“It’s not the money, it’s the system.” Thus Dr. Marcia Angell of Harvard Medical School explains why it is crucial to win universal single-payer health care as embodied in HR 676, sponsored by Congressman John Conyers (D-Mich.). The U.S., despite spending more per capita on health care than any other nation, has 44 million uninsured and declining benefits for most of the rest. About 9 million lost their employer-based insurance from 2001 to 2003.

It’s hard to believe that it’s not the money. State after state, facing a deficit budget, is cutting back on care. Some states are dropping certain patients — autistic children or teenagers with mental health crises. It seems like it’s the money, and there isn’t enough of it to pay for the health care we need. But it’s the system.

Workers are laid off when their factory closes. They can maintain health benefits for their families by paying $800 a month — money unemployed workers don’t have. Sure looks like it’s the money. But it isn’t — we’re already paying enough to cover them.

With each contract negotiation, every union faces a threat to cut health benefits. The employer, or the fund, or the insurance company, or the HMO wants more money. To the worker on strike trying to persuade the employer to pay the dough to keep benefits, it certainly feels like it’s the money. To patients confronted by hospital demands for upfront payments or lawsuits for collection of debt, it feels like it’s the money. But it’s not the money, it’s the system.

We put enough into health care to cover us all with excellent care. The U.S. spends $1.7 trillion — $6,200 per person each year — on health care. That’s about double what the Canadians, Australians, Germans, Swedes, and Swiss spend — yet they have universal care and lower death rates. That $1.7 trillion is sufficient to cover all the uninsured and to improve the quality of care for every man, woman, and child in the U.S. Yet the U.S. is 37th in quality of care according to the World Health Organization. There are 18,000 deaths per year in the U.S. solely due to lack of health insurance. Our infant mortality rate is rising. We are falling behind in life expectancy.

We’re paying for the best health care for everyone — so why aren’t we getting it? The problem is that up to 50 percent of what we spend on health care goes to unnecessary administrative costs, profits, advertising, CEO salaries and bonuses, and other wastes. Our health care dollars are channeled through insurance companies and HMOs. Their interests lie in collecting as much as they can while paying out as little as they can. They set up elaborate structures to screen out expensive patients and procedures. They set up preapproval for treatment, second guess physicians, and deny care when they can get away with it. That administrative apparatus devours health care dollars while making no contribution whatsoever to care.

A struggle solely to stop cuts in care or to expand Medicaid cannot bring universal coverage nor prevent the decline in benefits. No matter how much money we pour in, the insurance companies, HMOs, and for-profit hospitals rake off a greater and greater share. That’s why every health care fight should include a focus on universal single-payer health care.

The bill introduced by Rep. Conyers — HR 676 — is simple and inclusive. It is familiar because it is set up like Medicare. It ends insurance payments, health insurance companies, and for-profit HMOs. It converts for-profit hospitals to non-profits. It does away with deductibles and co-payments as impediments to care. It is paid for by a modest payroll tax plus a tax on the very wealthiest and on stock transactions. It will use its power as the sole purchaser of drugs to rein in the drug companies. It will expand coverage to all and include: hospital, home health, rehab, physician care, dental, prescriptions, long-term care, physical therapy, vision, mental health, whatever is medically necessary. It will be with us if we change jobs, lose a job, or retire. It will end the privatization of Medicare. Unlike the recent fraudulent prescription bill, it will really cover seniors and all of us for prescriptions.

HR 676 will allow us to choose our own doctors, and free doctors from the HMO dictators. We just have to build a powerful, bold, gigantic, energetic, determined movement to make it politically possible. We can put millions into motion. We already pay enough to cover great health care for everyone. We deserve to get it. HR 676. Universal single-payer health care. Spread the word. Let’s do it!

Carolyn Taylor is a labor activist in Kentucky. She can be reached at pww@pww.org.