Aetna, Cigna, Humana, United Health, and Wellpoint scored record profits totaling $12.2 billion. In 2008, Ron Williams, CEO of Aetna, received over $24 million in compensation, about $450,000 per week. His weekly compensation would be enough to pay the yearly salary of three family doctors, whose median income in the United States is $159,000 per year.

While middle class families were struggling to pay their escalating health insurance premiums, rising deductibles and co-payments, Wellpoint’s profits increased by 91 percent in 2009, $2.3 billion over the previous year. Not content with this level of profiteering, Wellpoint’s subsidiary, Anthem Blue Cross of California, seeks to raise its premiums for some by an astounding 39 percent this year.

A study in the Journal of the American Medical Association last week reports that physician fees, adjusted for inflation, decreased by 25 percent between 1996 and 2006. This coincided with a decrease of 5.7 percent in the number of hours that doctors worked per week, a reduction that amounts to the equivalent of a loss of 36,000 doctors from the work force, had the hours per physician not changed.The authors’ suggested “the possibility that economic factors such as lower fees and increased market pressure on physicians may have contributed, at least in part, to the recent decrease in physician hours. Further reductions in fees and increased market pressure on physicians may therefore contribute to continued decreases in physician work hours in the future.”

Will President Obama’s health reform proposal, crafted to gain bipartisan support from a Congress that has been lobbied by the Big Five with $16. 8 million last year, actually reform health care? Not a chance, because the proposal preserves a central role for the for-profit insurance industry. This leads to several problems.

First, his plan will give subsidies to people who are unable to afford insurance policies. While more people would have insurance coverage, this is the equivalent of giving billions of taxpayer dollars to the private health insurance industry.

Second, the individual mandate he proposes will force millions of middle class Americans to buy inadequate insurance products, which have rapidly escalating premiums, and high deductibles and co-payments. This will contribute to financial hardship and medical bankruptcy for those who suffer serious illnesses, and actually need to use their insurance.

And, third, at least 23 million people will remain uninsured.

Dr. Quentin Young, speaking for Physicians for a National Health Program, said, “This proposal is an insurance company bonanza, not good, evidence-based reform. The president would do better by abandoning the insurance and drug companies and instead taking up the single-payer approach . . . By building on and improving the already popular Medicare program, we could put our patients’ interests first. Were Obama to do so, he would meet with strong public support, including from the medical community.”

Obama’s proposal supports the health insurance industry to the detriment of the American people. Private health insurance companies have been given our health care dollars in order to pay doctors and hospitals: they are robbing the coffers, with their exorbitant compensation packages for CEOs and profits for their investors. An improved “Medicare for All” would cover everyone, and provide payment for care people need when they are ill: that is the health care reform Americans need and want.

Susanne L. King, M. D., is a Lenox-based practitioner.

Everyone is talking about health care reform and trying to decipher the differences between the bills in the House and the Senate. The “public option” is praised by some and derided by others. Politicians are influenced by the financial support of various interest groups who are lobbying furiously to retain or extend their turf.

Regardless of the legislation Congress passes, the health insurance industry is primed to expand its consumption of U.S. health care dollars by selling more insurance policies to people who are currently uninsured. And American taxpayers are going to subsidize many of these policies, a windfall profit for private insurance companies.

In a statement about why he voted against the House Bill (H.R. 3962) passed this weekend, Rep. Dennis Kucinich said, “In H.R. 3962, the government is requiring at least 21 million Americans to buy private health insurance from the very industry that causes costs to be so high, which will result in at least $70 billion in new annual revenue, much of which is coming from taxpayers. This inevitably will lead to even more costs, more subsidies and higher profits for insurance companies — a bailout under a blue cross.”

Few others in power are discussing the important question, “Is all of this legislation real reform or phantom reform?” Universal coverage is important, but what are the other necessary components of health care reform that American people desire? There are four other important elements beyond universal coverage: choice, adequate coverage, security, and cost-effectiveness.

First, phantom reform does give you choice, but it is the choice between many HMOs and other private, for-profit insurance plans. Real reform would give patients the choice they actually want, which is to choose their doctors and hospitals. Americans don’t want a choice of insurance company bureaucrats; they want a choice of health care providers.

Second, phantom reform does give you insurance coverage, but with deductibles and co-pays, as well as exclusions for various services. Real reform would provide coverage with no out-of-pocket costs; i.e., comprehensive care for all medically necessary services, as decided by you and your doctor, not a faceless bureaucrat in an insurance company intent on maximizing its profits.

