Tag: health care challenges

The Next Healthcare Battle

Thursday 7/20/2017 – Most people are at the least relieved with the demise of the latest vicious Republican healthcare proposal cooked by old-all-white-all-male-Republican Senators. Obamacare appears to be safe for the moment. But now is the time to double down on the battle for real healthcare reform in this country.

Millions are still not covered by Obamacare; the performance of the healthcare system is appalling; it is a giant ripoff of over-priced-super-profitable prescriptions and procedures masquerading as health.

Here are the basic facts:

  • Health outcomes: the US ranks
    • 56th in infant mortality out of 225 countries;
    • 48th in maternal mortality out of 184;
    • 42nd in life expectancy at birth out of 224.1
    • all developed countries provide universal healthcare and do much better
  • Healthcare spending: the US spends more than double per capita on healthcare compared to other developed countries.

    (click for full size)

Obamacare Is Not the Solution

Obama and the Democrats never had the political will and strength to tell the pharmaceutical companies, doctors, hospitals and insurance companies that their game was over. We should be outraged that they charge exorbitantly high prices and deliver terrible results. But they live in a marketplace where they set the prices and the incentives in their marketplace urge them on to prescribe more drugs and procedures. The things that are being purchased in their marketplace are not health. We need to demand that we develop a healthcare system focused on health not profits.

The Proof Is In the Pudding

Just look at the chart from the Commonwealth Fund2 comparing performance and spending. Certainly if all of these countries (and others not included in this study) have figured out how to deliver much better healthcare at half the cost we need to demand that our government do at least as well.

 

 

  1. Current CIA The World Factbook – https://www.cia.gov/library/publications/the-world-factbook/ accessed 5/13/2017 []
  2. http://www.commonwealthfund.org/publications/fund-reports/2017/jul/mirror-mirror-international-comparisons-2017 accessed 07192017 []

Delusions – the US healthcare system – the postings

The Next Healthcare Battle
July 20, 2017

Certainly if all of these countries, Canada, UK, France, Germany, Australia (and others not included in this study) have figured out how to deliver much better healthcare at half the cost we need to demand that our government do at least as well. Obamacare is not the solution to our healthcare problems of access and cost.

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Healthcare and Markets – why don’t they work together?
June 26, 2017

A consistent chattering point in American discussions of healthcare is the claim that if we can only bring transparency and competition to healthcare we will drive prices down and bring sanity to healthcare. The rest of the world knows that this is not the answer but we seem to remain in the thrall of universal free-market thinking. To answer this question lets start with an example of a market that…

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The Democratic Party and Healthcare – Preserving Obamacare Cannot Be The End Game
June 24, 2017

The Democratic Party must absorb the reality of our situation. We need to develop and express some outrage at the current healthcare providers. None of this will happen as long as Democrats are taking money from the rich and corporations. If there is a single lesson from the Bernie Sanders campaign it is that with messages and programs that reflect the needs of the vast majority of Americans, you can…

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The Republican Party – vicious at the edges
June 23, 2017

None of the failings of our healthcare system outrages the vicious Republicans. They hate poor and middle class people, the hate black and brown people, the hate government, the love to make the rich richer. That is the essence of the Republican Party.

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Naive Talk about Healthcare from Adam Davidson in the New Yorker
May 25, 2017

The solution to our healthcare problems cannot be clearer. Look at Canada, Germany, France, Japan, Australia, Netherlands, UK, Denmark, Sweden, and others. Plenty of healthcare systems with decades of operational experience producing much better outcomes for very single person in these countries at less than half the cost!!

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The Global Context of the US Healthcare Debate
May 14, 2017

The solution to our healthcare fiasco is first to recognize its true nature and then to face down those who are consuming a fifth of our economic output while producing profoundly bad results.

