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A Sick Health Care System

Somewhere in the shuffle, as you may recall, the now almost defunct Iraqi Governing Council approved an interim constitution. American experts and authorities had a good deal of influence on the constitution’s content, and the result of their work is fascinating. Here, for example, is Article XIV: “The individual has the right to security, education, health care, and social security.”

Now, we know that the constitutions of many nations around the world promise things they either cannot deliver or have no intention of delivering. The many written since World War II are especially prone to politically correct language. Still, it is remarkable — if not downright shocking — that an American-inspired constitution, even one intended only for an interim period, should identify “health care” as a basic right — a position that goes well beyond anything in American law, whether constitutional or merely legislative. True, John Kerry proposes that “high-quality, accessible, and affordable health care should be a right for every American,” and he may even mean it. But so far, at least, Kerry is only a candidate for president, and the idea that health care is a basic right remains far from the established norm of our nation.

Until it becomes a basic right for all Americans, just as education and Social Security are rights, the system will continue to operate in its current anomalous ways. Just today, for example, we’ve learned that at least some major pharmaceutical companies lavishly reward physicians who agree to prescribe their drugs. And we’ve known for a while how vast are the profits of the pharmaceutical companies when compared with the rest of American industry. For a decade now, the pharmaceutical companies have had an average annual profit of 18.5%, compared with the median 3.3% of the rest of the Fortune 500 companies.

Oh, well, the drug companies need all that money for research, right? Wrong: The typical large drug company has profits that run two and three times the amount it invests in research on new drugs — and, in fact, spends some 60% more on advertising and marketing than it does on research.

And then there’s the matter of executive compensation: In 2001, the five highest-paid executives of drug companies received aggregate salaries of $183 million, and owned $332 million in unexercised stock options. As long as the health care industry is seen as a profit center, such excesses will persist. And as long as health care is de facto defined as a privilege rather than a right, it will be seen as a profit center.

The government recognizes the right to fair profits and compensation; what it doesn’t recognize is a right to health care — except when it is drafting constitutions for other countries.

The structure of our current health care system invites both fraud and an absence of accountability. A few months ago, I had a bloody nose. When nothing I did helped, I betook myself to the hospital emergency room, late on a Saturday night, where I spent much of the next five hours waiting. The itemized bill charged $233 for the visit itself, and another $1,556 for “control of nosebleed.”

In its wisdom, Medicare chose to pay $52.43 for the visit and $119.94 for control of the nosebleed. Now, any system that invites an inflation of more than 1,000% in the billing process is plainly a broken system. (For the kind of money they charged, I should have had a whole new nose.)

This next piece I cannot resist: My brother was recently invited to lecture at Oxford in England. His field is medical economics, and he began his lecture by relating how, on the flight over, he’d somehow run out of reading material and, casting about for something — anything — to read, he came up with his passport. His is newer than mine, and includes in its introductory informational pages the following item: “Health insurance: Medical costs abroad can be extremely expensive. Does your insurance apply overseas, including medical evacuation, payment to the overseas hospital or doctor, or reimbursement to you later?” My brother read that caution to the English audience, and wondered out loud what their passports might say in warning them about health care costs in America. And, of course, the passport offers no advice to the 44,000,000 Americans who have no health insurance at all.

Plus: I’ve concluded that the question of whether the new drug benefit for seniors is worth signing up for is one that only an accountant can answer, and that you’re not likely to save on your prescriptions more than your accountant will charge you for his or her advice.

All of which does not mean that I think we should move to Baghdad, since even if health care there is regarded as a right, there are one or two other problems that linger on and render the quality of life less than optimal. It is by way of saying that in virtually every industrialized country, health care is indeed seen as a right, and the system there, however cumbersomely, however sluggishly, knows the standard to which it is bound to aspire.

Not so in the United States of America. We allow ourselves to be dazzled and diverted by the latest developments in biotech, hence to neglect fundamental issues of equity. We fail many tens of millions of our fellow citizens while we permit and even subsidize megaprofits to companies that ostensibly exist in order to provide a public service. Establishing an enforceable right to health care will not solve all the system’s problems, but it will, in time, create the ethical foundation for a more just system and repair at least some of the current anomalies.

Leonard Fein’s most recent book is “Against the Dying of the Light: A Father’s Story of Love, Loss, and Hope” (Jewish Lights, 2001).

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