Private for-profit insurance is the very cause of our healthcare crisis--not the solution (MJS editorial, 10/7 "Mandating Coverage: A Sensible Solution" )

"Private insurers maximize profits mainly by limiting benefits or by not covering people with health problems," points out Dr. Marcia Angell of Harvard Medical School. "The United States is the only advanced country in the world with a health care system based on avoiding sick people."

How will a mandate for individual coverage address this basic yet perverse motive of the health-insurance industry? Nor will it address the enormous waste from this huge private-sector bureaucracy dedicated expressly to denying insured to those with "pre-existing conditions" and refusing coverage to the insured whenever possible.

The amount of excess administrative overhead in the US as been estimated to range from $98 billion a year by the corporate-friendly McKinsey Group consulting firm to $399 billion by Harvard Medical School scholars and Drs. David Himmelstein and Steffie Woolhandler writing in The New England Journal of Medicine.

Mandating that individuals purchase private insurance will not address this administrative waste, and thus fail to contain the astronomical costs of insurance premiums. Nor will individual mandates guarantee coverage of the 47 million uninsured. Such a mandate is flopping in Massachusetts and is sure to fail nationally, simply because the near-poor could not afford it before the mandate was imposed and cannot afford it now.

As for the alleged virtue that individuals should pay private health insurers simply because it is "familiar," why not recognize that Americans are also very familiar with paying for libraries, police and fire protection, and other basic public goods through public mechanism? Healthcare is an essential human need, and trying to further "corporatize" it will only add to the cost and complexity.

The Journal Sentinel contends that a single-payer, like those in Canada, Taiwan,and France, is not "politically doable," If so, there are two simple reason: insurers' campaign contributions short-circuit democracy by intimidating Congress and state legislatures, while elite politicians and the media like the Journal Sentinel refuse to recognize the overwhelming majority opinion of the American people, To cite just one poll, Business Week (5/17/05) summarized its own poll in these terms: “67% of all Americans think it’s a good idea to guarantee healthcare for all US citizens, as Canada and Britain do, with just 27% dissenting,” .

As Leo Brideau, president and CEO of Columbia St. Mary's healthcare in Milwaukee,. explains it, private insurers "don't take any risk by simply serving as third-party claims processors and yet spend 70 cents of the premium dollar on health care and the rest goes to shareholders."

Since for-profit health insurers take no risk yet add immensely to healthcare costs and complexity, they must no longer be the commanding force in our healthcare system. Replacing them with a single state-level payer, funded by employers, workers, and the public, would dramatically cut costs, ensure access, and improve quality. This step is long overdue.

The willingness of presidential candidates--especially the Democrats' Hillary Clinton (whose lackluster plan was based on close consultation with the medical-insurance industry), Barack Obama and John Edwards--to confront this reality and confront the for-profit health insurance industry will be a fundamental test of their fitness to lead America in 2008.