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 The Sick of the World

Is being alive a right? Life, liberty and the pursuit of happiness are the reasons we have a federal government. Health at home and abroad is perhaps one of the most serious and misunderstood issues in the United States. Republican leaders are often heard to say that America has the best healthcare in the world. Of course no one asks the question, "To whom we are being compared?" Are we being compared to other industrialized nations or 3rd world countries when one makes this statement? We certainly seem to have more money than everyone else. But how do we manage it? How does insurance affect health quality and costs? How does our pharmaceutical industry and FDA regulations affect its quality? How does the American free-market affect health in the U.S. and abroad? Although this website cannot comprehensively answer all of these questions, this website can explain the basics and help you understand the moral implications on U.S. and world health depending on if you vote Republican or Democrat.

Let's begin with a very basic moral question. Do you deserve better health care if you are rich than if you are poor? Many Republicans would argue and have argued that the value you bring to the marketplace determines the value of your life and as that value decreases so should your access to healthcare.

Today, 45.5 Million Americans do not have health insurance. 81% of those are from working families. Only 7% of those choose to be uninsured. (Source: Kaiser Commission on Medicaid and the Uninsured and the US Census Bureau) In our country, seniors pay about 22% of their income for health care costs despite their Medicare coverage.

So, in other words, if you have the ability to pay for health care, you can have it. If you have even more money, you can get the best doctors and specialists because health care is supposed to be "market driven." Is this a moral issue? Of course it is. Morality is all about esteeming one human above another. Are all men created equal or are some more equal than others?

Republicans consistently fight against the idea that all Americans have an equal claim to life and health. Why? Because they believe that one of the foundational building blocks of our society is that money and capital must be a motivator in order for society to progress. This cynical world view promotes the idea that people will not do things for altruistic reasons, but rather that greed is the greatest motivator to progress. Without money, people will not try as hard, will not innovate, and will not create quality products.

In no way do the rich feel more helpless than in thinking they can't pay their way out of a problem. This is why they oppose any kind of Universal Health Care. Because the rich have money, they feel they have a right to better health care than the poor, because they are more valuable to the marketplace. Of course this is short sighted in determining the value of a human being. Some of the greatest Americans who have positively changed our society came from abject poverty. So, again, just how valuable is a human being? Should the marketplace determine a person's right to life and health?

"No American should lack access to health care because he or she lacks the ability to pay for it when needed, and no American should suffer serious financial distress or personal bankruptcy as a result of unpaid medical bills." Uwe Reinhardt, Princeton health economist

Universal Healthcare

Of all the industrialized countries of the world, how many do not have Universal Healthcare? You may be surprised to know that the answer is only one: the United States. Every other industrialized nation has it. Now, when you hear Republicans say that we have the best healthcare system in the world, is this true? Not by a long shot. Here are true rankings reported by the W.H.O. (World Health Organization).



You will notice that we are number 37, near the bottom of industrialized countries! Why are we ranked so low? Let's talk about it.

First, are all these nations which have Universal Health Care practicing "Socialized Medicine?" Nothing of the sort. Universal Health Care (UHC) has nothing to do with socialized health care. This is often used as a scare tactic to cause people to think the quality of their care will decrease. The truth is that socialized medicine refers to medicine that is both financed and delivered by the government. In other words, the government pays for and owns the healthcare system. If we adopted Universal Health Care in the United States, delivery would remain predominantly private. Very few of the world's Universal Health care programs are actually delivered by the government meaning physicians exist mostly in the private sector. Adopting this system would change only the financing mechanism of our system.

Another fear presented by those against Universal Health Care is that doctors won't make as much money and therefore won't be attracted to the profession. Again we see the "money as a motivator" doctrine of the Republicans. But what is the truth? Let's look again at how the U.S. stands up to other industrialized countries (all of which have Universal Health Care).

In 2002, the United States had 2.3 practicing physicians per 1000 population, below the OECD (organization of industrialized countries) average of 2.9 per 1000 population. There were 7.9 nurses per 1000 population in the United States in 2002, below the OECD average of 8.2 per 1000 population. The number of acute care hospital beds in the United States in 2003 was 2.8 per 1000 population, below the OECD average of 4.1 beds per 1000 population.

In other words, more health care workers seem to be attracted to a profession that is not only better operated, but sees all humans as equally valuable, regardless of income.

