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Entries in "Health care"
July 26, 2007
Single payer health universal insurance coming to Ohio?
(For previous posts on the topic of health care, see here.)
Efforts are underway to try get a universal, single payer health care system in Ohio. The group behind it is the Single-Payer Action Network Ohio (SPAN Ohio), which is supporting legislation instituting such a plan. Their website provides more information about their initiatives and meetings.
The Health Care for All Ohioans Act has been introduced in the Ohio House (H. B. 186) and the Senate (S. B. 168).
The main points of the legislation can be seen here but here are the highlights:
- 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.
In each case, the health care provider is reimbursed from the Ohio Health Care Fund.
So how does the Ohio Health Care Fund get its money? Under the proposed plan, people who earn less than the Social Security tax cap (currently $97,500 per year) pay no additional taxes. The money to fund the system comes from a variety of sources: up to 3.85% payroll tax paid by employers; up to 3% gross receipts tax paid by businesses; 6.2% tax on individual compensation in excess of the Social Security tax cap; 5% surtax on adjusted gross income over $200,000; funds from other government sources. Remember that currently employers that provide private health insurance have to pay for it. That money can now be directed to the Ohio Health Care Fund instead.
An Ohio health care agency runs the program and its governing board consists of the state director of health and fourteen other members, two from each of the seven regions that make up the state. The two members are elected for two-year terms by a regional health advisory committee, which in turn is elected by a meeting convened of the county and city health commissioners of each region.
Since there are many misconceptions (often deliberately perpetrated by the health care industry and its allies in the media) about what a single payer system involves, here is a handy document that compares the myths with the realities.
One of the big distortions that will be perpetrated by the health insurance and drug industries and politicians is to treat 'universal' and 'single-payer' as if they are synonymous terms. They are not and people should be vigilant when that sleight-of-hand is attempted. 'Universal' refers to the fact that every person should be covered, with no exceptions. 'Single payer' refers to the mechanism by which the health care system is financed and health care providers reimbursed.
It is not difficult to provide 'universal' private health insurance coverage, if that coverage is bad. All one needs to do to achieve that is to compel everyone to purchase some kind of health insurance, like the way people are compelled to buy auto insurance in order to drive, and some states have gone that route. But all that achieves is people or their employers being forced to purchase high-deductible, low-treatment coverage. Such policies will not result in better and more accessible treatment for more people or reduce the frustrating bureaucracy that we all encounter now. In fact, it will be a profit windfall for the private insurance companies as they get even more people into their nets. Such 'universal' programs would not be an improvement on the current system, though it will be touted as such by the health-care industry and their apologists.
'Single-payer' means something different, that there should be just one single entity, preferably run by the government or at the very least a non-profit publicly accountable board, that collects the money and spends it on the health care system. The single payer plan calls for the complete elimination of profit-driven private health insurance companies from the health care system, and has to be an essential component of any meaningful health care reform. As Sicko pointed out, the introduction of profit-making bodies between the patient and the doctor is the single feature that has resulted in the health care system in the US being so inferior to its peer countries.
Candidates should not be able to evade the issue by saying they support universal health-care. The question that should be asked is whether they support single-payer universal health care. Of all the presidential candidates in both parties, only Dennis Kucinich is calling for such a universal single-payer system, although many of the other Democratic candidates have signed onto the vague 'universal' health care part.
A petition has also been started by SPAN Ohio to gather signatures to put the legislation onto the statewide ballot. This petition contains the officially approved summary of what the legislation contains, as well as the full text of the bill. It is a parallel track strategy to the bills in the state legislature to get the same results.
I am collecting petition signatures so if anyone wants to sign it, or collect signatures as well, please contact me or SPAN Ohio. My petition form is limited to those who reside in Cuyahoga County.
The Cleveland branch of SPAN Ohio meets at 7:00pm on the first Monday of each month at the ACLU building, 4506 Chester Avenue. Other branch locations and meeting times can be found on their website.
POST SCRIPT: Handy guide to candidates
With so many people running for president, it is hard to compare their stands on the various issues. One enterprising website has done us all a favor by preparing a table that gives capsule summaries of their views. Of course, you will need to look elsewhere for more details and nuances.
July 24, 2007
CNN, Michael Moore, Sicko, and fact-checking as propaganda tool
(For previous posts on the topic of health care, see here.)
All Michael Moore's films deal with very serious topics in ways that are both informative and entertaining. His films have dealt with corporate greed, violence in society, the Iraq war, and now the health industry. Along with Robert Greenwald's Brave New Films, he provides a perspective and viewpoint that is almost completely absent from the mainstream media.
What is curious is the response to his films. People seem to find it hard to accept that his critiques are largely accurate and desperately seek to find something, however trivial or immaterial to his main point, that is wrong so that they can discredit his entire case. They seem to be eager to characterize Moore as not being a "serious" person.
The so-called "fact-checking" by CNN medical correspondent Sanjay Gupta, for example, has to be seen to be believed. He accused Moore of "fudging facts" but got his own facts wrong, and the only "expert" his report showed was an academic who did business with the medical industry, although this fact was not pointed out. Gupta accused Moore of cherry-picking data, when the same charge could be leveled at CNN, and the differences in any case were small and immaterial to the case Moore was making.
