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Health Care Terror

by Paul Krugman

These days terrorism is the first refuge of scoundrels. So when British authorities announced that a ring of Muslim doctors working for the National Health Service was behind the recent failed bomb plot, we should have known what was coming.

"National healthcare: Breeding ground for terror?" read the on-screen headline, as the Fox News host Neil Cavuto and the commentator Jerry Bowyer solemnly discussed how universal health care promotes terrorism.

While this was crass even by the standards of Bush-era political discourse, Fox was following in a long tradition. For more than 60 years, the medical-industrial complex and its political allies have used scare tactics to prevent America from following its conscience and making access to health care a right for all its citizens.

I say conscience, because the health care issue is, most of all, about morality.

That's what we learn from the overwhelming response to Michael Moore's "Sicko." Health care reformers should, by all means, address the anxieties of middle-class Americans, their growing and justified fear of finding themselves uninsured or having their insurers deny coverage when they need it most. But reformers shouldn't focus only on self-interest. They should also appeal to Americans' sense of decency and humanity.

What outrages people who see "Sicko" is the sheer cruelty and injustice of the American health care system - sick people who can't pay their hospital bills literally dumped on the sidewalk, a child who dies because an emergency room that isn't a participant in her mother's health plan won't treat her, hard-working Americans driven into humiliating poverty by medical bills.

"Sicko" is a powerful call to action - but don't count the defenders of the status quo out. History shows that they're very good at fending off reform by finding new ways to scare us.

These scare tactics have often included over-the-top claims about the dangers of government insurance. "Sicko" plays part of a recording Ronald Reagan once made for the American Medical Association, warning that a proposed program of health insurance for the elderly - the program now known as Medicare - would lead to totalitarianism.

Right now, by the way, Medicare - which did enormous good, without leading to a dictatorship - is being undermined by privatization.

Mainly, though, the big-money interests with a stake in the present system want you to believe that universal health care would lead to a crushing tax burden and lousy medical care.

Now, every wealthy country except the United States already has some form of universal care. Citizens of these countries pay extra taxes as a result - but they make up for that through savings on insurance premiums and out-of-pocket medical costs. The overall cost of health care in countries with universal coverage is much lower than it is here.

Meanwhile, every available indicator says that in terms of quality, access to needed care and health outcomes, the U.S. health care system does worse, not better, than other advanced countries - even Britain, which spends only about 40 percent as much per person as we do.

Yes, Canadians wait longer than insured Americans for elective surgery. But over all, the average Canadian's access to health care is as good as that of the average insured American - and much better than that of uninsured Americans, many of whom never receive needed care at all.

And the French manage to provide arguably the best health care in the world, without significant waiting lists of any kind. There's a scene in "Sicko" in which expatriate Americans in Paris praise the French system. According to the hard data they're not romanticizing. It really is that good.

All of which raises the question Mr. Moore asks at the beginning of "Sicko": who are we?

"We have always known that heedless self-interest was bad morals; we know now that it is bad economics." So declared F.D.R. in 1937, in words that apply perfectly to health care today. This isn't one of those cases where we face painful tradeoffs - here, doing the right thing is also cost-efficient. Universal health care would save thousands of American lives each year, while actually saving money.

So this is a test. The only things standing in the way of universal health care are the fear-mongering and influence-buying of interest groups. If we can't overcome those forces here, there's not much hope for America's future.

Paul Krugman is Professor of Economics at Princeton University and a regular New York Times columnist. His most recent book is The Great Unraveling: Losing Our Way in the New Century.

© 2007 The New York Times

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