Tag: health insurance

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…

Read more →
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…

Read more →
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 []

Naive Talk about Healthcare from Adam Davidson in the New Yorker

Adam Davidson

Adam Davidson writing today in The New Yorker offered us “A BIPARTISAN WAY TO IMPROVE MEDICAL CARE – A straightforward change would save money and improve health. So why isn’t Congress talking about it?” This is an astonishingly naive misleading bit of chatter about healthcare.

Election Results: The Next Ten Years

img_1844– The Morning After –

The election of Trump and the continued Republican control of both Congress and Senate guarantee that the rich will continue to get richer at the expense of the shrinking middle class and further aggravate conditions for the poor. Trickle down economics and tax subsidies will flow for the rich and corporations. The financial sector will buy its way out of the weak regulations of Dodd/Frank and lurch towards new adventures in gambling; a financial disaster will once again require the socialization of their risk at taxpayer expense.

Health Care Crisis – the data

Be sure to scroll down to the “Yellow” coded scores for the US.

Comparative Health System Data

Health Spending per

Capita 2002


Infant Mortality per 1000 Births 2003


Life Expectancy in Years at Birth 2003


1

United States

$4,271

1

Sweden

3.44

1

Andorra

83.49

2

Switzerland

$3,857

2

Iceland

3.53

2

Macau

81.87

3

Norway

$3,182

3

Singapore

3.6

3

San Marino

81.43

4

Denmark

$2,785

4

Finland

3.76

4

Japan

80.93

5

Luxembourg

$2,731

5

Japan

3.84

5

Singapore

80.42

6

Iceland

$2,701

6

Norway

3.9

6

Australia

80.13

7

Germany

$2,697

7

Andorra

4.07

7

Guernsey

80.04

8

France

$2,288

8

Netherlands

4.31

8

Switzerland

79.99

9

Japan

$2,243

9

Austria

4.39

9

Sweden

79.97

10

Netherlands

$2,173

10

France

4.41

10

Hong Kong

79.93

11

Sweden

$2,145

11

Switzerland

4.42

11

Canada

79.83

12

Belgium

$2,137

12

Macau

4.44

12

Iceland

79.8

13

Austria

$2,121

13

Slovenia

4.47

13

Cayman Islands

79.67

14

Canada

$1,939

14

Belgium

4.64

14

Italy

79.4

15

Australia

$1,714

15

Germany

4.65

15

Gibraltar

79.38

16

Finland

$1,704

16

Luxembourg

4.71

16

France

79.28

17

Italy

$1,676

17

Spain

4.85

17

Monaco

79.27

18

United Kingdom

$1,675

18

Australia

4.9

18

Liechtenstein

79.25

19

Israel

$1,607

19

Liechtenstein

4.92

19

Spain

79.23

20

Ireland

$1,569

20

Guernsey

4.92

20

Norway

79.09

21

United Arab Emirates

$1,428

21

Canada

4.95

21

Israel

79.02

22

New Zealand

$1,163

22

Denmark

4.97

22

Jersey

78.93

23

Spain

$1,043

23

Gibraltar

5.4

23

Faroe Islands

78.9

24

Greece

$965

24

Ireland

5.43

24

Greece

78.89

25

Portugal

$859

25

United Kingdom

5.45

25

Aruba

78.83

26

Slovenia

$746

26

Czech Republic

5.46

26

Netherlands

78.74

27

Singapore

$678

27

Jersey

5.52

27

Martinique

78.72

28

Argentina

$654

28

Northern Mariana Islands

5.61

28

Virgin Islands

78.59

29

Uruguay

$621

29

Malta

5.72

29

Malta

78.43

30

Bahamas, The

$612

30

Monaco

5.73

30

Germany

78.42

31

Barbados

$601

31

Hong Kong

5.73

31

Montserrat

78.36

32

Korea, South

$470

32

Italy

5.76

32

New Zealand

78.32

33

Lebanon

$469

33

Portugal

5.84

33

Belgium

78.29

34

Saint Kitts and Nevis

$408

34

San Marino

6.09

34

Guam

78.27

35

Czech Republic

$380

35

New Zealand

6.18

35

Austria

78.17

36

Bahrain

$358

36

Greece

6.25

36

United Kingdom

78.16

37

Hungary

$318

37

Aruba

6.26

37

Saint Pierre and Miquelon

78.11

38

Brazil

$308

38

Man, Isle of

6.3

38

Man, Isle of

77.98

39

Chile

$289

39

Guam

6.58

39

Finland

77.92

40

Slovakia

$285

40

Faroe Islands

6.66

40

Jordan

77.88

41

Costa Rica

$257

41

United States

6.69

41

Luxembourg

77.66

42

Poland

$248

42

Taiwan

6.8

42

Guadeloupe

77.53

43

Panama

$246

43

Croatia

7.06

43

Bermuda

77.41

44

Estonia

$243

44

Cuba

7.27

44

Saint Helena

77.38

45

Mexico

$236

45

Israel

7.55

45

Ireland

77.35

46

South Africa

$230

46

Korea, South

7.58

46

Cyprus

77.27

47

Colombia

$227

47

Martinique

7.62

47

Puerto Rico

77.26

48

Dominica

$208

48

Cyprus

7.71

48

United States

77.14

49

Trinidad and Tobago

$204

49

Montserrat

7.98

49

Denmark

77.1

50

Grenada

$193

50

Saint Pierre and Miquelon

8.18

50

Taiwan

76.87

51.