What about cost? Is it more expensive? Not at all. In fact the insurance industries hate Universal Health Care because it cripples their ability to charge $18 for an aspirin or $2000 a day for a hospital room. You may think that the insurance company doesn't actually charge for those things. Unfortunately they do, indirectly, because the hospital has to charge those prices because of skyrocketing insurance costs.

The United States spent 15% of its GDP (Gross Domestic Product) on health care in 2003, the highest percentage in the OECD. The average percentage of GDP spent on health care in OECD countries was 8.6%. The United States also spends more on health care per capita than any other OECD country. In 2003, total health spending per capita was $5,635 US dollars, more than twice the OECD average of $2,307 US dollars.

So, we spend more, and yet are ranked 37th by the World Heath Organization. Throwing money at health care doesn't seem to improve its quality--except maybe for the rich. In other words, when you hear we have the best health care in the world, we aren't referring to normal Americans receiving that care, but rather the health of the rich.

Hospitals and doctors are not the only ones being held hostage by insurance costs. Because of the present system, insurance premiums are growing out of control for the average American. Under President Bush, health premiums have grown to over five times as much as inflation or the average earnings of Americans. Take a look at the following graph to understand:



Interestingly enough, one huge group that suffers without Universal Health Care are the self-employed entrepreneurs that do not have company health plans. You see, the rich do not want true capital competition but want an increased employee force (read the Economic Morality section and wage-labor capitalism). One way to deal with this is to get rid of labor competition so wealth is consolidated into the hands of a few and the rest lose a piece of the American pie. Americans need to be encouraged to be entrepreneurial instead so they can take back the true capital from the wealthy few. Putting health care in the market place creates benefits that do not encourage people to become self-employed. In other words, it inspires less people to pursue their own dreams and instead spend their lives working for the dreams of others as employees.

The Pharmaceutical Industry



As long as health is dependant on wealth, the pharmaceutical (drug) industry will be as well. What good is finding a cure if only the wealthy can afford the cure? Some argue that allowing pharmaceuticals into the free-market will produce more cures and more scientists working on drugs that will prolong lives. Unfortunately, worse has happened. We see practices emerge such as marketing strategies designed to sway the prescribing habits of physicians, drug testing practices that avoid head-to-head comparisons of similar drugs, and an FDA whose very funding for enforcement depends on money from the companies they are trusted to investigate.

The result? Americans pay more than 60% greater for pharmaceuticals than citizens of other countries. Market forces threaten the lives of millions of people living with HIV, TB, malaria and other curable conditions by denying them the right to access essential medicines. Evidence-based prescribing occurs only half of the time, and pressure from consumers and industry is pushing me-too drugs towards sale before sufficient data has been collected or published.

What's a me-too drug? They are almost identical to current drugs but no better than those already on the market to treat the same condition. Around 75 percent of new drugs approved by the FDA are these me-too drugs. They can be less effective than current drugs, but as long as they're more effective than a placebo, they can get pass regulatory muster.

The top ten pharmaceutical companies make more profits than the rest of the Fortune 500 combined. These companies fight and destroy smaller companies who try to create generic drugs at affordable prices. For example, recently Astra-Zeneca, maker of Prilosec, filed multiple lawsuits against generic drug makers to prevent them from entering the market when the company's exclusive marketing rights expired. The company "obtained a patent on the idea of combining Prilosec with antibiotics, then argued that a generic drug would infringe on that patent because doctors might prescribe it with an antibiotic."

Get the picture? This isn't about health at all, but profits. It also not about Research and Development costs. The truth is, that these companies spend on average 2 to 2 and a half times more on marketing than research. In spite of these costs, they are the number one industry in the U.S. in profits. In spite of the profits, the Republican Legislators keep handing them huge tax deductions and tax credits. Why? Because they support their campaigns.

Even worse, if the pharmaceutical system remains in a free market system, and is nothing more than a business, then what is the motivation to find cures? If there is a greater motivation to keep you needing their drugs, what motivation is there to get you to a point when you don't need their drugs? This opens the door to a great deal of abuse in the medical and psychiatric industries to whom these companies engage in huge marketing campaigns and strategies.

As for the FDA, who is supposed to approve the drugs and make sure they are safe, this organization depends on the money from the very companies they are supposed to investigate. Scientists who investigate these drugs can easily slip back and forth between working for pharmaceutical companies and the FDA. Does that make you feel safe? Is this perhaps why our health care system is 37th? Is this why our life expectancy numbers are so low and our infant mortality numbers so high among OECD countries? Here are the infant mortality numbers from OECD Health Data:



And here are the life expectancy numbers:



So how exactly is anyone stating, we have the best heath care in the world? It is nothing but political rhetoric designed to support the largest industry in America.

