The health care debate-11: The Brits fight back

(For previous posts on the issue of health care, see here.)

I have written before of my direct personal experience with the British National Health Service (NHS) and can report that it was wonderful, helping me tremendously when I was seriously ill, entirely free of charge.

As people should know, the NHS is a truly socialized medical system in which people are treated free, doctors are government employees, and hospitals are directly run by the government, although there is a private system overlaid on top of it. It is like the VA hospital system in the US. But even though I think that the socialized model of the NHS is admirable, I think it would not be a suitable model for the US and that the single payer systems of France or Canada would be better.

Part of the strategy of the health care reform opponents has been to lie shamelessly about the systems in other countries in order to make the current terrible system in the US look good in comparison. They are helped in this effort by the fact that most people in the US have no idea what people in other countries have and so believe the distortions. In addition, the people in those countries are not bothered to combat this propaganda, even if they have heard of it. After all, what does is matter to them if foreigners malign their health care? Their attitude seems to be that they are quite happy with what they have and if Americans want to continue to wallow in ignorance, let them.

But once in a while, things get taken too far and the attacks o insultingly unfair that the people in those countries get riled up and rise to defend their system. This seems to be happening with the recent attacks on the British NHS.

One of the triggers was a recent editorial in the Investor Business Daily that tried to give support to the hallucinations of the deathers by suggesting that in the NHS people are ranked according to their usefulness when getting treatments. The editorial said:

The U.K.’s National Institute for Health and Clinical Excellence (NICE) basically figures out who deserves treatment by using a cost-utility analysis based on the “quality adjusted life year.”

One year in perfect health gets you one point. Deductions are taken for blindness, for being in a wheelchair and so on.

The more points you have, the more your life is considered worth saving, and the likelier you are to get care.

In order to drive their point home, the editorial then went on to give what it clearly thought was a killer example of the ghastly results that ensue from such a system.

People such as scientist Stephen Hawking wouldn’t have a chance in the U.K., where the National Health Service would say the life of this brilliant man, because of his physical handicaps, is essentially worthless.

It was clear that the writers were under the impression that Hawking, easily the most famous living scientist and the victim of a degenerative motor neurone disease that has steadily eroded his abilities until now he can only move a finger or two, was American and was able to survive and even flourish as a productive scientist because he was being treated in America.

The truth of course is that Hawking is British, was born there, lives there, and has been treated by the NHS all his life so that even now at the age of 67 he continues to work. As Hawking himself responded, “I wouldn’t be here today if it were not for the NHS. I have received a large amount of high-quality treatment without which I would not have survived.”

The ignorance of the editorial writers was greeted with hoots of derision both here and abroad and in response they have removed the offending sentence about Hawking claiming it was only a factual error about citizenship, without acknowledging that what was considered by them to be an example in their favor is actually a counterexample that destroys their case that the NHS is a soulless, uncaring, bean counting system.

Faced with this embarrassment, perhaps the deathers will take a cue from the birthers and challenge Hawking’s British citizenship. After all, has anyone actually seen his original birth certificate? And shouldn’t he also produce documentation that he lives in the UK and was treated by the NHS? The latter might be difficult since that system doesn’t drown sick people with mountains of bills and other paperwork like the private, profit-seeking health insurance industry in the US.

As a result of the Hawking fiasco, more stories about the virtues of the NHS are emerging from people fed up with the lies. Read about how the NHS helped an American living in the UK with his tragic experience when his child was born with serious problems. And here’s another story from someone recounting the way his father’s kidney disease was treated was treated:

The National Health Service paid for the installation of a dialysis machine plus all the necessary plumbing and renovation of a room in his home so that he could use the machine three times a week rather than travel to the hospital in London. The cost was enormous and there is no way my parents could have afforded it. His quality of life for his last years was improved beyond recognition. I don’t recall any bureaucracy or fuss: the entire decision was the doctor’s. After he passed away the NHS paid for the disassembly and removal of everything too. (my emphasis)

And here’s yet another another story about an American woman who was treated first in the US (where her case was dismissed as being purely psychosomatic) and then, since she later became a student in the UK, was correctly diagnosed and treated by the NHS for what turned out to be a serious illness that required chest surgery plus post-operative care. Her father continues:

Recently, we flew back to New York to consult with perhaps the world expert on Myasthenia. After reviewing her symptoms and treatment he declared that the doctors in Scotland were doing all the right things. He then asked how much this cost. He had a bit of a hard time understanding that the cost was exactly zero. By the way, I spent about two months paying various bills associated with that one visit to his office. Quite a contrast I’d say. (my emphasis)

Defenders of the NHS have also taken to Twitter to spread their message.

The British government has been hesitant to vigorously correct the falsehoods that are being spread here:

As myths and half-truths circulate, British diplomats in the US are treading a delicate line in correcting falsehoods while trying to stay out of a vicious domestic dogfight over the future of American health policy.

But others are stepping up:

The degree of misinformation is causing dismay in NHS circles. Andrew Dillon, chief executive of the National Institute for Health and Clinical Excellence (Nice), pointed out that it was utterly false that [Senator Edward] Kennedy would be left untreated in Britain: “It is neither true nor is it anything you could extrapolate from anything we’ve ever recommended to the NHS.”

