Single-Payer Health Care for New York

Do you think that our state legislature should pass Assemblyman Kevin Cahill's proposal for a single-payer system of health care across NY ("The New York State Health Plan": A.6576) that would save billions for small businesses, corporations, and all of us-- while covering everyone and giving us back the choice we once had of which doctor and hospital to go to?

The New York State Health Plan would be "a comprehensive system of access to health insurance for New York state residents: provides for administrative structure of the plan, including its status as a public benefit corporation; provides for powers and duties of the governing board, the scope of benefits, payment mechanisms and cost controls; establishes the New York Health Trust Fund which would hold monies from a variety of sources to be used solely to finance the plan; establishes a mechanism to collect plan premium payments (an 8\% employer premium and a 2\% employee payroll premium, which may be paid by an employer, plus a 9\% premium payment on self-employment income); establishes a temporary commission on implementation of the plan and makes a $500,000 appropriation therefor; and directs the superintendent of insurance to examine the premium rate structure for insurance underwritten in the state and to identify that portion of premiums which are attributable to health care expenditures due to implementation of the plan."
[from http://www.assembly.state.ny.us/leg/?bn=A6576 ]

Fact: Most employers spend well over 8\% of their payroll on health insurance for their employees-- this plan would save small businesses and corporations a lot of money.

Fact: Most New Yorkers who have health insurance spend well over 2\% of their income on health insurance premiums; this plan would save the vast majority of New Yorkers a lot of money.

Fact: Assemblyman Kevin Cahill and seventy-six other members of the NYS Assembly are co-sponsors of Assemblyman Richard Gottfried's "The New York State Health Plan" (A.6576; see http://www.assembly.state.ny.us/leg/?bn=A6576 ):

Grannis, Brennan, Gantt, Jacobs, Seminerio, Tonko, Dinowitz, Paulin, Bing, Peoples, Zebrowski, Schroeder, Abbate, Aubry, Benedetto, Benjamin, Boyland, Bradley, Brodsky, Clark, Cohen A., Colton, Cook, Cymbrowitz, Diaz L, Diaz R, DiNapoli, Eddington, Englebright, Espaillat, Farrell, Friedman, Glick, Gordon, Green, Greene, Gunther, Heastie, Hikind, Hooper, Hoyt, John, Karben, Lafayette, Lavelle, Lavine, Lentol, Lifton, Lopez, Lupardo, Magee, Markey, Mayersohn, McEneny, Millman, Nolan, O`Donnell, Ortiz, Peralta, Perry, Pheffer, Powell, Pretlow, Ramos, Reilly, Rivera J, Rivera N., Rivera P., Robinson, Rosenthal, Scarborough, Sweeney, Towns, Weinstein, Weisenberg, and Weprin.

Fact: State Senator (and likely future Lieutenant Governor) David Paterson is a co-sponsor of state Senator Eric Schneiderman's companion bill in the state Senate (S.3459); other co-sponsors include state Senators Brown, Diaz, Dilan, Duane, Krueger, Kruger, Montgomery, Onorato, Oppenheimer, Parker, Sampson, Smith A., Smith M., and Stavisky; see http://www.assembly.state.ny.us/leg/?bn=S3459 .

Fact: Three years ago an ABC News/Washington Post survey of over 1000 Americans found that 80 percent of us say it's more important to provide health care coverage for all Americans-- even if it means raising taxes-- than to hold down taxes but leave some people uncovered.
[ http://abcnews.go.com/sections/living/US/healthcare031020_poll.html ]

Fact: "The overwhelming majority [of Americans]-- 75 percent, according to an October 2005 Harris Poll-- want what people in other wealthy countries have: the peace of mind of universal health insurance."
http://www.commondreams.org/views06/0818-27.htm

Fact: 89\% of Americans believe our system of health care is broken:
http://www.americansforhealthcare.org/media/pressreleases.cfm?pr_id=119 .

