Health-care system needs critical care

Every time I go to refill a prescription, I wonder how people who don't have health insurance manage.

My wife and I are insured through work. We have a choice of plans, none of which is ideal. You have to predict what might go wrong with you, then pick the plan that might do you the most good. But we know we can see a doctor when we or our son need to. There are about 45 million Americans who don't have health insurance. I don't really have to wonder how they deal with health care. When I was a kid my family didn't have health insurance, and we rarely saw a doctor.

There were no regular checkups, no visits to the dentist. I didn't realize I needed glasses until junior high school when someone came to check students' vision.

Health care is a funny thing in the United States. Every year we make spectacular advances and spend unfathomable amounts of money. Every year millions of Americans do without health care. People suffer and die because they can't afford medical care.

OK, maybe that's not something insured people are roiling around in bed thinking about at night, but even if you have a plan it's likely to be a bureaucratic tangle, ever changing and more expensive every year.

Something's wrong. Every few years there arises a movement to reform health care, but those plans are easily squelched. It's not as exciting as bird flu, and all an opponent of change has to do is say it'll turn you into a socialist and people run screaming the other way.

The health of Americans has been left up to the private sector for the most part. Companies insure their workers, but not all companies do, and plans range wildly.

People can buy health insurance directly, of course. It's expensive, but people can buy it, unless there is something wrong with them. Private insurance is so costly that I can't count the number of people who've said they'd like to retire but keep working for the insurance.

Way back, just after World War II, unions in Europe agitated for national health-care plans. Unions in the United States bargained with individual companies for plans to cover their members. Most of those plans are straining under the weight of cost increases.

General Motors workers just agreed to give the company some relief and pay more themselves for health insurance. GM is a big company, but it's not big enough to wrestle with health care.

Some things — defense, public safety — are just not manageable except by all of us together (i.e., the government, scary as that thought may be to many).

It wasn't until the '60s that Medicare and Medicaid came about to take up some of the slack. They're both pretty limited. Lots of people fall through the gaps, particularly the working poor.

Most responsibility for Medicaid rests on individual states, and they can't keep up financially forever.

I was in Nashville this month for a gathering of columnists who listened to expert after expert speak on a variety of issues that affect the country. Medical care kept coming up.

It was at the heart of a discussion with Tennessee Gov. Phil Bredesen, who put himself on the hot seat this year when he cut thousands of people from his state's Medicaid plan.

Bredesen said his state's program was the most extensive in the nation, and it also consumed a higher proportion of the budget than other states commit to health care.

A number of other states, blessed with increased tax revenue this year, reversed plans to make cuts and instead used some of the money to expand their programs. But Bredesen believes they'll eventually exhaust their treasuries trying to keep up. Tennessee just arrived at a decision point early.

He decided it was time to draw a line, but he knows his cuts aren't a real solution to the problem. Bredesen said health care "cries out for a national system."

Bredesen is no socialist. He made millions in the HMO business as the founder of HealthAmerica Corp. before going into politics. But he knows our current system is broken. Most Americans say in surveys that the system isn't working. What we need is a new prescription.

Jerry Large: 206-464-3346 or jlarge@seattletimes.com. His column runs Thursdays and Sundays and is at www.seattletimes.com/jerrylarge.