- The Washington Times - Saturday, March 25, 2006

Our health-care system is in deep trouble and, according to some pundits, threatened with a “meltdown.”

Soaring costs now account for 16 percent of the U.S. annual gross domestic product (GDP) and are slated to climb to 20 percent by 2015. This is deemed “unsustainable” without severely effecting our national economy.

Equally serious are the millions of Americans with limited access to our health-care system due to lack of medical insurance.

Unique among Western industrialized societies, we do not provide coverage for all our citizens through either private or public insurance. This national disgrace has aroused relatively little concern from an administration that has seen the world’s only “superpower” increase its medically uninsured from 41 million to 46 million (rising 100,000 monthly) since Mr. Bush took office.

Despite health-care shortcomings of skyrocketing costs and inadequate access, health-care quality remains high, thanks to brilliant advances of medical science and technology that have far outpaced medical socioeconomics.

Mike Leavitt, secretary of health and human services, who developed a well-earned reputation as a health-care innovator while governor of Utah, has acknowledged that our deteriorating health-care system will remain out of control so long as huge numbers of Americans lack basic medical insurance. Nothing in President Bush’s agenda, however, promises to change this.

Nor has any health-care proposal been advanced by the administration that calls for ending our anachronistic employer-based, multipayer private health insurance system, a holdover from World War II. At that time, employers picked up the entire health insurance tab to lure workers whose wages were frozen by the War Labor Board. Thus, some 25 percent of current total health care costs are eaten up by the insurance industry’s overhead expenses — marketing, advertising, competition, stockholder dividends and huge executive salaries — none of which cure a single patient.

The answer to our health care dilemmas is single-payer, government-sponsored universal health insurance (UHI) — Medicare, with an overhead of less than 5 percent, for all age groups. Evolved and improved over the last 25 years, Canada has such a UHI system that provides one standard of care for rich and poor alike, with no additional costs (copayments or deductibles) so economic considerations are not paramount at the time of accident or disease.

A recent ABC News poll indicated that, 2-1, Americans would prefer government-sponsored UHI over our current employer-based health insurance. Moreover, in a Harris Interactive poll among Western democracies of patient satisfaction with their health-care systems, Canada ranked first and the U.S. last.

Because of its advanced technology, Canada spends one-tenth as much as U.S. insurance providers spend for overhead. Indeed, more people are needed to administer Blue Cross Blue Shield in Massachusetts than to administer the entire health-care system of Canada.

Of further significance, Canada’s health-care system functions at almost one-half the cost of ours yet boasts lower infant and maternal mortality and longer life expectancy than the U.S.

There is not the slightest chance the Bush administration will consider changing to the Canadian health-care system. Our president is more oriented toward the corporate than the public good. This was well shown when he rammed a prescription drug benefit bill through Congress that disallowed any drug-price negotiation (Canada has negotiated these prices for 16 years).

But once Mr. Bush makes up his mind on an issue, foreign or domestic, he “stays the course.”

Mr. Bush’s final word on health care was expressed during the debates prior to the last election: “Our health care system is the envy of the entire world.” Unfortunately, his losing contact with reality poses a far more serious problem with the fiasco in Iraq than with our health-care system. As the war goes from bad to worse, our brave soldiers die and our treasury hemorrhages, the president looks the public in the eye on TV and proclaims, “We are winning.” Little wonder his approval rating has plunged to a historic low, and he has lost the trust of the public — not only here but abroad.

Over the last two years, the phrase, “world’s only superpower” has been fading from the lexicon in Europe (where I spend four to five months yearly and stay attuned to the media).

As for health-care reform, the best we can hope for is a wait of a few years when perhaps there will be a wholesale change in Washington, and a new leader will not surround him- or herself with “yes” men and women loath to tell the emperor he is without clothes. Until then America, be patient.

Alex Gerber, M.D., is a clinical professor of surgery emeritus at the University of Southern California and a former health-care consultant to the White House and U.S. Department of Health and Human Services.

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