Healthcare

US healthcare is more expensive than any other country and does not produce better results. You won't hear that because it might offend insurance or pharma advertising: another example of media extortion. Reasonable solutions cannot be considered because powerful, well funded corporate interests and the GOP block them. Other social programs, which are mostly privatized are also doing poorly including childcare, seniorcare, housing, food, medicine, are not up to standards of the developed world. The military, however, got more funding than it asked for.

Why is it so difficult to recognize that public health systems are much less expensive and better performing than private ?

The whole point of privatization is to facilitate a corporate feeding frenzy at the expense of the taxpayer and the sick. Although privatized healthcare is much more expensive, corporations get to profit from the sick. Often the poor, uninsured pay much more for their treatment, a frequent cause of bankruptcy.

It was always a mistake to put the burden of healthcare on employers. It suppresses job mobility, creates bureaucracy in large companies to deal with the problem, allows insurers to redline some companies, it leaves out many people who are not in the job market for whatever reason, has mediocre outcomes, and is much more expensive than other developed countries. Canadian healthcare performs much better.

We are one of only two countries in the world to allow direct to consumer pharmaceutical advertising (the other is New Zealand.) Because some companies charge ruinous prices for life-saving drugs, we should regulate drug prices, or at least allow prescriptions to be filled in Canada. Regular evening ads buy off media. American healthcare is a feeding frenzy for corporate America including media, Pharma, Computer software vendors, hospitals, and others. Large contributions to lobbyists and politicians insure there will be no change or even a repeal of the ACA.

Obamacare was based on a Republican idea that Mitt Romney fairly successfully implemented in Massachusetts. Still, we spend more than two-and-a-half times more than most developed nations in the world, including relatively rich European countries like France, Sweden and the United Kingdom.

Republicans were unable to repeal and replace Obamacare, so they are undermining it and making it even worse. A much simpler Medicare for all solution would be a great improvement on Obamacare. If Republicans cannot at least improve what we have, they should do nothing at all. Based on their performance, they should be voted out of office as soon as possible.

A Medicare-for-All system could save an enormous amount by bringing expenses in line with the rest of the developed world, and it could cover everyone. It would likely slow the ongoing collapse of the middle class. Even the CEO of Aetna thinks it’s a good idea. The bill for the public service would be much less than the private bill.

Countries with Universal Healthcare 2023

Doctors and insurers clash over US law that protects against surprise billing (9/29/2023)

How Do We Fix the Scandal That Is American Health Care? (8/16/2023)

It’s time to guarantee healthcare to all Americans as a human right Bernie Sanders (5/18/2023)

Congress must listen to working families and overhaul healthcare, minimum wage and education (1/9/2023)

Stop the Medicare “Advantage” Scam Before Medicare is Dead (8/5/2022)

How to Fight the New GOP Scheme To Kill Social Security & Medicare (8/4/2022)

Why Public Health Faces a Crisis Across the U.S. (10/18/2021)

Understaffed, underfunded, under siege: US public health amid COVID-19 (10/15/2021)

Science Alone Can’t Heal a Sick Society (9/10/2021) NYT

Stunning new report ranks US dead last in health care among richest countries—despite spending the most (8/6/2021)

Are Healthcare Parasites Sucking Americans Dry? (8/2021)

“They've Been Doing It Forever” (6/25/2021)

They Say They Are Attacking Abortion. They Are Really Hurting the Poor. (2/16/2021)

America’s New Peculiar Institution: Health Care only for those who Can Afford it (10/11/2020)

Which Country Has the World’s Best Health Care? by Ezekiel J. Emanuel

Taking health back from corporations: Pandemics, big pharma and privatized health (8/5/2020)

Why I’m Obsessed With Patients' Medical Bills (8/8/2020)

Medicare Turns 55: Let’s Celebrate by Covering Everyone! F. Douglas Stephenson (08/01/2020)

G.O.P. Faces Risk From Push to Repeal Health Law During Pandemic (6/22/2020)

Nearly 27 million Americans may have lost job-based health insurance, study shows (5/13/2020)

The Trump Virus (3/27/2020)

