This Consumer Union report is fact-based and helpful. With its 1992 study as a "baseline", we can see how medical care became criminalized by profiteering corporations exploiting the fears and hopes of consumers in the last decades of having any "consumer" power in government.

This book documents the fact that by 1992, the US medical care system was already "costly and exclusionary", and not very effective at sustaining actual "health" outcomes. In addition, the authors present rational outlines of the Canadian system which provides better care for more people. The examination references the concerted attacks on the Canadian system, by interested lobbies, and illustrates actions taken in Hawaii, and Minnesota. [193-254]

A "single-payer" system has clearly been shown to produce the best outcomes for the least cost. [197]

The book concludes with an analysis of the claims made by critics of the Single-payer systems. Without accusing the AMA and the insurance companies of "fraud", this book shows numerous examples of claims made which are fraudulent--directly misleading the American public. While many of the fraudulent quotes highlighted here are made by Republican Party politicians, on the whole the authors avoid "political" grand-standing.

For example, President Bush (the first one) states that "we don't need to put government between patients and their doctors and create another wasteful federal bureaucracy." Opponents of Canadian-style single-payer healthcare often add that "government should not tell doctors how to practice medicine". Of course, the Canadian/single-payer system does neither. [198] [And the authors do not characterize the attacks as fiendish frauds.] Very few Americans, in fact, have any actual relationships with "their doctors", and their employers have failed to negotiate prices on their behalf. Americans now have offshore insurance companies telling doctors how to practice medicine.

"Our health care system does not just allow prices to rise--it practically demands that they do....The American system stands alone in the developed world." [6] In other civilized countries, universal standard payment schedules are set by direct negotiation with doctors and hospitals. Most have a ceiling on medical expenditures. Not a single country other than the US devotes more than 10 percent of its gross national product to health care. The US broke that barrier in 1985. In 1992, the US is expected to spend 14 percent on GNP on health--of course, an increasing percentage is simply going to profit for insurance companies, not medical care at all. Compare, in 1960, US spent 5.3 percent of GNP on health care, comparable to Germany and Canada.

What changed everything? In 1965, Medicare was set up to serve the over-65 population. At that time, there were few private insurers covering the population, and they left treatment entirely to doctors. Medicare made a compromise with the medical opposition to "socialized medicine", by agreeing to pay "usual and customary fees". This allowed physicians to set their own prices. Employer-financed insurance plans bought into this system, without "bargaining" with the doctors. With no constraints on costs, doctor's bills began an inexorable climb.

"Experience has shown that attempts to manage the health care system a piece at a time are likely to fail." [9]

"Medical care is unlike services delivered by other professionals. When clients hire an architect or a lawyer, they generally know what they need and roughly how much it's going to cost. But in medicine, physicians make virtually all the decisions that determine the cost of care." [11]

Doctors create "medical need", and then profit from it. This is called "induced demand". [12] In the 1970s and 80s, Rand Corporation began studying the systemic incentives for over-treatment and self-dealing referrals. Nearly 1/3 of the elderly patients referred for removal of athreosclerotic plaque from the carotid artery did not need it. 14% of heart bypass operations were unnecessary. [14] Of course, the abuses by the self-dealing doctors attracted the insurance companies to examine the procedures.

The authors document the fact that doctors are surprisingly isolated and uncertain. Typical physicians spend their entire careers within a single referral network, based at one hospital. Local colleagues are the principal influence, but may not be the most reliable resource--based on the variations visible between small areas. This is a "striking demonstration of just how unscientific medical practice really is". [16]

For me, it is staggering to see that since 1992, our "system" has increasingly gotten worse, and more profitable for the rich. Medical care has been a weapon wielded against the middle class and employees. With all the hopes and fears inside the world of involuntary hospitalization and disease, fascists found the perfect cover to use to grab power and money. ( )