Defenders of Britain’s system point out that the UK spends less per head on healthcare but has a higher life expectancy than the US. The World Health Organisation ranks Britain’s healthcare as 18th in the world, while the US is in 37th place. The British Medical Association said a majority of Britain’s doctors have consistently supported public provision of healthcare. A spokeswoman said the association’s 140,000 members were sceptical about the US approach to medicine: “Doctors and the public here are appalled that there are so many people on the US who don’t have proper access to healthcare. It’s something we would find very, very shocking.”

Again, it should be emphasized that the British NHS is far from perfect. But its shortcomings and the complaints about it stem not from the nature of the system itself but the fact that the British government does not put enough money into it. Many people do not realize that the per capita public health expenditure in the UK is less than the US public (not total) health expenditure alone (i.e., what the US government spends just on Medicare, Medicaid, and the VA).

POST SCRIPT: Stephen Colbert and Howard Dean discuss health care

Howard Dean is a good spokesperson for single payer systems and the public option.

<td style='padding:2px 1px 0px 5px;' colspan='2'President Obama’s Health Care Plan – Howard Dean
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The deathers get routed in Cleveland

On Wednesday evening, Marcia L. Fudge, Ohio’s congresswoman for District 11, held a town hall meeting for her constituents. These events, once staid and even boring exercises in democracy, have recently become notorious for the groups of vociferous opponents of health care reform who have stormed them, armed with a strategy formulated by the health care industry and its Republican Party allies to shut down meaningful discussion on this important issue, intimidate elected representatives, and give the impression that those who oppose reform are more numerous and care more deeply about their point of view than those who support reform efforts such as single-payer.

But at the Fudge event, they got their come-uppance, big time. Fudge not only represents a solidly Democratic district that spans the East side of Cleveland and some adjoining suburbs like Shaker Heights (where I live), it is also a very progressive one. Fudge is a strong single-payer supporter and one of the 86 co-sponsors of John Conyers’ House Resolution 676 that seeks to expand Medicare coverage for all. Fudge claimed in her remarks that our district is the most diverse in the nation. I am not sure how such things are measured and if she has data to support it, but from first hand experience living there, I see no reason to doubt it.

Since the event was held at the place I work (Case Western Reserve University) in an auditorium in the very building my own office is in, I got a ringside view of the events. My corner office overlooks the two main streets that intersect at my building and I could see the demonstrators with placards gathering on the sidewalks from about 4:00 pm for the 6:00pm meeting. It was clear that the pro-reform forces had mobilized because on the streets they clearly outnumbered the anti-reform forces.

When I entered the auditorium shortly before 6:00 pm, it was full to its capacity of about 500. The chair of the session got loud applause when he asked that all people be given a respectful hearing. The first 45 minutes consisted of introductions and various people being recognized, especially ten young community leaders, each of whom spoke briefly.

The shape of things to come became clear when one of the honorees spoke briefly. He was Zac Ponsky from the nonprofit group MedWish, a group that works to provide free health services to those who need it, both home and abroad. He said that we needed action on health reform now, and we needed to do it on a national level. He got generous applause but then there came some boos and this generated much louder applause to drown out the boos. It was clear that the anti-reform groups were in for a tough time with this crowd, who were prepared and ready to combat them.

When Fudge spoke at 6:45 she covered some general ground before she got to health reform and she said that we are definitely going to get it this year. This was met with loud cheers, before some boos were heard which again were responded to with louder cheers for Fudge. From the relative loudness of the two sides, I estimated that the pro-reform forces outnumbered the anti-reformers by about 10 to 1.

Soon after Fudge began her remarks, the anti-reform groups, which seemed to be in three different clusters in the auditorium, went into the mode that those of us who have been following these events are familiar with. They started yelling out their slogans (“Why the rush?” “This bill will kill old people”, “What about the cost?” etc.) and refusing to let Fudge speak, even though the crowd started yelling for them to keep quiet and let her go on. It was clear, though, that university security had prepared for this. An officer went up to two men yelling the loudest and spoke to them, presumably to ask them to stop preventing the speaker from continuing. When they did not, they were both force-marched out of the room. This seemed to deflate the protest groups and they quieted down. Later on, during the Q and A, when another man started yelling from his seat and interrupting Fudge’s answer to a question from a person in the line, the head of the campus police, a genial but firm man, went and spoke quietly to him and he subsided.

At the end of Fudge’s brief remarks, the anti-reform people knew the drill and quickly got in line for questions in greater percentage (about 50%) than their presence in the room (about 10%) warranted. This was actually a good thing since it enabled Fudge to challenge the misconceptions on which they work. Fudge was not at all rattled. She is sharp, articulate, personable, and quick-witted. She knew what to expect and was ready. The largely pro-reform audience listened quietly to the questions and comments of even those who opposed reform, except for a couple of questioners who refused to yield the microphone when they were done but started to harangue Fudge. At that point, officials took the microphone away from them and moved them aside to allow the next person up, to the cheers of the crowd.

As to the question “Why the rush?”, she said that we were actually too slow, that health reform has been talked about for 60 years, and that nothing had been done at all during the Bush years.

As to the question as to whether the reform bill will euthanize old people, she said, to loud applause and laughter, that anyone who would even think such a thing has real problems. She said that all of us, including her, have elderly relatives whom we love. Why would we want to kill them? She then explained clearly what the bill says about end-of-life issues, a far cry from the ‘death panels’ that exist in the fantasy world of Sarah Palin and the nutters. (“Sarah and the Nutters” would make a good name for a music group, don’t you think?).

