Frost Illustrated
The term “infant mortality rate” is a measure of the number of babies that die under one year of age per 1,000 live births. It is a useful indicator of how effective a healthcare system is—the lower the number, the fewer babies die.
Although there are a lot of people who feel the U.S. has the best healthcare system in the world, according to the Center for Disease Control, the United States actually ranks 29th in the world for infant mortality. And it gets worse. Infant mortality for African Americans is consistently more than twice that for white Americans—infant mortality among African Americans in 2007 was 13.3 deaths per 1,000 live births compared to a rate for non-Hispanic whites of 5.6.
There are a lot of reasons why this disparity exists—it happens to be a very complex issue. One big factor is simply the lack of access to appropriate healthcare. Healthy babies need healthy mothers, and the process starts well before a woman gets pregnant. But, that process can’t happen if you don’t have insurance and can’t afford to see a doctor.
Every other developed country in the world has decided that people should be able to get the care they need when they need it, and without having to worry about going bankrupt. In America, the healthcare system has ended up protecting the interests of for-profit companies over the needs of individuals and, as a result, people are left without access to care. And, the problem is spreading—even people with insurance are finding that their copays and deductibles are becoming so expensive that they put off needed care because they can’t afford it.
And, now we have the debt crisis, and a lot of politicians who want to simply cut back on spending without thinking about the consequences. Unfortunately, this means that there will be less money available to solve problems like our higher infant mortality rate. And, that means that not only will babies continue to die, but people who need all types of medical care will only show up sicker and in worse shape, which means it will cost us even more to take care of them.
Those politicians don’t seem to get the fact that when you cut back on healthcare, not only do you hurt people, but you also make it more expensive for everybody else.
Instead of blindly cutting back on spending, we should start by making sure that everyone gets the care they need. Then we could sit down as a society and begin to control the free-for-all that exists amongst the for-profit companies that are fighting to get healthcare dollars while people suffer.
Every other developed country has figured this out, and their babies live. But, we seem to be incapable of trying to learn from them—powerful vested interests want us to think that any way besides our way must be wrong.
An entire world of solutions is out there, but in America, lobbyists and politicians can literally stop the debate with irrelevant accusations of “socialized medicine” or “government takeover of healthcare.” So we all end up paying more for healthcare and more people are afraid to go to the doctor because they can’t afford it.
If we could say that we actually had the best results in the world, perhaps this would be tolerable. Unfortunately, the real result is that the youngest, sickest and poorest of us will be hurt, and we will all pay the rising cost of treating the ones that survive. It means that babies—and especially African American babies— will be dying because no one wants to look at the obvious solutions that are all around us.
Dr. Walker is a local physician and member of Hoosiers for a Commonsense Health Plan.
Wednesday, August 31, 2011
Sunday, August 28, 2011
Invitation to a Dialogue: A National Health Plan
New York Times
To the Editor:
In “Will Health Care Reform Survive the Courts?” (State of Play, Sunday Review, Aug. 21), Philip M. Boffey states that “reforms would work far less well without an individual mandate” that requires citizens to buy health insurance or pay a penalty.
I disagree. Health care reform could provide better care at less cost by replacing individual mandates with a single-payer national health care plan financed by taxes. Congress’s power to mandate purchase of private products sold at a profit is disputable, but Congress’s power to tax is not.
Other industrialized countries have national health plans providing care to more citizens at less cost with better outcomes than our system. And they don’t use mandates that allow insurers to charge different prices for different people.
These health care systems have three common properties: public subsidies ensure that everyone has access to care regardless of health, wealth or employment; primary care is encouraged; and publicly accountable, transparent, not-for-profit agencies transfer funds from patient to provider.
There is no need to experiment with mandates. Convert our current health care system into a national health plan.
SAMUEL METZ
Portland, Oregon
The writer, an anesthesiologist, is a founding member of Mad as Hell Doctors, which advocates a single-payer system.
To the Editor:
In “Will Health Care Reform Survive the Courts?” (State of Play, Sunday Review, Aug. 21), Philip M. Boffey states that “reforms would work far less well without an individual mandate” that requires citizens to buy health insurance or pay a penalty.
I disagree. Health care reform could provide better care at less cost by replacing individual mandates with a single-payer national health care plan financed by taxes. Congress’s power to mandate purchase of private products sold at a profit is disputable, but Congress’s power to tax is not.
Other industrialized countries have national health plans providing care to more citizens at less cost with better outcomes than our system. And they don’t use mandates that allow insurers to charge different prices for different people.
These health care systems have three common properties: public subsidies ensure that everyone has access to care regardless of health, wealth or employment; primary care is encouraged; and publicly accountable, transparent, not-for-profit agencies transfer funds from patient to provider.
There is no need to experiment with mandates. Convert our current health care system into a national health plan.
SAMUEL METZ
Portland, Oregon
The writer, an anesthesiologist, is a founding member of Mad as Hell Doctors, which advocates a single-payer system.
Sunday, August 21, 2011
Can We Have Health Reform Without an Individual Mandate? Yes, It's Called 'Medicare for All'
The Nation blogs
The essential vote on the 11th Circuit Court of Appeals panel that ruled that the individual-coverage mandate in President Obama’s healthcare reform is unconstitutional did not come from a reactionary Republican appointed by Ronald Reagan or George W. Bush.