I am all for fact-checking statements made by public figures, and Moore should not be exempted. But the point is that while CNN enthusiastically "fact-checks" anti-establishment figures like Moore, they almost never do similar things for the statements by government and industry personnel. This is characteristic of the media propaganda model that was pointed out by Noam Chomsky and Edward Herman in the classic work Manufacturing Consent. Moore rightly chastised Blitzer for the fact that the mainstream media uncritically passed on all the outrageous statements by Iraq war advocates leading up to the 2003 invasion. They are doing a similar thing now with respect to Iran. Where is their vaunted "fact-checking" on those important issues? To find any serious fact-checking of statements by Bush or Cheney or any administration spokespersons, one needs to read blogs.
There is no question that big media outlets are completely beholden to the medical and drug industries because of the extensive advertising revenue they receive from them, and thus avoid taking a hard line against them. If Gupta or Blitzer did a really serious comparison of the US and (say) French health care systems and concluded that the French were better, the CNN top brass would get stern calls from the health-related industry and they would feel the heat. The point is not that Blitzer and Gupta are deliberately hiding the truth (though that might be the case), it is that the way the media filters operate is that only people who think like them, who are already sympathetic to the US health care industry and will bend over backwards to show them in a good light, will get to the position they currently occupy. So the fact that they effectively act as shills for the health industry should not come as a surprise. (See my previous post and here for more on how the media works.)
It seems that if you are well-dressed, articulate person from a so-called "respectable" institution like a think-tank or government or academia or the media (I am thinking of people like William Kristol, Charles Krauthammer, Mitt Romney, Alan Dershowitz, Rudy Giuliani, Joe Lieberman, and the innumerable loyal Bushies and Cheneyites), you can say the most outrageous, even borderline insane, things (such as advocate torture and indefinite detention without trial or access to lawyers, undermine the Bill or Rights, attack Iran, link Iraq to al Qaeda and 9/11, and not even rule out the use of nuclear weapons) without being challenged and fact-checked, as long as you are promoting the pro-establishment or pro-war or pro-business point of view. Running fact-checks on what these people say, especially George Bush during his public speeches and press conferences, would be very helpful but is rarely done.
But when it comes to Michael Moore, the mainstream media are eager to trot out their "fact-checking" teams to scrutinize him, because he is challenging the joint war/business establishment of which they are an integral part. The news media tends to assume that when Moore (a big fat guy in an open-neck shirt and unkempt hair stuffed under a baseball cap and looking like a trucker) comes ambling along, he must be simply shooting from the hip, as sloppy with the facts as he is with his appearance.
The reality is that Moore is a sharp guy who has a research team in place to back up the statements in his films. He is not a just-off-the-boat bumpkin that his cinematic persona projects and he knows that all the big establishment guns are just waiting for him to make a mistake so that they can pounce and use that single slip to discredit his whole thesis, a common tactic used by big corporations. It is not an accident that he can provide immediate refutations of Gupta's allegations. His research team has probably anticipated every possible challenge to his film and prepared a counter-offensive before even releasing the film. (CNN has now responded to Moore's charges against them.) See also Moore's website on the detailed documentation behind his film.
This is why CNN was reduced to desperately looking for something, anything, to support their contention that he "fudged the facts," and resorted to distortions when they couldn't find anything substantive. But people who condescend to Moore and take him lightly because he does not talk or look or act like a sophisticated intellectual are falling into a trap because they tend to underestimate him, and then are taken by surprise when he slaps them down with facts and reason, as Blitzer and Gupta experienced. When directly challenged, Gupta could not provide even a single example of how Moore "fudged the facts," and was reduced to whining about Moore using different sources for his data (even though all the sources used were authoritative) and how Moore described the health care systems of other nations as "free" when they were funded by taxes. This alone shows how far Gupta is stretching to try to discredit Moore. Does Gupta think we are so stupid that we believe that all the services we all commonly describe as "free" (libraries, parks, public schools etc.) magically appear as gifts from Santa Claus and are not funded by our taxes? The point is that "free" in those contexts is commonly understood as meaning that we can access those services at any time without having to produce cash or prove that we can pay.
And most importantly, in the other countries which have universal, single-payer health care systems, not a single person goes bankrupt or loses their home or has to forego other of life's essentials because of their health care needs. That is what "free" means, as Gupta must know but chooses to obfuscate.
In his report, Gupta also seemed to act like he had made a big journalistic scoop by 'discovering' that Cuba was at rank #39 (behind the US at rank #37) in the overall health care quality ranking. In fact, Moore's film clearly showed the two rankings. It was Gupta's CNN report that implied that Moore's film hid this fact by themselves hiding Cuba's on-screen ranking in the film behind a caption, as can be seen below where the left is from the film and the right is what was shown by CNN. This was a truly outrageous thing for a so-called journalist to do. So it was Gupta and CNN who were "fudging the facts."
(Pam Martens points out that Gupta co-hosts a TV show called AccentHealth that is sponsored by drug companies likeMerck, whose products Gupta has been praising. And here is some background on Sanjay Gupta that suggests that he is a Deepak Chopra wannabe, using the same kind of medical-related, feel-good, pseudo-scientific mumbo-jumbo that seems to appeal to a lot of people.)
What I find odd is that even some people who share Moore's politics tend to try and distance themselves from him and treat him as a gadfly. One of the best analyses of the responses to Moore and his film was done by James Clay Fuller and it is well worth reading in its entirety. As Fuller says: "Apparently there is a rule in corporate journalism that every mention of Moore and his films, or Moore without his films, must contain at least two snide observations about his biases, his ever so naughty attacks on rich and powerful but somehow –- in the eyes of the corporate journalists -- defenseless people such as the chairman of General Motors, and, if you can slide it in, Moore's physical appearance." Another good analysis of the facts in Moore's film can be heard in this Fresh Air interview with Jonathan Oberlander.
