Prescription for a sick health care system

Book Review

Health Care Meltdown: Confronting the Myths and Fixing Our Failing System By Robert H. LeBow, M.D. Alan C. Hood Co., 2004 Softcover, 304 pp., $15.00

“America is the only developed nation that fails to guarantee access to needed care for all its citizens and the only advanced country that permits someone to go bankrupt because of poor health.” Thus, Dr. Robert LeBow, a community health clinic physician of 30 years’ experience, immediately draws the reader’s attention to two of the most salient but least known characteristics of health care in the U.S. – its uniqueness and destructiveness.

LeBow criticizes American health care as “a disorganized overly complex creature that robs people of their health, their money, and their dignity.” It is a system driven by “self interest and the pursuit of profit,” that has turned millions of uninsured middle-class Americans into “health care beggars,” with hundreds of thousands more pushed into personal bankruptcy. This is despite the fact that we spend more on health care than any other country in the world.

LeBow observes that the U.S., unlike other advanced nations, treats health care as an economic commodity, not a public good or human right. The market decides who gets what care, leaving more than 40 million Americans without health insurance and 50 million others underinsured. The former depend on charity care. The latter dig deeper into their pockets to pay excessive insurance premiums, deductibles, and co-payments, enriching stockholders, or go without care.

Cost and lack of access to health care largely explain the American health care system’s rank at 37th in the world by the World Health Organization in the year 2000. In contrast, LeBow notes that “Every [other] developed country … has made a genuine effort to assure that every person living in that country has health care coverage (not just access).”

Control of our health care system, LeBow observes, is in the hands of a “Gang of Four”: pharmaceutical companies, the insurance industry, hospitals, and organized medicine. These vested interests have maintained control through often repeated myths and outright lies about the state of health care in the U. S. and other advanced nations.

We are told that the market is the solution to our health care problems. After all, the market is the American way, and the U. S. has the best health care system in the world (for those who can pay). We are told that other health care systems do not offer a solution because they have led to rationing, waiting lists, loss of choice, and, of course, that horror of all horrors – socialism.

LeBow criticizes our emphasis on the individual rather than the value of community. He underscores our “human responsibility to one another,” declaring that “health care in America has evolved today beyond the capabilities of ‘personal responsibility’ at least when it comes to the issue of financing.”

LeBow proposes a universal health coverage plan that puts everyone – young, old, healthy, sick, rich, and poor – in the same risk pool, the same plan, with health coverage separated from employment status. Insurance premiums, co-payments and deductibles would be eliminated. He further proposes that the system be funded through progressive taxation, much like Canada’s single-payer system, which covers 99 percent of Canadians.

The Canadian system is offered only as a suggestion by LeBow, who also proposes simply expanding Medicare coverage to every American. Whichever system is chosen, he reminds us that 60 percent of all health care expenses in the United States are already paid by the government, with Americans certainly not receiving a good return on their money. Universal health coverage would be a giant step forward and away from the fragmented, costly, profit-driven leviathan that now passes for health care in the U.S. Perhaps most importantly, it would establish health care coverage as a right for every American.

The struggle to establish health care as a right in this country is inherently tied to other movements, including living wage and full employment struggles. Success requires undoing decades of right-wing propaganda and lies, educating people about the real state of health care in the U.S., and how the problem has been handled in other nations. LeBow’s book is a valuable contribution to that end.

The author can be reached at pww @ pww.org.