News

JAMES ADAMS
NATIONAL ARTS CORRESPONDENT

Supporters of socialized health care in Canada and the United States have a seemingly unlikely friend in Rex Morgan M.D., the handsome, deeply decent physician who has been a staple of newspaper comics since 1948.

So far there's no record of the Romanow health care commission or the U.S. Secretary of Health having consulted the fictional doctor.

However, as any of the 30 million readers of the syndicated strip carried by 300 newspapers in 15 countries can tell you, Rex has come out foursquare in favour of what his creator calls "a single-payer, state-supported health care system."

Interestingly, the man behind Rex Morgan's position isn't some "communist or liberal socialist" -- although he has received plenty of mail calling him that, and worse. He's Woody Wilson, a 55-year-old registered Republican from Tempe, Ariz., who voted for George W. Bush in the 2000 elections.

"I believe the country that is supposedly the richest and most powerful in the world shouldn't be forcing its citizens to choose between paying their mortgage or saving their lives. Yet that is what is happening with millions of Americans right now," Mr. Wilson said in an interview this week.

"What's needed is health care for everyone instead of dividends for stockholders in pharmaceutical companies."

Mr. Wilson has been writing Rex Morgan M.D., a sort of soap opera in comic form, since 1991, having worked as an apprentice under its originator, psychiatrist Nicholas Dallis (now deceased), since 1982.

Under Mr. Wilson, Rex Morgan hasn't hesitated to tackle domestic violence, epilepsy, drug abuse, AIDS, organ transplants, asthma and sexual harassment.

"We've never made people laugh; we're about informing and entertaining," he likes to say, and, in fact, medical professionals and support groups have included some of his strips in their educational packages.

But in recent months Mr. Wilson has pulled his rock-jawed hero firmly into the far more dicey arena of health policy, even sending him to Washington, D.C., to testify before legislators.

The strip's current storyline is dealing with the fallout from the death of Rex Morgan's friend, Dick Coleman, who lost his job after being diagnosed with colon cancer. Losing the job resulted in the loss of his family's health coverage and the threatened foreclosure on the mortgage on the Colemans' home.

In the wake of Dick's death -- "the very week [in June this year] that Dubya got his colonoscopy," Mr. Wilson noted -- his wife Marsha became borderline suicidal and his daughter Dana started to use drugs and get involved with criminal elements.

"All because they couldn't afford health insurance," a sombre Rex Morgan mused in one recent strip.

It's estimated that nearly 40 million Americans share the plight of Dick Coleman. Meanwhile, "We're adding a million or more people to the rolls of the uninsured each year," Mr. Wilson said.

Mr. Wilson likes to call himself "just a comic-strip guy," but he's a guy whose wife happens to have a PhD in health-care policy from Massachusett's Brandeis University and who "sits and talks with me about my stories."

Moreover, it's a measure of Mr. Wilson's perceived clout that he has been invited to speak in November at the annual convention of the 9,000-member U.S. Physicians for a National Health Program.

Despite the flak Mr. Wilson has received from some readers, no newspaper has pulled Rex Morgan M.D. from its comics section.

"Our problem goes to something else," Mr. Wilson said.

"Strips like ours -- they're called continuity strips -- are perceived to be old-fashioned these days. So we have to work harder to keep them fresh."

Rex Morgan, he added,"will always have to be about hot issues, will always have to try to be a bit ahead of the curve, if only because we're syndicated in so many countries."

Mr. Wilson said Rex's campaign for a national, state-financed health-care regime "is going to be a recurring theme for years to come."

Right now the fight for a comprehensive medical program "isn't a national priority," he acknowledged, "nor is there the political will for it."

But this could change in two or three years, if the ranks of the uninsured swell to, say, 50 million.

"That's a political party, in effect, right there," he said. "If someone can mobilize those people . . . that's a major force."

Unsurprisingly, those Americans critical of Mr. Wilson's position like to ask him, "Do we want to have a Canadian health-care system? Do we want rationing? Do we want to wait in line for hip-replacement surgery?"