There are many reasons that the free-market must not apply to the health care industry. One is that there is a huge disparity of information between health providers and the consumer. Physicians undergo years of highly specialized training, and patients (particularly acutely ill patients) are not able to make fully educated decisions given their lack of training in medicine, despite attempts by physicians to communicate fully with them. Also, one of the requirements for a free market is that there are a large number of buyers and sellers. Because of the consolidation of hospitals and insurance companies, there are actually in any given area very few buyers and sellers of health care. One the nations top heath economists, Uwe, Reinhardts, stated,

"The issue of universal coverage is not a matter of economics. Little more than 1% of GDP assigned to health could cover all. It is a matter of soul."

The Sick Outside the United States

Here is another fact about health: Millions of people are sick and dying throughout the world, the U.S. can do something about it and has chosen not to. Why? For some, it is simply a lack of awareness.

When the recent tsunami hit, Americans, as they do with most natural disasters, banded together and try to help the afflicted. About 100 thousand died in that tsunami. Seems like a lot. But would you be surprised to know that about 165 thousand die of malaria, 140 thousand of diarrhea, and 240 thousand of Aids every single month? (and of course many more of simple hunger). What do Americans do about them? Do we rush to their aid? Do we send life saving drugs?

Some Americans may simply not be aware of the sheer amount of death in the world but others don't help because of greed, bigotry and even religious beliefs.

Many members of the religious right believe, for example, that AIDS was sent by God as a punishment for immoral behavior.

Jerry Falwell recently said,

"AIDS is not just God's punishment for homosexuals; it is God's punishment for the society that tolerates homosexuals"

He is not the only religious leader to say things like this.

Others don't want to help the sick because so many of them are in Africa. "They have brought upon themselves their own misery, so why should we help them," ask so many politicians today. However, most of the time, politicians can no longer get away with this rhetoric. They give lip service to the afflicted of the world and even make financial promises, but then out of view of the American people, break those promises.

For example, In his 2003 State of the Union address, President Bush stated,

"To meet a severe and urgent crisis abroad, tonight I propose the Emergency Plan for AIDS Relief - a work of mercy beyond all current international efforts to help the people of Africa...I ask the Congress to commit $15 billion over the next five years, including nearly $10 billion in new money, to turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean."

So what actually happened? The AIDS plan announced in the State of the Union address in January 2003 was not an "emergency" plan - President Bush requested no new money (referring to the 10 billion) for this initiative for the entire year of 2003. As for the 15 billion, the actual amount Bush requested was half a billion. He then changed it to "globally" instead of Africa and the Caribbean dramatically reducing what they would get anyway. He then urged Congress not to spend their allotted money in 2003 right after visiting African countries and telling them a different story.

At the same time, Bush announced that more than 41 thousand AIDS victims in Botswana had received life-extending treatments from the United States. Top Managers of Botswana's treatment program were irate, reporting that NO American money had arrived and calling the US claims, "false and a gross misrepresentation of the facts." The true number that had received treatment: zero.

The annual budget for fighting malaria is only about 90 million and of that, 95 percent goes to consultants and not mosquito nets, drugs, and insecticide. We promised 5 billion to help these fights at the Monterrey conference where Bush announced a "Millennium Challenge." What actually arrived? Less that 1%. In 2003 We promised 3 billion to sub-Saharan Africa. And when we were done? 18 cents per afflicted person arrived.

The Millennium Project estimated that funds needed to fulfill our commitments would amount to 44 cents per $100. To put this in perspective, during the same period of time, our defense spending since 2001 has been $1.70 per $100 and tax cuts for the top 1% of Americans have amounted to $3.30 per $100 of GNI (Gross National Income).

Other industrialized nations generally exceed their promises. It is becoming increasingly evident to other nations of our failure to meet our promises. So where do we as Americans stand in relationship to health? Are we going to keep supporting the political party that supports the Pharmaceutical Industry, the Health Insurance Lobby, and broken promises? Or will you support the party that believes that life and health are rights and that everyone has an equal right to health care, regardless of income? Is this not also a moral issue?



Links and Further Reading

Read responses to arguments against Universal Health Care:
http://www.amsa.org/uhc/uhc_counterarguments.pdf





Dr. Marcia Angell The Truth About Drug Companies: How They Deceive Us and What to Do About It
















Selling Sickness: How the World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients (Paperback) by Ray Moynihan









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