Is Our Health Care System Broken?

Is the Health Care system in this country broken? This is the basic question we need to ask ourselves as Americans. I think there is a lot of evidence to suggest that it is; that we are paying for a Cadillac and receiving a Yugo with warranty issues. I often hear it said that we have the greatest health care system in the world but I seldom hear that particular sentiment out of anyone who is not a right wing Republican, a doctor, an insurance spokesman, or a drug company executive. This issue really isn’t that different from any other; it is all a matter of perspective.

Let’s look at that argument of those who like the system as it is. First off, if you are a doctor in this country you make almost twice as much as a doctor in the rest of the world on average. This number climbs to four times as much for specialists but on the average it comes out around twice as much. There are probably numerous reasons for this but the ones most often presented as justifications are the costs of doing business as a doctor. Education to become a doctor is extremely expensive and time consuming. There is little doubt about this but I would also point out that it is the AMA who controls the medical education field. The AMA controls how many doctors get into the field and how long it takes to get a medical degree. The AMA, as a union for doctors, well understands that the best protection for high fees is a moderate supply of doctors and almost all studies agree that we have a shortage of doctors in this country so I would suggest that they are doing a very good job of controlling the supply of doctors which can be directly correlated to the pay of doctors by the simplest rules of supply and demand. The AMA also regulates who can practice medicine in this country which is why we don’t have nurse practitioners, holistic doctors, and other types of medical practitioners treating many patients in this country. In alliance with the AMA, private insurance providers refuse to provide payment to non AMA approved practitioners even though they are much more cost effective for most common ailments.

The next argument that the AMA puts forward as a reason for high costs is tort policy in this country. It is without doubt that high malpractice insurance adds cost to the practice of medicine. However, experiments in tort reform policies in Texas and several other states have shown that such reforms actually only lower medical costs some 1-2%. While this is not something to be ignored it hardly goes towards explaining why health care costs in this country are higher than in any other industrialized nation in the world but I will get back to tort reform a little later. As a percentage of GDP we are fast approaching 20% for health care costs in this country while no other industrialized nation in the world has more than 12% of their GDP associated with health care costs. It is also worth remembering that our GDP is larger than any other country in the world.

Let’s look at some numbers to see if we can decide how our health care system fares when compared with the rest of the industrialized world. The US GDP is estimated to be 14.1 Trillion dollars. If you are anything like me you have a hard time visualizing this type of number but I decided to do some comparisons with other countries to try and make sense of this number. If you add up the GDP totals of Germany, France, United Kingdom, Italy, Canada, Spain, Belgium and Australia you get a number just a little less than the 14.1 Trillion dollars of the US GDP. Therefore, the combined total of these countries’s GDP is roughly equal to the US GDP. If you add up the averages of these western countries percentage of GDP spent on health care and average it out it comes out to a roughly 9%. Currently in this country the best estimates put our percentage of GDP spent on health care at 17.3% (and projected to grow at an astonishing 6.78% per year in the near future).

To decide what this means in actual dollars per person I looked at the population totals. The population total in the US is presently some 307,212,123 people. If you take 17.3% of our 14 trillion dollar GDP and divide that by the number of people in the US you get $7883.00 per person as the average cost per person in this country. If you take the total population of the eight countries I listed above (352,179,713) and do the same calculation based upon 9% of their GDP the total comes out to $3552.00 per person. In other words we pay on average 221% higher health care costs per person in this country than do the people in these eight nations which I would argue are probably the closest to this country in culture and standard of living.

This is exactly why so many of the supporters of the present system are so adamant about saying we have the best system in the world. It better be; as it is more than twice as expensive as any other system that is directly comparable. Let’s look at some comparison studies to see if this theory holds water. In terms of general health and measurable statistical information I am afraid that the numbers don’t support this theory at all. According to the CIA World Factbook the US ranks 41st in the world in infant mortality rate which is hardly something to brag about. There is controversy over how these figures are gathered in that many countries vary according to how they specify when an infant is alive but the US also ranks 41st in the world in infant low birth weight which I think anyone can see is directly correlated to infant health. We rank 46th in the world in life expectancy and it is worth noting that there is a rapidly growing disparity in this country between life expectancy for the wealthy upper classes and life expectancy for the financially lower classes. Those who can afford our best health care simply live longer.