You should really see Sicko if you have not already done so.
POST SCRIPT: Michael Moore with Stephen Colbert
It was a great interview. See the clip.
July 19, 2007
Oh, and about those wait times for medical treatment. . .
When all their other arguments about the advantages of the current US health care system compared to universal, single-payer systems in France, Canada, England, Germany, etc. are shown to be false, apologists for the US health care system turn to their trump card: alleging that wait times to see a doctor in those countries is longer than it is in the US. This statement by the lobbying group America's Health Insurance Plans is typical: "The American people do not support a government takeover of the entire health-care system because they know that means long waits for rationed care."
The problem with this type of allegation is that the US does not systematically collect data on wait times, whereas the other countries do collect the data and make them public. The assumption seems to be that in the US, if there is no data, then the wait times must be zero. No data, no problem!
But using the scant data that is available, BusinessWeek points out that except in a few selected, non-emergency situations, even this charge is false: "In reality, both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems."
As Paul Krugman points out in his New York Times July 16, 2007 column:
[B]y and large, opponents of universal health care paint a glowing portrait of the American system that bears as little resemblance to reality as the scare stories they tell about health care in France, Britain, and Canada.
The claim that the uninsured can get all the care they need in emergency rooms is just the beginning. Beyond that is the myth that Americans who are lucky enough to have insurance never face long waits for medical care.
. . .
[N]ot all medical delays are created equal. In Canada and Britain, delays are caused by doctors trying to devote limited medical resources to the most urgent cases. In the United States, they're often caused by insurance companies trying to save money.This can lead to ordeals like the one recently described by Mark Kleiman, a professor at U.C.L.A., who nearly died of cancer because his insurer kept delaying approval for a necessary biopsy. ''It was only later,'' writes Mr. Kleiman on his blog, ''that I discovered why the insurance company was stalling; I had an option, which I didn't know I had, to avoid all the approvals by going to 'Tier II,' which would have meant higher co-payments.''
He adds, ''I don't know how many people my insurance company waited to death that year, but I'm certain the number wasn't zero.''
(You can read about Kleiman's plight here, which occurred despite having what he calls "fancy-dancy health insurance through my employer, which as it happens also owns one of the world's dozen best medical centers".)
And what about that favorite of US health care apologists, the waiting time for hip replacements? Krugman looked at that too:
On the other hand, it's true that Americans get hip replacements faster than Canadians. But there's a funny thing about that example, which is used constantly as an argument for the superiority of private health insurance over a government-run system: the large majority of hip replacements in the United States are paid for by, um, Medicare.
That's right: the hip-replacement gap is actually a comparison of two government health insurance systems. American Medicare has shorter waits than Canadian Medicare (yes, that's what they call their system) because it has more lavish funding -- end of story. The alleged virtues of private insurance have nothing to do with it.
Krugman's conclusion is right on target:
The bottom line is that the opponents of universal health care appear to have run out of honest arguments. All they have left are fantasies: horror fiction about health care in other countries, and fairy tales about health care here in America.
POST SCRIPT: Déjà vu
As usual, cartoonist Tom Tomorrow succinctly captures how the media is colluding with the administration in fanning the flames for war with Iran, exactly the way it did with Iraq.
July 17, 2007
Hidden costs of US health care
(For previous posts on the topic of health care, see here.)
In my previous posts following on the film Sicko (Haven't seen the film yet? It is well worth it.) I have been focusing on the tangible costs and benefits of the US health care system compared to those of other developed countries, and showing why the US system comes out badly in comparison. The chief culprit is the insertion of profit-making private health insurance companies between the patient and health care providers, creating an immediate trade-off between profit and providing care that is detrimental to the latter.
But there are several intangibles that are also important. The main one is that having one's health insurance tied to one's place of employment highly distorts the basis on which people make important life decisions. Right now, many people make decisions of what job to take and where to live based on the health care provided by employers. People with families and young children are especially caught in a bind. Some people spend their entire lives in dead-end jobs that they hate, trapped because of the fact that they cannot afford to leave and lose the health benefits. This is especially so if they or a member of their family has a health problem that becomes a non-covered 'pre-existing condition' in their new workplace, and thus denied coverage, at least for a limited time.
What is the cost of this? For one thing, it discourages entrepreneurs and freelancers. A person who wants to quit his or her job to start their own business or implement an innovative idea is strongly discouraged from doing so, especially if they have families. Not only is the cost of purchasing private insurance for themselves prohibitive, so is the cost for providing it for their employees. In 2004, the average cost of health insurance for family coverage was $9,950, which means that it is likely to be around $12,000 in 2007. This is close to the amount earned annually by a full-time minimum wage worker. How many business ideas have never seen the light of day, how many jobs never created, because potential innovators just could not bring themselves to risk the health of their families by leaving their jobs?
Health insurance tied to businesses also discourages the creative arts. Painters, writers, sculptors, poets, actors, dancers, and musicians are people who add enormously to the quality of life of a community. A community that has a vibrant arts community is one that is lively and healthy. Most artists do not go into it for the money (although they have dreams of their work becoming widely recognized someday) but because they really love what they do and are willing to suffer some hardship for it. They are willing to forego luxuries and live fairly Spartan lives with respect to housing, food, clothing and the like, just to have the opportunity to create art. Many are willing to take part-time jobs to cover life's essentials so that they have the time and freedom to devote to their passion. But the biggest single expense for such people is the cost of buying health insurance as private individuals. Many simply do not do so, gambling that they will not get very sick.
