By Susanne L. King
Berkshire Eagle
Friday, July 13

A MAN sews up the gaping wound in his own leg because he has no health insurance. Another decides whether to save his ring finger for $12,000, or his middle finger for $60,000, since he can’t afford reconstructive surgery for both fingers.

So begins “Sicko,” Michael Moore’s new documentary on the failures and travesties of the United States’ health care system, which leaves almost 50 million people uninsured and many more underinsured.

These stories are only two of the 25,000 that Moore received when he sent an e-mail request for reports from patients who have experienced difficulties with the health care system. With these stories of shattered lives, Moore masterfully weaves a powerful narrative that is an indictment of our health care system. He shows us people who suffer unnecessary pain, chaos, indignity and death because of their lack of access to health care.

Moore details the failures of our system by focusing on working adults who can’t get insurance because of pre-existing conditions, who have insurance but can’t afford their co-payments and deductibles, or who have been denied coverage by their insurance companies when they develop a health problem.

The people around me cried as we watched a middle-aged couple move into a small room in their daughter’s house after declaring medical bankruptcy. The husband had survived three heart attacks and his wife had developed cancer. Even though both had been gainfully employed and had insurance, they went bankrupt in their retirement years because of “cost-sharing,” the term insurance companies use for sticking patients with high deductibles and co-payments.

By showing how having insurance does not guarantee access to health care in America, Moore highlights the underhanded practices of insurance companies. A devastated mother describes her child’s death, which occurred because the family’s managed care insurance company would not pay for treatment at the closest hospital emergency department.

A former medical reviewer, Dr. Linda Peeno, cries as she testifies in a government hearing about the practices she implemented to deny care to patients insured by Humana before she quit her job in protest. .

Moore not only details the problems of our current health care system, he also shows us the solution. He supports a national health care plan, similar to that of every other industrialized country in the world. He goes to Canada, Great Britain, France, and, yes, to Cuba, to highlight the benefits of a single-payer plan funded and administered by the government.

He also debunks the myths and distortions about a national health plan, which are promulgated by the insurance companies, including the specter of “waiting lines,” and the bogeyman of “socialized medicine.” As he points out, we have “socialized” education, “socialized” police and fire departments, and a “socialized” postal service.

The truth is that a national health plan would not be “socialized medicine,” as doctors and hospitals that are now private would remain so. The change would be in the administration of the health care funds. Rather than a system with multiple insurance companies that drains health care coffers of 31 percent of the health care dollars, the government would be the “single payer” and administer the funds. (The administrative costs for Medicare are 3.6 percent, and Canadian costs are 1.3 percent). A similar system in the United States would save $300 billion annually.

In addition, patients would be able to choose their own doctors and hospitals, without intrusion into their health care decisions by faceless bureaucrats.

Moore raises the moral issue of denying patients access to health care in our country. A wonderful moment in the film occurs when he talks with a conservative party member in Canada who strongly supports his national health care system. The Canadian conservative believes that society should support equal access to health care for each person, regardless of means, even though that might affect his own pocketbook. This is not a partisan movie: This documentary is about social values and the right of everyone to have adequate and affordable health care.

While there is humor in this movie, the stories elicit raw emotions of sadness and rage. Unlike his previous movies, Moore is not confrontational; he just lets people tell their gripping stories. “Sicko” will help you better understand the problems of our health care system, and it makes a strong case for a national health plan as the obvious solution.

See this movie, and then call your legislators and ask them to sponsor the current national health care legislation in Congress, H. R. 676.

By Susanne L. King
Berkshire Eagle
Friday, July 13

A MAN sews up the gaping wound in his own leg because he has no health insurance. Another decides whether to save his ring finger for $12,000, or his middle finger for $60,000, since he can’t afford reconstructive surgery for both fingers.

So begins “Sicko,” Michael Moore’s new documentary on the failures and travesties of the United States’ health care system, which leaves almost 50 million people uninsured and many more underinsured.

These stories are only two of the 25,000 that Moore received when he sent an e-mail request for reports from patients who have experienced difficulties with the health care system. With these stories of shattered lives, Moore masterfully weaves a powerful narrative that is an indictment of our health care system. He shows us people who suffer unnecessary pain, chaos, indignity and death because of their lack of access to health care.

Moore details the failures of our system by focusing on working adults who can’t get insurance because of pre-existing conditions, who have insurance but can’t afford their co-payments and deductibles, or who have been denied coverage by their insurance companies when they develop a health problem.