There are other basis for doing relative comparison studies on health care efficiency that are based upon years of life lost under the age of seventy in cases amenable to being saved by health care. The Organization for Economic Cooperation and Development publishes studies based upon these cases under the heading of “years of potential life lost”. This is where we should shine as a nation if our health care system, which is heavily slanted towards cure instead of prevention, is actually efficient. Unfortunately, the US ranks third from the last for women in the study just behind Mexico and Hungary. For men, we rank fifth from last for men just ahead of Slovakia and Poland. Being in a class with Mexico, Hungary, Slovakia, and Poland is not necessarily something I think we need to be bragging about; especially when we pay more per person than anyone in the world to get there.

The fact of the matter is that the US leads the world in specialized care for many types of technologically complex treatment systems. This is one area of health care where our system shines and this is exactly the area that is so often highlighted by proponents of the system. If you have plenty of money and inexhaustible insurance coverage this is the place to come for such treatments and people from all over the world come here for that reason. However, if you don’t have insurance and a lot of money besides this is not something you will likely be afforded access to in this country. After all, the medical industry has to make a profit in this country too; that is how capitalism works.

As I have covered in several posts already the private insurance industry in this country well understood the pitfalls of providing health care insurance from the beginning and they have avoided them admirably. By tying insurance to employment from the beginnings of the rise of private health insurance in this country they effectively assured themselves that they could control profit margins by providing insurance for the healthiest people (those that are gainfully employed) while removing those from their rolls who are the worst risks (the elderly and those who get too sick to work). While this is good business for private health insurance companies it is a problem for those who actually need medical care and one that continues to add exponentially to actual health care costs. As is often the case, the goals of meeting profit margins and providing needed services are frequently in direct opposition.

For example, a very high percentage of personal bankruptcies in this country are directly attributable to health care costs. Estimates range from 50-80% as far as percentage of people filing bankruptcy because of medical bills depending on which agency you get your information from. The story that is repeated over and over again is the same. Person A, who has health care insurance through their work, is unlucky enough to get cancer or some other debilitating medical condition. This person soon loses their ability to work and with it their health care insurance (some 80% of medical related bankruptcies come from people who originally HAD health care insurance through their work but later lost it). Being unexpectedly unemployed bring many financial hardships to working class people and very few of them can afford the higher rates they are forced to pay to keep insurance after being removed from a group plan where they work. Therefore, they are soon without insurance and the bills instantaneously get higher without insurance. If any of you have been to a hospital recently you know that the bill you get is usually two to three times higher than what the hospital eventually accepts from the insurance company as payment. However, if you don’t have insurance you also don’t have the power to barter with the hospital to get this same reduction. The truth is that the hospital recognizes that people cannot afford to pay the high costs associated with a long treatment and they fully expect to take a loss on the costs so they are not willing to barter. They would much rather take a loss and write it off on their taxes while collecting what they can through government sponsored Medicaid. It is just good business sense for them and they too are part of the capitalist system wherein profit is the final motive. The end result is bankruptcy for the individual who is unlucky enough to need the care. Even worse, if this person is lucky enough to survive the disease, the treatment, and the bankruptcy they are now faced with the certainty of not being able to attain private health insurance for this condition for the rest of their lives. This leads to the surprising conclusion (and one that most working class people aren’t aware of until it is too late) that having private health care insurance through your work is a lot like playing Russian roulette; everything is fine until you hit on the chamber with the bullet in it.

