The most important health-care document released this week was not Sen. Max Baucus's Healthy Future Act. It was the Kaiser Family Foundation's 2009 Employer Benefits Survey.
While the proposal by Baucus, chairman of the Senate Finance Committee, outlines a direction for policy, the survey, which polls employers about health benefits to assemble a detailed look at the actual cost of health care, fits it squarely in our pocketbooks.
The truth is we all pay, and much more than we recognize, for health care.
For many, it's among the largest investments we'll make, on par, even, with the money we spend on a house or tuck away for retirement. But while it's easy to track our stock portfolios as they tank along with the market, our outlay for health care is less obvious. Employers pay some, and so do individuals, and taxpayers. And some even hides behind the deficit. As such, few of us see the full picture. But to make sense of the proposals for reform, getting a grasp of the cost is critical.
The average health-care coverage for the average family now costs $13,375, according to Kaiser. Over the past decade, premiums have increased by 138 percent. And if the trend continues, by 2019 the average family plan will cost $30,083.
Three years of slightly above-average health insurance will cost a solid six figures.
Those are numbers to marvel at. Those are numbers to fear. But they are not the numbers that loom in the minds of most Americans. And therein lies the problem for health-care reform.
About 160 million Americans receive health coverage through their employers. In general, the employer picks up 73 percent of the tab. This seems like a good deal. In reality, that money comes out of wages.
As Ezekiel Emanuel, who advises Office of Management and Budget Director Peter Orszag on health-care policy, has pointed out, health-care premiums have risen by 300 percent over the past 30 years (and that's after adjusting for inflation). Corporate profit per employee has soared by 200 percent. Hourly earnings for workers, adjusted for inflation, have fallen. The wage increases have been consumed by health-care costs.
Another 80 million Americans are on public plans, mainly Medicare and Medicaid. Those costs are paid by taxpayers. And about 46 million Americans are uninsured. The costs for their care are shifted to the insured: This raises premiums for the average family by $1,100 each year, according to an analysis by Ben Furnas and Peter Harbage of the Center for American Progress.
Imagine if people who touched a hot stove felt only a small fraction of the pain from the burn. That's pretty much what's happening in our health-care system. It hurts enough that we would prefer it to stop, but the urgency is lost.
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.
Since there's suddenly a lot of talk about the long waits for treatment in Canada--and how reform will supposedly produce similarly long waits here--this seems like a fine time to remind people that long waits for treatment already exist here.
From Business Week, in July 2007:
both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems. ...
If you find a suspicious-looking mole and want to see a dermatologist, you can expect an average wait of 38 days in the U.S., and up to 73 days if you live in Boston, according to researchers at the University of California at San Francisco who studied the matter. Got a knee injury? A 2004 survey by medical recruitment firm Merritt, Hawkins & Associates found the average time needed to see an orthopedic surgeon ranges from 8 days in Atlanta to 43 days in Los Angeles. Nationwide, the average is 17 days. ...
There is no systemized collection of data on wait times in the U.S. That makes it difficult to draw comparisons with countries that have national health systems, where wait times are not only tracked but made public. However, a 2005 survey by the Commonwealth Fund of sick adults in six nations found that only 47% of U.S. patients could get a same- or next-day appointment for a medical problem, worse than every other country except Canada.
The Commonwealth survey did find that U.S. patients had the second-shortest wait times if they wished to see a specialist or have nonemergency surgery, such as a hip replacement or cataract operation (Germany, which has national health care, came in first on both measures). But Gerard F. Anderson, a health policy expert at Johns Hopkins University, says doctors in countries where there are lengthy queues for elective surgeries put at-risk patients on the list long before their need is critical. "Their wait might be uncomfortable, but it makes very little clinical difference," he says.
Rising health care costs coupled with eroding health care benefits are having a substantial effect on Americans' ability to get needed health care, with women particularly affected. Women experience cost-related access problems and medical bill problems more often than men. In 2007, more than half (52%) of women reported problems accessing needed care because of cost and 45 percent of women accrued medical debt or reported problems with medical bills. Since women use more health care services than men, they are more exposed to the fragmentation and failings of the current health care system—underscoring the need for affordable and high-quality health insurance coverage that is available to all.
In a national Commonwealth Fund survey, elderly Medicare beneficiaries reported greater overall satisfaction with their health coverage, better access to care, and fewer problems paying medical bills than people covered by employer-sponsored plans. The findings bolster the argument that offering a public insurance plan similar to Medicare to the under-65 population has the potential to improve access and reduce costs.