Rather, it came from respected jurist whose two appointments to the federal bench—first as a judge for the Northern District of Georgia in 1994 and then to the 11th Circuit in 1997—were made by then-President Bill Clinton. No, Judge Frank Mays Hull is not a raging lefty, but nor is she a right-wing judicial activist. A former law clerk for Judge Elbert Parr Tuttle, who as the chief justice of the US Court of Appeals for the Fifth Circuit from 1960 to 1967 led the court in issuing a series of epic decisions on behalf of civil rights, Judge Hull has a reputation as a moderate defender of the rule of law who has earned reasonable marks for her pragmatic and decidely mainstream interpretations of the Constitution.
So why did Hull join with another member of the appeals court panel (Chief Judge Joel Dubina, an appointee of George H.W. Bush) to form the 2-1 majority that rejected the individual mandate while affirming the rest of the law? Perhaps it was because one can favor sweeping healthcare reforms—including an expansion of Medicare—while still believing that it is wrong to require Americans to buy insurance from for-profit insurance companies.
Hull telegraphed her thinking with repeated questions during June oral arguments in Atlanta regarding the case. Noting that “the panel spent a significant amount of time discussing whether the mandate is ‘severable’ from the rest of the law,” Politico pointed out that: “Hull in particular asked the federal government three times where the line should be.”
Ultimately, Hull and Dubina came to the conclusion that the individual mandate could, and should, be removed from an otherwise constitutional plan.
Why? Because, as the judges wrote in their majority decision: “This economic mandate represents a wholly novel and potentially unbounded assertion of congressional authority: the ability to compel Americans to purchase an expensive health insurance product they have elected not to buy, and to make them re-purchase that insurance product every month for their entire lives.”
Those of us who favor fundamental healthcare reform have always been uncomfortable with the individual mandate. So was candidate Barack Obama, who distinguished himself from Hillary Clinton (a mandate backer) by saying in a February 2008, interview: “Both of us want to provide health care to all Americans. There’s a slight difference, and her plan is a good one. But, she mandates that everybody buy health care. She’d have the government force every individual to buy insurance and I don’t have such a mandate because I don’t think the problem is that people don’t want health insurance, it’s that they can’t afford it. So, I focus more on lowering costs. This is a modest difference. But, it’s one that she’s tried to elevate, arguing that because I don’t force people to buy health care that I’m not insuring everybody. Well, if things were that easy, I could mandate everybody to buy a house, and that would solve the problem of homelessness. It doesn’t.”
Candidate Obama was right.
The individual mandate was always a bad idea. Instead of recognizing that healthcare is a right, the members of Congress and the Obama administration who cobbled together the healthcare reform plan created a mandate that maintains the abuses and the expenses of for-profit insurance companies—and actually rewards those insurance companies with a guarantee of federal money.
Those who think that the for-profit (or even not-for-profit) insurance industry has to control any healthcare reform initiative have every right to be upset with the 11th Circuit’s ruling—which almost certainly will send the case of the Obama healthcare plan to the US Supreme Court.
But those of us who have no desire to perpetuate the insurance industry can and should recognize that the proper—and entirely constitutional—reform is an expansion of Medicare to cover all Americans.
There is no question that Medicare is a sound and popular program. (Just ask House Budget Committee chair Paul Ryan, R-Wisconsin, who took an epic political beating when he proposed a scheme to replace the successful single-payer system with a voucher scheme designed to enrich insurance firms.)
While Medicare is exceptionally popular, polling shows that the individual mandate is not—according to recent surveys, roughly 60 percent of Americans oppose it.
It also passes constitutional muster.
As former Labor Secretary Robert Reich notes: [No] federal judge has struck down Social Security or Medicare as being an unconstitutional requirement that Americans buy something. Social Security and Medicare aren’t broccoli or asparagus. They’re as American as hot dogs and apple pie.”
“So if the individual mandate to buy private health insurance gets struck down by the Supreme Court or killed off by Congress, “ says Reich, “I’d recommend President Obama immediately propose what he should have proposed in the beginning — universal health care based on Medicare for all, financed by payroll taxes.”
The insurance companies would, of course, scream.
But let them complain.
Americans don’t need mandates. They need healthcare.
And they have every right to ask, as activists with Physicians for a National Health Program have, that Medicare be expanded to cover all Americans —affordably, efficiently, capably and constitutionally.
The essential vote on the 11th Circuit Court of Appeals panel that ruled that the individual-coverage mandate in President Obama’s healthcare reform is unconstitutional did not come from a reactionary Republican appointed by Ronald Reagan or George W. Bush.
Rather, it came from respected jurist whose two appointments to the federal bench—first as a judge for the Northern District of Georgia in 1994 and then to the 11th Circuit in 1997—were made by then-President Bill Clinton. No, Judge Frank Mays Hull is not a raging lefty, but nor is she a right-wing judicial activist. A former law clerk for Judge Elbert Parr Tuttle, who as the chief justice of the US Court of Appeals for the Fifth Circuit from 1960 to 1967 led the court in issuing a series of epic decisions on behalf of civil rights, Judge Hull has a reputation as a moderate defender of the rule of law who has earned reasonable marks for her pragmatic and decidely mainstream interpretations of the Constitution.
