Web site makes the case for government-administered single-payer programs, and has downloadable slide shows about the state of U.S. health care. Healthcare-Now posts a regularly updated calendar showing events around the issue of health care--including activities coordinated with the release of the film Sicko.

For a compact history of U.S. health care policy and the struggles for a national health program, from the progressive era to today, read One Nation, Uninsured: Why the U.S. Has No National Health Insurance, by Jill Quadagno. Donald Barlett and James Steele's Critical Condition: How Health Care in America Became Big Business--and Bad Medicine is a fact-packed expose of the for-profit health care industry.

Marcia Angell, a former editor of the New England Journal of Medicine, takes on Big Pharma in The Truth About the Drug Companies: How They Deceive Us and What to Do About It. Another recent book on the crisis is Uninsured in America: Life and Death in the Land of Opportunity, by Susan Starr Sered and Rushika Fernandopulle.

For the international perspective, the World Health Organization Web site is an invaluable source of research on global health, especially its annual World Health Report (the 2007 edition is due in August).

London Health Emergency publishes a newsletter and monitors stories about Britain's NHS and campaigns to save it. The Council of Canadians reports on threats to the Canadian health care system--its online pamphlet, "Profit is Not the Cure," has excellent information on the dangers of privatization.


The truth about U.S. health care is one most people know too well: This system isn't "the best in the world," with "private medicine" encouraging "innovation and change," as George Bush boasted at a meeting of the American Hospital Association.

Instead, by innovating new ways to ration care and boost profits, this sick system causes 18,000 unnecessary deaths a year. And that's just the annual U.S. death toll for those who have no health coverage. Moore's new documentary tells the stories of the millions more whose health coverage doesn't ensure adequate, affordable care.

It portrays a woman denied treatment for her ailing infant at a Los Angeles emergency room outside her HMO network. Hours later, en route to an approved hospital, the baby dies.

A Kansas City woman recounts the perpetual battle she faced to get insurers to cover her husband's kidney cancer medicines--and their refusal to approve what might have been a life-saving bone-marrow transplant.

A couple in their mid-50s facing cancer and heart trouble is forced to sell their home and move into their daughter's basement when the bills not covered by their HMO pile up faster than they can pay.

Such stories from Sicko aren't the result of a few "bad apple" insurance companies and corporate hospital chains. In fact, a surveillance camera captures disoriented patients herded from a University of Southern California hospital to a homeless shelter when their coverage runs out.

Even Time's usually churlish Richard Corliss concedes that "the HMOs and pharmaceutical companies have made billions while Americans have health care below the standard of other industrialized countries, and pay more for it."

Sicko packs a phenomenal punch--even Fox News lauds it as "brilliant"--because, as London's Independent puts it, "Everyone in America has a health-care horror story or knows someone who does."

Moore apparently squanders some of that power, however, by pitting health care for U.S. citizens against health care for Guantánamo prisoners. His attempted visit to this notorious gulag could have underscored that the United States leads not in health care, but in prisons; it could turn emotion into solidarity and struggle against Washington's twisted priorities.

Nevertheless, commentators suggest that viewers will take from footage of American patients welcomed at a Havana hospital a sound, straightforward lesson: "A poor Caribbean island, whatever its ideology, can afford health care for everyone, while we do not," writes Salon's Andrew O'Hehir. "The only possible conclusion is that our society has chosen not to."

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BUT HOW did this "choice"--leaving the U.S. alone among 40 industrialized nations in failing to provide universal coverage--come about?

Sicko points to 1971, when Richard Nixon speculated about the boon that health care could be for the insurance industry because "the less they give 'em, the more they make." The 1970s were indeed a turning point. Faced with intensifying global competition and declining profits, U.S. capitalism sought new markets, turning to resources and services such as health care that had been largely outside the for-profit realm.

After Nixon, corporate health care had many more politicians to thank for its more than 30-year bonanza. In the 1980s, Congress handed out the bipartisan gifts of the Hatch-Waxman and Bayh-Dole bills, permitting drug companies to patent medicines created with federal funds and shutting out competition from lower-cost generics.