Let’s talk about the uninsured for just a moment. Some 15% of the population in this country is currently uninsured. While a good percentage of these people are younger workers who are not working in industries that offer employer health care programs the fact remains that all of these people are at risk of accident or catastrophic disease that would quite literally bankrupt them if it were to occur. Russian roulette is equally deadly whether you are aware you are playing it or not. If an uninsured person does need routine medical care, no matter how innocuous, the large majority of them show up at emergency rooms where health care costs are the most expensive because most emergency rooms are required to provide the care they need. Because there is often no other choice these people get the most expensive care possible; often for problems that could easily be taken care of much more efficiently at a clinic by a nurse practitioner were lobbyist from the AMA not actively making sure this is not legal. Between the government’s reluctance to help set up such alternative programs and the AMA’s insistence on protecting their memberships ability to make exorbitant amounts of money we have another situation wherein the worst solution is the only possible one for people without insurance.

Tort reform is another solution that is often tossed about as something that will cure the problems we currently have with health care costs. The theory is that by protecting doctors from high lawsuit settlements we can thereby bring down the costs of malpractice insurance which will be reflected in lower overall costs for the consumer. Even though there have been several instances in the last few years where such plans have been tried out, the results are not encouraging as costs have simply not come down appreciably from such efforts. If we had a nationalized health care system where everyone was guaranteed health care coverage this whole argument would disappear because the whole system of high settlements is based upon the recognition that health care costs are so high. This isn’t a chicken or egg argument, it is more like a cow and calf argument in that it is quite evident which one came first in this situation; the high health care costs. If you pursue a lawsuit against a doctor for malpractice the vast majority of the settlement set aside it is to cover the costs of future medical expenses. If you had nationalized health care insurance that will cover these costs already; there is little reason to collect a high settlement outside of pain and suffering incurred due to the doctor’s negligence. Without the high settlement possibilities the very volume of such lawsuits will steadily diminish as lawyers are capitalists too.

There is yet another aspect to this marriage of employment and private health insurance that we as consumers are now being forced to deal with. In an economic downturn such as we just experienced in this country unemployment is one of the first symptoms. With unemployment comes loss of employment based insurance for the workers who lose their job; involuntary Russian roulette for both the worker and his immediate family. Therefore, the Medicaid costs in the states where they live grow as well as these people are still going to inevitably have the normal every day health care needs even if they are lucky enough to avoid catastrophic disease or accident. The states are forced to come up with money to make up this difference at the same time they are suffering loss of revenue associated with the recession; both from payroll taxes and from dwindling sales tax revenues. The net result is higher deficits for the state at the same time they need more revenue; in effect a double blow to the economy. We are currently seeing this played out all across the country as states struggle to balance their budgets with rising costs and dropping revenue. The Kaiser Family Foundation released a study in 2008 that suggested a 1% increase in unemployment equates to roughly 1 million extra people without health care insurance in this country which winds up costing some 3.4 billion dollars in extra health care costs. This is a direct result of the fact that our current system of private health care insurance is largely weighted towards employment benefit packages and simply would not occur with a nationalized health care system.

Aside from same tired old mass hysteria argument that the right always trots out about the country being overrun by socialists who want to turn us into a communist state, the main fear surrounding a nationalized health care system is that it would be too expensive for us to afford. Unfortunately, as we have seen and continue to see on a yearly basis, health care costs are the real issue and we have to be able to control these costs to deal with health care issues. The average administrative cost of private health care servicea in this country is about 12% of total costs. Add to that a 3-6% profit margin for the company and we now have an additional 15% levied on top of our health care costs with the present system that is quite unavoidable. I would start out by saying that adding 15% to the costs right off the bat by having private health insurance belongs in the tally of problems rather in the tally of solutions. In any case, as a worker who has employment provided insurance my costs have steadily risen over the last ten years as costs have increased. The national average for such coverage has risen 78% since 2001 while employee compensation has risen just 19% during the same time period. Plainly, rising health care costs are the source of the problem and we have to make strides toward solving this problem. However, I now pay some $350 a month in payroll deductions for my health care insurance with the promise that it will only grow more in the future while the problem itself continues to spin out of control due to all the reasons I have listed above. A lot of these issues would be solved by integrating a national health care system and if we took what we are all paying into private health insurance plans that add to the problem and put that money into taxes that would help alleviate the problem I think it would be a step in the right direction.

