In the health care section of the Gray Panther Manual published in 1980, Barbara Creagh, then chairperson of the National Health Task Force, wrote: "Gray Panthers believe that health care is a right to which all people are entitled-babies and the elderly, and people of all ages in between; the poor and the rich; those without jobs and those who are employed."

Most of us probably still believe that. And most of us probably would also agree that "…our present profit-oriented, sickness care system is not providing health care to the people of this country, but is a nonsystem that is a barrier to health care" -another quote from 1980 which indicates how little things have changed.

Well, how should our health care system look? The members of the San Francisco Gray Panthers Health Care Committee have done a little brainstorming on this, and we'd like to throw out some ideas. The goal is to draw in broad strokes a model to which we can compare various proposals for single payer and/or universal health care-the Kuehl bill, Bodaken/Blue Shield proposal, the Conyers-McDermatt bill, and others down the line. We strongly encourage anyone who's interested to join the Health Care Committee and help us with this project.

In establishing their federal system, the Canadians began with five very simple principles, which seemed a useful starting place. These were that "…core medical services should be universal, portable, accessible, comprehensive, and publicly administered."

Health care should be universal.

Health care should be free to all-no co-pays, no deductibles, no monthly payments. It should be given on the basis of need only, not ability to pay; not immigration status or residence; not age, gender, or race; not health status. No one, no one in our society or any society should sicken or die because they cannot afford to see a doctor or afford care which is available to those with more money. In addition, there should be a one-tier system, so the rich and the poor go to the same providers, clinics, and hospitals and thus have the same interest in high standards of care for all. And there should be a single risk pool which includes everyone from the catastrophically ill to the glowingly healthy.

Health care should be portable.

All of us know people who would like to move, but can't because of their health insurance coverage. A member of Blue Cross of Nevada, for example, must reapply for health insurance if she moves to California…and unless she qualifies for a group plan, may find any serious medical condition excluded from coverage. People with cancer, heart disease, chronic back problems, etc., often are forced to remain where they are because of the need for health insurance at a time when the need to be closer to family is paramount. Why should insurance companies decide where we live? Or where we work? Many people stay in jobs they hate because they cannot afford to give up the coverage provided by their employer's group plan. A health plan should cover everyone regardless of where they live or work. And you should be able to take it with you when you travel.

Health care should be accessible.

In San Francisco, we have many medical providers and hospitals, but they are not evenly distributed throughout the city. Certain neighborhoods-Bayview-Hunter's Point, Ingleside, Excelsior, outer Sunset, are quite a way from a hospital, and in some, doctors' offices are not plentiful. Many doctors do not accept the low reimbursements of some insurance plans, and this, too, limits access to care.

But compare this to rural areas. In Susanville, a town of 17,000 in northeastern California, people diagnosed with cancer must go to Reno-one and a half hours away by car and in a different state-for radiation therapy. There is no bus or rail service between Susanville and Reno, no public transportation at all. People either rely on family or friends to drive them-a four to five-hour commitment-or, what? Hitchhike? Die?

Accessibility can be a life and death issue. Sick and premature babies often are transported by ambulance, helicopter, or plane from areas which have no intensive care nurseries to the big city centers. Tiny, fragile babies are not easy to stabilize during a jouncing ambulance ride, and some of them suffer severe consequences. If you give birth to a premature baby in Eureka, that baby will be transported to an intensive care nursery in Sacramento or San Francisco where he could stay for months, while his parents desperately divide their lives between their ill infant in San Francisco and their jobs and families in Eureka.

How would a rational system deal with this problem? Well, statewide, or even better, nationwide planning would help-an agency which looks at the health needs of the population and tries to distribute the resources fairly. Is it really necessary, from a health care delivery point of view, for all the technologically advanced hospitals to be located in densely populated areas? Possibly it is. But as long as much of that decision is profit-driven, we're not likely to find out.

Health care should be comprehensive.

Everyone should have the same coverage: prevention, screening, outpatient visits, and hospitalization; physical therapy, occupational therapy and speech therapy; home care, long-term care and hospice care; drug and alcohol rehabilitation, inpatient and outpatient psychiatric care; durable medical equipment and medical supplies. And drugs. Let us definitely not forget drugs. Why do we keep hearing these horrible stories about people who have to choose between buying food and buying medicine? Because of profiteering by pharmaceutical companies whose interest is selling products, not enhancing health. This is such an outrage. It should not be happening.

All the alternative therapies that are proving so useful should also be covered: acupuncture, chiropractic, osteopathy, Chinese herbal medicine, Feldenkrais, etc. How do we know they work? The same way we know anything works-research and trials. Money must be allocated for basic and applied health research untainted by funding from the pharmaceutical and medical equipment companies who could profit from it.

This list is not meant to be complete. It is meant to suggest a wide and generous scope for the health care system we should have. We need a system which isn't quibbling over every penny spent on individual or community health.

How is it possible to achieve this?

The health care system should be publicly administered and publicly funded.

In every clinic and hospital, there are far more people processing claims and collecting bills than there are people practicing medicine. If a patient covered by, say, Blue Cross/Blue Shield, goes to the doctor, the patient must fill out forms which the doctor's office must process and send to Blue Cross/Blue Shield where a claims person processes them again. If the claims person questions the submission (as is his job, since insurance companies make more money if they can deny claims), the papers go back again to the the doctor's office and the cycle repeats itself. And these claims people have supervisors and managers and adminstrators and CEOs. There are huge health insurance conglomerates, building after building of them, where no one is practicing medicine. When we or our employers or the government pay for health insurance, much of it goes to support these extra-medical activities.

Now, imagine the beautiful simplicity of a plan which allows anyone with a health card to have any treatment recommended by a medical practitioner and covered by the plan. One plan, one bureaucracy. If we took even half the money we and our employers and the government are now paying in health insurance and co-pays, we could have a magnificent health plan which would give better coverage to all of us who are insured and would also cover the 41 million (and growing) uninsured. Take the profit out of health care and patients will benefit. Yes, we might have to pay more taxes. But wouldn't you rather pay taxes for a better system than you now get by paying health insurance premiums-especially if it would cost less?

One last point:

The health care system must be built on a foundation of strong, community-controlled public health.

In Richmond, there are extremely high rates of asthma, cancer, lupus, liver problems, and other serious illnesses. Many people in the community believe dioxin-containing emissions from the oil refineries have a lot to do with this. No scientific study has supported this belief because none has been done. In a rational system, high disease rates would be investigated and corrective action demanded. Why has this not been done?

The truth is, the U.S. public health system is in a shambles, and what little is left of it is being redirected to defense against bioterrorism. Who, then, is responsible for making sure the air and water are clean, the food uncontaminated, the soil free of toxins? A hodgepodge of underfunded agencies so hogtied with restrictions and exemptions as to be virtually powerless.

In her book on the collapse of global public health, Betrayal of Trust, Laurie Garrett writes:

…the basic factors essential to a population's health are ancient and nontechnological: clear water; plentiful, nutritious, uncontaminated food; decent housing; appropriate water and waste disposal; correct social and medicinal control of epidemics; wide-spread-or universal-access to maternal and child health care; clear air; knowledge of personal health needs administered to a population sufficiently educated to be able to comprehend and use the information in their daily lives; and, finally, a health care system that follows the primary maxim of medicine: do no harm.

What we want, and need, is a public health system which protects the public's health, and free, universal, comprehensive, publicly-funded and administered health care. At the beginning of the 21st century in the richest country in the world, this should not be beyond our capabilities.