Fudge was also challenged as to whether she had read the entire 1,000-page bill. When she said she had not, they was a triumphant “Aha!” sound from the protest groups, implying that this meant that she did not know what was in the bill that she was supporting. She then explained what should be obvious. No congressperson is going to read every line of every bill that they vote on. It is not humanly possible. That is why they have staffs to do that work and flag those things that she should focus her attention on.

The most moving moments during the Q and A came from two women who spoke about their personal situations. One was a middle-aged nurse who works three jobs but cannot get health insurance because of a family history of cancer, not for any reasons directly related to her. She has been turned down by 14 companies and had her coverage taken away by another two. Another woman spoke of her husband who fortunately gets free treatment from the (government run) VA that costs $43,000 per year, but she herself cannot afford to buy her own insurance and they are going to lose their home because of her health care costs. Both women pleaded for the adoption of an affordable public plan and they received warm and sympathetic applause.

Twice Fudge was asked why the single-payer option was off the table and she replied both times that it was because Obama had taken it off, which is true. But perhaps not wanting to sound too critical of the president, she qualified it the second time round by saying that in order to pass reform legislation, they needed some conservative Democratic and/or Republican votes and they felt that single-payer would not be able to get that support.

In summary, the crowd was overwhelmingly in favor of health care reform with a public option, with a sizeable chunk pushing for single payer. The anti-reform groups were completely routed.

POST SCRIPT: The Daily Show on boisterous town halls

I showed this yesterday, but it seems to fit today’s post better.

<td style='padding:2px 1px 0px 5px;' colspan='2'Healther Skelter
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Here come the nutters!

Am I imagining it or does there seem to be a sudden upsurge in the number of people who seem to be disconnected with reality? To elaborate, is there an increasing number of vocal and visible people who are believe strongly in some crackpot idea despite the complete lack of plausible evidence in favor of their belief?

Into this category I put those who believe that the Earth is 6,000 years old and that evolution did not occur. Also included are the so-called ‘truthers’ (those who think that the events of 9/11 were planned and executed by the US government or that they had advance knowledge of it and yet allowed it to happen), and the ‘birthers‘, those who think that Obama is not a natural born citizen of the US and is thus ineligible to be president. And then we have the ‘gunners’, those who are convinced that Obama is going to take away their guns and enslave them. They have been forming militias and stocking up on weapons and ammunition ever since the election, presumably to prevent the military takeover of the country under the orders of Generalissimo Obama.

It is not surprising that this kind of paranoid climate would encourage individual nutcases like the Baptist preacher who is asking god to put a hit on Obama. Some have even gone on murderous rampages as a result of their beliefs

The health care reform debate has spawned yet another group of crackpots, called the ‘deathers’, who roam town hall meetings and yell about how the health care reform plans currently under consideration will result in government bureaucrats deciding who will live and who will die, and that they seek to kill off old people and anyone with any defects. This is quite an amazing level of delusion

The fact that there exist a sizable number of people who believe in each of these things is not surprising. I have long felt that there is no proposition, however crazy, that you cannot persuade up to about 20% of Americans to take seriously, simply by using spurious arguments that seem to have a veneer of plausibility, along with ‘evidence’ consisting exclusively of vague references to ‘they say’ or ‘I read somewhere’, with the source never specified. For example, a survey finds that 23% say ‘no’ or ‘not sure’ to the question of whether they believe Obama was born in the US. (Among Republicans, the figure is an incredible 58%!)

It is quite likely that there is strong overlap amongst all these groups, given their common basis in irrationality, so that the total number of believers may not be that much larger than the number that believes in just one of them. But given the rapid proliferation of such groups, it may be useful to adopt an umbrella label of some sort that covers everyone. How about the ‘nutters’? Tom Tomorrow describes the weirdness of these people in a recent cartoon.

These people are helped in their paranoia delusions by prominent politicians, who should know better, reinforcing their beliefs. A report says that Representative Paul Broun (R-GA) said “spoke of a “socialistic elite” – Obama, House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid – who might use a pandemic disease or natural disaster as an excuse to declare martial law.”

Then there is the ever-reliable serial exaggerator Sarah Palin. On her Facebook page she says the following about health care reform: “And who will suffer the most when they ration care? The sick, the elderly, and the disabled, of course. The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.”

Her statement has no connection to reality. Can she really be so stupid and ignorant as to believe this? Can she really not know that the proposed health reform legislation does not say anything of the sort? Or is she cynically deceiving and exploiting her followers? In addition, she once again shamelessly uses her baby as a political prop when it suits her purposes, while whining that her family should be off limits.

(To make it worse, Palin uses for support Minnesota Republican congresswoman Michelle Bachman, a person with an Alan Keyes level of craziness. Deciding which of Bachmann’s statements and actions is the loopiest is not easy, but my favorite was when she warned that Obama was thinking of abandoning the dollar as the US currency.)

Stephen Colbert gives his take on the death panels.

<td style='padding:2px 1px 0px 5px;' colspan='2'Death Panels
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As I said earlier, some greedy geezer seniors are prominent among the deathers who are trying to whip up anger against health care reform with their insanities, perhaps in order to preserve their own government-run Medicare health privileges. Christopher Beam writes: “To be sure, there are plenty of legitimate reasons for seniors to be concerned about reform. Seniors already have universal health care in the form of Medicare. There remains the possibility that a broader universal plan will drain resources from a program they like as it is, thank you very much.”

The Daily Show has some thoughts on the motivation that drives these people.