Local doctor: COVID-19 exposes weaknesses of health care, leadership (3/23/2020)

How testing failures allowed coronavirus to sweep the U.S. (3/8/2020)

Trump Could Profit From Coronavirus Testing (3/6/2020)

Medicare For All Would Save More Than 68,000 Lives And $450 Billion Every Year, According To New Study (2/2020)

When a Pandemic Meets a Personality Cult (2/27/2020)

Trump Makes the American Health Care System Even Worse (2/22/2020)

US underprepared for coronavirus due to Trump cuts, say health experts (1/31/2020)

Outbreaks of lethal diseases like Ebola and the Wuhan coronavirus happen regularly. The US government just cut funding for the hospitals that deal with them (1/22/2020)

To the Contrary, Trump Has Tried to Weaken Protections for Pre-existing Conditions (1/13/2020)

Trump’s Plot Against Health Care Continues, He is still coming for your coverage — and lying about it. (01/13/2020)

Economists 'Surprised Americans Aren't Revolting' Over $8,000 Tax They Pay Each Year Due to For-Profit Healthcare System (01/07/2020)

Did Warren Pass the Medicare Test? I Think So (11/1/2019)

Would ‘Medicare for All’ Save Billions or Cost Billions? (10/16/2019)

The Huge Waste in the U.S. Health System (10/7/2019)

The Health 202: The Trump administration considered defending the ACA in court (9/27/2019)

Does Anyone Really ‘Love’ Their Private Health Insurance? (9/17/2019)

The New Plot Against Obamacare (7/11/2019)

The Trump Administration Is Creating a Health Nightmare Near the Border (8/25/2019)

‘Government-Run Healthcare’ Is a Product of Health Industry–Run Media (7/1/2019)

Self-Inflicted Medical Misery, Red America’s homemade rural health crisis. (6/24/2019)

Anti-Vaxxers Are Just as Bad as Climate Deniers (4/22/2019)

Republican Health Care Lying Syndrome (4/1/2019)

Donald Trump’s Latest Move to End Obamacare Is One of the Dumbest Things He Could Have Done Ahead of 2020 (3/26/2019)

Bill Barr Moves to Destroy ObamaCare and the Republican Party (3/26/2019)

Build Your Own ‘Medicare for All’ Plan. Beware: There Are Tough Choices. (2/27/2019)

Democrats Are Introducing Medicare-for-All With Actual Outside Support (2/27/2019)

Meet the Person Behind Trump’s War on Medicaid (Mother Jones 1-2/2019)

Conservative Elites Will Go to Amazing Lengths to Deny People Basic Healthcare (12/16/2018)

'Easy to pay for something that costs less': New study shows 'Medicare for All' would save US $5.1 trillion over 10 years (12/1/2018)

The Trump Administration Announced New Rules Further Dismantling Obamacare (11/29/2018)

Voters must catch on to Republicans’ con on health care (10/23/2018)

Don't trust the GOP with your health care (10/12/2018)

Republicans Take the Hypocrite’s Oath, On health care, a determination to deceive voters as much as possible. (9/27/2018)

Get Sick, Go Bankrupt and Die (9/4/2018)

Want Reliable Medical Information? The Trump Administration Doesn’t (7/20/2018)

G.O.P. to Americans With Health Problems: Drop Dead (6/15/2018)

The Plot Against Healthcare (5/28/2018)

Tracking Trump’s Sabotage of the ACA (4/18/2018)

David J. Shulkin: Privatizing the V.A. Will Hurt Veterans (3/28/2018)

It Sure Looks Like The GOP Is Trying to Kill Us (3/13/2018)

A Proposal Designed to Confuse Public and Prevent 'Medicare for All' (2/23/2018)

Unconscionable Republicans delayed CHIP to use kids as a bargaining chip to sell out Dreamers. (1/17/2018)

Dollars, Cents and Republican Sadism (1/11/2018)

Leading Democrats Are Way Behind the Public on Health Care (10/25/2017)

Millions of Lives at Risk as GOP Lets CHIP Expire (10/4/2017)