Third, phantom reform provides illusory security. Sure, you get an insurance policy, but if you can’t work or pay, you lose your insurance. Real reform would provide security for everyone, for as long as they needed care, just as Medicare does now for those over 65.

Fourth, phantom reform saves money by providing less care. “Medical loss” is the term insurance companies use for the dollars they pay out to health care providers and hospitals for their services, at times resorting to criminal means to hold on to the money patients have paid for insurance to cover the health care services they need . Real reform would save $400 billion per year by eliminating private, for profit health insurance, if the government were the non-profit single payer of the health care funds.

Real reform is a single-payer national health insurance program that would be comprehensive, universal, and cost-effective. Phantom reform is what Congress is now hotly debating, and the public option is a red herring in the pursuit of real reform.

According to Dr. Steffie Woolhandler of Harvard Medical School, who has studied the financing of health care reform, the public option would deliver very little of the administrative savings possible in a single-payer program. There would be no savings on hospital billing or the administrative bureaucracies of nursing homes and doctors’ offices. In reality, the public option would save only a fraction (1/7th) of the $400 billion savings available through a single-payer program, even if half of the privately insured were to switch to a public option.

In addition, our experience with Medicare HMOs shows that private insurance plans avoid patients who are seriously ill and have high medical costs. Despite regulations, private insurance companies undermine fair competition. There is no reason to believe the public option would fare any better in this arena.

Unlike politicians, the American people know real reform when they see it. In 2009, a CBS News/ New York Times poll showed that 59 percent of Americans support national health insurance, up from 40 percent in 1979. And Americans know that we have what it takes in the United States to deliver top-notch care: excellent hospitals, well-trained professionals, and superb research.

We already spend at least twice as much per person for health care as other wealthy countries. Even our public spending is greater than the total spending in other nations. We have the money for health care for everyone. The money just needs to be spent on health care delivery, rather than bureaucracy and profits for insurance companies.

If you cannot afford insurance, or your health insurance premiums keep rising, along with your out-of-pocket costs, consider our neighbor to the north. Canada has Medicare for all, a single-payer national health program that provides universal, comprehensive coverage. Canadians also have a life expectancy two years longer than Americans, infant deaths 25 percent lower, more doctor visits and hospital care per person, and a quality of health care equivalent to that of insured Americans. Canada spends half the amount per person that we spend on health care. Now that is real reform.

The disruptions at town meetings in August were not just the work of conservative hecklers and their corporate backers. The wave of anger also revealed that many Americans feel left out during the current recession. It is not just the 50 million people who are left out because they don’t have health insurance, or the tens of millions who are left out because they have inadequate health insurance, or even the many people who have been bankrupted by their medical bills (the most common cause of bankruptcy in the United States).

Millions of other Americans also feel left out and angry, frustrated by the bailouts for Wall Street and other corporations which profit from the tax dollars of struggling Americans.

The current health insurance reform bill being created in Congress is looking like just another bailout – this time for health insurance and pharmaceutical companies. With their lobbying dollars and influence, these companies are crafting health insurance legislation to expand their profits and power.

A proposed individual mandate to force 47 million citizens to buy health insurance will be a windfall for private health insurance companies, and will be partially paid for with taxpayer dollars for subsidies to support premiums for people who can’t afford health insurance.

And the drug companies pulled a real coup. President Obama agreed to a promise of $80 billion from the pharmaceutical companies over ten years in exchange for an agreement with the government to not bargain down medication prices for Medicare, and to not allow people to buy cheaper drugs from Canada. The drug companies did not give the government $80 billion, nor agree to cut prices, but only to reduce the amount they would otherwise have raised prices. $80 billion over ten years translates into savings of only 2 percent of the projected U.S. spending on prescription drugs. What was Obama thinking?

What ordinary people seem to be thinking is, “We’ve given enough bailouts to the private sector, and we are sick of our government continuing to subsidize private corporations.”

At a “Community Meeting for Healthcare” in New Hampshire during his campaign for president in 2007, Barack Obama talked with 200-plus people about health care reform. He said, “I want to be held accountable for establishing a universal health care plan by the end of my first term, but I have to insist on the voters rallying for this change. When I take office I have to feel I have a mandate for change.”

According to the Associated Press, his audience at the community meeting was “almost single-mindedly focused on a single-payer system.” What we know from polls is that 59 percent of Americans support a single payer national health insurance program, an improved “Medicare for All.” So why have our president and Congress abandoned single payer health care when the majority of Americans support it?