The people around me cried as we watched a middle-aged couple move into a small room in their daughter’s house after declaring medical bankruptcy. The husband had survived three heart attacks and his wife had developed cancer. Even though both had been gainfully employed and had insurance, they went bankrupt in their retirement years because of “cost-sharing,” the term insurance companies use for sticking patients with high deductibles and co-payments.

By showing how having insurance does not guarantee access to health care in America, Moore highlights the underhanded practices of insurance companies. A devastated mother describes her child’s death, which occurred because the family’s managed care insurance company would not pay for treatment at the closest hospital emergency department.

A former medical reviewer, Dr. Linda Peeno, cries as she testifies in a government hearing about the practices she implemented to deny care to patients insured by Humana before she quit her job in protest. .

Moore not only details the problems of our current health care system, he also shows us the solution. He supports a national health care plan, similar to that of every other industrialized country in the world. He goes to Canada, Great Britain, France, and, yes, to Cuba, to highlight the benefits of a single-payer plan funded and administered by the government.

He also debunks the myths and distortions about a national health plan, which are promulgated by the insurance companies, including the specter of “waiting lines,” and the bogeyman of “socialized medicine.” As he points out, we have “socialized” education, “socialized” police and fire departments, and a “socialized” postal service.

The truth is that a national health plan would not be “socialized medicine,” as doctors and hospitals that are now private would remain so. The change would be in the administration of the health care funds. Rather than a system with multiple insurance companies that drains health care coffers of 31 percent of the health care dollars, the government would be the “single payer” and administer the funds. (The administrative costs for Medicare are 3.6 percent, and Canadian costs are 1.3 percent). A similar system in the United States would save $300 billion annually.

In addition, patients would be able to choose their own doctors and hospitals, without intrusion into their health care decisions by faceless bureaucrats.

Moore raises the moral issue of denying patients access to health care in our country. A wonderful moment in the film occurs when he talks with a conservative party member in Canada who strongly supports his national health care system. The Canadian conservative believes that society should support equal access to health care for each person, regardless of means, even though that might affect his own pocketbook. This is not a partisan movie: This documentary is about social values and the right of everyone to have adequate and affordable health care.

While there is humor in this movie, the stories elicit raw emotions of sadness and rage. Unlike his previous movies, Moore is not confrontational; he just lets people tell their gripping stories. “Sicko” will help you better understand the problems of our health care system, and it makes a strong case for a national health plan as the obvious solution.

See this movie, and then call your legislators and ask them to sponsor the current national health care legislation in Congress, H. R. 676.

Oakland, California. The 140,000 member United Healthcare Workers West, an affiliate of SEIU, has endorsed HR 676, legislation introduced by Congressman John Conyers (D-MI) which would implement a single payer healthcare system in the U.S.

In a letter to Conyers’ office announcing the endorsement, Richard Thomason, Policy Director for the union, expressed the union’s “strong support for HR 676” and went on to state:

“Like every other industrialized nation, the United States should provide health security for its residents as a matter of basic human dignity. Your legislation would accomplish that critically important goal.

“Our local represents 140,000 caregivers who work in hospitals, clinics, nursing homes and homecare programs across California. Every day our member see the harmful consequences of being uninsured among their family members and the people they care for on the job. HR 676 will ensure that all Americans have health coverage through a publicly financed, privately delivered health care system that provides high quality, cost- effective health care.”

United Healthcare Workers West is the second largest local in the SEIU. The largest, 1199SEIU United Healthcare Workers East has also endorsed HR 676 along with Local 73 in Chicago and Pennsylvania locals 668 and 1199P.

By Thomas L. Fisher
Washington Post
Sunday, July 1, 2007; Page B02

CHICAGO At 4 a.m., the ambulance rushed the driver in a single-car accident to the emergency room where I was the attending physician. The victim, a man in his late 20s, had been knocked unconscious when his head slammed into the windshield. The paramedics handed me two-thirds of his scalp in a plastic bag.

That sounds horrible, of course, but modern medicine can do a lot in such cases — if it has the chance. Our team worked to stabilize the patient and to save his scalp. Human tissue can die in a just few hours if it’s cut off from its blood supply. So to avoid a disfiguring injury, our patient would need the care of a specialist who could reattach his scalp’s blood vessels. Unfortunately, my hospital didn’t have such a surgeon; the closest one worked at a sibling hospital in a more affluent neighborhood 15 miles away.