Sen. Murphy thinks he can build an on-ramp to single-payer health care (9/8/2017)

The US Has the Highest Maternal Death Rate of Any Developed Country. Why Aren't We Doing More About It? (7/27/2017)

And Jesus Said Unto Paul of Ryan ... (3/16/2017)

The Republican Health Care Zombie Is Back (9/19/2017)

Bernie Sanders: Why We Need Medicare for All (9/13/20170)

Why So Many Democrats Are Embracing Single-Payer Health Care (7/18/2017)

A GOP stunt backfires, and accidentally reveals a truth Republicans want hidden (7/5/2017)

Senate Republicans Said Their Bill Wouldn’t Hurt The Poor. It Would. (6/27/2017)

It’s Time to Worry about Health Care in the Senate (5/23/2017)

Aetna’s surprising single-payer stance (5/12/2017)

Buffett: GOP Health Care Bill a Tax Cut for the Rich (5/7/2017)

The House Health Care Disaster Is Really About Taxes (5/6/2017)

Time for a Trump Carnage Index (5/6/2017)

Business Partnerships between Fitbit and Health Insurance Companies (4/11/2017)

Noam Chomsky: Our Privatized US Healthcare Program Is an "International Scandal" (4/5/2017)

GOP Lawmakers Now Admit Years of Obamacare Repeal Votes Were a Sham (3/21/2017)

Bernie Sanders Wants to Expand Medicare to Everybody — Exactly What Its Architects Wanted (3/31/2017)

"Thunderous Applause" Welcomes Sanders' Call for Medicare-for-All (3/27/2017)

The Republicans' Not-So-Secret Strategy to Pass TrumpCare (3/13/2017)

CBO: TrumpCare Would Wipe Out Coverage for 24 Million People (3/13/2017)

A Bill So Bad It’s Awesome [Paul Krugman] 3/10/2017

For the Insurance Lobby, Old Habits Are Hard to Break (2/15/2017)

8 Epic EHR implementations with the biggest price tags in 2015 (7/1/2015)

GOP Prohibits CBO From Reporting How Much ACA Repeal Blows Up the Deficit (1/11/2017)

Everything you need to know about the GOP’s plan to repeal Obamacare (1/14/2017)

Repealing Obamacare Will Be Negligent Homicide (1/6/2017)

Republicans Are Afraid to Let Americans See Their Health Care Plan (1/4/2017)

Media Legitimizing GOP’s ‘Universal’ Health Plan That Doesn’t Exist(12/19/2016)

Trump’s Health Czar Tom Price is a One-Man Death Panel for Obamacare (11/29/2016)

Will Republicans Try to Privatize Medicare in 2017? (11/20/2016)

"Every dollar not taken from Medicare could come from the hide of a tax-cut beneficiary, a defense contractor, or some other worthy and hungry mouth that needs feeding."

Local Health System Performance, 2016 Edition

Cry Me a River, Aetna: Wendell Potter (8/29/2016)

Aetna's Greed Proves That Medicare-for-All Is the Best Solution (8/16/2016)

Sanders Has It Exactly Right: Majority of Americans Want 'Medicare for All' System (May 16, 2016)

Single-Payer Health Care (12/24/2015)

Fewer Patients Have Been Dying From Hospital Errors Since Obamacare Started (12/2/2015)

Majority of Americans Say Government Should Ensure Healthcare Coverage (11/23/2015)

Single Payer is the Only Hope: How the Health Insurance Industry is Devouring the Economy (11/9/2015)

With Mergers, Concerns Grow About Private Medicare (8/25/2015)

How The Right-Wing Media Is Orchestrating A Public Health Crisis (8/21/2015)

Don't Privatize Medicare (3/26/2015)

GOP congresswoman gets surprise on Facebook after asking constituents for Obamacare horror stories (3/26/2015)

This Red State Almost Expanded Health Insurance to 280,000 Poor People -- Then Koch Group Got Involved (4/1/2015)

The Future of the Affordable Care Act (3/27/2015)

Greed, fear and other roadblocks to health care reform (2/19/2015)