Then we have young people, straight out of high school or college who may want to experience a carefree life for at least a short time before settling down, and maybe travel around this vast country doing various jobs, seeing new things, meeting new people, and learning about the various communities they pass through. Maybe they want to work in underprivileged areas. Right now, the only way to safely do that is to do it through an organization that provides health insurance. If they go on their own, they have to buy expensive private health insurance or take the risk that they will not need health care. Even for the volunteer organizations that provide health insurance, providing it is a big headache and expense.
Then there is the problem of transitioning between jobs and between school and jobs. There are often gaps between the times when students leave college and start their first jobs. Because they have left school, they no longer are covered by their family or school health insurance policies. They have to shop around for some coverage for the transition period until they get their first job. People who have a gap when they move from one job to another can sometimes use COBRA coverage during the transition.
Even people who like their jobs and have health insurance plans to choose from (the so called 'lucky ones') face all kinds of irritations. The family may select an insurance plan and from it choose pediatricians for their children, an internist for the parents and a gynecologist for the mother, all within that one plan. The next year, they are likely to find that some of the physicians are now on different plans. So you have to repeat the process of comparing health care plans, weighing the costs and benefits, comparing physician lists, and trying to figure out who and what to keep and to jettison. This has to be done every year. And then you have to keep track of all the paperwork and receipts and co-payments. I think people have got so beaten down that they simply do not realize how much time goes into taking care of all these details. It is only when they get drawn into the bureaucratic nightmare that results when coverage is denied or some major illness strikes that they realize what a crazy system they are in.
Why have people in the US become so numb and accepting of this state of affairs? In surveying the responses to the film Sicko, James Clay Fuller makes a good point:
Not one mentions the comments by Tony Benn, a former member of Britain's Parliament. Yet Benn's statements probably are the most profound element of the film.
He notes, as other good people often do, that "if we have the money to kill (in war), we've got the money to help people."
But, more importantly, Benn tells Moore, that all of Europe and many other places have good health care systems while the United States lacks such a basic service because in Europe and elsewhere, "the politicians are afraid of the people" when the people get angry and demand some action. In the United States, he observes, "the people are afraid of those in power" because they fear losing their jobs, fear being cut off from health care or other services if they speak up and make demands.
"How do you control people?" Benn asks, and he answers: "Through fear and debt."
His point is that in the United States we have a great overabundance of both.
When are people going to get angry enough to say "We're mad as hell and we're not going to take it anymore"?
POST SCRIPT: The invertebrate Congress
On Bill Moyers' show, Conservative Bruce Fein argues why Bush should be impeached and criticizes a spineless Congress for not doing so, and John Nichols (author of the book The Genius of Impeachment) agrees.
Here is a transcript.
Another conservative Paul Craig Roberts (Assistant Secretary of the Treasury in the Reagan administration and former Associate Editor of the Wall Street Journal editorial page and Contributing Editor of National Review) has also called for the immediate impeachment of both Bush and Cheney.
The idea of impeachment was inserted into the US constitution as a vital check against the president assuming dictatorial powers akin to those of a king. It was almost tailor-made to deal with situations like that which currently exists. But the Democratic Party leadership seems unwilling to do this.
July 12, 2007
How universal single-payer systems protect us against catastrophes
(For previous posts on the topic of health care, see here.)
I think almost everyone across the political spectrum would concede the fact that the fifty million Americans currently without health insurance would definitely benefit from the adoption of a universal, government-run, single-payer health care system. The reason that it has not been adopted is that many of the remaining 250 million have been frightened into thinking that their medical coverage would decline from what they have now.
This feeling that "The present system works for me so why tinker with it?" is based on the assumption that our lives are stable and that things will continue just as they are into the foreseeable future. I am not so sanguine about this, perhaps because I am older and have repeatedly seen and experienced how the slings and arrows of outrageous fortune can strike anyone at any time and dramatically change lives. As a result I think it unwise to base our policy decisions on the rosy assumption that what is true for me now will continue to be true for me tomorrow. All it takes is a single catastrophe that causes the loss of our job, which could happen to any of us at any time, and all our comfortable assumptions about the future can end up in the trash can.
It is not uncommon for people who are incapacitated by an illness or an accident to themselves or someone in their family to lose their jobs and not be able to get another one with health benefits. As a result, such families are faced with stark choices: suffer or die for lack or treatment or have the family risk bankruptcy paying for it.
US News & World Report summarized the findings of a study that looked at a representative sample of bankruptcies across the country:
We have health insurance for several reasons, but one of the big ones is to protect us from high medical bills when we get sick. But insurance, it turns out, may not be the protection that many people think it is. Illness and medical bills are big reasons behind fully half of all personal bankruptcies, affecting about 700,000 households per year, according to a new study. And most of those households had insurance.
. . .
These were working- class or middle-class people, and 76 percent of them had health insurance when they first got sick. (Many lost this coverage because the insurance was through their jobs, so it disappeared when they couldn't work.) Half of the bankruptcies were caused, in part, by illness and medical debt. Their median debt was about $16,500, and the major part of that debt was payments to doctors and hospitals. Families initially tried to pay the debt for several months, says Elizabeth Warren, a bankruptcy expert at Harvard Law School. Sixty-one percent went without needed medical care to make payments, 30 percent had a utility shut off, and 22 percent cut back on their food.
If you simply ask around, you will find many examples of people who have been forced to make drastic decisions because of their health care situation. A couple I know moved to Mexico because they could not afford to pay for their health care here.
