Filmmaker Michael Moore is making headlines again. His new documentary, "Sicko," promotes a national healthcare program like Canada's. The film, due to open in theaters June 29, got a big boost when the US Treasury Department sent Mr. Moore a letter acknowledging a probe into his trip to Cuba to obtain medical treatment for three 9/11 rescue workers – and film a segment for his movie.
An "appalling" form of harassment, declared Moore, saying his work as a journalist is protected by the United States Constitution.
Advocates of a single-payer national healthcare system welcome Moore's movie. With millions of viewers likely to see the film, it's "unquestionably" helpful, says a spokesman for Physicians for a National Health Program. PNHP, with a membership of 14,000 physicians, has been campaigning for a national system for 20 years. But the prospects of success for PNHP are not great yet, figures Henry Aaron, an economist at the Brookings Institution in Washington.
One reason is the power of various medical industry lobbies. Americans spend as much on healthcare today as the entire gross domestic product of France and Spain combined, notes one economist. If health-related costs continue to rise rapidly, spending could soon equal the entire GDP (that is, the output of goods and services) of Germany.
The $2.1 trillion the US spends per year on healthcare creates "strong interest groups," notes Mr. Aaron. These include a host of politically powerful private health insurance companies and for-profit hospitals.
But a cofounder of PNHP, Steffie Woolhandler, a Harvard Medical School associate professor, is more hopeful for radical reform – though not under the Bush administration. That's because she sees a slow-motion collapse of the present employer-based health insurance system.
Faced with globalization and severe competition from abroad, American companies are moving to reduce their health insurance costs. They are raising deductibles, requiring bigger copayments, and trimming the medical services covered. As these trends hit the middle class, the political result will be a "big storm," Dr. Woolhandler predicts.
As it is, the US devotes about twice as much to healthcare as a proportion of GDP than do other rich nations with nationalized health systems.
Economists at the federal Centers for Medicare and Medicaid Services said last February that, if current trends continue, $1 of every $5 spent in 2016 will go toward healthcare. Today, healthcare takes close to $1 of every $6, or about 16 percent of GDP. "We must do something large and serious and soon," says Alain Enthoven, a healthcare expert at Stanford University in California.
If a Republican president is elected in 2008, reform will be "relatively timorous," says Aaron, possibly involving deductions for health insurance premiums on income and payroll taxes. Changes will probably most benefit the well-to-do, he says, and not much will be done to cover the 47 million Americans without health insurance.
If a Democrat is elected president, reform could be more ambitious. The "implicit taboo" on a large-scale health plan that followed Hillary Clinton's failed effort in 1993 is gone, says Aaron. But no Democratic candidate is advocating a national health insurance plan, a move that would substantially redistribute national income and impact strong health-industry interest groups.
Aaron would like to see Washington help fund state measures to broaden health insurance coverage, such as the plan in Massachusetts. In California last week, Moore joined the California Nurses Association to push for a statewide, single-payer healthcare system at a legislative briefing and rally. But Gov. Arnold Schwarzenegger vetoed a bill in 2005 that would have broadened coverage in the state in favor of working with insurance companies.
So far, such Democratic presidential candidates as John Edwards and Barack Obama are advocating plans that keep the private health insurance industry intact. "Different flavors of the same plan," complains a PNHP spokesman. Insurance companies would still strive to insure the healthy and exclude the sick, he says, noting this process adds to administrative and other overhead costs.
A study by Woolhandler and others published in 2003 calculated that, in 1999, health administration costs in the US amounted to at least $294 billion. That's $1,059 per capita, compared with $307 per capita in Canada. By now, administrative costs are probably about $350 billion, a sum big enough to provide insurance coverage for uninsured Americans, reckons a PNHP spokesman.
Americans would like to have the federal government guarantee health insurance to everyone, especially children, according to a recent New York Times/CBS News poll. They say they'd be willing to pay as much as $500 more in taxes a year and forgo future tax cuts to do so. But a campaign against a national health insurance plan is already building.
Harry and Louise, the couple portrayed in TV ads by America's Health Insurance Plans that helped kill Hillary Clinton's health plan, may yet return.