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Why Health Care Reform Isn't Working, and What Ithaca, N.Y. is Doing About It

by Dave Steele

Let's face it. We've got a really big problem. This country spends far more of its income on health-care than does any other country in the world - more than twice as much, per person, as any European nation. Yet 44 million Americans have no health insurance. Premiums for those who do are skyrocketing, and access to physicians is being limited. Many HMOs are dumping their elderly Medicare subscribers. Life-expectancy, access to health-care and general health are all significantly worse than in many other countries.

According to the United Nations, our health system ranks 37th in the world, far behind first-ranked France and second-ranked Italy. The main reason for our poor performance is that health-care here is seen as a for-profit business. In every other industrialized country, health-care is a right delivered through some sort of national health program. That, I think, is the way it should be here. Unfortunately, our prospects for getting a national health-care system of our own don't seem too good - at least not by the normal routes. Neither Al Gore nor George W. Bush proposed any such thing. And they probably couldn't deliver even had they wanted to. Just look back to 1994.

Back then, Bill Clinton proposed a sort of mega-corporate national health insurance system. The proposal wasn't very good, and deserved to fail, as it did. But a very good alternative presented in Congress certainly did not deserve the same fate. Dubbed the McDermott-Wellstone bill, it had the largest number of co-sponsors, and would have given us, hands down, the best health-care system in the world. But the bill was never even brought to a vote.

McDermott-Wellstone would have created a national "single-payer" system of health insurance, guaranteeing access to comprehensive health care for all; it would have allowed free choice of doctor and hospital. The 44 million uninsured would have received full coverage. And, as confirmed by the Congressional Budget Office, it would have accomplished this for billions less than we're paying now.

McDermott-Wellstone was truly a wonderful proposal. Virtually all Americans would have benefitted from increased access to health services and from the savings the single-payer system would have provided. Indeed, for the past 50 years, poll after poll has shown significant majorities of Americans favor single-payer. A 1989 Harris poll showed 61% of Americans in favor; a 1992 poll showed 69%. Why did it not pass? How is it that a bill that would benefit virtually everyone in the country didn't even make it to a vote?

The problem is that power in this country is not distributed to the benefit of the majority. Speech is free, but it's much freer if you can pay for it. In the health-care debate, insurance mega-corporations stood to lose. So, they poured millions into defeating all proposals. Millions in campaign contributions were paid to members of Congress who would block reform. Propaganda was unleashed with a vengeance. Remember Harry and Louise? Worse, the insurance powers colluded with the mass media, who depend on advertising for their existence, to limit the debate. Discussion of single-payer, the biggest threat, was effectively quashed. According to FAIR (Fairness and Accuracy in Reporting), in a year of programming during the health-care debate, Nightline mentioned single-payer only twice - both times negatively. The MacNeil-Lehrer Newshour, glad to air debate of other proposals, similarly avoided discussion of single-payer. Single-payer never had a chance.

And approached this way, single-payer probably never will have a chance.

Change has to come from the grassroots. At the national level, there is far too much entrenched power. Democratic change for the good of the majority of us is nearly impossible to achieve there. Only in real communities - local communities of people who care about each other - is real reform likely to take root. The people of Swift Current, Saskatchewan realized as much over 50 years ago.

In the 1940s, farmers and civic leaders in this Canadian community of some 15,000 got together. They were convinced that health-care should not be a commodity - that it should be readily available to all. And they decided to do something about it. So, in 1947, they created a local system of universal medical insurance. Everyone paid in according to his or her ability and their medical expenses were covered. The next year, the Province of Saskatchewan implemented a hospital insurance program based largely on the Swift Current model.

By 1960, Swift Current's example had led to an extraordinary event in Saskatchewan. Tommy Douglas, first elected Premier in 1944, fought the 1960 election promising comprehensive, taxpayer-funded health care for all Saskatchewan residents. He won handily. And on November 17, 1961, the Saskatchewan Legislature passed his bill. Single-payer was to be implemented on July 1, 1962.

Now the powerful forces stepped in. Business groups and nearly all of the newspapers, radio and television stations in the province immediately railed against it. Both the Canadian and American Medical Associations came in full-force to stop it. They launched major propaganda campaigns. Doctors wrote their patients, falsely telling them that they would lose their right to choose their physician and that the physician-patient relationship would be destroyed. Posters portrayed government leaders as Nazis and communists. Tommy Douglas was burned in effigy.

On July 1, as the law came into effect, the doctors went on strike. But they and their allies had seriously underestimated the public. Grassroots support for a public health-care system was very, very high. So, after just over three weeks, the strike collapsed. Single-payer medicare was established. The system worked extremely well and the doctors soon became among its most staunch supporters. By 1971, every province in Canada had adopted a single-payer. And, in 1998, the Canadian Medical Association enshrined Tommy Douglas in its Hall of Fame. No other non-physician has been honored in this way.

Despite right-wing attacks and sometimes serious underfunding by conservative governments, single-payer remains immensely popular in Canada. Over 90% support it in the polls. Only 2% prefer the American system to their own. The battle in Canada is not over. American "health-care" corporations are attempting to enter the Canadian "market" and the propaganda blitz against Canada's medicare is intense. But the fact is that Canadians enjoy 2 years longer life-expectancy, unrestricted choice of physician, more doctors visits and procedures --- all for about two-thirds of what Americans pay.

As I said earlier, the point is that change must come from the grassroots. Canada would still have a U.S.-style health-care system had not the people of a small community gotten together to make change for the better. It can happen here, too.

People in Ithaca have created their own health plan, the Ithaca Health Fund, http://www.IthacaHealth.org. It's young and growing, but it's working and it has immense potential. Subscribers pay $100 a year ($175 for partners, $50 for a child) and receive discounts and coverage for a variety of medical needs. If everyone in Ithaca were to join, and pay according to their ability, it could be the best health insurance plan in the country. Why not sign up to the Ithaca Health plan? Even if you have health insurance from work, join in your community. Fight for change. In time, you won't need that expensive outside insurance. Single-payer could be a reality. Ithaca could be the next Swift Current.

Ithaca Health Fund, Box 362, Ithaca, NY 14851 Donations are tax-exempt when made to: Southside Community Center, Inc. (memo: Ithaca Health Fund)

On the history of Single-Payer in Canada and the current threats to its existence:

  • Canadian Health Coalition
  • Policy Alternatives

  • The Ithaca Health Fund
  • Physicians for a National Health Program
  • United Nations World Health Report
  • Information sheet on single-payer
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