Nearly 25 years ago, as I began a career as a physician, I became aware of how poorly our American health care system was working. I saw how millions of people were being denied the care they needed. I saw my own patients being pushed in to bankruptcy by medical bills. I could not understand how we as the richest nation in the world could allow this to happen. I come before you now with two goals today:

1. The first is to show you how utterly broken our health care system is.

2. The second is to convince you that there is only one cure for our ailing health care system: universal health insurance under a single-payer. I will explain what a single-payer is later. It is sort of like Medicare-for-all. But first let us talk about health care in America as it is now.

46 million Americans have no health care insurance, including over 11 million children. Over 80% of the uninsured live in a household with at least one full time working adult.

America has the highest number of citizens without health insurance- -.Which wealthy nation has the second highest?? It's a trick question.

Every other industrialized nation in the world including all of Europe, Japan, Canada, even Taiwan-all of them provide health insurance to every one of their citizens. This is a moral issue: America is the richest nation in the world, and yet we stand alone in allowing citizens to go without health insurance.

Let me tell you about some people without insurance seen by a colleague of mine at a community clinic and hospital:

1. Julie, a 24 year-old single mother of two who is very ill with fevers and weakness, delays coming in for a few days because she is afraid of the bill. She dies the next day with a bacterial infection of her heart valves.

2. Teresa, a 29 year old married mother of two who skips prenatal care because she cannot afford the fees. She comes to the hospital two weeks overdue with a dead 12-pound baby; she herself dies of a complication of pregnancy- amniotic fluid embolus.

3. Ralph, a 37-year-old diabetic, does not take his diabetes medications for a few years because he cannot afford them. He presents with sudden blindness from diabetes- retinal bleeding and is also found at the same time to have severe kidney failure from diabetes- He is now blind and on chronic kidney dialysis.

It sounds bad doesn't it? But it gets worse.

You see, another 45 million Americans are underinsured for health care- what that means is that they have health insurance, but their health insurance is so inadequate that if they actually have a serious illness, they would either be unable to get the health care that they need or the cost of the treatment could leave them bankrupt.

Examples of the underinsured: over 1 million workers at large employers, such as McDonalds, have health insurance that covers up to a maximum benefit of 1,000 dollars per year. How much would 1,000 dollars help if you needed major surgery?

Another example: 9 million women of child bearing age in our country have health insurance that specifically does not cover any prenatal or OB care.

Think about that--- if you were designing a health care system, does it make sense to allow millions of women to have insurance that actually encourages them when they are pregnant to not seek prenatal care??

If you total the numbers, around 90 million Americans either have no health insurance or have totally inadequate insurance-that is one out of every three Americans.

How can we be so different from all other wealthy nations?? It turns out that America is the only nation to have a health care system based upon the free market. All other industrialized nations have planned health care systems that are based on universal health insurance.

So what's the difference??

1. Well, in America's free market system, we "shop" for health insurance, and millions of Americans cannot afford to pay for it. For some people, employers do the shopping for them, but health insurance is a commodity in our country just like selling automobiles and refrigerators.

Every single other industrialized country- even those with strong free market economies like Japan and Germany-think health insurance is not a commodity to be bought and sold, but is a basic right guaranteed to all of their citizens.

2. The second difference: In America, pursuit of profit is the number one goal in health care. The underlying theory that drives our system is that, in the free market, corporations seek to increase their profits while competing to provide health care, and that this competition will result in a more efficient system with better health care for all.

Thus large for-profit stock-owned corporations oversee or run the majority of our health care: Think of PacifiCare, United health care, and Banner.

In all other industrialized nations, for-profit companies do not play any major role in health care, and the health insurance is essentially all non-profit.

3. A third major difference is that most Americans have a managed care company or HMO that oversees their care. Examples of this managing of health care are: a. most insurance plans have limited provider networks-- you cannot see any doctor you choose. You cannot even go to any hospital or laboratory that you choose. b. They all have limited prescription drug formularies in which only certain medications are approved. c. when your doctor wants to perform surgery or admit you to the hospital, the physician needs to ask for approval from the managed care insurance company before proceeding.

