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.
[Read more…]

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.

<td style='padding:2px 1px 0px 5px;' colspan='2'Current Events – Tasers
The Colbert Report Mon – Thurs 11:30pm / 10:30c
www.colbertnation.com
Colbert Report Full Episodes Political Humor Mark Sanford

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

<td style='padding:2px 1px 0px 5px;' colspan='2'Henry Louis-Gate – Race Card
The Daily Show With Jon Stewart Mon – Thurs 11p / 10c
www.thedailyshow.com
Daily Show
Full Episodes		 Political Humor Joke of the Day

The health care debate-6: The curious case of the swine flu vaccine guidelines

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

The US is preparing for an expected outbreak of the H1N1 (‘swine’) flu epidemic in the fall. Scientists are in the process of developing a vaccine that is due to be available in October. A federal advisory board to the Centers for Disease Control (CDC) issued guidelines on July 29 for who should get priority in vaccinations.

The committee recommended the vaccination efforts focus on five key populations. Vaccination efforts are designed to help reduce the impact and spread of novel H1N1. The key populations include those who are at higher risk of disease or complications, those who are likely to come in contact with novel H1N1, and those who could infect young infants. When vaccine is first available, the committee recommended that programs and providers try to vaccinate:
[Read more…]

The health care debate-5: How other countries health systems compare to the US

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

The advantages of single-payer systems over the current US system are becoming increasingly obvious. Another pro-business publication BusinessWeek concedes the advantages of the single payer system as is practiced in France.

In fact, the French system is similar enough to the U.S. model that reforms based on France’s experience might work in America. The French can choose their doctors and see any specialist they want. Doctors in France, many of whom are self-employed, are free to prescribe any care they deem medically necessary. “The French approach suggests it is possible to solve the problem of financing universal coverage…[without] reorganizing the entire system,” says Victor G. Rodwin, professor of health policy and management at New York University.
…
France also demonstrates that you can deliver stellar results with this mix of public and private financing. In a recent World Health Organization health-care ranking, France came in first, while the U.S. scored 37th, slightly better than Cuba and one notch above Slovenia. France’s infant death rate is 3.9 per 1,000 live births, compared with 7 in the U.S., and average life expectancy is 79.4 years, two years more than in the U.S. The country has far more hospital beds and doctors per capita than America, and far lower rates of death from diabetes and heart disease. The difference in deaths from respiratory disease, an often preventable form of mortality, is particularly striking: 31.2 per 100,000 people in France, vs. 61.5 per 100,000 in the U.S. (my italics)

PBS’s Frontline had a program Sick Around the World that looked at the health care systems in England, Taiwan, Germany, Switzerland, and Japan.

The private, profit-seeking health industry knows that their system is terrible compared to what single payer or socialized systems can offer and so they have to obscure and confuse things as much as possible. What has been amusing to watch has been the logical knots that the health industry has been tying itself up in to avoid even the minimal public option that has been proposed, saying that it would drive them out of business. Of course, if their claims that the government cannot run anything properly, that the private sector is far more efficient and will provide better health care at lower cost, then they should not have anything to fear from a public option. Even president Obama, who has been trying to placate the private health insurance industry, found this argument a bit much, saying, “Why would it drive private insurers out of business? If private insurers say that the marketplace provides the best quality healthcare, if they tell us that they’re offering a good deal, then why is it that the government — which they say can’t run anything — suddenly is going to drive them out of business? That’s not logical.”

The fact that they are trying to prevent a public option shows that the opposite is true. What they really fear is that once you take the profits, the huge salaries and bonuses of their top executives, and their exorbitant bureaucratic costs out of the system, the public system will be cheaper and more efficient and people will flock to it. Because of this fear, they and their lobbyists will first try to prevent any discussion at all of a meaningful public option, such as single payer.

healthreform.gif.jpeg.gif

If forced to concede one, they will try to hobble it by either limiting access to it or put in a lot of restrictions and rules in order to make is as inefficient and expensive and callous as the private system. “Opponents say private insurers could not compete with a public plan that didn’t have to make a profit. They argue that private health plans would end up going out of business, leaving only an entirely government-run health care system.”

I sincerely hope that this is true. Profit-making entities have no business being in the position of making health care decisions.

What the industry would really like is for the government to mandate that everyone have private insurance and pay for it, and at the same time reserve the right to deny coverage so that they make more profits. Because of this, we should be aware that the public plan that finally emerges from Congress may not be that good because of the amount of money that the health industry funnels to members of Congress. They may try to fob off on us some lousy system that they label the ‘public option’ that is designed to fail.

We should keep pushing for a single-payer, Medicare-for-all type system. The group Physicians for a National Health Program (PNHP) has done wonderful work in pushing for single payer and has created a comparison chart of public option vs. single payer. Single Payer Action Network in Ohio (SPAN Ohio) has come up with a plan just for the state that has the following features:

  • Patients get free choice of health care providers and hospitals.
  • When you go to your own personal physician for visits, there are NO premiums, NO co-payments, NO deductibles, NO one excluded. You pay nothing.
  • When you get your prescription filled by your pharmacist, there are NO premiums, NO co-payments, NO deductibles, NO one excluded. You pay nothing.
  • If you need hospitalization, there are NO premiums, NO co-payments, NO deductibles, NO one excluded. You pay nothing.

It beats me why anyone would prefer the current bureaucratic, service denying nightmare of the private, employer-based, profit-seeking system over such a plan.

POST SCRIPT: Tom Tomorrow on health care

One of my favorite cartoonists has been on a tear recently with three strips on health care: one, two, and three.

On books, audiobooks, and eBooks

When it comes to new communication technology, I can be labeled as both an ‘early adopter’ and and ‘early abandoner’. I got a Facebook account very early on, and now don’t do anything with it. I similarly got a Twitter account and abandoned it. I finally broke down and got a cell phone a couple of months ago under pressure from my family after I was in a few situations where having it would have been really helpful, but I use it only for emergencies and have given out the number to just a handful of people. In the three months since I got it, I have received about three real calls and a half dozen wrong numbers, which suits me just fine.

I think it is already pretty clear that I am a bit slow when it comes to new technology, adopting new things only when I absolutely have to. It is not that I am pathologically averse to new technology. It is just that so many new things come along that I prefer to wait until I feel that it serves a real need before I put in the time to learn the new tool. For example, I was quite happy with a pocket diary to keep track of my appointments until I got in a position where other people needed to make appointments on my behalf. Then I got a PDA (first a Palm and now an iTouch) so that I can sync with an online calendar that others have access to.
[Read more…]