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In Article IV, the founders said "The United States shall guarantee to every state in this Union a Republican [representative] Form of Government . . . ." To perpetuate representative government in the United States, the SOVEREIGN POWER of the American is re-delegated at periodic intervals through the election or re-election of individuals to legislative and executive positions, and with certain exceptions, to judicial positions.

The critical role of information in the perpetuation of representative government was recognized by the Founders in the First Amendment to the Constitution. And up until the Rehnquist Court, the critical role of information needed to perpetuate representative goverment was recognized again and again in a number Supreme Court decisions.

Over the past several months, I have been been analyzing the lack of newspaper coverage on environmental and health care issues that have been before the U.S. Congress from 1995 to the year 2000. For the reasons stated above, media coverage of our legislators and important legislative matters in the U.S. House and Senate is essential to continued existence of representative government in the United States. Without this information we no longer have a representative government.

Over the last thirty years, powerful private interests in the United States have destroyed the right of the American People to a Free Press. This is not accidental, for these private interests realized that truly reprentative government in the United States and the Sovereign Power of an informed American People representing their will through elections is dangerous to private special interests. It threatens the extent of private power in this country and if left untouched, it would erode the exercise of this power. These private special interests realized years ago -- most probably during the New Deal years of the 1930's -- that the transfer of real power from the People to private interests could only be accomplished through a long-term propaganda effort denigrating the only viable alternative to untrammeled private power -- the power of governments at all levels to protect the rights of private citizens.

When in political power, the proponents of private power misused and abused the powers of government to discredit representative government across the board. When out of political power, the proponents of private power continued their attack, with the enthusiastic cooperation of those who control our Mainstream Media.

Together with the anti-democratic and anti-republican messages of the propaganda campaign, it was also necessary for the media to provide major distractions to politics and the problems of the country through sports and entertainment. Why bother with informing yourself and voting when you can watch a football, basketball, or baseball game? Here the winners and the losers are distinctly identified -- and someone wins and someone loses. Why bother with informing yourself and voting when there is the latest movie or TV series to see? Here, as in the case of sports, almost instant gratification is possible.

But above all, the media must not address the nation's problems and issues in a way that is understandable to the American people. Fragment the reporting of problems, issues and threats to the United States into pieces, and then obfuscate the reporting of those pieces. Better still, simply do not report on these things at all -- just CENSOR them out of the news. Who will know the difference?

If you were to ask most Americans about the legislative battles going on in the Congress since 1995 on health, safety and evironmental regulations, or that swirled around the Democratic attempts during the same time to legislate an affordable health care system, they would look at you as if you had lost your mind. What is the world are you talking about? There were no battles in Congress on these issues, for if there had been, the newspapers, radio, and TV would have reported it.

It was not reported, therefore it did not happen. For the powerful private interests running this country have gone far beyond the totalitarianism of George Orwell's 1984 -- if news of something is not disseminated, it simply doesn't exist. There is no need for someone to go through the daily newspaper correcting the news items the regime wishes to conceal -- flushing the previous news down a memory hole. By preventing in the first place the publication of news on important problems, issues and threats confronting the American people, private power can consolidate its gains, and plan its next steps to a corporatist state.

At the present time, the American People spend about one dollar out of every seven dollars of our Gross Domestic Product on health care. This is double the comparable per capita health care costs of all other First World countries.

How much does U.S. health care cost, and who is actually paying for it? The answer to the first of these two questions can be easily found in Table 115 of the HHS Handbook, Health, United States, 2000.

According to Table 115, the total health care expenditures in the United States in 1998 amounted to $1.149 trillion dollars. Divided by the population of the United States, this amounts to $4,094 per citizen (our per capita health care costs). This was 13.5 ercent of our Gross Domestic Product in 1998, thus we paid slightly more than one dollar in seven of the GDP for health care costs. In 1997, the per capita cost was $3,912 -- from 1997 to 1998 our health care costs per citizen increased by $182 (see Table 114).

Adding the known health costs, we arrive at a sum of $1.097 trillion dollars in 1998, leaving about $51 billion dollars (4.5%) coming from private sources.