So why did Hull join with another member of the appeals court panel (Chief Judge Joel Dubina, an appointee of George H.W. Bush) to form the 2-1 majority that rejected the individual mandate while affirming the rest of the law? Perhaps it was because one can favor sweeping healthcare reforms—including an expansion of Medicare—while still believing that it is wrong to require Americans to buy insurance from for-profit insurance companies.
Hull telegraphed her thinking with repeated questions during June oral arguments in Atlanta regarding the case. Noting that “the panel spent a significant amount of time discussing whether the mandate is ‘severable’ from the rest of the law,” Politico pointed out that: “Hull in particular asked the federal government three times where the line should be.”
Ultimately, Hull and Dubina came to the conclusion that the individual mandate could, and should, be removed from an otherwise constitutional plan.
Why? Because, as the judges wrote in their majority decision: “This economic mandate represents a wholly novel and potentially unbounded assertion of congressional authority: the ability to compel Americans to purchase an expensive health insurance product they have elected not to buy, and to make them re-purchase that insurance product every month for their entire lives.”
Those of us who favor fundamental healthcare reform have always been uncomfortable with the individual mandate. So was candidate Barack Obama, who distinguished himself from Hillary Clinton (a mandate backer) by saying in a February 2008, interview: “Both of us want to provide health care to all Americans. There’s a slight difference, and her plan is a good one. But, she mandates that everybody buy health care. She’d have the government force every individual to buy insurance and I don’t have such a mandate because I don’t think the problem is that people don’t want health insurance, it’s that they can’t afford it. So, I focus more on lowering costs. This is a modest difference. But, it’s one that she’s tried to elevate, arguing that because I don’t force people to buy health care that I’m not insuring everybody. Well, if things were that easy, I could mandate everybody to buy a house, and that would solve the problem of homelessness. It doesn’t.”
Candidate Obama was right.
The individual mandate was always a bad idea. Instead of recognizing that healthcare is a right, the members of Congress and the Obama administration who cobbled together the healthcare reform plan created a mandate that maintains the abuses and the expenses of for-profit insurance companies—and actually rewards those insurance companies with a guarantee of federal money.
Those who think that the for-profit (or even not-for-profit) insurance industry has to control any healthcare reform initiative have every right to be upset with the 11th Circuit’s ruling—which almost certainly will send the case of the Obama healthcare plan to the US Supreme Court.
But those of us who have no desire to perpetuate the insurance industry can and should recognize that the proper—and entirely constitutional—reform is an expansion of Medicare to cover all Americans.
There is no question that Medicare is a sound and popular program. (Just ask House Budget Committee chair Paul Ryan, R-Wisconsin, who took an epic political beating when he proposed a scheme to replace the successful single-payer system with a voucher scheme designed to enrich insurance firms.)
While Medicare is exceptionally popular, polling shows that the individual mandate is not—according to recent surveys, roughly 60 percent of Americans oppose it.
It also passes constitutional muster.
As former Labor Secretary Robert Reich notes: [No] federal judge has struck down Social Security or Medicare as being an unconstitutional requirement that Americans buy something. Social Security and Medicare aren’t broccoli or asparagus. They’re as American as hot dogs and apple pie.”
“So if the individual mandate to buy private health insurance gets struck down by the Supreme Court or killed off by Congress, “ says Reich, “I’d recommend President Obama immediately propose what he should have proposed in the beginning — universal health care based on Medicare for all, financed by payroll taxes.”
The insurance companies would, of course, scream.
But let them complain.
Americans don’t need mandates. They need healthcare.
And they have every right to ask, as activists with Physicians for a National Health Program have, that Medicare be expanded to cover all Americans —affordably, efficiently, capably and constitutionally.
US Physician Practices Versus Canadians: Spending Nearly Four Times As Much Money Interacting With Payers
HealthAffairs.org
Physician practices, especially the small practices with just one or two physicians that are common in the United States, incur substantial costs in time and labor interacting with multiple insurance plans about claims, coverage, and billing for patient care and prescription drugs. We surveyed physicians and administrators in the province of Ontario, Canada, about time spent interacting with payers and compared the results with a national companion survey in the United States. We estimated physician practices in Ontario spent $22,205 per physician per year interacting with Canada’s single-payer agency—just 27 percent of the $82,975 per physician per year spent in the United States. US nursing staff, including medical assistants, spent 20.6 hours per physician per week interacting with health plans—nearly ten times that of their Ontario counterparts. If US physicians had administrative costs similar to those of Ontario physicians, the total savings would be approximately $27.6 billion per year. The results support the opinion shared by many US health care leaders interviewed for this study that interactions between physician practices and health plans could be performed much more efficiently.
Physician practices, especially the small practices with just one or two physicians that are common in the United States, incur substantial costs in time and labor interacting with multiple insurance plans about claims, coverage, and billing for patient care and prescription drugs. We surveyed physicians and administrators in the province of Ontario, Canada, about time spent interacting with payers and compared the results with a national companion survey in the United States. We estimated physician practices in Ontario spent $22,205 per physician per year interacting with Canada’s single-payer agency—just 27 percent of the $82,975 per physician per year spent in the United States. US nursing staff, including medical assistants, spent 20.6 hours per physician per week interacting with health plans—nearly ten times that of their Ontario counterparts. If US physicians had administrative costs similar to those of Ontario physicians, the total savings would be approximately $27.6 billion per year. The results support the opinion shared by many US health care leaders interviewed for this study that interactions between physician practices and health plans could be performed much more efficiently.