We raced against time to avoid permanent tissue damage. I called and called and called, searching for a physician willing to take care of our patient. But no one would accept him. After 40 minutes, we flew him — and his dying scalp — by helicopter to a hospital 45 minutes away.

The patient should have been recuperating after a close call. Instead, by the time he was whisked away from me, he was facing lifelong disfigurement. This is the reality I see every day as an ER doctor: Large groups of people — mainly those from communities of color, and also those who are poor and uninsured — are not receiving basic care that can make all the difference.

Many Americans have been talking more about health care these days because of the buzz around Michael Moore’s new documentary, “Sicko,” a polemical look at unfairness in the nation’s health care industry. However, the types of communities I care for are barely addressed. Moore says up front in the movie that he is not focusing on the nearly 50 million people who have no access to care at all. His decision to concentrate instead on the substandard care given to the working and insured is an understandable attempt to touch the heartstrings of Middle America. Unfortunately, by giving cursory treatment to race and class, he avoided tackling the most intractable problems in this country’s health care system.

Here’s the view from the front lines: Hospital waiting times of 10, 12 hours. Emergency rooms so packed that ambulances must be turned away. People suffering from ailments ranging from organ failure to psychotic breakdowns, all preventable.

These issues affect not only individuals, but whole communities and the health outlets serving them. I sympathize with those who are unhappy about the quality of their insured care, but I’m more worried about those with no insurance at all. The bigger problem is that we all want the finest of health care, and as a result, many of us — largely black and brown — are left with nothing.

One scene in “Sicko” does deal directly with race: A white woman questions whether her husband, who is black and has kidney cancer, would receive better care if he were white. I can’t speak to their situation, but my experience is that the influence of race and racism on health care is rarely that obvious. But it is unmistakable, nonetheless.

For instance, the young driver in the car accident essentially had the misfortune of getting hurt in the wrong part of town. At the time, I was an emergency medicine physician fresh out of residency, working in a community hospital system in the Midwest that consisted of two very different hospitals. Hospital A (where the patient started) served a blighted, post-industrial city of about 100,000 residents, about 85 percent of whom are black and largely poor and uninsured. Hospital B (the one we couldn’t get him into) is 15 miles away, in a more affluent community of about 30,000 people, about 70 percent of whom are white. Although technically the two comprised a single hospital system, physicians were allowed to choose to work at one or both of the locations. Most chose Hospital B, leaving few specialists on call for emergencies at Hospital A. By dumb luck, my patient wound up at the wrong hospital, and that made all the difference.

The reasons behind the two-tier structure weren’t malicious. In most hospital systems, physicians are not direct employees but instead have privileges to deliver care through the facility. In this structure, the patient receives one charge from the doctor and one from the hospital. That means there’s less of a financial incentive to work in communities with many uninsured members. Many specialists did not want to leave their neighborhoods and their families in the middle of the night and disrupt their upcoming workday schedule to care for a patient who may not be able to pay but could nevertheless file suit over care.

It’s honest to say that most poor people — not just those from communities of color — suffer from inadequate or nonexistent care. But I’ve found that decisions that seem race-neutral at face value can systematically hurt such groups. These decisions create racial disparities in health care that go beyond what can be explained by class alone. The challenge presented by that emergency case at 4 a.m. was determined by the earlier decision not to require physicians to provide care at both hospitals. The difference in care between these two facilities went beyond just a single car-accident victim and wounded the entire community that Hospital A was supposed to serve.

These are the kinds of systemic problems that lead to widespread racial disparities in health. Consider the medical picture for my black male peers. According to the Henry J. Kaiser Family Foundation, black men are the least healthy ethnic group in the United States. Their death rate (1,282 per 100,000 in 2004) outstrips that of all other ethnic groups, including non-Hispanic whites, 949; Native Americans, 750.2; Hispanics, 702.7; and Asians, 534.1. Black men also have higher rates of heart disease, HIV/AIDS and certain kinds of cancer, including prostate, lung and colon.

Such statistics send a larger message about medical care and race: The lack of equity seen in wealth, income, education and insurance has considerable impact on health.