The unvarnished truth about our system’s private health insurance is that the only way it is profitable to sell and administer is if there are enough healthy people paying premiums to offset the costs of those who need care. Insurance executives recognized this fact from the very beginning which is why they were so anxious to tie insurance to employment in the beginning. In our system the private health care insurance companies get to reap the benefits of insuring the healthiest Americans while skipping out completely on paying for health care for the unhealthiest. When people in this country retire or are unemployed the government picks up the tab for their health care which is exactly why Medicare and Medicaid programs are so expensive; they are forced to deal with the unprofitable refuse that private health insurers have tossed overboard after they have milked them for all the money they can get. If we had a comprehensive health care system like the rest of the civilized world we would be able to offset the high health care costs for the elderly with the premiums in the form of taxes paid in by the healthiest citizens; the young working class people. Is this a socialist idea? Of course it is but so are Social Security, Medicare, and Medicaid. These programs were put in effect originally because we were faced with the choice in this country of providing steadily rising health care costs for retiring citizens with little or no savings or letting them die. Capitalism had no solution for the problem so we adapted a socialist idea to solve the problem.

Over the course of the last 30 years we have proven that the combination of rising health care costs and an aging population have contributed to another situation that Capitalism has no solution for so maybe it is time we started to admit that what we need is another socialist solution. I shouldn’t say Capitalism doesn’t have a solution as the unseen hand of the free market always has a solution. The only problem is that this solution is the same as all others in the free market. If you can’t afford health care do without. To paraphrase our esteemed Speaker in the House of Representatives when told that the Republican spending cuts proposed recently would cost 800,000 jobs in an economy already in recession, “So be it.”

The AMA and its part in the debate, part 1

One of the players in the current health care debate and in every other health care debate in the history of this country is the American Medical Association. In 1847 the AMA was set up by Dr. Nathan Davis of New York. Dr. Davis’ idea was to set up a governing body to improve and standardize medical training which was both rudimentary and inconsistent at the time. In the interest of improving this training Dr. Davis formed the AMA and by the early 1900’s it was the recognized authority on medical practices and training for physicians. By 1899 the AMA set up the Committee on National Legislation, one of the first lobbying groups in Washington, and began to work to influence all government legislation having to do with healthcare. By this time the AMA was also the accrediting organization for medical schools, hospitals, and all manner of health care services and therefore was a force to be reckoned with as a political entity from this point on.

Health care in the United States has a long history of being a private concern between the physician and his patient and the AMA has been an assertive protector of this type of system from its inception. As an organization originally set up to improve health care by controlling and standardizing training practices and circulating educational information to both doctors and the general public the AMA has also evolved into a powerful political organization that first and foremost protects the interests of its member physicians. If there is any doubt about where the interests of the AMA lie, one has only to look at the history of its actions to understand the reality of the situation.

The AMA has been an outspoken and vigorous opponent of health care insurance since the very first plans were formulated in the early twenties. Two things drive this opposition according to the AMA. First, there is the fear that insurance will interfere with the patient-physician relationship which the AMA holds sacrosanct. Second, there is the fear that physicians will lose the ability to charge fees on an individual basis. Physicians, with the AMA’s approval, have long charged different rates for different patients based upon the individual’s ability to pay for such services. Group health care insurance plans have tended to set costs across the board and have the added effect of forcing physicians to compete with each other on a cost basis much like every other industry in a free market society. The AMA has opposed all such setting of costs from the very beginning. One may accurately surmise which of these two problems that the AMA is more concerned with by the actions they have taken to defend them.

