Circleville Herald -- January 8, 2009

The Titanic and the U.S. Healthcare Crisis

“Rats and roaches live by competition under the laws of supply and demand. It is the privilege of human beings to live under the laws of justice and mercy.” - Author Wendell Berry.

The Titanic sinking of April 1912 bears many similarities to our failing U.S. healthcare system. The captains of industry of 1912, ensconced on luxurious upper deck suites, profited from a workforce they could exploit at will with unlimited hour work weeks, child labor, certainly no safety protections or health insurance, an ill or injured worker was simply fired .Despite optimism that the free market had engineered an “unsinkable” ship, the Titanic went down, broken in pieces, with lifeboats available for less than one-half of the souls on board. Less privileged passengers drowned, locked below decks, without hope. The captains of the U.S. healthcare industry invest heavily in propaganda mis-informing us that our profit-driven ,pay-for-care is system is the world’s best, that it is “unsinkable”. Yet, many of us know we are locked below decks, while the water is rising .

The prestigious Institute of Medicine estimates at least 18,000 Americans perish yearly from lack of health insurance. The American Cancer Society released a report December 2007 noting that the uninsured have 50% of the five year survival rate that the insured have. 47 million Americans, most of them working, often two jobs, have no health insurance. Twice that many are underinsured with deductibles as high as $5,000, co-pays and co-insurance high enough to present a barrier to care, high enough that one heart attack, one wife with breast cancer, one asthmatic child is sure to cause bankruptcy. 50% of all bankruptcies in America are in fact directly related to health care costs.

The World Health Organization rates the United States healthcare “system” as 37th among all other nations overall, 54th for “fairness”, that is equitable access to care. In the U.S. life expectancy is 27th, maternal mortality 29th, infant mortality 35th, overall mortality ages 15 to 60: 35th, odds of death before age 5: 36th. The United States leads the world in only two categories: the amount of money spent on health care per capita per year ,over $7600, and the percent of gross national product , over 16.5%, spent on health care. We easily spend twice, the amount per capita than do other nations that perform better than we do: Canada, Great Britain, Norway, France. Among the industrialized, civilized nations we are alone, absolutely alone, in denying health care access to a large proportion of our population, a direct function of our belief that healthcare is a commodity on the free market, not a basic human right. This belief that our health is simply one more commodity, like plasma screen televisions or oversize SUVs is the iceberg that is sinking our Titanic healthcare system.

Why is our healthcare “system” so inefficient, that we spend so much more money for less health? Answer: 31 cents of every healthcare dollar spent is absolutely wasted on overhead, marketing, profit. Your doctor has to hire all those folks in the office to file papers and argue with the over 1500 idiosyncratic insurance companies. The insurance companies all hire hundreds of bureaucrats to deny your claims and argue back with your doctor. “Private is always better” insurance companies average about 15-20% overhead costs, Medicare’s overhead, a tax supported “government bureaucracy” is 3%! The pharmaceutical companies, surely the captains of industry on the promenade deck of the Titanic, rake in profit margins of 19%, when 5% is the median for all of the Fortune 500 companies! The pharmaceutical companies, working closely with the Bush administration, crafted the Medicare Part D legislation that actually protects drug company profits by forbidding, yes forbidding, Medicare from negotiating prices for drugs!

The ethical, moral, faith and values based solution is Medicare for all, proven, with it’s correctable faults, to be the most efficient and thorough provider of health care. As an emergency physician, I am face to face, heart to heart, with struggling, worthy, working families without health insurance every day. The emergency department (ED) is the one place in America where everyone is treated, without exception. I would practice no other way. We are great lifeboat doctors, but my patients need ongoing care for their diabetes, their high blood pressure, their child with a chronic health condition. I send them out of the ED, knowing that they will have to decide between gasoline and prescriptions, knowing they and their children will suffer as a profit driven healthcare system will only guarantee them shorter, sicker, less productive lives..

Republican Catherine Crier, addressing the opening session of the American College of Emergency Physicians annual meeting October 2007, noted that our nations overloaded and overwhelmed emergency departments are “the canaries in the mine”. Ms. Crier urged emergency physicians to be “effective revolutionaries” and take to the streets, march on the Capitol and demand serious healthcare reform. Our nations EDs are being overrun by all the unfortunates left below decks by our healthcare system. We are sending out a distress signal on their behalf. Is anybody listening?

I urge you to join me and write, phone call, e-mail your U.S. legislators to support H.R. 676 “Medicare for All” and likewise contact your Ohio legislators to support the “Healthcare for all Ohioans Act”, H.B. 186 and S.B. 168. Shall we allow “small government” to protect pharmaceutical and insurance company profits in our system that wastes 31 cents of every dollar? Who will we let drown? Or shall we demand a safe ship for all?

Dr. Brad Cotton is a full-time emergency physician and member of Physicians for a National Health Program. He is available to speak at church, civic, business groups on universal single payer health care. E-mail: