Public Comment

The Limits of Healthcare Reform

By Marvin Chachere
Thursday August 27, 2009 - 01:22:00 PM

For 12 years, beginning in 1970, I was director of studies for international educational programs sponsored by UC Berkeley Extension at Oxford, Leningrad, Venice and elsewhere. On several occasions both in England and the Soviet Union, persons in my programs got sick.  

Upon arrival in Oxford, an elderly gentleman suffered a heart attack and was rushed to the Radcliffe Infirmary. After a week he spentin the hospital and two days of convalescence, I escorted him to Heathrow and made sure someone from my Berkeley office would be at San Francisco International Airport to meet him.  

In Kiev upon returning to our hotel after an all-day excursion, a young woman stepped off the bus and immediately passed out. Medical Emergency—a “vrach” (Russian for a first responding physician) and two nurses—was there within five minutes. The patient was quickly diagnosed with dehydration and just as quickly treated.  

No money changed hands in either case. In England the National Health Service (established in 1948) was available to sick persons on demand, no questions asked. At the Radcliffe Infirmary checking out was as unencumbered by paperwork as checking in had been; all the staff wanted to know about the elderly American heart-attack victim were facts related to his condition and care.  

Congressional leaders of both parties in both houses, pundits of every persuasion and even the president extol the capitalistic economic model. Competition stimulates efficiency and diminishes cost, and it is heresy, that is, un-American, to believe otherwise. Thus, the finance industry, auto makers and insurance companies must be saved—they are “…too big to fail.” President Obama and some congresspersons want “a public option,” public insurance that will compete with private insurance.  

Accordingly, the debate on healthcare reform, such as it is, assumes an unbreakable bond connecting care and cost. It is also confusing because, whereas there are exactly two sides to a debate, pro and con, in this matter there are about a dozen sides. Even the possibility of informal discussion seems futile because out-of-control partisan contentiousness fills the air, stifling rational discourse. Few town-hall meetings are productive, many are raucous and some feed the comedy circuit, their entertainment value usurping their informational purpose. In the end, a bewildering swirl of plans and criticisms tragically obscures the basic problem: real needs of real people with real ailments, from migraines and allergies to aneurisms and cancers, are not met.  

When it reconvenes next month, who knows what action, if any, Congress will take? The Republican minority seems united in its resolve to block any and every reform plan—Republicans can prosper only if Obama fails—while among Democrats there are as many plans as there are legislators willing to formulate them.  

Meanwhile, a clear majority of the unwashed masses, myself included, prefer a “single-payer system of universal healthcare.” The insurance and pharmaceutical industries are adamantly opposed and, unfortunately, the modus operandi in Congress places corporate interests above public interests.  

To escape the furor, I took a distant view and reflected on my experiences decades ago in foreign lands. The following immutable facts stood out. 

In this country we have one doctor for every 358 people, and we have one bed for every 304 people (in 7,567 hospitals). Almost everyone will make use of medical resources at one time or another, but medical resources, unlike water, food and clean air, are not needed by everyone, every day.  

Insurance does not relieve pain or cure illness. I know, I know: this is a trivial statement. But the insurance companies advertise their products with such compelling force as to overshadow this simple truth. They tell us that tens of millions die every year because they don’t have insurance; they want us to believe that buying insurance protects us from ailments. And we appear to accept these blatant absurdities. 

Pharmaceutical companies spend tens of millions of dollars every day in prime-time-TV advertisements for prescription drugs—“Ask your doctor if such and such is right for you!” I sometimes think they develop a new drug and afterward find or invent an ailment it can cure.  

Hospital advertisements mimic those for five-star motels and vacation resorts.  

I do not question the importance of insurance, but all insurance—life, auto, home and especially health—is rooted in a conundrum: out of myriads of purchases, insurance is the only product we buy that we truly hope we’ll never have to use. 

Finally, not only is our system out of step with those of other industrialized nations (we get half the benefit for twice the cost), but it is also absurd, idiotic and stupid to allow the nation’s medical needs to rest with companies whose main objectives are to generate and increase profits. 


Marvin Cachere is a resident of San Pablo.