Healthcare

After decades of experience, notice that privatized health care has been obscenely profitable, complex, bureaucratic, error prone, and expensive. It does not cover a large fraction of the people, and it is not the best in overall quality. The private market does not work well for healthcare for a lot of reasons.

It is an unfortunate fact that medical errors are a major problem. "Death by medicine is now the leading killer and cause of injury in this country, ahead of the prior champion killers, heart attacks and cancer." (Gerry Spence quote) That is why victims need a way to recover damages. 'Tort reform' can allow errors to go uncorrected and a way to be sure consumers do not get justice. Victims should have their day in court.

Not only is US healthcare expensive, it is corrupt. Politicians use it for their own ATM and for jobs: examples include Jeb Bush, Bill Frist, Billy Tauzin, Rick Scott and many others.

Insurance companies seem to run the show now. They have thousands of employees to 'process' health insurance claims, many in very expensive office buildings, and many obscenely paid CEOs. For all that expense, what do they contribute to the actual delivery of health care ? Nothing. They have no business making decisions that are rightfully made by doctors and their patients. Although they do deny payment and exclude sick people (very crude rationing) , they do nothing to actually provide health care. (They pay plenty to lobby politicians though, so they may manage foil any real reform, and continue to rip off sick people for profit.)

Everyone agrees that health care reform is necessary. Our outsized healthcare expenses are, alone, enough reason. There is evidence that a single payer plan would save billions, but it is not even discussed.

Because right-wing ideologues are constantly assuring us that the government can't do anything for us (Republicans seem to want to prove it), there does not seem to be real discussion of functions that are best done by the public or private sector. Since I am covered by Medicare, it is reassuring to know that I will not arbitrarily be dropped, that copays are not necessary, that pre-existing conditions will not exclude me. I'd say the government mostly does an excellent job when it is simply paying for health care.

It is true that the US has heavy expenses that other countries do not. It has a military that is larger than the rest of the world's combined, it is a world leader in incarcerations, and, its healthcare expenses are much more than other developed countries. If money is your most important 'value', you could argue that we cannot afford more inclusive healthcare. Then again, an unhealthy population is itself a heavy expense, and it is a drag on the economy. It is not a matter of money. It is a moral obligation. There is no excuse for the lack of a working, efficient system.

Although prospects for health reform are better than they have been in a long time, Republicans are throwing up serious obstructions. Money (paper) is more important to them than the public good, and besides they wouldn't want Democrats to get credit. Our own Senator Lieberman, often on the Republican page, opposes a public health option. (His Contributions from health & insurance interests: $3,308,621.) Actually, A Public Option would save many Billions (9/1/2009)

Links

Here's an eye-opening letter to the editor of The Economist, Jan 22, 2009 issue:

Insurance companies probably have many thousands of employees to 'process' health insurance claims, many in very expensive office buildings, and many obscenely paid CEOs. For all that expense, what do they contribute to the actual delivery of health care ? Nothing. They have no business making decisions that are rightfully made by doctors and their patients. They do nothing to actually provide health care. (They pay plenty to lobby politicians though, so they may manage to continue to rip off sick people for their personal profit.)

So here's a suggestion for health care reform. Retrain health insurance employees so that they can actually do real work in doctors offices, hospitals, or other real jobs in health delivery. Close down the health insurers. We could go to a single payer plan like most civilized, advanced countries. My understanding is that there is a bill, HR676 which would do that. That would simplify the system and save enough money to guarantee universal health care.

Republicans like Jeb Bush are enjoying the healthcare gravy train and they still have enough people to stop real reform. Money (paper) is more important to them than results, and besides they wouldn't want Democrats to get credit for any improvement.

The White House severely edited congressional testimony given Tuesday by the director of the Centers for Disease Control and Prevention on the impact of climate change on health, removing specific scientific references to potential health risks, according to two sources familiar with the documents. (Oct.23,2007)

Paul Krugman| Health Economics 101

Paul Krugman writes that the free market doesn't work for health insurance, and never did. All we have ever had was a patchwork, semi-private system supported by large government subsidies.