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So what is making these people so unhinged? Is it the thought that any Democratic president must necessarily be evil, and that a black one has to be the anti-Christ? Could they be that unhinged? It is strange because Obama is not even a liberal. He has kept and even increased the secrecy practices of the Bush regime, he is not planning a total pull out of Iraq any time soon (if ever, which I doubt), he is rapidly escalating the US war in Afghanistan, he has done little to advance gay rights, he has refused to close down the torture prisons that the US runs in other countries or to forbid the policy of extraordinary renditions, he is not prosecuting the lawbreaking torturers of the Bush regime, he has continued policies friendly to Wall Street in general and Goldman Sachs in particular, he has undermined support for a single-payer health care system, he continues the violation of human and constitutional rights such as habeas corpus, and so on.

We should not be that surprised. As cartoonist Tom Tomorrow points out, Obama has made vague promises into an art form that enabled his starry-eyed followers to read into his speeches what they wanted to hear and thus believe he was far more liberal than he really is. As a reality check, this website keeps a scorecard on Obama’s promises. Sam Smith also keeps tabs on Obama.

So why are these people so angry about his presidency when he is really not opposed to their interests in any fundamental way, just making changes in the margins? I do not believe that their anger is completely artificial, although powerful interest groups are definitely bankrolling and urging these groups on. Is it as simple as racism, that these people cannot stand the prospect of white people not having exclusive control of the power structure, even if the minorities who replace them pursue pretty much the same policies?

The Daily Show has some thoughts on the racial fears that seem to be driving at least some of these people batty.

<td style='padding:2px 1px 0px 5px;' colspan='2'Reform Madness – White Minority
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POST SCRIPT: The Daily Show on the level of current discourse

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YouTube nostalgia: Barney Miller

I hardly ever watch TV anymore, mainly because I cannot stand the constant commercial interruptions. This used to bother me less in the past and I used to watch a lot more when I was in graduate school and have fond memories of many shows: comedies such as M*A*S*H, Mary Tyler Moore, Soap, Newhart, Alice and dramas like Lou Grant and Trapper John

Recently I stumbled on another old favorite TV show on YouTube. Someone had posted clips of Barney Miller, and I have been enjoying them online. And the bonus is that there are no commercials, which more than compensates for the poor quality image.

Barney Miller was in many ways an unusual comedy that ran from 1975-1982 and although not a huge hit, it developed a loyal following. It was set in a police precinct in New York’s Greenwich Village and featured the precinct captain Barney Miller and his team of around three or four detectives, and one uniformed officer constantly striving to be promoted to detective.

The show was different in that there was no glamour or action at all. Everything took place in the small and grungy squad room and the adjoining private office of Miller. All the main characters were male and there was little or no romantic or sexual comedy, although some of the characters had relationships that were occasionally referred to but remained off-camera. There was no slapstick or broad humor. It was all low-key. It also had an unusually long opening sequence before the credits kicked in.

In most comedies there are quirky characters with exaggerated and easily labeled characteristics (the dumb, the smart, the oblivious, the eccentric, the greedy, the ambitious, etc.), and the rest play the straight roles that the others get laughs off. But in Barney Miller none of the series regulars were particularly weird, although they each had distinctive personalities and were well-developed characters, and the interactions between them provided a lot of the humor. None of the characters had standard tics or mannerisms or tag lines. There were no obvious eccentrics (a la Kramer in Seinfeld) or doofuses (Joey or Phoebe in Friends) or exceptionally dim people (Coach or Woody in Cheers). In Barney Miller, all the regulars were normal and played, in effect, the straight part and were the foil for the oddball characters that wandered into the precinct room in each episode. These people were usually petty criminals, drunks, vagrants, neighborhood residents and shopkeepers, and so on, and how the detectives dealt with them provided the humor.

In many TV comedies, you get cued mirth (either in the form of a laugh track or a live audience) where there is uproarious laughter for even the lamest of jokes or when characters did some standard shtick they have done hundreds of times before. I find that really annoying. In Barney Miller, the show’s writers did not insult the audience with exaggerated canned laughter. It was subdued and realistic, corresponding more closely to what was called for, sometimes just a chuckle.

Here is one episode, called “The Psychic”, to get a taste of what the show is like.

Part 1:

Part 2:

Part 3:

Most sit-coms periodically fall victim to having a “special” episode where they get preachy about some issue and try to give a “message” full of “meaning”, and in the process forget to be funny. Seinfeld was a notable exception. Barney Miller did not fully escape the temptation but when it did try to give a “message”, it managed to do so briefly and with a light touch, as in this clip about bigotry.

The health care debate-10: More comparisons with Canada

(For previous posts on the issue of health care, see here.)

The Canadian system is a single-payer system in which the federal government sets certain baseline services that have to be provided and then the provinces have some flexibility in what they provide over and above that. This means that there can be variability from province to province in the quality of health services with currently Ontario seeming to have the most complaints. Thom Hartmann talks to Sarah Robinson, who explains how it works.

But as to the question as to whether Canadians would prefer the US system to what they have there, this is an easy one: No. When the Canadian Broadcasting System held a poll to select the greatest Canadian of all time, the winner was Tommy Douglas, the socialist politician identified as the originator of the state-financed health care system in that country.

Let’s look at the comparisons.

