Every
humane society in the world today with the means to do so provides
healthcare to all of its citizens, except for the United States of
America. And "if we had set out to design the worst system that we
could imagine, we couldn't have imagined one as bad as we have," says
Marcia Angell, former editor-in-chief of the New England Journal of
Medicine.

The U.S. health care system is the most expensive in
the world on both a per-person basis-$7-8,000-and as a percentage of
the total economy-15-16%. Switzerland's, the next-most-expensive
system's, per-person costs are 56% of ours. Canada's are 44%; Great
Britain's, 22%.

Yet 47 million U.S. residents have no health
insurance, and the numbers keep growing. Back in the economy's boom
days, more than half of all personal bankruptcies were the result of
medical emergencies.

While American healthcare is the most
costly, its outcomes are shameful. The United Nations ranks U.S. life
expectancy at 29th in the world and our infant mortality rate at 33rd.
Our own CIA puts these rankings at 45th, and 42nd respectively. The
World Health Organization ranks the U.S. 37th in health system
performance, between Costa Rica and Slovenia.

Our system's
staffing levels are low, and it lacks safety controls, putting staff
and patients at risk. Estimates of annual deaths resulting from medical
errors range from 48,000 to 98,000.

Virtually every analyst who
studies the entire system from a perspective free of self-interest and
ideological presuppositions concludes that a single-payer healthcare
system is the best solution. In such a system, the government
negotiates contracts with doctors and hospitals and pays their bills.
Citizens pay for healthcare through the kind of payroll tax that now
funds Medicare.

Propagandists and fools call this "socialized
medicine," but that would be a system that is owned by the government
and employs the doctors. The Veterans Administration is socialized
medicine. A single-payer system is not.

From statistics already
cited, it should be clear that single-payer systems produce better
health outcomes. By covering everyone and emphasizing preventative
care, many health problems never arise, while those that do can be
identified at an early stage, where treatment is more effective and
less expensive.

Single-payer plans can also disseminate and
encourage best practices. Mitchell Selzer, a leading hospital
consultant studied the practice profiles of 24,000 physicians treating
1.5 million patients. He found that a subgroup of those doctors studied
consistently admitted, diagnosed, and treated patients using 20-to-30%
fewer resources and incurring correspondingly lower costs than the
average doctor studied. Yet this group produced better care-fewer
errors, shorter stays, fewer infections, fewer readmissions, fewer
deaths.

Preventative care and best practices are not the only
reasons why single-payer is less expensive. A landmark Harvard Medical
School study determined that some 30% of healthcare dollars go to
administrative costs. Health insurance companies dispute this figure,
citing an industry-average administrative expense of 15 percent. But
they don't acknowledge that healthcare practitioners absorb the
expenses required to deal with insurance companies. By comparison,
Medicare's administrative costs are 1%. And insurance companies don't
have the will or bargaining power to negotiate the kind of prices that
send Americans to Canada to purchase their prescription drugs.

Single
payer is a fiscally conservative solution. Between decreased healthcare
costs and increased taxes, Americans would spend less. And American
businesses would be more competitive. General Motors' healthcare costs
are $1,500 for every car that it manufactures.

I began this
series during the elections, when the word most often on presidential
candidates' lips was "change." My intent was to show that in every
policy area, a fundamental transformation of our economic and political
institutions would be required to achieve the basic conditions that all
Americans should expect.

Single-payer healthcare is an
excellent example in that its implementation would not require such
fundamental change. But apparently, its adoption would.

Instead,
policy makers support piecemeal solutions that add large costs, reward
those responsible for the mess, and do not solve the problem. The
prescription drug benefit passed in 2003 comes to mind.

A CBS
News/New York Times poll published in February reported that 59% of
Americans say the government should provide national health insurance.
Other polls put this figure as high as 70%. Meanwhile, 59% was also the
portion of doctors who told researchers for an Annals of Internal
Medicine study that they support legislation to establish national
health insurance.

Opposing these citizens and doctors are
lobbyists and publicists, well paid by the multibillion-dollar health
insurance industry. In addition to broadcasting falsehoods that
single-payer healthcare is a "socialized" system that would be more
expensive and less effective, they say that consumers would have fewer
choices.

The reverse is true. Freed of restrictions imposed by
their current medical plans, consumers could choose any doctor or
hospital that they wanted, increasing competition.

Politicians
who posture as defenders of the people's interests quail in response to
forces mobilized by health insurers. It's not just the huge campaign
contributions that insurers can invest. Once something is considered to
be politically unfeasible, it's suicidal for a politician, no matter
how well established, to keep advocating it. He or she is considered to
be hopelessly unrealistic and disloyal to the party.

Journalists
focus on politics rather than substance. They reflect opinion rather
than inform it. They confuse objectivity with impartiality,
uncritically quoting both sides of an issue and thereby passing along
myths and lies.

Forceful and consistent presidential leadership
that continually points to hard evidence and poll results could defeat
the health insurers, for-profit hospital chains, and right-wing
ideologues. Instead, we are moving toward another piecemeal policy.

In
Canada, politicians had the courage and vision to say to health
insurers, "you're out of business. You have a much better chance to
find new work than citizens have to improve their health under the
current system." In the United States, we allow an industry with
140,000 agents to kill policies that would benefit 250 million
Americans.