We’ve all heard the old mantra “The United States has the best health care in the world.” The best for whom? Best for pharmaceutical companies’ 18.6 percent profits? Best for insurance companies like Anthem where CEO Larry Glasscock received a whopping $42.5 million three year bonus? Best for Hospital Corporation of America’s CEO Thomas Frist, MD, who took home more than $127 million in 1992? That’s more than $500,000 per working day!

We have the most expensive healthcare system in the world. Last year we spent $5,400 per capita on health care. That’s $1.44 trillion gross dollars or 15.4 percent of the gross domestic product. It’s 47 percent more than the next most expensive country, Switzerland. So we surely have the best quality, right? Wrong. Life expectancy in the U.S. is 48th in the world. We fall behind Puerto Rico and Guam. We rate right along with Cuba, which spends $177 per capita. We are 57th in measles immunization, 17th in maternal mortality and the only industrial country whose asthma mortality rates are climbing.

We have 44 million uninsured in this country (including 728,000 Hoosiers), 80 percent of those from working families. Nearly 75 million Americans under age 65 were uninsured for all or part of two years.

At a Town Hall meeting for “Cover the Uninsured Week,” Marion County Health & Hospital Corporation President and CEO Matt Gutwein listed some symptoms of this sick system. Healthcare coverage is the single largest growing expense at every level of our economy. Healthcare costs have skyrocketed compared to the cost of living. Healthcare expense is the number one reason for personal bankruptcy. The US is the only country that links health insurance to employment. The Kaiser Family Foundation reports that between 2000 and 2003, employee contributions for health premiums increased 50 percent. And small employers have stopped providing coverage at all.

The Institute of Medicine recently blamed gaps in insurance for 17,000 preventable deaths a year. A 1992 comprehensive study by the National Academy of Sciences found that “being uninsured for even a year appears to diminish a person’s general health.” Despite the popular assumption that people without health coverage just waltz into the Emergency Room and get good treatment, the ER is the single highest cost of treatment and often the poorest quality. Most of the uninsured go without health care until a serious illness becomes impossible to ignore. The study showed that lack of insurance results in 360 to 600 premature annual deaths from breast cancer, 1,400 HIV-related deaths, and 1,400 preventable deaths from untreated hypertension.

Access to healthcare is what separates a civilized country from a third world country. Our system lacks fairness and justice. Leo Gerard, President of the United Steel Workers of America (USWA) goes so far as to say “our current health care system is racist, sexist and class-based. We should be ashamed of a system that builds in misery in every step.”

Indiana and Marion County have some successful programs to help deal with the large number of uninsured and poor, but the system needs much more than just a few stopgaps or band-aids. We have the ability. In fact we are spending far more money this way than it would cost to have a more rational, decent system that is fair, good and works well for everyone. In response to fears that universal healthcare would cause “rationing,” Gutwien maintains we already have rationed care in a very unfair, unjust and irrational manner.

Why are we paying so much more than other countries? In his book As Sick As It Gets, Rudy Mueller, M.D. blames lack of preventive care along with such apparent factors as excess pharmaceutical marketing and higher prices, higher physician incomes, higher insurance costs and excess administrative costs of a multi-layered system, better and more medical technology, and “defensive medicine.” Mueller states that a national health insurance system would lower malpractice premiums, with fewer malpractice suits and fewer angry patients.

There is little relief in sight from the Bush administration. Their proposal for an income tax credit for high-deductible health insurance premiums will do nothing for half the uninsured households with income too low to receive it. Another proposal, The Health Insurance Tax Credit (HTIC), intended to help the uninsured obtain individual or non-group coverage, is severely flawed. In fact, researchers say that both these proposals combined would barely make a dent, helping insure about 1.3 million. Plus, this tax proposal could give employers an excuse to stop offering employee health benefits altogether. This is hardly a healthy way to reduce the growing number of uninsured.

Dr. Quentin Young, a leader in the campaign for a universal, single payer system, says the marketplace is poisonous to health care, with its many ways of denying and delaying care. But, our political system makes a shift away from “big business” to “basic right” very difficult in this country. Absent a federal solution, states are forced to make changes in policy. Katie Humphreys with Health Evolution suggests that Maine has a health care bill worth watching. Maine was a leader in publicly financed elections, too. Maybe there’s a connection. Stefanie Miller is a founding member of the Indiana Alliance for Democracy