Why won't Congress consider how other countries do it?
By Timothy Noah
Every day Washington's leaders tell us that we live in an interdependent world with a globalized economy. A butterfly beats its wings in Guangdong province, and four Wal-Marts materialize in Duluth. The peso plunges, and 30 Honda workers get laid off in Marysville. A coal-fired power plant belches carbon dioxide in Prague, and Lohachara Island sinks into the Bay of Bengal.
But change the subject to reform of the health care system, and the community of nations abruptly vanishes. No France, no Canada, no Germany, no Japan. Let there be no mention of any industrialized democracy save that of the United States, which is proud to claim 37th place in the World Health Organization's rankings of the world's health systems and 15th in the Commonwealth Fund's ranking by avoidable mortality of 19 industrialized countries (the highest rank indicates the fewest such deaths). To achieve a better score would be unpatriotic!
The political establishment's hubristic refusal to consider how other countries manage health care is encapsulated in the cliché "uniquely American," which is what Sen. Max Baucus, D-Mont., the lead legislator on health care reform, says he wishes his bill to be. It therefore goes without saying that the finance committee Baucus chairs could find no place in this year's exhaustive health care hearings for a single expert on how other countries achieve better health outcomes for their populations while typically spending, on a per capita basis, half what we do. When the finance committee releases its draft bill this week, it will be almost completely free of foreign influence. Read it all at Slate Magazine
Media figures and outlets have characterized Sen. Kent Conrad's cooperative health insurance proposal as a 'compromise,' 'hybrid,' or bipartisan 'alternative' to a public insurance option without noting the argument by progressive economists that a public option is necessary for health care reform to be successful. Read more at Media Matters for America
She was covered by her employer's health plan and also, of course, by Workman's Comp, since her injury happened while she was on the job. You'd think this would be a good situation, right? More insurance coverage is better because if company A can't cover you, company B will, right?
Wrong.
Instead of getting her into surgery to repair the rotator cuff, the two insurers started a battle over who was responsible for her care. Neither one wanted to pay for it, because it would cut into their profits. So while she waited for them to come to some kind of an agreement, she had to stay at home, on full workman's comp disability, and her doctors prescribed megadoses of painkillers - specifically, ibuprofen - for her to use to deal with the pain. And, of course, she was in excruciating pain, so she took them. Rad More...
Activism pays off:
Those who rallied outside the Framingham and Medford offices of U.S. Rep. Edward Markey to get him to become a co-sponsor of a bill that would provide universal health insurance were thrilled when they achieved their goal. Read more...
By Dr. Abraham Verghese
I mention this because I have similar problems with the way President Obama hopes to pay for the huge and costly health reform package he has in mind that will cover all Americans; he is counting on the “savings” that will come as a result of investing in preventive care and investing in the electronic medical record among other things. It’s a dangerous and probably an incorrect projection. But I’d like to officially let McAllen off the hook and say that having practiced in five states, including 15 years in the great state of Texas, we are all complicit in practicing just that kind of medicine if you look hard enough and if you looked at us individually. Conflicts of interest are rife; they are almost the rule. So is the ability to wear blinders so we are (mostly) oblivious to our conflict.
Which brings me to my problem with the president’s plan: despite being an admirer, I just don’t see how the president can pull off the reform he has in mind without cost cutting. I recently came on a phrase in an article in the journal “Annals of Internal Medicine” about an axiom of medical economics: a dollar spent on medical care is a dollar of income for someone. I have been reciting this as a mantra ever since. It may be the single most important fact about health care in America that you or I need to know. It means that all of us—doctors, hospitals, pharmacists, drug companies, nurses, home health agencies, and so many others—are drinking at the same trough which happens to hold $2.1 trillion, or 16% of our GDP. Every group who feeds at this trough has its lobbyists and has made contributions to Congressional campaigns to try to keep their spot and their share of the grub. Why not?—it’s hog heaven. But reform cannot happen without cutting costs, without turning people away from the trough and having them eat less. If you do that, you have to be prepared for the buzz saw of protest that dissuaded Roosevelt, defeated Truman’s plan and scuttled Hillary Clinton’s proposal. The good news is that the AMA, representing perhaps 15% of active practicing physicians, is not as powerful as it was in Truman’s time, and in the eyes of the public and many in medicine, it’s identity in the reform debate, is that of a protectionist, self-serving, organization; as a result, even their most progressive statements are viewed with suspicion. I’ve found the views of the American Medical Student Association particularly exciting—the next generation of physicians I sense has a deeper commitment to affordable health care for all than ours; they are, simply put, better people.