Representatives John Conyers and Dennis Kucinich are sponsoring HR 676, the single-payer, not-for-profit health insurance bill in the house, along with 85 other representatives. Kucinich says, “Insurance companies will stop at nothing to hold on to the American people’s wallet when it comes to health insurance.” He believes that health care reform needs to come from public input, not the special interest groups who are driving the legislation in Congress.

He recommends that we step back and start over on health care reform, and that congressmen should go back to the people and listen to their stories. They need to talk to all their constituents, not just those who scream the loudest. They need to hold town meetings where civil discourse prevails.

For those of us who support single payer health care, we can make it clear to our representatives in Congress that this will be an important issue in their re-election as we go to vote next year.

Since health insurance lobbyists have effectively squelched discussion of single payer bill HR 676 as an option for health care reform in Congress at this time, Rep. Anthony Weiner, a single payer supporter, has filed an amendment to the health reform legislation recently created in the House, HR 3200. Weiner’s amendment would effectively change HR 3200 into a single payer bill.

Speaker Nancy Pelosi has promised an up or down vote on this amendment in September. If you support single payer health care, please call your representative, or go to www.pnhp.org and send an email asking him to support the Weiner amendment to HR 3200.

If we had an improved “Medicare for All” program, everyone would have comprehensive coverage, including medical and dental care, prescription drugs, and long term care, all without deductibles and co-payments. This approach would not add to our burgeoning national deficit, but would save $400 billion in administrative costs alone by eliminating for-profit health insurance companies.

The current Medicare program is financially threatened: Medicare viability would be enhanced by including everyone in the system, rather than siphoning off healthy workers to the for-profit insurance industry. Only with a single payer national health program will we have “everybody in and nobody out.”

There is a moral imperative to providing comprehensive health care to everyone. Health care should be a human right, not a market good. As Senator Teddy Kennedy said, “For all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives, and the dream shall never die.”

Susanne L. King is a Lenox-based practitioner.

Headlines in the Berkshire Eagle recently proclaimed that Berkshire Health Systems (BHS) is cutting the equivalent of 65 full-time jobs, and will lose $3 million this year. This is neither good for employment nor for the health of our population in the Berkshires. The culprits are the cuts to Medicaid and Medicare, the programs that cover 70 percent of the BHS population.

BHS president David Phelps reports that financial problems at Berkshire Medical Center have been aggravated by Massachusetts health care reform. While more patients have enrolled in insurance plans, the reimbursements for these plans are similar to Medicaid rates, which don’t actually cover the cost of care.

As the major non-profit provider of health care for the Berkshire community suffers financially, the for-profit insurance industry, (which only administers the funds, and provides no actual health care services), is raking in the money. In the current economic and health care crisis, United Health Group, America’s largest health insurance company, enjoyed an increase of 8 percent in revenues for the first quarter of 2009, with a net profit of $984 million. There is something wrong when the administrators of the health care funds are making exorbitant profits, while the providers of the health care services are struggling to remain solvent.

The private for-profit insurance industry diverts roughly $400 billion/year from medical services. In addition, the Senate Commerce Committee recently released a staff report about how health insurers have forced consumers to pay billions of dollars in medical bills that the insurers should have paid themselves.

Will the current health care reform being formulated in Washington address these issues? Not a chance, even if President Obama gets a public plan option into the reform legislation. Dr. Steffie Woolhandler, a founder of the 16,000-member Physicians for a National Health Program, stated in her testimony to Congress: “Insurers compete by not paying for care: by denying payment and shifting costs onto patients or other payers. These bad behaviors confer a decisive competitive advantage. A public plan option would either emulate them — becoming a clone of private insurance — or go under. A kinder, gentler public plan option would quickly fail in the marketplace, saddled with the sickest, most expensive patients, whose high costs would drive premiums to uncompetitive levels.”

In addition, the overhead for a public plan option would be higher than for Medicare, which automatically enrolls seniors at 65, deducts premiums from Social Security checks, and does no marketing. The administrative costs for the whole health care system would remain astronomical, as health care providers would continue to struggle with mountains of paperwork and denials of payment from multiple insurance companies. A public plan option would not curb the escalating costs of new technology, and would not address variability in the quality of care.