As a professional organization open only to members of the industry it is hard to argue against the supposition that the AMA is a guild. The AMA in effect is a union of doctors which has repeatedly shown its first interest is the protection of its member’s financial interests. As I discussed in an earlier post about the health care plans, the Blue Shield plans were formed largely in response to Blue Cross plans that the AMA perceived as threats to its members ability to price discriminate. In 1934 the AMA adopted a set of ten principals that were to be the guiding factors in physician’s health care plans. One of the prime considerations of these principles was that physicians would be in charge of all such voluntary plans and that the AMA would retain control of such plans in the future. The overwhelming consideration in these efforts was an attempt to retain control of pricing for medical services which the AMA has consistently insisted should not be subverted by competition or “socialist” government and private based plans that would set prices by controlling where patients would receive services and seeking out the best prices accordingly. The AMA has used this term repeatedly in every campaign they have launched throughout the last century to retain price controls in the hands of physicians. As we shall see, it is a consistent theme adopted by what is inarguably a union of doctors in order to protect them from competition. It is a little ironic that they should be allowed to use a term that is such an anathema to free markets to protect themselves from the competition that is the core principle of free markets without being called to answer for it but history has shown that this is a recurring process.

The first efforts at organizing a national health care policy occurred in the early 1930’s and were soon an integral part of the New Deal policies of the Roosevelt administration. In June of 1934 Roosevelt formed the Committee on Economic Security to study problems relating to the economic security of individuals and report back on their findings by December of that year. The committee was charged with studying all manner of insurance policies and their possible impact upon the financial health of individuals in the United States. The country was still in the throes of the worst economic depression that had at that time been visited upon this country and people wanted to find ways to keep such a collapse from happening again in the future.

Most of the members of this committee were convinced that rising health care costs and the obvious inability of most consumers to withstand the financial costs of any sort of long term health problem were a danger to almost every US citizen. Several members of this committee had extended experience with the American Red Cross which was inundated with health care requests from the lowest tier of society in the country at the time and were convinced that the only course available to take care of such problems was a form of governmental health care. There was no argument on the committee that a form of government health care was not needed to provide care for Americans who could not otherwise afford it but there was concern that there were other more pressing economic issues that should be dealt with first; such as unemployment insurance and crop insurance for failing farms. Several of the committee members also argued forcibly that the AMA would fight any governmental health care program with all the means at its disposal, which were considerable.

As it turns out, they were exactly right. The AMA immediately spearheaded a national campaign against government involvement in any sort of nationalized health care plan as the first step in a “socialist” movement dangerous to US national interest. Roosevelt was besieged by requests from the AMA to appoint organization members to any board that would consider health care reforms and widespread campaigns financed by the AMA began railing against the takeover of health care by a “socialist” agenda aimed at the collapse of the free enterprise system itself. If this sounds familiar, it is much the same logic that is being used today to lambast the supporters any sort of government involvement in health care issues. Precisely because the AMA was so opposed to any such reform in 1935 the administration dropped its push for health care reform even though every study done at the time pointed out that it was the only possible way to take care of large scale health care problems at the time.

Since there was no organized support against the AMA’s views health care reform was tabled in favor of other reforms that did have organized lobbies. The AMA’s concern was that government health care would effectively set prices for their member’s services. It would in essence force doctors to compete with each other for government care contracts. While competition is the very nature of free enterprise it is an anathema to the AMA and always has been. This is fairly simple to understand if we remember that the AMA is a union of doctors organized for the interests and in the protection of doctors. Any system that forces doctors into a free market system wherein they have to compete like every other industry for customers is bad news to the AMA.

In 1936 a report was released by the National Health Care survey, a group formed by the federal government to study health care issues. It was the first comprehensive report on the state of medical care in the United States ever published. The results of this study were comprehensive and far reaching. The survey’s findings were significant. According to the survey the rich get sick much less often than the poor. These numbers were further broken down by dividing acute illness and chronic illness. The poor were 47% more likely to get an acute illness and 87% more likely to get a chronic illness. The poor also were shown to stay sick longer than the rich, 63% longer for those on public relief programs. There was a definitive division between those on relief programs and those who were not as far as if they received medical treatment at all for illnesses of a week or longer with 30% of those on relief receiving no care at all for such problems. Upper income families were shown to avail themselves of 46% more doctor’s visits per illness. Some of the darker findings of the survey reported that annual mortality rates in the US were higher than any other civilized country in the world and that infant mortality rates were higher than in any other industrialized nation at the time. The final part of the report stated that a large proportion of the population had no financial cushion to pay for the rising costs of health care.

