Dr. Quentin Young.

Notes from bio, by moderator, Prof. Cheryl Jackson:

Dr. Young is a graduate of Northwestern University Medical School.
He did his residency at Cook Cty Hospital, served in U.S. Army,
U.S. public health care service. In 1951, was founder of committee
to end discrimination in Chicago medical institutions. In 1980,
founded Chicago- based health and medical research group. Volunteers
as national coordinator for PNHP. Past president of American public
health program. Medical commentator for a local public radio station.
He now limits his medical practice so as to to spend more time
fighting the corporate takeover of medicine in America.

"What is National Health Care?"

DR. YOUNG:

When I received this invitation I was very pleased to get it. 
Not that I want for invitations to speak, I have my share.
But it's a political issue. Bob Mueller's wonderful, devastating
description of where we're at, made it clear I hope, if you didn't
know it coming through the door, that the solution to this problem
is political. That is to say, this country will have to [assert its]
democratic right through the legislative process to achieve reform
of our health care. And I know I'm in a community that has a firm
reputation for conservatism. But the last election addressed
this problem ... one candidate supported national health reform,
the other, the incumbent, opposed it. It was a very close race
by my standards, and I'm optimistic that DuPage will be in the
leadership of the attempt to fix the American health system, thanks
to that recent event.

Having said that, I already paid homage but want to repeat, Bob
that was marvelous, I watched the audience's faces get grimmer and
grimmer. Our health system is amateur night in the lunatic asylum.
We have to emphasize the fact, the utterly crucial fact, that it
doesn't have to be this way. My definition of tragedy - it's not mine
alone, I've heard it elsewhere - is that it's the failure of what
might have been. It isn't when things are bad - things are usually
bad; it's when you have the capacity to have it different, that's
tragedy, whether it's personal or political, and we are in a colossal
political tragedy.

I'm going to describe our assets and if any person ... feels that
we are getting a fair shake from our health system I'd like to
[recommend some mental care]

Here are the assets, it's not a long list, from our economy:

- 1.9 trillion dollars

- 1/6 of our whole gross domestic product

- 6200 dollars for every person in the country last year,
       more this year - more every year

Well, how does that compare, dollarwise? It's twice as much as the
next three countries to us: Switzerland, France, Germany spend about
3200. Canada spends less than that, 40%, less than half. It goes
all the way down to Great Britain, a third of what we pay. Indeed
all of the industrialized, advanced economies, the democratic
countries of the world have chosen to make health care a responsibility
of society, "health care is a human right" is the slogan.

Our slogan, incidentally, I'm going to recite it and you can echo
it is, "everybody in, nobody out" [audience repeats]. You feel
better already, don't you? We're living in a country where a lot
of people are out. Forty-five million have no insurance. And Bob
would point out, I'll echo, that no insurance happily doesn't mean
no care in this country, but it means delayed care, it means poorer
outcomes, more deaths, more morbidity, more suffering, more anguish.

I'll tell you what else it means - it means economic disaster. They
just passed a terrible bill, all the bills they're passing this
season are terrible. They made it easier for these lenders, is what
credit card companies usually are, to hurt people who default.
First they drive you crazy begging you to buy their products or
take their products, and then they wreck you. How about this for a
stat: in the year 2001, 2001 only because the data takes three or
four years to be complete, one half of all personal bankruptcies,
one million personal bankruptcies, which affected two million people
when you include family, one half were due to unpaid medical bills.

Now, you have a health system that is defined as helping people
... relieving suffering when nothing else can do it, and it turns
out to be a 294-pound gorilla that's driving a million families
into bankruptcy each year, and next year it's another million. So
after a reasonable period of time, a huge section of our most rich
nation in the world has tens of millions of people with the curse
of bankruptcy failure in their finances, caused by the health system.

Let's look at the larger economy before I return to the inventory
of resources. The larger economy is in trouble. You've heard of
of outsourcing of jobs and instabilities here and there. What is a
major source of that shift in our economy, which is going full thrust?
It is of course the cost of health insurance to manufacturers, to
business people.

The most vivid example I can cite you is the auto industry... The
big three auto makers as we talk are in negotiation with the unions.
Today's Tribune front-page headlines - not back-page stuff - what's
the issue? What's the cost of health care? It was best put by Henry
Clay Ford, the chief executive officer of the company with the same
name that his grandfather founded. He said we are at a disadvantage
in the international market because of a $1400 surcharge for health
services to our employees in their negotiated benefits over Canada.

Now, Canada is a country that you could argue that most resembles
us in the whole world. Their industries even are like ours. They
are major automobile producers. I give you a stat that makes everybody
who worries about the country's economic health worried, that is
to say, there are now more Ford cars produced in Ontario than there
are in Michigan. That process goes forward. It doesn't have to go
much further forward than cars and other items where health insurance
is at least a part of the issue ... before you're talking about our
standard of living, our [place] in the world is at a disadvantage
that we become not number or number two but down the line. That's
what the health care system craziness is doing to our society.