The only way to attain universal health care coverage, while containing escalating health care costs and standardizing quality of care, is to eliminate the insurance companies, and establish a single-payer “Improved Medicare for All” program. Hospitals, doctors and other providers must be adequately reimbursed for their medical services. This would be possible if the profiteering and waste of the health insurance industry were eliminated, and those health care dollars went to the actual provision of medical care. And hospitals could be paid like fire departments, with a single monthly check and little billing. There is federal legislation for a national health program in both houses of Congress, John Conyers bill, HR 676, and Bernie Sanders bill in the Senate, S.703.

Last year a survey of doctors showed that 59 percent support a national health plan, up from 49 percent in 2002. (Only one in five doctors are in the American Medical Association, which opposes a national health plan). So why is single-payer health care reform “off the table”‘ as Senator Max Baucus, chairman of the Finance Committee, said, before he threw eight single-payer advocates, including several doctors, out of a “public roundtable discussion” and had them arrested. Could it be related to the more than $1 million in donations Baucus received from the insurance and pharmaceutical industries in the 2008 election year cycle?

Wendell Potter, a former health insurance industry insider has this to say, “. . . big for-profit insurers have high-jacked our health care system and turned it into a giant ATM for Wall Street investors, and . . . the industry is using its massive wealth and influence to determine what is (and is not) included in the health reform legislation members of Congress are now writing.”

What is going on in Washington right now is not in the best interests of patients, or the doctors and hospitals that serve them. Patients have no lobbyists speaking for their interests in Congress. Most doctors do not want the AMA to speak for them. Contact your congressmen and ask them to sponsor HR 676 and Bernie Sander’s bill. (On his Web site, Sanders also has an online petition you can sign and pass along to your friends).

Sen. Bernie Sanders, a Vermont Independent, has just introduced a single-payer health care reform bill into the United States Senate. This legislation stands in sharp contrast to the reform models offered by the White House and Sen. Max Baucus, which are similar to our current Massachusetts reform. Unlike Massachusetts, the Sanders bill would eliminate the many private insurance companies and create a “single payer” to administer health care funds.

Single-payer health care would save American taxpayers $400 billion in administrative costs, says Sanders, which would be enough money to provide health care coverage for everyone in our country. Sanders is a senator who knows how to save money at a time when taxpayers are paying billions to keep AIG afloat.

As we know from our Massachusetts experience with health care reform, preserving the role of private health insurance companies does not lead to universal coverage or contain rising health care costs. The Massachusetts reform program has not been affordable for the individual or for the state, and access to health care continues to be problematic, with nearly a quarter of the state’s residents saying they had difficulty getting care in 2008.

The provisions of Senator Sander’s bill are: (1) universal coverage; (2) comprehensive benefits, including mental health, dental and prescription drug coverage; (3) patient choice of doctors and hospitals; (4) fully-funded community health centers to provide access to care for the 60 million people living in rural and other underserved areas; and (5) resources for the National Health Service Corps to train 24,000 new health professionals to address the shortage of primary care doctors and dentists.

Massachusetts continues to have a critical shortage of primary care doctors, and providing health insurance for the uninsured through our current program has only made that deficiency more visible. Having health insurance in Massachusetts doesn’t guarantee health care if you can’t find a doctor when you are sick. Others with insurance can’t get care because they can’t afford their co-payments and deductibles.

Sanders’ program would be paid for by taking the current sources of government health care spending, and combining them with modest new taxes that would be less than people now pay for insurance premiums and other out-of-pocket expenses. Four hundred billion dollars would be saved annually by eliminating insurance company profits and overhead, as well as the paperwork that burdens doctors and hospitals.

Dr. Uwe Reinhardt said at a hearing before the U.S. Senate Finance Committee, “We have 900 billing clerks at Duke (a 900 bed university hospital). I’m not sure we have a nurse per bed, but we have a billing clerk per bed. . . it’s obscene.”

Doctors and hospitals are sick of the paperwork and the health care dollars that don’t go for health care delivery. And everyone hates the intrusion of insurance companies into health care decisions. A poll published in the Archives of Internal Medicine found that 64 percent of doctors in Massachusetts now support single-payer health care.

Sen. Bernie Sanders’ legislation is a bold step forward. Five hundred physicians in Massachusetts have signed a letter to Sen. Kennedy, asking him to support a single-payer reform similar to Sanders’ bill. Kennedy supports universal coverage, but would leave the current dysfunctional system of multiple insurance company payers intact. Kennedy has said, “Health care is not just a commodity . . . to be rationed based on the ability to pay. It is time to make universal health insurance a national priority, so that the basic right to health care can finally become a reality for every American.”