Mr. Wilson chuckled. "My wife and I were talking about this and she said, 'Well, in Canada, [health care] is about waiting; in America, it's about money.' I want the waiting."

Posted by pnhp at 01:46 PM | Permalink | Comments (1)

Friends of PNHP:  Please don't miss the special message at the end of
today's quote.

Harris Interactive
Volume 2, Issue 17
August 21, 2002
Attitudes toward the United States' Health Care System: Long-Term Trends
Views of the public, employers, physicians, health plan managers are closer
now than at any time in the past

In the more than twenty years since Harris Interactive (or Louis Harris &
Associates, as it was then) first asked the American people what they
thought of the nation's health care system, there have been many changes,
both up and down. And when we have asked the same questions of other groups
(physicians, employers, hospital managers and health plan managers), we have
usually found quite big differences among the views of those different
groups. This year these differences have narrowed; the level of support for
radical change is somewhat similar in all these groups.

The Big Picture

While legislators in Washington are still deeply scarred by the 1994 debate
and the defeat of the Clinton health care reform proposal, it is clear that
only very small minorities of any of the five groups' surveyed hold a good
opinion of the health care system as it is now. Those who believe that "on
the whole the health care system works pretty well and only minor changes
are necessary" include only 19% of physicians and smaller percentages of all
other groups surveyed.

If our survey data were to serve as our only guide, there are several other
reasons why one might expect a big push for health care reform. Employers
are more hostile toward the system now than they were in any of our previous
surveys. So are health plan managers. While physicians' attitudes are a
little bit less negative than they were two years ago, they are more
negative than they were at any time between 1984 and 1997.

The public also has a considerable appetite for health care reform, even if
the radical change score is lower than it was in some previous years,
particularly in the early 1990s. But only 17% of the public thinks that "the
system works pretty well and only minor changes are necessary." Almost twice
as many (31%) think that "we need to completely rebuild the system," with
almost everyone else (49%) thinking that "fundamental changes are needed."

Overall, therefore, a stronger consensus for radical reform is building.

http://www.harrisinteractive.com/news/newsletters/healthnews/HI_HealthCareNe
ws2002Vol2_Iss17.pdf

Comment:  Over four-fifths of physicians, employers, hospital managers,
health plan managers, and the public now all agree that either "fundamental
changes are needed" in our health care system or "that we need to completely
rebuild it." Less than one-fifth believe that "only minor changes are
necessary." The most dramatic change is that "doctors became much more
negative in 1999 and have remained more negative ever since."

Physicians can now do something about it. We have launched a campaign to
invite every physician and medical student in the United States to endorse a
proposal for national health insurance, a proposal that would eliminate
wasteful administrative excesses and assure that health care dollars are
directed more equitably to the health care delivery system. The proposal and
the endorsement form can be accessed at:
http://www.physiciansproposal.org/

The form also provides the option of joining Physicians for a National
Health Program and becoming an active part of the growing physician movement
demanding that we change our policies and priorities from those that are
directed to creating a friendly and profitable environment for health plans
to those that channel our health care resources directly to patient care...
all patients.

A printer friendly version of the full proposal is available at:
http://www.pnhp.org/pproposal.doc

Again, for the endorsement form:
http://www.physiciansproposal.org/

Special message to our friends who share our vision:

Please distribute this message to any physician or medical student whom you
believe is ready to take action to reform the flawed system of funding
health care in the United States. Refer them to these websites, or print out
the proposal and endorsement form and distribute copies, as appropriate. The
crescendo of the physicians' voices must be heard.

Posted by pnhp at 08:32 AM | Permalink | Comments (0)

By Uwe E. Reinhardt

FEDERAL BUDGETS can be viewed as memorand ums in which the president and the majority of the Congress tell God about the moral tradeoffs they have made on behalf of the nation. From that perspective, last year's memo was illuminating for health policy.

When President Bush and the new Congress began their terms in January 2001, they faced a projected 10-year federal surplus of $3.1 trillion (excluding a projected Social Security surplus of $2.5 trillion). Even before Sept. 11, by August 2001, that surplus had melted to merely $847 billion, primarily as a result of the huge tax cut enacted in the preceding months. By January 2002, the budget had deteriorated further to a projected 10-year deficit of $742 billion.