But even if people are willing to shut out from their minds the possible of such an unfortunate turn of events happening to them personally (and human beings are very skilled at avoiding thinking about such things), surely they would like to feel that their families and children and grandchildren and great-grandchildren will not have to suffer? The odds are very high that several people in each one of our extended families will face a health-related crisis in their lives that will threaten to send them into destitution. Even if we are blasé about ill health striking total strangers, surely we cannot be so complacent about our own descendents?
David U. Himmelstein, MD and Steffie Woolhandler, MD provide a detailed case (scroll down) for "Why the US Needs a Single-Payer Health System" outlining the toll the present system in the US takes on both patients and health care professionals, and the increasing monopolization of the system by a few giant corporations. They describe the huge amounts of paperwork that doctors in the US have to do because of the complicated and cumbersome health insurance system here. They have to employ a number of clerical staff simply to process the different paperwork with all the different insurance companies and then haggle with them over payment and treatment. In addition, the health insurance companies have to negotiate contracts with different companies in different states with different laws and regulations. As a result, "Blue Cross in Massachusetts employs more people to administer coverage for about 2.5 million New Englanders than are employed in all of Canada to administer single payer coverage for 27 million Canadians."
Perhaps we should start by providing single payer health care coverage to all children. Children are not responsible for their lot in society and should not be deprived of basic needs of food or shelter or clothing or education or health care.
There was a very sad story in the film Sicko. (Although I keep talking about the sad stories in it, I should emphasize that Sicko is also a very funny film.) It was about a little girl who was taken to a hospital emergency room with very high fever. They refused to provide treatment because she was not 'entitled' to be treated there, and insisted that she be transferred to a hospital across town, the place where she was 'supposed' to go to. She died during the time that she was transferred from one hospital emergency room to another.
To be denied treatment for purely bureaucratic reasons is unconscionable. It puts the health care professionals also in an impossible situation. If the emergency room physicians and nurses at the first hospital had realized that the child had a life-threatening condition, I am certain that their natural humanity would have taken over and they would have treated the child irrespective of whether she qualified or not. But if they had treated the child and it was something that could have waited, they might have been reprimanded for providing treatment to an 'unauthorized' patient. Why should health care professionals have to be put into making such kinds of bureaucratic decisions instead of doing what they are trained to do, which is simply treating the patient in front of them as best as they can?
As Martin Luther King, Jr. said, "Of all the forms of inequality, injustice in health care is the most shocking and inhumane."
POST SCRIPT: Where's Freud when you need him?
Comedian Craig Kilborn gets a laugh out of our ability to see sex symbolism everywhere .
July 10, 2007
Time for 'socialized' medicine in the US?
(For previous posts on Sicko and the merits of a government-run, universal, single payer health care system, see here and here.)
Michael Moore's excellent film Sicko has cinematically exposed the deep flaws of the US health system. His film scarcely touches on the awful plight of the 50 million people who have no insurance at all. That would have been bad enough but instead he sought to highlight the plight of those who do have health insurance and think they are secure, but discover to their horror that their insurance companies let them down in their moments of greatest need.
He emphasizes the fact that when you introduce profit-making entities in between the patient and the health care providers, you have guaranteed that attempts will be made to deny health care as much as possible. The insurance companies actually have employees whose task is to dig deep into your past to see if they can find anything, anything at all, that would enable them to invoke the fine print in their policies and deny coverage. Hence many people receive nasty shocks that they are not covered just as they are reeling from the discovery that they have a serious illness.
And this is why in the US you have a system in which the minority who are rich and powerful and influential have access to very good health care because they are in a position to create trouble for the insurance companies, while the vast majority are vulnerable to finding out that getting ill can mean ruin.
One of the curious things about the health care debate in the US is that the opponents of a government-run, single payer, universal health care system try to portray it as this mysterious, unknown, complicated, untried, massively bureaucratic, expensive system that one should not experiment with.
This is ridiculous. It is the system in the US that is mysterious, complicated, massively bureaucratic, and expensive. Government-run, universal, single payer systems are the norm in the developed world and in many countries of the third world. There are any number of working models that have been in existence for over half a century for which cost-benefit analyses exist and the operating structures are well known. It is the US, almost in isolation, that has a bizarre, labyrinthine, bureaucratic, and expensive system.
The basic concept of how single payer health care works is very easy to understand as this wonderful little animation illustrates. What is needed is to select the model that might adapt best to the US and modify it to meet our needs. The only difficulty to doing that would be to combat the vested interests of the health insurance and drug interests who will fight tooth and nail to keep making massive profits off the sickness of people.
Even magazines like BusinessWeek concede that the French system is superior to the US:
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.
There will still be some bureaucracy because it will be needed to do all the paperwork to run the health care system. But the point is that this bureaucracy is invisible to the patients. As far as the patient is concerned, you go to the doctor and you get treated. That's it. You do not have to fill in any forms. The paperwork goes on behind the scenes between the government, the drug companies, hospitals, and the health professionals. Even for the doctors the paperwork is simplified because they are now dealing with just a single payer of their services and don't have to keep track of multiple health insurance companies, each of which has different rules for what they can and cannot do. This is why the entire health system in Canada has fewer workers (scroll down) to serve its population of 27 million than Blue Cross requires to service less than one-tenth that population in New England alone.
But while the surface debate is about policy, the deeper debate is about a fundamental difference in philosophy
At one extreme, there are those who take the view that it is up to each one of us to look after our own interests and feel perfectly comfortable ignoring the needs of others. Such people take the point of view that each person is responsible for their health care. The 'free market' should operate and people should shop around for what works for them. If they do not have the means to do so, then that is their own fault or their own tough luck. They have failed to provide for themselves and cannot expect the rest of society to look after them, except for what private charities might provide.