Unfortunately, leaving the current system intact would not save the $400 billion now lost to administrative expenses. We ask Sen. Kennedy to listen to Massachusetts physicians and reject the lobbying forces of the profit-driven insurance industry. We also ask him to join Sen. Sanders in sponsoring the only solution for health care reform that will cover everyone at a cost we can afford.

Massachusetts has been lauded for its healthcare reform, but the program is a failure. Created solely to achieve universal insurance coverage, the plan does not even begin to address the other essential components of a successful healthcare system.

What would such a system provide? The prestigious Institute of Medicine, part of the National Academy of Sciences, has defined five criteria for healthcare reform. Coverage should be: universal, not tied to a job, affordable for individuals and families, affordable for society, and it should provide access to high-quality care for everyone.

The state’s plan flunks on all counts.

First, it has not achieved universal healthcare, although the reform has been a boon to the private insurance industry. The state has more than 200,000 without coverage, and the count can only go up with rising unemployment.

Second, the reform does not address the problem of insurance being connected to jobs. For individuals, this means their insurance is not continuous if they change or lose jobs. For employers, especially small businesses, health insurance is an expense they can ill afford.

Third, the program is not affordable for many individuals and families. For middle-income people not qualifying for state-subsidized health insurance, costs are too high for even skimpy coverage. For an individual earning $31,213, the cheapest plan can cost $9,872 in premiums and out-of-pocket payments. Low-income residents, previously eligible for free care, have insurance policies requiring unaffordable copayments for office visits and medications.

Fourth, the costs of the reform for the state have been formidable. Spending for the Commonwealth Care subsidized program has doubled, from $630 million in 2007 to an estimated $1.3 billion for 2009, which is not sustainable.

Fifth, reform does not assure access to care. High-deductible plans that have additional out-of-pocket expenses can result in many people not using their insurance when they are sick. In my practice of child and adolescent psychiatry, a parent told me last week that she had a decrease in her job hours, could not afford the $30 copayment for treatment sessions for her adolescent, and decided to meet much less frequently.

In another case, a divorced mother stopped treatment for her son because the father had changed insurance, leaving them with an unaffordable deductible. And at Cambridge Health Alliance, doctors and nurses have cared for patients who, unable to afford the new copayments, were forced to interrupt care for HIV and even cancers that could be treated with chemotherapy.

Access to care is also affected by the uneven distribution of healthcare dollars between primary and specialty care, and between community hospitals and tertiary care hospitals. Partners HealthCare, which includes two major tertiary care hospitals in Boston, was able to negotiate a secret agreement with Blue Cross Blue Shield of Massachusetts to be paid 30 percent more for their services than other providers in the state, contributing to an increase in healthcare costs for Massachusetts, which are already the highest per person in the world. Agreements that tilt spending toward tertiary care threaten the viability of community hospitals and health centers that provide a safety net for the uninsured and underinsured.

There is, though, one US model of healthcare that meets the Institute of Medicine criteria: Medicare. Insuring everyone over 65, Medicare achieves universal coverage and access to care, is not tied to a job, and is affordable for individuals and the country. Medicare simplifies the administration of healthcare dollars, thereby saving money. We need to improve Medicare, and expand this program to include everyone.

A bill before Congress, the United States National Health Insurance Act, would provide more comprehensive coverage for all. The bill includes doctor, hospital, long-term, mental health, dental, and vision care, prescription drugs, and medical supplies, with no premiums, copayments, or deductibles.

People would be free to choose doctors and hospitals, and insurance would not be tied to a job. Costs would be controlled because health planning in a national health program can reestablish needed balance between primary/preventive care and high-tech tertiary care. A modest, progressive tax would replace what people currently pay out of pocket. This program would pay for itself by eliminating the wasteful administrative costs and profits of private insurance companies, and save $8 billion to $10 billion in Massachusetts alone.

We must let Congress know we want improved access to affordable healthcare for all, not more expensive private health insurance we can’t afford to use when we are sick. Massachusetts healthcare reform fails on all five Institute of Medicine criteria. Congress should not make it a model for the nation.

As Tom Daschle, President-elect Obama’s choice for secretary of health and human services, flies across the country to attend community meetings on health care reform, and the Obama Web site solicits opinions and health care stories from citizens, those of us who support a single-payer national health insurance program hold our collective breath. Will the incoming government really listen to the citizens who, in poll after poll, by a clear majority, support single-payer health care? Or will the vested interests of the private, for-profit health insurance lobby win again?