Fact: Our County Legislature's Democratic Caucus leaders (Roger Higgins and Sandy Goldberg) put forth a resolution in January 2005 (sponsored by the entire caucus) calling for a single-payer health care plan to be put on the ballot this November for referendum.

The truth is also that this one is a bit personal for me, folks; May 29th marked the seventh anniversary of the death of my stepfather, Bob ("Piggy") Malstrom from heart attack at 59-- way too young.

Though he worked most of his adult life (twenty years for IBM), he didn't have health insurance at the end, and was too proud to go to anyone for help, though he knew something was wrong with his health; the CPR I gave him in his last dying minutes failed (recall-- petitiononline.com/forpiggy/petition.html).

Bob's not alone, though (see below for more on this; please share your story online on this if you can).

Toll-free number for Governor/State Legislature: (877) 255-9417.

Joel Tyner
Dutchess County Legislator
Clinton/Rhinebeck
324 Browns Pond Road
Staatsburg, NY 12580
[email protected]
JoelTyner.org

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Fact: In 2002 the National Academy of Sciences' Institute of Medicine found in their "Care without Coverage: Too Little, Too Late" study that 18,314 Americans die each year because they lack preventative services, a timely diagnosis or appropriate care. This includes about 1,400 people with high blood pressure, 400 to 600 with breast cancer and 1,500 diagnosed with HIV. Odds are the number of deaths is even higher.
[see http://books.nap.edu/books/0309083435/html/161.html#pagetop ]

Fact: That's over a thousand New Yorkers dying each year because they don't have access to health insurance.

Fact: St. Francis Hospital spokesman Larry Hughes stated on his radio show on WHVW 950 AM this summer that the hospital spent $14 million over the last two years alone on care for uninsured patients.

Fact: "Uninsured patients treated at Saint Francis Hospital climbed dramatically from 16 percent in 2000 to 33 percent in 2004. The cost escalated too, up 20.6 percent to $12.9 million from 2004 to 2005 alone. That amounted to 9 percent of the Poughkeepsie hospital's budget."
[from "Soaring Health Costs Leave Many in a Bind" by Dan Shapley
Poughkeepsie Journal 3/23/06
http://www.poughkeepsiejournal.com/apps/pbcs.dll/article?AID=/20060323/NEWS01/603230332/0/NEWS01&theme=NIF ]

Fact: "New York has 2.9 million uninsured residents, who last year cost hospitals $1.7 billion in so-called uncompensated care...$908,000 in 2002 at Northern Dutchess Hospital, $4.1 million at St. Francis Hospital, and $1.7 million at Vassar Brothers Hospital."
[from "New York's Uninsured Need Not Be" by Mary Beth Pfeiffer (9/03
Poughkeepsie Journal):
http://www.cdfny.org/News/clips/PoughkeepsieJournalUninsured\%20need\%20not\%20be.pdf

Fact: A 2001 Dyson Foundation/Marist Institute survey found uninsured in one of every four households here in the Hudson Valley. Basic insurance costs for individuals range anywhere from $350 and above per month, while a family plan is over $1000 per month and is too prohibitive for most residents.
[ http://www.DysonFoundation.org/resources/resources_show.htm?doc_id=212586 ]

Fact: 80 percent of those without health insurance have jobs or live in working families, according to the Cover the Uninsured Week, a national coalition that includes both the U.S. Chamber of Commerce and A.F.L.-C.I.O.
[ http://www.CovertheUninsuredWeek.org ]

Eliot Spitzer: "The cost of an insurance policy for a family of four in New York State also more than doubled, from $5,300 in 1996 to more than $11,000 in 2005. The high cost of providing health benefits has also weakened the state's competitive position in attracting and retaining businesses...Something is wrong when our hospitals collectively lost $2.3 billion on hospital operations over the last seven years, while one for-profit insurance company made nearly $1.5 billion over the last year alone." [Note from yours truly-- our representatives in Albany need to put the brakes on skyrocketing health insurance premiums that are bleeding all of us dry and a big part of the reason why school budgets originally (unfortunately) went down in flames in May in Arlington, Beacon, Hyde Park, Millbrook, Rhinebeck, Spackenkill, Wappingers, Pawling, and Red Hook.]
http://www.Spitzer2006.com/main.cfm?actionId=globalShowStaticContent&screenKey=cmpSpeeches&htmlId=4927&s=spitzer3