Universal Healthcare Advocates Renew Push Toward Medicare-For-All (2/4/2015)

Budget Cuts "Eroded our Ability to Respond to Ebola" (10/1/2014)

The GOP's 20 Year War On Healthcare (7/25/2014)

The Hobby Lobby Lesson: We Need To Fight For Single-Payer Health Care (7/1/2014)

US Health System Ranks Last Among Eleven Countries on Measures of Access, Equity, Quality, Efficiency, and Healthy Lives (6/16/2014)

Health Care Nightmares (4/10/2014)

Poll: Big Majority Wants To Keep Obamacare (3/13/2014)

Falsely Presenting Obamacare as a Job-Killer (2/5/2014)

The Obamacare We Deserve (1/1/2014)

9,000 Texans will die needlessly per year because Republicans refuse to expand Medicaid. (NEJM)

Racism And Cruelty Drive the GOP Health Care Agenda (10/8/2013)

Health Care For All (Bernie Sanders) 10/6/2013

Hospital medical errors now the third leading cause of death in the U.S. (9/20/2013)

There won’t be any GOP alternative to Obamacare (8/20/2013)

The Real Reason FoR The GOP's All Out War On Obamacare (8/11/2013)

Many Of The Counties Most In Need Of Obamacare Are Represented By Republicans Who Want To Repeal It (8/2/2013)

GOP support grows to force shutdown over funding ObamaCare (7/22/2013)

House 'Conservatives' Call For a New Vote To Kill Obamacare (4/24/2013)

Bitter Pill: Why Medical Bills Are Killing Us (2/20/2013)

"Death Panel" of GOP Governors Refuse Medicaid Expansion (1/8/2013)

ObamaCare: A Blessing For Millions of Real Americans (7/3/2012)

The GOP's Biggest Lies About Health Care Reform

Congress: Don't Void Our Insurance Refunds(7/2/2012)

Over 12 Million Consumers to Benefit From 1.1 Billion in Rebates From the Health Care Law.

The Real Winners (6/29/2012)

The Ten Most Hilariously Unhinged Right-Wing Reactions to the Obamacare Ruling (6/28/2012)

Corporate Media's War on Obamacare (6/24/2012)

Realigning Health With Care (5/2012)

Single Payer or Bust (3/30/2012)

Hurray for Health Reform By PAUL KRUGMAN (3/12)

Map of the Countries That Provide Universal Health Care (America's Still Not on It) (6/28/2012)

Elizabeth Warren Debunks A Few Healthcare Myths

Crowd Cheers For Uninsured Americans Dying At Tea Party Debate (9/13/2011)

US Healthcare Once Again Lags Behind Other Developed Countries In Quality (6/23/2010)

About GOP Health Care

It's The Empathy Crisis, Stupid (7/24/2011)

The GOP's Health Care Plan: Blame the Lawyers (1/20/2011)

Healthcare Reform Will Help Everybody.

The Healthcare Debate: Social Reflections (10/29/2010)

Companies Shift Health Costs to Employees (9/3/2010)

End of the NHS

The Problem

Republicans want to roll back the ACA, but they have not released a replacement plan. It appears they have no useful solutions for the problems that it addresses.

After decades of experience, privatized health care has been obscenely profitable, complex, bureaucratic, error prone, and expensive. It does not cover a large fraction of the people, and it is not the best in overall quality. The private market does not work well for healthcare for a lot of reasons. It is more expensive than any other country.

There are some things that are done well by the market, but health care is not one of them.

You can be ineligible on account of a pre-existing condition. You can be dropped for arbitrary reasons. Your coverage may be capped at an amount that makes insurance ineffective. In short, private insurance works well as long as you don't really need it.

However, insurance companies call the shots by spending large amounts on lobbyists, so Republicans like the system just the way it is.

If money is your most important 'value', you could argue that we cannot afford more inclusive healthcare. Then again, an unhealthy population is itself a heavy expense, and it is a drag on the economy. It is not a matter of money. It is a moral obligation. There is no excuse for the lack of a working, affordable, efficient system.

The worst features of the ACA are due to the Republican scheme on which it is based. It rewards every major player except the public.

