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The Good Doctor

   I just finished Howard Dean’s Prescription for Real Healthcare Reform: How We Can Achieve Affordable Medical Care for Every American and Make Our Jobs Safer (Chelsea Green), a call-to-action for those who have finally come to grips with the unjust lock that private health insurance companies have on the health and well-being of so many Americans.   
   According to Public Citizen, a new nationwide study showed that 62 percent of bankruptcies in 2007 were related to illness or medical bills, more than 75 percent of which befell people who had health insurance. You would think that these findings would underscore the need for a single-payer health care system. Despite the cost-saving benefits of a single-payer system, Dean does not advocate a single-payer universal plan.
   Dean writes that our country should keep the choice of both private and public health insurance options. He claims that choice is uniquely American and that we can learn from studying the plans that our other Western neighbors adopted when they were forced to their knees. The British came up with their universal plans in the wake of World War II, when they were faced with scores of wounded soldiers. Churchill formalized the system he adopted during the war.
    Dean addresses the arguments that many conservatives offer as reasons why we should remain complacent with the status quo. He says that while most of us have an “altruistic streak,” many of us are not willing to put a stranger’s welfare ahead of our own interests. He says Americans rejected Clinton’s efforts to reform healthcare because most Americans were concerned with their own personal situations and were unlikely to vote to provide health insurance for their neighbors who were unable to buy or afford insurance. Now, he says, most Americans feel personally affected by the recession.
    In the past 15 years since Clinton’s efforts to enact health care reform, many people have seen their own employment futures become unstable. More and more employers are passing increasing health care costs on to their employees. Major companies such as GM find themselves unable to compete in a global economy against countries who have more reasonable and universal health care coverage. Some companies don’t offer health insurance at all. Another difference today is the increase in the cost of health care that has grown at 3 times the rate of inflation. Many of us have personally known friends who have had a major illness and faced economic ruin because they found their insurance declined to cover their care or they lost their jobs and were unable to afford COBRA or were unable to purchase health insurance because of “pre-existing conditions.” Dean writes that he plans to make sure Americans are never going to be denied health insurance nor be limited by the financial limits—sometimes a lifetime limit of $300,000—currently imposed on patients, which can be exhausted by one serious surgery, illness or transplant. He advocates public health coverage for life, equal premium costs for everyone despite age or illness, and fewer dollars wasted on management and more spent on medicine.
    Dean outlines the myths traditionally circulated by conservatives about the dangers of initiating a public insurance option, including “socialized medicine,” scaring people about losing their existing coverage, rationing care, ruining competition and increasing costs for private insurers. He addresses each of these myths with concise arguments. He says that Americans should have the opportunity to make decisions about their health care providers; he writes that our country’s proclivity for competition should be preserved. Dean argues that without choice between public and private insurance, Americans will not achieve health care reform. Really?
    Many argue that the single-payer plan is the only way to significantly lower healthcare costs, and that is the ultimate cost saver. What if, as private insurance defender Sen. Chuck Grassley argues, 119 million Americans ditch their private insurance if they had a choice? What does that say about the health system we now have?
    And how do we pay for a public plan? Dean points to Obama’s plan to begin rational cost-saving initiatives such as streamlining computer compatibility so that hospitals can share data with specialists, testing current procedures and drugs for effectiveness, and eliminating expensive services currently provided when uninsured patients have no recourse but to go to emergency rooms for chronic conditions after they have stalled getting medical attention until the situation is severe and expensive to treat. Obama also plans to fund prevention-oriented efforts and harness group purchasing of services and drugs. If Dean is on the money, Americans will have a public option in the health insurance market from which to choose. If not, it can be argued that we are doomed to a system that is headed to bankrupt its citizens, businesses and eventually, our country. 

Our Body of Water   
    Chicago Life wrote a feature on the safety of municipal drinking water in the wake of the 1993 Milwaukee water contamination. The tiny protozoan responsible for the outbreak of flu-like symptoms made more than 400,000 people sick. The deaths of 100 people, mostly elderly and immunosuppressed patients, were attributed to cryptosporidium, when the protozoan was let loose on the public because one of Milwaukee’s purification plants was down for a period of two weeks. The drinking water, taken from Lake Michigan, was believed to been tainted by abnormally heavy rains that made the water cloudy. The cryptosporidium source is believed by many to be caused by animal feces, primarily calves. The tiny oocysts that cause the illness can pass right through most filtration systems. A Wisconsin Department of Natural Resources report cited a national study that found the oocysts in 27 percent of treated drinking water taken in 1991 from rivers or lakes. More stringent standards for cloudiness (turbidity) in water are now in effect, making it less likely to recur with such a large impact on the population.   
    After we ran the above feature, I received a call from a scientist in San Francisco who told me the next big story on water safety would be pharmaceuticals ingested by humans. We have since read that estrogens, steroids, antibiotics, NSAIDS and other drugs humans ingest are excreted and may eventually be flushed down the toilets, only to find their way back into our drinking water. There are fears that pharmaceuticals originating in hospital waste may eventually show up in our water supplies, too. While we still have scarce science to measure the cumulative effects of ingesting these drugs and combinations of these drugs, we now have more evidence to measure the effects that antibiotics and steroids given to cattle—and estrogens and estrogen-like compounds released by industry—can have on our environment. Many of the drugs given to animals by factory farms are identical or similar to antibiotics taken by humans, thus making humans antibiotic-resistant. Estrogens given to animals may have effects on humans affected by estrogen-linked cancers. Sexually ambiguous reproductive organs of fish should be our canaries in the coal mine. We need more testing of pharmaceuticals in our water treatment facilities so that we can prevent a future catastrophe on a grand scale.

Published: August 09, 2009
Issue: Fall 2009 Water Issue