Fact: the four CEO's of Aetna, United Health, Wellpoint, and Humana made more than $58 million in salaries and compensation last year alone-- while 46 million Americans went without health insurance.

Fact: "In 2004, New York health maintenance organization (HMO) profits totaled $847 million, bringing their total profits to $3.7 billion over the past six years," according to the Health Association of New York State.
[see:
http://www.hanys.org/communications/pr/2006/upload/budget_impact_by_hospital_attach.pdf ]

Fact: HMO's reported a $6.98 billion profit for the first six months of last year-- a 21\% increase over the same period in 2004 according to Weiss Ratings, Inc. (GAO: most accurate insurance rater); more from
http://www.weissratings.com/News/Ins_HMO/ :

1/30/2006-- HMOs Earn $7 Billion in First Half of 2005
10/24/2005-- HMO Profits Jump 21\% in First Quarter 2005
8/8/2005-- Nation's HMO Profits Increase 10.7\% in 2004
5/24/2005-- Profitability Continues to Surge for the Nation's HMOs
12/8/2004-- HMO Profits Increase 33\% in First Quarter 2004
8/30/2004-- HMOs Earn $10.2 Billion in 2003, Nearly Doubling Profits
5/3/2004-- HMO Profits Skyrocket to $6.7 Billion in First Nine Months of 2003
3/2/2004-- HMO Profits Surge 73\% in Second Quarter 2003
1/20/2004-- HMO Profits Jump 60\% in First Quarter 2003
12/10/2003-- HMOs' Profits Climb 81\% to $5.5 Billion in 2002
12/18/2002-- HMO Profits Skyrocket 162\% in First Quarter 2002
9/3/2002-- HMOs', Health Insurers' Profits Increase 25\% to $4.1 Billion in 2001
2/4/2002-- HMO Profits Up 16 Percent in Second Quarter 2001
11/26/2001-- HMO Earnings Climb 8 Percent to $323 Million in First Quarter 2001

Fact:

1999: $97 million in HMO profits in NY (a 57\% increase from the year before)
2000: $403 million in HMO profits in NY (a 315\% increase from the year before)
2001: $523 million in HMO profits in NY (a 30\% increase from the year before)
2002: $756 million in HMO profits in NY (a 44\% increase from the year before)
2003: $1 billion in HMO profits in NY (a 32\% increase from the year before)
[from http://www.nystla.org/nicecontent/documents/HMOs.pdf ]

Fact: Canada didn't switch to a national system of single-payer health care all at once; it went province by province, and the first province to switch in 1960 was Saskatchewan (the most heavily indebted one)-- to save money-- the Conservative government in control liked the results they saw after initiating that pilot project and expanded it throughout the country. Note-- Rep. Maurice Hinchey and seventy other members of the House of Representatives are co-sponsors of Rep. John Conyers' single-payer health care bill to expand Medicare to cover everyone (H.R. 676); call Congress toll-free on this at (888) 355-3588.

Fact: Assemblyman Pete Grannis spoke on the virtues of a single-payer health care plan for NYS in April as part of the four-part series of "The Pros and Cons of Medicare for All" on WAMC coordinated by Physicians for a National Health Plan, NYS Nurses Association, Hunger Action Network of NYS, and others; download these four great forums @ http://www.wamcarts.org/artsarchive.html .