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Trump Loves Australia’s Universal Government Paid Healthcare, “Better than ours”
May 6, 2017

Trump loves Australia’s universal healthcare: Speaking to Australian Prime Minster Trumbull, Trump said, “We have a failing healthcare. I shouldn’t say this to our great gentleman and my friend from Australia, because you have better healthcare than we do.” A day later Trump repeated his praise for the Australian healthcare system, “Of course the Australians have better healthcare than we do – everybody does,” he wrote on Twitter. “Obamacare is dead! But…

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NYTimes Book Review Misses Major Points About US Healthcare
April 5, 2017

Jacob S. Hacker, Yale professor and author of many books and article critiquing the American political system, economy, and the fate of the poor and middle classes, reviewed a new book, AN AMERICAN SICKNESS: How Healthcare Became Big Business and How You Can Take It Back by Elisabeth Rosenthal (NY: Penguin Press, 2017). Most of the review takes up the question of why healthcare is not like other commodities and does not…

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Affordable Healthcare Act (Obamacare) Review – Rob Bujan
April 1, 2017

Dan Udell videotaped a presentation on the US healthcare system by Rob Bujan on 3/25/17. I could not attend so I watched Dan’s YouTube video –   The discussions towards the end of this presentation (about minute 50) concerning single-payer systems would have been more vigorous and perhaps useful with a little international context. We live in a world where every other developed country has universal healthcare and has had for…

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Congressman Faso and the proposed American Health Care Act
March 8, 2017

Congressman Faso Today I received an email from my Congressman, John Faso, concerning the proposed American Health Care Act. It included a link to a Republican website that speaks to their proposed legislation and a link to the the actual legislation. Asking me to read the legislation is insulting because though I am fairly literate it is well known that the language of legislation is a swamp of references to…

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Congressman Faso’s Challenge
January 30, 2017

To put the situation in sound bite language we spend twice as many healthcare dollars as almost all of our competitor nations and get developing country results. That Mr. Faso is your challenge.

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average health care spending
The Health Care Debate Is About The Wrong Issues
September 1, 2012

WE DO NOT HAVE THE BEST HEALTH CARE IN THE WORLD – IN FACT WE ARE NOT EVEN REALLY COMPETITIVE WITH OUR PEERS IN THE DEVELOPED WORLD “The United States was number 1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy.”

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Naomi Wolf’s The End of America – the movie
May 27, 2011

The End of America – a film by Annie Sundberg and Ricki Stern Here is a summary1 of the ten steps discussed and illustrated by Ms. Wolf in the movie. 10 STEPS THAT CLOSE AN OPEN SOCIETY 1. invoke an internal and external threatPeople who are afraid are willing to do things that they wouldn’t otherwise do. 2. establish secret (unaccountable) prisons where torture takes…

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The Future of Healthcare??
May 21, 2011

I don’t generally pause long over the editorials in the NY Times. This morning’s caught my eye. As a recent state resident I watched the debate closely and supported the single payer approach. Since then the results have been interesting and as noted in the Time’s editorial generally good. Here us the editorial: Health Reform in Massachusetts Last Updated: 11:18 PM EDT Mitt Romney’s defense of the Massachusetts health care…

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Just Another Cost of Doing Business? – Pfizer’s $2.3 billion penalty and fine
September 4, 2009

Is $2.3 billion really a lot of money? The Obama administration is touting the action taken this week against Pfizer for illegal promotion of several of its drugs. The $2.3 billion sounds like a lot of money to me, and I suspect most people. Is it really a lot of money or just an annoyance to a large company, just another cost of doing business? Take a look at Pfizer’s…

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More Blather about Healthcare from "Experts"
June 16, 2009

Acknowledge the basic facts about how the healthcare system is working today. Yesterday in a radio interview, “How to conquer health care challenges”, with Professor Glenn Melnick  from the Rand Corporation and USC, we were again offered up “expert” opinion that does not even acknowledge the basic facts about how the healthcare system is working today. Here are a couple of examples from the interview lead by Kai Ryssdal: “RYSSDAL: Well, let…

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Healthcare Crisis
September 8, 2008

Originally written in 2005 The healthcare crisis in the US is growing in severity and yet is not the subject of any real public debate. More than 44 million Americans are without health insurance and almost 65 million will experience a lack of coverage during the year. Emergency rooms are the primary care provider of necessity. All of this despite the fact that, as a nation, we spend more than…

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The Healthcare Crisis
February 2, 2006

The healthcare crisis in the US is growing in severity and yet is not the subject of any real public debate. More than 44 million Americans are without health insurance and almost 65 million will experience a lack of coverage during the year. Emergency rooms are the primary care provider of necessity. All of this despite the fact that, as a nation, we spend more than any other country in…

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  1. from the endofamericamovie.com website – 05/27/2011 []

Healthcare and Markets – why don’t they work together?

