Tag: healthcare crisis

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 []

US Healthcare System

Americans are regularly sold a story of the world-class healthcare available in the US. Certainly for the rich and those with top-level corporate health insurance such care is available. The facts for most Americans are so enormously out of line with this persistent mythology that “delusion” barely touches the gap.

Healthcare Outcomes

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 224.1 This makes our healthcare near Third World and if you have the misfortune of being black, brown or rural poor white the results are significantly worse.

US Healthcare Costs

In 2014 the US spent $9,024 per person on healthcare. Japan, Canada, France, Australia and UK all spent between $3,900 and $4,500 per person. Switzerland, next closest to us in spending, was at $6,787. All but the latter spent less than half our spending. ALL of them had results far better than ours.2 If we had great results, it might make sense to say that it is worth spending 19% of of our economic output on health, in contrast to the 8-10% spent by our developed country competitors. But the facts speak for themselves.

Every other developed country provides universal healthcare as a right. But they do not depend on a healthcare market to deliver it. They recognize that healthcare is not a commodity; it is not like corn, oil, automobiles or cell phones. And since healthcare is not a commodity, it can’t be subject to market controls. While their structures for providing healthcare differ in the details, every other developed country sets a national budget for healthcare and the doctors and hospitals work within the budget. Doctors and hospitals are incentivized to maintain people’s health because that is the only way they can be sure that they live within their budget. They have a larger focus on prevention and no incentive to produce more procedures and prescriptions to increase their income. The proof of the efficacy of this approach is in their results.

In the US, we have a market focused health system that produces lots of procedures and prescriptions. The prices set by the providers for these procedures and prescriptions are across the board much higher than our developed country competitors.3 This enriches doctors, administrators, drug companies and insurance executives but it does poorly at getting the health results we need and deserve.

There are plenty of healthcare models for us to study. We truly can learn from others’ experiences if we have the political will to do so.

  1. Current CIA The World Factbook – https://www.cia.gov/library/publications/the-world-factbook/ accessed 5/13/2017 []
  2. data from Peter G. Peterson Foundation – http://www.pgpf.org/chart-archive/0006_health-care-oecd -accessed 5/12/2017 []
  3. See 2015 Comparative Price Report – Variation in Medical and Hospital Prices by Country – http://www.ifhp.com accessed 5/14/2107 []

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:

 

Vicious Republicans Not Trump Are The Problem

With today’s release of the Senate’s version of the Republican healthcare bill we see clearly that the Republican Party is a vicious, immoral pack of angry white people – mostly men it would appear from the faces representing the party in the media (see below). No matter how you slice up this legislation it says clearly that Republicans want to punish poor and middle class people for their slovenly, lazy, unhealthy lifestyles, and reward the wealthy with a large tax holiday. The healthcare industry gets to continue charging outrageously high prices while providing last in the pack healthcare outcomes. 

Trump is a side-show

The problem is the Republican Party bought and sold by the wealthy and corporations. The Republicans are busy destroying families through their attacks on healthcare, education, family income, and government protections. The Republicans are busy mouthing talk about job creation while doing nothing to create jobs, just more rhetoric about job creators and government regulations. The Republicans are busy doing nothing to assure that a person working a full-time job can achieve a livable standard of living. The Republicans are busy destroying the environment through their actions internationally and at the EPA. The Republicans are busy destroying women’s lives through their attacks on reproductive rights and women’s healthcare. The Republicans are busy encouraging white supremacists and racists in general through their endless pandering about immigration and Muslims. The Republicans are busy destroying the very fabric of our society by completely failing to maintain our infrastructure and decrying any action by government at any level to invest in our common future and protect us from the attacks by corporations on our health and well-being.

Meanwhile the Democratic Party is still dominated by the same old people and the same old rhetoric. They need to declare war on the ruling class and its Republican Party. There should be no more talk about pleasant bipartisan legislative efforts.

Forget about Trump!

We need to defeat the Republican Party and take back the country from the wealthy and corporations.

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.

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.