Not only is US healthcare expensive, it is corrupt. Politicians use it for their own ATM and for jobs: examples include Jeb Bush, Bill Frist, Billy Tauzin, Rick Scott and many others.

Insurance companies seem to run the show. They have thousands of employees to 'process' health insurance claims, many in very expensive office buildings, and obscenely paid CEOs. For all that expense, what do they contribute to the actual delivery of health care ? Nothing. They have no business making decisions that are rightfully made by doctors and their patients. Although they do deny payment and exclude sick people (very crude rationing) , they do nothing to actually provide health care. (They pay plenty to lobby politicians though, so they foil any real reform, and continue to rip off sick people for profit.) Rating each individual for health insurance requires a large bureacracy engaged in invasive, privacy-invading, procedures.

Everyone agrees that health care reform is necessary. Our outsized healthcare expenses are, alone, enough reason. There is evidence that a single payer plan would save billions, but it is not even discussed because ours is a system thoroughly corrupted by big money. Lobbyists freed pharma from having to negotiate prices, and stopped consumers from filling prescriptions in unsafe places like Canada.

Republican propaganda that privateis always better than public is just an excuse for profiteering. At least for health care, public would be much better than private.

It is an unfortunate fact that medical errors are a major problem. "Death by medicine is now the leading killer and cause of injury in this country, ahead of the prior champion killers, heart attacks and cancer." (Gerry Spence quote) That is why victims need a way to recover damages. 'Tort reform' can allow errors to go uncorrected and a way to be sure consumers do not get justice. Victims should have their day in court.

Because right-wing ideologues are constantly assuring us that the government can't do anything for us (Republicans seem to want to prove it), there does not seem to be real discussion of functions that are best done by the public or private sector. Since I am covered by Medicare, it is reassuring to know that I will not arbitrarily be dropped, that pre-existing conditions will not exclude me. I'd say the government mostly does an excellent job when it is simply paying for health care. Republicans would killl it.

It is true that the US has heavy expenses that other countries do not. It has a military that is larger than the rest of the world's combined, it is a world leader in incarcerations, and, its healthcare expenses are much more than other developed countries.

Although prospects for health reform are better than they have been in a long time, Republicans are throwing up serious obstructions. Money (paper) is more important to them than the public good, and besides they wouldn't want Democrats to get credit. Our own Senator Lieberman, often on the Republican page, killed a public health option. (His Contributions from health & insurance interests: $3,308,621.) Actually, A Public Option would save many Billions (9/1/2009)

A simple solution that works well in other countries, that would make US business more competitive by removing the healthcare burden, and level the global playing field would be a plan that would cover everyone. Media has blacked out this approach. Powerful interests: pharma, insurance companies, and others can effectively block any efficient system.

It's a moral commitment. Everyone should be covered, and the cost should be covered by taxes. Wisely spent tax dollars would get a much better deal.

The U.S. has been cursed with self-serving leadership that does not work in the public interest. Healthcare is but one example.

Slide Show: Enemies of Health Reform

Health Care Policy The Nation spotlights the senators, amendments, activists and organizations most likely to derail healthcare reform efforts.

Senator Sander's Comments (10/24/2009)

Insurance Industry Whistleblower Wendell Potter Blasts Senate Panel Rejection of Public Insurance Option

Links

Here's an eye-opening letter to the editor of The Economist, Jan 22, 2009 issue:

Insurance companies probably have many thousands of employees to 'process' health insurance claims, many in very expensive office buildings, and many obscenely paid CEOs. For all that expense, what do they contribute to the actual delivery of health care ? Nothing. They have no business making decisions that are rightfully made by doctors and their patients. They do nothing to actually provide health care. (They pay plenty to lobby politicians though, so they may manage to continue to rip off sick people for their personal profit.)

So here's a suggestion for health care reform. Retrain health insurance employees so that they can actually do real work in doctors offices, hospitals, or other real jobs in health delivery. Close down the health insurers. We could go to a single payer plan like most civilized, advanced countries. My understanding is that there is a bill, HR676 which would do that. That would simplify the system and save enough money to guarantee universal health care.

