- Jarret B. Wollstein

Affordable health care has become one of the most important social issues of our time. Every news broadcast seems to have a special report on "America's health care crisis" or a politician demanding "universal health insurance." Evidence cited for the need for immediate and drastic government action includes:

High medical costs. The United States reportedly has the highest per capita medical expenditures of any country in the world. According to Insight magazine, U.S. citizens spent an average of $2,051 on health care in 1990, compared to $1,483 for Canadians and $1,093 for West Germans.

Rapid increase in medical expenditures. The average American now spends 11.1% of his income on medical care. If current trends continue, health care will consume over 17% of the Gross Domestic Product within 15 years.

High administrative costs. In the U.S., administrative costs consume nearly 12% of health dollars compared to 1% under Canada's socialized system. More than 1,100 different insurance forms are now in use in the United States.

Americans without insurance coverage. At any given time, over 13% of Americans have incomes that are too high to qualify for Medicare or Medicaid, but are too low to pay for medical insurance themselves. [1]

The free market in health care, we are told, has failed. The solution offered by a growing chorus of commentators and candidates is universal, mandatory, national health insurance; in other words, socialized medicine. Is socialized medicine the answer, or will it only make things worse?

HOW WELL HAS SOCIALIZED MEDICINE WORKED ELSEWHERE?

Most of the developed countries of the world presently have some form of socialized medicine. How well has it worked?

Great Britain. Great Britain adopted socialized medicine in 1948, with the creation of the National Health Service (NHS). The political rhetoric in Britain exhorting the adoption of nationalized health insurance is similar to what we are hearing in the U.S. today. In 1942, Prime Minister Winston Churchill declared:

"The discoveries of healing science must be the inheritance of all. ...Disease must be attacked whether it occurs in the poorest or the richest man or woman, simply on the ground that it is the enemy. ...Our policy is to create a national health service, in order to secure that everybody in the country, irrespective of means, age, sex, or occupation, shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available." [2]

With the adoption of national health insurance, Labour Minister Dr. David Owen predicted, "We were going to finance everything, cure the nation and then spending would drop." [3] Unfortunately things didn't work out exactly as planned.

The first problem with Britain's National Health Service was skyrocketing demand. With health care paid entirely by the government, there was no reason not to go to a doctor. Why take aspirin or wait out a cold, when professional medical care is free? As Michael Foot observed, within months "the demand (for health care) was exceeding anything (its creators) had dreamt of." [4] First-year operating costs of the NHS were 52 million pounds higher than original estimates. [5]

NHS soon found itself in direct competition for funds with national defence, pensions, and all other governmental functions. Budget cuts for NHS quickly followed. British economists John and Sylvia Jewkes estimated that between 1950 and 1959 the United States spent six times more per capita on hospital construction than England. [6] As a result, there was a steady deterioration in the quality of British medical care.

By 1977, British general practitioners rarely had any medical instruments except for stethoscopes and blood-pressure meters. They had to send their patients to hospitals even for such routine procedures as X-rays and blood tests. The waiting time for routine, non-emergency surgery had increased to years. [7] By the mid-1970s, more than 700,000 English men, women, and children were on hospital waiting lists at any given time. [8] The average British doctor now has over 3,000 patients, compared to 500-600 for the average American doctor. NHS doctors spend an average of less than five minutes with their patients, who usually wait hours to see them. [9]

In 1975 Bernard Dixon, then editor of the British magazine New Scientist, provided this summary of the state of National Health Insurance:

"The plight of Britain's Health Service conflicts desperately with the avowedly utopian ideals of its founders. For most of us, it is only when we join a year-long hospital waiting list, or have to take an injured child to a hospital casualty department, that we realize just how threadbare and starved financially the service really is. Not only is there an acute shortage of resources, but the expertise and facilities that are available are all to often dispensed via a conveyer-belt system which can at times be positively inhuman." [10]

As a result of widespread public dissatisfaction, in 1989 the British government began dismantling its National Health Service, and reintroduced market-based health care competition. [11]

Canada. What of the Canadian National Health System, which many U.S. politicians are now championing as a less expensive and more efficient alternative to our supposed free market system?

