Ya wanna know what the problem is? I'll tell ya what the damn problem is. Here we have, in Washington and in America, a health


Don't get sick

Ya wanna know what the problem is? I'll tell ya what the damn problem is. Here we have, in Washington and in America, a health care system that is in sheer crisis. Managed care has been a disaster, costs are skyrocketing, access to health care is shrinking, bureaucrats are making health care decisions, insurance companies and HMOs have everybody by the balls, people are foregoing basic and preventative care because they can't afford it, and as a result the richest country in the history of the world is paying extortionate amounts for health care but still has public health indices that in some corners rival those of Bangladesh. And the problem is, the problem is, that for the only women and men who can do something about it, the folks in the state legislatures and in Congress, IT'S NOT THEIR PROBLEM. Government employees are virtually the last sector of the economy to enjoy comprehensive health benefits in their jobs. They don't have a problem. We do.

The quickest solution—and this would apply to a few other of our society's problems, too—would be to make legislators have to live by the same miserable rules as the rest of us. See how they like it. See how quickly the problem would be fixed.

In 1992-93, when a political consensus that the health care system needed serious change magically evolved, it was somehow handed off at the federal level to the president's wife, who botched it. Hillary Clinton crafted a plan to please big insurance companies and it panicked medium-sized insurance companies, who launched those infamous "Harry and Louise" TV ads and killed it. (Remember that "socialized medicine" was going to take away our freedom to choose our doctors? Pretty perverse joke, huh?) In Washington state, our legislature passed a sweeping, nearly visionary health care reform package, which over the next four years was neatly skeletonized (think cows in a South American river with hungry fish) by insurance companies and other predators with the spineless acquiescence of our state's politicians.

The net result is that over the last seven years things have gotten a lot worse. In an era of little general inflation, costs have consistently risen at double-digit annual rates. Far more people—nationally, some 45 million of them, and over 600,000 in Washington state—are without any health insurance at all. And the remarkable thing is, in an economy that can actually afford to tackle this problem, nobody is doing anything about it.

It keeps coming back to the legislators. In DC, interest in comprehensive reform is nil. There's one desperately needed bandage—Clinton's proposal to cover prescription drugs in Medicare.

An enormous gap in coverage exists because drug companies enjoy huge markups and obscene profits, Medicare recipients are often on fixed incomes, and supplemental Medicare insurance policies, even if they're affordable, almost always require patients to pay a percentage of that huge markup. Amazingly, even that reform is stuck in a battle with Republicans who would rather spend the money on yet another tax cut for the wealthy.

Sunny Jim & Claritin

How bad is it? Our own Rep. Jim McDermott, once one of Congress's most articulate critics of profit-driven health care and an advocate of a Canadian-style single payer system, is now shilling for the drug companies. He is cosponsor, along with Rep. Ed Bryant (R-TN), of a bill to extend by three years the patent on the antihistamine drug Claritin, which expires in 2002. In Congressional testimony, a competing drug company said it could market a generic version of the drug for about $15 a month—as opposed to Claritin's monopolistic cost of $87 a month. McDermott, who has been musing aloud about running against Slade Gorton next year, got $7,000 in campaign donations from Claritin's manufacturer in 1997-98. Bryant got $10,000. It's a dirt-cheap investment for the drug maker, which sold $2.3 billion of Claritin last year and stands to profit by hundreds of millions from the patent extension.

Back home, Regence Blue Shield, the only company that offers individual health coverage in much of Washington state, just jacked up their rates by 28 percent, betting—so far successfully—that state insurance commissioner Deborah Senn would be too busy running for Senate to object. The rate hike came after the failure in the last legislative session of an insurance-friendly "reform" package designed to make the individual market more profitable by, among other things, making it harder for sick people to get coverage. This is the essence of our 1999 health care policy: don't get sick.

The insurance industry bill, championed by Gov. Gary Locke and Rep. Eileen Cody, was essentially a response to industry blackmail: threats, so far unfulfilled, to pull out entirely from the individual health plan market. Cody recognizes the emergency nature of the situation but is not hopeful of relief soon. "Nobody wants to face up to the fact that we need the big overhaul," she says, noting that with the complexity of the issue, chances for meaningful action in 2000 are not good, either. And she adds, correctly, that it's hard to empathize with insurance industry claims of losses when company CEOs are pulling down enormous salaries.

So who's going to do something? A single payer advocacy group, Health Care 2000, is trying to get a statewide initiative on the ballot next year for universal health care in Washington state. Similar initiatives in other states have faced formidable opposition from entrenched lobbyists and industry groups. Too many people are making too much money from the current system. The problem is, of course, that this has nothing to do with health care. It's good for business, but people are quite literally dying as a result.

Maybe if our legislators had to pay for health care for their families themselves—from the median income of an average American and with the limitations on care that most Americans now face—maybe then we'd see that big overhaul. We're waiting.

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