I gave you the dollars. That's always vivid. But as I speak, I want
you to ask yourself the question, are we not ingenious? Are we not
intelligent? Are we not wise enough to take these massive resources
in the economy and have indeed the best health care system in the
world? That's a rhetorical question. The answer is, of course we
can do it. We have twice as much money as anyone else to start with,
even though in the numerator of that per capita expenditure forty-five
million people have no insurance; a hundred million have very poor
insurance ... we have to take extraordinary makeshift measures in
order to help them - it's laudable but we have all these piecemeal
answers.

What about the other two elements in any health care system? What
about the workforce? Are we to know that we neglected turning out
skilled doctors and nurses and scientists? The answer is emphatically
not. We are endowed with a remarkably excellent health workforce,
perhaps eleven million people, Americans, work in the health care
system, including seven hundred thousand doctors - seven hundred
thousand highly trained, excellent doctors, including two million
nurses although we are battering the nursing profession, literally
moving them to extinction. As my friends know that's a mouthful;
if there's a question and time, I'll try to say what I mean by that.

There we have the whole array of elements that go into any health
system, the scientists ... and of course the basic health workers
that tend people in hospice and nursing homes. Eleven million of
them, highly trained, the envy of the world. There's no question
that that's the problem, that we don't have skilled workers.

So what else is left? Well, the capital element, the facilities,
the hospitals, the clinics, the MRI's. Where are we on that? We're
number one. It's boasted, ... in the usual Canada bashing, which
is standard operating procedure in this debate, to point out ...
that there are more MRI's in the Bay area around San Francisco than
there are in all of Ontario. It's a true statement. But is more
better, always? If you have a three million dollar MRI machine and
you have to pay top dollar for the skilled technicians around the
clock, there's a tendency to use the machine more. Your reason for
a head scan goes from suspect brain tumor to suspect brain, sometimes
even suspect head. Now, I'm being facetious, but there is no question
that the plethora of high tech, high cost equipment stimulates its
use, particularly if you organize the system on the business model that
Bob described.

Now, [about] national health systems. The system we support, we in
this case is the fastest growing medical group, doctor's group, in
the country, Physicians for a National Health Program. How many
have you got, Quentin? We've got thirteen thousand. But that's
doubled in the last year and a half. When JAMA, the Journal of the
American Medical Association, published our proposal called Physician's
Working Group Proposal for Single-Payer National Health Insurance.
And we have thirteen thousand. Out of seven hundred thousand, it
doesn't sound like much, but it's a lot. Our dues are fairly high,
and they pay them. Perhaps more important than the numbers we're
having are the people who are committed to support the program, and
not just raise a hand and say "I'll do it", they take courses. [
We offer speaker and leadership training to physicians. ] We did a
hundred and that was too many. So now we've cut the maximum to
sixty. We have wait lists of doctors who want to learn how to lead.
I don't know how many of you people are organizers, I have a feeling
that all of you are civically and politically concerned.

When you get hundreds of doctors across the country talking about
an issue like this and talking about it to their colleagues and
mentioning it on grand rounds, which is a standard way in which
doctors talk to each other - we give nearly 900 grand rounds,
which is a great number, in a whole year. In that way we bring the
message to our colleagues. Let me hasten to point out that we do
not believe that doctors are going to bring national health care
into being, but they certainly can be an impediment if they oppose
it and they certainly can make it come faster if they show its
virtues and that's what we're up to. We know the people will make
the decision, but the doctors can obviously play a big role.

And I say that because another organization that I belong to, one
worth mentioning by way of full disclosure, is the American Medical
Association. Fifty-two year membership, I agreed with their politics
for one and a half minutes in that long period of time. You ask
me why I pay such expensive dues.. The AMA has been a remarkably
reactionary group They succeeded in determining all health policy
of any importance at local, state, and national level up until 1965.

What happened in 1965? Medicare. Medicare was over their dead bodies.
Johnson's skill as a legislator ... Kennedy his assassinated
predecessor had nothing happening. He was a very dynamic man and
we remember him for his sacrifice, but the facts are, nothing
happened. It took Johnson's skills to bring a whole bunch of stuff
out of that congress: voter's rights act, civil rights act, food
stamps, Medicaid, Medicare, and he did it... We know for other things
he was not admired that much, but for that set of acts I for one
will remember him very well as a great leader. And Medicare was
squeaked through over AMA opposition. Up until that point AMA 
- nothing happened.

In 1937 when Social Security came forward, [some people] wanted
Social Security and national health insurance. And those who [watched
Congress] said it won't go - They had two thirds majority Democrats
New Deal was right behind them, but they couldn't get it out of
committee... The AMA as much as they could used the personal physician
of every legislator as their lobbyists. The AMA succeeded, I mean
that's an amazing run from 1911 when they took power to 1965 - never
lost anything. Well they are much weaker than that now, but still
very powerful. They are part of the reactionary [group] that are
trying to keep you from getting national health insurance.

Now [some points about the assigned topic] which I'd like to give
you very quickly. It is government financed, but mind you don't get
scared. We have government financed health: it's called Medicare.
It's a tremendous success. Medicare has weaknesses that were imposed
on it; in the defeat of AMA they got serious concessions, which are
part of the problem with Medicare.