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Bill Summary for A.6576
[from http://www.assembly.state.ny.us/leg/?bn=A6576 ]

SUMMARY OF SPECIFIC PROVISIONS: Section 1 amends the Public Health Law by adding a new Article 51 establishing the New York Health Plan. Article 51 sets forth the administrative structure of the New York Health Plan (including its establishment as an independent public benefit corporation), the powers and duties of the governing board, the scope of benefits, payment mechanisms and cost controls.

Key features of New York Health include the following:

- Benefits would include medically necessary health services including
preventive and primary care, hospital care, dental, eye care,
prescription drugs, mental health, treatment for drug and alcohol
addictions, and rehabilitative care;

- Coverage would be extended to residents of New York State without
regard to age, income, health or employment status;

- Payment for provider services would be on the basis of global budgets for hospitals and other institutional providers, individual
practitioners would be able to choose fee-for-service, capitation or
be salaried by a global budget institution. There would be no
out-of-pocket charges for individuals, and no balance billing;

- Administration of the plan, as an independent public benefit
corporation, would be by an 18-member Board of Governors, appointed by the Governor and confirmed by the Senate. The Board would be
representative of consumers and providers of health care services, as
well as labor and business;

- Financing of the program would be through several sources. Current
federal, state and local expenditures for health care services--
primarily through Medicare and Medicaid - would be incorporated into
the New York Health Plan. Employers and employees, persons who are self employed and those with high investment incomes would pay a uniform New York Health Plan premium. In addition, as much as $5
billion in administrative over-head - under our current method of
providing health insurance - would be eliminated, redirecting dollars
to broadened coverage under the plan.

Section 2 amends the State Finance Law by adding a new section 97-00 establishing the New York Health Trust Fund. Monies in the fund would be used to finance the New York Health Plan. Sources include:
federal, state and local expenditures for the Medicare and Medicaid
programs; premium payment revenues paid by employers and employees; funds previously appropriated for services that would now be covered by the New York Health Plan. Monies in the fund would be solely for the purposes of New York Health, and would not be subject to
appropriation.

Section 3 amends the Tax Law by adding a new Article 35 establishing a mechanism to collect New York Health Plan premium payments. An 8\% employer and 2\% employee payroll premium (the employer may pay the employee's share), and a 9\% premium payment on self-employment income would be established. Premium payments would also be levied on unearned income in instances where such income exceeds 50\% of an individual's total income, additional revenues include premium payments by out-of-state employers. Persons eligible for Medicare benefits would be exempt from payment of the premium on unearned income.

Section 4 establishes a temporary commission on implementation of New York Health to examine New York statutes and make recommendations to conform state statute to the provisions of New York Health. The commission would be jointly appointed by the Governor and the Legislature.

Section 5 directs the Superintendent of Insurance, in consultation
with a technical advisory committee, to examine the premium rate
structure for insurance underwritten in the state and to identify that
portion of premiums which are attributable to health care expenditures
due to implementation of New York Health.

Section 6 appropriates $500,000 to the temporary commission on
implementation of New York Health.

Section 7 provides for an effective date on the first of January
following enactment into law, and also establishes the following
timetable for implementation:

- by February 28 the Governor shall make the initial appointments to
the New York Health Board of Governors;

- by March 31, the Commissioner of Health is directed to apply for
necessary federal waivers to allow for the participation of Medicare
and Medicaid in the New York Health Plan;

- by December 31 the Board of Governors and the Commissioner of Health shall develop a procedure for the deposit of Medicare and Medicaid funds into the New York Health Trust Fund;

- On January 1 premium payments and New York Health Plan benefits
would begin.

JUSTIFICATION: The New York Health Plan achieves savings through the consolidation of health care expenditures under a single, publicly financed, insurance program. Such a program eliminates more than $5 billion in administrative waste, including excess insurance company administration and costs of billing and collecting for hospitals, physicians and other health care providers. It also provides stability to New York's hospitals, freeing up resources for patient care. The savings would be used to finance increased health care coverage for the over 3 million New Yorkers lacking coverage, and the many million more with inadequate coverage. Funds could thus be targeted for
primary and preventive services, training of health care workers, and to enable physicians to set up practices in inner city and rural communities.