This report quotes a multi-nation study that found that:

One-third of Americans told pollsters that the U.S. health care system should be completely rebuilt, far more than residents of Australia, Canada, New Zealand, or the U.K. Just 16 percent of Americans said that the U.S. health care system needs only minor changes, the lowest number expressing approval among the countries surveyed.

Sixty percent of patients in New Zealand told researchers that they were able to get a same-day appointment with a doctor when sick, nearly double the 33 percent of Americans who got such speedy care. Only Canada scored lower, with 27 percent saying they could get same-day attention. Americans were also the most likely to have difficulty getting care on nights, weekends, or holidays without going to an emergency room.

Four in 10 U.S. adults told researchers that they had gone without needed care because of the cost, including skipping prescriptions, avoiding going to the doctor, or skipping a recommended test or treatment. (my emphasis)

Michael Rachlis, a Canadian doctor, exposes more myths in an article in the Los Angeles Times of August 3, 2009, where he does a side-by-side comparison of the Canadian and US health systems:

On coverage, all Canadians have insurance for hospital and physician services. There are no deductibles or co-pays. Most provinces also provide coverage for programs for home care, long-term care, pharmaceuticals and durable medical equipment, although there are co-pays.

On the U.S. side, 46 million people have no insurance, millions are underinsured and healthcare bills bankrupt more than 1 million Americans every year.

He then draws some lessons:

  • Lesson No. 1: A single-payer system would eliminate most U.S. coverage problems.
  • Lessons No. 2 and 3: Single-payer systems reduce duplicative administrative costs and can negotiate lower prices.
  • Lesson No. 4: Single-payer plans can deliver the goods because their funding goes to services, not overhead.
  • Lesson No. 5: Canadian healthcare delivery problems have nothing to do with our single-payer system and can be fixed by re-engineering for quality.

And what about the bureaucracy? In an interview, Uwe Reinhardt, a professor of political economy at Princeton University compares the two countries:

Edie Magnus: We were in a hospital that was affiliated with McGill University [in Canada], and it was a regional system that had six hospitals that were affiliated with one another, and they annually have some 39,000 inpatients, and they do about 34,000 surgeries and they deliver about 3,000 babies. And managing all of this is a staff of 12 people doing the billing, the administration. What would an equivalent hospital in the U.S. take to run administratively?

Uwe Reinhardt: You’d be talking 800, 900 people, just for the billing, with that many hospitals and being an academic health center. We were recently at a conference at Duke University [in the US] and the president of Duke University, Bill Brody, said they are dealing with 700 distinct managed care contracts. Now think about this. When you deal with that many insurers you have to negotiate rates with each of them. In Baltimore, they are lucky. They have rate regulations, so they don’t have to do it. But take Duke University, for example, has more than 500,000 and I believe it’s 900 billing clerks for their system. (my emphasis)

It is time to put the lies about Canada to rest. My colleague Ross Duffin (whom I must thank for sending me several of the links in the posts about Canada) put it best in a blog post way back in 2005:

[D]on’t talk to me about inferior medical care in Canada. Its low reputation here is based solely on scare-mongering, knee-jerk anti-socialism, and just plain ignorance. A lot of people make a heck of a lot of money in the health care industry in this country, and would hate to see the system change, no matter how much it would benefit Americans to change it. And they can afford to spend a lot of money on advertising and lobbying to keep things just they way they are, thank you very much.

That seems to me to be exactly right.

POST SCRIPT: Bill Maher on health insurance reform

Bill Maher’s final segment on New Rules says what I have been saying all along, that the US is essentially a pro-business/pro-war one party state with two factions, which is why some Democrats are allying themselves with Republicans to block meaningful health care reform.

The health care debate-9: Oh, Canada!

(For previous posts on the issue of health care, see here.)

One has to feel sorry for Canada. There they are, this perfectly nice country to the north of us, just minding its own business. And yet, whenever there is talk of health care reform in the US, the most blatant lies are told about their health system, treating it as this awful, low-quality, bureaucratic nightmare, when by any objective measure they provide better service for all their people, with better outcomes, with little bureaucracy, and at lower cost.
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The health care debate-8: Where the money goes in the US system

(For previous posts on the issue of health care, see here.)

The indisputable fact is that per capita costs for health care in the US is almost twice that of other developed countries, while producing worse outcomes. So where does the money go?

This study in the journal Health Affairs compares the US with those of OECD countries to identify what other factors are leading to the inflated costs in the US, while at the same time providing lower quality care.

In 2000 the United States spent considerably more on health care than any other country, whether measured per capita or as a percentage of GDP. At the same time, most measures of aggregate utilization such as physician visits per capita and hospital days per capita were below the OECD median. Since spending is a product of both the goods and services used and their prices, this implies that much higher prices are paid in the United States than in other countries. But U.S. policymakers need to reflect on what Americans are getting for their greater health spending. They could conclude: It’s the prices, stupid.

U.S. per capita health spending was $4,631 in 2000, an increase of 6.3 percent over 1999… The U.S. level was 44 percent higher than Switzerland’s, the country with the next-highest expenditure per capita; 83 percent higher than neighboring Canada; and 134 percent higher than the OECD median of $1,983… Measured in terms of share of GDP, the United States spent 13.0 percent on health care in 2000, Switzerland 10.7 percent, and Canada 9.1 percent. The OECD median was 8.0 percent.

People in the OECD countries can also purchase private insurance if they wish to supplement the single payer systems that most of them have.

