If you want to fix the disaster that is called the American healthcare system, the first thing to do is to clearly point out what its major failings are, and there are two of these.

The first is cost. America is one of the most expensive places, or possibly the most expensive place, in the world to get sick or injured. The corollary of that is that it is one of the best places to make a killing if you are in the medical business, whether as a doctor, a hospital company, a pharmaceutical firm or a nursing home owner.

The second is access. One in six Americans—a total of 50 million people at latest count—have no way to pay for that care. Too young for Medicare, too “well off” for Medicaid, but too poor to buy private health insurance or too sick to be admitted into a plan, or employed by a company that doesn’t provide health benefits, these people get no medical care until they get so sick that they are brought into a hospital emergency room where they get treated (often too late) at public expense, or at the hospital’s expense, with the cost shifted onto taxpayers or onto insured patients’ premiums.

Any reform of this atrocious “system” must address these two major failings or it is no reform at all.

And that’s where all the various versions of Obamacare fall flat.

Simply put, you cannot solve either of these problems by leaving the payment system for medical care in the hands of the private insurance industry, since the whole paradigm of insurance is to make money by keeping high-risk people out of the insured pool, and by keeping reimbursements and coverage for premium payers as low as possible.

Having a so-called “public option” plan working in competition with private insurance plans will not solve this problem. Either the public option will become like the private options—trimming benefits and rejecting some applicants—or it will become a dumping ground for all the high-cost, high-risk people that the private sector insurance industry doesn’t want. At that point, the public plan will become a huge cost burden on the taxpayer, who will begin demanding that it cut back in the benefits it provides, taking us right back to where we started.

The fact that the Obama administration and the Democratic Congress are both raising the issue of the high cost of health care “reform,” and are talking about ways to raise revenues to pay for it tells us all we need to know about the alleged “reform” schemes they are contemplating. They are doomed and, even if implemented, will not work.

Real reform of the American health care system would not cost money. It would save money.

There is a level of dishonesty in what passes for the debate over health care “reform” in both Congress and the media that is stunning in its brazenness and/or venality. Of course real reform would cost more in government spending. But that is because real reform would remove the cost of medical care from both employers and from workers (who over the last 20 years have been shouldering an increasing share of their own medical care). And that shift would mean more profits for US companies, which would free up more money for wages, and it would mean less money deducted from paychecks, meaning higher incomes for workers.

If President Obama had any political courage at all, he’d simply get on TV and say this: I will create a plan that will cover everyone, lift the burden of paying for health care from individuals and employers, and have the government pay for it all. You the taxpayer will pay for this plan with higher taxes, but you will no longer have any significant medical bills, you will no longer have health insurance premiums deducted from your paycheck, your employer will no longer be paying for employee medical coverage, and you will never have to worry about losing health benefits again, even if you are laid off. (Incidentally, eliminating employer-funded health insurance would go a long way towards allowing workers to fight to have unions, and to strike for contracts, by ending the threat that they would lose their benefits.)

Of course, to do that the president would have to be talking about what is variously known as national health care or a single-payer plan, in which the government is the insurer of health care for all.

This option isn’t even being discussed in this so-called debate. As I’ve written earlier, even though there is an excellent single-payer system in place that has been running for a third of a century just to the north in Canada—a system where patients have absolute freedom to choose their doctor, get instant access to a hospital and to expert specialist care in emergencies, and have a healthier society by every statistical measure—all at a fraction of the staggering cost of healthcare in the US, not one Canadian expert working in that system has been invited down to discuss its workings with the White House or with members of Congress.

There has been a lot of negative propaganda spread about Canada’s single-payer system, by right-wing, business-funded “no-think” tanks, and by medical industry lobbies from the American Medical Assn. to the pharmaceutical industry, but no government committee or agency has bothered, or dared, to bring in Canadian experts to respond to and debunk that propaganda. The corporate liars talk about waiting lists and lack of access to CAT-scan or MRI machines. But all we really need to know about the Canadian, and other similar single-payer systems, is that nowhere that they have been instituted have they been later terminated, even when, as in Canada, right-wing governments have been elected to power. The public, whether in Canada, or France, or England, or Taiwan or elsewhere, loves their public health insurance system, whatever flaws or problems with underfunding those systems may have at certain times. Trying ot eliminate such systems would be political suicide for a conservative government, as even arch-free-marketer British Prime Minister Margaret Thatcher, who never met a government activity that she didn’t want to privatize, learned.

Right now, with half of all Americans reportedly fearing that they could lose their jobs, and with one in five Americans reportedly either unemployed, or involuntarily working part-time, we have a situation where a majority of Americans either have no health insurance, have lost their health insurance, or are in danger of losing their employer-funded health insurance. It is a unique moment when a bold president and Congress could act to end private health insurance and establish a public single-payer insurance plan to insure and provide access to affordable medical care to all Americans.

Instead of this, we are being offered half measures or no measures at all by leaders who are shamelessly in hock to the health care industry or who are afraid of its power.

17 years ago, the Clintons had a similar opportunity to grab the health care industry by the neck, strangle it, and produce a single-payer alternative. They blew that chance by trying to keep the health care greed-heads happy. Now, almost a generation later, we have another shot at it, and Obama and his Democratic Congress are doing the same thing again. There is a strong likelihood that they will fail, like the Clintons before them. If they succeed in coming up with some kind of hybrid public-private Frankenstein of a system that includes a public insurance option, it will simply delay the inevitable disaster, as medical costs, already 20 percent of GDP—the highest share of any economy in the world—continue to soar, and as the cost of the public plan, which will inevitably become a dumping ground for high-cost patients, becomes politically untenable. In the end, we will have even more expensive and inaccessible healthcare than we have today.

It doesn’t have to be this way, but only if Americans rip their eyes away from their crisp new digital-image TV screens and start demanding real health care reform will we get honest reform. A good place to begin would be to start writing and phoning your local media outlets to ask why they are not reporting on single-payer, and in particular on the single-payer bill sponsored by Rep. John Conyers (D-MI), which is being silently blocked and killed by his colleagues in the Democratic congressional leadership and by the White House. A good place to begin would also be to start calling your elected representatives to demand that they support Rep. Conyers’ single-payer bill.

Dave Lindorff is a Philadelphia-based journalist and columnist. He is author of Marketplace Medicine: The Rise of the For-Profit Hospital Chains (BantamBooks, 1992), and his latest book "The Case for Impeachment" (St. Martin's Press, 2006). He is the founding editor of ThisCantBeHappening.

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