FISCAL IMPLICATIONS: No new costs to state and local government. Current governmental expenditures for the provision of health care services, such as Medicaid, would be utilized to support coverage under the New York Health Plan, cost control and quality assurance mechanisms under the plan will restrain health care cost increases otherwise experienced by governmental payors. In addition, as an employer, state and local government - like all employers providing health benefits - will realize a reduction in their expenditures for
employer provided health insurance coverage by paying the lower New York Health Plan premium payment.

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"Single-Payer: Good for Business" by Morton Mintz
[excerpt here below from The Nation 11/15/04]
http://www.TheNation.com/doc/20041115/mintz ;

Publicly financed but privately run healthcare for all-- including free choice of physicians would cost employers far less in taxes than their costs for insurance. Universal coverage could also work magic in less obvious ways. For example, employers would no longer have to pay for medical care under workers' compensation, which in 2002 cost them more than $38 billion. Auto-insurance rates would fall for them- -and everyone-- if the carriers were no longer liable for medical and hospital bills...

Canada has had a single-payer system for more than thirty years. (Australia, Denmark, Finland, Iceland, Sweden and Taiwan also have one.) American executives who have run Canadian subsidiaries see it as a business boon. Take General Motors.

In 2003 its costs of building a midsize car in Canada were $1,400 less than building the identical car in the United States (the comparable figures for DaimlerChrysler and Ford were $1,300 and $1,200). Such savings are no mystery. Canadian companies pay far less in taxes for health coverage for everyone than the premiums they would pay under the US system to provide their employees with comparable benefits...(A
recent report by the World Bank ranked welfare states like Denmark, Finland and Sweden high in international competitiveness. An author of the study said, "Social protection is good for business, it takes the burden off of businesses for health care costs.")

Monthly health-coverage costs for Canadian employers average about $50, mostly for items such as eyeglasses and orthopedic shoes; health-insurance costs for US employers average $552, the Washington Post has reported.

The rising cost of health benefits is the biggest issue on our plate that we can't solve," Ford CEO William Clay Ford told a 2003 conference of Michigan business executives. "Healthcare is out of control-it's a system that's broken." Last year the company spent $3.2 billion on healthcare for 560,000 employees and their dependents and surviving spouses, or more than six times net profits of $495 million...

After Jack Smith, president and general manager of GM Canada, became president and CEO of the parent company, an ad in the New York Times placed by single-payer advocates in 1994 quoted him as saying, "I personally favor single-payer"...

A General Motors that hugs single-payer in Canada would seem to have compelling reasons to hug it here. GM covers healthcare costs for 1.1 million Americans. Last year's bill was $4.8 billion-$I billion more than earnings. In its third-quarter report the company reduced its 2004 earnings forecast because rising US healthcare costs were hurting profits. GM'S projected costs for providing healthcare benefits to current and future retirees is $63 billion, a burden immensely heavier than is carried by competitors based in universal-coverage countries, the New York Times reported in September. Yet, as the Detroit Free Press has noted, GM "has set aside less than $10 billion for that obligation."

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Of note-- this from The Wall Street Journal (its regular doctor columnist):

"Government-Funded Care Is the Best Health Solution: Multiple Insurers, Multiple Plans Create Expensive, Draining Hassle"
by Dr. Benjamin Brewer, M.D.
[Wall Street Journal April 18, 2006: "The Doctor's Office" column]
http://online.wsj.com/public/article/SB114528925682927634-_5EosXnvZvOGsZWwHcizX8WTpck_20070418.html?mod=blogs

A recently approved Massachusetts plan designed to force all residents to get health insurance was a step in the right direction, but it doesn't go far enough.