Of the federal and state tax dollars spent in 1998, $216.6 billion was in Medicare and $170.6 billion in Medicaid, for a total of $387.2 billion.

In 1997, the United States spent $1.088 trillion dollars on health care. If we had had the per capita cost of $1,757, our total health care bill would have been $488 billion dollars, $599.5 billion dollars less than we actually paid.

In 1999, 84.5 percent of the American population -- about 231.5 million people -- had health insurance. Of these, 194.6 Americans were covered by premiums paid by families or individuals to private health insurance companies. 66.2 million Americans had government insurance -- (36.1 million - Medicare, 27.9 million Medicaid, and 8.5 million military, active and retired). About 30 million Americans with government insurance also paid premiums to private insurance companies for supplemental health insurance.

The 42.6 million uninsured in the United States are treated in local public hospitals, with all costs for this treatment paid for by the local taxpayers in the town, city or county. Essentially, the rest of the U.S. health care system is a private system. With the exception of 8.53 million active duty or retired military personnel receiving treatment from service or VA hospitals, the remaining Americans obtain their health care (drugs, medical treatment, hospitalization) from private providers. This includes the people on Medicare and Medicaid, and people in the Federal health care plans.

Let us look more closely at the largest health care market in the United States -- the 231.5 million Americans covered by private health insurance. According to the 1998 figures, these Americans paid out about $570 billion dollars for out-of-pocket health costs ($199.5 billion) and for health insurance premiums ($375.02 billion).

A November 2000 study published in the journal Health Affairs, and reported on by the New York Times on November 14th, states that the cost growth of health insurance premiums averaged about 2 percent a year from 1994 to 1998, less than the cost of inflation. In 1999, health insurance premiums rose an average of 8.3 pecent for all businesses. For larger businesses with 200 or more workers the health insurance premiums were 7.5 percent, indicating a much larger cost growth in premiums for the hundreds of thousands of smaller businesses.

Prescription drug costs accounted for 44 percent of the increase, doctors' services 32 percent, outpatient health care 21 percent, and inpatient hospital care 3 percent.

We have been paying the highest health care costs in the World, yet over 15 percent of our people are without health insurance. Those who do have health insurance are paying more and more for less and less. Doctors in the United States are either leaving medical practice or are joining together in unions to fight the HMOs and the private health insurance companies in an effort to provide good and affordable health care in the United States.

In March 1996 and again in January 1997, Democrats in the House of Representatives introduced bills, HR.3059 and HR.183, to direct the Secretary of Health and Human Service to prepare and publish a guide to prescription drug prices in the United States study. Both bills were killed in Republican-controlled sub-committees of the House.

Why did the Democrats think a guide to prescription drug prices was necessary and why did the Republicans kill both bills? We Americans pay more, and in fact, pay much more for prescription drugs than any other country in the World. An October 1999 study by House Democrats shows that the Consumer Price Index, which measures inflation, rose 99% from 1981 to 1999. In short, by the end of those eighteen years, what cost $100 in 1981 cost $199 dollars in 1999 -- a doubling of real dollar costs. During this same period of time, prescription drug prices increased by 306 percent, rising by 18.4 percent in 1999 alone. Thus the prescription drug that cost $100 in 1981 cost over $400 dollars in 1999.

The 1999 Democratic study also showed that we Americans were paying 49% more for prescription drugs than Italy, almost twice as much. We were paying 43% more than France, 36% more than Canada, 35% more than the United Kingdom, 32% more than Sweden, and 29% more than Germany. This was before the large prescription drug price increases of 1999 mentioned above went into effect.

The three primary targets of fraud in the U.S. health care are (1) the 195 million people with health insurance, (2) the Medicare program, and (3) the Medicaid program. Actually, the 195 million people with health insurance are targeted in two ways. First, as the payer of out-of-pocket medical costs and health insurance premiums. Second, as taxpayers paying local, state, and Federal taxes for the medical care of the uninsured in the United States and the people on Medicare and Medicaid.

