Bartiromo, both with me and in this spot with Weiner, has been hammering home the same point, that the proof that a public option won’t work can be found in the fact that the public health care system in England will not pay for the colorectal cancer drug Erbitux. I guess she is trying to say that there is rationing of health care in a single-payer system — that the fact that the government will not pay for the most expensive non-generic cancer drug on the market is proof that we shouldn’t have a public option in the U.S.
It drives me crazy when people make this argument. Fuck a fancy boutique drug like Erbitux — I have a very expensive private plan and I can’t even go to a doctor, not even to ask a simple question, unless it’s an emergency. I can’t get a routine checkup, can’t find out what that weird lump in my left foot is, can’t have the pleasure of a routine proctological exam unless I want to pay cash for it, and, well, forget about getting a filling replaced or seeing a therapist to deal with my incipient nervous collapse/burgeoning mid-life crisis. Hell, forget about paying for Erbitux, if I wanted to get a colonoscopy to find out if I needed Erbitux, I wouldn’t be able to — I’d probably have to wait until I was a fully symptomatic cancer patient before I could even have that conversation on my insurer’s dime. And I’m one of the lucky ones, I actually have money to pay for care out of pocket, if I had to. No country in the world rations care more than the U.S. There are whole generations of Americans (20-40 year-olds in particular) who don’t know what it is to be able to go to a doctor for preventive care or routine checkups. Erbitux, for Christ’s sake! Give me a break.
I’ve been getting phone calls from some folks in DC with some ugly stories about how the Democrats have systematically sandbagged the progressive opposition, with the White House pulling strings and levering the funding for various nonprofit groups in order to prevent them from airing ads attacking the insurance and pharmaceutical industries. I suspect in the end this is going to be the main story of the health care reform effort, how the Democrats (and some progressive groups) sold out their constituents in exchange for financial contributions from the relevant industries. But at the same time, you can’t discount the role certain media outlets are playing in all of this. Nobody is ordering Maria Bartiromo to lobby to keep poor people from having access to the kind of excellent health care she is fortunate enough to have been given by CNBC, for being so good at flattering Wall Street pirates on air (and off, according to some folks I know at certain banks). She just does it because that’s who she is naturally. I just don’t know how these people sleep at night — it baffles me.
Journalist and author T.R. Reid set out on a global tour of hospitals and doctors' offices, all in the hopes of understanding how other industrialized nations provide affordable, effective universal health care. The result: his book The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.
As Americans search for the cure to what ails our health-care system, we've overlooked an invaluable source of ideas and solutions: the rest of the world. All the other industrialized democracies have faced problems like ours, yet they've found ways to cover everybody -- and still spend far less than we do.
I've traveled the world from Oslo to Osaka to see how other developed democracies provide health care. Instead of dismissing these models as "socialist," we could adapt their solutions to fix our problems. To do that, we first have to dispel a few myths about health care abroad:
1. It's all socialized medicine out there.
Not so. Some countries, such as Britain, New Zealand and Cuba, do provide health care in government hospitals, with the government paying the bills. Others -- for instance, Canada and Taiwan -- rely on private-sector providers, paid for by government-run insurance. But many wealthy countries -- including Germany, the Netherlands, Japan and Switzerland -- provide universal coverage using private doctors, private hospitals and private insurance plans.
In some ways, health care is less "socialized" overseas than in the United States. Almost all Americans sign up for government insurance (Medicare) at age 65. In Germany, Switzerland and the Netherlands, seniors stick with private insurance plans for life. Meanwhile, the U.S. Department of Veterans Affairs is one of the planet's purest examples of government-run health care.
2. Overseas, care is rationed through limited choices or long lines.
Generally, no. Germans can sign up for any of the nation's 200 private health insurance plans -- a broader choice than any American has. If a German doesn't like her insurance company, she can switch to another, with no increase in premium. The Swiss, too, can choose any insurance plan in the country.
In France and Japan, you don't get a choice of insurance provider; you have to use the one designated for your company or your industry. But patients can go to any doctor, any hospital, any traditional healer. There are no U.S.-style limits such as "in-network" lists of doctors or "pre-authorization" for surgery. You pick any doctor, you get treatment -- and insurance has to pay.
Canadians have their choice of providers. In Austria and Germany, if a doctor diagnoses a person as "stressed," medical insurance pays for weekends at a health spa.
As for those notorious waiting lists, some countries are indeed plagued by them. Canada makes patients wait weeks or months for nonemergency care, as a way to keep costs down. But studies by the Commonwealth Fund and others report that many nations -- Germany, Britain, Austria -- outperform the United States on measures such as waiting times for appointments and for elective surgeries.