Sunday, August 14, 2011
Address why, not how, of health costs
Ft. Wayne Journal Gazette
Politicians and special interest groups are always trying to control the debate over health care. But there is one undeniable fact: we are paying more for health care than we ever have before.
People offer lots of explanations for this: malpractice, fraud, private insurance, obesity. All these problems contribute to the rising cost of health care. However, the primary reason is that there has been so much money sloshing around our health care system, and so many fragmented, for-profit entities getting that money, that prices keep climbing at a higher rate than almost anything else in the economy.
Unfortunately, politicians are reluctant to look closely at whether we are getting our money’s worth because special interests have tremendous control over the system. For instance, we hear about how expensive Medicare is, but did you know that although Medicare is spending our tax dollars, pharmaceutical lobbyists have made sure that it is forbidden to bargain over drug prices? Or if two treatments are equally effective, but one is expensive and the other is cheap, Medicare is required to pay for both without question?
To make matters worse, private insurance companies usually emulate Medicare, but they have to pay even more because otherwise health care providers won’t deal with them. There could be huge cost savings if we looked carefully at issues like these. But whenever someone tries to raise such questions, businesses that might lose money start complaining about “government takeover of health care” and the debate is shut down.
Since politicians don’t want to look at cost-effectiveness, the only way employers, insurance companies and the government can save money is to have us, the consumers, bear more of the cost. This is why co-pays and deductibles have increased so much over the past few years, and why employees have had fewer raises as employers spend more on insurance. It is also why some people want to change Medicare to a voucher program; doing so would further unload the cost onto patients. But none of this addresses why the costs are going up in the first place – it just gets us to pay more.
And there is another reason why this is happening. There are a lot of powerful people who think that the state of American health care will be better if we have more “skin in the game.” The feeling is that, as we pay more for medical treatments, we will become better shoppers for health care and that will bring costs down. Actually, there is a lot of data that suggest that putting more of our skin in the game doesn’t solve the problem. Instead, people end up putting off needed care and become sicker, or people who are really sick burn through their deductible so quickly that it doesn’t have any effect on costs at all. Plus, if huge corporations and the government can’t control the rising cost of health care, it is hard to imagine that individuals can. Unfortunately, it doesn’t make any difference that putting more of our skin in the game won’t solve the problem – the people with that viewpoint dominate the situation.
It is frustrating that our leaders are fighting over issues that are irrelevant when it comes to addressing the real problems. Things such as waivers or changing the eligibility age for Medicare do nothing to solve rising costs or improve the quality of care – they simply unload the costs onto us. We need to demand that politicians look at what we are paying for, rather than just how to pay for it. As we spend more every year on insurance, co-pays and deductibles, remember that it is our money and our health that are at stake. Unless we take the time to get involved, we may soon lose all of our skin to their game.
Dr. Jonathan D. Walker is a member of Hoosiers for a Commonsense Health Plan (hchp.info).
Politicians and special interest groups are always trying to control the debate over health care. But there is one undeniable fact: we are paying more for health care than we ever have before.
People offer lots of explanations for this: malpractice, fraud, private insurance, obesity. All these problems contribute to the rising cost of health care. However, the primary reason is that there has been so much money sloshing around our health care system, and so many fragmented, for-profit entities getting that money, that prices keep climbing at a higher rate than almost anything else in the economy.
Unfortunately, politicians are reluctant to look closely at whether we are getting our money’s worth because special interests have tremendous control over the system. For instance, we hear about how expensive Medicare is, but did you know that although Medicare is spending our tax dollars, pharmaceutical lobbyists have made sure that it is forbidden to bargain over drug prices? Or if two treatments are equally effective, but one is expensive and the other is cheap, Medicare is required to pay for both without question?
To make matters worse, private insurance companies usually emulate Medicare, but they have to pay even more because otherwise health care providers won’t deal with them. There could be huge cost savings if we looked carefully at issues like these. But whenever someone tries to raise such questions, businesses that might lose money start complaining about “government takeover of health care” and the debate is shut down.
Since politicians don’t want to look at cost-effectiveness, the only way employers, insurance companies and the government can save money is to have us, the consumers, bear more of the cost. This is why co-pays and deductibles have increased so much over the past few years, and why employees have had fewer raises as employers spend more on insurance. It is also why some people want to change Medicare to a voucher program; doing so would further unload the cost onto patients. But none of this addresses why the costs are going up in the first place – it just gets us to pay more.
And there is another reason why this is happening. There are a lot of powerful people who think that the state of American health care will be better if we have more “skin in the game.” The feeling is that, as we pay more for medical treatments, we will become better shoppers for health care and that will bring costs down. Actually, there is a lot of data that suggest that putting more of our skin in the game doesn’t solve the problem. Instead, people end up putting off needed care and become sicker, or people who are really sick burn through their deductible so quickly that it doesn’t have any effect on costs at all. Plus, if huge corporations and the government can’t control the rising cost of health care, it is hard to imagine that individuals can. Unfortunately, it doesn’t make any difference that putting more of our skin in the game won’t solve the problem – the people with that viewpoint dominate the situation.