At the other end (which is where I am) are those who feel that when it comes to basic issues like health care, it is the responsibility of every one to look after everyone else. Decent health care is not a commodity like toothpaste to be bought and sold on the market. It is a fundamental right that everyone (especially children and the elderly) is entitled to, irrespective of their ability to pay, and should be seen as a collective social obligation. Most such systems are based on spreading risk over a large number of people and because of that principle, while there are options for people to buy supplemental insurance on the private market, there cannot be an opt out provision, just as there is no opt out for police or fire systems or trash collection or libraries or parks or all the other similar collective systems that we currently have in place.
Those who oppose single payer health care systems try to frighten people with all kinds of bogeymen. The extent to which they are willing to go sometimes reaches levels of downright lunacy. In the wake of the release of Sicko, some have even said, if you can believe it, that adopting a single payer system could result in more terrorism! There are no depths of fear-mongering to which they will not sink.
But the tried and true standby to try and frighten people is the charge that single payer systems equate to 'socialized medicine', as if that is an automatic disqualifier.
It is a tribute to the success of the propaganda model that simply the word 'socialism' strikes such fear in so many people in the US. But the fact is that the word is ill-defined in this context. There are some health care systems where the hospitals are actually run by the government, and the health care professionals are government employees. This is perhaps closest to what might be meant by 'socialized medicine' and is close to what England has with its National Health Service. Then there is the French system where things are a mix of public and private, and the government mainly acts as the sole entity financing the system, collecting money in the form of taxes and using that to pay for services.
If the scaremongers want to invoke the word 'socialized' so broadly as to mean the spreading of the risk across the whole population, then that is no strange concept to the US because then socialism is already rampant in the US.
Sometimes US 'socialism' occurs a highly distorted form, where the risks are spread around to everyone but the benefits accrue to a wealthy few. Consider for example the FDIC insurance that banks carry. Every person is underwriting that insurance through our taxes, but it benefits the banks and those who have money to deposit. The past US government bailouts of the auto and airline industries when they were in trouble are examples where the costs and risks are borne by all of us, but the benefits accrued to a select few. The savings and loan debacle of the 1980s was again an instance of the risks and costs being 'socialized' (i.e., spread over the entire population), irrespective of whether people had money in the savings and loans institutions or not.
The better form of 'socialized' services is where everyone pays for services and everyone also benefits, such as is currently the case in the US with 'socialized' fire departments, 'socialized' police departments, 'socialized' parks, 'socialized' libraries, 'socialized' trash collection, 'socialized' hurricane and weather forecasting, 'socialized' air traffic control, 'socialized' roads, the list goes on endlessly. All these function on the assumption that there are certain things which are a collective good, and that we all should contribute to their maintenance so that we benefit as needed. 'Socialized' medicine should be seen as a natural addition to such existing 'socialized' public services, not some strange alien concept.
No health system is perfect. There will always be people who suffer and die because of the lack of equipment or drugs or incompetence. But no one should suffer and die because of the lack of ability to pay or because of bureaucratic hurdles erected in their path in order that some people can make a profit.
In the next post in this series on Thursday, I will look at the "But I'm ok, aren't I?" attitude that opposes change in the health care system because the speaker thinks that he or she is secure now.
POST SCRIPT: Health care industry contributions to candidates
Michael Moore is helping us keep tabs on how the health care industry is contributing money to presidential candidates of both parties.
Of course, the industry is doing this purely out of a sense of public service and for the sake of supporting democracy, and not to bribe the candidates to make sure that a government run, single payer, health care system is never seriously considered, whoever happens to win.
July 06, 2007
Discussing health care seriously
In my discussions with people on serious and controversial topics, I have some simple rules of thumb to tell me tell whether the discussion is worth pursuing or whether the other person is not serious and talking further is a waste of time.
For example, when discussing evolution, as soon as someone says something along the lines of Mel Gibson's "If we descended from monkeys, then how come there are still monkeys? How come apes aren't people yet?" then you know that you are dealing with someone who is either being willfully dishonest or is so ignorant of the basic facts of the topic under discussion that it is not worth continuing unless one is willing to spend a lot of time to bring that person up to speed. The wrongful use of the second law of thermodynamics is another example of a warning sign.
A similar situation applies to global warming when, during a cold or snowy spell someone triumphantly suggests that this has conclusively proven that global warming is a myth.
In discussing politics, the signal is when one makes a criticism of some action of the US government (such as its decision to ignore habeas corpus, or to invade Iraq, or its numerous covert destabilization actions in other countries) and the other person replies "If you don't like it, then why don't you go to Russia/France/China/Cuba/Sweden/(fill in the blank for whatever other country the speaker does not like)?"
In all these cases, the signs are clear that there has been no attempt by the other person to really engage with the issue and he or she has resorted to what he or she thinks is a clever debating point but in actuality has little or no content behind it.
In the case of the debates over the merits of a universal, government run, single-payer health care system, the signal that someone is not serious is when he or she trots out the waiting times for hip replacements in Canada as an argument about how the Canadian system is so terrible in comparison to the US. In the wake of the release of Michael Moore's film Sicko, we can expect to see this being trotted out repeatedly, as indeed it already has.
As Kevin Drum pointed out a few months ago, the hip replacement argument is a sign of egregious cherry picking of data.
