I get that Sen. John McCain thinks I have too cushy a deal with my health insurance. I don’t have to go through the laborious task of figuring out what health insurance plan I should buy—my human resources manager does all the work. (And, because I have a chronic disease, I don’t have to be bothered with all of the rejections from insurance companies that won’t insure me at any price.) When I see my doctor, I don’t think about how much that blood test is going to cost or haggle over the cost of that shot he thinks I need.

I’d be better off, McCain says, if I had more of a free-market relationship with the health care system. Cut off the tax incentive that employers get for providing health care for employees, give me some of that instead in the form of a tax credit, and let me loose in the health care supermarket, where I’ll be a diligent, cost-conscious consumer. (Hmm, green leaf lettuce or iceberg? The green leaf looks healthier and fresher but is it really worth $1.59 a head?)

What I don’t get is how all of McCain’s free-market fundamentalism on health care is supposed to help make sure my neighborhood hospital is up and running when I need it.

McCain didn’t address the health of our nation’s hospitals when he rolled out his health care plan last week. Perhaps that’s because the issues are complex and many of the proposed solutions don’t fit neatly into ideological lines. Perhaps it’s because if he started delving into our health care infrastructure, he’d have to admit that the conservative mantra that we have "the best health care system in the world" is false.

A report this week by the House Government Reform and Oversight Committee looked at just one consequence of the dysfunction in our health care delivery system.

Committee staff members surveyed hospital emergency rooms in seven major cities on one Tuesday afternoon to get a snapshot of emergency room capacity, with the goal of determining if emergency rooms in these cities were capable of handling a disaster of the scale of the March 2004 terrorist train bombing in Madrid, Spain. In that attack, 15 Madrid hospitals handled a surge of nearly 1,000 injured people.

The bottom line:

The results of the survey show that none of the hospitals surveyed in the seven cities had sufficient emergency care capacity to respond to an attack generating the number of casualties that occurred in Madrid. The Level I trauma centers surveyed had no room in their emergency rooms to treat a sudden influx of victims. They had virtually no free intensive care unit beds within their hospital complex. And they did not have enough regular inpatient beds to handle the less severely injured victims. The shortage of capacity was particularly acute in Los Angeles and Washington, D.C.

Almost 60 percent of the hospital emergency rooms surveyed were operating above capacity at the time of the survey. The closest hospital to my home, Washington Hospital Center, happened to be "the single most overcrowded hospital surveyed." Its emergency room was already operating at 286 percent of capacity at the time of the survey.

In essence, this survey doesn’t tell us anything that especially those of us who live in big cities don’t already know: Our hospital system is badly strained on a calm day. And if that’s the case, God help us if any sort of major disaster hits.

Committee chairman Rep. Henry Waxman used the report findings to highlight the damage that the Bush administration’s latest Medicaid funding proposals threaten to do to hospitals:

… The level of emergency care they can provide is likely to be further compromised by three new Medicaid regulations, the first of which takes effect on May 26, 2008. According to these hospitals, the new Medicaid regulations will reduce federal payments to their facilities by $623 million per year. If the states choose to withdraw their matching funds, the hospitals could face a reduction of about $1.2 billion. The hospitals told the Committee that these funding cuts will force them “to significantly reduce services” in the future and that “loss of resources of this magnitude inevitably will lead to curtailing of critical health care safety net services such as emergency, trauma, burn, HIV/AIDS, neonatology, asthma care, diabetes care, and many others.”

Health and Human Services Secretary Michael Leavitt told the committee in prepared remarks Tuesday the rule changes exist "to restore greater accountability to the Medicaid program, while safeguarding limited resources for actual services to those individuals who rely on the Medicaid program."

That’s music to McCain’s ears, and it’s innocuous-sounding enough until you recognize that this is more of the conservative strategy of starving the beast without doing a thing to reform the system that gave birth to the beast to begin with.

That system has not only left us with a hospital system that we can’t depend on in a mass emergency, and that many of us would at risk to rely on even at a time of personal emergency. It is also a system that, as R. J. Escow recently wrote in The Huffington Post, is a form of medical apartheid—in which people of color and the poor of all colors get less, and therefore die more quickly. And the fact that hospitals in urban and people-of-color communities are chronically underfunded is no small reason why.

Getting our hospital system fixed means fixing a lot of interrelated problems, including coming up with a sensible health-care-for-all plan. This needs some of the best progressive minds in health care that we have. The fix certainly isn’t going to happen by giving people the so-called freedom to shop for health care in a market where they might have to stand in line—or lie in a gurney in line—just to get in the door.

Image by watertiger nyc.