This is the reality of America's "free-market" medicine: Spending hardly a dime on research and protected from competition, Big Pharma scoops up the drugs developed in the NIH and university labs, and reaps colossal rewards.

At the start of 1980s, Wyeth was the only drug company in the Fortune 100, with barely a toehold at 99. Today, there are four pharmaceuticals in the top 100, and two others ranked just outside.

But it was the 1990s that really fulfilled Nixon's dream. After abandoning an attempt to implement the Democratic Party's 40-year-old promise of a national health program, Bill Clinton gave the green light for for-profit HMOs, which helped complete U.S. health care's corporate domination.

The result has been a full-blown crisis, made in Washington for Wall Street. As one insurance industry employee explains in Sicko: "You're not slipping through the cracks. They made the crack and are sweeping you toward it."

While critics who've caught sneak peaks widely agree that Sicko makes a convincing case against for-profit health care, some, like Time's Richard Corliss, chide Moore for not presenting the tab for a universal, government-administered (or single-payer) program. For all the virtues of universal coverage, Corliss implies, it could prove too costly.

On the contrary, data from the Organization for Economic Cooperation and Development shows that countries with universal coverage, such as France, Germany, and Canada, spend at least one-fourth less of their gross domestic product--between 8 and 11 percent--on health care while keeping virtually everyone covered.

By contrast, the U.S. spends 16 percent of GDP--more than $2 trillion every year--while failing to insure or insure adequately 35 percent or more of the population.

Where does the money go? For starters, to profits--especially profits made through cutting care and marketing lifestyles. For instance, UnitedHealth Group (number 21 on Fortune's list) reveled in earnings up 26 percent last year, while also facing racketeering charges for routinely denying patient claims.

Pfizer (39 on the Fortune 500) likewise saw its bottom line swell by 139 percent. Pfizer isn't getting rich by inventing needed treatments for malaria or drug-resistant TB. Instead, it pushes the profit-enlarging Viagra.

A piece of every health-care dollar also goes to Republican and Democratic Party candidates, plus lobbying organizations--to keep them on corporate health care's side.

The results are obvious. In 2003, Congress could have expanded traditional Medicare to include prescription drugs, for which the government would negotiate a reasonable price.

Instead, the 2003 Medicare Modernization Act puts no government brake on the price-gouging drug companies. What it does do is turn over a chunk of this program to for-profit insurers--which are charging, two recent studies show, 11 to 19 percent more than traditional Medicare to deliver the same care.

Now the AARP wants in on this lucrative business too, announcing in April that it would team up with UnitedHealth and Aetna to become the nation's biggest provider of private insurance to Medicare recipients.

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ALL THIS profit-making comes at a steep bureaucratic cost. A 2005 study in Health Affairs found that only 66 cents of every private-sector health-care dollar goes to medical care. Another 21 cents goes to billing paperwork--the price for extracting profit.

Compare this with the purchasing power of every public Medicare dollar: 97 cents for patient care and only 3 cents for overhead. According to Physicians for a National Health Program, we could shift everyone to a program like Medicare, scrap our current system of some 1,500 insurance plans--each with its own marketing, premiums, paperwork and money-guzzling CEO--and save $150 billion in bureaucracy every year.

When Physicians for a National Health Program's David Himmelstein met with Hillary Clinton in the early 1990s to pitch the affordability of a national program, Clinton reportedly replied, "You make a convincing case, but where's the power to do that?" At Himmelstein's response--"How about the president of the United States leading a crusade of the American people?"--Clinton scoffed, then asked "for something real."

But real grassroots forces are starting to step up to build this critical crusade. Advocacy groups like Healthcare-Now have called on activists to leaflet outside screenings of Sicko so viewers can channel their anger and ideas raised by the film to work into organizing panels, truth hearings and demonstrations.

In Hartford, Conn., activists didn't wait for Sicko. Twenty-two people, many of them from local unions, were arrested earlier this month when they refused to budge from a state capitol sit-in calling for universal health care and a single-payer program.

"This type of behavior was disruptive to the legislative process," scolded Capitol Police Chief Michael J. Fallon. But if Sicko helps inspire many more of these disruptions, it could be just what the doctor ordered.

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