Traveling groups of dentists in Texas target minority children covered under Medicaid and provide them with the most expensive dental procedures such a ceramic caps on teeth when much cheaper dental care would have taken care of the dental problems. The Texas taxpayer and the Federal taxpayer pick up the bill. In Medicaid the estimates of fraud are about 10.96 percent per year. Assuming this fraud rate is correct, that's almost $15 billion in 1994; $16 billion in 1995, almost $17 billion in 1996, $17.5 billion in 1997 and almost $19 billion in 1998.

But what about fraud in the largest health care market? This is the $762 billion dollars spent in 1998 on out-of-pocket health costs and for private health insurance premiums, and for all those local, state, and federal taxes being paid for the medical treatment of the uninsured. The percentage of criminal fraud in this market has not been measured, but a very low estimate would be about 9.97 percent -- so we are talking about almost $76 billion dollars of FRAUD in this one market alone in 1998.

When we add all of these numbers together for the single year of 1998 -- $21 billion in Medicare, almost $19 billion in Medicaid, and $76 billion in the private health insurance market -- there was probably almost $116 billion dollars in criminal fraud in the entire U.S. health care industry in that year.

Below is a summary of the features of a STRONG Patients' Bill of Rights extracted from remarks in the Congressional Record and from the laws themselves that the Mainstream Media, for some reason, has TOTALLY IGNORED over the past five years. Some of these features are from 1995, others from 1996 and 1997, still others were incorporated during the UNREPORTED legislative battles in 1998, 1999, and the months leading up to November 2000.

1. The right to be treated by properly-trained medical personnel

2. The right to be informed of all of their medical options--not just the cheapest medical options approved by the HMOs and health plans.

3. The right to go to an emergency room and to be treated there.

4. The right to see a medical specialist when they need to.

5. The right to take their children to a pediatric specialist when they need to.

6. The right NOT to be denied medical treatment without an initial physical examination.

7. The right NOT to be denied medical treatment because of ill-defined criteria established by the HMO or health insurer.

8. The right of transportability of medical care. A patient being treated for an illness or a pregnant woman has the right to stay with their own doctor, even if an employer changes health plans.

9. The right of medical accountability. This is the right to hold HMOs and health insurers accountable for their decisions. If an HMO or insurer refuses to cover a prescription or procedure, patients have a right to immediately appeal that decision to an independent third-party.

10. The right to sue. If a patient suffers serious harm as a result of an HMO or health insurer's decision to delay or deny needed care, that patient has the right to sue their HMO or insurer.

11. The right NOT to be treated by health providers who are offered incentives to recommend cheap medical options to save the HMO or insurer money, particularly if the disallowed options are actually medically necessary.

1. The right NOT to be gagged by HMOs and health insurers or to be threatened with firing if they recommend medical treatments beyond those approved by the HMO or health insurer.

2. The right NOT to be threatened with punitive actions if they inform a hospital, HMO or health insurer of dangerous conditions in medical treatment programs prescribed by those organizations.

1. Insure that participating doctors and pharmacists are involved in developing that formulary.

2. Disclose to providers, and upon request, disclose to the HMO and other health plan members full information on formulary restrictions.

3. Provide for exceptions to the formulary restrictions if a non-formulary alternative is medically needed.

But even with the highest prescription drug costs in the Worlld, and a health care system riddled with fraud, we still cannot determine why U.S. per capita health care costs are still twice as much as the average of 21 other First World countries. In 1997, the United States spent $1.088 trillion dollars on health care. If we had had the per capita cost of $1,757, our total health care bill would have been $488 billion dollars, $599.5 billion dollars less than we actually paid.

The estimates of the total fraud in the U.S. health care system over the last few years are slightly more than $110 billion dollars. In 1998, the total cost of prescription drugs in the United States was $93.8 billion. If we cut this approximately in half to the international price, we would have savings of no more than $50 billion dollars. Even if we assume a total cost of $150 billion dollars lost through fraud and overpriced prescription drugs, this is still only 25% of the $599.5 billion dollar difference between our actual health costs and the international average.