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Q. "How big a risk does the insurer take?"
A. The more people the insurer is able to "cover" in the risk pool, the less risk. If all Californians were in one risk pool of 30 million people, the risk would be spread, and if only 15 percent of people require health care services in a given year, the insurer is able to keep 85 percent of the premiums, which should more than cover the costs of health care for the 15 percent, with money left over.

Q. "What is meant by 'cherry picking'?"
A. When an insurer selects only young, healthy people to "cover," risk is reduced, but somebody else will be stuck with providing coverage for the older and less healthy people.

Q. "Who would want to insure the old, sick people?"
A. Well, nobody who wants to profit from health insurance. That's why we need a not-for-profit health insurance program like Medicare.

Q. "So you say we need the biggest possible risk pool, and a not-for-profit health insurance program - but how would you control the growth in health care spending?"
A. The first step is to eliminate administrative waste and paperwork which amounts to about $14 billion per year in California. This can be done by replacing the hundreds of health plans with a single plan administered by a single agency. Next, all the health care dollars must be directed into a state health care trust fund. And third, we use our united purchasing power in bargaining to reduce the costs of pharmaceuticals and medical equipment.

Q. "Do you really think that the cost of such a system could be controlled in three simple steps?"
A. No. Eventually the growth of health spending can only be controlled when every Californian has a doctor and gets regular preventive care, and if medical decisions are made by doctors, including decisions about the necessity for and the effectiveness of treatments and medications.

Q. "What else do you think we need to do to bring down the spiraling cost of health care?"
A. The easy part will be to develop simple, standardized forms. Then we need to allow medical professionals to establish standards of care; create an annual health care budget with the authority to make sure we operate within it; develop electronic patient records and ensure that all professionals treating a patient have access to all of that patient's records; set up statewide health databases to enable statewide planning; provide adequate funding for education of health professionals; coordinate major capital expenditures; develop comprehensive disease eradication programs; identify causes of medical errors and take steps to eliminate them; regionalize specialty care and expensive technology to reduce duplication; use data-based drug and treatment protocols; eliminate ineffective, unnecessary treatments and fraud.

Q. "All that? But how will you ever get people to change the health care system as it now exists?"
A. As more people encounter increasing difficulty in getting timely and appropriate care, as the costs of health care rise and health professionals become increasingly frustrated and angry, as millions more are unable to afford health insurance and medicines while the pharmaceutical and insurance industries prosper, as public outrage finally gets the attention of the politicians, the changes will come.

Mike Luff, National Representative of the National Union of Public and General Employees, Canada's second largest union, responds to Humphrey Taylor's commentary on rationing:

Re: Humphrey Taylor commentary:

Humphrey Taylor's commentary on rationing health care is a classic exercise in manifestly missing the point. It's also a prime example of how the truth can be found to be inconvenient and incompatible with hidden agendas and ideology but nicely layered over with the guano of "expert" evidence.

The truth is, almost all Canadians, and I suggest most Americans as well, want, like, and need universal and comprehensive health coverage. Yet, we are saddled with this Great Medicare Debate. How can that be? Canadians and Americans live in a democracy. We are citizens in a nation where the will of the people is paramount. How is it that Canadians and Americans can be so long denied something we like and want so much? Who is doing this to us and why?

It's clearly not everyday Canadians that are making an issue out of medicare. We already did that. It's how we got medicare in the first place. Elections were won and lost on this issue until the politicians got the message and we got what we wanted: a medical care plan that covered every Canadian citizen, everywhere in Canada, no matter what we suffered from and no matter how much money we had in our wallets.

Comprehensive, universal medical coverage was our priority, often our top priority. It was the best hedge we could provide to ourselves against life's unending uncertainties. We knew that without our health, we had nothing. With it, we always had a chance.

So we got our medicare. It worked well for a long time. Now politicians and "experts" like Mr. Harris are telling us it can't last. Not without rationing it. Not without changing it beyond all recognition. Not without disregarding and dismissing the will of the people.

So the armies of actuaries, squads of statisticians and platoons of policy analysts debating the best way to ration health care will do no good. Because the heart of the Great Medicare Debate in Canada and the United States is not simply about the provision of medical care. It is, first and last, about responding to the will of the people. It is about democracy.

I would like to remind Mr. Harris that no one ever thought to ask whether we could afford World War II, whether we could afford to fight for our right to have our life to be the way we wanted it. In the same way, the question "can we afford comprehensive and universal public medicare" need never be asked. Of course we can afford Medicare, it is our life and our money and we can "afford" to spend it any way we like.

There will be no resolution to the Great Medicare Debate in Canada and the U.S. until the "experts" and our elected leaders acknowledge and accept that reality, no matter how disturbing it is to their big-money friends.

