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America's Two Healthcare Systems

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Two months ago, I opened the mail to find new health insurance cards for me, my wife, and my son. We were now covered, apparently, by a new insurance company. We had no warning that this change was coming. The new carrier apparently thought we already knew about this, because it explained nothing. The cards were accompanied by a short letter that said, "Here are your new insurance cards!"

Don't get me wrong -- I'm happy to have health insurance. The U.S. Census Bureau reported this morning that the number of uninsured Americans has risen again, to 47 million in 2006, up from 44.8 million a year earlier. That's 15.8 percent of the population -- nearly one in six Americans. That figure has been increasing since 2000, and there is every reason to think it will continue to climb.

So I'm glad to have health insurance, as confusing and mysterious as it sometimes seems. My family and I are covered under COBRA, following a job my wife left a year ago. I suppose the employees at the place where she worked were told about the shift, but we were told nothing. I had to call the insurance company -- which initially couldn't find us in the computer -- to ask for something explaining our benefits. And I asked how much we owed now, and where we should send the check. "Oh, you will have to check with your COBRA administrator," the woman on the phone said. I didn't know I had a COBRA administrator; we'd been paying the previous insurer directly.

It took another computer search, and consultation with others in the office, for her to figure out who our COBRA administrator was. I called said administrator, and I was told what my bill would be. I paid it. Now it's the second month, and I've still received no bill. I called yesterday to check, and I was told we're not in the computer system.

Why do so many Americans still think we have a perfectly fine health care system? Have they never filed a claim? Have they never had a question about a bill? Have they never had to fight for coverage of a so-called pre-existing condition? Have they never been surprised by a large co-payment at the drug store because their doctors was foolish enough to prescribe a brand-name drug? Who are these people? And where are they getting their health care? Because they clearly must have a better arrangement than I do.

The Kaiser Family Foundation released a poll yesterday looking at public perceptions of health care in the wake of Michael Moore's documentary critique of the healthcare system, SiCKO. Of those who had seen the movie or heard about it, 43 percent said they were more likely to see a need to reform U.S. health care. Nearly as many were more likely to think other countries had better health care than the U.S.

But, astonishingly, health insurers, drug companies, and HMOs -- three of the organizations that need reforming -- were still viewed favorably by about half the American public.

It's actually not as astonishing as it might seem, when we realize that we have two health-care systems in this country -- one for the middle- and upper-classes, and another one for the poor.

As critics of healthcare point out, the U.S. does not rank favorably in terms of infant mortality rate and longevity. Most of Western Europe beats us on that measure, as do Slovenia, the Czech Republic, South Korea and Cuba.

But here's the catch: Suppose we calculated the infant mortality rate only for our well-to-do citizens. We'd leave South Korea in the dust, man. We'd be way up there! It's the poor people, with their poor infant mortality rate, who are making us look bad. It's their healthcare system that stinks, not ours.

The same is true for longevity, another measure on which the U.S. ranks below most of its industrialized peers. The poor people are bringing down the stats.

The reason so many Americans like their health care system is that they are the fortunate half; they do pretty well. I can deal with the confusing, badly run insurance companies that provide my coverage. That's merely an inconvenience. In the end, as a member of America's functioning health care system, I'll get pretty good care most of the time.

The question is: How long can we watch our less fortunate citizens, including the growing numbers of uninsured, die young and suffer a disproportionate share of infant mortality?

How long can we tolerate two health care systems, one that works, and one that doesn't?