On balance, the middle and upper-middle classes are relatively healthy, as evidenced by their lengthening life spans and rising quality of life. Meanwhile, the bad outcomes disproportionately affect the poor, including many working-class and poor whites but more often people of color. In these populations, health and health care in the United States are not dissimilar to the standards in some developing nations. For instance, in 2005, the average life expectancy for black men in this country was 69.2 years; according to CIA estimates for 2007, the life expectancy for all Iraqis is 69.3.

Health care is not a run-of-the-mill service like an oil change. It’s a massive industry that shapes our lives and sometimes saves them. But our health care options are more than just commodities. That being said, providing health care to the underserved alone will not solve every problem — broader issues of equity will need to be addressed.

Many Americans oppose a single-payer health care system. My support of this initiative has grown from witnessing inequities daily through years in an emergency room.

I hear the concern about such a system; people worry that they won’t get what they need, that the government will ration health care. But in fact, that’s exactly what we have right now. It’s just a little more subtle, a form of rationing that’s based on a person’s ability to endure hours of anxiety in the ER, to wait for the next medical appointment, to afford high-quality insurance.

So how can we have a public discussion about this subject? This country has limited resources to devote to health care. But it also is saddled with an inefficient health care system that gives advantages to the privileged and well-off while ignoring preventive care and abandoning those most in need.

In some ways, given escalating costs, health care is a zero-sum game. So what are people willing to give up, and what care should be provided to all? Many middle-class Americans take comfort from knowing that their health care is covered. But all those little choices add up to big society-wide choices and market incentives for drug companies — and produce an America where one man pops his Medicare-covered Viagra pills while another can’t get life-saving cancer medication.

Many Americans do get the Mercedes-Benz of health care. But given the scarcity of resources, they may be doing so at the expense of many others. Ultimately, we will need to find a middle option — providing all Americans with the health care equivalent of a Prius, a vehicle that will take efficiently to where you need to go and is affordable enough that nobody will have to walk. Because you never know what neighborhood you may wind up driving in.

tfishermd@gmail.com

Thomas L. Fisher serves on the faculty of the University of Chicago’s Department of Medicine and practices in the emergency room at the University of Chicago Medical Center.

Wall St. Journal
LETTERS
Sunday, July 8, 2007

The commentary by David Gratzer (“Who’s Really Sicko?”editorial page, June 28) presents an extremely prejudicial view of the publicly funded Canadian health system. It highlights the unfortunate story of a man from Ontario who had difficulty accessing a head MRI scan for a malignant brain tumour. Undoubtedly there are similar anecdotes describing difficulties in accessing care experienced by the 44 million Americans who lack health insurance. However, in making a rational comparison of the Canadian and American health systems it is more reasonable to contrast service levels and costs of the systems rather than trading anecdotes.

Canadians pay about 9% of national GDP to insure 100% of citizens in our single-payer system, compared with more than 14% of GDP to insure 85% of Americans. The Kaiser Family Foundation reports that the average compound annual growth rate in U.S. health insurance costs has been 11.6% over the past five years. It is therefore not surprising that polling by Kaiser found that 75% of Americans were worried or very worried about the amount they would need to pay for health insurance in the future and that 63% were worried or very worried about not being able to afford health-care services.

There is no question that restriction of supply with sub-optimal access to services has contributed to the lower cost of health care in Canada. However, a new approach of targeting investments to reduce waiting times combined with transparent reporting of wait times is having a substantial impact on access in the Canadian system. Dr. Gratzer wrote about prolonged waits for treatment in Ontario but did not refer readers to the public Web sites that detail Ontario waiting times for cancer surgery, chemotherapy, radiation, cataract, heart, arthroplasty and imaging procedures:

(http://www.health.gov.on.ca/transformation/wait_times/wait_mn.html and http://www.cancercare.on.ca)

Canadians spend about 55% of what Americans spend on health care and have longer life expectancy, and lower infant mortality rates. Many Americans have access to quality health care. All Canadians have access to similar care at a considerably lower cost. In “Sicko,” Michael Moore has apparently exaggerated the performance of the Canadian health system — there is no doubt that too many patients still stay in our emergency departments waiting for admission to scarce hospital beds. However, Mr. Moore’s description of the advantages of the Canadian system in the film is more accurate than the jaundiced view of our system proposed by Dr. Gratzer.

Robert S. Bell, M.D.
President and CEO
University Health Network
Toronto

(The letter was also signed by Carolyn Baker, R.N., president and CEO, St. Joseph’s Health Centre, Toronto, and Catherine Zahn, M.D., executive vice-president of Clinical Programs and Practice, University Health Network, Toronto.)

