Critical Condition: How Healthcare in America Became Big Business-and Bad Medicine by Donald L. Barl

There is something appallingly pathetic about the state, and the state of discourse, of health care in the United States. Every attempt to converse seriously about health care is maliciously buried under the ruins of special interest groups, corporate profit margins and political rhetoric of the two major parties and their benefactors. While health care may appear to be a constantly bandied about topic, there has been only modest debate about reforms since Newt Gingrich, the pharmaceutical industry and the erstwhile fictional naysayers Harry and Louise foiled the Clinton administration’s mammoth plan to revolutionize American health care.

Surely next year’s planned release of blustery lightning-rod Michael Moore’s documentary Sicko, will ratchet-up civic dialogue a few polemical turns, and maybe that’s a good thing. Any discussion of domestic issues, even the perilous ramifications of an eroding manufacturing base, a ballooning budget deficit or an absurdly instituted health care lottery where there are real winners and losers were kept from the public arena by substantially weightier issues like whether or not the president had fulfilled his National Guard commitment thirty years or if his opponent had been sufficiently and severely wounded enough to deserve his medals, again 30 years ago.

Between current media inattention, the smothering silence of lobbyists’ money bags and what is certainly to be an insanely passionate, but unfocused examination when Moore releases his latest work, health care is an inaudible blip on the American media’s national issues radar.

So, leave it to investigative journalism stalwarts Donald L Barlett & James B. Steele to throw their pens into the fray with their latest work, Critical Condition. If the time comes, and if the history of empires and great powers is to be believed, obituaries of the once mighty U.S. will come through the hindsight of historians, pundits and soothsayers. Whatever course reflections take, they will inevitably veer through a shelf of not-so ancient texts by a pair of Pulitzer Prize-winning journalists who have been chronicling America’s ills for over three decades. Barlett & Steele’s tomes have weaved the decline of America’s economic superpower status into a cautionary tale for well over a decade with the likes of America: Who Stole the Dream?, The Great American Tax Dodge and America: What Went Wrong?.

Conservative ideologues like to drag Barlett & Steele down to a dogmatic wrestling mat, trying to pin them with innuendos of Marxism, communism and socialism, but their work, like many arguments of social and economic equality that emanate from the liberal quarters of the U.S., is rooted in morality and commonsense. The idea that medical coverage is something of a commodity and not a right, a unit to be sold and bought, bargained and denied, had its roots entrenched in the Reagan years, where the authors argue: “It was no accident that American health care became a profit center for Wall Street. The transformation of many not-for-profit providers into for-profit corporations was engineered by Washington in the early 1980s.”

Cost is key. Let the market sort it out, and everyone will be better off. But as Barlett & Steele are apt to point out, the push for profit-driven health care as an attempt to rein in costs has actually increased costs, given patients less choice and helped drive information processing jobs to India where low wages leverage even higher profit margins for companies. As for the bureaucracy, sign up for an insurance program today, if you’re lucky enough to be eligible or even able to afford one, and watch the efficiency that comes with private sector ownership. After filling out a multitude of forms, you’ll have to take the time to page through a hefty volume of providers that are members of your insurance network. If your current doctor is not a member, too bad, find a new one and hope they are taking new patients. Don’t forget to look over that actual merits of the program: co-pay pricing, prescription costs, deductibles, long-term care, preexisting condition terms and so on. Vision, dental? That might be separate. It would be comical if not for the dire consequences that so many individuals reap. The authors layout dozens of cases where Wall Street is heartbreakingly guilty of neglect in the run for profit.

After the five years of investigation, the authors have managed to craft a solution to the woes they have diagnosed The remedy they argue is a single-payer system, one that offers all Americans the same basic service and rights, and all doctors and hospitals the ability to bill one agency and be reimbursed by the same agency. Anybody could be treated anywhere, no referrals needed and as the authors write. “without fear of financial ruin.” Barlett & Steele argue for an independent agency much like the Federal Reserve, one free of an overt political bent, to oversee the collection of taxes and the administration of services.

The authors foresee a bitter battle over reform, resistance from providers, antitax advocates, those content with what they have and especially members of Congress who are lavished with end-of-the-rainbow riches that lobbyist and backers provide in abundance. For the public itself, there is an almost incapacitating irrational fear of anything which appears to approach a socialist program; although it seems alright for big corporations to piggyback government subsidies or for localities to fund sports stadiums for privately owned teams, when it comes to the ills of society, private always trumps public. And so progress, if any is to be made, will not come until the wall is broken on the myth that a national public health care system is opposed to the core values of the United States’ free market principals, and that a giant government agency will only serve to impose its will. What Barlett & Steele point out is that it is America’s current system that is the inefficient nightmarish lumbering giant that will probably crush everyone. Let’s just hope that the insurance will cover the injuries or that the nearest hospital made it past the recent round of closings.

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