A consistent chattering point in American discussions of healthcare is the claim that if we can only bring transparency and competition to healthcare we will drive prices down and bring sanity to healthcare. The rest of the world knows that this is not the answer but we seem to remain in the thrall of universal free-market thinking.

To answer this question lets start with an example of a market that works reasonably well and which we all know very well. In our little patch here in Hudson we have four supermarkets within about a six mile radius servicing roughly 20 thousand people. I can choose to shop at Price Chopper, ShopRight, Hannafords, or Walmart. There are also farmer’s markets and roadside stands. I have lots of suppliers to choose from. Generally I shop at two places, but I certainly stop at all of them with some frequency. When I step inside I regularly pick up the green and red peppers, the onions, and other vegetables that I like to chop up for my cooking. Now, I do not hold a degree from CIA (Culinary Institute of America) so I am not exactly expert, but I generally can identify a fresh vegetable when I see one. Unlike some Presidents I do know how much things generally cost and there are price points for green peppers, for example, that reduce how many I pick up from three or four to one or none.

So,  a functioning market has a number of suppliers (sellers) and lots of buyers. The product for sale is understood by the buyers and they can examine it for quality readily. Prices move up and down in reaction to supply and demand. Market capitalism in action.

Health is not a green pepper

Health is complex and above all it is about life and death of the buyer, me and you. It is inherently emotional. Generally, people will do whatever is necessary to avoid pain and discomfort. This is not a choice between green and yellow peppers. Further, diagnosis and treatment options require many years of advanced education and training to understand. It is simply not true, and never will be true, that people without this training can make well informed decisions about which treatment path to take. Then, unlike our supermarket example, here in Hudson there is one supplier of health services, Columbia Memorial Health, the local hospital. To choose a different supplier I can drive an hour north to Albany or 45 minutes south to Rhinebeck. Even in Boston where I lived for many years, the choices were broader but then I was faced with the fact that the appearance of choice confronted me with my lack of expertise to make a well informed optimal decision. Health is not green peppers. Doctors and hospitals are not grocery stores. I did not graduate from Harvard Medical School.

Fee for services not for health – perverse incentives in action

In reality our market based healthcare system operates just as one would expect given the imbalance of expertise and relative small number of suppliers.  The suppliers have enormous power and they are taking advantage of the buyers, us. They set the prices as they wish. Through historical accident we have added a mixture of government and private insurance that obscures what is going on. Worse, this market is not selling health at all. In a self-enriching cycle, the doctors and hospitals are incentivized to use as many tests, procedures, and prescriptions as possible. They are paid for these; not for health. This is the pay for service model.

Every other developed country in the world understands all of this very well and has for decades. Each country has evolved systems to establish a national or regional budget per capita for health. This is done in negotiations between the government, other stakeholders, and the medical providers. The providers are expected to deliver health. Markets and profits enter, if at all, only peripherally. It is up to them to determine how many tests, procedures and drugs to prescribe. They can decide that preventive medicine is more effective than costly technology intensive treatment. They  optimize the mix.

The proof is in the pudding

Here are a set of facts that speak loudly to both the cost and poor quality of the American healthcare system. The US spends $9,800 per capita on healthcare. Our developed country cohort spends approximately one half of that (excepting Switzerland the outlier at approximately 70% of our spending). These countries all achieve a life expectancy between 81 and 83 years while the US is at 79 years. This numerically small gap in fact represents a very significant gap in performance. According to the most recent CIA World Factbook: “The US ranks 56th in infant mortality out of 225 countries; 48th in maternal mortality out of 184; and 42nd in life expectancy at birth out of 224.“ These facts should outrage all Americans.

Click for large size.

The Democratic Party and Healthcare – Preserving Obamacare Cannot Be The End Game

While our current attention is on the Republican Party’s transfer of wealth to the rich and corporations through the charade of a healthcare reform, the Democratic Party needs to face up to its future and the future of our healthcare system in particular.

