802 Bookshelf: “Health Care Meltdown – Confronting the Myths And Fixing Our Failing System”

by Bob LeBow, M.D., M.P.H., JRI Press, $16, 268 pages, paperback

Volume CIII, No. 5May, 2003

In case you haven’t noticed, America’s health care system is falling apart, and policymakers can’t agree on what to do about it. It’s not hard to find signs of its collapse. Nearly every day, there are news reports about:

  • Health costs skyrocketing far in excess of inflation;
  • Growing race- and class-based health disparities;
  • Federal and state officials considering Medicare and Medicaid cuts;
  • Insurers denying benefits or abandoning policyholders;
  • Drug companies (with government help) suing to stop affordable pricing;
  • Strikes and other labor disputes over employee health benefits;
  • Workers becoming uninsured when employers cut benefits or drop coverage altogether.

“Health Care Meltdown” is the best book yet when it comes to explaining America’s health care mess and suggesting solutions for its problems.

Author Bob LeBow, until recently the medical director of an Idaho community health center, tells us how all other developed nations provide health care much more simply and efficiently.

These nations put everyone – young, old, sick and healthy – in the same health plan, reducing per capita costs and enabling them to cover all residents for far less than we spend.

“Meltdown” pulls no punches in attacking the Medical-Industrial Complex, a/k/a the “Evil Empire” or “The Gang of Four” (the pharmaceutical industry, insurance companies, hospitals and the American Medical Association) for spending millions on advertising, lobbying and campaign contributions.

Speaking from extensive public health experience in more than 20 countries, Dr. LeBow says our system is “unique in having a fragmented, inefficient, and administratively wasteful system that excludes one-seventh of our population from insurance coverage.”

How did such a state of affairs develop?

The author wryly suggests that Franz Kafka and Dr. Frankenstein designed our system, with a grant from the Alfred Hitchcock Foundation. In a more serious vein, he blames laissez-faire principles for helping to create “a ‘monster’ of a health care system, or more correctly stated, nonsystem.”

The Gang of Four’s recommended reliance on free market competition “has been an abject failure,” he says, because “buying health care is a far cry from buying a hamburger.”

The currently popular “personal responsibility” mantra is “an excuse to ‘blame the victim,'” and is simply a “ploy to (a) justify co-pays or (b) punish the poor, who often can’t afford the co-pays and thus delay care.”

“Meltdown” discusses the “perverse incentives” of employer-based coverage such as “job lock,” where workers are afraid to change jobs for fear of losing health insurance, especially when a family member is already suffering from a pre-existing condition.

But, kept clueless by corporate propaganda, most Americans “are generally unaware of what other arrangements could be feasible,” says Dr. LeBow. “They are also wary of change.”

To “people who object to giving government…a large role” in the system, he explains that federal, state and local governments already account for over 60 percent of all health care spending in the U.S.

His answers to special interests’ scare tactics that warn of rationing under a national plan: (1) health care is already rationed, inhumanely based on patients’ ability to pay; (2) decisions about allocating health care would be out in the open, rather than behind the closed doors of employers’ or insurers’ offices, and would be guided by public input; and (3) eliminating the present system’s waste and inefficiency would free enough resources to fund comprehensive services for everyone.

LeBow’s optimistic view is that despite the vast economic and political power of the Medical-Industrial Complex, time is on the side of advocates for a national, “one risk pool” health care program.

He predicted that by 2003 (that’s now) health care problems would resemble “A Perfect Storm,” with growing numbers of uninsured, rapidly rising insurance premiums, a worsening economy, increasing unemployment, employers demanding relief and state governments approaching fiscal panic. His forecast was all too accurate.

Dr. LeBow also foresaw groupings like the coalition behind the recent “Cover the Uninsured Week” which includes labor, management, insurers, drug companies, doctors and hospitals.

“I personally won’t believe they’re serious about doing anything more than wringing the last dollar they can possibly squeeze out of the system until they put their money where their words are,” says LeBow. “I’d like to see the drug companies, the insurance industry, and the AMA pool their resources on a $60 million publicity effort to persuade Americans to support national health insurance,” he writes. “It wouldn’t be so impossible if business joined the bandwagon.”

Despite the present Washington administration’s opposition to universal health care, LeBow finds hope in Sen. John Breaux’s (D-LA) recent defection from the Medicare-privatizing camp and advocacy of “health care as a basic right.”

“Political winds can shift quickly,” he says, and “2004 is not far away.”

Shortly after this book was published, Dr. LeBow suffered a broken neck in a bicycling accident and is now a quadriplegic. It would be a fitting tribute to his inspiring work if “Health Care Meltdown” became a best seller. It should certainly be read by all Americans who are interested in improving our health care system.

If you can’t obtain “Meltdown” from a bookstore (where sales count toward the best seller listings), it is available from JRI Press, 5398 N. Cattail Way, Boise, ID 83703 or at It may also be found in Local 802’s library.

– John Glasel