It is frustrating that our leaders are fighting over issues that are irrelevant when it comes to addressing the real problems. Things such as waivers or changing the eligibility age for Medicare do nothing to solve rising costs or improve the quality of care – they simply unload the costs onto us. We need to demand that politicians look at what we are paying for, rather than just how to pay for it. As we spend more every year on insurance, co-pays and deductibles, remember that it is our money and our health that are at stake. Unless we take the time to get involved, we may soon lose all of our skin to their game.
Dr. Jonathan D. Walker is a member of Hoosiers for a Commonsense Health Plan (hchp.info).
Editorial: If U.S. is serious about debt, there's a single-payer solution.
St. Louis Post-Dispatch
If America truly is serious about dealing with its deficit problems, there's a fairly simple solution. But you're probably not going to like it: Enact a single-payer health care plan.
See, we told you weren't going to like it.
But the fact is that everyone who has studied the deficit problem has agreed that it's actually a health care problem — more specifically, the cost of providing Medicare benefits to an aging and longer-living population. The bipartisan National Commission on Fiscal Responsibility and Reform reported last December: "The Congressional Budget Office (CBO) projects if we continue on our current course, deficits will remain high throughout the rest of this decade and beyond, and debt will spiral ever higher, reaching 90 percent of GDP in 2020.
"Over the long run, as the baby boomers retire and health care costs continue to grow, the situation will become far worse. By 2025 revenue will be able to finance only interest payments, Medicare, Medicaid, and Social Security. Every other federal government activity — from national defense and homeland security to transportation and energy — will have to be paid for with borrowed money."
That being the case — and nobody argues that it isn't — there are two broad ways for the government to address its spiraling health care costs. One, shift more of those costs to recipients, by trimming benefits and/or extending eligibility ages and indexing eligibility to personal income. This is politically unpalatable, particularly to most Democrats, President Barack Obama being a conspicuous exception.
The second way for government to address its health costs is not to shift them, but to reduce them. This is what a single-payer health care system would do, largely by taking the for-profit players (insurance companies for the most part) out of the loop.
The advocacy group Physicians for a National Health Program estimates that "private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans."
Once everyone is covered, the government would have the clout to bring discipline into the wild west of health care spending. It could insist that providers be paid for quality of service, not quantity. Health facilities and equipment could be managed by regional boards. Medical services could be "bundled" — rather than paying hospitals and doctors and laboratories separately, there would be fixed prices for treatments. And so on.
The Patient Protection and Affordable Care Act passed in 2009 contains many pilot programs designed to test cost-reduction strategies. Most of them won't kick in for another six to eight years, by which time health care costs will be approaching 20 percent of U.S. gross domestic product. The combined state and federal share of that will be 49 percent, up from 45 percent today.
Indeed, a study published this month in the journal Health Affairs estimates that while the Affordable Care Act will pay for itself by 2020, it won't actually "bend the cost curve," as the Obama administration had hoped. But the study, done by the Actuary Centers for Medicare and Medicaid Services, says the ACA will significantly slow the rise of health care costs to state and local governments.
But consider those two findings: In effect, they say that if reducing overall health care costs is the goal, then the ACA didn't go far enough. Thirty million more people will be insured and government costs will grow more slowly. But overall health care costs will continue to explode.
Sooner or later, a nation serious about controlling spending must take broad control of the health care system.
It surely won't be sooner. Compared to the political fight that would erupt over a single-payer plan, the congressional battle over the Affordable Care Act would seem as tame as resolution praising mom, the flag and apple pie.
The ACA was a compromise. Mr. Obama brought everyone to the table — doctors, insurance companies, drug companies, hospitals — and came away with a "best we can get" kind of bill. Many of those at the table turned around and lobbied against it or sought special favors once the bill came before Congress.
It passed by narrow margins, and Congress is decidedly more conservative now. Indeed, the new House majority has voted to repeal the ACA and challenges to its constitutionality continue to work their way toward the Supreme Court.
But now, like a baby discovering its toes, Congress has discovered the deficit. And the plain fact is that unless you want to commit political suicide and cut Medicare to the bone — as Rep. Paul Ryan's, R-Wis., budget plan would do — the best way to seriously address long-term deficits is to get control of health care costs through a single-payer plan.
In 2008, when health care costs amounted to "only" 16 percent of U.S. gross domestic product, Great Britain was spending 8.7 percent of its GDP on health care, and Canada was spending 10.4 percent. Both nations have single-payer plans. Quality of care scores in both nations are at least comparable, and in most cases, better.
Eventually, the United States will have a single-payer plan. But we'll waste a lot of money and time getting there.
If America truly is serious about dealing with its deficit problems, there's a fairly simple solution. But you're probably not going to like it: Enact a single-payer health care plan.
See, we told you weren't going to like it.
But the fact is that everyone who has studied the deficit problem has agreed that it's actually a health care problem — more specifically, the cost of providing Medicare benefits to an aging and longer-living population. The bipartisan National Commission on Fiscal Responsibility and Reform reported last December: "The Congressional Budget Office (CBO) projects if we continue on our current course, deficits will remain high throughout the rest of this decade and beyond, and debt will spiral ever higher, reaching 90 percent of GDP in 2020.
"Over the long run, as the baby boomers retire and health care costs continue to grow, the situation will become far worse. By 2025 revenue will be able to finance only interest payments, Medicare, Medicaid, and Social Security. Every other federal government activity — from national defense and homeland security to transportation and energy — will have to be paid for with borrowed money."
