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

I have pointed out repeatedly that the US lags badly behind other developed countries in the quality and cost of the health care it provides its people. And all indications are that the US is going to fall further and further behind as other countries adopt universal health coverage based on the single-payer model.

President Obama keeps saying that if we were starting from scratch, a single payer system would be the best option, but that given the existing situation of an employer-based private health insurance system, it would be too disruptive. This is just an excuse for protecting the interests of the drug and insurance industries. After all, Medicare was introduced in 1965 and within one year, by July 1, 1966 19 million seniors were enrolled in it, almost all of the nearly 20 million people over the age of 65 at that time (see table 2-1, page 9), and there were no major problems in that transition.
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(For previous posts on the issue of health care, see here.)

Despite all the manifest advantages of the single-payer system, why is it not even discussed seriously in the decision-making bodies of government? To pose the question is to answer it. It is because the current US system is so bad that its supporters must prevent public discussion of obviously better rivals if it is to survive. The current system is the emperor that has no clothes.

Rich and powerful people either benefit directly from money that they get from the private, profit-seeking health industry (like those who work in the industry or the politicians who get big contributions from them) or have the money to get good treatment. It is these same people who protect the interests of the drug and insurance companies by refusing to even consider a single-payer system. These people use fear to keep others in line, raising downright dishonest fears of shortages, queues, rationing, lack of choice, etc if any reform should occur. They have even started upping the ante on their craziness, saying that with health reform we will start killing all old and sick people.
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(For previous posts on the issue of health care, see here.)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

But others are stepping up:

The degree of misinformation is causing dismay in NHS circles. Andrew Dillon, chief executive of the National Institute for Health and Clinical Excellence (Nice), pointed out that it was utterly false that [Senator Edward] Kennedy would be left untreated in Britain: “It is neither true nor is it anything you could extrapolate from anything we’ve ever recommended to the NHS.”
…
Defenders of Britain’s system point out that the UK spends less per head on healthcare but has a higher life expectancy than the US. The World Health Organisation ranks Britain’s healthcare as 18th in the world, while the US is in 37th place. The British Medical Association said a majority of Britain’s doctors have consistently supported public provision of healthcare. A spokeswoman said the association’s 140,000 members were sceptical about the US approach to medicine: “Doctors and the public here are appalled that there are so many people on the US who don’t have proper access to healthcare. It’s something we would find very, very shocking.”

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

POST SCRIPT: Stephen Colbert and Howard Dean discuss health care

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

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

The Colbert Report	Mon – Thurs 11:30pm / 10:30c
www.colbertnation.com
Colbert Report Full Episodes Political Humor Stephen Colbert in Iraq

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

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

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

(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.

(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:
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(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.
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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.

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.

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

The fact that the current US system is broken and needs a complete overhaul with government involvement is becoming increasingly apparent to almost anyone except for those who have some kind of visceral reaction to the government being involved in anything. It is because of the stark reality faced by ordinary people that, despite the incessant propaganda against single payer public plans by the health industry and its allies in Congress and the media, the polls are pretty clear that people favor a greater government involvement in the health care system.
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