Evidently, then, last year's memo to God read in part: ''Thank you, Lord, for gracing us with a 10-year projected surplus of $3.1 trillion. If it's a choice of spending that surplus on (A) providing health insurance to the 40 million or so hard-working Americans now without it or (B) providing tax relief to the nation's overtaxed well-to-do, we'll take the tax cut. Respectfully yours, George W. Bush and the majority of the US Congress.''

As an ex-Christian with only a vague memory of the New Testament, I have no idea how well that memo may sit with the good Lord. As an economist trained in the Theory of Revealed Preference, however, I can infer clearly the preferences of the nation's politically dominant elite. If that elite could not find it in its heart and mind to extend health insurance to uninsured Americans when the nation was awash in budget surpluses, it is unlikely to do so as the government once again faces red ink as far as the eye can see.

After chatting about the problem but leaving it unresolved for more than half a century, the political elite last year gave the clearest signal yet that upwards from 30 million to 40 million uninsured will remain a permanent feature of our health system, deep into the current century.

As in the past, the uninsured will continue to forgo the timely, early medical interventions that well-insured Americans take for granted. In case of serious illness, however, most of them probably will be able to scrounge up critical needed care from kindly doctors and hospitals, albeit in the undignified posture of health-care beggars. In the process, they will severely stress the finances and the morale of these kindly providers of care.

Many other uninsured will be hounded by medical bills and slide into personal bankruptcy. In research by Harvard law professor Elizabeth Warren, medical bills were found to be the second most frequently cited reason for family bankruptcy in the United States, behind loss of employment.

The next tier up in our health system will be HMOs catering to Medicaid beneficiaries. In principle, they should be able to offer patients better coordinated care than the traditional Medicaid program could, but only as long as the federal and state governments pay premiums high enough to cover the cost of well-managed modern health care. It remains to be seen how well the legislators will own up to that contract in the tight budgetary climate ahead.

For Americans receiving insurance as part of the labor contract there will be a wide array of private insurance products, ranging all the way from tightly managed HMOs for low-wage workers to more open-ended Preferred Provider arrangements for middle-income families to the completely open-ended, no-holds-barred health care that moneyed elite has always taken for granted.

Many of the private insurance products, however, are currently being changed to shift larger fractions of health care costs into the patients' own budgets, providing quite explicitly for rationing health care by price and ability to pay.

Sitting on the sideline will be the Medicare program for the elderly, whose spotty benefit package always has explicitly called for the rationing of important components of health care (e.g., prescription drugs) by price and ability to pay. The program may be absorbed one day into the income-tiered private health insurance products, although that prospect remains uncertain.

This income-tiered health system will remain an inexhaustible source of confusion and rancor, primarily as a result of a built in dissonance over the distributive ethic for health care. The American public still expects physicians and hospitals to deliver health care on a strictly egalitarian basis. Woe to the physicians or hospitals thought to dabble in boutique medicine for the well-to-do or to deny the uninsured health care.

On the other hand, the nation's policy-making elite clearly signals through the payment system it put in place that the health-care experience of Americans can be let to vary by income class. For example, when federal and state legislators are willing to offer pediatricians, say, $75 per visit with their own children, but pay pediatricians seeing children of poor inner-city family fees that may not even cover practice costs - or simply leave such children uninsured - do they sincerely expect the delivery of health care to all Americans on an egalitarian basis?

One sympathizes with health professionals who must practice within this sea of dissonance. It makes ours the messiest and, in some ways, the most dishonest health system anywhere in the world.

As last year's federal budget memo to the good Lord makes clear, however, the providers of health care must learn to live with this dissonance as one more chronic condition they confront. It is as good as it will get in our latitudes.

Uwe E. Reinhardt is the James Madison professor of political economy at Princeton University.

(c) 2002 Boston Globe

Posted by pnhp at 10:29 AM | Permalink | Comments (0)