Welcome to America, the only industrialized nation without universal health care

It's situation critical
Sun, November 23, 2008 | Lisa Van Dusen | Sun Media

On the morning of last June 19, in the waiting room of the psychiatric ward of King's County Hospital in Brooklyn, Esmin Green slumped from her chair to the floor. She lay there for almost an hour, ignored by other patients and staff, before dying of causes still undetermined.

The hospital's closed circuit security cameras produced a video so disturbing (www.youtube.com/watch?v=OA29VwnZ4cE), that when it was released two weeks later it got worldwide attention.

Green was a 49-year-old mother of six. In the days before her death, she lost her job in a day care centre, then lost her apartment: One version of a story that will happen more and more as the economic meltdown trickles down every Main Street.

That the video of Green's death surfaced in the middle of the presidential campaign seemed like a cry for help from a system that works for fewer and fewer people at higher and higher costs.

The United States health care system is a spaghetti junction full of toll booths set up by private insurance companies that provide coverage for care in the form of HMOs (health maintenance organizations), PPOs (preferred provider organizations) and POS (point of service) programs. Most Americans (60%) get health coverage from these companies through their employers.

There are government programs such as Medicare and Medicaid for people without private insurance but roughly 15% of Americans remain uninsured. The ones who are insured interface with doctors and hospitals using a business lexicon of deductibles and co-payments and non-network treatment and paperwork unfathomable in both volume and content.

The system costs more per capita than any other on earth and represents a greater chunk of GDP (15%) than any other UN member except the Marshall Islands. The United States is the only wealthy industrialized nation that doesn't have universal health care.

When I moved to the U.S. in the early 1990s, I spent a lot of time explaining that the Canadian health care system wasn't a choice-less socialist nightmare of back-alley quacks and deadly wait times to people who couldn't believe universal health care could be so straightforward.

The most rattling culture shock then was getting used to a health care system that had the same creative accounting scandals, advertising schemes and class divides as any other business. The amount of money floating around it -- from liability insurance and personal injury attorneys to $500 bedpan suppliers to fly-by-night providers who post hand-scrawled ads on utility poles -- is staggering.

The horrors of the system chronicled in news accounts about people such as Green and by Michael Moore in the documentary Sicko happen every day and will be happening more and more a the economy worsens.

Money question

But Americans make decisions involving health coverage all the time that you never think of when it all comes down to one card in your wallet: Career choices, personal choices, where to live, what to do on a Saturday afternoon with your kids, whether to go to an emergency room.

The Canadian system has been strained in the past decade and we're a lot less self-righteous about it now, but when Canadians talk about the merits of changing it, the bottom line isn't so much the bottom line as a consensus on the value of fairness.

U.S. polls conducted before the economy dwarfed all other issues showed that most Americans share that view.

Fifteen years ago, when the Clintons tried to overhaul the U.S. health care system, resistance from the insurance lobby proved fatal.

Now, even the health insurers are admitting that change is needed (last week, two insurance lobby groups agreed to cover sick people as well as healthy ones, if they really have to) and that health care is becoming a huge economic problem.

New presidents can only focus on so many priorities and Barack Obama is a new president at a time when the things that need fixing seem outnumbered only by the obstacles to fixing them. But his reported choice of former Senate Democratic leader Tom Daschle, who wrote the book, Critical: What We Can Do About the Health-Care Crisis, as Secretary of Health and Human Services, means this is a priority.

While the economy, energy, education and climate change need fixing, people aren't dying in classrooms or in gas stations because of a system that seems based on the very un-American idea that some lives are worth more than others.