The introduction of private insurance or private-for-profit health care for medically necessary services is not the answer to challenges in the Canadian health-care system. In a systematic review of 38 studies published in Open Medicine in May, 17 leading Canadian and U.S. researchers confirmed the Canadian system leads to health outcomes as good, or better, than the U.S. private system, at less than 50% of the cost.

Unwanted side-effects of competitive health care include a drain of highly trained professionals from the public system and “cream skimming” of patients by private clinics who choose the healthiest patients, leaving the most complex to the increasingly overburdened public system.

In June 2006, the Canadian Medical Association reviewed all the evidence from other jurisdictions and concluded that private insurance for medically necessary physician and hospital services does not improve access to publicly insured services; does not lower costs or improve quality of care; can increase wait times for those who are not privately insured; and, could exacerbate human resource shortages in the public system.

Medicare is not only more equitable, but more efficient and produces higher quality health care than the alternatives. This conclusion is supported by the best national and international evidence, including reports from the World Health Organization and the Organization for Economic Co-Operation and Development.

So what should Canada do about patients who do not receive timely access to essential medical care? Numerous expert reports, including the 2002 Royal Commission on the Future of Health Care in Canada, have already told us we need to restore and strengthen Medicare, not decimate it.

In May the Canadian Centre for Policy Alternatives reported that successful initiatives in team-based care and improved administration produced dramatic cuts in waiting times for surgery in B.C. Alberta, Saskatchewan and Ontario, without any need for competition.

Danielle Martin
Board Chair
Canadian Doctors for Medicare
Toronto

Deborah Burger
SF Chronicle
Tuesday, July 10, 2007

What country endures such long waits for medical care that even one of its top insurers has admitted that care is “not timely” and people “initially diagnosed with cancer are waiting over a month, which is intolerable?”

If you guessed Canada, guess again. The answer is the United States.

Scrambling for a response to the popular reaction to Michael Moore’s “SiCKO” and a renewed groundswell for a publicly financed, guaranteed single-payer health care solution, such as SB840, the big insurers and their defenders have pounced on Canada, pulling out all of their old tales of people waiting years in soup kitchen-type lines for medical care.

But, here’s the dirty little secret that they won’t tell you. Waiting times in the United States are as bad as or worse than Canada. And, unlike the United States, in Canada no one is denied needed medical care, referrals or diagnostic tests due to cost, pre-existing conditions or because it wasn’t pre-approved.

U.S. waiting times are the elephant in the room few critics care to address. But, listen to what the chief medical officer of Aetna had to say in March.

Speaking to the Aetna Investor’s Conference 2007, Troy Brennan let these pearls drop:

The U.S. “health care system is not timely.”

Recent statistics from the Institution of Healthcare Improvement document “that people are waiting an average of about 70 days to see a provider.”

“In many circumstances, people initially diagnosed with cancer are waiting over a month, which is intolerable.”

In his former stint as an administrator and head of a physicians’ organization, he spent much of his time trying “to find appointments for people with doctors.”

Brennan’s comments went unreported in the major media. But some reports are now beginning to break through, spurred by the debate “SiCKO” has spawned.

Business Week reported (www.businessweek.com/technology/content/jun2007) that “as several surveys and numerous anecdotes show, waiting times in the United States are often as bad or worse as those in other industrialized nations — despite the fact that the United States spends considerably more per capita on health care than any other country.”

A Commonwealth Fund study of six highly industrialized countries (www.commonwealthfund.org), the United States and five nations with national health systems (Britain, Germany, Australia, New Zealand and Canada) found waiting times were worse in the United States than in all the other countries except Canada .

There’s something else you probably don’t hear about Canada. Substantial progress is being made.

Most of the wait-time problems derive from funding cuts by conservative national or provincial governments, or from the siphoning off of resources by private providers. But precisely because the Canadian system is publicly administered, Canadians are able to force their elected officials to fix problems, or get voted out of office.

Throughout Canada, there are multiple pilot programs that have succeeded in slashing wait times. Canada’s latest statistics show that median wait times for elective surgery in Canada is now three weeks — that’s less time than Aetna’s chief medical officer says Americans typically wait after being diagnosed with cancer.

