by Walter Brasch

Marie Antoinette, contrary to popular opinion, never said a solution for the starving masses of revolutionary France in the late 18th century was, "Let them eat cake." But, Sen. Charles Grassley (R-Iowa) apparently said something close to it.

At a public meeting, one of Grassley's constituents asked him, “Why is your insurance so much cheaper than my insurance and so much better than my insurance?” He then asked, "How come I can’t have the same thing you have?” Grassley's response was a flip, “You can. Just go work for the federal government.” Grassley, who opposes universal health care, is happy with health care programs paid for with tax dollars and available for every member of Congress, all Congressional staffers, everyone in the executive and judicial branches, and the military and their families. He doesn't even oppose Social Security and Medicare. He just doesn't want the masses to have the same quality of medical care that Senators have.

In response, Sen. Edward M. Kennedy (D-Mass.), who has led the fight for universal health care for more than four decades, writing for the July 27 issue of Newsweek, argues that "quality care shouldn't depend on your financial resources, or the type of job you have, or the medical condition you face. Every American should be able to get the same treatment that U.S. senators are entitled to."

The liberals, and most Democrats, are outraged that 46–48 million American citizens still don't have health care coverage, and millions more have such minimal coverage that they often decline to get medical help when necessary. About 62 percent of all bankruptcies are the result of extraordinary medical costs, according to a report to be published in the August issue of The American Journal of Medicine. Of those who declared bankruptcy because of medical bills, "78 percent of them had health insurance, but many of them were bankrupted anyway because there were gaps in their coverage like co-payments and deductibles and uncovered services," Dr. Steffie Woolhandler, the study's senior author, told CNN. "Other people had private insurance but got so sick that they lost their job and lost their insurance," she said.

Liberals complain that the problem has become even more acute during the Recession when every day about 12,000 workers are losing health insurance, either because of forced layoffs or because a company cuts back on its insurance coverage for its workers. They question why the same drugs sold in Canada are significantly less expensive than ones sold in the U.S., and why the conservatives have blocked all attempts for Americans to go to Canada to buy the less expensive drugs. The liberals also point to a scientific study by the Commonwealth Fund that concluded, "Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries." That study also concluded that the U.S. "fails to achieve better health outcomes than the other countries [Australia, Canada, Germany, New Zealand, the United Kingdom], and as shown in the earlier [studies], the U.S. is last on dimensions of access, patient safety, efficiency, and equity." Of the top 50 economies in the world, only the U.S. doesn't have universal health coverage.

Two major competing plans—Single Payer and Public Option— are proposed to alleviate the problems of health care coverage. Under the Single Payer health care system, there would be one program, similar to Medicare but with all citizens covered. Although President Obama, as a senator, advocated the Single Payer system, he now believes the best proposal is the Public Option. The Public Option plan allows more than 80 million workers to keep or change their insurance coverage, buy into the government-run public plan, or go uninsured. The Public Option plan would protect the insurance industry, while reducing costs; the Single Payer system would threaten the industry, and relegate it to providing only supplemental or special needs insurance. The Public Option plan allows workers and employers to keep their own insurance or to enroll in the government insurance; there would be no choice in Single Payer system. Advocates of the Single Payer system argue that by enrolling all citizens into one system, costs would be significantly less because of the ability to negotiate with the health care industry and the probable reduction in administrative costs. The Public Option would also influence drug companies and health care providers, but the result could be less reduction than under the Single Payer system. Both Single Payer and Public Option plans eliminate or significantly reduce deductibles and co-pays.

The conservatives, and most Republicans, don't buy into either plan. Sen. Jim DeMint (R–S.C.) explained one of the major reasons why conservatives will do everything they can to block health care reform. DeMint told about 100 leaders of Conservatives for Patients Rights, July 17, "If we're able to stop Obama on this, it will be his Waterloo. It will break him." Of course, DeMint may be an unofficial paid puppet for the parts of the health care industry that doesn't want reform. During the past five years, DeMint received $2,917,870 in campaign contributions from the health care industry, according official campaign reports published by OpenSecrets.com. Michael Steele, chair of the Republican National Committee, agrees with DeMint's "analysis" of what defeating health care reform can do to the Obama presidency. “I think that’s a good way to put it," he told reporters at the National Press Club, July 20. For his part, Newt Gingrich, former Speaker of the House and possible Republican candidate for president, gleefully claimed on talk radio that health care reform "could be the bill that drags his whole presidency down and they look back on it and suddenly the whole thing is unraveled."