Under the Massachusetts approach, there will still be a maze of plans provided by any number of insurers. That multiplicity is the problem. Multiple insurers and multiple plans create layers of unneeded expense and bureaucracy related to billing, collections and the entire assembly line of middlemen between the service rendered and the payment.

The solution that would really put health-care dollars, and providers, to their best use would be a single-payer system -- namely, government-funded health coverage for all.

It took me a while to conclude that a single-payer health system was the best approach. My fear had been that government would screw up medicine to the detriment of my patients and my practice. If done poorly, the result might be worse than what I'm dealing with now.

But increasingly I've come to believe that if done right, health care in America could be dramatically better with true single-payer coverage; not just another layer -- a part D on top of a part B on top of a part A, but a simplified, single payer that would cover all Americans, including those who could afford the best right now. Representatives and senators in Washington should have to use the same system my patients and I do were they to vote it in.

Doctors in private practice fear a loss of autonomy with a single-payer system. After being in the private practice of family medicine for 8 1/2 years, I see that autonomy is largely an illusion. Through Medicare and Medicaid, the government is already writing its own rules for 45\% of the patients I see.

The rest are privately insured under 301 different insurance products (my staff and I counted). The companies set the fees and the contracts are largely non-negotiable by individual doctors.

The amount of time, staff costs and IT overhead associated with keeping track of all those plans eats up most of the money we make above Medicare rates. As it is now, I see patients and wait between 30 and 90 days to get paid. My practice requires two full-time staff members for billing. My two secretaries spend about half their time collecting insurance information. Plus, there's $9,000 in computer expenses yearly to handle the insurance information and billing follow up. I suspect I could go from four people in the paper chase to one with a single-payer system.

It would be simpler and better for the patient, and for me, if the patient could choose a doctor, bring their ID card with them, swipe it in a card reader at the time of service and have the doctor get paid on the spot with electronic funds transfer.

Instead, patients have to negotiate a maze of deductibles, provider networks, out-of-network costs, exclusions, policy riders, ER surcharges, etc. Wouldn't a card swipe be simpler? No preexisting conditions to worry about. No indecipherable hospital bills. One formulary to deal with and one set of administrative rules to learn instead of 300.

With a single-payer system, there are concerns about waiting times for procedures and not getting access to the "best doctors." These are real issues, but not unsolvable ones. We have these disparities now. Fact is, they are mostly a matter of geography, insurance status and personal wealth.

A single-payer system would increase access to care for the uninsured and the underinsured, including the working poor. It would lower total health costs, in part by replacing 50 different state Medicaid programs and umpteen insurers with one system. This approach has the potential to improve quality and lower costs by improving care for chronic illnesses such as diabetes, high blood pressure and heart disease.

Such a system of care would rely on evidenced-based interventions, that is, providing the right care at the right time to the right patients, according to generally accepted best practices, and it would reduce the disparities in access to and quality of care among ethnic groups. Better tracking of chronic diseases, outbreaks and identification of bioterrorism would also be benefits.

There are powerful forces that oppose a single-payer system -- the health insurance industry for one. The insurance industry got its share of the Medicare drug benefit pie, as did the pharma industry. It would have been better and simpler for the government to design one plan with a standard drug fee schedule that everyone could understand, as the government does with care that doctors provide to Medicare patients. But that's not the way it happened.

Doctors have been supportive of the idea of universal access to care, but not necessarily a single-payer system. Some fear delays in obtaining necessary testing and surgeries. What I suspect they fear most is a loss of income and the fear of the unknown.

A single-payer system would admittedly lower fees for subspecialty care, such as radiology and cardiology. But if more doctors went into family medicine or obstetrics and fewer into subspecialties like plastic surgery, that shift might help correct the physician manpower imbalances that exist now. That wouldn't necessarily break my heart.

I suspect doctors would be more likely to support a single-payer system if national malpractice reform was part of the package -- which it should be.