I know that it seems like a radical idea, but in all other Western nations, doctors and patients are actually trusted to make their own decisions about health care.

The WHO has ranked health care systems across the world. Does anyone know where America ranks as to quality of our health care??

37th- Just for fun, here is a little homework to do with your children tonight-try to name 36 other countries in the world, but don't allow yourself or your child to name any third world or developing countries. It's not easy.

It is a moral crisis that we allow so many to be harmed by what should be a basic right-a right to good health care.

But we also have a medical crisis in health care: 1. One out of every nine Americans with diagnosed diabetes has no health insurance. 2. One out of every nine Americans with diagnosed high blood pressure has no health insurance.

There are huge numbers of Americans with all kinds of treatable illness that cannot afford relatively cheap and highly effective treatments such as insulin.

It is heartbreaking to me-- In my practice I see patients every single day that are unable to get the help they need because they cannot afford it. I went to medical school because I wanted to help people, but in America often times what I do is help put people in to bankruptcy.

As a country what makes the most sense??

To pay pennies per day for preventive treatments,.or allow millions of Americans with medical problems to go untreated, and then have them present a few years later with a stroke or a heart attack??

let's talk about the economics of health care:

===> America spends over $6,000 per person every year on health care-this adds up to $1.7 trillion. That is twice what every other nation spends on health care.

===> If we paid the same as the second most costly nation in the world, we would save over $800 billion every year.

===> Think of the crisis with social security, the cost to fix it is peanuts compared to this. Think of the cost of recovering from hurricane Katrina and preparing for future national crises. Think of our increasing national debt- we are passing on hundreds of billions of dollars every year that our children and grandchildren will be stuck paying back.

===> If we reformed our health care system we would save enough money to balance the budget and take care of social security, Medicare, hurricane Katrina, and numerous other important programs.

Health care costs are also killing American business. Paying for health care for its workers adds $1,500 to the cost of every car built by General Motors in America. And every other American business has the same handicap-huge added costs because of health care when compared to their foreign competitors.

Thus thousands upon thousands of American jobs are being sent overseas at least in part because our companies have to pay so much for health care.

In fact, having health insurance in America is sort of a misnomer since for many of us it provides almost no security from the risk of financial devastation by illness.

Over half of all bankruptcies in America result from unpaid medical bills and illness- this affects over 2 million Americans each year. And 75% of those bankrupted by illness actually had health insurance at the time they got sick. Also, it is often the American middle class that is losing health insurance when they need it most. Think of this: increasingly American business is dropping health care benefits-especially retiree benefits. It is predicted that within a decade almost no companies will offer retiree medical benefits. So I have a question for all of you-Do you or anyone you know plan to retire from their job before they turn 65? I wish you all good luck in finding health insurance, because it is doubtful your company will provide it.

From a fiscally conservative point of view-universal health insurance is a slam-dunk. No wonder that in every other industrialized nation, an overwhelming majority of political conservatives support universal health insurance.

In the past 120 years, no country that has tried universal health insurance has ever decided to go back to a free-market approach.

So how does a universal health insurance system work and what is single-payer?? Single-payer means a single insurance entity would cover every American, like Medicare for all. Except it would be a much stronger, better Medicare.

Why? Because we would all have the exact same health insurance- President Bush, the local Wal-Mart employee and the unemployed would all have the same insurance. No one would be allowed to buy his or her way above the rest of us. This guarantees good benefits.

Once passed into law, it would have strong political support since we all sink or swim together.

Please note: Single-payer is not socialized medicine-only the insurance function is centralized.

1. The actual delivery of health care would remain private.

2. doctors would keep their private offices and

3. local hospitals would continue as private non-profits.

4. We would be rid of the large for-profit corporations

5. We would pay for our health care system with taxes: The shocking fact is that currently the United States pays more in taxes for health care than every other nation in the world pays for their entire health care system.