Disregarding the absurdity of Republican statements that place partisan politics above health care reform, the conservatives have other issues. They complain they don't want government running any part of anything, especially health care. They ignore provisions of proposed Single Payer legislation that remove the middle-men insurance companies. They claim that no bureaucrat should step between a physician and a patient. Of course, they don't mind that private enterprise, in the guise of the megagoliath insurance and drug industries, do that all the time.

The conservatives argue that competition between insurance companies keeps costs low, but they ignore a study published in the prestigious New England Journal of Medicine that concluded that about 30 percent of all health care costs are for overhead expenses, including executive bonuses and aggressive advertising and marketing campaigns by drug and insurance companies. They disregard the reality that patients and their physicians, dentists, optometrists, and other health care providers will determine the best treatments, and not an insurance clerk reading myriad pages of rules and regulations established by—who else?—insurance companies. They ignore the fact that universal health care coverage would reduce "cherry picking," the enrollment of only healthy persons in order to "maximize profits." The Public Option plan allows insurance companies to continue to "cherry pick," but has provisions for those who are denied coverage to enroll in the Public Option plan. Under the Single Payer system, there would be no denial because of pre-existing conditions.

Conservatives falsely claim there won’t be any choice when government takes over health care, but disregard the reality that under both plans Americans can still choose whoever they wish to be their health care providers. But if the conservatives want to push what they call the terror of "no choice," let them realize that even with excellent private insurance, patients currently have no choice in some situations. Those who go to an emergency room already have no choice of personnel. Except in the smaller hospitals, hospitalized patients, no matter how admitted, usually receive care from anonymous residents and hospitalists who are neither the patient's primary care physician nor the patient's own specialists.

In yet another attempt to scare the working class, the conservatives tell the masses that government-run health care will be as much a boondoggle as the Post Office. But, while every organization has myriad problems, six days a week a member of the working class, a letter carrier, comes to almost every house or business in America and cheerfully delivers the mail on time, stopping occasionally from 10-mile routes to chat.

Conservatives claim that a universal health care system will cost $1 trillion. They conveniently forget that George W. Bush, with the approval of a lame Congress, ran up far more than $1 trillion in debt during his two terms and that the cost of the unnecessary war in Iraq, begun by a jingoistic president and vice-president who lied to the people, will easily cost more than $1 trillion.

Nevertheless, the conservatives are right about two issues. They are right that the proposed Public Option plan doesn't specify which taxes are to be raised or what would be required for both individuals or businesses to become part of a national insurance plan. However, proposals for the Single Payer system, such as one proposed in Pennsylvania, will impose a 3 percent personal income tax; each business would pay 10%, significantly lower than what most businesses that insure their workers currently pay. Additional revenue would be from existing programs, including Medicaid.

Conservatives also are right that there will be some fraud and the cost will probably be far greater than the projections, something that is part of almost every large private business and government-run programs. However, the conservatives conveniently ignore the reality that the Bush–Cheney Administration, again with little Congressional concern, handed out innumerable multi-million dollar no-bid contracts, often to their friends and business associates, and did little to investigate cost over-runs, wasteful spending, and fraud.

Although President Obama is firm that there would be no additional tax for persons making less than $250,000 a year, conservatives are worried that the government will increase taxes for anyone making a net of $1 million a year or more. Apparently, impoverished conservatives and their conservative representatives must protect millionaires from harm.

About six of every ten Americans, according to a CBS News/New York Times poll in February 2009 say they want the government to provide universal health care coverage. Groups as diverse as the AFL–CIO, the AARP, and the American College of Physicians want universal health care coverage. According to a study published in the Annals of Internal Medicine, only one-third of physicians oppose universal health care coverage.

"America's health care system," said Walter Cronkite in 1993, "is neither healthy, caring, nor a system." Nothing has changed since then.

Sen. Grassley has no worries about health care coverage. Under a quasi-socialist system for all three branches of government, including the military, he gets the best medical, dental, and optometric care in the country. As for the rest, like his conservative colleagues, Sen. Grassley believes that cake is the best medicine for those without adequate coverage.

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[Walter M. Brasch is a university professor of journalism, award-winning social issues columnist, and the author of 17 books. His current book is Sinking the Ship of State: The Presidency of George W. Bush, available from amazon.com, bn.com, and other stores. You may contact him through his website, www.walterbrasch.com. Assisting on this column were Rosie Skomitz, Ron Stouffer, and Rosemary R. Brasch]