I used to think a single-payer system would keep my income down and inject bureaucracy into my medical decision-making. But with the efficiency it could bring, it would at worst be an economic wash; more likely, the trimmed costs would more than make up for any foregone revenue. As for autonomy, I'm already struggling to maintain it amid the interference of insurers.

On the whole, the efficiency -- and equality -- that a single-payer system would provide would more than compensate for its shortcomings.

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"Health Care: It's What Ails Us"
by Doug Pibel and Sarah van Gelder
[excerpt here from Yes Magazine 8/18/06]
http://www.commondreams.org/views06/0818-27.htm

An estimated 50 million Americans lack medical insurance, and a similar and rapidly growing number are underinsured. The uninsured are excluded from services, charged more for services, and die when medical care could save them-an estimated 18,000 die each year because they lack medical coverage.

But it's not only the uninsured who suffer. Of the more than 1.5 million bankruptcies filed in the U.S. each year, about half are a result of medical bills; of those, three-quarters of filers had health insurance.

Businesses are suffering too. Insurance premiums increased 73 percent between 2000 and 2005, and per capita costs are expected to keep rising. The National Coalition on Health Care (NCHC) estimates that, without reform, national health care spending will double over the next 10 years. The NCHC is not some fringe advocacy group-its co-chairs are Congressmen Robert D. Ray (R-IA) and Paul G. Rogers (D-FL), and it counts General Electric and Verizon among its members...

And most Americans know why: the United States leaves the health of its citizens at the mercy of an expensive, patchwork system where some get great care while others get none at all.

The overwhelming majority - 75 percent, according to an October 2005 Harris Poll - want what people in other wealthy countries have: the peace of mind of universal health insurance...

In 2005, more than a quarter of insured Americans didn't fill prescriptions, skipped recommended treatment, or didn't see a doctor when sick, according to the Commonwealth Fund's 2005 Biennial Health Insurance Survey.

People stay in jobs they hate - for the insurance. Small business owners are unable to offer insurance coverage for employees or themselves. Large businesses avoid setting up shops in the United States - Toyota just chose to build a plant in Canada to escape the skyrocketing costs of U.S. health care...

The United States spends by far the most on health care per person - more than twice as much as Europe, Canada, and Japan which all have some version of national health insurance. Yet we are near the bottom in nearly every measure of our health.

The World Health Organization (WHO) ranks the U.S. health care system 37th of 190 countries, well below most of Europe, and trailing Chile and Costa Rica. The United States does even worse in the WHO rankings of performance on level of health-- a stunning 72nd. Life expectancy in the U.S. is shorter than in 27 other countries; the U.S. ties with Hungary, Malta, Poland, and Slovakia for infant mortality - ahead of only Latvia among industrialized nations.

Where is the money going? An estimated 15 cents of each private U.S. health care dollar goes simply to shuffling the paperwork. The administrative costs for our patched-together system of HMO's, insurance companies, pharmaceutical manufacturers, hospitals, and government programs are nearly double those for single-payer Canada. It's not because Americans are inherently less efficient than Canadians - our publicly funded Medicare system spends under five cents per budget dollar on administrative overhead. And the Veterans Administration, which functions like Britain's socialized medical system, spends less per patient but consistently outranks private providers in patient satisfaction and quality of care.

But in the private sector, profits and excessive CEO pay are added to the paperwork and bureaucracy. The U.S. pharmaceutical industry averages a 17 percent profit margin, against three percent for all other businesses. In the health care industry, million-dollar CEO pay packages are the rule, with some executives pulling down more than $30 million a year in salary and amassing billion-dollar stock option packages.

Studies conducted by the General Accounting Office, the Congressional Budget Office, and various states have concluded that a universal, single-payer health care system would cover everyone-- including the millions currently without insurance-- and still save billions...

And while we hear complaints about Canada's system, a study of 10 years of Canadian opinion polling showed that Canadians are more satisfied with their health care than Americans.

Although you'd never know it from the American media, the number of Canadians who would trade their system for a U.S.-style health care system is just eight percent...