Canada has had socialized medicine for 20 years, and the same pattern of deteriorating facilities, overburdened doctors, and long hospital waiting lists is clear. A quarter of a million Canadians (out of a population of only 26 million) are now on waiting lists for surgery. [12] The average waiting period for elective surgery is four years. Women wait up to five months for Pap smears and eight months for mammograms. [13] Since 1987, the entire country spent less money on hospital improvements than the city of Washington, D.C., which has a population of only 618,000. [14] As a result, sophisticated diagnostic equipment is scarce in Canada and growing scarcer. There are more MRIs (magnetic resonance imagers) in Washington State, which has a population of 4.6 million, than in all of Canada, which has a population of 26 million. [15]

In Canada, as in Britain under socialized medicine, patients are denied care, forced to cope with increasingly antiquated hospitals and equipment, and can die while waiting for treatment. Canada controls health care costs the same way Britain and Russia do: by denying modern treatment to the sick and letting the severely ill and old die. [16]

Despite standards far below those of the United States, when variables such as America's higher crime and teenage pregnancy rates are factored out, and when concealed government overhead costs are factored in, Canada spends as high a percentage of its GNP on health care as in the United States. [17] Today a growing chorus of Canadians, including many former champions of socialized medicine, are calling for return to a market-based system.

The Worldwide Failure of Socialized Medicine

Throughout the world the story is the same: socialized medicine results in skyrocketing demand for nominally "free" health care, doctors are over-burdened, medical services steadily deteriorate, and there are endless waiting lists for health care. In the Soviet Union before the collapse of Communism, anaesthetics, painkillers, and most drugs were rationed; 57% of hospitals had no hot running water; and it was standard practice to clean needles with steel wool and reuse them. [18] In New Zealand, which has a population of just 3 million, there is a waiting list of 50,000 for surgery. [19]

Socialized medicine doesn't even fulfill its promise of equal access to treatment regardless of ability to pay. For example, in Canada "a small child with a skin rash is 22 times more likely to see a dermatologist if the child is living in Vancouver (a major city) than in the East Kootenay district (a remote rural area)." In Brazil, "residents of urban areas experience nine times more medical visits, 15 times more related services, 2.7 times more dental visits and 4.5 times more hospitalization," than do rural dwellers. [20]

Throughout the world, there are more and more refugees from socialized medicine. Middle- class Canadians flock across the U.S. border to avoid waiting months or years for routine procedures. In England a system of private, quasi-legal clinics has developed to care for patients who can no longer tolerate the abysmal medical services provided by national health insurance. In Russia, desperate patients bribe doctors and secretly visit them after hours to get decent treatment and scarce drugs.

Socialized medicine, like all forms of socialism, has been a world-wide failure. As people throughout the world from the Soviet Union to South America are learning, socialism cannot work. Socialism is fundamentally incompatible with human nature.

Socialism fails because it denies and degrades our essential humanity by treating us as objects. Socialized medicine takes away our control over our own health and body, and gives that power to the state. Under a socialized medical system, the government, not you or your doctor, decides what treatments, doctors, and drugs you get. If you don't like the service the government gives you, your only alternative is to flee to another country or to break the law and bribe a doctor. Under socialized medicine, the exercise of free choice becomes a crime.

Even after it destroys quality health care and individual liberty, socialized medicine still cannot achieve equal treatment for all. When planners try to make all people equal, they confront the inescapable paradox of equality: Abolishing inequality requires massive government power. But power by its nature is unequal: there are those that have it and those that do not. Giving government the power to make everyone equal necessarily creates the worst form of inequality: that of master and subject. In practice under socialized medicine, those with more money and friends in the government get vastly better health care than those without power and connections.

Socialized medicine will not work any better in the United States than it has in England, Canada, Russia or elsewhere. Consider just the economics of socialized medicine in the U.S. Medicare and Medicaid costs are already skyrocketing out of control. State governments cannot afford the 20% of their budgets that Medicare and Medicaid now consume. Where will government get hundreds of billions of dollars more for national health insurance? A complete Canadian-style national health insurance system for the U.S. would initially cost over $339 billion and require that payroll taxes be nearly doubled, or require a new national 10% business tax. [21]

Socialized medicine does not work, but has the free market failed as well? If freedom works, why is American health care now in crisis?

Government Intervention and Health Care Costs

The answer is that America does not have a free market in health care, and in fact has not had one for 50 years. What we have had is a half century of mounting government encroachment upon medical freedom, leading to more and more health care problems.

Over 42% of funds spent on American medical care are now controlled by government. Over 700 state laws, some hundreds of pages long, govern all health care providers and institutions. [22] According to some estimates, for every man-hour of health services provided by doctors, two hours are spent by clerks filling out government paperwork. Dr. Francis A. Davis estimated in the March 1991 issue of Private Practice that government regulations have already increased the cost of medical care by up to 50%!