While none of this information was surprising, it was enough of an impetus to push Congress into an effort at rectifying the problem which eventually resulted in the introduction of the Wagner Bill in Congress on February 28, 1939. The Wagner Bill touched off widespread debate and committee hearings in Congress but was immediately targeted as a “socialist” agenda by the AMA. The AMA formed the “National Physicians’ Committee for the Extension of Medical Services” to combat the bill. It seems that this committee for the extension of medical services actually was a lobbyist group with the express purpose of defeating the Wagner bill while offering little or nothing in the furtherance of actual services but this is a closely followed pattern that the AMA has historically used to protect its interests. The Wagner Bill lost impetus with the coming of WWII and a shift in government’s interests but the AMA’s committee offered exactly zero solutions to the problem; it simply faded away into obscurity when the bill which it was formed in opposition to died.

As WWII started to wind down and the country’s focus shifted from the international scene back to internal policies the health care debate began again. The Social Security Board who had been deeply immersed in home-front mobilization efforts during the war had also not been entirely free from health care concerns during this same period. By 1942 reports from this board began expressing the view that health care reform was needed and later that same year Congress organized Emergency Health Care Services for the lower four grades of dependents of American servicemen. The EMIC (Emergency Maternity and Infancy Care) was seen by many as a stopgap measure needed for the inevitable implementation of a national health care system for citizens unable to pay for modern medical care and most people believed it was the first step in this process.

By 1943 as the tide of war began to shift the US government was swept with enthusiasm for wholesale governmental social welfare programs such as those being espoused by our allied partners in the war. The Beveridge Report formulated by a British committee formulated for advancing new social welfare programs received widespread support and acclaim in the US at the time and talk began anew of a new national health care plan that would make medical care a reality for all in the United States.

On the heels of this reports circulation in the United States the Wagner-Murray-Dingell bill was presented in Congress in June of 1943. Mobilization of lobbying groups against this bill was quick with the well organized AMA taking the lead with its National Physicians' Committee for the Extension of Medical Service at the head.

It was joined in this fight by a revitalized Insurance Economics Society of America group that was actually a consortium of private insurance concerns who were beginning to be powerful players as the spread of private insurance usage subsidized by state legislatures had become a booming business by then. The Pharmaceutical Manufacturers' Association which was something of a union of drug manufacturers also joined in efforts at defeating this bill as it too was afraid of open competition in the market and was notoriously alarmed at the prospect of the government setting prices on drugs as a part of a national health care effort.

In the face of such organized opposition the bill died in committee. At the time, the Roosevelt administration was lukewarm on a national health care policy so it was another case of an organized lobbying effort succeeding due to the lack of an opposing organized force. It is worth noting here that the overriding concern of each of the opposition forces against the bill was financial. The AMA has always protected profit of its members over and above any other principle and the other two groups in this effort had profit margins as their only concern in this issue as well. While most experts and virtually all reports agreed that health care reform was necessary, the sticking point was as to who would control the reforms and the AMA and its allies have consistently insisted upon control of pricing as the first principle in their opposition to all such government reforms.

By 1944 Roosevelt’s view of the situation had begun to change. In election campaigning in that year he began to move toward an endorsement of nationalized health care. He urged an Economic Bill of Rights under which "the right to adequate medical care and the opportunity to achieve and enjoy good health" and "the right to adequate protection from the economic fears of old age, sickness, accident, and unemployment” would all be sheltered by Social Security. Following his re-election in that year and after the end of the war in 1945 he proposed a personal sponsorship of such a plan in a budget message of January of that year. He reiterated these views in his 1945 state of the union address and promised to get back to Congress on these issues in the near future. Unfortunately, Roosevelt died in office before these proposals came out. His successor, Harry Truman, promised to push for these same reforms and the opposition began to line up against him.