Krugman's recent book "The Conscience of a Liberal" is particularly good on health care reform.

Confronting Health Insurance Companies

Why Does Everyone Bow Down to the Health Insurance Industry?

Bow your heads and raise the white flags. After facing down the Third Reich, the Japanese Empire, the U.S.S.R., Manuel Noriega and Saddam Hussein, the United States has met an enemy it dares not confront -- the American private health insurance industry.

With the courageous exception of Dennis Kucinich, the Democratic candidates all rolled out health "reform" plans that represent total, Chamberlain-like, appeasement. Edwards and Obama propose universal health insurance plans that would in no way ease the death grip of Aetna, Unicare, MetLife, and the rest of the evil-doers. Clinton -- why are we not surprised? -- has gone even further, borrowing the Republican idea of actually feeding the private insurers by making it mandatory to buy their product. Will I be arrested if I resist paying $10,000 a year for a private policy laden with killer co-pays and deductibles? (more)

State Medicaid Programs Throughout the Nation Are Extremely Deficient, Public Citizen Analysis Reveals

New Report Ranks State Programs and Highlights Disparities in Services and Eligibility

WASHINGTON, D.C. - State Medicaid programs have severe deficiencies and suffer from a great disparity of coverage and eligibility from state to state, according to report released today by Public Citizen. The report concludes that the federal Medicaid program, which provides health care coverage to 55 million mostly low-income Americans, is failing to deliver adequate services to millions of people because of differing state eligibility requirements, benefits and performance.

U.S. health care is bad for your health

[A new] study ... finds that not only is the U.S. health care system the most expensive in the world (double that of the next most costly comparator country, Canada) but comes in dead last in almost any measure of performance. Although U.S. political leaders are fond of stating that we have the best health-care system in the world, they fail to acknowledge an important caveat: It is the best only for the very rich. For the rest of the population, its deficits far outweigh its advantages. [The] study compared the United States with Australia, Canada, Germany, New Zealand and the United Kingdom. Although the most notable way in which the United States differs from the other countries is in the absence of universal coverage, the United States is also last on dimensions of access, patient safety, efficiency and equity. The other five countries considered spend considerably less on health care, both per capita and as a percent of gross domestic product, than the United States. The United States spends $7,000 per person per year on health care, almost double that of Australia, Canada and Germany, each of which achieve better results on health status indicators than the United States. The United States also lags behind all industrialized nations in terms of health coverage. 46.6 million Americans (about 15.9 percent of the population) had no health insurance coverage during 2005. It is no wonder, then, that medical bills are overwhelmingly the most common reason for personal bankruptcy in the United States.

Jeb Bush Joins the Tenet Gravy Train

Remember how imports from Canada were popular last year and how the drug companies said that those imports were unsafe ? Well, the problem was solved with Medicare part D. It was simply really, Medicare Part D does not reimburse imports from Canada. See how the wonders of the free market can take care of problems ? On the other hand Pfizer has decided to shut down production in the US and move it to India. After the problems with heparin, the Congress held hearings to determine what could be done to be sure that drugs remain safe when imported. Now the FDA will need to periodically inspect the Asian drug manufacturing plants. Pfizer privatizes profits from going offshore, eliminates those expensive US workers, dodges those pesky environmental regulations, and passes the inspection costs on to the taxpayer.

Michael Moore on Keith Olberman (video)

Physicians Proposal.

The Problem

That Americans do not have security of their health care coverage is a national disgrace. US health care is the most expensive in the world in % of Gross Domestic Product (GDP), but it does not cover a lot of us. Over 45 million people are not insured for health care in the US, although estimates, including underinsured or partially insured range up to one and a half times that amount, and the number is increasing.