Republicans like Jeb Bush are enjoying the healthcare gravy train and they still have enough people to stop real reform. Money (paper) is more important to them than results, and besides they wouldn't want Democrats to get credit for any improvement.

The White House severely edited congressional testimony given Tuesday by the director of the Centers for Disease Control and Prevention on the impact of climate change on health, removing specific scientific references to potential health risks, according to two sources familiar with the documents. (Oct.23,2007)

Paul Krugman| Health Economics 101

Paul Krugman writes that the free market doesn't work for health insurance, and never did. All we have ever had was a patchwork, semi-private system supported by large government subsidies.

Confronting Health Insurance Companies

Why Does Everyone Bow Down to the Health Insurance Industry?

Bow your heads and raise the white flags. After facing down the Third Reich, the Japanese Empire, the U.S.S.R., Manuel Noriega and Saddam Hussein, the United States has met an enemy it dares not confront -- the American private health insurance industry.

With the courageous exception of Dennis Kucinich, the Democratic candidates all rolled out health "reform" plans that represent total, Chamberlain-like, appeasement. Edwards and Obama propose universal health insurance plans that would in no way ease the death grip of Aetna, Unicare, MetLife, and the rest of the evil-doers. Clinton -- why are we not surprised? -- has gone even further, borrowing the Republican idea of actually feeding the private insurers by making it mandatory to buy their product. Will I be arrested if I resist paying $10,000 a year for a private policy laden with killer co-pays and deductibles? (more)

U.S. health care is bad for your health

[A new] study ... finds that not only is the U.S. health care system the most expensive in the world (double that of the next most costly comparator country, Canada) but comes in dead last in almost any measure of performance. Although U.S. political leaders are fond of stating that we have the best health-care system in the world, they fail to acknowledge an important caveat: It is the best only for the very rich. For the rest of the population, its deficits far outweigh its advantages. [The] study compared the United States with Australia, Canada, Germany, New Zealand and the United Kingdom. Although the most notable way in which the United States differs from the other countries is in the absence of universal coverage, the United States is also last on dimensions of access, patient safety, efficiency and equity. The other five countries considered spend considerably less on health care, both per capita and as a percent of gross domestic product, than the United States. The United States spends $7,000 per person per year on health care, almost double that of Australia, Canada and Germany, each of which achieve better results on health status indicators than the United States. The United States also lags behind all industrialized nations in terms of health coverage. 46.6 million Americans (about 15.9 percent of the population) had no health insurance coverage during 2005. It is no wonder, then, that medical bills are overwhelmingly the most common reason for personal bankruptcy in the United States.

Jeb Bush Joins the Tenet Gravy Train

Remote Area Medical (See A Republican State's Health Plan)

Watch Michael Moore's film "Sicko" on-line for free.

Michael Moore on Keith Olberman (video)

Physicians Proposal.

The Problem

That Americans do not have security of their health care coverage is a national disgrace. US health care is the most expensive in the world in % of Gross Domestic Product (GDP), but it does not cover a lot of us. Over 45 million people are not insured for health care in the US, although estimates, including underinsured or partially insured range up to one and a half times that amount, and the number is increasing.

Making health benefits an obligation of employers was a fatal flaw because it polarized business against it. Since it is more a public obligation in other countries, it makes globalization very unlevel. The auto and other industry are visibly suffering from this. They are responding by busting their unions and moving offshore.

Slowly, through increases in the employee contribution and copays the burden is being shifted away from companies. For some retirees they are pulling out . Insurance companies are in control. Many insurance companies sell their product based on the identification of low-risk pools, thus denying insurance to those most in need. You do not get insurance if you have a ‘pre-existing condition’. A health care system that does not cover sick people is an oxymoron.

Insurance companies have a close working alliance with Republicans. The MSA scheme, although derided as a kooky idea by most economists and health care experts, is now the ideological crown jewel of the Republican Medicare plan. The genius who came up with the ‘use it or lose it’ idea in which the money you set aside for healthcare at the end of the year becomes the employers. That’s Republican privatization for you…and like most of Bush policy is corporate welfare.

