Medicare a model for health system

YOU MAY HAVE WONDERED why health care is so expensive. Or you may not have wondered, since the media pretty scrupulously avoid pointing out how cheap it is abroad. Canadians pay about 60 percent of what we do. And why on Earth should the media spill the beans? When you get big advertising bucks from drug companies and HMOs, it's foolish to mention other, better, national systems where those fat cats are either tightly controlled or don't exist at all.

Thus, we citizens may snort about rapacious corporations, but we tend to accept that their existence must have been guaranteed somewhere in Genesis or Leviticus. It's good that's not true.

For those lucky folks who make it to age 65, it's like reaching the Pearly Gates. Heaven is Medicare, where sins and HMOs are washed away, along with most health insurance bills. If my cousin, for example, age 64 years, 6 months, can last another 6 months, Medicare may lift her out of poverty. No more backbreaking HMO premiums.

But, cursedly, Medicare is actually socialized insurance, run by the hated government. Indeed, it's what other lesser countries perniciously provide for all their citizens. To avoid the term "socialism," Americans now call it the "the single-payer" system. That certainly clarifies everything. But even seniors ought not to get too accustomed to Medicare's charms. The president is trying to tear off chunks of it and give them to private insurance companies.

So why is our HMO system more expensive than Medicare? Easy - it's waste. All those private insurers waste vast sums on advertising, conflicting accounting systems and duplicative staffs, including doctors and nurses. If HMOs disappeared tomorrow, so would the nursing shortage.

Then there are the big salaries, fancy buildings and shareholders. Medicare uses only a tiny fraction of that sort of overhead. So yes, we'd be wise to rid ourselves of HMOs altogether.

Pharmaceutical companies are the health system's other main scourge. They spend more on advertising than they do on research. You may have noticed on your e-mail that their prices are much lower in other countries - all other countries - than here. That's because those dreaded socialized insurance agencies in foreign lands bargain hard for drugs for their whole nation. They wring the obscene profits out of life-saving medications.

By contrast, in this country Congress recently prohibited Medicare and the Veterans Administration from muscling drug companies in the same way. As you might guess, those companies not only spend huge sums on advertising, but fund political campaigns.

In the end, of course, it's you and I who pay for all this hanky-panky.

But it's not just the bad guys who make costs go up. Here in Connecticut the race is on among our sainted hospitals for permission to do cardiac surgery. Years ago, the state limited that right to just a few places so as to hold down the cost of duplicative expensive facilities and staffs. But now everyone wants in. Cardiologists see profit and prestige from having a center in their own towns, and hospitals are rubbing their hands over this potential new profit center.