I always come very close to having a stroke when I hear a conservative claim every poor person is poor because of something he or she did. Any sane person knows that isn’t true. Sure there are lazy people out there who try and screw the system or just milk it for all it’s worth. But, the majority of the poor just got dealt a shitty hand. They become adults with few means because of the lack of access to healthcare, education, good parenting, etc . . . in their youth. I don’t know why conservatives won’t admit that – maybe it’s because then they’ll have to try and do something about it.

One of the worst things about money is its ability to replicate if you have it, and cause devastation if you don’t. Somehow, the abundance or lack of money creeps it’s way into other things, like healthcare. The debate about access and the affordability of healthcare has taken a philosophical turn, which is astonishing to me. The richest country in the world should be able to provide basic, preventative care to all of its citizens. There should be no debate about that – none. The existence of a basic medical system which cares for each and every American should be a major priority for the incoming Congress and the next President. On this topic, Paul Krugman published an interesting piece in the New York Times on New Year’s Day. His article begins:

‘The U.S. health care system is a scandal and a disgrace. But maybe, just maybe, 2007 will be the year we start the move toward universal coverage.

In 2005, almost 47 million Americans – including more than 8 million children – were uninsured, and many more had inadequate insurance.

Apologists for our system try to minimize the significance of these numbers. Many of the uninsured, asserted the 2004 Economic Report of the President, “remain uninsured as a matter of choice.”

And then you wake up. A scathing article in yesterday’s Los Angeles Times described how insurers refuse to cover anyone with even the slightest hint of a pre-existing condition. People have been denied insurance for reasons that range from childhood asthma to a “past bout of jock itch.”‘

That’s just good business. Fortunately, people like William McGuire aren’t overpaid while Americans work nine jobs to afford basic prescriptions. I’m a proponent of universal healthcare, at least as a basic level. Krugman offers another idea though:

“If it were up to me, we’d have a Medicare-like system for everyone, paid for by a dedicated tax that for most people would be less than they or their employers currently pay in insurance premiums. This would, at a stroke, cover the uninsured, greatly reduce administrative costs and make it much easier to work on preventive care.”

He explains the problem with America’s healthcare system is:

“that our fragmented system has much higher administrative costs than the straightforward government insurance systems prevalent in the rest of the advanced world. As Anna Bernasek pointed out in yesterday’s New York Times, besides the overhead of private insurance companies, “there’s an enormous amount of paperwork required of American doctors and hospitals that simply doesn’t exist in countries like Canada or Britain.”

I’ve written about another problem with our system in the past – and that’s overcapacity. Man oh man does that drive up costs. Krugman continues:

“Such a system would leave people with the right to choose their own doctors, and with other choices as well: Medicare currently lets people apply their benefits to HMOs run by private insurance companies, and there’s no reason why similar options shouldn’t be available in a system of Medicare for all. But everyone would be in the system, one way or another.”

The key word in this quote is everyone; not those who have jobs or those who can afford it or those without pre-existing conditions, but everyone. I wonder if healthcare companies come up with crap like restless leg syndrome in hopes of denying people coverage if they ever have a lapse in insurance. Bastards . . . through and through.

Krugman also points out plans currently under development. The first is by Democrats in Congress, who want to provide healthcare to all children in the U.S. The second is a call by presidential candidate John Edwards for universal healthcare coverage. Finally, there’s the effort by Oregon Senator Ron Wyden, who has “introduced a Massachusetts-type plan for the nation as a whole.” But, Krugman isn’t bullish on these plans and neither am I. Why?

“But now is the time to warn against plans that try to cover the uninsured without taking on the fundamental sources of our health system’s inefficiency. What’s wrong with both the Massachusetts plan and Senator Wyden’s plan is that they don’t operate like Medicare; instead, they funnel the money through private insurance companies.

Everyone knows why: would-be reformers are trying to avoid too strong a backlash from the insurance industry and other players who profit from our current system’s irrationality.

But look at what happened to Bill Clinton. He rejected a single-payer approach, even though he understood its merits, in favor of a complex plan that was supposed to co-opt private insurance companies by giving them a largely gratuitous role. And the reward for this “pragmatism” was that insurance companies went all-out against his plan anyway, with the notorious “Harry and Louise” ads that, yes, mocked the plan’s complexity.

Now we have another chance for fundamental health care reform. Let’s not blow that chance with a pre-emptive surrender to the special interests.”

You, me and Mr. Krugman are going to have access to decent healthcare the rest of our lives. The people not reading this article. The people working their fingers to the bone to keep their families healthy and happy are the ones we need to worry about and fight for. Do what you can to support candidates and the issues that will help over 45 million Americans get what the rest of us take for granted.

That’s what “Common Sense for the Common Good” is all about.

I experienced the American healthcare system at its best and worst over the last few days. And after this morning’s experience I’m left wondering how long this country can keep going like this. Let me tell you what happened.

My ankle’s been hurting for a while so I made an appointment two weeks ago to see my doctor. I went to see him last Monday and he prescribed an x-ray. He called me two days later with the diagnosis . . . I needed to see a specialist. I saw an orthopedic surgeon yesterday. He said I needed to get an MRI. His assistant called a clinic and got me an appointment sixteen hours later. Now that’s service. It’s 10am on the eighth day after I first went to see my primary care physician, and in six more I’m going see my orthopedist again to discuss the results of my MRI. What’s so bad about that?

Well nothing that actually happened to me – except the copays . . . woe is me. This experience reinforced how disparate health care in this country is. I work and live in an urban area and see people every day who need just a minimal level of care to dramatically improve the quality of their lives. I may be in the minority but I’d be willing to wait just a little longer to have my non-emergency diagnosed if healthcare resources could be redistributed to those who need it more urgently.

Over capacity is the problem in America. It’s not that there aren’t enough resources. It’s that there are so many that sit idle for so long the cost to access them becomes prohibitive. If I own an MRI machine that’s only used a few times a week I’m going to charge more to use it because I need to recoup my expenses. The equilibrium falls at such a point that even people with the means to pay for the exam need very expensive insurance to cover its costs. What kills me is that the assistant at my doctor’s office even told me the MRI clinic is pretty open so I could name a time that worked for me. Pretty open? How much does one of those machines cost? Who made the decision to allow it to remain idle that long every week?

I had a conversation with a Canadian once (yes, they exist) who told me that medical care isn’t measurably worse in the Canada, it’s just more efficient, and therefore more affordable. I would not have been able to get an MRI within sixteen hours of my doctor recommending one in Canada. Is that such a bad thing? I’m able to function, my condition is not getting worse and it’s not life-threatening. I think I can wait a bit. Do I want to? Of course not, but if it means the less fortunate have access to the care they need then the answer is a resounding yes. And we all no preventive care saves costs in the long run.

I’m no health care expert and I’m sure we’re short on resources in certain areas and of certain types. But, fewer MRI machines means more vaccinations for children and earlier diagnosis of very preventable diseases. In no industry but the bloated health care industry would over capacity like this be able to sustain itself. A glut of housing is front page news. Extra manufacturing capacity is quickly outsourced or utilized for producing something else. But, a lonesome MRI machine sitting in an office building shared with a jeweler across the street from a Neiman Marcus only drives up costs and eliminates access. Well, at least for some us.