As I write this, political campaigns are heating up and, as usual, the country, as it is, is in terrible shape, but help is on the way. Solutions to our problems, real or imagined, are just a vote away.

One area of criticism that you can always count on as a focal point for candidates is our health care system. They usually have an easy solution, details of which are kept secret, to be revealed when the candidate is elected. It always amazes me how those same candidates suffer severe memory loss after they are elected and we never learn the details of that super-duper plan.

As part of the posturing about our current health care dilemma, you can be sure most blame for our shortcomings will be directed in 4 areas: government inaction (read Washington), pharmaceutical company profits and misdeeds, provider costs and insurance company indifference, and profiteering.

Perhaps it would be useful to look at the record to see what these 4 perennial targets have actually done for our country and its citizens. For starters, one should consider that in 1900, life expectancy was 48.3 years; today it is in excess of 77 and rising. This has been accomplished along with a better lifestyle healthwise. How did this happen?

It is generally conceded that the number one contributor to better health has been improvements in sanitation, and that has been essentially a government function–federal, state and local. Today we have clean water, effective sewers, garbage collection and disposal, and a host of other services to make life more livable and healthy.

But when we open a tap for a drink or take a shower, how often do we think about how things were 100-plus years ago? A look at conditions in third world countries will provide the answer. In my lifetime, I can remember when the toilet, with the path in the backyard, was commonplace in many parts of the country. Government has set standards for food, water, air quality, drugs and on and on, so that we live longer and healthier. Our tax dollars at work!

Concurrently, pharmaceutical companies have devised drugs and vaccines to eliminate many of the dread human killers such as polio, diphtheria, malaria, yellow fever and many more. Other diseases can be cured by miracles in a capsule or pill. Still others, like high blood pressure and diabetes, can be easily controlled.

As to profit, in recent years I have owned stock in 3 of the top pharmaceutical companies–but sold them because of lackluster performance. If they are making excess profits, it certainly does not show up in the market value of their stock. One reason, of course, is the enormous costs of research and development required to bring a new drug to market. Other countries, where drugs may be cheaper, typically do not bear the burden of such costs.

As for providers–hospitals, medical technicians, doctors, nurses–what can you say? Last week one of my neighbors had a hip replacement. One hour after the operation, he was on his feet and 2 days later, he was home. In 1934, when I had my appendix removed at St. Vincent’s Hospital in New York City, I was in the hospital 3 weeks and out of school a month. Many operations and procedures that formerly required hospitalization are now done on an outpatient basis.

Progress in this area has been an enormous boost to the nation’s productivity. Expensive, you bet, but then the new Ford I bought for $1,100 in 1947 costs a great deal more today. You can argue that the Ford of today has many more features than the one bought in 1947. True, but then, so is the quality of health care today. What was life like before the MRI, CAT scan, open heart surgery and stents? The answer was often debilitating illness, disability or death and, not so minor an issue, loss of productivity.

And finally, those real bad guys so often painted as the worst villains by candidates–the insurance companies. Most people living today have not experienced what life was like before the advent of health insurance, particularly group insurance. I remember it vividly and witnessed it first hand what illness did to the family finances. On two occasions, my in-laws were reduced to poverty because of medical bills to treat my brother-in-law. There was no insurance available and my father-in-law worked years for doctors just to pay off their bills.

Health insurance enables people to finance the ultimate in healthcare–no matter how expensive. This has enabled millions to access care that was formerly beyond their reach. This financing has also helped to pay for the wonderful advances in medicine that we often take for granted. But then, the audience for this column is as aware as I am as to what insurance has done and is doing to help people access the best healthcare in the world–so I will not belabor the point.

As to profit, the last figure that I saw indicated insurers were realizing only 2% or 3%–certainly not unreasonable. Additionally, some companies have exited the business because it was unprofitable.

Despite all the progress, is there still room for improvement? Of course there is, but as you get closer to perfection, improvements are harder to come by. The most often cited area for improvement is the plight of 40-plus million people who are uninsured (voluntarily or otherwise). But being uninsured does not necessarily mean a person does not have access to the health care system. Medicaid and state and county initiatives regularly provide excellent care for those who cannot pay for such services.

There are indeed opportunities for improvement, but my guess is that they will more likely come from the 4 targeted areas I noted than from some “secret” plan being touted for votes.