That being the case — and nobody argues that it isn't — there are two broad ways for the government to address its spiraling health care costs. One, shift more of those costs to recipients, by trimming benefits and/or extending eligibility ages and indexing eligibility to personal income. This is politically unpalatable, particularly to most Democrats, President Barack Obama being a conspicuous exception.
The second way for government to address its health costs is not to shift them, but to reduce them. This is what a single-payer health care system would do, largely by taking the for-profit players (insurance companies for the most part) out of the loop.
The advocacy group Physicians for a National Health Program estimates that "private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans."
Once everyone is covered, the government would have the clout to bring discipline into the wild west of health care spending. It could insist that providers be paid for quality of service, not quantity. Health facilities and equipment could be managed by regional boards. Medical services could be "bundled" — rather than paying hospitals and doctors and laboratories separately, there would be fixed prices for treatments. And so on.
The Patient Protection and Affordable Care Act passed in 2009 contains many pilot programs designed to test cost-reduction strategies. Most of them won't kick in for another six to eight years, by which time health care costs will be approaching 20 percent of U.S. gross domestic product. The combined state and federal share of that will be 49 percent, up from 45 percent today.
Indeed, a study published this month in the journal Health Affairs estimates that while the Affordable Care Act will pay for itself by 2020, it won't actually "bend the cost curve," as the Obama administration had hoped. But the study, done by the Actuary Centers for Medicare and Medicaid Services, says the ACA will significantly slow the rise of health care costs to state and local governments.
But consider those two findings: In effect, they say that if reducing overall health care costs is the goal, then the ACA didn't go far enough. Thirty million more people will be insured and government costs will grow more slowly. But overall health care costs will continue to explode.
Sooner or later, a nation serious about controlling spending must take broad control of the health care system.
It surely won't be sooner. Compared to the political fight that would erupt over a single-payer plan, the congressional battle over the Affordable Care Act would seem as tame as resolution praising mom, the flag and apple pie.
The ACA was a compromise. Mr. Obama brought everyone to the table — doctors, insurance companies, drug companies, hospitals — and came away with a "best we can get" kind of bill. Many of those at the table turned around and lobbied against it or sought special favors once the bill came before Congress.
It passed by narrow margins, and Congress is decidedly more conservative now. Indeed, the new House majority has voted to repeal the ACA and challenges to its constitutionality continue to work their way toward the Supreme Court.
But now, like a baby discovering its toes, Congress has discovered the deficit. And the plain fact is that unless you want to commit political suicide and cut Medicare to the bone — as Rep. Paul Ryan's, R-Wis., budget plan would do — the best way to seriously address long-term deficits is to get control of health care costs through a single-payer plan.
In 2008, when health care costs amounted to "only" 16 percent of U.S. gross domestic product, Great Britain was spending 8.7 percent of its GDP on health care, and Canada was spending 10.4 percent. Both nations have single-payer plans. Quality of care scores in both nations are at least comparable, and in most cases, better.
Eventually, the United States will have a single-payer plan. But we'll waste a lot of money and time getting there.
Monday, August 8, 2011
Getting Up Close And Personal With Emergency Care, Canadian Style
Kaiser Health News
It had been a gorgeous day of cycling the rolling hills of Quebec's Eastern Townships. I wasn't traveling very fast when I hit a patch of gravel on the trail, but I went flying, landing hard on my left side.,
I sat up, holding my left arm. I couldn't lift it, and it hurt much more than could be explained by the cuts and scrapes that were dripping blood all over my shorts. Meanwhile, the base of the thumb on my right hand, with which I'd apparently tried to break my fall, was misshapen and swollen. I'd also injured my left flank, as I discovered when I tried to walk.
As my two friends propped me up and tried to identify our location for the 911 dispatcher, I awaited my first real-life encounter with the mostly government-funded Canadian health-care system.
As a health care writer, I talk with people all the time about their experiences navigating the system, whether in the United States or elsewhere. Writing about health care is different from writing about the arts, say, or sports, in one crucial way: When you write about health care, you're often left feeling profoundly grateful that you didn't have to experience firsthand the event that you're describing. But now my luck had turned, and I was about to get up close and personal with emergency care, Canadian style.
The ambulance arrived within 15 minutes, and I had a bumpy but uneventful ride to the hospital, a regional trauma center at one of the local universities. On arrival, we showed them my passport and American insurance card. Because I was a trauma patient, I was wheeled right in, just as would happen in a U.S. hospital. A nurse removed my clothes, cutting off my shirt since I couldn't move my arm. Another nurse drew blood.
At the request of a very young-looking resident, I moved various body parts on command and answered questions about what hurt. The resident, who was my main contact throughout the visit, also looked over my injuries, including checking my ears and eyes. She was friendly and kind, and kept up a running commentary in mostly fluent English explaining what she and others were doing. (One of my friends, a French-speaking Montreal resident, stayed with me and interpreted when the medical staff's questions or my answers were complicated.)
One of the most striking things about the exam was how little high-technology equipment they employed. Until I had X-rays made of my hand, hip, shoulder and knee, a blood-pressure cuff was the most advanced equipment I encountered.