Because of press bias in health care reporting, the public is constantly misled from all sides. Media limits debate to private sector choices, denies voice to other points of view, and fails to provide coverage of experience in other countries. The Bush administration worked hard to suppress speech by further concentrating media.

Although there are variations, almost all Western countries fund health care with a single payer system. (There are always private options for people willing and able to pay for them.) Germany’s expenditures are half of ours per capita, and provide universal coverage.

Not only is our healthcare system dysfunctional, it is causing manufacturers, instead of improving product, to bust their unions and move offshore.

Republican tax cuts were taken from health care and it shows. Hospitals were sold (privatized) just to keep the doors open. Electing Republicans assures that the current flawed system will not only remain in place but also get worse. Instead you will get a 'Star Wars' program guaranteed (by Ted Postol of MIT) not to work.

To make the global free market a level playing field, healthcare should be largely taxpayer funded. The profit motive is out of place in medicine and only produces god awful results.

I Am Not a Health Reform

IN 1971, President Nixon sought to forestall single-payer national health insurance by proposing an alternative. He wanted to combine a mandate, which would require that employers cover their workers, with a Medicaid-like program for poor families, which all Americans would be able to join by paying sliding-scale premiums based on their income.

Nixon’s plan, though never passed, refuses to stay dead. Now Hillary Clinton, John Edwards and Barack Obama all propose Nixon-like reforms. Their plans resemble measures that were passed and then failed in several states over the past two decades.

In 1988, Massachusetts became the first state to pass a version of Nixon’s employer mandate — and it added an individual mandate for students and the self-employed, much as Mrs. Clinton and Mr. Edwards (but not Mr. Obama) would do today. Michael Dukakis, then the state’s governor, announced that “Massachusetts will be the first state in the country to enact universal health insurance.” But the mandate was never fully put into effect. In 1988, 494,000 people were uninsured in Massachusetts. The number had increased to 657,000 by 2006.

Oregon, in 1989, combined an employer mandate with an expansion of Medicaid and the rationing of expensive care. When the federal government granted the waivers needed to carry out the program, Gov. Barbara Roberts said, “Today our dreams of providing effective and affordable health care to all Oregonians have come true.” The number of uninsured Oregonians did not budge.

In 1992 and ’93, similar bills passed in Minnesota, Tennessee and Vermont. Minnesota’s plan called for universal coverage by July 1, 1997. Instead, by then the number of uninsured people in the state had increased by 88,000.

Tennessee’s Democratic governor, Ned McWherter, declared that “Tennessee will cover at least 95 percent of its citizens.” Yet the number of uninsured Tennesseans dipped for only two years before rising higher than ever.

Vermont’s plan, passed under Gov. Howard Dean, called for universal health care by 1995. But the number of uninsured people in the state has grown modestly since then.

The State of Washington’s 1993 law included the major planks of recent Nixon-like plans: an employer mandate, an individual mandate for the self-employed and expanded public coverage for the poor. Over the next six years, the number of uninsured people in the state rose about 35 percent, from 661,000 to 898,000.

As governor, Mitt Romney tweaked the Nixon formula in 2006 when he helped devise a second round of Massachusetts health care reform: employers in the state that do not offer health coverage face only paltry fines, but fines on uninsured individuals will escalate to about $2,000 in 2008. On signing the bill, Mr. Romney declared, “Every uninsured citizen in Massachusetts will soon have affordable health insurance.” Yet even under threat of fines, only 7 percent of the 244,000 uninsured people in the state who are required to buy unsubsidized coverage had signed up by Dec. 1. Few can afford the sky-high premiums.

Each of these reform efforts promised cost savings, but none included real cost controls. As the cost of health care soared, legislators backed off from enforcing the mandates or from financing new coverage for the poor. Just last month, Massachusetts projected that its costs for subsidized coverage may run $147 million over budget.

The “mandate model” for reform rests on impeccable political logic: avoid challenging insurance firms’ stranglehold on health care. But it is economic nonsense. The reliance on private insurers makes universal coverage unaffordable.

