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Editor’s Note: There are two ways of seeing health care – as a vital service that people should get for a reasonable price or as a big business that can lead to huge salaries, big profits and fat stock prices even if many sick people have to go bankrupt or go without.

Whatever feel-good messages the health insurance companies and the medical industry have been sending in recent months about how much they, too, care about health-care reform, the tone is about to get a lot nastier, as Bill Moyers and Michael Winship write:

This is a story of health care and two Americans; a tale of two citizens, if you will.

This week, Regina Benjamin was nominated by President Obama as our next surgeon general, charged with educating Americans on medical issues and overseeing the United States Public Health Service. She was the first African-American woman to head a state medical society, a member of the board of trustees of the American Medical Association and last year was named the recipient of a MacArthur Foundation genius award.

But more important, she's a country doctor, a family physician along the Gulf Coast of Alabama, serving the poor and uninsured - white, black and Asian. After Hurricane Katrina destroyed her clinic - the second time a hurricane had done so - she mortgaged her own home to rebuild it.

The day it was to reopen, a fire burned the clinic to the ground. Moving to a trailer, Dr. Benjamin and her staff never missed a day of work.

Stan Wright, the tobacco-chewing mayor of Bayou La Batre, the small shrimp-fishing community in which Dr. Benjamin practices, told National Public Radio, "She'll do whatever she's gotta do to make sure everyone's taken care of."

Benjamin will no doubt bring that same ethic to the fight for health care reform.

When President Obama announced her nomination in a Rose Garden ceremony Monday, Dr. Benjamin said, "These are trying times in the health care field, and as a nation, we have reached a sobering realization. Our health care system simply cannot continue on the path that we're on. Millions of Americans can't afford health insurance or they don't have the basic health services available where they live."

Although the clinic has not been able to give Dr. Benjamin a salary for years - Mayor Wright says she's owed over $300,000 - she buys medicine for her patients out of her own pocket. In fact, many of the folks in Regina Benjamin's bayou town are so poor that sometimes she's paid with a pint of oysters or a couple of fish.

She's fine with that. And she makes house calls.

Now meet H. Edward Hanway, the chairman and CEO of CIGNA, the country's fourth largest insurance company. At the beginning of the year, CIGNA blamed hard economic times when it announced the layoff of 1,100 employees, but it reported first quarter profits of $208 million on revenues of nearly $5 billion.

Mr. Hanway has announced his retirement at the end of the year, and the living will be easy, financially at least. He made $11.4 million in 2008, according to the Associated Press, and some years more than that.

That's a lot of oysters, although he lags behind Ron Williams, the CEO of Aetna Insurance, who made $17.4 million last year, or John Hammergren, the head of McKesson, the biggest health care company in the world. His compensation was $29.7 million.

Here's the difference. To Dr. Regina Benjamin, health care is a public service, helping people in need with grace and compassion. To Ed Hanway and his highly paid friends, it's big business, a commodity to be sold to those who can afford it. And woe to anyone who gets between them and the profits they reap from sick people. 

That's what Wendell Potter, the former CIGNA executive turned health care reform advocate, told us on last week's edition of “Bill Moyers Journal.”

"Just about every time there has been significant legislation before Congress, the industry has been able to kill it," he said. "Yeah, the status quo works for them. They don't like to have any regulation forced on them or laws forced on them. They don't want to have any competition from the federal government, or any additional regulation from the federal government. They say they will accept it. But the behavior is that they will not."

As we reported last week, that behavior includes spending nearly a million and a half a day to make sure health care reform comes out their way. Over the years they've lavished millions on the politicians who are writing and voting on health care reform. Now it's payback time.

Proposed legislation finally is coming out of House and Senate committees, and Thursday's Los Angeles Times reported "signs that the debate was moving into a more bruising phase in which insurance companies, hospitals and others fight to shape the details of legislative provisions that affect them."
 
It's going to get ugly, especially now that some Democrats, according to ABC News, are contemplating new taxes on health insurance and pharmaceutical companies to help pay for reform, perhaps as much as $100 billion worth.

In other words, no more Mister Nice Guy. Those TV commercials you've been seeing from the health care companies about their generosity and miracles of modern medicine are about to change, as the opposition shifts gears from charm to alarm.

It's the war against the Clinton health care plan all over again. This time, don't let them scare you.

"It should not be this hard for doctors and other health care providers to care for their patients," Dr. Regina Benjamin said when she was nominated this week. "It shouldn't be this expensive for Americans to get health care in this country."

Bill Moyers is managing editor and Michael Winship is senior writer of the weekly public affairs program Bill Moyers Journal, which airs Friday night on PBS.  Check local airtimes or comment at The Moyers Blog at www.pbs.org/moyers. Research provided by producer Gail Ablow and associate producer Julia Conley.

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