In this election season, non-profit community organizations must be particularly careful that we do not overstep the bounds, and endanger our non-profit status. We are prohibited from lobbying or electioneering. We cannot endorse any candidates, propositions or legislative bills. If we did, the IRS would do terrible things to us. That said, we must nevertheless fulfill our role as an educational center and as a coalition of health advocates, and address the health care issue in the context of the presidential election of November 2004.

One candidate in a speech this year told us that "we have the best health care system in the world." That glib statement stands out in our memory, because it is so sharply at variance with everything we know about this country’s health care system. We have some of the best-trained doctors and some of the best-equipped hospitals in the world, and we have the most hi-tech gadgets in the world, but that’s it.

According to the Institutes of Medicine, some 18,000 Americans under 65 die needlessly and prematurely each year because they lack access to timely and appropriate health care. That’s about equivalent to six World Trade Center disasters each year. Between forty and fifty million Americans are without health insurance, most of them employed, most of them unable to afford the ever-increasing costs of premiums. Does that sound like "the best health care system in the world"?

We have an increasingly critical shortage of nurses. The World Health Organization ranks our system 47th in the world on such criteria as distribution of health resources and access to care. Does that sound like "the best health care system in the world"?

Ours is the only employer-based health care system in the world. Increasingly, businesses are unable to afford to provide coverage for employees. More and more workers are required to foot more of the bill, or go without coverage. We are told that this is a good thing, since patients should be made aware of the "real cost" of the services they receive, but each year the costs increase and the coverage decreases. Seniors strive to obtain prescription drugs from Canada. At the same time, more than half of all labor/management conflicts, including the grocery workers’ long strike and the transportation strikes across America, have been over health care coverage, and almost half of all bankruptcies are due to medical bills. Does that sound like "the best health care system in the world"?

What happens to our health care dollars? Where does most of the money we spend on health care go? In a recent article in the Los Angeles Times, we learn that the California Insurance Commissioner has been struggling mightily to curb the corporate excesses of Anthem, Inc. which proposes to acquire Wellpoint, Inc. including Blue Cross Life and Health Insurance Company, the Blue Cross of California HMO. In the process, Wellpoint announced that the sale would trigger payment of between $200 million and $600 million in severance pay, retention bonuses (whatever they are) and stock options to its executives. Apparently the Insurance Commissioner cannot block the deal, but he is valiantly trying to persuade Anthem to provide a like amount for uninsured Californians as it will for payments to executives. In the article, Insurance Commissioner Garamendi was quoted as saying that the same amount of money would buy a year’s worth of health care coverage for as many as 577,000 uninsured children.

Anthem, Wellpoint and the Blues are middlemen in the delivery of health care. Somehow, they have inserted themselves between the patient and the doctor. Not one tongue depressor is applied to one patient by Anthem, Wellpoint, or the Blues. Not one pill is prescribed, not one bone set, not one patient treated. Yet Anthem has accumulated so many of our health care dollars that this acquisition deal alone is for $17.4 billion, and would create the nation’s largest health insurance company. This is one reason why ours is the most expensive health care system in the world. Profitable for the middleman, yes, but does that sound like "the best health care system in the world"?

And finally, "the proof of the pudding…". How do health outcomes of the United States compare with those in other industrialized nations? When measured on any number of objective criteria, from the health of newborn babies to Americans’ years of healthy productive life lost to diseases and illness, the "best health care system in the world" falls short. While paying more than double the cost of care in any other country, we have a system rife with ineffective or unnecessary medical interventions, expensive medications, iatrogenic (doctor-caused) illness and disability, medication errors, out-of-date hospital systems and patient records, over-utilization of scanners and other hi-tech hardware, and little or no access for forty or fifty million people who are uninsured, and millions more who are under-insured

If you’re as angry as we are about being lied to, you won’t vote for the candidate who told us that we have the best health care system in the world.

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