Government regulations and controls now intrude upon virtually every area of health care in America. These regulations increase tremendously the cost of health care. Here are some examples:

The War on Drugs. U.S. federal drug certification requirements are the most burdensome in the world. It presently can cost $231 million and takes 12 years to develop, test, and certify a single new drug in the U.S. [23] The introduction of many drugs, which have been thoroughly studied and used safely in Europe, has been delayed for years or even decades in the U.S. by the Food and Drug Administration. FDA delays in the introduction of just one drug, the beta-blocker propranolol, used to treat angina and hypertension, caused at least 30,000 avoidable deaths in the U.S. [24]

Literally hundreds of thousands of Americans have died in the last two decades, and millions have suffered needless pain and expense, as a result of government drug regulations. [25] Further, the prohibition of marijuana, heroin, and cocaine has created a growing public health crisis in America.

Consider the medical implications of the government's ban on marijuana. On September 6, 1988, Drug Enforcement Administration (DEA) Administrative Law Judge Francis L. Young stated: "The evidence in this record clearly shows that marijuana has been accepted as capable of relieving the distress of great numbers of very ill people, and doing so with safety under medical supervision. It would be unreasonable, arbitrary and capricious for DEA to continue to stand between those sufferers and the benefits of this substance in light of the evidence in the record." [26]

Judge Young concluded that many classes of patients could potentially benefit from medicinal use of marijuana, including sufferers from glaucoma, chemotherapy, multiple-sclerosis, spasticity, and hyperparathyroidisim. [27] Glaucoma sufferers alone currently number over two million Americans. Despite this finding by the DEA's own administrative judge, marijuana continues to be totally banned for all uses, including medical applications. Indeed, penalties for possession and use of marijuana have steadily increased over the last 20 years.

Medicare, Medicaid, and Tax Policy. A growing chorus of politicians and social activists decry the "high cost" of medical care in the United States and the increasing percentage of our Gross Domestic Product it consumes. What is seldom mentioned is that mounting health care spending and prices are largely a result of escalating demand, public policies, government health care entitlements, and tax policies.

Medicare and Medicaid, our major health care entitlements, were enacted in 1965. Closely allied with the Social Security system, Medicare provides health insurance for approximately 30 million Americans, primarily the elderly. Medicaid provides health care for tens of millions more of the disabled and indigent, and is administered by the states. In the last 25 years Medicare and Medicaid expenditures have soared: from less than $5 billion in 1967, to $79 billion in 1984, to over $160 billion in 1990. [28]

Prior to 1983, Medicaid used a "cost-plus" system for reimbursing medical providers. Doctors were allowed to base their billings upon the cost of the services they provided. Thus the higher a doctor's costs, the more a doctor would make. The cost-plus system made it in a doctor's self-interest to make his costs as high as possible, contributing to a rapid growth in health care costs.

Overall, the effect of Medicare, Medicaid, and other rapidly expanding government health care spending has been greatly to increase the demand for medical services and facilities of all types, which has led to rising health care prices.

Government tax policies are another major factor in escalating demand for and prices of medical services. When health insurance is provided as an employee benefit it is fully tax-deductible; in other words, it is paid for with pre-tax dollars. But when health care is paid for by employees directly, it is paid for with very expensive after-tax dollars, and is not fully tax-deductible. Hence there is an incentive for health care to be provided by employers in the form of insurance, rather than for employees to pay for health care directly out of their own pockets. Largely as a result of U.S. tax policies, "The share of health care spending paid by business increased from 17% in 1965 to 28% in 1987, while the share paid directly by individuals fell from almost 90% in 1930 to just 25% in 1987." [29]

The growing reliance of Americans upon insurers (public and private) to pay their medical bills has destroyed virtually all incentive for health care consumers to monitor and control costs. As Louise B. Russell noted in her 1977 Brookings Institution study:

"This incentive structure means that at the point at which decisions are made about the use of resources, the people who make those decisions are able to act as if the resources are free. Rationally they can and do make decisions that bring little or no benefit to the patient, since the resource costs of the decisions --- to the people making them --- are also little or nothing... (T)here are virtually no economic constraints left to prevent decision makers in medical care from doing everything they can think of, no matter how small the benefits nor to whom they accrue." [30]

Medical Licensing. U.S. doctors are among the most regulated in the world. State medical boards, monopolized by the American Medical Association members, license doctors, hospitals, and medical schools. The declared purpose of medical licensing is to assure quality health care. The actual effect has been to limit the number of doctors, increase the cost of health care, and promote medical practices favored by the AMA at the expense of less costly alternatives. Many alternative practitioners --- such as osteopaths and chiropractors --- were almost run out of business by AMA-dominated medical boards.