Making health benefits an obligation of employers was a fatal flaw because it polarized business against it. Since it is more a public obligation in other countries, it makes globalization very unlevel. The auto and other industry are visibly suffering from this. They are responding by busting their unions and moving offshore.

Slowly, through increases in the employee contribution and copays the burden is being shifted away from companies. For some retirees they are pulling out . Insurance companies are in control. Many insurance companies sell their product based on the identification of low-risk pools, thus denying insurance to those most in need. You do not get insurance if you have a ‘pre-existing condition’. A health care system that does not cover sick people is an oxymoron.

Insurance companies have a close working alliance with Republicans. The MSA scheme, although derided as a kooky idea by most economists and health care experts, is now the ideological crown jewel of the Republican Medicare plan. The genius who came up with the ‘use it or lose it’ idea in which the money you set aside for healthcare at the end of the year becomes the employers. That’s Republican privatization for you…and like most of Bush policy is corporate welfare.

Because of press bias in health care reporting, the public is constantly misled from all sides. Media limits debate to private sector choices, denies voice to other points of view, and fails to provide coverage of experience in other countries. The Bush administration worked hard to suppress speech by further concentrating media.

Although there are variations, almost all Western countries fund health care with a single payer system. (There are always private options for people willing and able to pay for them.) Germany’s expenditures are half of ours per capita, and provide universal coverage.

Not only is our healthcare system dysfunctional, it is causing manufacturers, instead of improving product, to bust their unions and move offshore.

Republican tax cuts were taken from health care and it shows. Hospitals were sold (privatized) just to keep the doors open. Electing Republicans assures that the current flawed system will not only remain in place but also get worse. Instead you will get a 'Star Wars' program guaranteed (by Ted Postol of MIT) not to work.

To make the global free market a level playing field, healthcare should be largely taxpayer funded. The profit motive is out of place in medicine and only produces god awful results.

I Am Not a Health Reform

IN 1971, President Nixon sought to forestall single-payer national health insurance by proposing an alternative. He wanted to combine a mandate, which would require that employers cover their workers, with a Medicaid-like program for poor families, which all Americans would be able to join by paying sliding-scale premiums based on their income.

Nixon’s plan, though never passed, refuses to stay dead. Now Hillary Clinton, John Edwards and Barack Obama all propose Nixon-like reforms. Their plans resemble measures that were passed and then failed in several states over the past two decades.

In 1988, Massachusetts became the first state to pass a version of Nixon’s employer mandate — and it added an individual mandate for students and the self-employed, much as Mrs. Clinton and Mr. Edwards (but not Mr. Obama) would do today. Michael Dukakis, then the state’s governor, announced that “Massachusetts will be the first state in the country to enact universal health insurance.” But the mandate was never fully put into effect. In 1988, 494,000 people were uninsured in Massachusetts. The number had increased to 657,000 by 2006.

Oregon, in 1989, combined an employer mandate with an expansion of Medicaid and the rationing of expensive care. When the federal government granted the waivers needed to carry out the program, Gov. Barbara Roberts said, “Today our dreams of providing effective and affordable health care to all Oregonians have come true.” The number of uninsured Oregonians did not budge.

In 1992 and ’93, similar bills passed in Minnesota, Tennessee and Vermont. Minnesota’s plan called for universal coverage by July 1, 1997. Instead, by then the number of uninsured people in the state had increased by 88,000.

Tennessee’s Democratic governor, Ned McWherter, declared that “Tennessee will cover at least 95 percent of its citizens.” Yet the number of uninsured Tennesseans dipped for only two years before rising higher than ever.

Vermont’s plan, passed under Gov. Howard Dean, called for universal health care by 1995. But the number of uninsured people in the state has grown modestly since then.

The State of Washington’s 1993 law included the major planks of recent Nixon-like plans: an employer mandate, an individual mandate for the self-employed and expanded public coverage for the poor. Over the next six years, the number of uninsured people in the state rose about 35 percent, from 661,000 to 898,000.