The Congressional Budget Office just released a 197-page report analyzing issues related to health care reform. In discussing an array of proposals for reform, the report gave a scant two paragraphs to reviewing the single-payer, “Medicare for All” option. Yet given the fact that a single-payer national health care program would save $400 billion in administrative costs and pay for itself, rather than adding billions of dollars to an already overburdened system, one would think the “Medicare for All” option would be front and center, and would have received extensive attention in this report.

In addition to potential savings of $400 billion a year in administrative costs, a single-payer federally-administered national health program would help contain costs by creating global budgets and bulk purchasing, including prescription medications. Single-payer is the only feasible route to universal health care that would cover everyone, and be cost-effective for government, individuals, and business. Everyone would benefit except the private insurance companies, which would be eliminated in a single-payer system.

The public/private financing mix that is the foundation of the proposals made to date by president-elect Obama and Senators Ted Kennedy and Max Baucus simply won’t work, because they are unable to contain costs. This has been shown in numerous state experiments patterned after this model. The most recent example is our Massachusetts “Chapter 58″ health reform legislation, which is being billed as the “model for the nation.”

The Massachusetts plan is not financially sustainable. State payments for premiums for the fully state-subsidized insurance plans will increase by an average of more than 9 percent in 2009. Participating insurers are trying to keep premiums down by decreasing benefits and shifting more costs to individuals, creating plans with huge deductibles and large co-payments. Governor Deval Patrick has said, “The increases at this rate over time (are) just not sustainable, not for families, not to business, not for government.”

Meanwhile, private insurance companies continue to rake in profits and pay their CEOs millions of dollars. CEO William van Faasen of Massachusetts Blue Cross Blue Shield earned $16.4 million in retirement benefits in 2006, in addition to almost $3 million paid for his other role as chairman of the insurance company. These bloated compensation packages would not be paid to administrators in a single-payer health care system.

Mr. Van Faasen has recently been in the news again in a Boston Globe exposé about his agreement with Partners Healthcare in Boston to pay their hospitals 30 percent more than other hospitals in the area. Such behind-the-scenes arrangements would not be possible in a more transparent non-profit single-payer system.

HR 676 is the national single-payer bill, known as “The Expanded and Improved Medicare for All Act.” This legislation would eliminate the for-profit insurance companies, and the government would administer our health care funds. However, our private health care delivery system would remain the same.

This is not “socialized medicine,” as hospitals and doctors’ services would remain private. There would be comprehensive coverage for everyone, paid for with a progressive tax. There would be no other premiums, co-payments or deductibles. Everyone would have a choice of doctors and hospitals, and there would be effective cost control. This would be accomplished without increasing health care costs.

Why isn’t this legislation the centerpiece of the Congressional Budget Report, rather than a two-paragraph footnote? Please call your congressional representative and ask him or her to support single-payer health care (HR 676). Then send this article to your friends and ask them to do the same.

As you prepare to begin your presidency during a period of severe recession, you will be searching to make financially sound decisions for our country. You have promised to reform the health care system, and only one solution will enable you to create an effective system and save money: a single-payer national health program.

During your campaign, you proposed a health plan to extend coverage to the 45 million uninsured Americans by expanding private and public programs, with the help of federal subsidies and mandates. This will only add to the cost of our health insurance system, currently a hefty $7,129 per person. However, if we adopt a single-payer national health program rather than attempting to expand our dysfunctional multiple payer, private insurance system, we would save money.

Drs. David Himmelstein and Steffie Woolhandler, health care researchers at Harvard Medical School, have calculated that the United States could save $350 billion/year by adopting a single-payer national health program. A single-payer program would eliminate private insurance companies and the enormous expense of their administrative costs and profits.

Every other industrialized country in the world has a national health plan that covers everyone and is administered by the government. And other countries spend less than half as much per person on health care as we do in the United

States. One reason they are able to provide health care for everyone for much less money is because their administrative costs are a small fraction of the costs in our country.

A single-payer national health program would also be a real boon to individuals faced with rapidly rising health insurance costs, and would rescue people who are falling into bankruptcy and are losing their homes because of medical debts. American automakers might not need bailouts if they didn’t have to provide insurance for their workers and retirees. Small businesses would no longer shoulder the expense and administrative burden of providing health insurance for their workers.

Not only would we save money for the government, business, and the individual, but a single-payer national health program would also cover everyone, and we would all have access to more comprehensive benefits. These benefits would include medical care, mental health care, dental care, prescription drugs, and long-term care, which is a primary concern for the baby boomers who have been watching their life savings and retirement funds evaporate with the collapse of Wall Street.