We may not like it, but the only way a government can control costs is by wielding great purchasing power to get concessions on the price of drugs, physician fees, and hospital services; the only way they can control administrative costs is by providing a simplified service, yes, the Medicare model (with a 3% overhead), and not allowing private insurance to cherry-pick patients (some of them operating with 30% overheads, the cost passed on to you).
Contrary to what we might think, comparative studies show us that the US when compared to other advanced countries, does not have a sicker population: we actually use fewer prescription drugs and we have shorter hospital stays (though we manage to do a lot more imaging in those short stays—got to feed the MRI machines). The bottom line is that our health care is costly because it is costly, not because we deliver more care, better care or special care. Alas, a solution that does not address the cost of care, and negotiate new prices for the services offered will not work; a solution that does not put caps on spending and that instead projects cost-savings here and there also won’t cut it. Leaders have to make tough and unpopular decisions, and if he is to be the first President to successfully accomplish reform there does not seem to be much choice: cut costs. —Abraham Verghese is Professor and Senior Associate Chair for the Theory and Practice of Medicine at Stanford University. He is the author of the novel “Cutting For Stone.”Read more in at WSJ.com
In the latest draft of the healthcare bill, Democrats in the U.S. House of Representatives suggested all citizens should be able to get insurance regardless of medical history and that coverage should be mandatory for individuals and businesses.
The proposal would create a new government plan to help cover the uninsured -- a move backed by President Barack Obama but resisted by Republicans and some centrist Democrats who fear it will overwhelm private insurers and require vast amounts of public funding. Read More at Reuters
Scheiner, 71, was Obama's doctor from 1987 until he entered the White House; he vouched for the then-candidate's "excellent health" in a letter last year. He's still an enthusiastic Obama supporter, but he worries about whether the health care legislation currently making its way through Congress will actually do any good, particularly for doctors like himself who practice general medicine. "I'm not sure he really understands what we face in primary care," Scheiner says. "He doesn't see all the pain, it's so tragic out here," he says. "Obama's wonderful, but on this one I'm not sure if he's getting the right input."
What should the president be focused on? Scheiner thinks that a good health reform would be "Medicare for all," a single-payer system where the government would cover everyone and pay for it by cutting out waste in the system. Read the reast at Forbes.com
Health care reform could be the insurance industry's greatest nightmare or a dream-come-true, depending on the fate of some of the most sweeping proposals. And health and accident insurers, in addition to HMOs and health services, are hoping that the $586 million they've spent on lobbying since 1998 will pay off now.
What these insurers want more than anything, of course, is to get some help in improving their bottom line, and they can't do it if the system maintains the status quo. According to the Chicago Tribune, private insurers have been rapidly losing customers since 2000 and this trend has only accelerated since the start of the recession, when people lost their jobs en masse. They're also worried about what will happen to their business when baby boomers are eligible for Medicare and no longer need private insurance. The perfect fix, the industry says, is the government requiring all people to buy medical coverage, which would add millions of new customers and generate a steady revenue stream, the Tribune reported. Read more at OpenSecrets
At a glance, the plight of these 47 million appears to be much if not most of what needs fixing. But, as Chronicle business columnist Loren Steffy observes in his column this past Sunday (“Insured but not covered”), things are far from copacetic for those millions of Americans supposedly adequately covered by health plans through their employers.
They are not. As Steffy puts it, this umbrella leaks, and thousands of families are going under financially because their health insurance does not perform as advertised. Steffy cites a study in the American Journal of Medicine showing that two-thirds of all bankruptcies over the past six years were related to medical expenses, and that a surprising three-fourths of those filing for bankruptcy for medical-related reasons had medical insurance when they did so.
Or perhaps this is not so surprising. Certainly it will not astonish anyone who has attempted to navigate the maze of co-pays, deductibles, explanations of benefits and frequently inscrutable bills from hospitals, laboratories and other care providers. For the unwary and uninformed health-care consumer, these can all be a source of emotional and financial stress on top of whatever medical condition may afflict them or a family member.
Harvard Professor David Himmelstein , author of the study mentioned above, doesn’t mince words. “Private health insurance is a defective product, he says, “akin to an umbrella that melts in the rain .”
