Like Moore, I have looked at the healthcare systems in many countries, but unlike Moore, I am "inside" the profession and, if the truth be known, I have been thinking about healthcare since socialized medicine was first introduced to Sweden and the U.K. when I was still a child.  Of course, when socialized medicine was introduced, it was hailed as a very progressive and enlightened political achievement.

I used to spend summers with my grandfather in Sweden. One of my aunts had an accident and was permitted a free visit with a physician, but the visit was not to exceed three minutes.  Given the courtesies of saying "hello" and commenting on the weather, this is about enough time to write a prescription for a pain reliever.  The patient may have a second appointment if the condition does not relieve the problem and eventually, the person may be referred to an expert or a hospital.  After seven weeks, it was finally obvious that my aunt had a compound fracture, and this is when the fabulous Swedish medical system could offer her the best of modern care.

Needless-to-say, I was not too impressed.  Another relative had various complaints, odds and ends of "not quite spiffy" reports.  It was three years before she was referred to an oncologist and then, of course, no effort was spared, but it was too late.  After I left the State Department, I was sick of American politics and I went to Sweden again. Shortly after my grandfather's 90th birthday, he had a minor accident and was taken to the hospital. I jumped in my car and raced over, only to find him on a guerney in the hallway, howling in pain.  No one could be bothered to see him because it was a Friday afternoon and the regular doctors would not be there until Monday.  I think the staff were embarrassed because I seemed so shocked by his "care" so they finally agreed to put him into a proper room, run some diagnostic tests, and address his pain.  I stayed there the whole time. He went to ICU but no one was watching him except me. The doctors were perfectly incapable of making the slightest rational observations, and he died.  I had never been with anyone who was dying so the poignancy of his transition was deeply moving to me, but I will never forget the doctors and their total inability to assess his overall condition much less to see when a person is nearing transition.

I dated a poet for a while.  He was so Swedish, 100% Swedish and I used to challenge his ability to think just a little outside the box. He was so "radical" in his estimation of himself, but I thought "radical" is just another cult with its own highly predictable ways of dressing and acting out.  He used to "interview" people who were passed out on the sidewalks because he was curious about what goes on inside people's heads and hearts, but hospitals don't admit drunks who pass out, even if they are diabetics and in mortal danger.  In short, I was not impressed.

So, what about England?  The people I met had dual insurance, the one provided everyone as well as a secondary policy for private care should their requirements (and fortunes) exceed what is offered in the system.  The horror stories are about the same as elsewhere.

I work in a field that most likely would not be covered by a universal health care plan.  So, let me tell some more tales.  Recently, the father of a teenager with testicular cancer took his son abroad for treatment because despite the fact that all care is 100% covered in Australia, his son was not getting better. He is thriving in a private clinic in Europe.  I am sure everyone is going to ask for the name of the clinic, and this is the point.  Within the system, the types of treatment are limited, more or less the way most insurance policies limit coverage.

When the AIDS epidemic was just starting, an insurance executive asked me to develop a plan for treatment of patients with AIDS, and heck, while you are at it, throw in cancer as well. At the time, AIDS treatment, which was never successful, was costing insurance companies (or patients) about $250,000. The insurance company counts the dollars from the date the first payment is made until, as this young executive told me, "the nails are hammered into the coffin."  The figure for cancer was considerably higher, at least $500,000, sometimes two million.

So, the other side of the picture is that healthcare is an industry, a simply enormous industry and one that provides employment for a lot of people. It also generates huge revenues for pharmaceutical company and hospitals, not to mention surgeons and others whose fees can be astounding. Patients have shown me bills in which the surgeon was paid more for a single operation than some people earn in a year.  There is a lot of turf to protect, and this is why there are so many lobbyists padding the paws of the politicians.

Now, when I gave careful thought to the needs of people with AIDS as well as people with cancer, I was totally convinced that for a tenth of the cost and a significantly better outcome, the alternative could be created.  I was told to develop a plan for a pilot study involving a small number of patients and a budget of three million.  Then, something happened and communication stopped.  I had put a lot of time into this so was after a few weeks, I called to find out what the lay of the land was. The long and short is that the president of the company, obviously one of the many evil insurance companies, had decided that AIDS would not, in fact, bankrupt the company and they made more money off the system that they lost in payments.  I am not a good enough mathematician to figure out how this could be the case.  I mean, even if the insurance company invests in hospitals and pharmaceuticals, it must be losing money when people in the 20s and 30s require expensive and useless treatment and then die so that they have to make good on both the health insurance and life insurance.

I was told the president axed the project for political reasons.  There is a lot more to this story than needs to be told now, but we have seen one report after another of political access, corruption, and influence.  When a politician has to announce his campaign months and years in advance, his campaign chest has to contain millions. People do not spend millions for nothing; they are buying something with their donations.  Most people who have a lot of money have it because they are invested with the status quo.  If you are ahead of the times, you work creatively and often as not scratch and claw while alive and then the honors come posthumously.  No one with influence is afraid of ghosts so the celebrations are allowed after the nuisance is gone.

I am being facetious but I am very serious. For instance, I watched testimony in Congress about the "war on cancer".  Sen. Specter and Sen. Hatch were asking what would appear to be reasonable questions except that it is very hard to believe that they don't know the answers to the questions they asked.  They know exactly how to appear on camera and C-SPAN was televising the testimony.  "You mean with the billions we are spending, the cure rate is ..."  What can we do about it?   Oh, gee whiz, we could spend billions more;we could spend billions more so long as none of it goes to alternative medicine or stem cell research.

The status quo is the main deterrent to new ideas because they are living prosperously on the old ideas and this is a very important point to keep in mind.  In politics, there is no real progressive party, just people who are an inch or so either way of middle.  The moment, they step outside the mainstream box, they become controversial and no longer politically viable.  As all the insiders will say, the corporations own both parties (and they intend to maintain the illusion of whatever they wish to project so long as it serves their purposes . . . because no one with power surrenders easily.)

Now, then, we need to ask who has the power.  It is not the politicians but the people who control them. The politicians are expendable. We see how easily Blair was replaced in England, but there is no suggestion that anything but a name and face have changed.  This is what the lobbyists buy when they pad paws.

Bear in mind that lobbyists merely represent their customers.  Like lawyers, they do the bidding of their clients, right or wrong.  I want to emphasize this because aside from the marvelous concept of "modern research," there are other realities and many myths. Madison Avenue is paid to develop ad campaigns that sell products.  They are not paid to investigate the efficacy of products, merely to find the selling point and to capitalize on the market potential. Big Pharma makes $4 for every $1 spent on advertising so if you are sick of the commercials for Head On or Lunesta or Viagra, keep in mind that if the ads weren't working, you wouldn't be seeing them.

My sense is that if the ads weren't working, Big Pharma would find another way to ram itself down our throats and this is scary indeed.  If you are intuitive, then you have already figured out that the bottom line is that universal health are without many other reforms would just be a bonanza for big business.  Unless the quality of health care were also improved, we would find ourselves trapped in an increasingly narrow system in which senseless surgery and dangerous drugs rule the day.  I am not saying that surgery is unnecessary, but we perform roughly ten times more operations than is the case in other modern countries.  It's doubtful that all the operations are necessary, which may be why we listen to advertising for surgery also.