A group of 15,000 U.S. doctors in the organization Physicians for a National Health Program have called on you to enact a single-payer program. A Massachusetts poll revealed that 64 percent of doctors support single-payer health care, and the American College of Physicians has voted its support for a national health program as well.

As a Massachusetts resident, I am witnessing an attempt at health care reform that has similarities to your proposed plan, and is being touted as a model for our country. This program has expanded health insurance coverage to people who were previously uninsured, but it is not economically sustainable for our state government or for individuals. Many people are unhappy with the current health insurance program in Massachusetts, which has not reduced rapidly rising premium costs, co-payments and deductibles for the working individual. Massachusetts residents who were able to vote on local ballot initiatives in their legislative districts on Nov. 4, supported single-payer health care by landslide margins. Opinion polls also show that two-thirds of the public supports this kind of reform.

You have a mandate from the American people, and from many doctors and other health care professionals who actually provide our care. You have the opportunity to seize this moment of economic crisis, and create financially sound, sustainable health care reform. As Dr. Quentin Young, a long-time single-payer advocate, has said, “Adopting a nationwide single-payer system will build on the great achievement of Medicare, further unify our people, strengthen our country’s economic competitiveness and assure President Obama’s legacy as an American hero.”

McCain’s central idea for health care reform is his solution for every issue: let the markets determine the outcome, with unfettered competition as the driver. Ironically, he continues to tout this philosophy even as Wall Street crumbles around us, and financial companies look for bailouts from the government.

McCain would raise taxes for working people, by taxing their health insurance benefits. This would lead to younger healthy workers opting out of employer insurance, which would raise employer health insurance costs for the remaining workers, leading to more and more employers terminating coverage for their employees. Working individuals would be thrust into the private insurance market.

Navigating the private insurance market is not only daunting, but it can be dangerous for your health. Age and health status are factors the insurance companies look at to determine whether they will take the risk of insuring an individual, and they try to weed out anyone who is sick or likely to get sick. They want your premiums, but they don’t really want to pay out any money for health care. So workers who now have insurance in group plans through their employers will have to fend for themselves in the private market, and may not be able to get insurance.

McCain wants “to restore control over our health care system to the patients themselves,” and he thus proposes a tax credit of $2,500/ person for the purchase of health insurance. When cheaper policies cost $6,500/person and carry deductibles of $1,000, with co-payments every time you try to access benefits, $2,500 is a paltry sum if you actually have to use your insurance. This is health insurance in the private market: increasing costs for fewer benefits.

McCain also proposes decreasing the regulation of health insurance, allowing people to buy insurance from companies that don’t operate in their states. This would benefit only the insurance companies, who would be able to avoid state legislation requiring certain necessary health benefits, like mammograms. And doctors would have even more paperwork, more administrative costs, and more headaches than they do now, as they try to deal with even more insurance companies.

Health care costs would rise because of increased administrative costs for private insurance companies, as it is more expensive to underwrite policies for individuals than it is for groups. We already spend $350 billion in unnecessary administrative costs because of the private insurance industry.

Four economists reported their analysis of the McCain plan in the journal “Health Affairs,” concluding that it would radically transform the U.S health insurance landscape, with little impact on the number of the uninsured, while raising costs, reducing benefits, and leaving people with fewer consumer protections.

The problems with our health care system are extremely serious. Projected health care spending for 2008 is almost $2.4 trillion, which is close to $8,000 per person. This represents 16.6 percent of the gross domestic product in the United States. In spite of our spending on health care, which is twice that of any other industrialized country in the world, 46 million Americans remain uninsured. Many more are underinsured and have to pay so much in out-of pocket costs that they forego needed health care, even though they have health insurance.

According to a Commonwealth Fund study, there was a 60 percent increase in the number of the underinsured between 2003 and 2007. The underinsured tend to defer preventive care, choosing not to get mammograms or have their cholesterol checked. Underinsured adults with chronic conditions are not filling their prescriptions. Being underinsured affects personal health, as well as the cost of providing health care in our country, since not getting needed health care only means bigger health care bills down the road when the problems are more serious.

I agree with Senator McCain that it is time for a radical change in our health care system, and I agree that health insurance should be divorced from employment. But radical reform is useful only if it addresses the problems in our current health care system, and McCain’s plan does not do that.

A national single-payer health program, administered by the government rather than private insurance companies, would cover everyone, provide more comprehensive benefits, and do so without raising health care costs. With the $350 billion saved in administrative costs, everyone could have health insurance coverage. And national health insurance has a proven track record in other countries, where health care costs are lower and people live longer. Single-payer health care reform is the only meaningful reform, and is now supported by 15,000 members in Physicians for a National Health Program.