In Japan, waiting times are so short that most patients don't bother to make an appointment. One Thursday morning in Tokyo, I called the prestigious orthopedic clinic at Keio University Hospital to schedule a consultation about my aching shoulder. "Why don't you just drop by?" the receptionist said. That same afternoon, I was in the surgeon's office. Dr. Nakamichi recommended an operation. "When could we do it?" I asked. The doctor checked his computer and said, "Tomorrow would be pretty difficult. Perhaps some day next week?"
3. Foreign health-care systems are inefficient, bloated bureaucracies.
Much less so than here. It may seem to Americans that U.S.-style free enterprise -- private-sector, for-profit health insurance -- is naturally the most cost-effective way to pay for health care. But in fact, all the other payment systems are more efficient than ours.
U.S. health insurance companies have the highest administrative costs in the world; they spend roughly 20 cents of every dollar for nonmedical costs, such as paperwork, reviewing claims and marketing. France's health insurance industry, in contrast, covers everybody and spends about 4 percent on administration. Canada's universal insurance system, run by government bureaucrats, spends 6 percent on administration. In Taiwan, a leaner version of the Canadian model has administrative costs of 1.5 percent; one year, this figure ballooned to 2 percent, and the opposition parties savaged the government for wasting money.
The world champion at controlling medical costs is Japan, even though its aging population is a profligate consumer of medical care. On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3,400 per person annually on health care; the United States spends more than $7,000.
4. Cost controls stifle innovation.
False. The United States is home to groundbreaking medical research, but so are other countries with much lower cost structures. Any American who's had a hip or knee replacement is standing on French innovation. Deep-brain stimulation to treat depression is a Canadian breakthrough. Many of the wonder drugs promoted endlessly on American television, including Viagra, come from British, Swiss or Japanese labs.
Overseas, strict cost controls actually drive innovation. In the United States, an MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98. Under the pressure of cost controls, Japanese researchers found ways to perform the same diagnostic technique for one-fifteenth the American price. (And Japanese labs still make a profit.)
5. Health insurance has to be cruel.
Not really. American health insurance companies routinely reject applicants with a "preexisting condition" -- precisely the people most likely to need the insurers' service. They employ armies of adjusters to deny claims. If a customer is hit by a truck and faces big medical bills, the insurer's "rescission department" digs through the records looking for grounds to cancel the policy, often while the victim is still in the hospital. The companies say they have to do this stuff to survive in a tough business.
Foreign health insurance companies, in contrast, must accept all applicants, and they can't cancel as long as you pay your premiums. The plans are required to pay any claim submitted by a doctor or hospital (or health spa), usually within tight time limits. The big Swiss insurer Groupe Mutuel promises to pay all claims within five days. "Our customers love it," the group's chief executive told me. The corollary is that everyone is mandated to buy insurance, to give the plans an adequate pool of rate-payers.
The key difference is that foreign health insurance plans exist only to pay people's medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage.
In many ways, foreign health-care models are not really "foreign" to America, because our crazy-quilt health-care system uses elements of all of them. For Native Americans or veterans, we're Britain: The government provides health care, funding it through general taxes, and patients get no bills. For people who get insurance through their jobs, we're Germany: Premiums are split between workers and employers, and private insurance plans pay private doctors and hospitals. For people over 65, we're Canada: Everyone pays premiums for an insurance plan run by the government, and the public plan pays private doctors and hospitals according to a set fee schedule. And for the tens of millions without insurance coverage, we're Burundi or Burma: In the world's poor nations, sick people pay out of pocket for medical care; those who can't pay stay sick or die.
This fragmentation is another reason that we spend more than anybody else and still leave millions without coverage. All the other developed countries have settled on one model for health-care delivery and finance; we've blended them all into a costly, confusing bureaucratic mess.
Which, in turn, punctures the most persistent myth of all: that America has "the finest health care" in the world. We don't. In terms of results, almost all advanced countries have better national health statistics than the United States does. In terms of finance, we force 700,000 Americans into bankruptcy each year because of medical bills. In France, the number of medical bankruptcies is zero. Britain: zero. Japan: zero. Germany: zero.
Given our remarkable medical assets -- the best-educated doctors and nurses, the most advanced hospitals, world-class research -- the United States could be, and should be, the best in the world. To get there, though, we have to be willing to learn some lessons about health-care administration from the other industrialized democracies.
Reid is a foreign correspondent for The Washington Post and the former chief of the paper's London and Tokyo bureaus.
Reid was the lead correspondent for the 2008 Frontline documentary Sick Around the World, which examined five other capitalist democracies, looking for lessons on health-care delivery. His books include Confucius Lives Next Door: What Living in the East Teaches Us About Living in the West and The United States of Europe: The New Superpower and the End of American Supremacy.
Ah yes, I'm not surprised that psychiatrist David Gratzer testified this week that the Canadian healthcare system is just awful and how the poor deprived Canadians are simply pouring across the border to the Mayo Clinic to get specialized medical care.
