Universal Health Care for Americans

The health care system in the US is so broken and there are so many examples of successful systems in other countries that it's one of the easiest problems for which to find solutions.

At the outset I'll suggest a single-payer plan, in which the federal government would provide the insurance function instead of private insurance companies. What I am suggesting is not socialized medicine, in which the federal government would hire the doctors and run the hospitals and so on. Our health care is of the highest quality; it is the insurance function that is broken. Insurance costs in the US are reported to run at 25 to 30 percent of total costs.
Are there alternatives? A single-payer plan need not be the only possible approach. A look at systems in other countries could indicate attractive features from which the US could choose in formulating a system.

First, let's do a quick overview of the problem: The US spends more than twice as much per capita on health care as does the average developed country, and its outcomes in the usual categories such as longevity and infant mortality are not as good as in other developed countries. The main reason for this is that more than 46 million Americans have no health insurance and millions more are underinsured. Significant categories are not covered in US plans, while Canada, for example, covers long-term care, mental health care, and dental care. Firms in the US find it difficult to compete with firms in other countries because of the cost of health care for employees: General Motors has reported that this adds an expense of $1,500 per automobile. Additionally, the prescription drug program just adopted in the US, with its donut hole and high prices, is a fiasco. All in all, dissatisfaction with the US system is higher than in other developed countries.

Let's recognize, at the same time, that opponents can offer some relevant arguments. Pharmaceutical firms in the US finance most of the R&D for drugs, and as a result other countries can sell those drugs at reduced prices. The US Department of Commerce reports that 8 out 0f 10 of the top-selling drugs are produced by companies headquartered in the US. Also, there can be long waits in other countries for surgery and other treatment; health care is rationed by design, rather than by affordability as in the US. Those who can pay may find medical treatment in the US a preferred option. Medical technology in the US may be the best in the world, and care should be taken not to jeopardize that. And finally, lifestyle decisions that Americans make, along with longer working hours and shorter vacations, may add to medical expenses.

Well then, how would one go about planning a system for the US? It need not be hopelessly difficult. Medicare could be extended to all rather than just the elderly. Its administration costs are less than 2 percent. The Veterans Administration, with similar costs of administration, also could serve as a model upon which to build. As for drug costs, Medicare should be empowered to negotiate with pharmaceuticals.

The usual argument that the US cannot afford universal health care is the easiest of all to refute. We can do it, no, we can do it better, for half the price.

What Democrats Should Do

Democrats have to try harder than Republicans. Not that we've exactly been doing it. And Republicans have been trying pretty hard, at least leading up to and following 1994 when they took over Congress. They choose language to color our thinking (like "death tax"), they're all on the same page, and they usually raise more money. But a lot of what they do is just plain nasty, and wrong. They impeach, they recall, they redistrict when it's not legal. And much more, but I'll try to get on with my message.

My point is that the Democrats' thing is to build, to create--to devise a universal health-care system, for example--to improve human welfare, to contribute to the common good. And the Republicans' thing is, sometimes anyway, to get government out of the way so individuals can do what they want, and they have the money and the power to do this. Except that they use government for themselves when they want, like for huge weapons systems and pre-emptive invasions. In any case, it's (usually) harder to build than to destroy. And an awful lot of what they want to do is to tear down. We Democrats just have to live with this, and try harder.

The first thing Democrats must do is get our message out. Be positive. And don't be wimps. We're for universal single-payer health care, for example, not just enough for children. And we're for stopping our military aggression in Iraq now and focusing instead on supporting rebuilding infrastructure and so on. And we're for full employment. And better wages. In other words, we're interested in attacking the real issues, things people care about. Not burning the flag, defining what marriage is, prayer in public schools, and other so-called wedge issues designed to divert attention from the real issues. Ane we have to say what we're for.

Another thing is the tone of compaigning. It seems the case that dirty campaigning works. Lies often work, as the Swift Boat thing did in attacking Kerry. And stealing votes works, as with tampering with voting machines. Nonetheless, we Democrats must take the high road. In the long run it will pay off--I really believe this--to be the party that talks about the issues and favors voting machines that work and leave a paper trail, and sees that there are enough for people in all the districts, not just the rich ones. Let's make politics a good thing, not one everyone thinks is rotten. I've noticed that some of my Republican friends will say, when Democrats do something bad, yeah, that's awful, but when Republicans do something bad, they say, well, that's politics, that's why they don't want to get involved. But politics is so important that it's almost impossible to exaggerate this. It affects almost everything in our lives, large and small. We've all got to get into it and make politics better. It wouldn't hurt for Democratic candidates to point out that they're not attacking their opponents but that they will respond immediately if they are attacked.

I want to address particular questions as I go on with these political blogs. I'm thinking especially about things the Democrats, not to mention everyone else, seem to be a bit mixed up on. I hope people will bear with me. So let's get on with it for an energy plan, for jobs, for working with the rest of the world for peace, as with the PeaceJam kids meeting in Denver now with Nobel Peace Laureates.

We can make the world better. For the common good.