The single-payer national health program would be paid for with a modest tax, much as Medicare is today. Instead of just covering the elderly, a single payer plan would cover everyone for all necessary hospital and outpatient medical care, as well as full prescription drug coverage, home-care benefits, and nursing home care.

The usual response I get from people is positive, supportive and enthusiastic. Everyone has horror stories about their lack of health insurance or the travesty of their current private health insurance plans, which cost more and more yet cover less and less.

When someone does express doubts about a single-payer health insurance program, the reservation I hear most frequently is “I don’t trust the government.” This is an interesting response, since “we, the people,” are the government in a democracy. If you are committed to the belief that less government is always better and that all current government services should be privatized, than the current costly and inequitable health care system fits with your belief.

However, the majority of us realize that we depend on the government for protection and many services, which we do not want to give up, including national defense, police and fire protection and public education. Medicare, Social Security and Medicaid are the federal government programs for the elderly, poor, and chronically ill, and most recipients of these programs are satisfied with them: Witness the rapid demise of President Bush’s attempt to privatize Social Security.

People who say they don’t trust the government need to recognize that the United States already has a health care system in which the federal government currently pays for 60.5 percent of total health care spending. This amounts to government spending of $4,084 per person in our country; the other 40 percent is paid by individuals and employers. By contrast, total health care spending in Canada, which has a single-payer national health care program, amounts to only $2,337 per person. In addition to paying less, Canadians get more comprehensive care and have better health care outcomes.

Yet some people fear that a single-payer system would result in government control and intrusion into health care, resulting in “loss of freedom of choice.” This is ironic in our current era of managed care insurance, where workers have to accept the insurance their employers choose for them and where insurance companies decide which doctors and hospitals patients can use. The myth of “loss of control” with government administration of our health care funds is perpetuated by for-profit health insurance companies, pharmaceutical companies and “free market” ideologues, who do not want to see windfall health care profits disappear from the marketplace.

What are the facts to counter this myth of “loss of control” with a national health plan? First, under a single-payer health care program, there would be free choice of health care providers. Patients would no longer be forced to see the providers on their insurer’s panel in order to get health care benefits.

Doctors and patients together would manage the care a patient needs, rather than for-profit insurers who invade a patient’s confidentiality and are interested in denying care to increase their profits.

Second, providers would have a method to negotiate fees, which they do not have now under managed care, where insurers in corporate boardrooms decide the reimbursement rates.

Third, decisions about the taxes, fees and benefits for a single-payer health insurance plan would not be under direct government control but would be decided by a diverse board representing patients, providers, business and government. Single-payer health insurance would replace all current private insurance premiums, co-payments, deductibles, and any other out-of-pocket payments, with a modest 2 percent income tax on individuals and a 7 percent payroll tax on employers. For most people, this is less than what they now pay in private health insurance costs, and they would receive much more comprehensive coverage. The payroll tax would replace all other employer expenses for employee health care.

Rather than taking away control, a single-payer plan would improve the health and longevity of Americans, as shown in the health outcome measures of other countries with single-payer national health plans. This is because the priority of such a program is to provide comprehensive health care coverage for everyone. This stands in contrast to the priorities of the private health insurance companies. They try to avoid insuring people who are ill and avoid paying for health care benefits in order to make profits fo their shareholders and provide outlandish compensations for their CEOs, as much as $29 million per year.

Single-payer health insurance is not “socialized medicine.” “Single-payer” refers to a health care payment system, not a health care delivery system. Under a single-payer program, the government would simply take in money via taxes and pay benefits to heath care providers and hospitals. A total of $350 billion would be recaptured for health care by eliminating the private insurance industry, as administrative costs under the current system consume 31 percent of our health care dollars. Our current health care delivery system would remain in place, with private doctors and hospitals continuing to provide care for their patients. The government would not own hospitals and doctor practices, nor would health care providers be government employees, as they are in socialized medicine.

Too many doubters say that single-payer health care is not politically feasible and that incremental steps are the only possible way to try to reform our expensive and broken health care system. To paraphrase Dr. Steffi Woolhandler, a Harvard physician and co-founder of Physicians for a National Health Program, “Politics is not the art of the possible but the art of creating the possible. And what is possible is what people believe can be done.”

We, the people, are the government; we live in a democracy; and we need to exercise our political rights in order to access our health care rights.