Ailing health system defies easy fix

When the Democratic Party snatched 29 House seats and six Senate seats away from the Republicans in November, putting themselves in the majority for the first time in 12 years, the party's presumptive leader Nancy Pelosi promised that during their first 100 hours in power, the law would be changed to allow the government to negotiate directly with drug companies for lower prices for Medicare patients. Welcome news, some public health advocates said, even as others worried that the move represents but a chink in the armor of a complex problem that has grown worse under the tenure of President Bush and a Republican Party that controlled both houses of congress since 1994. Although the United States stands alone among industrialized countries in lacking a national healthcare "safety net" (other than that available for the poorest of the poor), spending on healthcare here is greater than any other developed country, and continues to rise at nearly four times the rate of inflation. The issue of universal health care has been a supremely contentious one in recent US political history. Before his election in 1992, Bill Clinton had made health care one of the centerpieces of his presidential campaign. After he took office, Clinton created the Task Force on National Health Care Reform, headed by First Lady (now Democratic Senator from New York) Hillary Rodham Clinton, and charged them with creating a plan that would extend health care to all citizens. Currently, some 48 million people in this country do not have health insurance. The resulting proposal, which mandated that all employers provide health insurance to their workers through a system of competitive health maintenance organizations (HMOs), was complex and met with resistance and misunderstanding both from the left and from the right. The Republican sweep of Congress in the 1994 mid-term elections sealed the plan's doom. One of the keystone programs of the Bush administration's domestic agenda has been the Medicare drug benefit, known popularly as "Medicare Part D," which was created in 2003 and took effect in January 2006, affecting some 22.5 million seniors. Recent polls suggest that more than 80 percent of those enrolled are thus far satisfied with the plan, although it includes a so-called "donut hole," or period when senior citizens covered by Medicare must pay 100 percent if their drug costs top $2,250, with coverage only kicking in again once costs go beyond $3,600. "It would be very difficult to find a more inefficient, wasteful and hostile way to deliver a consumer drug benefit," says Robert Hayes, president and general counsel of the Medicare Rights Center, based in New York City. "Many people still can't get the medicines they need, and medicine is still unavailable to millions of people as the drug and insurance industries are laughing all the way to the bank." Among the biggest producers of prescription drugs, Pfizer reported $51 billion in sales last year, and saw its stock increase by 29.7 percent over the same period. Another major drug supplier, Merck, banked $16.6 billion in profits for the first nine months of 2006, and looked set to finish the year substantially above its revenue of $22.01 billion for 2005. The ranks of the uninsured have also swollen under the Bush administration. Before the president took office in 2001, the US Census Bureau calculated that 14 percent of citizens lacked health coverage. By 2003, that number had grown to 15.6 percent, or 45 million people. In 2006, that number rose still further, by 1.3 million, to 46.6 million people, 15.9 percent of the population. For his part, the president cites such measures as the Medicare Prescription Drug Improvement and Modernization Act, signed into law in 2003, which contains such features as a Health Savings Account, a medical savings account available to US taxpayers which supporters say acts as an alternative to traditional health insurance. With these accounts, patients, who are not permitted to be covered by any other health program, pay for current health benefits but save for future costs that meet certain qualifications on a largely tax-free basis. At a bill signing in Washington this month, Bush lauded the accounts, which he said "allow people to save money for health care tax-free, and to take these accounts with them if they move from job to job." The moves, however, underwhelmed many health care advocates. "Things are much worse now than when we were founded," says Leonard Rodberg, the chair of the Urban Studies Department at the Queens College campus of the City University of New York, and research director for Physicians for a National Health Program, an organization of 14,000 members and chapters across the United States that advocates for a single-payer national health program. "A larger portion of the population is uninsured, and a smaller group is covered by the employer system," Rodberg says. "There are many people and many employers who can't afford [it], and you're in a debt spiral. Fewer can afford it, and those who are left have to pick up the cost." A recent poll by the Journal of the American Medical Association about out-of-pocket payments for health care services by patients found they had shot up from a 1997 total of $162 billion to $236 billion in 2004, with health care expenditures consuming an ever-larger share of the US gross domestic product. At the same time, unpaid medical bills are the cause of a majority of personal bankruptcy filings. Some are trying to aggressively address the problem. The United States National Health Insurance Act, H.R. 676, introduced by Democratic Reps. John Conyers, Dennis Kucinich, Jim McDermott and Donna Christensen in 2003, seeks to establish a publicly financed, privately delivered national health insurance program in the United States. It has languished in committee since 2005. The goal of the legislation, sponsors say, "is to ensure that all Americans will have access, guaranteed by law, to the highest quality and most cost effective health care services regardless of their employment, income, or health status." "We must stop this zealous, ideological drive towards privatization," says Robert Hayes, of the president's program. "It's a waste of money and it's not helping people. We need to push hard to develop new techniques to pay for quality care."