he Big,
ad Wolf?

U.S . should adopt Canada's single-payer system.

DR. BARNETT ZUMOFF SPECIAL TO THE JEWISH NEWS

W

ia is going on? Almost
every American thinks
there is a crisis in our
health-care system.
Even so, the Clinton adminis-
tration, most of Congress and
nearly all media are ignoring the
one proposal that would bring
the crisis to an end quickly.
The American Health Secu-
rity Act (S.491/H.R. 1200), in-
troduced principally by Sen.
Paul Wellstone and Rep. Jim
McDermott, is a single-payer
system modeled after the effec-
tive and highly popular Cana-
dian program. It is the most
comprehensive, the simplest
and the cheapest of all the
health-care reform proposals
pending in the Congress. It does
the most to preserve patient
freedom of choice and the high-

ly successful free-enterprise sys-
tem of health care in the Unit-
ed States. And it is the only one
that is demonstrably workable.
But it isn't being taken seriously
by the decision makers or peo-
ple who influence decisions.
President Bill Clinton's pro-
posal is intended to provide uni-
versal coverage for all
Americans, but it would do so
only gradually and through a
highly complicated and com-
pletely untested structure de-
signed to minimize opposition
from the health-insurance in-
dustry by allowing it to contin-
ue its expensive and profitable
role in financing health care.
That appears to be the major, if
not the only, reason for propos-
ing such a complex bureaucratic
and expensive program. But it

hasn't blunted the insurance in-
dustry opposition at all. They
want more concessions.
Then there are the several
other proposals based on the slo-
gan of "universal access." These
disingenuous approaches are
like Anatole France's comment:
"The law in its majestic equali-
ty forbids the rich as well as the
poor to sleep under the bridges."
It is like saying that "everyone,
even the poor and homeless, has
universal access to all the food
and lodging they can afford to
pay for." Or like Marie An-
toinette's famous words: "Let
them eat cake!"
It's too bad, she might say, if
people can't afford cake, but that
doesn't change the fact that the
cake (read "the quality ofAmer-
ican medicine") is the best...

Hitler's Germany
And Health Reform

Nationalized medicine and Nazism have ominous parallels.

DR. ANNA SCHERZER SPECIAL TO THE JEWISH NEWS

I

n the Holocaust Memorial
Museum there is a comput-
er system made of punch
cards. It is the German pro-
totype of the Universal Health
Card.
Yes, they thought of it first.
Each German citizen would
have a card which reflected a cen-
tralized health record. (The field
trials were on the Jewish segment
of society.) Every medical prob-
lem or condition for which a pa-
tient had a history or had received
some type of treatment was
recorded on the individual's cen-
tral and comprehensive health
record. In that manner, the Nazi
government was not only aware
of the costs imposed upon the
Aryan People and the Fatherland,
but who specifically incurred
these costs.
The Fatherland could then
calculate the financial risk to its
resources due to any one indi-
vidual and also the value, the

likely productivity or the liabil-
ity of any individual to the State.
In short, the Lebenswert of any
one person.
How many of you remember
the image of President Bill Clin-
ton holding up the Universal
Health Card during his speech
in September 1993? He used it
as a symbol of health care for
all. The Universal Insurance
Card. What a potentially pow-
erful and decisive instrument.
All our medical records in the
hands of the bureaucrats, with-
out guarantee or promise of con-
fidentiality. How simple it
would be for one person to de-
cide if we march to the left and
be excluded from care, or march
to the right...
One thing we all did before
becoming physicians was to
take an oath. I did not take the
Oath of Hippocrates but instead
took the Oath of Maimonides,
which dates back to the 13th

century. Both oaths sanctify the
relationship with our patients.
We pledged to do our best to re-
lieve an individual's suffering.
We pledged to knowingly do no
harm.
I did not pledge to the state
to satisfy its greater political or
budgetary goal, but rather to do
my best for the individual pa-
tient.
But what has been happen-
ing? The medical-political scene
has changed since I took my
oath...Ten years later, the physi-
cian was asked to deliver ade-
quate care. Then we were asked
to deliver fiscally responsible
care, and finally we are now t ,
asked to manage covered lives.
As physicians we are being sad-
dled with the actuarial risk in
the form of capitated contracts
which are being imposed upon
our relationship and treatment
of our patients.

HEALTH REFORM page 36

What's keeping the best idea,
the single-payer plan, from get-
ting serious attention? Opinion
makers and molders seem to be
operating under a cynical and
demeaning view of the inherent'
good sense of the American peo-
ple. They are capitalizing on the
myth that Americans have lit-
tle trust in government to meet

Social Security
and Medicare:
"Efficient
American
institutions."

Dr. Barnett Zumoff

their basic needs, that "big gov-
ernment" is the "big, bad wolf."
Sure, Americans worry about
the lack of responsiveness and
accountability in many govern-
ment programs. But two of the
most popular and efficient
American institutions, Social
Security and Medicare, are ex-
amples of big government.
As a matter of fact, there is
great similarity between
Medicare and the single-payer
system. The government,
through payroll taxation, pays
for health care of those persons
eligible for Medicare. Under the
American Health Security Act,

the government, through pay-
roll taxation, will pay (without
copayments or deductibles) for
all the health care of all Amer-
icans! And the overhead costs
under the American Health Se-
curity Act will probably be even
lower than the 5 percent under
Medicare, and much less than.
The Well s to ne-McD ermott
single-payer system, according
to the Congressional Budget Of-
fice analysis, will deliver uni-
versal coverage right from the
very first year of implementa-
tion, will provide up to $100 bil-
lion of savings in administrative
costs, won't increase the deficit
and will cut projected spending
by $75 billion more in 2004 than
the president's plan.
Under S.491/H.R. 1200, all
health insurance premiums will
be eliminated. No American will
have to pay more than 2.1 per-
cent of his or her taxable income
for the universal, comprehen-
sive coverage provided under
the single-payer system. For
more than 75 percent of all
Americans, their health care
costs will be less than they are
now.
So, who's afraid of the big,
bad wolf? ❑

1k. Zumoff is an endocrinolo-
gist with Beth Israel Medical
Center in New York City and
president of the national chap-
ter of Workmen's Circle.