The notion of competition in the health-care insurance industry is mostly myth, Himmelstein contends. For most consumers, the choices are limited by what their employers offer and at what cost they choose to offer it. For some lucky ones the choices may be made broader by the option of insuring through a spouse. Read more at the Houston Chronicle
A Senate source just passed me the latest outline of the Senate Finance Committee's health reform proposal. This is the post-CBO revision. Apparently, after the committee staff received the scores, they dug deep and quickly developed this proposal to circulate among members and then send back to CBO. It was presented earlier today at a closed-door meeting.
Sources say that it's a major scale-back of the outline they had before. Specifically, subsidies have dropped from 400 percent of the poverty line to 300 percent. Medicaid eligibility has been tightened to 133 percent of poverty for children and pregnant women and 100 percent of poverty for parents and childless adults. The plans being offered in the exchange have seen their actuarial values sharply lowered. read more from Ezra Klein
Today, former senators Tom Daschle and Bob Dole released a plan for health care reform that is being hailed a bipartisan way forward. Headlines blare about the Daschle/Dole plan for health care. But were these two to not have had illustrious careers in the Senate, the headlines would tell a far different story: “Health Care Lobbyists Release Health Care Plan.”
Both Daschle and Dole work for a major Washington, DC lobbying firm, Alston & Bird. Many of Alston & Bird’s major clients are from the health care sector including the American Hospital Association, HealthSouth Corp, and pharmaceutical companies Abbott Laboratories, Bayer, Celgene, and Mylan Laboratories. In total, Alston & Bird is currently representing 31 clients from the health care sector. Of the $2,730,000 reported income received from clients, nearly 50% of that, $1,070,000, comes from these 31 health care clients.
This looks like another benefit of the revolving door. You can release a legislative proposal from outside of Congress and the first thing anyone thinks of is your previous job and not your current one. Read the rest at the Sunlight Foundation Blog
Fast Facts On Rural Health Insurance - June 12, 2009 ·
* Percentage of noncorporate farmers and ranchers with health insurance: 95
* Percentage of all Americans with health insurance: 84.7
* The likely rate of underinsurance in rural areas compared with cities and suburbs: double
* Percentage of the rural poor covered by Medicaid: 45
* Percentage of the urban poor covered by Medicaid: 49
* Percentage of all Americans dependent on individual health insurance policies with reduced benefits and high deductibles: 8
* Percentage of farmers and ranchers dependent on individual health insurance policies: 33
* Percentage of farmers and ranchers carrying medical debt: 20
* Percentage of all Americans carrying medical debt: 28
* Percentage of rural workers who have jobs with small businesses: 50
* Percentage of urban workers who have jobs with small business: 37
* The likely rate of having no insurance for small-business workers compared with all workers: double
* Percentage of non-elderly urban workers insured at work: 72
* Percentage of non-elderly rural workers insured at work: 61
* Percentage of U.S. physicians working in rural America: 10
* Percentage of U.S. population defined as rural: 25
* Number of dentists practicing in urban areas per 100,000 people: 60
* Number of dentists practicing in rural areas per 100,000 people: 40
Sources: National Rural Health Association, The Access Project, Office of Rural Health Policy, U.S. Census Bureau, The Commonwealth Fund and Center for Rural Affairs
Read the rest and listen at NPR
By Timothy Noah
Every day Washington's leaders tell us that we live in an interdependent world with a globalized economy. A butterfly beats its wings in Guangdong province, and four Wal-Marts materialize in Duluth. The peso plunges, and 30 Honda workers get laid off in Marysville. A coal-fired power plant belches carbon dioxide in Prague, and Lohachara Island sinks into the Bay of Bengal.
But change the subject to reform of the health care system, and the community of nations abruptly vanishes. No France, no Canada, no Germany, no Japan. Let there be no mention of any industrialized democracy save that of the United States, which is proud to claim 37th place in the World Health Organization's rankings of the world's health systems and 15th in the Commonwealth Fund's ranking by avoidable mortality of 19 industrialized countries (the highest rank indicates the fewest such deaths). To achieve a better score would be unpatriotic!
The political establishment's hubristic refusal to consider how other countries manage health care is encapsulated in the cliché "uniquely American," which is what Sen. Max Baucus, D-Mont., the lead legislator on health care reform, says he wishes his bill to be. It therefore goes without saying that the finance committee Baucus chairs could find no place in this year's exhaustive health care hearings for a single expert on how other countries achieve better health outcomes for their populations while typically spending, on a per capita basis, half what we do. When the finance committee releases its draft bill this week, it will be almost completely free of foreign influence. Read the rest at Slate Magazine
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