The AMA has opposed prevention and treatment alternatives that would greatly reduce medical costs, such as midwives, nurse-practitioners, and nutritional therapy. There is mounting scientific evidence that many suppressed alternative forms of treatment are not only less expensive, but are more effective than government-approved medicine. Alternative practitioners are often much more compassionate as well.

The AMA has used its monopoly to exclude women, blacks, and alternative practitioners from the medical profession. Artificially restricting the number of doctors makes health care much more expensive for everyone. As Dr. Mary Ruwart reports in Healing Our World:

"By the early 1900s, every state had agreed to the aggression of physician licensing... One half of the existing medical schools were approved, so most of the others had to close their doors by 1920. By 1932, almost half the medical school applicants had to be turned away...

"Licensing of physicians was largely a result of lobbying by the AMA... Not surprisingly, the established practitioners suggest giving licenses to those already in practice, setting high standards for new entrants, and denying approval to practitioners who use different techniques from theirs... In 1910, there were seven medical schools specializing in training black physicians. By 1944, only two had survived. Women were excluded from the medical profession in the same manner.

"In 1938, students of homeopathic, osteopathic, and chiropractic medical schools could no longer qualify for licensing as medical doctors. Hospitals or medical schools that dared to employ them risked losing their approved status... Alternative practitioners were frequently denied other privileges as well. So blatant were these discriminatory practices that in 1987 the American Medical Association was found guilty under the antitrust laws of having 'conspired to destroy the profession of chiropractic in the United States' by using the political power afforded them by licensing laws." [31]

Another tragic effect of medical licensing has been the disappearance of competent medical services from most poor communities, particularly rural ones. Thanks to government regulations and the litigation explosion, many rural communities and small towns now have no doctors at all.

Insurance Regulations. Insurance underwriters, like doctors and hospitals, are subject to hundreds of government-issued mandates. As a result they seldom pay for drugs or treatments which the government has not approved. Again, the effect is to make many safe and inexpensive forms of treatment unavailable to American citizens, while raising health care costs for everyone.

Other Factors. Government regulation is not the only factor in escalating U.S. health care costs. Other major factors include mounting social violence, which is overloading urban emergency rooms. Many hospitals are closing their ERs to avoid bankruptcy. The explosion of litigation against doctors and the willingness of juries to give multi-million dollar punitive damage awards have made $100,000-a-year malpractice premiums commonplace, and litigation is causing many doctors to abandon high-risk specialties such as pediatrics and obstetrics. Finally, the expense of coping with the AIDS epidemic and the medical needs of an aging populace have increased the demand for medical services and hence their cost. Some of these factors have been greatly aggravated by government policies. Others have little or nothing to do with government regulations. In either case, socialized medicine will do nothing to alleviate these problems.

Health Care Alternatives

Fortunately, socialism and inaction are not our only two options. We can make health care more affordable and more available while preserving quality and freedom of choice. Here are some positive steps we can take now:

Privatize Health Care. Medicare and Medicaid are imposing horrendous costs upon American taxpayers. There is no free lunch. When health care is "free" (i.e., indirectly financed by taxation), there is little incentive for either patients or doctors to minimize costs. Government-guaranteed medical services raise prices and costs, result in massive waste, and create a bureaucracy in a futile attempt to control costs.

Government should get out of the medical insurance business. We will get far better value for our health care dollars if we spend them directly ourselves.

Free Insurance Companies from Government Regulations. Government insurance mandates --- specifying how insurance policies must be written, what illnesses may be covered, and what fees can be charged --- put a straitjacket on health insurance providers and cost the U.S. economy over $60 billion a year. There are now over 700 mandates enforced by state governments. These mandates prohibit inexpensive policies with limited coverage --- leaving 8.5 million Americans uninsured. [32]

Using medical insurance to pay for small claims is also highly inefficient. As Joseph Bast points out in Why We Spend Too Much On Health Care, "it costs as much as $50 to process a $50 claim," adding billions to medical costs. [33]

Insurance companies should be free to innovate and introduce new policies which meet the diverse needs of the American people. Relieved of the governmental regulations currently imposed on them, health care insurers could become leaders in cutting costs and creating inexpensive coverage for currently uninsured Americans. The single reform of ending all mandates would reduce health care insurance costs in the U.S. by 30%! [34]