The median country finances 26 percent of its health care from private sources. The range is as high as 56 percent in the United States and Korea to as low as 7 percent in Luxembourg and 9 percent in the Czech Republic. As a percentage of GDP, the OECD countries spent 0.4–7.2 percent of GDP on privately financed health care in 2000, with an OECD median of 2.0 percent. The United States was the highest at 7.2 percent. U.S. private spending per capita on health care was $2,580, more than five times the OECD median of $451.

What about the fear that people die in those other countries because of waiting for care for acute treatment (leaving aside the fact that people here also die because they do not have access to health care at all)?

The German and Swiss health systems appear particularly well endowed with physicians and acute care hospital beds compared with the United States. The two countries rank much higher than the United States does on hospital admissions per capita, average length-of-stay, and acute care beds per capita. The average cost per hospital admission and per patient day in these countries must be considerably lower than the comparable U.S. number, however, because both countries spend considerably less per capita and as a percentage of GDP on hospital care than the United States does. The average U.S. expenditure per hospital day was $1,850 in 1999—three times the OECD median.

The fact is that because of the profit-making emphasis in the US, health care services simply cost a lot more here.

First, the inputs used for providing hospital care in the United States—health care workers’ salaries, medical equipment, and pharmaceutical and other supplies—are more expensive than in other countries. Available OECD data show that health care workers’ salaries are higher in the United States than in other countries. Second, the average U.S. hospital stay could be more service-intensive than it is elsewhere. While this may be true, it should be noted that the average length-of-stay and number of admissions per capita in the United States are only slightly below the OECD median. Third, the U.S. health system could be less efficient in some ways than are those of other countries. The highly fragmented and complex U.S. payment system, for example, requires more administrative personnel in hospitals than would be needed in countries with simpler payment systems. Several comparisons of hospital care in the United States with care in other countries, most commonly Canada, have shown that all of these possibilities may be true: U.S. hospital services are more expensive, patients are treated more intensively, and hospitals may be less efficient.

The final argument that apologists give for the US system is that the US is unique in its ability to provide easy access to high-tech treatments. This is also not true.

Quite remarkable, and inviting further research, is the extraordinarily high endowment of Japan’s health system with CT and MRI scanners and its relatively high use of dialysis. These numbers are all the more remarkable because Japan’s health system is among the least expensive in the OECD.

On his show, Bill Moyers spoke about some of the other wasteful costs that occur in the form of bloated health insurance CEOs salaries:

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 $4 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 dollars 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 more than $17 million dollars last year, or John Hammergren, the head of McKesson, the biggest health care company in the world. His compensation was nearly $30 million.

As a CNN report says:

So, if Americans are paying so much and they’re not getting as good or as much care, where is all the money going? “Overhead for most private health insurance plans range between 10 percent to 30 percent,” says Deloitte health-care analyst Paul Keckley. Overhead includes profit and administrative costs.

“Compare that to Medicare, which only has an overhead rate of 1 percent. Medicare is an extremely efficient health-care delivery system,” says Mark Meaney, a health-care ethicist for the National Institute for Patient Rights.

The entire health system in Canada has fewer workers to serve its population of 27 million than Blue Cross requires to service less than one-tenth that population in New England alone! This is the much-vaunted efficiency of the private sector.

Let’s face the facts. The US has the most expensive and yet the worst health care system in the developed world. And it is largely due to the presence of profit-making drug and insurance companies and extortionist pricing that is squeezing money out of the system at the cost of people’s health.

This is why we need to eliminate the profit-seeking private health insurance companies and institute a single-payer system.

POST SCRIPT: Bill Moyers, Sidney Wolfe, and David Himmelstein discuss single payer

In this must-see discussion, Wolfe and Himmelstein brutally expose the dirty truth about the current US health system and why the health industry here is violently opposed to the single payer system being even discussed, because they will come out far worse in comparison. They point out that we cannot create a health system that works if the private profit-seeking health insurance industry continues to play the main role.

Film review: Woodstock

Next week marks the 40th anniversary of the Woodstock folk festival. I was not in the US at that time and my only encounter with it was reading about it in the newspapers and seeing the documentary when it came to Sri Lanka some time after 1970. Since Sri Lanka did not have TV until 1977 (we skipped the entire black-and-white age and went straight into color) documentaries like this were the only means by which we could see rock musicians playing, so the film was quite an experience.

Even if I had been living in the US I would not have gone to the festival. My parents would never have agreed to let me go, besides which I was too strait-laced and would not have relished the drug use and the thought of camping out in a muddy field with filthy toilets.

But the film was fun to watch then, both for the music and to vicariously experience hippies having a good time.

I watched the film again last week. There is a new director’s cut that has added 40 minutes more so that the film, already long, now runs to almost four hours.

I did not enjoy the film that much the second time around. It seemed to drag. Some of the musical sets, especially the one by Jimi Hendrix, went on way too long for my tastes and I was never a fan of his style of guitar virtuosity to begin with. This is a common problem with ‘director’s cut’ versions of films. They are too self-indulgent. My lowered enjoyment is also probably because the experience of rock concerts is not the same when you are old.

But I thought that that I would share those moments that still had magic.

Richie Havens got the festival off to an electrifying start with his Freedom/Motherless Child.

A favorite moment in the film was a very young Arlo Guthrie singing Coming into Los Angeles, and using the quaintly dated slang of that time when he talks to the concertgoers.

Country Joe McDonald and the Fish singing the Vietnam protest Feel like I’m fixing to die rag was also another high point.

