Tag: Healthcare

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 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:

 

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.

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??

1 Our Situation

Our Situation button

For some time I have been thinking, writing, and gathering information, not necessarily in any good order, about our situation here in the US. For more than a decade I have thought that we are in a protracted crisis.

This crisis can be felt at the personal, family, local and national level in all areas of life. Some of the sources are systemic to technological change and the global dynamics of capitalism. Some find their roots in fundamental failures in humans – racism, sexism, religion, etc. Some flow from our political system, some from our economy.

The focus of this work has been to try to identify what this crisis is about within the US context, to describe it, without any real notion of even suggesting solutions.

Where Did This List Come From and Is There an Order?

I first started this list two or three years ago while we were still in the deepest part of the Great Recession. Most of the early entries related to the political system and economic inequality. As I have returned to it I have broadened the coverage of social and political topics. Most recently I have added ones that relate to the mythology underlying our approaches to life in the US.

Here is my current list of topics:

  • Underperforming, expensive healthcare system
  • Political system controlled by big money, private and corporate
  • Distorted role of corporations
  • Quasi-religious faith in “free market” capitalism
  • Race, sex, ethnicity, klans….
  • Myth of social mobility
  • National and State Political Systems Designed to Be Anti-democratic and Dysfunctional
  • 30+ year stagnation of income
  • Disappearance of living wage jobs
  • The rich are at their feeding troughs
  • Expensive, underperforming K-12 educational system
  • Expensive, underperforming higher ed system
  • Web access and infrastructure
  • Homelessness and poverty
  • Bloated, dysfunctional global military and empire
  • Our longest war – the war on drugs
  • Criminal justice system – aka the judicial-incarceration gulag
  • Persistent income disparities
  • Super rich vs. everyone else
  • Intrusion by organized religion into government and politics
  • Energy policy focused on consumption instead of efficiency

 

The Health Care Debate Is About The Wrong Issues

The rhetoric about our health care system continues to center around market religions of one sort or another. For all of the blathering about “Obamacare” taking us over the edge into the territory of socialized medicine, it remains, like it’s progenitor dreamed up by Romney while governor of Massachusetts, a market focused policy. Even now Massachusetts is struggling to come up with policies to restrain the growth of costs to the rate of inflation plus 1%. At the national level it will be years before Obamacare can begin such considerations in real terms.

What is missing is a willingness by the political system to engage the undeniable truths about our health care system.

The Future of Healthcare??

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 reforms was politically self-serving. It was also true.

Despite all of the bashing by conservative commentators and politicians — and the predictions of doom for national health care reform — the program he signed into law as governor has been a success. The real lesson from Massachusetts is that health care reform can work, and the national law should work as well or even better.

Like the federal reform law, Massachusetts’s plan required people to buy insurance and employers to offer it or pay a fee. It expanded Medicaid for the poor and set up insurance exchanges where people could buy individual policies, with subsidies for those with modest incomes.

Since reform was enacted, the state has achieved its goal of providing near-universal coverage: 98 percent of all residents were insured last year. That has come with minimal fiscal strain. The Massachusetts Taxpayers Foundation, a nonpartisan fiscal monitoring group, estimated that the reforms cost the state $350 million in fiscal year 2010, a little more than 1 percent of the state budget.

Other significant accomplishments:

The percentage of employers offering insurance has increased, probably because more workers are demanding coverage and businesses are required to offer it.

The state has used managed-care plans to hold down the costs of subsidies: per capita payments for low-income enrollees rose an average of 5 percent a year over the first four years, well below recent 7 percent annual increases in per capita health care spending in Massachusetts. The payments are unlikely to rise at all in the current year, in large part because of a competitive bidding process and pressure from the officials supervising it.

The average premiums paid by individuals who purchase unsubsidized insurance have dropped substantially, 20 percent to 40 percent by some estimates, mostly because reform has brought in younger and healthier people to offset the cost of covering the older and sicker.

Residents of Massachusetts have clearly chosen to tune out the national chatter and look at their own experience. Most polls show that the state reforms are strongly supported by the public, business leaders and doctors, often by 60 percent or more.

There are still real problems that need to be solved. Small businesses are complaining that their premiums are rising faster than before, although how much of that is because of the reform law is not clear.

Insuring more people was expected to reduce the use of emergency rooms for routine care but has not done so to any significant degree. There is no evidence to support critics’ claims that the addition of 400,000 people to the insurance rolls is the cause of long waits to see a doctor.

What reform has not done is slow the rise in health care costs. Massachusetts put off addressing that until it had achieved universal coverage. No one should minimize the challenge, but serious efforts are now being weighed.

Gov. Deval Patrick has submitted a bill to the Legislature that would enhance the state’s powers to reject premium increases, allow the state to limit what hospitals and other providers can be paid by insurers, and promote alternatives to costly fee-for-service medicine. The governor’s goal is to make efficient integrated care organizations the predominant health care provider by 2015.

The national reform law has provisions designed to reduce spending in Medicare and Medicaid and, through force of example, the rest of the health care system. Those efforts will barely get started by the time Massachusetts hopes to have transformed its entire system. Washington and other states will need to keep a close watch.