Emergency department technology use varies, of course, in Canada and elsewhere. Still, clinicians at a trauma center in the United States treating someone with injuries similar to mine would probably wheel a portable ultrasound machine to the bedside in the trauma bay to scan for internal injuries, says Sandra Schneider, president of the American College of Emergency Physicians. They would also probably do CT scans, perhaps of my neck, pelvis and back, to make sure there were no bone breaks that didn't show up on the X-rays. Some of the tests might not be absolutely necessary, but "a lot of what [U.S. emergency physicians] do is because we are very frightened of getting sued, because we get sued so often," says Schneider.
In an analysis of data from 2003 to 2008, researchers at Yale and in Canada found that Americans were nearly twice as likely to get a CT scan during an emergency department visit as were Canadians living in Ontario.
In Canada, residents who go to the emergency department pay nothing for the visit, not even for X-rays or other imaging tests or for lab work, says Michael Schull, an emergency physician who co-authored the study on CT use. They also pay nothing for specialist visits and hospital admissions, he said.
"Hospitals aren't making any money off these tests," Schull says. "There's no incentive to do them, because they're not going to get paid for them."
After the X-rays were taken and I was wheeled back into the trauma bay (No. 13, but I figured I'd already had my bad luck for the day), the resident came to my bedside with a big smile on her face and said, "You really are in pain! You have three fractures!" Validation is nice, but I wished the news were different.
I had two fractures at the top of the humerus, the long arm bone that attaches to the shoulder, and another break in a bone at the base of my thumb. The shoulder breaks could be expected to heal cleanly, she said, but the thumb was slightly out of alignment and might require surgery. There were no broken bones in my pelvis or hip; the pain and difficulty walking I was experiencing there was probably caused by torn or otherwise damaged muscles, tendons and ligaments.
The trauma team referred me to an orthopedist to examine my shoulder and a plastic surgeon with expertise in hands to look at my thumb. Unfortunately, an orthopedist wouldn't be able to see me until two days later. (The chief orthopedic resident, however, stopped by that night and reassured me that it would be okay to wait.) I did get examined by a plastic surgeon that evening, but my friends had to drive me to a sister hospital several miles away to see him. Specialists, it seemed, were pretty thin on the ground.
According to a 2010 Commonwealth Fund survey of health care in 11 countries, 33 percent of Canadians waited six days or more to see a specialist when they were sick, compared with 19 percent of Americans.
My pelvis apparently did not warrant special attention. Since the injury seemed to be muscular rather than skeletal, the hospital staff would do nothing further to diagnose what was wrong, the resident said. Her recommendation for me — rest and exercise — would probably be the same no matter what I'd done to any tissue.
I couldn't argue with her reasoning, and if she was right, it was the sensible course. But what a difference in approach from what I would be likely to experience in the United States, Schneider says, where clinicians would probably have worked hard to nail down a definite diagnosis. I left with prescriptions for morphine, naproxen (an anti-inflammatory) and Tylenol.
Puzzled by my U.S. private insurance card, the billing person estimated that my care that night would cost 700 Canadian dollars (about $740) and charged my credit card. If it turned out I had been overcharged, she said, they would send me a refund. Yes, you read that right: overcharged.
Although comparing costs and bills is tricky, by any measure my evening in the Canadian emergency department was a good deal.
It had been a gorgeous day of cycling the rolling hills of Quebec's Eastern Townships. I wasn't traveling very fast when I hit a patch of gravel on the trail, but I went flying, landing hard on my left side.,
I sat up, holding my left arm. I couldn't lift it, and it hurt much more than could be explained by the cuts and scrapes that were dripping blood all over my shorts. Meanwhile, the base of the thumb on my right hand, with which I'd apparently tried to break my fall, was misshapen and swollen. I'd also injured my left flank, as I discovered when I tried to walk.
As my two friends propped me up and tried to identify our location for the 911 dispatcher, I awaited my first real-life encounter with the mostly government-funded Canadian health-care system.
As a health care writer, I talk with people all the time about their experiences navigating the system, whether in the United States or elsewhere. Writing about health care is different from writing about the arts, say, or sports, in one crucial way: When you write about health care, you're often left feeling profoundly grateful that you didn't have to experience firsthand the event that you're describing. But now my luck had turned, and I was about to get up close and personal with emergency care, Canadian style.
The ambulance arrived within 15 minutes, and I had a bumpy but uneventful ride to the hospital, a regional trauma center at one of the local universities. On arrival, we showed them my passport and American insurance card. Because I was a trauma patient, I was wheeled right in, just as would happen in a U.S. hospital. A nurse removed my clothes, cutting off my shirt since I couldn't move my arm. Another nurse drew blood.
At the request of a very young-looking resident, I moved various body parts on command and answered questions about what hurt. The resident, who was my main contact throughout the visit, also looked over my injuries, including checking my ears and eyes. She was friendly and kind, and kept up a running commentary in mostly fluent English explaining what she and others were doing. (One of my friends, a French-speaking Montreal resident, stayed with me and interpreted when the medical staff's questions or my answers were complicated.)
One of the most striking things about the exam was how little high-technology equipment they employed. Until I had X-rays made of my hand, hip, shoulder and knee, a blood-pressure cuff was the most advanced equipment I encountered.