So with universal health insurance under a single-payer there would be no health care premiums or deductibles, and there is already plenty of money in the system to allow everyone to have good health insurance.

1. All 290 million Americans would be in the same insurance pool-- with real buying power to lower prices for doctors' fees and prescription drugs. 2. No family would ever be bankrupted by an illness. 3. Much better preventive health since checkups and doctor visits would be free.

4. Dramatically less bureaucratic waste: a single-payer uses less than one penny per health care dollar to administer insurance and takes no profit. Does anyone know how much our for-profit insurance companies take in overhead??

5. Under single-payer --if you end up in a nursing home, you don't have to worry that there goes your retirement savings, because under single-payer-- long-term care is fully covered.

Finally, I want to touch on why no other health reform plan will work. We have the only free-market for-profit run health system in the industrialized world. We have had more than 30 years to compete with planned universal heath insurance systems, and the results are clear.

1. We rank at the bottom on every measure of quality and

2.our costs are twice that of every other nation.

If you try to reform health care, but you leave in place the free-market approach, and you allow for-profit companies to run the system, it won't work. In fact, we have already tried these incremental reforms many times, and they have never worked.

For examples, just look at previous Medicaid expansions and the Children's Health Insurance Program.

Numerous states have also tried to reform our current system, leaving intact our free-market approach. All have failed miserably.

How about expanding Medicaid or have some other " basic" bare bones health insurance to cover all Americans as a back-up to our current insurance companies??

===> Let us not fool ourselves-in America every program that is tailored to be a safety net for the poor, is chronically underfunded, and future plans by our political leaders- both Democrats and Republicans-are to cut those programs even further. In fact this year Congress cut funding to Medicaid by billions of dollars even after hurricane Katrina left tens of thousands without health insurance.

===> So if we pass a bill for bare-bones Medicaid type coverage, plan on its budget being cut every few years because the healthy, the middle class and the wealthy, who can purchase their own private insurance, will not want to pay much in taxes for something they don't think they will ever use.

===> Plus current Medicaid is lousy health insurance: Most physicians refuse to see or try to avoid treating Medicaid patients. We don't treat any Medicaid in my clinic at Poudre Valley Hospital, and when someone with Medicaid is admitted to my ward, we actually lose money on him or her. The largest pediatric practice in Colorado canceled its Medicaid contract in 2004 stating they were losing 20 dollars every time a Medicaid patient came in to see them. Only one in four Colorado Pediatricians treats children with Medicaid without restrictions.

If the politicians try to convince you of some health care reform plan that leaves the for-profits in place, just say no. If they try to leave our free-market approach intact, just say no. Or if they want to pass some reform bill that does some incremental change promising someday in the future they will work toward universal insurance, just say no! In fact we don't want health reform- it does not work. Tell them-what you want is to scrap our profit and greed driven system.

If you want America to have a great health care system with universal health insurance, tell them you want single-payer!!

Health insurance as a guaranteed right, not a commodity Everyone in, nobody left out-you and President Bush, the exact same insurance It should cover all medically necessary care, cradle to grave. It's Single-Payer Thank you.

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Let me tell you about Jill. She is in her 40's, has two young children, had a husband Mark who works full-time, and a few years ago they celebrated their 20th wedding anniversary. Then Jill was diagnosed with a serious medical condition. They had insurance, but it didn't cover the many thousands of dollars in medications. They are devout Catholics, but because they were going bankrupt from her medical bills, they made the heart wrenching decision to get divorced so that Jill could qualify for Medicaid. Who wants a health care system that encourages people to get divorced?

In 1993 a reform plan was passed in Minnesota with the goal of lower costs, better quality and universal insurance, by 1997. The main two reforms were more reliance upon HMOs believing that they would lead us to lower costs and universal insurance, and a bare-bones back-up health insurance plan subsidized by tax dollars called MinnesotaCare. About 90% of twin cities residents are now in HMOs: the result: health care costs have gone up by double digits in Minnesota every year just like the rest of America, and more Minnesotans are without health insurance now than when the bill was passed.