Map of life expectancy at birth from Global Education Project.

Friday, September 14, 2007

View from the East Bank of the Atlantic

Suzanne Goldenberg, in The Guardian, explains our mysterious ways to the Brits. Nothing my loyal 4 1/2 readers don't already know, of course -- I could have written this myself, and who knows, maybe I did some time, I can't remember:

America spends more money on prevention and treatment of disease than ever before, yet it is falling behind on such basic indicators of health as infant mortality and life expectancy.

The US spends about 16% of GDP on healthcare, a proportion expected to climb to 20% by 2015, according to the National Coalition on Health Care. At present spending levels of $1.6 trillion a year, which works out at $6,700 per capita, is double what is spent in countries such as France. And yet that still leaves some 47 million Americans entirely without health coverage, and tens of millions of others under-insured, according to latest census figures.

It also fails to guarantee a better service to those Americans with access to healthcare. The US ranks last or near the bottom on quality, access, efficiency, equity and healthy lives, according to a report in May 2007 from the Commonwealth Fund, which studies healthcare.

"The US healthcare system is considered a dysfunctional mess," writes Ezekial Emanuel, chairman of the department of clinical bioethics, in a recent issue of the Journal of the American Medical Association.

But, "None of the mainstream proposals would move America towards the national healthcare systems of Europe or Canada. That idea remains taboo." Here, Goldenberg's explanatory powers falter. Why is the idea taboo?

This is a two-part answer. First, drug companies and insurance companies are among the biggest contributors to political campaigns and the most powerful lobbies in Washington. Our political system is not structured to produce good public policy, it's structured to reward the most powerful vested interests, and they're it. Physicians, sadly, have not been much help. The AMA was for many decades the leading opponent of national health care. It has now backed off that position, but is not doing anything proactively to promote real reform.

The second part of the answer is that our corporate news media, instead of featuring informed explanation like Goldberg's, features dishonest propagandists like John Stossel. The main issues in health care are actually pretty simple, although the truth doesn't quite fit on a bumper sticker. But the corporate media won't allow the basic facts and logic of the problem to be laid out simply and directly in a way the people can understand, because that wouldn't be balanced.

Since none of the Democratic presidential candidates who are considered to have a legitimate chance are willing to tell the truth about this, I think we need to eschew all strategic compromise and refuse to endorse any halfway measures. And by "we" I mean my friends at Health Care for All and the Center for American Progress and all of those institutes and think tanks and advocacy organizations that fooling around with the margins of the eligibility standards for S-CHIP and employer mandates and bare bones insurance products for 20-somethings. There is only one legitimate message, only one cause worth fighting for, so let's keep saying it, as clearly and as plainly as possible until it doesn't seem radical or taboo any more.

We need universal, comprehensive, single payer national health care, and nothing else. That's the way to save money -- lots of it -- make the people healthier and the economy stronger, achieve equity and justice, and give us a chance at still being a great and prosperous nation in the 21st Century. No compromise.

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