Oddly enough, he forgot to mention that the Canadian government was not only sending them across the border, they were picking up the check. Yes, it's a system so awful, even Canadian conservatives defend it.
How gratifying it was, to see Dennis Kucinich lay the smackdown on this guy.
Dr. Gratzer has been a prominent freemarket advocate since his college days and has been riding that gravy train ever since. He is especially beloved of freemarket conservatives because of a piece he wrote two years ago that hit the wingnut sweet spot: "The Ugly Truth About Canadian Health Care."
He's a fellow at the Manhattan Institute, a "non-partisan" think tank funded by the usual partisan suspects:
The Manhattan Institute received $19,470,416 in grants from 1985-2005, from foundations such as the Koch Family Foundations, the John M. Olin Foundation, Inc., the Lynde and Harry Bradley Foundation, the Scaife Foundations, and the Smith Richardson Foundation. The Manhattan Institute does not disclose its corporate funding, but the Capital Research Center listed its contributors as Bristol-Myers Squibb, Exxon Mobil, Chase Manhattan, Cigna, Sprint, Reliant Energy, Lincoln Financial Group Foundation, and Merrill Lynch.
So I think you can see where he's coming from. And really, what could make the right wing more excited than a Canadian doctor, criticizing the Canadian health care system?
You're probably not aware that for the past decade or so, right-wing American groups have been pouring a lot of money into Canada to undermine their health system. (Can you guess why? I knew you could! So American health care corporations can make a killing there, too!)
Dr. Gratzer's biggest thing is hammering away on wait times - even though the long wait times are mostly for non-urgent care. (You can read a rebuttal about many of the common myths here.) He also thinks the way to bring down the cost of prescription drugs is... to cut back on those pesky FDA requirements!
While serving as an adviser to Rudy Giuliani's campaign, he was called out by Factcheck.org and others for supplying a bogus cancer statistic Rudy used in an ad:
Rudy Giuliani's latest radio ad, which began airing in New Hampshire this week, draws a stark picture for anyone diagnosed with prostate cancer in England. "I had prostate cancer, five, six years ago," the Republican presidential candidate says in the ad. "My chance of surviving prostate cancer, and thank God I was cured of it, in the United States, 82 percent. My chances of surviving prostate cancer in England, only 44 percent under socialized medicine.”
"You would get an F in epidemiology at Johns Hopkins if you did that calculation," said Johns Hopkins professor Gerard Anderson, whose 2000 study "Multinational Comparisons of Health Systems Data" has been cited by Gratzer as a source for his statistics.... Five-year prostate cancer survival rates are higher in the United States than in Britain but, according to Howard Parnes of the National Cancer Institute, this is largely a statistical illusion.... Both Anderson and Parnes say that it is impossible, on the basis of the available data, to conclude that Americans have a significantly better chance of surviving prostate cancer than Britons.
The Office for National Statistics says that the five-year survival rate from prostate cancer in Britain is 74.4 per cent.
Mr Giuliani’s campaign did not give an immediate response. But a spokeswoman has previously insisted that he would continue to repeat the statistic and run the advertisement. She said the 44 per cent figure came from an article in a “highly respected intellectual journal” published by the right-wing Manhattan Institute, which he had read because “he is an intellectually engaged human being”.
The article’s author, David Gratzer, who is an adviser to Mr Giuliani’s campaign, has acknowledged to The New York Times that the statistic is seven years old and “crude”.
He said that it came from the Commonwealth Fund, which specialises in health policy issues. But the same organisation has since issued a statement accusing Dr Gratzer of misusing its research.
In fact, the five-year survival data cited in the City Journal article do not come from The Commonwealth Fund report, and cannot be calculated from that report. What the report, Multinational Comparisons of Health Systems Data, 2000 by Gerard F. Anderson and Peter S. Hussey of Johns Hopkins University, includes are data on prostate cancer incidence and mortality rates in the two countries.
Specifically, The Commonwealth Fund report features a chart showing that, in 1997, the incidence of prostate cancer in the U.S. was 136 per 100,000 males and the mortality rate (death rate) was 26 per 100,000 males. By comparison, in the U.K. the prostate cancer incidence was 49 per 100,000 and the death rate was 28 deaths per 100,000. (The prostate cancer incidence rate—which is the number of men diagnosed with the disease in a given year—in the U.S. is thought to be higher because prostate cancer screening is much more common in this country.)
The incidence rates simply report the number of men diagnosed with prostate cancer in a given year. Prostate cancer mortality rates report the number of men who died of the disease in a given year. Neither speaks to length of survival, and that figure can not be calculated using the others.
Yes, Dr. Gratzer (like most right-wing true believers) is prone to seeing what he wants to see, and then insisting it's the truth. How refreshing to see him treated as the willful nincompoop he is.