The next three years were full of acrimonious debate in Congress and across the nation on the issue as opponents of health care reform lined up to fight government involvement. The AMA declared all out war on the premise of government healthcare. After Truman was unexpectedly re-elected in 1948 the AMA’s House of Delegates met to in December and voted to charge each of its members an additional $25 to avoid “enslavement of the medical profession”. A prominent public relations firm was hired to spearhead the advertising campaign and some 4.5 million dollars was appropriated by the AMA to fight the passage of any bill having to do with government involvement in the health care system. A highly organized propaganda campaign was organized in specific reaction to the new administration sponsored Wagner-Murray-Dingle bill which organized mass media, vast speechmaking efforts, and congressional lobbying against the bill.

While public opinion polls had in 1948 shown 70-79% approval for government reform of the health care bill, the public campaign by the AMA and its allies began to have an effect. The gist of the campaign focused on three issues. First, the AMA and its supporters suggested that the US at the time enjoyed the highest standards of medical care the world had ever known at the time. While this was not true according to health organization reports, it was trumpeted loud enough and long enough that people began to believe it. Medical standards in this country and everywhere else in the world with pure capitalist systems have always been based upon the care that individuals could afford and under the American system most of the country could not afford the best care so the averages for American health care standards necessarily suffered in comparison to many European countries where nationalized health care had already seen widespread usage. While the AMA’s publicity program admitted that there were deficiencies in the system it insisted that these were greatly exaggerated in the face of directly opposing information from the National Health Surveys conducted at the time.

Second, the AMA and its allies claimed the National Health Insurance would lead to federal control of all medical care, which would undermine the system of free enterprise that the system was based upon. This is a claim that is universally made even today in such discussions even though the AMA and the medical profession in this country has been completely isolated from the free enterprise system since the inception of the AMA in a flagrant and self-serving manner that has been pointed out in numerous instances in this post. Every political action that the AMA has sponsored has been aimed at the elimination of competition which is by any understanding of the term one of the basic tenants of the free market system. For the AMA to claim that government intervention in health care would undermine the free market there would have to be a free market to start with and this is categorically not the case in our current medical system or in the one that existed in 1948.

Third, the AMA and its allies suggested that government intervention would necessarily drive the cost of health care up; probably beyond the ability of American citizens to pay for it. As an adjunct to this argument the AMA began pushing for the spread of private health care insurance programs provided of course that doctors maintained control over all billing practices so that they could continue to set rates without being faced with competition. One can argue that private enterprise and the free market are the best controls for cost but not if the free market is eliminated from the field; which is exactly what the AMA and private insurers in collusion have managed to do in this country since the turn of the century. Judging from the runaway costs that this collusion have fostered in the industry in the ensuing 60 years it is hard to make this argument intelligently today but it is still being made in much the same manner as if we haven’t already seen health care costs explode in such a manner that no one can afford health care without insurance.

If any or all of these arguments sound familiar that is because they are still being used today in our current debate about health care. Very little has changed on this front besides the undeniable fact that health care is now impossible to afford without insurance. Still, the argument in the late forties was swung even further to the side of those against National Health Care by the great bogeyman of free enterprise; socialism and its more fearsome cousin communism. As the battle lines began being drawn in the debate organized labor and social security administration stalwarts joined the issue on the side of governmental health care for the public.

In the face of these reactions other issues began to color the debate against these organizations. The Alger-Hiss trials began and exposure to communist threats within branches of the US government and organized labor began to lead to suspicions of motives. China fell to the communists soon afterwards and Russia exploded an atom bomb of their own as the lines between Eastern Europe and the US began to be drawn ever more definitively. The charge of socialist tendencies took on more sinister overtones in the face of these developments and the AMA and its supporters used fears on this front to drive their point home more forcefully. The McCarthy hearings hysteria began to gather public notice and dominate the news and it was relatively easy to use these fears to squash the efforts to nationalize health care. By 1952 it was evident that Truman had lost his battle to nationalize health care and the AMA had won.