Lithuania

$183

51

New Caledonia

8.23

51

Cuba

76.8

52

Antigua and Barbuda

$179

52

Reunion

8.31

52

Anguilla

76.7

53

Venezuela

$171

53

Slovakia

8.76

53

French Guiana

76.69

54

Latvia

$166

54

Hungary

8.77

54

Kuwait

76.65

55

Jamaica

$157

55

French Polynesia

8.95

55

Costa Rica

76.43

56

Turkey

$153

56

Chile

9.12

56

Portugal

76.35

57

Saint Lucia

$151

57

Poland

9.17

57

Chile

76.35

58

Maldives

$150

58

Virgin Islands

9.21

58

Northern Mariana Islands

76.16

59

El Salvador

$143

59

Bermuda

9.28

59

Libya

76.07

60

Namibia

$142

60

Puerto Rico

9.3

60

British Virgin Islands

76.06

61

Peru

$141

61

Guadeloupe

9.3

61

Uruguay

75.87

62

Jordan

$139

62

Cayman Islands

9.89

62

Jamaica

75.85

63

Iran

$128

63

American Samoa

10.09

63

American Samoa

75.75

64

Botswana

$127

64

Nauru

10.52

64

Slovenia

75.51

65

Gabon

$122

65

Costa Rica

10.87

65

Argentina

75.48

66

Mauritius

$120

66

Kuwait

10.87

66

French Polynesia

75.45

67

Syria

$116

67

Netherlands Antilles

11.06

67

Netherlands Antilles

75.38

68

Thailand

$112

68

Barbados

11.71

68

Korea, South

75.36

69

Tunisia

$108

69

Estonia

12.32

69

Czech Republic

75.18

70

Burma

$97

70

Macedonia, The Former Yugoslav Republic of

12.54

70

United Arab Emirates

74.75

71

Dominican Republic

$95

71

French Guiana

13.22

71

Macedonia, The Former Yugoslav Republic of

74.49

72

Paraguay

$86

72

Jamaica

13.71

72

Slovakia

74.43

73

Fiji

$86

73

Tonga

13.72

73

Tunisia

74.4

74

Romania

$86

74

Fiji

13.72

74

Paraguay

74.4

75

Belarus

$85

75

Brunei

13.95

75

Croatia

74.37

76

Belize

$82

76

Belarus

14.12

76

Brunei

74.3

77

Malaysia

$81

77

Bulgaria

14.18

77

Dominica

74.12

78

Guatemala

$78

78

Uruguay

14.25

78

Turks and Caicos Islands

74

79

Honduras

$74

79

Lithuania

14.34

79

Serbia and Montenegro

73.97

80

Bolivia

$69

80

Grenada

14.63

80

Poland

73.91

81

Kazakhstan

$62

81

Saint Lucia

14.8

81

Venezuela

73.81

82

Bulgaria

$62

82

Latvia

14.96

82

Bahrain

73.72

83

Ecuador

$59

83

Sri Lanka

15.65

83

New Caledonia

73.52

84

Nicaragua

$54

84

Saint Kitts and Nevis

15.83

84

Reunion

73.43

85

Guyana

$51

85

Dominica

15.94

85

Qatar

73.14

86

Swaziland

$46

86

United Arab Emirates

16.12

86

Saint Vincent and the Grenadines

73.08

87

China

$40

87

Saint Vincent and the Grenadines

16.15

87

Saint Lucia

73.08

88

Congo, Democratic Republic of the

$40

88

Palau

16.21

88

West Bank

72.68

89

Cape Verde

$37

89

Mauritius

16.65

89

Sri Lanka

72.62

90

Philippines

$37

90

Seychelles

16.86

90

Oman

72.58

91

Zimbabwe

$36

91

Bahamas, The

17.08

91

Albania

72.37

92

Albania

$36

92

Argentina

17.2

92

Panama

72.32

93

Bhutan

$36

93

Greenland

17.28

93

Mexico

72.3

94

Kenya

$31

94

Serbia and Montenegro

17.36

94

Bosnia and Herzegovina

72.29

95

Nigeria

$30

95

Turks and Caicos Islands

17.46

95

China

72.22

96

Turkmenistan

$30

96

Romania

18.88

96

Hungary

72.17

97

Sri Lanka

$29

97

Bahrain

19.18

97

Solomon Islands

72.1

98

Ukraine

$28

98

British Virgin Islands

19.55

98

Lebanon

72.07

99

Cote d’Ivoire

$28

99

Panama

19.57

99

Ecuador

71.89

100

Papua New Guinea

$25

100

Jordan

19.61

100

Barbados

71.84

Data  for Spending: World Bank. 2002. World Development Indicators 2002. CD-ROM. Washington, DC

Data for Infant Mortality: CIA World Factbook, December 2003

Data for Life Expectancy: CIA World Factbook, December 2003

