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For-profit health care makes us sick

November 9, 2007 | Page 9

Arnold S. Relman, M.D., A Second Opinion: Rescuing America's Health Care. Public Affairs/The Century Foundation, 2007, 205 pages, $19.95.

ELIZABETH LALASZ reviews a new book on why we need a single-payer health care plan.

A SECOND Opinion: Rescuing America's Health Care makes a concise, convincing case for why we need to eliminate the for-profit health care industry in the U.S. and replace it with a single-payer system.

As author Dr. Arnold Relman, a physician and the former editor of the New England Journal of Medicine, explains, major reform is the only solution. "I am convinced that within a decade or so, we will begin to see drastic reforms...because the present commercialized system cannot last longer and incremental improvements will be of little avail."

But to get to this place, Relman rightly concludes, requires a broad public understanding of the basic problems. With this book, he hopes to help take a step in the direction of dispelling the popular misinformation and confusion around what a public health care system would look like.

With years of experience, Relman provides much-needed facts and a comprehensive history to help any reader thoroughly grasp the trajectory of the U.S. health care crisis today.

In A Second Opinion, he states, "Total U.S. expenditures are now over $2 trillion per year, or over 16 percent of our gross domestic product." Further, Relman writes, "They predict that 'optimal health spending' will rise to more than 30 percent of the GDP by the year 2050."

This exposes the motivation for why big-money interests--like the insurance and pharmaceutical companies--will fight tooth and nail to maintain their unbelievable profits. And it illustrates why reforming the health care system in the way Relman argues in favor of will be a long-term battle of building a movement to take these on.

He also explains why acquiring health care services is not like purchasing other things within the capitalist "free market" economy. Relman writes, "[T]hose who receive care do not make a free choice, like ordinary consumers. They usually receive care because the circumstances of their illness or injury create a need."

Thus, if a patient needs a procedure, it shouldn't be a question of cost--should they shop around for cheaper care--it should be a question first of what is required to become healthier.

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A SIGNIFICANT portion of A Second Opinion provides an in-depth history of how, over the last 40 years, medicine has become progressively more privatized and industrialized, a development of health care immediately following the Second World War.

Relman begins with the rise of Health Maintenance Organizations (HMOs), Preferred Provider Organization (PPOs) and then what is currently known collectively as Consumer-Driven Health Care (CDHC), like they have in Massachusetts and is proposed by Gov. Arnold Schwarzenegger in California.

Each new "formation" within the health care industry is about increasingly putting the burden on the individual, rather than on employers or the federal government to provide the coverage necessary to make health care something every human being has access to.

With the recent contract between General Motors (GM) and the United Auto Workers (UAW) union still fresh in people's minds, Relman explains the motivation of corporations to offload health care costs to their employees, including retirees.

As costs continue to rise, cutting these benefits--once considered a mainstay in the U.S. labor movement--is common practice for companies like GM that justify it in order to remain "competitive."

But, as Relman points out, another option does exist. Just compare UAW members in the U.S. to those in Canada: "In 2005, GM spent $5.3 billion on the health care costs of its 1.1 million workers and retirees and their families, or over $5,000 per year for each GM-insured person. That adds an estimated $1,525 to the average price of every vehicle the company builds in the United States," writes Relman.

"By comparison, GM spends only $1,385 per year for each insured person in its Canadian plant, which adds only $197 to the average cost of each vehicle assembled there. The difference is due primarily to Canada's national health system, which pays most of the medical bills of Canadian workers."

Relman lays out clearly what is the only solution--creating a public single-payer system that provides quality care at costs affordable for everyone. Such a plan would provide a standard package of benefits to everyone, with no private insurance. Doctors, nurses and other health care workers would work within multi-specialty, not-for-profit organizations, and their salaries would be determined through the management of the group.

Essentially, it would be a much more rational system than what we have currently.

A Second Opinion makes a quick, yet extremely thorough case for why a change is not only necessary, but also coming. It arms readers with the tools to break through the myths and rhetoric that creating a single-payer health care system is not possible in the U.S.

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