by Miles Mogulescu

As moderator of Thursday's Democratic Presidential debate, here's a follow-up question: Do you think your plan is better than Medicare-For-All, or do you fear being attacked as an extremist by Republicans, big insurance, and big pharma and so propose a less effective plan as more politically pragmatic?

The leading Democratic candidates--Hillary Clinton, John Edwards and Barack Obama-- criticize America's broken health care system and call for fundamental change with great rhetorical flair. But when it comes to proposing the most effective plan for change--Medicare-For All-- they don't show an audacity of hope. They show a paucity of courage.

Obama's rhetoric can soar: "The times has come for universal health care in America...Plans that tinker and halfway measures belong to yesterday...[It's] wrong when businesses have to layoff one employee because they can't afford the health care of another. Wrong when a parent cannot take a sick child to the doctor because they cannot afford the bill that comes with it. Wrong when 46 million Americans have no health care at all. In a country that spends more on health care than any other nation on Earth, it's just wrong." Or, as John Edwards proclaims, "We put more money into health care than any country in the industrialized world and we get one of the worst products out in the other end."

Obama, Edwards and Clinton are great at denouncing the problem. But they are timid when suggesting the solution. As with Hillary Clinton's failed 1993 health care plan, out of fear of being accused by opponents of advocating socialized medicine, Obama's and Edward's plans try to piece together a patchwork of employer plans, private insurance, new government regulations, subsidies and tax credits which is over-complicated, only goes part way towards solving the problem, and in Obama's case does not even guarantee universal coverage. Of course as in 1993, such caution will not keep Republicans and their corporate lobbyist cronies from attacking these plans. The day after Obama announced his plan, Rudolph Guliani denounced it as "socialized medicine."

Hillary's 1993 plan and Obama's and Edward's 2007 plans all try to build reform on top of the twin pillars of the current flawed American health care system--private insurance and employer-provided benefits--while attempting to fill in the cracks. The problem is that these twin pillars are rotting from their foundations and any reform built on them is likely to collapse.

The first pillar of the system--private insurance--is an inherently flawed means of providing health care. First, the incentive of a private insurance company is to find ways to deny needed care--the less care provided for the same premiums, the higher the profits and the bigger the salaries and bonuses of their top executives. So private health insurance companies pay huge staffs to review claims and deny coverage. Michael Moore's "Sicko" shows horrifying examples of people who actually have health insurance coverage but suffer from lack of care because insurance companies wrongly denied their claim, and presents eloquent testimony from former insurance company employees about how they were promoted and award bonuses for finding ways to reject coverage.

Second, private health insurance involves a colossal waste of money. Nearly 1/3 of private health insurance premiums go to administrative costs of underwriting (i.e. turning down insurance applications from consumers who might actually need to use their insurance), claims processing (i.e. denying as many claims as possible), marketing and advertising, plus shareholder profits and multi-million dollar executive salaries and bonuses. By contrast, Medicare's administrative run approximately 2-3% of costs. At the same time, to deal with numerous different insurance companies and their varying claims procedures, doctors and hospitals have to employ large staffs, not to provide care, but just to process insurance claims. Approximately 20% of doctor's income goes to the overhead of processing insurance. It has been estimated that approximately $350 billion a year of health care dollars goes to administrative costs. Saving most of these costs alone could pay to insure the tens of millions of uninsured Americans in a Medicare--For-All system.

Moreover, the second pillar of the system--employer-provided health insurance--is collapsing. No less a businessman than the chairman of Ford Motor Company stated that employee health costs are "the biggest issue on our plate that we can't solve. Health care is out of control. It's a system that's broke."

Every year, fewer and fewer employers offer health insurance. Increasingly, most labor/ management disputes are less about wages and working conditions than about health care coverage, as American companies struggle to remain competitive in the world market by reducing benefits, raising deductibles, and increasing employee's share of premiums. Average health care costs run 7-10% of wages, putting a tremendous burden on American companies who must complete with companies from almost all the other capitalist democracies where health care is provided by the government, not to mention emerging economies like Taiwan which instituted single payer health care a decade ago.

The Big Three automakers issued an incredible statement recently that "The [Canadian] public health-care system reduces total labor costs for automobile manufacturing firms, compared to the cost of equivalent private insurance services purchased by U.S. based automakers; these health insurance savings can amount to several dollars per hour of labor worked. Publicly-funded health care thus accounts for a significant portion of Canada's overall labor cost advantage in auto assembly, versus the U.S., which in turn has been a significant factor in maintaining and attracting new auto investment to Canada. Recently, Toyota cited the savings in health care costs as the primary reason for deciding to open a new auto plant in Canada rather than the U.S.

The societal costs of a health care system built on private insurance and employer-paid premiums is 49 million uninsured and an equal number of underinsured, rightful insurance claims going unpaid, $350 billion dollars a year in wasted costs, a reduction in America's economic competitiveness, and the loss of American jobs. Yet this is the rotten system on which Obama, Edwards and Clinton want to build their reforms. As one blog stated, Obama's plan "offers just enough federal bureaucracy for the GOP to caricature, just enough private insurance involvement to annoy liberals and just enough confusion to keep everyone else from knowing just what to think." In other words, in 2007, political timidity is no more a guarantee of success than it was in 1993.

The type of hybrid private/public health care patchwork health reform proposed by Obama, Edwards, and Clinton is a vast, untried social experiment which has never been proven to work anywhere in the world. The type of health care program that works--a single payer government run service--has already proven itself in virtually every other capitalist democracy. The US spends twice as much per capita on health care as Britain, France or Canada, yet America ranks only 39th in the world in the health of our people. Life expectancy is shorter and infant mortality higher in the US than in most other wealthy countries.

If the leading Democratic Presidential contenders think that by avoiding proposals for a single payer system they will somehow neutralize the opposition to reform and make their proposals more appealing, they are kidding themselves. It didn't work for Hillary in 1993 and it won't work now. It only makes their proposals more complicated and harder to explain to voters. Besides its inherent virtues, a single payer healthcare system is easy to explain--Just like social security (and Medicare of those over 65), every American is automatically enrolled and covered by insurance and every American can choose his or her own doctor. Short, simple and sweet.

Moreover, polls show that Americans are ready to accept single payer health insurance. A recent poll by the Pubic Policy Institute of California found that "by a two-to-one margin, most prefer 'a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by the taxpayers' nationally to 'the current health insurance system in the United States, in which most people get their health insurance from private employers, but some people have no insurance' The preference here is a descriptor of what is known as 'single payer.'"

If the Democrats win the Presidency and increase their control of Congress in 2008, there will be one chance to reform health care in America. Whatever system is then put in place, there will likely not be another chance at fundamental reform for another thirty years. Obama's, Edward's and Clinton's timid half-way measures are as likely to be attacked by Republicans, big pharma and the insurance industry as a Medicare-For-All. Why not do it right the first time?

Miles Mogulescu is an entertainment attorney and social justice advocate.
© 2007 Huffington Post