For example there was no drug benefit. The traditional retrospective
explanation - well drugs weren't important in 1965. Now was anybody
here around in 1965? I was. Drugs were very important. They didn't
put it in. Because they wanted to keep - would you believe that
the original Medicare bill - they just now corrected it - prevented
payment for preventive care: a checkup, a mammogram, flu vaccine,
were not to be covered, that's in the law. Over the years the idiocy
of that was overcome, because it's not great to pay for a hospitalization
for pneumonia when a ten-buck shot would have prevented it.
I emphasize to those of you who hear these attacks on Medicare and
complaints about it should recognize, these were harms inflicted
on the system by its enemies and we don't have to have them.

A thousand dollars a year deductible - it's stupid. We don't need
that. Those deductibles, every one of them, are put forward by
business minded people on the logic that it will reduce use by
putting up financial barriers. You will, in proportion to a person's
ability to pay. If they're poor, a ten-dollar co-pay will keep them
away from the doctor. If they're rich, that's chump change. It
turns out, in our society, in every society, the sick get poorer
and the poor get sicker. You want your system to get to the poor
people. You don't want ten-dollar co-pay. It doesn't amount to
much. It just makes the system dysfunctional, and you have the added
cost of delayed care. 

So I want to also stress one thing because you're talking about a
government system of financing... We've done it, it has worked
wonderfully for all these years. It will work better when we make
corrections to the system but it is not anything to be frightened
of. However, we continue a private system of delivery of care. The
hospitals and medical practices remain private, except for the
traditional public hospitals about which we'll hear more later.
But the facts are that we must resist idiocy like calling it
socialized medicine. It is merely government financing of the
system and preserving the strengths of a private system of private
physicians and private hospitals.

Our private hospitals up until very recently were all - there were
no exceptions - were not-for-profit... Look at the names of the
hospitals in Chicago - they tell a story - Swedish Covenant, Illinois
Masonic, Mercy. They tell you the name of the group that fifty,
eighty, a hundred years back saw a need, came together in a volunteer
basis, and made a social compact. The compact is: you give us
services, round the clock emergency, obstetrical services, special
services according to population needs, and we in turn will give
you no taxes, they don't pay taxes, We will give you urban renewal
around your hospital to make it a better place and we will give you
grants... It's a match of local initiative, private patients, based
on altruism and service, religion and secular motivation.  We had
a very healthy system, not without flaws ...

We have had a new development [new problem], the advent of for
profit hospitals and surgical practices and all the other
business-oriented investor-driven arrangements that are the current
fad that everything will be solved by the market, the invisible
hand with extended middle finger. Well the point is, health care
is not susceptible to market forces. Do you need [bad] outcomes
discouraged, good competition where people who do well get more
business? That's fine, but to go to market solutions to get...  I
think ill of it. No other country has thought that you could solve
it that way. The marketeers are making a real run, through
globalization. They are attempting in Canada, Britain, all these
countries that have alternate systems to argue that flaws in the
system will be solved by market forces. It doesn't work in health
care. I don't doubt that it works with computers it appears, even
automobiles to a certain extent. There are models that seem to work.
But not in health care, because of the disconnect between your
need and your ability to pay. It's almost a hundred and eighty
degrees.

Indeed you have a good society that thinks... access to health care
is so important to human dignity and life that it is a responsibility
to society provide it. Then you talk national health [programs].
Everybody in, nobody out. [audience repeats] That's very healthy.

Now, having said all that, somewhat whimsically, I don't want to
underestimate the struggle. Let me make a prediction... There is a
coalition of powerful forces, that include the AMA, chambers of
commerce,... and by the end of this year we will be hearing from
them. There's going to be a potpourri of all the failed arrangements.
When they talk about tax credits or medical savings accounts as if
they are new things, they're not. They have been tried. They all
failed. They don't work. They don't work. And they talk about more
competition. [these options lead to bad outcomes, increased morbidity]
When you compare the not-for-profit sector with for-profit and
[for-profit] comes out worse in almost every database you've got.

[To] recount from the beginning - we have the resources, the
hospitals, the high-tech equipment, we have the work force, we have
the money earmarked. This is the only social justice problem I can
think of where you have enough resources to fix it almost overnight.
And everything else we are worried about, the greenhouse effect
(global warming), ecology,.. children's education, all these big
ones that civic-minded people worry about. When you get to health
care, all the elements are there. What's not there? The politicaL
will. That's the challenge to the American people. My view of
American history is just that, the ability to confront a problem
in the country as odious as human slavery ... having minimum wages,
addressing workplace abuses. We have the potential. As Churchill
said, "you always can count on the American people to do the right
thing, after they've tried everything else."

...The forces opposing us are awesome...I don't guarantee victory.
But I'm old enough, [having been] active in the civil rights
movement... So I commend all of you ... to become active, and that
includes everything from understanding the problem, forming church
groups, community groups,... [to solve this political problem].

Thank you very much.