The Global Context

The chart shown here tells you everything you need to know about the outrageous amounts of money we pay versus the astonishingly poor outcomes for our health. Basically we pay twice (200% more) than almost every other developed country in the world for healthcare that is distinctly second rate.1 To put it simply we have a healthcare system that is ripping us off and laughing all the way to the golf course. It is a market system that incentivizes tests, procedures, and prescriptions, not health. It is a market system in which the providers, doctors, hospitals, insurance and pharmaceutical companies set prices as they wish.  Our healthcare system consumes just shy of 20% of our economic output. Our developed country competitors use 8%-10% of their output.

click for large size.

Preserving Obamacare is not enough to bridge these gaps.

Obamacare addresses the lack of access to healthcare in a significant but hardly comprehensive manner. It only hints at changes to the incentives and pricing that drive the unhealthy outcomes. Obamacare is not the solution. Better than nothing, but given the enormous resources being spent and the fundamental failings of the outcomes it is not sufficient.

Health Not Profits

In order to create a world class healthcare system we need to focus it on health not profits. Every other developed country long ago recognized that a market based system would not work because health is not a commodity like corn, cars, or cell phones. It is complex, multi-dimensional, and emotional. It requires a system capable of a holistic approach to people and the society they live in. Each of the countries with universal healthcare approaches implementation very differently in the details, but all have some sort of national/regional health budget that is negotiated with the various constituents. This amounts to a lump sum per person with which the health system operates to deliver health outcomes. The proof that it works is in the chart above. 

Outrage and Political Will – Stop Taking Big Money from the Rich and Corporations

The Democratic Party must absorb the reality of our situation. We need to develop and express some outrage at the current healthcare providers. It will not be a simple task to bring a sector of the economy that consumes nearly a fifth of economic output to understand that we cannot allow this to continue. We need them to evolve to a system that consumes a tenth while vastly improving healthcare for the entire population. A basic truth here is that we as a society cannot and should not allow one sector to consume so many resources, so inequitably, for such poor outcomes. In the global context this is not sustainable and makes us less competitive and less flexible to meet the changes. 

None of this will happen as long as Democrats are taking money from the rich and corporations. If there is a single lesson from the Bernie Sanders campaign it is that with messages and programs that reflect the needs of the vast majority of Americans, you can raise enough money to fight off the Republican Party and its wealthy and corporate sponsors. Time to start now.

  1. The US ranks 56th in infant mortality out of 225 countries; 48th in maternal mortality out of 184; and 42nd in life expectancy at birth out of 224. – source Current CIA The World Factbook – https://www.cia.gov/library/publications/the-world-factbook/ accessed 5/13/2017 []

The Republican Party – vicious at the edges

A brief review of how the so-called moderates and the fundamentalist right wing of the Republican Party are reacting to the Senates healthcare bill demonstrates how fundamentally vicious and immoral the whole party is.

Though facts may be out of style lets just take note that we live in one of the wealthiest countries in the world. Also take note that the rest of the developed world provides universal high quality healthcare at roughly half the cost or less of our system which ranks near third world in performance.

The “Moderates”

Susan Collins, Senator from Maine, finds solace in what she perceives to be increases in support for low income people but is “concerned about the long-term cuts to Medicaid funding.” Senator Dean Heller of Nevada is likewise concerned about Medicaid cuts. Senator Lisa Murkowski of Alaska doesn’t want Planned Parenthood defunded. Senator Rob Portman of Ohio- “I continue to have real concerns about the Medicaid policies in this bill….”

The Conservatives

Senator Rand Paul of Kentucky never saw anything except the military and police to be the proper subject for government. Senator Ted Cruz of Texas wants outright repeal of Obamacare and lower premiums. Likewise for Senator Mike Lee of Utah.

Vicious to the Core

Here we have a bill that is designed to throw millions of people out of the healthcare system, give the rich a huge tax break, allow doctors, hospitals, insurance and drug companies to continue to set prices and make huge profits while delivering lousy healthcare to only part of the population.It throughs the definition of basic healthcare into the free for all of the mostly Republican dominated state legislatures. This bill continues the decades long assault by the Republican Party on women. Beyond the perpetual war against women’s right to choose the bill defunds Planned Parenthood entirely. Even the recent upsurge in opioid addiction among white people gets the short end of the dollar. 