All data courtesy of http://www.nationmaster.com/index.php (09/29/04)











Healthcare Crisis

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 any other country in the world; 11% more than the next closest country; 90% to 100% more than countries like Germany, Japan, Canada, Australia, and France. Yet the outcomes for our healthcare system are completely second tier and nearly third world.

You may be shocked to see exactly how poorly our phenomenally expensive health system is performing. Just to add some further context, note that Sweden (1st in Infant Mortality to the US 41st position) has a per capita income roughly equal to that of Mississippi (the poorest US state) and spends almost exactly half of what the US does per capita on health care. Examine the Comparative Health System Data in which I have color-coded a few countries for quick comparison.

During our quadrennial presidential personality sweepstakes, neither candidate offered real solutions, really not even a discussion of the issues. We are stuck in a political environment in which neither the Republicans nor the Democrats are offering, and I would argue, are capable of offering real solutions.

Lets make a one basic observation about the situation:

This is not a money problem. As demonstrated by the data on the Comparative Health System Data chart, we clearly are spending enough money in aggregate.

But, this crisis is about money, namely, who gets it and what do they do with it. And, starting from the last serious attempt to tackle the problem during the first year of the Clinton administration, it is very clear that the political system is completely in the pockets of the various interests who have the money now, namely insurance and drug companies, hospitals, and doctors.

It seems obvious to me that we just need to look at any of a number of the top performing countries for the solution. Then, we need to have the political forces in place to tell some of the current participants that the rules have changed.

Central to any solution will be the participation of all US residents in the system. Healthcare is a basic human right and we should not be treated as “risk” factors in insurance company profit calculations. If everyone is part of the healthcare system, then we can effectively share the individual risks and expenses of healthcare across the whole population. Healthcare should not be an actuarial game to derive profit. It should be a system that delivers a reasonable level of service to everyone in the society.

Two players clearly are at the top of the hit list. First, most assuredly the insurance industry, which adds no value to our health care, but consumes by many estimates 15% to 20% of the resources, must go. Second, the drug companies can be brought into reasonable competition for prices that will bring market forces to bear.

Ironically, given the long history of doctors opposing national or single-payer systems in the US, doctors have now been reduced to the status of wage slaves like the rest of us. Many, if not a solid majority of doctors, will support real reforms to the system.

I close here with two basic notions:

  • our healthcare problems are not about a lack of money, and
  • we need to develop political forces that can overcome the control of government (Federal and state) health policies by the current players in the healthcare system.

Given the current Bush administration, I believe the focus of reform must be at the state level. It seems feasible to envision a single-payer system that covers all residents in a state like Massachusetts. We should try it.