As governor, Mitt Romney tweaked the Nixon formula in 2006 when he helped devise a second round of Massachusetts health care reform: employers in the state that do not offer health coverage face only paltry fines, but fines on uninsured individuals will escalate to about $2,000 in 2008. On signing the bill, Mr. Romney declared, “Every uninsured citizen in Massachusetts will soon have affordable health insurance.” Yet even under threat of fines, only 7 percent of the 244,000 uninsured people in the state who are required to buy unsubsidized coverage had signed up by Dec. 1. Few can afford the sky-high premiums.

Each of these reform efforts promised cost savings, but none included real cost controls. As the cost of health care soared, legislators backed off from enforcing the mandates or from financing new coverage for the poor. Just last month, Massachusetts projected that its costs for subsidized coverage may run $147 million over budget.

The “mandate model” for reform rests on impeccable political logic: avoid challenging insurance firms’ stranglehold on health care. But it is economic nonsense. The reliance on private insurers makes universal coverage unaffordable.

With the exception of Dennis Kucinich, the Democratic presidential hopefuls sidestep an inconvenient truth: only a single-payer system of national health care can save what we estimate is the $350 billion wasted annually on medical bureaucracy and redirect those funds to expanded coverage. Mrs. Clinton, Mr. Edwards and Mr. Obama tout cost savings through computerization and improved care management, but Congressional Budget Office studies have found no evidence for these claims.

In 1971, New Brunswick became the last Canadian province to institute that nation’s single-payer plan. Back then, the relative merits of single-payer versus Nixon’s mandate were debatable. Almost four decades later, the debate should be over. How sad that the leading Democrats are still kicking around Nixon’s discredited ideas for health reform.

David U. Himmelstein and Steffie Woolhandler are professors of medicine at Harvard and the co-founders of Physicians for a National Health Program.

Laurie Garrett's comments from her book: "Betrayal of Trust"

"Ronald Reagan swept into the presidency in 1980. His two terms in that office were marked by the dismantling of public health's regulatory powers. Within eight years the Reagan administration had so thoroughly defeated its regulatory adversaries that public health was forced into defeat, even on issues of bona fide community health threats, its most outspoken voices of environmental concern sidelined along the margins of academia and political activism" page 580.

A report from the U.S. Department of Health "made clear that the infrastructure upon which the national public health system functions requires definition, coordination, and strength to realize the universal public health mission. [The report] documents continued deterioration of the national public health system; health departments closing, technology and information systems outmoded; emerging and drug resistant diseases threaten to overwhelm resources; and serious training inadequacies threaten the capacity of the public health workforce to address new threats and adapt to changes in the health care market." Pg 559.

Laurie Garrett's books are instructive about public health policy.

Dr Paul Farmer

See also Mountain Beyond Mountains, the quest of Dr. Paul Farmer, a man who would cure the world: by Tracy Kidder. It will surprise you, after reading US media, how Farmer admires the Cuban health care system. Excellent book. It is persuasive in arguing that health care is a right, not a commodity.

Global Health Equity (a video of Paul Farmer)

Dr Farmer's charity is Partners in Health.

Drug Industry

Both patent and copyright protection have led to increasing inefficiencies and abuses in recent years, exactly the effects that economists would predict from government-granted monopolies. Drug patents have been especially problematic. Because drug companies stand to make such enormous profits from patented drugs, there is a continuous stream of scandals involving efforts to conceal negative research findings, to falsely tout the benefits of specific drugs, and payoffs to experts, regulators, and politicians. In addition, drug patents lead to drugs being priced at levels that make them unaffordable for much of the population in the United States and around the world. While drugs are almost invariably cheap to manufacture, and therefore would sell for a low price in a competitive market, patent monopolies allow drug companies to sell life-saving drugs for thousands or even tens of thousands of dollars per prescription. From the Conservative Nanny State.