LETTERS: FIDDLING WITH HEALTH CARE

To the editor:

HMOs, managed competition, managed care -- whatever -- simply preserves two great myths embedded in our present system.

First: The mistaken, longstanding assumption that health-care coverage should be attached to employment. Health care is fundamentally a claim by members of a community on each other. It is a claim of human beings, not of workers. It is a citizenship claim, not an employment benefit. In the origins of our present system, health care was presented as a benefit of employment. Companies used it as part of a compensation package that was obtained by unions or simply instituted through corporate self-enlightenment. However, over the decades, health care has become a right springing from our common life together, whether employed or unemployed, rich or poor. It arises from our shared humanity, from the bonds between generations and among families, friends and communities. Attaching this rightful claim to employment misses the point. Servicing our present system has become a heavy burden for our nation's employers. Why burden them with monitoring of health in addition to their primary purpose of conducting a business ethically? Inasmuch as health care is the right of people as citizens and members of interdependent communities, why not let the associations and particularly government(s) responsible to those people deal with health care?

Second: That private insurance carriers and their immense, overlapping bureaucracies, with the resulting quagmire, are somehow indispensable to the health-care delivery system.

Winston Churchill said, "You can always count on Americans to do the right thing ... but only after they have tried everything else." We're seeing this truism played out at this very time. We are trying everything else, and we are now in worse condition than when President Clinton began his effort several years ago. Our present shambles of a health-care coverage system is intrinsically unfair, cruel, discriminatory and appalling wasteful. At the onset of President Clinton's efforts, The Citizens Jury, the brainchild of a wealthy Minnesotan, Ned Crosby, selected 24 members from a random sample of 2,000 adults on the basis of age, gender, politics, geography, ethnicity and other demographic specifics to represent a true section of America. They determined "when it comes to health care, the good of America is in universal health-care coverage with a single payer." This is very much the sentiment of middle America. That verdict came in defiance of the inside-the-Beltway wisdom that says a single-payer plan can't be passed. It can be.

Insurors have created a system designed to maximize industry profits. For-profit managed care has proved so lucrative that it is offered by companies created to do nothing else. Former U.S. Surgeon General C. Everett Koop said recently, "Insurance companies are accumulating enormous power/welath by taking over the ownership or management of entire health-care delivery systems, even some medical schools. ... All across America we see an accelerating trend of taking medical decisions away from doctors and patients and allowing them to be made by business." Managed care as practiced by the insurance industry is simply an arrangement to redistribute health-care dollars to industry administrative functions.

If we as a society cannot agree that health care must be addressed on an all-inclusive basis, we are accepting the present lottery-like non-system. It invites industry to maintain contraol of health care with the present stupifying panoply of programs designed to benefit insurors and their stockholders. To steamroll such programs, Americans are bludgeoned with the horrible specter or socialism and communism if a health-care program with universal coverage and single-payer characteristics were introduced. If patients and doctors fear government bureaucrats under such a program, their eyes will be opened, in not already, to what a taskmaster private, for-profit industry can be. An Associated Press release last March points to backlash legislation in at least 40 states due to just such heavy-handed influence of managed care.

One could cite many statistics and comparisons with other industrialized nations. Unless we catch the drift of what's really at stake, we'll simply continue to fiddle. All of the fancy footwork and fragmented concepts to avoid what America ultimately must do to be true to itself are only way stations on the road to the adoption of a universal, single-payer health-care coverage system.

GILBERT DEGENHARDT

Cape Girardeau