When comparing huge and complex systems like the health care or education systems in different nations, making point-to-point comparisons of isolated cases is of little use. No system is going to be better at every single thing, so this kind of debate results in each side selecting just those pieces of data to suit its purposes. There are probably some elective procedures for which there are longer waiting times in other countries than for those with high quality insurance plans in the US. It would not surprise me in the least if access to tests using expensive equipment like MRI machines is easier in the US (for those who have the requisite insurance coverage, of course) than it is for people in other countries. Health care in the US is aimed at servicing the well-to-do, because it is they who are the decision and policy-makers and as long as they are kept content, they are unlikely to want to make changes that reduce the profits of the health care industry, let alone eliminate them entirely, even if the changes benefit the general public.
One needs to look at aggregate measures to better compare quality and cost across nations. For example, the World Health Organization in 2000 put out The world health report 2000 - Health systems: improving performance in which it used the following measures for the comparison for health systems, using measures of both goodness and fairness:
- overall good health (e.g., low infant mortality rates and high disability-adjusted life expectancy);
- a fair distribution of good health (e.g., low infant mortality and long life expectancy evenly distributed across population groups);
- a high level of overall responsiveness;
- a fair distribution of responsiveness across population groups; and
- a fair distribution of financing health care (whether the burden of health risks is fairly distributed based on ability to pay, so that everyone is equally protected from the financial risks of illness)
Based on these criteria, according to the WHO study (p. 152), the US comes in at #37 in rank internationally, compared to France (#1), England (#18), Canada (#30), and Cuba (#39).
Michael Moore's Sicko (which you should really see) points out that on measures like life expectancy at birth and infant mortality rates (i.e., the number of infants who die before reaching the age of one year for each 1,000 births), the US lags behind its developed world counterparts, even though its spends far more on health care as a fraction of its GDP (13.6% in 1998) than its nearest competitor Germany (10.6%). Per capita spending is also highest is the US ($4,178) with the next highest being Switzerland ($2,794).
The reason the US gets so much less for the money it spends on health care is because of the vast amounts siphoned off to the insurance and drug companies, partly due to profits and partly due to a huge bureaucracy to handle the complex billing and processing process involved with private health insurance. Such costs account for between 19.3 and 24.1% of health care spending in the US compared with between 8.4 and 11.1% in (say) Canada.
There is a strong (negative) correlation between infant mortality and life expectancy, as can be seen from this graph, where each dot represents the data for a country, along with a linear regression line. The implication is clear that the best way to improve life expectancy is to reduce infant mortality. The reason that many developing countries have high infant mortality rates and resulting low life expectancy is that lack of access to clean water results in diarrhea and this leads to dehydration, which is often fatal for infants. (As an aside, the international conglomerate Nestle deserves widespread condemnation for its policy of marketing infant formula in the developing countries, despite the lack of easy access to clean water to prevent infection. Breastfeeding is always preferred except in exceptional cases, but because of the Nestle marketing campaign became perceived as inferior to formula.)
But when comparing the US to the rest of the developed world, access to clean water is not the main issue, so widespread access to health care emerges as the prime suspect for its low ranking. For example, infant mortality rates for non-whites in US cities are two to three times as high as the national average.
What really irks many people in the US about Moore's film is perhaps not so much the adverse comparison with Canada, England and France. People who for some reason are enamored of the system here will complacently trot out once again hip replacement waiting times to claim a spurious superiority. It is the fact that among the 221 countries listed, Cuba's infant mortality rate (6.04, rank 40) and life expectancy rates (77, rank 56) are almost identical with the US infant mortality (6.37, rank 42) and life expectancy (78, rank 45) that really rankles.
The US government's implacable animosity to Cuba, trying to strangle its economy with boycotts and embargos and repeated attempts at destabilization and even assassination of its leaders, has to be one of the cruelest policies ever implemented towards a country that is not a threat to its security. And yet despite that deliberate attempt at destroying the Cuban economy, Cuba has managed to create a public health system that is a model for third world countries, and produces results in key indices that are comparable with the US. Cuba is legendary among third world countries in its generosity, sharing its medical personnel and expertise around the world.
Kevin Drum wonders if Moore's use of Cuba in his film was a clever public relations strategy, knowing that it would trigger the almost reflexive anti-Cuba venom that exists in certain quarters in the US and that they would make a huge fuss, thus giving him free publicity. "Moore's brilliance at getting his mortal enemies to do all his publicity for him is unparalleled."
Drum may be right. In the weird media world we live in, it is not enough for Moore to accurately portray the scandal that is the US health system compared to its peer countries. That information has been out there for a long time, and ignored by the power elites. He had to create a fuss and by going to Cuba, he did so.
POST SCRIPT: This Modern World
Cartoonist Tom Tomorrow sums up the predictable responses to Sicko by the apologists for the US health care industry.
July 02, 2007
Film review: Sicko
When I was just six years old, I became gravely ill with polio. Although Sri Lanka had first-rate doctors, they felt at that time that they did not have the specialized services to provide the kind of treatment that was best for me and recommended that, if at all possible, my family take me to England. We were not wealthy, just middle class, and did not have the kind of money that would enable my parents to afford this. But by an incredible stroke of luck, my father just happened to work for the Sri Lankan state bank that just happened to have a branch in England. It was the bank's practice to rotate their officers to that branch and my father was due to go in few years but because of the urgency of my illness, his bosses quickly arranged for him to be immediately transferred to the London branch. As a result we arrived in England and simply by virtue of the fact that we now lived there, I was able to get health care through the British National Health Service.
