refocuses healthcare debate

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refocuses healthcare debate

His latest film, 'Sicko,' may boost efforts for a national healthcare

system, an idea that still faces stiff resistance in Washington.

By R. Francis | Columnist

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Filmmaker is making headlines again. His new

documentary, " Sicko, " promotes a national healthcare program like

Canada's. The film, due to open in theaters June 29, got a big boost

when the US Treasury Department sent Mr. a letter acknowledging

a probe into his trip to Cuba to obtain medical treatment for three

9/11 rescue workers – and film a segment for his movie.

An " appalling " form of harassment, declared , saying his work as

a journalist is protected by the United States Constitution.

Advocates of a single-payer national healthcare system welcome 's

movie. With millions of viewers likely to see the film, it's

" unquestionably " helpful, says a spokesman for Physicians for a

National Health Program. PNHP, with a membership of 14,000 physicians,

has been campaigning for a national system for 20 years. But the

prospects of success for PNHP are not great yet, figures Henry ,

an economist at the Brookings Institution in Washington.

One reason is the power of various medical industry lobbies. Americans

spend as much on healthcare today as the entire gross domestic product

of France and Spain combined, notes one economist. If health-related

costs continue to rise rapidly, spending could soon equal the entire

GDP (that is, the output of goods and services) of Germany.

The $2.1 trillion the US spends per year on healthcare creates " strong

interest groups, " notes Mr. . These include a host of politically

powerful private health insurance companies and for-profit hospitals.

But a cofounder of PNHP, Steffie Woolhandler, a Harvard Medical School

associate professor, is more hopeful for radical reform – though not

under the Bush administration. That's because she sees a slow-motion

collapse of the present employer-based health insurance system.

Faced with globalization and severe competition from abroad, American

companies are moving to reduce their health insurance costs. They are

raising deductibles, requiring bigger copayments, and trimming the

medical services covered. As these trends hit the middle class, the

political result will be a " big storm, " Dr. Woolhandler predicts.

As it is, the US devotes about twice as much to healthcare as a

proportion of GDP than do other rich nations with nationalized health

systems.

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Economists at the federal Centers for Medicare and Medicaid Services

said last February that, if current trends continue, $1 of every $5

spent in 2016 will go toward healthcare. Today, healthcare takes close

to $1 of every $6, or about 16 percent of GDP. " We must do something

large and serious and soon, " says Alain Enthoven, a healthcare expert

at Stanford University in California.

If a Republican president is elected in 2008, reform will be

" relatively timorous, " says , possibly involving deductions for

health insurance premiums on income and payroll taxes. Changes will

probably most benefit the well-to-do, he says, and not much will be

done to cover the 47 million Americans without health insurance.

If a Democrat is elected president, reform could be more ambitious.

The " implicit taboo " on a large-scale health plan that followed

Hillary Clinton's failed effort in 1993 is gone, says . But no

Democratic candidate is advocating a national health insurance plan, a

move that would substantially redistribute national income and impact

strong health-industry interest groups.

would like to see Washington help fund state measures to broaden

health insurance coverage, such as the plan in Massachusetts. In

California last week, joined the Cali­fornia Nurses Association

to push for a statewide, single-payer healthcare system at a

legislative briefing and rally. But Gov. Arnold Schwarzenegger vetoed

a bill in 2005 that would have broadened coverage in the state in

favor of working with insurance companies.

So far, such Democratic presidential candidates as and

Barack Obama are advocating plans that keep the private health

insurance industry intact. " Different flavors of the same plan, "

complains a PNHP spokesman. Insurance companies would still strive to

insure the healthy and exclude the sick, he says, noting this process

adds to administrative and other overhead costs.

A study by Woolhandler and others published in 2003 calculated that,

in 1999, health administration costs in the US amounted to at least

$294 billion. That's $1,059 per capita, compared with $307 per capita

in Canada. By now, administrative costs are probably about $350

billion, a sum big enough to provide insurance coverage for uninsured

Americans, reckons a PNHP spokesman.

Americans would like to have the federal government guarantee health

insurance to everyone, especially children, according to a recent New

York Times/CBS News poll. They say they'd be willing to pay as much as

$500 more in taxes a year and forgo future tax cuts to do so. But a

campaign against a national health insurance plan is already building.

Harry and Louise, the couple portrayed in TV ads by America's Health

Insurance Plans that helped kill Hillary Clinton's health plan, may

yet return.

http://www.csmonitor.com/2007/0618/p15s02-cogn.html