Can Obama, Clinton or McCain Heal Our Healthcare System?


On the night before last week’s primary vote, one of the city’s savviest political consultants sat on a bed on the 16th floor of NYU Hospital wearing a loose blue gown that kept slipping off his shoulders. Gary Tilzer didn’t bother about the gown. But he was careful to keep his right foot hidden under the covers. This was to help protect it from doctors who had been urging him to have the foot removed due to urgent matters related to diabetes.

A hospital aide approached to ask if he’d changed his mind. Tilzer held up a hand as though to ward away evil. “No, no way,” he said.

Generally, this is the kind of thing that happens to people who badly neglect their health. Here, Tilzer, 50, must plead guilty: “I never knew I had this diabetes until my foot got bad,” he said.

He didn’t know about the diabetes because he hadn’t been to a doctor in years. This was a particularly bad idea because Tilzer had added to his own risk factors by being somewhat overweight. “I’m working on that,” he said. But he hadn’t been to a doctor, he said, because he didn’t have health insurance. And he didn’t have health insurance, he insisted, because he is self-employed and hasn’t been able to afford it.

The self-employment part is not entirely voluntary. In recent years, Tilzer has embarrassed local Democratic Party organizations by soundly defeating their candidates in primary elections. He managed winning campaigns for both of Brooklyn’s current Surrogate Court judges, beating the machine both times for what are the most highly sought judicial posts in the borough. In 2005, his candidate—an unknown—came within one percentage point of defeating an entrenched Republican state senator, Serph Maltese, someone the Democrats had ignored for decades.

His reward for these rebel campaigns has been that when it came time to dole out the sweet government jobs that come with things like pensions and health-care coverage, Tilzer was never on the receiving end.

“I don’t get it,” he said in his hospital room last week. “I win, and the other guys end up with the jobs and the coverage.”

Either way, this situation makes Tilzer a prime exhibit in one of the biggest issues at stake in this election year: health care. Outside on the streets, thousands of excited people were passing out flyers for their candidates. Across the country, people flocked to the polls in bigger numbers than they have in decades, mostly to vote for the Democrats. Other than the endless war in Iraq, if there is one reason American voters are looking to see a Democrat in the White House, it is because of the candidates’ promises to finally deal with this crisis.

John McCain and the Republicans have had little to say about health care, except that we should let companies compete to keep costs down. This philosophy has already resulted in 46 million Americans, like Tilzer, going without health insurance. It has helped make insurance premiums rise four times faster than wages. It has turned every union contract negotiation into a battle over which side will eat the latest hike in insurance costs (up 73 percent since 2000). It has helped push two million Americans into bankruptcy because they can’t pay their medical costs.

Both Hillary Clinton and Barack Obama are running for president on pledges to make sure people like Tilzer never have the excuse of saying they can’t afford to go to the doctor. Clinton says she would do so by mandating that everyone get coverage. Obama says he would make insurance so affordable that people can’t resist.

Actually, neither plan gets to the root of the problem, since both are built around the continued profitability of insurance companies, which are part of the problem and, to put it mildly, are not in this business just for our health. But the candidates’ proposals are a start.

On Super Tuesday, a veteran organizer named Marilyn Clement stayed up late to watch the returns and write an encouraging e-mail to her troops. Clement is running a national campaign called Healthcare-NOW that seeks to win support for a bill in Congress that would create a new national health-care plan. Technically, this is known as a “single-payer plan.” Since this is incomprehensible to most of us, it is often referred to as “Medicare for all,” on the reasonable assumption that most Americans might be in favor of extending a workable health-care program that even Ronald Reagan was afraid to dismantle.

“Today is a day of great hope!” Clement typed. “There is exuberance and commitment among the voters we have not seen in our country for many years.”

If none of the remaining candidates are pushing the “Medicare for all” concept, Clement was asked, what made it such a great day?

“Well, I wrote it at 2 a.m., so God only knows what I was thinking,” Clement said. “But I am encouraged by the huge numbers of young people who are turning out for this election. I hear them talking what I call ‘big-picturetalk’: They’re making the connections between the war and the budget and the environment and health care. None of the presidential candidates still standing are going to fulfill what people are really hoping for,” she continued, “but the power is coming from this upsurge of people who are excited about change. The kids have high expectations. I’m hoping they’ll hang in.”

Clement said she had cast her own ballot for Obama. “It wasn’t out of confidence in his health-care plan, but more in the hope that is engendered by his candidacy—that it gets carried over into action, that people will get him to do what he needs to do.”

Judy Wessler, who has long been New York’s leading health-care activist, said she also voted for Obama despite her misgivings about his health-care proposal. “Neither he nor Hillary have proposed what needs to happen,” said Wessler, director of a nonprofit group called the Commission on the Public’s Health System. “But what is happening around Obama is so extraordinary I think it will get us started.”

Up in his hospital room, Tilzer said that other than this business with his foot, his main complaint on primary day was that he couldn’t be near any polling places. All day, he took reports at his bedside about broken voting machines in Brooklyn. “They’re down in the 39th A.D., the 41st, and the 42nd,” he said. “Nobody’s complaining either, because no one out there knows what they’re doing. If I was healthy, I could do something about it. Then again,” Tilzer added, “if I ever get out of here, I may have to get a real job—with benefits.”