Despite the outrages of this bill (and its brethren bill in the House),  the so-called moderates are just complaining at the edges. No one in the Republican Party is talking about how to solve our healthcare disaster. The Republican Party is not thinking of how to improve healthcare at all. They are fulfilling the imperatives of their anti-government, pro-rich program. While the rest of the developed countries in the word devote 8-10% of the economic output to healthcare we spend 19%. While the rest of the developed world manages to provide healthcare to every single person with top flight results our healthcare system ranks 48th in longevity and 54th in infant mortality. Near Third World results.

None of this outrages the vicious Republicans. They hate poor and middle class people, they hate black and brown people, they hate government, they love to make the rich richer. That is the essence of the Republican Party.

Brandon Weber, new to me but clearly troubled by similar incongruities, offers up the following comparison with the UK health system:

 

Congressman Faso and the proposed American Health Care Act

Congressman Faso

Today I received an email from my Congressman, John Faso, concerning the proposed American Health Care Act. It included a link to a Republican website that speaks to their proposed legislation and a link to the the actual legislation. Asking me to read the legislation is insulting because though I am fairly literate it is well known that the language of legislation is a swamp of references to other pieces of legislation frequently calling for comprehensive knowledge of the topic to even begin understanding its implications. 

The site also spends a lot of time bad-mouthing Obamacare. I get it. Republicans don’t like Obamacare. The question is how will they improve upon it??

More Blather about Healthcare from "Experts"

Acknowledge the basic facts about how the healthcare system is working today.

Yesterday in a radio interview, “How to conquer health care challenges”, with Professor Glenn Melnick  from the Rand Corporation and USC, we were again offered up “expert” opinion that does not even acknowledge the basic facts about how the healthcare system is working today.

Here are a couple of examples from the interview lead by Kai Ryssdal:

“RYSSDAL: Well, let me make sure I understand that. If doctors and hospitals are making less money, what is that do for the quality of care? I’m just trying to think about the argument that’s going to come up on Capitol Hill on this one.

MELNICK: Quality will have to suffer in some way. Whether it’s through reduced access, whether it’s through slower development of new technology…….”

The US spends nearly 50% more on healthcare than the next closest country (Switzerland) and more than twice most developed nations. Yet our basic outcomes of infant mortality and longevity remain at near third world performance. These are the facts of our situation. Money is not the problem. It is what we spend our money on that is the problem. To say that quality will inevitably decline as a result of spending less money is just nonsense. This flies in the face of the facts of the performance of all of the developed countries in the world, except us.

Within the current US performance there are clear demonstrations of how superior performance is not driven by spending more money

Even within the current US performance there are clear demonstrations of how superior performance is not driven by spending more money. Just read “THE COST CONUNDRUM: What a Texas town can teach us about health care.” by Atul Gawande in the New Yorker. Here is part of Gwande’s discussion of this point:

Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse. For example, Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen. Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state’s quality ranking tended to be. In fact, the four states with the highest levels of spending—Louisiana, Texas, California, and Florida—were near the bottom of the national rankings on the quality of patient care.

Melnick is not done demonstrating his lack of awareness of further basics about how healthcare works in the US.

There are a number of economists who feel that health-care is expensive for good reason. And the reason is that it’s valuable. That new innovation and new technology, while it may add to the cost of the health-care system, also brings with it tremendous benefits. The real challenge is can we develop a system to do the research to identify those things that are going to be high value in the first place, and to screen out those things that are low value and not adopt them as quickly as we have in the past. And that will be a challenge, but I think there’s potential savings there. I don’t know any country that has done it very well so far, because new innovation is just so complex and hard to predict.

One of the well reported facts about “innovation” in American medicine is that there is no requirement for new technologies, new procedures, new medical devices, or even new drugs to prove their efficacy. This is well known and examples of the consequences are abundant. If we only knew which of all these “innovations” really provided improvements in healthcare outcomes we would all be better of and probably at a lower cost.

I am not sure who Professor Melnick is, but, based on his performance during this interview, he would appear to be another example of that alternative text for PhD.