Canada also has no waits for emergency surgeries. It also doesn’t have 44 million people who are uninsured because everyone has a national health-care card guaranteeing health care from any doctor or hospital they choose. And it doesn’t burden those with insurance with rising deductibles or co-pays. A study reported by Health Affairs, a policy journal, for example, found that out-of-pocket costs to U.S. consumers jumped 76 percent this year over last year alone.

Canada also surpasses the United States in a broad array of health barometers, including life expectancy, infant mortality rates, adult mortality rates, deaths due to HIV/AIDS, mortality rates for cardiovascular diseases and years of life lost to injuries and diseases, according to data from the World Health Organization and the Organization of Economic Co-operation and Development.

No wonder some people are so afraid we’ll learn the real comparative story about Canada’s system — and our own.

Deborah Burger, R.N., is president of the California Nurses Association.

http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/07/10/EDG6QQ4VGD1.DTL

This article appeared on page C – 11 of the San Francisco Chronicle

By PAUL KRUGMAN
Op-Ed Columnist
New York Times
July 9, 2007

These days terrorism is the first refuge of scoundrels. So when British authorities announced that a ring of Muslim doctors working for the National Health Service was behind the recent failed bomb plot, we should have known what was coming.

“National healthcare: Breeding ground for terror?” read the on-screen headline, as the Fox News host Neil Cavuto and the commentator Jerry Bowyer solemnly discussed how universal health care promotes terrorism.

While this was crass even by the standards of Bush-era political discourse, Fox was following in a long tradition. For more than 60 years, the medical-industrial complex and its political allies have used scare tactics to prevent America from following its conscience and making access to health care a right for all its citizens.

I say conscience, because the health care issue is, most of all, about morality.

That’s what we learn from the overwhelming response to Michael Moore’s “Sicko.” Health care reformers should, by all means, address the anxieties of middle-class Americans, their growing and justified fear of finding themselves uninsured or having their insurers deny coverage when they need it most. But reformers shouldn’t focus only on self-interest. They should also appeal to Americans’ sense of decency and humanity.

What outrages people who see “Sicko” is the sheer cruelty and injustice of the American health care system — sick people who can’t pay their hospital bills literally dumped on the sidewalk, a child who dies because an emergency room that isn’t a participant in her mother’s health plan won’t treat her, hard-working Americans driven into humiliating poverty by medical bills.

“Sicko” is a powerful call to action — but don’t count the defenders of the status quo out. History shows that they’re very good at fending off reform by finding new ways to scare us.

These scare tactics have often included over-the-top claims about the dangers of government insurance. “Sicko” plays part of a recording Ronald Reagan once made for the American Medical Association, warning that a proposed program of health insurance for the elderly — the program now known as Medicare — would lead to totalitarianism.

Right now, by the way, Medicare — which did enormous good, without leading to a dictatorship — is being undermined by privatization.

Mainly, though, the big-money interests with a stake in the present system want you to believe that universal health care would lead to a crushing tax burden and lousy medical care.

Now, every wealthy country except the United States already has some form of universal care. Citizens of these countries pay extra taxes as a result — but they make up for that through savings on insurance premiums and out-of-pocket medical costs. The overall cost of health care in countries with universal coverage is much lower than it is here.

Meanwhile, every available indicator says that in terms of quality, access to needed care and health outcomes, the U.S. health care system does worse, not better, than other advanced countries — even Britain, which spends only about 40 percent as much per person as we do.

Yes, Canadians wait longer than insured Americans for elective surgery. But over all, the average Canadian’s access to health care is as good as that of the average insured American — and much better than that of uninsured Americans, many of whom never receive needed care at all.

And the French manage to provide arguably the best health care in the world, without significant waiting lists of any kind. There’s a scene in “Sicko” in which expatriate Americans in Paris praise the French system. According to the hard data they’re not romanticizing. It really is that good.

All of which raises the question Mr. Moore asks at the beginning of “Sicko”: who are we?

“We have always known that heedless self-interest was bad morals; we know now that it is bad economics.” So declared F.D.R. in 1937, in words that apply perfectly to health care today. This isn’t one of those cases where we face painful tradeoffs — here, doing the right thing is also cost-efficient. Universal health care would save thousands of American lives each year, while actually saving money.

So this is a test. The only things standing in the way of universal health care are the fear-mongering and influence-buying of interest groups. If we can’t overcome those forces here, there’s not much hope for America’s future.