I remember many, many visits to doctors and tests, followed by major surgery that required weeks of recovery in a city hospital followed by months of convalescence and rehabilitation in a country hospital that was more like a country retreat than a hospital. The single-story wards opened out onto rolling fields and woods. The hospital was for people having extended stays and so we had teachers who came every day to help us keep up with our school work and we also had crafts and games and social events.
Six years later the process was repeated when I required a second major operation to consolidate the results of the first.
I remember my hospital experience as a very happy one, with kindly doctors and nurses, and a caring environment. It is because of all this treatment that I have been able to lead a normal and healthy life since then.
And all this treatment was completely free. No paperwork, no deductibles, no applying for reimbursement, none of the headaches and the sheer bureaucratic drudgery that awaits anyone who gets ill in the US. The only thing that my parents had to be concerned about was my health.
All these memories came flooding back to me when I went to see Michael Moore's excellent film Sicko last Saturday. In his bemused everyman persona, Moore visited Canada, Britain, France, and Cuba and talked to doctors and patients and other people about the treatment they receive. Their experience now seemed the same as what I had long ago: When you get sick, you go to the doctor and the hospital and they treat you as best as they can, according to their best medical judgment.
That's it. It is very simple, just as it should be.
Moore compared this with the nightmare that is the health care system in the US, where your ability to pay and the quality of your insurance coverage is the determining factor in your treatment. Anyone who has had even routine treatment knows the rigmarole that one has to go to check whether the doctor is on the plan, whether the visit or treatment or test or facility is covered, what the co-pay and deductibles are, followed by all the stuff that one gets in the mail that are sometimes invoices, sometimes bills, the many phone calls that have to be made to correct errors and find out information, the haggling with insurance companies over complicated details. The list goes on.
Why this difference? Simple. It is in the US that private profit-making agencies have been inserted between the patients and the health care system. In a revealing clip using the famous Nixon tapes, Moore reveals how this came about. In 1971, Edgar Kaiser (founder of Kaiser Permanente), through Nixon's aide John Ehrlichman, presents to President Nixon the idea of having a private profit-making health care industry. Ehrlichman explains the best part of this plan: "Edgar Kaiser is running his Permanente deal for profit. . . .All the incentives are toward less medical care. . . . the less care they give them, the more money they make. . . . the incentives run the right way."
To which Nixon replies, "Not bad."
Once that private profit element is introduced, the rest follows. It now becomes in the interests of the insurance companies to deny or reduce both coverage and treatment because there is a direct trade-off between profit and treatment. The more treatment the patient gets, the less profit the insurance companies make. And the film shows how doctors working for the insurance companies were rewarded by the amount of care they denied, even if patients died as a result. Some of those people who did these things as part of their job were haunted by what they had done to people in order to increase the profits of the insurance companies.
As I watched, it struck me that the two major surgeries that I received for free in England would very likely not have been allowed by the health insurance companies here because at that time they were considered somewhat experimental. As the film shows, the charge of being 'experimental' and 'condition caused by a pre-existing condition' are two of the many, many excuses used by the health insurance companies to deny paying for treatment.
The film also shows how politicians of both parties are bought and sold by the insurance companies, and how their shills in the media fight tooth and nail the idea of universal health care. These shills for the insurance and drug companies also laughably try to make the case that the people in countries like Canada and Britain and France are dissatisfied with their systems, when in actual fact those people think it is bizarre that we have to make our own arrangements to pay for health care, rather than having it taken care of by our taxes.
Of course those systems are not perfect and people do complain about some things. But 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.
Needless to say, this being a Michael Moore film and one that spotlights a huge business-political alliance, there is a vigorous counteroffensive to discredit it. But CNN did a fact check on Moore's assertions and concluded:
Our team investigated some of the claims put forth in his film. We found that his numbers were mostly right, but his arguments could use a little more context. As we dug deep to uncover the numbers, we found surprisingly few inaccuracies in the film.
. . .
Moore says that the U.S. spends more of its gross domestic product on health care than any other country.Again, that's true. The United States spends more than 15 percent of its GDP on health care -- no other nation even comes close to that number. France spends about 11 percent, and Canadians spend 10 percent.
Like Moore, we also found that more money does not equal better care. Both the French and Canadian systems rank in the Top 10 of the world's best health-care systems, according to the World Health Organization. The United States comes in at No. 37. The rankings are based on general health of the population, access, patient satisfaction and how the care's paid for.
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.
I was expecting be angry by what I saw in Sicko and that did happen. Since this was a Michael Moore film, I also expected to laugh and that also happened because there are scenes that are vintage Moorisms. What I had not expected was to be so touched and moved by the human stories. At heart, ordinary people tend to care for one another. The film recounts one story after another of people reaching out across politics and nationality and class boundaries, because illness touches everyone's sensibilities. Scenes like the Cuban firefighters who wanted to honor the 9/11 rescue workers.
The difference is that in the US people tend to think in terms of helping informally, those whom they might know personally, or through charities. In countries like Canada, Britain, France, and Cuba, they realize that this does not work for something as basic as health care. The health of the people is too big and too important to be in the hands of private profit-making companies or charities. The government has to do such things, just like it does the fire departments and police, and they support it through their taxes. There is the sense in those countries that there is a shared social obligation to provide health care for everyone.
The only people who benefit from the kind of system the US currently has are the shareholders and top executives of health insurance and drug companies, and those doctors who aspire to great wealth.
What the US needs is a government-run, single payer health care system.
See Sicko and you will better understand why.
POST SCRIPT: Michael Moore on TV
See the interview with Jay Leno.
You can also see Moore respond to some questions on Larry King's show.