Politicians and "experts" must stop trying to talk us out of what we like and want. We must not let the talk, talk, talkers grind us down. We must not let the shills and shamans of private enterprise sway us with flash talk of better service by allowing them to ration care and make a buck out of it. We must hold out for ourselves. We must hold out for democracy. We must hold out for the kind of medicare we want.

Mike Luff, National Representative, NUPGE

[- Note: In Canada, the under-funded but still universal health insurance program is called "Medicare." In the USA, "Medicare" is also under-funded, and only available to those aged 65 and older. (Ed.)]

Collin urologist pursues 18-year struggle for universal insurance, By PAUL MEYER
The Dallas Morning News,6/24/2003

McKINNEY - Dr. Jerry Frankel still remembers the patient - uninsured and diabetic - who walked into his office four years ago after traveling to Mexico in search of a cheap treatment for a bad bladder. "She worked for a small local business that didn't provide insurance, so she went across the border where the doc told her he had an operation to fix her problem," recalled the 60-year-old McKinney urologist.

"He did major surgery that day using a synthetic material that had been banned in this country, and she was in agony for three months after she came back, until she finally came to see me. It was the worst abscess I'd ever seen and operated on. I still see her once in a while, and she can get along now, but the sad thing is that similar cases are occurring with increasing frequency."

For the McKinney doctor, such are the stories that dot his nearly two-decade fight for indigent health care and universal health insurance - waged on local, state, national levels since he left Pennsylvania for McKinney in 1985.

From inside his unassuming office, Dr. Frankel is a big name in the national health-insurance debate. Since 1995, he has served as one of 11 board members for Physicians for a National Health Program, a growing group of 10,000 doctors whose ranks include Parkland Hospital CEO Ron Anderson.

The national group - responsible for publishing one of the first major universal health-insurance proposals in the New England Journal of Medicine in 1989 - is pushing its plan to reform Medicare and expand the program to cover all Americans.

Dr. Frankel rattles off the most recent statistics: more than 41 million uninsured Americans; medical inflation running at more than 13 percent; prescription drug costs rising at more than three times the rate of inflation; and Collin County's own number of uninsured estimated at 78,000 residents.

Dr. Frankel said his battle has been a frustrating one locally as an unabashed Democrat in an area that has supported more than a decade of Republican dominance.

"Throughout the rest of the country, I can't get over how responsive people have been to the idea of Medicare for all, with the idea of national health care appealing to more and more groups and businesses who simply weren't interested in the past," Dr. Frankel said.

"Then there are times here in Collin County when I just ask myself what in the world I'm doing. It can be tough and discouraging, but you have to push on."

Government-run health care is opposed by many politicians, pharmaceutical companies and doctors.

"Government-run, national health programs haven't worked in socialist countries - or democracies like Britain and Canada - and they won't work in America," said Rep. Sam Johnson, R-Plano. "We need to guard the taxpayers' dollars, not flush them down the drain."

The role of the underdog is nothing new for Dr. Frankel. In 1996, he was soundly defeated in his bid for Congress by then House Majority Leader Dick Armey.
Before that, he served as president of the Collin County Medical Society in the late 1980s, when he started lobbying Austin for greater health care access.

"I got before the state medical group to speak and you would have thought I was a communist and the Russian invasion was coming," he said. "For four years I would go down to Austin four times a year, and I would go to the county every year as well. Then I became more pragmatic and stopped. It was just too painful to spend so much time and make no progress."

To his colleagues, Dr. Frankel is known for his professional excellence in addition to his political forays.

"He's an excellent doctor, and he's also very much of an individual," said Mack Hill, a longtime local pediatrician and secretary of the Collin-Fannin County Medical Society. "As far as his work with the medical society is concerned, he has been very interested and I admire him a great deal."

Undeterred by staunch opposition to his call for universal health insurance, Dr. Frankel now focuses most of his attention on the national landscape. He travels around the country two weeks a year to meet with activists, students, churches, businesses, and labor organizations. While at home, he writes up to five articles a week for publications, sends off a steady stream of editorial letters and counsels patients on ways to secure affordable treatments and order drugs from Canada.

He says his progress has come in fits and starts. Dr. Frankel cites a flurry of universal health-insurance bills, and he says businesses and labor groups are starting to see that national health insurance is a way to deal with the increasing health care costs.

"Outside of the metroplex, we're seeing businesses and government entities starting to advocate this because they simply can't absorb skyrocketing health care costs," Dr. Frankel said. Locally, however, Dr. Frankel has watched as other groups - most recently the Plano Area Interfaith - lobby unsuccessfully for greater county support for indigent care.

"It's like the Brooklyn Dodgers losing every year to the Yankees. But in 1955 we finally won, and it was such a great feeling it stuck with me," he said. "I may lose the daily, weekly and annual battle, but sooner or later common sense will prevail."

E-mail pmeyer@dallasnews.com

[- In Texas it must be even tougher than here in California! (Ed.)]

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