With the exception of Dennis Kucinich, the Democratic presidential hopefuls sidestep an inconvenient truth: only a single-payer system of national health care can save what we estimate is the $350 billion wasted annually on medical bureaucracy and redirect those funds to expanded coverage. Mrs. Clinton, Mr. Edwards and Mr. Obama tout cost savings through computerization and improved care management, but Congressional Budget Office studies have found no evidence for these claims.

In 1971, New Brunswick became the last Canadian province to institute that nation’s single-payer plan. Back then, the relative merits of single-payer versus Nixon’s mandate were debatable. Almost four decades later, the debate should be over. How sad that the leading Democrats are still kicking around Nixon’s discredited ideas for health reform.

David U. Himmelstein and Steffie Woolhandler are professors of medicine at Harvard and the co-founders of Physicians for a National Health Program.

Laurie Garrett's comments from her book: "Betrayal of Trust"

"Ronald Reagan swept into the presidency in 1980. His two terms in that office were marked by the dismantling of public health's regulatory powers. Within eight years the Reagan administration had so thoroughly defeated its regulatory adversaries that public health was forced into defeat, even on issues of bona fide community health threats, its most outspoken voices of environmental concern sidelined along the margins of academia and political activism" Laurie Garrett "Betrayal of Trust" page 580.

A report from the U.S. Department of Health "made clear that the infrastructure upon which the national public health system functions requires definition, coordination, and strength to realize the universal public health mission. [The report] documents continued deterioration of the national public health system; health departments closing, technology and information systems outmoded; emerging and drug resistant diseases threaten to overwhelm resources; and serious training inadequacies threaten the capacity of the public health workforce to address new threats and adapt to changes in the health care market." "Betrayal of Trust" Pg 559.

See Laurie Garrett's books about public health policy.

Dr Paul Farmer

See also Mountain Beyond Mountains, the quest of Dr. Paul Farmer, a man who would cure the world: by Tracy Kidder. It will surprise you, after reading US media, how Farmer admires the Cuban health care system. Excellent book. It is persuasive in arguing that health care is a right, not a commodity.

Global Health Equity (a video of Paul Farmer)

Dr Farmer's charity is Partners in Health.

Bibliography

The Hidden History of American Healthcare: Why Sickness Bankrupts You and Makes Others Insanely Rich by Thom Hartmann (Hidden History Series) – September 7, 2021

If It Sounds Like a Quack…: A Journey to the Fringes of American Medicine by Matthew Hongoltz-Hetling (youtube)

Our Malady, Lessons in Liberty From A Hospital Diary by Timothy Snyder: book review

Health Care Under the Knife: Moving Beyond Capitalism for Our Health: by Howard Waitzkin and the Working Group on Health Beyond Capitalism

The American Health Care Paradox: Why Spending More Is Getting Us Less, Elizabeth H. Bradley and Lauren A. Taylor

The Healing of America: T.R.Reid

Doctored: The Disillusionment of an American Physician: Sandeep Jauhar

Deadly Spin: Wendell Potter

Healing of America: T. R. Reid (or this)

Making a Killing: Jamie Court and Francis Smith.

Our Daily Meds: Melody Peterson

The Medical Malpractice Myth by Tom Baker (2005)

Critical Condition: Donald L. Bartlett and James B. Steele. Doubleday, 2004. See this also.

Severed Trust: George Lundberg, M.D.

To Err is Human

Betrayal of Trust: Laurie Garrett (see above)

Universal Healthcare: what the US can learn from the Canadian experience: Pat & Hugh Armstrong

Mad Cowboy: Howard Lyman

And the Band Played on: Randy S.

Blind Faith, the Unholy Alliance of Religion and Medicine: Richard P. Sloan, Ph.D

Health against wealth : HMOs and the breakdown of medical trust: George Anders.

The River Origin of Aids: Ed Hooper (see a short version of the video.)

Pigs at the Trough: Arianna Huffinton

Mountain Beyond Mountains: The Quest of Dr. Paul Farmer; Tracy Kidder (See Partners in Healthl). See the video.