One of the oddest acts was a very brief song by the 50’s nostalgia group Sha Na Na, which seemed totally out of place.

Their campy performance reminded me strongly of the Village People who came along about a decade later.

I have posted this last clip before, of Joe Cocker’s rendering of the Beatles’ A little help from my friends, a gentle song sung by Ringo Starr, which Cocker turned into an over-the top, weird, air-guitar-playing, frenzied, incoherent performance that looked like he was having some kind of seizure. Throughout it, you kept wondering what the hell he was singing since the lyrics seemed to have only a passing resemblance to the original.

Some helpful soul has now provided captions for Cocker’s words.

It all makes sense now. Or maybe not.

The health care debate-7: Why health care is so expensive in the US

(For previous posts on the issue of health care, see here.)

The current health system in the US is a disgrace. Let us take some indisputable facts.

  • Health care costs in the US are way higher than in any other country.
  • Despite this, close to 15% of the population is uninsured, with the only option for such people being to go to expensive emergency rooms if the situation is dire, while in every other developed country everyone has access to primary care.
  • Using almost any statistical measure of health (life expectancy, infant mortality, etc.), the US ranks way below other developed countries.

These facts are so obvious that even conservative and right wing publications that are not ideological to the point of willful blindness have to concede the problem. Take for example, The Economist. It says:

NO ONE will be astonished to hear that health care costs more in Indiana than in India. However, a few might be surprised to learn that Americans spend more than twice as much per person on health care as Swedes do. And many may be shocked to be told that in Miami people pay twice as much as in Minnesota, even for far worse care.

The American health-care system, which gobbles up about 16% of the country’s economic output, is by far the most expensive in the world.

Another magazine, Forbes which calls itself a ‘capitalist tool’ points out that the US is unique among developed countries in that people actually go bankrupt because of health needs.

In 2007, medical problems and expenses contributed to nearly two-thirds of all bankruptcies in the United States, a jump of nearly 50 percent from 2001, new research has found

They randomly surveyed 2,314 bankruptcy filers in early 2007 and found that 77.9 percent of those bankrupted by medical problems had health insurance at the start of the bankrupting illness, including 60 percent who had private coverage.

Most of those bankrupted by medical problems were “solidly middle class” before they suffered financial disaster — two-thirds were homeowners and three-fifths had gone to college. In many cases, these people were hit at the same time by high medical bills and loss of income as illness forced breadwinners to take time off work. It was common for illness to lead to job loss and the disappearance of work-based health insurance.

When you read about the quality of health care that you get in countries with single payer systems like in France, the pathetic state of affairs in the US become readily apparent. As BusinessWeek points out:

[T]he French system is much more generous to its entire population than the U.S. is to its seniors. Unlike with Medicare, there are no deductibles, just modest co- payments that are dismissed for the chronically ill. Additionally, almost all French buy supplemental insurance, similar to Medigap, which reduces their out-of-pocket costs and covers extra expenses such as private hospital rooms, eyeglasses, and dental care.

In France, the sicker you get, the less you pay. Chronic diseases, such as diabetes, and critical surgeries, such as a coronary bypass, are reimbursed at 100%. Cancer patients are treated free of charge. Patients suffering from colon cancer, for instance, can receive Genentech Inc.’s (DNA) Avastin without charge. In the U.S., a patient may pay $48,000 a year.

France particularly excels in prenatal and early childhood care. Since 1945 the country has built a widespread network of thousands of health-care facilities, called Protection Maternelle et Infantile (PMI), to ensure that every mother and child in the country receives basic preventive care. Children are evaluated by a team of private-practice pediatricians, nurses, midwives, psychologists, and social workers. When parents fail to bring their children in for regular checkups, social workers are dispatched to the family home. Mothers even receive a financial incentive for attending their pre- and post-natal visits. (my italics)

This must mean that the French system is really expensive right? Wrong. In France, the cost per capita of health care is about half that in the US! And this is despite the fact that in France, every single person is covered, while in the US 15% of its population is without health insurance. So health care should become much cheaper if we adopt the French model.

So why do people claim that providing that level of quality will be expensive here? Because the policy-makers and the media who are subservient to the profit-seeking, money-driven health industry start with the assumption that you have to preserve the interests (and of course the profits) of that industry, and then add the presently uninsured and underinsured on top of it. Of course that will be more expensive.

The economics of the situation are simple. The only way to get a better health system at lower cost is to drive the profit-seeking elements out of the system and institute a single-payer system.

POST SCRIPT: William Shatner on Sarah Palin’s farewell speech

Sarah Palin stepped down as governor of Alaska, presumably to devote her full attention to giving us early warning if Russian planes should invade American airspace via Alaska (because they haven’t figured out that the great circle route over the pole is much shorter) or if Vladimir Putin should unexpectedly raise his head.

Her farewell speech was the work of art we have come to expect of her, disjointed phrases that consist of brazen pandering to the military and Alaskans, swipes at the media, petty personal grievances gussied up as high principle, non sequiturs, sentences that don’t seem to end, all interwoven with ghastly and mangled imagery in the grand style of Thomas Friedman.

Conan O’Brien tried to make sense of her speech and, after several viewings, it finally clicked. It was meant as a poem.

If you can’t believe that Palin said this and think Shatner is making stuff up, watch her speech. The passage Shatner quoted verbatim comes very early on.

