Fix the prescriptions.

In this Presidential election year, universal health care ought to be a popular demand. Actually, it already is. According to an ABC-Washington Post poll last October, 62 percent of Americans favor a government program providing universal coverage, while only 32 percent oppose it. Unfortunately, the proposals of the two major candidates do not come close to universal care. Meanwhile, the reliance on the private health care system grows more and more malignant.

At present, forty-four million Americans are without health care, and more than one-third of these are from families below the poverty level. The uninsured have much poorer health, as a result. "Compared to persons who have health insurance, the uninsured receive less preventive care, are diagnosed at more advanced disease stares, and once diagnosed, tend to receive less therapeutic care and have higher mortality rates," according to the Kaiser Commission on Medicaid and the Uninsured. This results in 18,000 deaths a year among uninsured adults between the ages of twenty-five and sixty-four, according to a 2002 study by the National Academy of Sciences' Institute of Medicine.

For those who are insured, the cost of health care keeps rising. Employees are having to pay more money for premiums and co-pays and deductibles. For instance, in 2003, the average monthly employee premium contribution was $201, up from $178 in 2002, according to a 2004 Kaiser report entitled "Trends and Indicators in the Changing Health Care Marketplace" (www.kff.org). And retirees are getting hit, as well: Some 71 percent of employers have increased the amount that retirees have to pay to get coverage.

Even though Americans are shelling out more, they are not happy with what they are getting in return. Discontent with our current system runs high, with 54 percent of Americans dissatisfied with the overall quality of health care, the ABC-Washington Post poll found. And 79 percent of Americans expressed concern that they may be unable to afford health care when a family member gem sick, according to the Kaiser Family Foundation.

The total cost of our health care system is going off the charts. "Expenditures in the United States on health care have nearly doubled (+88 percent) since 1992 ... and are more than six times the $246 billion spent in 1980," the Kaiser report notes.

States, which use about 21 percent of their budgets on Medicaid, are trying to cut costs by scrimping on coverage for the poor. Tennessee is a prime example. Its plan "would limit the number of prescriptions and doctor visits for any patient and direct doctors to use the cheapest treatment alternative" for Medicaid patients, reports USA Today. It would cap doctor visits at ten a year and lab or X-ray procedures at ten a year. It would pay for only six prescriptions a month. And it would eliminate two categories of drugs--antihistamines and gastric acid reducers--from coverage altogether, said USA Today.

The Bush Administration, which has yet to approve Tennessee's plan, seems to be leaning toward it.

No wonder. For Bush, the answer to almost everything is less government. "Health care costs continue to rise not for lack of government involvement, but because too much government has crippled the normal market processes that allow individuals to have more control over their health care spending," his campaign website states.

Bush wants to make the individual even more vulnerable to market forces. "He would move the country from its group-insurance modal to one in which individuals, some armed with new tax credits, shop for health care like they do any other product or service," The Wall Street Journal notes. He would offer tax incentives to individuals who don't have health insurance and tax breaks for those who buy high-deductible insurance policies. But the millions who aren't in a bracket to be lured by these tax breaks are out of luck.

When John Kerry gave his speech announcing his pick for Vice President, the one line that got the crowd chanting Kerry, Kerry" was when he advocated "health care for all."

Kerry's plan has its good points. He vows to spend a lot of money, as much as $653 billion over the next ten years, to plug some of the holes in the system, and he pledges to finance it by' rolling back Bush's tax breaks to the rich.

Rather than go whole hog, Kerry's approach is one of "raging incrementalism," as The Wall Street Journal reports.

The best thing that the Kerry program has to offer is the pledge he would "assure that nearly 99 percent of all children have health care coverage." And it would expand coverage for other vulnerable groups, including immigrants.

But how would Kerry do this? He is offering a swap to the states: The federal government would cover all of the expenses of "the nearly twenty million kids enrolled in Medicaid," which is now a shared program. In exchange, the states would pick up the expenses for the shared State Children's Health Insurance Program. This program covers children up to nineteen years of age who are in families that earn too much to qualify for Medicaid.

"To participate in the swap, states would agree to expand eligibility for children to 300 percent of poverty," the Kerry website says.

But what if states don't go for this swap? The Kerry plan does not indicate how it would try to prevail on obdurate statehouses.

What's more, for single, childless adults, the Kerry plan says, basically, we'll catch you later. "There are approximately six million adults who are uninsured and live below poverty," the website says. "Once states get back on course to a more secure financial footing, they would cover single adults and childless couples at or below the poverty level."

Kerry offers a variety of tax incentives to companies, including offering to pay "75 percent of the catastrophic costs they incur above $50,000 as long as they guarantee such savings are used to reduce to the cost of workers' premiums." It's a sweet deal for companies, but how would Kerry make sure they lived up to their side of the bargain?

All in all, it's a complicated package that keeps in place the perverse system of private health insurance that is at the root of our health care ills.

Two candidates this year do understand the kind of changes that are necessary for our health care system: independent Ralph Nader and Green Party Presidential nominee David Cobb. Both have come out for universal health care.

"The Nader campaign supports a single-payer health care plan that replaces for-profit, investor-owned health care and removes the private health insurance industry (full Medicare for all)," says the Nader campaign web site. It explains how it would fund such a system: with a 7 percent tax on employers and a 2 percent increase in the income tax. (Most people would still come out ahead because they won't be paying for premiums.) "The time to act is yesterday," the Nader website says. "Let us end our disastrous descent into the corporatization of medicine and its callous consequences.

The Cobb plan, while less detailed than Nader's, is similarly unequivocal. "The currant U.S. health care system is a disgrace to our ideals of justice and equality," the Cobb website says. The answer, it says, is "public funded, universal health care insurance."

Neither Ralph Nader nor David Cobb is in a position to prevail in November. But by banging away at the need for national health care, they are providing a much-needed service this election year.

It is a terrible indictment of our democracy that though the people want universal health care, and though citizens in every other advanced country enjoy it, we have not yet been able to achieve it. And that is because the insurance companies, the Health Maintenance Organizations, and the hospitals that make money off of our privatized system of health care hold too much sway in Washington. Our health care system is ill because the profit motive is poisoning it.

The number of working-age adults without health insurance for more than a year was 24.5 million at the end of 2003, an increase of 2.6 million from the year before.

--The National Center for Health Statistics 

"A reduction in mortality of 5 percent to 15 percent could be expected if the uninsured were to gain continuous health coverage."

--The Kaiser Commission on Medicaid and the Uninsured