Deregulate Medical Research and Marketing. Burdensome government testing and certification requirements have added years of delay and billions of dollars in cost to the development and marketing of new drugs. Government has made it economically impossible for small pharmaceutical manufacturers to survive, or for any manufacturer to develop drugs for diseases that affect small population groups. Hundreds of thousands of lives have been needlessly lost as a result of delays and added costs imposed by government regulations. Drugs which could alleviate the suffering of millions are kept from the market because they don't meet the government's arbitrary standards. [35]

The decision whether or not to take a drug should be made by the patient and his doctor. In a deregulated market, misleading or dangerous claims would be minimized by natural market forces, including the threat of legal action by consumers. Unlike government regulatory agencies which are protected from lawsuits for their mistakes by sovereign immunity, non-governmental businesses are always subject to legal action.

Deregulating medical research and marketing would save tens of thousands of lives a year, make it economical to develop many new drugs, and drastically cut the cost of drugs for everyone.

End Medical Monopolies. The American Medical Association is a coercive monopoly which makes it difficult or impossible for alternative health care providers --- such as nurse-practitioners, midwives, osteopaths, chiropractors, and nutritionists --- to market their services. State medical licensing boards are composed virtually entirely of AMA-certified physicians and have created "medical standards" which make it impossible for medical schools to survive unless they adopt curricula approved by the AMA.

AMA-dominated, politicized state medical licensing ought to be abolished and replaced by independent certification of doctors. Consumers, not politicians or powerful groups of doctors, should decide which health care practitioners we can patronize.

End Drug Prohibition. Drug prohibition is a contributing factor to America's health care crisis. Legalizing drugs would eliminate many deaths from adulterated substances, permit addicts to seek treatment without fear of arrest, enable those suffering from glaucoma and cancer to use marijuana and cocaine therapeutically, and permit patients and doctors to use drugs now legally available in other countries. Ending the war on drugs would reduce health care expenditures in the United States.

A Warning

If you want to know how national health insurance would work in America, we have a model. For more than 60 years the Veterans Administration has been charged with handling the health needs of millions of disabled and discharged servicemen and women. With a fiscal 1990 budget of $30 billion, the VA runs America's largest health care system, including 172 hospitals, 233 outpatient clinics, and 122 nursing homes. [36]

Investigations of the VA have found abominable conditions: long waiting periods for surgery, filthy hospitals, severe shortages of staff and drugs, antiquated equipment, incompetent staff, indifferent and hostile administrators. [37] Here is just one example:

On January 15, 1992, CBS News reported that Walter Reed Army/Navy Medical Hospital had been refusing to provide amputees coming back from the Gulf War with artificial limbs. Other veterans were given shoddy prosthetics using antiquated technology. Compounding the tragedy, Walter Reed refused to accept donations of modern prosthetics offered by sympathetic Americans.

Commenting on why soldiers were denied modern artificial limbs, a Medical Services colonel retorted, "I am not going to spend the taxpayers' money if you will just be sitting at home. Why should I spend $5,000 for something that you will just look on?" Commenting on the refusal of Walter Reed hospital to accept donations of modern limbs for veterans, the colonel stated, "We disapprove it because we are the primary health-care providers and we believe that we provide the best total care to the patient. And the patients belong to us." [38]

The most callous Soviet bureaucrat could hardly have been more arrogant. This incident gives us a glimpse of the future of health care in America --- if national health insurance is enacted.

Footnotes To "National Health Insurance - A Medical Disaster"

1. David Holzman, "Seeking Cures for an Ailing System," Insight, April 8, 1991, pp.50-53.
   
2. Quoted in Paul F. Gemmill, Britain's Search for Health (Philadelphia: University of Pennsylvania Press, 1960), p.20.
   
3. Sunday Times, London, October 12, 1975, p.6.
   
4. Michael Foot, Aneurin Bevan: A Biography (New York: Atheneum, 1974), Vol. 2, p.191
   
5. Ibid.
   
6. John And Sylvia Jewkes, Value for Money in Medicine (Oxford: Basil Blackwell, 1963), pp.59-60.
   
7. Harry Schwartz, "The Infirmity of British Medicine," in R. Emmett Tyrell, Jr. editor, The Future That Doesn't Work: Social Democracy's Failure in Britain (New York: Doubleday, 1977) p.29.
   