When lese majestes collide

By now everyone must have heard about the Henry Louis Gates Jr. flap, where the Harvard academic had a confrontation with a Cambridge police sergeant James Crowley, when he was seen by neighbors breaking into his own home when could not open his front door. What should have been a simple misunderstanding that was quickly settled ended up with Gates being arrested and even president Obama being dragged into it as well.

As might have been expected, people have focused on the race aspect of the incident (Gates is black, Crowley is white) and the class aspect of the town-gown divide (Gates being perceived as a member of the privileged Harvard faculty and Crowley as working class).

So were race and class factors? In America, any encounter between people of different races always carries with it a racial subtext. That is inevitable and unavoidable. Underlying this whole episode is the almost universal feeling among black people that police treat them far worse than they do white people. Black people are always conscious that actions that would be seen as innocent if done by white people are viewed with suspicion when done by blacks. This is because black people of whatever status in society have usually experienced an incident where they were personally treated negatively by the police and other security personnel, even though they were totally innocent. This feeling is so strong in the black community that it explains the rare verbal misstep that Obama made when, instead of keeping out of the fray because he did not have all the facts (and he should not feel obliged to comment on every incident anyway), he ventured the comment that the police acted ‘stupidly’ in this incident.

It is a rare white person who has had that kind of negative experience at the hands of the police. At the risk of over-generalizing, white people, especially those in the middle and upper classes, tend to look on the police as their friends and protectors, while black people tend to look on them as a necessary evil.

Class conflict is a trickier issue in the US, since it is less spoken of by the general public but, like race, is always present in any encounter between people of different classes. Police officers in general get infuriated when people try to intimidate them with the “Do you know who I am?” and the “I know important people and can make life hard for you” class-based rhetoric that some people try to use to intimidate officers who are merely doing their duty, in order to avoid being charged with some minor offense.

So while race and class had to be factors in the Gates-Crowley incident, the real question is whether race and class played a greater role than usual here. That is hard to say, without knowing more about the people involved and the details of the incident. And since much of the contentious elements of the exchange occurred when only Crowley and Gates were present, we might never know.

What I would guess is that over and above the race and class issues, what escalated the confrontation between Gates and Crowley is that for each person the encounter created a sense of lese majeste, which Merriam-Webster defines as originating as “an offense violating the dignity of a ruler as the representative of a sovereign power” but now is used more generally as “a detraction from or affront to dignity or importance.”

Gates is an academic superstar and people outside academia may not be aware of how deferentially such people are treated in the normal course of their work lives. Although in any administrative flow chart of a university, faculty members like Gates are at the bottom of the hierarchy, ranking below their department heads, deans, provosts, and university presidents, in reality they are more famous, more powerful, and more valued by their institutions than their nominal superiors. They carry a lot of clout and every one around them treads very gingerly for fear of giving offense because such people will be quickly snapped up by rival institutions if they are not accorded the proper respect. So Gates is used to being treated like royalty and it must have been galling for him to be treated and talked to like just an ordinary person, let alone an ordinary black person.

Police officers are also used to people being very deferential to them. First of all, they are armed and can easily injure or even kill you. They also have the power to arrest, harass, taser, or otherwise make life very difficult for you. So most people, even if they are innocent and think that they have been wrongly stopped or questioned by the police, will talk to them politely, even obsequiously, so that they do not give the police an excuse to book them. When people do challenge police, the charge of ‘disorderly conduct’ can and is routinely invoked against them, as was done against Gates, since this is a very elastic term that gives a police officer wide latitude with which to arrest someone, even if the challenge consists of merely expressing annoyance or anger. The phrase ‘disorderly conduct’ is sometimes referred as being a euphemism for the crime of ‘contempt of cop’.
See this Colbert Report clip of police tasering people, including a 72-year old great-grandmother, who did not show sufficient ‘respect’ to the police officer.

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Can anyone doubt that the feisty great-grandmother was being punished with a tasering purely because the police officer was offended by her act of lese majeste?

People who are routinely treated with excessive deference, such as Gates and Crowley, are the ones who are most likely to overreact to perceived affronts, unless they are highly self-controlled or have a well-developed self-deprecating sense of humor. It is very likely that what triggered Gates’ outburst against Crowley was the thought that he, a famous academic, used to being kowtowed to, was being asked to show his identification in his own home by a lowly policeman, an act that, while not unreasonable under the circumstances under which the officer was summoned, he would have perceived as an act of lese majeste. It is very likely that what triggered Crowley’s use of the disorderly conduct arrest charge was that Gates talked back at him and demanded his name and number, again an act that while not unreasonable, would have also been seen by him as an act of lese majeste.

What is surprising is that Gates, whose field of study is race, seems to have been taken by surprise by being treated the way other blacks are routinely treated. This may be because, as Ishmael Reed suggests, Gates has benefited professionally from being a leading proponent of the view that America is now a post-racial society, which is why he reacted so angrily to the way that most black men are used to being treated all the time. Reed says that Gates actually got off easy. “If a black man in an inner city neighborhood had hesitated to identify himself, or given the police some lip, the police would have called SWAT. When Oscar Grant, an apprentice butcher, talked back to a BART policeman in Oakland, he was shot!”

All in all, it is an unfortunate incident, symptomatic of what happens when two self-important people prick each others’ ego balloons, resulting in an absurd situation in which the president ends up having to invite them both to the White House for a highly publicized beer, further feeding their already inflated sense of self-importance.

POST SCRIPT: Larry Wilmore on the Gates incident

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