8. Loc. cit., p.33
   
9. Loc. cit.
   
10. New Scientist, August 21, 1975, pp.410-11.
    
11. John C. Goodman and Gerald L. Musgrave, Twenty Myths About National Health Insurance (Dallas: National Center for Policy Analysis, 1991), p.1.
    
12. Estimate of the Fraser Institute quoted in Goodman and Musgrave, p.17.
    
13. Ibid., pp.11,12.
    
14. Malcolm Gladwell, "Why Canada's Health Plan Is No Remedy for America," The Washington Post, March 22, 1992, p.C-3.
    
15. Goodman & Musgrave, op. cit., p.11.
    
16. Ibid., pp.29-31.
    
17. Aldona and Gary Robbins, What a Canadian-Style Health Care System Would Cost U.S. Employers and Employees (Dallas: National Center for Policy Analysis, 1990).
    
18. For excellent discussions of the realities of socialized medicine in the Soviet Union, see David K. Willis, "Soviet Medicine: A Matter of Privilege" in Klass: How Russians Really Live (New York: St. Martins Press, 1985), pp.183-204; and Konstantin Simis, "Free Medical Care and Corruption" in USSR: The Corrupt Society (New York: Simon and Schuster, 1982), pp.221- 228.
    
19. Choices for Health Care: Report of the Health Benefits Review (Wellington Health Benefits Review committee, 1986), pp. 78-79.
    
20. Goodman and Musgrave, op. cit., p.51.
    
21. Robbins, op. cit., p.3
    
22. Joseph L. Bast, Richard C. Rule, and Stuart A. Wesbury Jr., Why We Spend Too Much on Health Care (Chicago: The Heartland Institute, 1992), pp.14-15.
    
23. William H. Walker, "National Health Care: Bringing Soviet Medicine to the U.S.," The Buckeye Libertarian, July/August 1991.
    
24. Louis Lasagna, "Congress, the FDA, and New Drug Development: Before and After 1962," Perspectives in Biology and Medicine, 32: 322-343, 1969; William M. Wardell, "Rx: More Regulation or Better Therapies?" Regulation 3:30, 1979.
    
25. See "The Denial of Medical Marijuana to Sick People," pp.83-106, and "Forcing People to Face Death from AIDS," pp.125-150 in Arnold S. Trebach and Kevin B. Zeese, Drug Prohibition and the Conscience of Nations (Washington, D.C.: The Drug Policy Foundation), 1990. See also Arnold S. Trebach, "The Sacrifice of Our Sick --- By Banning Hated Drugs in Medicine," The Great Drug War (New York: The Macmillan Publishing Company), 1987.
    
26. Francis L. Young, "Marijuana Should Be Medicine," in Drug Policy 1989-1990: A Reformer's Catalogue, Arnold S. Trebach and Kevin B. Zeese, editors (Washington, D.C.: Drug Policy Foundation, 1989), p.358.
    
27. Ibid., pp.325-358.
    
28. See Paul B. Ginsburg, "Public Insurance Programs: Medicare and Medicaid," in H. E. Frech III Editor, Health Care In America: The Political Economy of Hospitals and Health Insurance (San Fransisco: Pacific Research Institute, 1988), pp.179-218. Additional figures on Medicare and Medicaid expenditures for 1990 are taken from The Statistical Abstract of the United States: 1991, 111th edition (Washington, D.C.: U.S. Bureau of the Census, 1991), p.93.
    
29. Bast, op. cit., p.52.
    
30. Louise B. Russell, "Medical Care Costs," in Setting National Priorities: The 1978 Budget, edited by Joseph A. Pechman (Washington D.C.: The Brookings Institution, 1977), p.182.
    
31. Dr. Mary J. Ruwart, "Harming Our Health," Healing Our World (Kalamazoo, Mich., SunStar Press, 1992), pp.57-62.
    
32. Bast, op. cit., pp.14,63,65.
    
33. Ibid., p.1
    
34. Ibid., p.65
    
35. Arnold S. Trebach, "The Sacrifice of Our Sick --- By Banning Hated Drugs In Medicine," The Great Drug War (New York: Macmillan), 1987, pp.290-328.
    
36. Janet Novack, "Hands Off My Pork Barrel," Forbes, May 28, 1990, pp.183,186.
    
37. Robert Klein, Wounded Men, Broken Promises: How the Veterans Administration Betrays Yesterday's Heroes (New York: Macmillan, 1981).
    
38. CBS Evening News (transcript), January 15, 1992 (Livingston, N.J.: Burrelle's Transcripts, 1992), pp.7-9.

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