Emergency department technology use varies, of course, in Canada and elsewhere. Still, clinicians at a trauma center in the United States treating someone with injuries similar to mine would probably wheel a portable ultrasound machine to the bedside in the trauma bay to scan for internal injuries, says Sandra Schneider, president of the American College of Emergency Physicians. They would also probably do CT scans, perhaps of my neck, pelvis and back, to make sure there were no bone breaks that didn't show up on the X-rays. Some of the tests might not be absolutely necessary, but "a lot of what [U.S. emergency physicians] do is because we are very frightened of getting sued, because we get sued so often," says Schneider.
In an analysis of data from 2003 to 2008, researchers at Yale and in Canada found that Americans were nearly twice as likely to get a CT scan during an emergency department visit as were Canadians living in Ontario.
In Canada, residents who go to the emergency department pay nothing for the visit, not even for X-rays or other imaging tests or for lab work, says Michael Schull, an emergency physician who co-authored the study on CT use. They also pay nothing for specialist visits and hospital admissions, he said.
"Hospitals aren't making any money off these tests," Schull says. "There's no incentive to do them, because they're not going to get paid for them."
After the X-rays were taken and I was wheeled back into the trauma bay (No. 13, but I figured I'd already had my bad luck for the day), the resident came to my bedside with a big smile on her face and said, "You really are in pain! You have three fractures!" Validation is nice, but I wished the news were different.
I had two fractures at the top of the humerus, the long arm bone that attaches to the shoulder, and another break in a bone at the base of my thumb. The shoulder breaks could be expected to heal cleanly, she said, but the thumb was slightly out of alignment and might require surgery. There were no broken bones in my pelvis or hip; the pain and difficulty walking I was experiencing there was probably caused by torn or otherwise damaged muscles, tendons and ligaments.
The trauma team referred me to an orthopedist to examine my shoulder and a plastic surgeon with expertise in hands to look at my thumb. Unfortunately, an orthopedist wouldn't be able to see me until two days later. (The chief orthopedic resident, however, stopped by that night and reassured me that it would be okay to wait.) I did get examined by a plastic surgeon that evening, but my friends had to drive me to a sister hospital several miles away to see him. Specialists, it seemed, were pretty thin on the ground.
According to a 2010 Commonwealth Fund survey of health care in 11 countries, 33 percent of Canadians waited six days or more to see a specialist when they were sick, compared with 19 percent of Americans.
My pelvis apparently did not warrant special attention. Since the injury seemed to be muscular rather than skeletal, the hospital staff would do nothing further to diagnose what was wrong, the resident said. Her recommendation for me — rest and exercise — would probably be the same no matter what I'd done to any tissue.
I couldn't argue with her reasoning, and if she was right, it was the sensible course. But what a difference in approach from what I would be likely to experience in the United States, Schneider says, where clinicians would probably have worked hard to nail down a definite diagnosis. I left with prescriptions for morphine, naproxen (an anti-inflammatory) and Tylenol.
Puzzled by my U.S. private insurance card, the billing person estimated that my care that night would cost 700 Canadian dollars (about $740) and charged my credit card. If it turned out I had been overcharged, she said, they would send me a refund. Yes, you read that right: overcharged.
Although comparing costs and bills is tricky, by any measure my evening in the Canadian emergency department was a good deal.
Medicare for all would save billions on paperwork
The Capital Times
Medicare’s path started 46 years ago on July 30, 1965. Medicare has been a lifesaver for millions of senior and disabled Americans. Medicare has improved the health of our seniors, reduced their risk of poverty, and improved the financial security of their families.
Unfortunately, there are discussions in Congress that would steer Medicare off path. Wisconsin Congressman Paul Ryan’s “Path to Prosperity” proposes to shift Medicare to a private voucher system. Other proposals would increase the age of eligibility from 65 to 67, and increase deductibles and co-pays.
These approaches would increase the number of uninsured Americans and shift costs to Medicare recipients. The Congressional Budget Office estimates Ryan’s plan would shift two-thirds of the cost of care to consumers by 2030, with out-of-pocket costs amounting to over $20,000 per year for each Medicare recipient.
The current economic crisis was not caused by Medicare and will not be solved by cutting benefits or shifting costs to beneficiaries.
We should look to build on and expand Medicare, not weaken or dismantle it. By replacing our patchwork of private and public insurance programs with a single publicly financed system that handles all bills, we would save about $400 billion annually that’s currently spent on unnecessary paperwork and overhead — enough to provide comprehensive coverage to all the uninsured and to improve coverage for the rest of us.
Now is the time to take the path forward to an improved Medicare-for-all health care program.
Melissa Stiles, M.D.
Madison, WI
Medicare’s path started 46 years ago on July 30, 1965. Medicare has been a lifesaver for millions of senior and disabled Americans. Medicare has improved the health of our seniors, reduced their risk of poverty, and improved the financial security of their families.
Unfortunately, there are discussions in Congress that would steer Medicare off path. Wisconsin Congressman Paul Ryan’s “Path to Prosperity” proposes to shift Medicare to a private voucher system. Other proposals would increase the age of eligibility from 65 to 67, and increase deductibles and co-pays.
These approaches would increase the number of uninsured Americans and shift costs to Medicare recipients. The Congressional Budget Office estimates Ryan’s plan would shift two-thirds of the cost of care to consumers by 2030, with out-of-pocket costs amounting to over $20,000 per year for each Medicare recipient.
The current economic crisis was not caused by Medicare and will not be solved by cutting benefits or shifting costs to beneficiaries.
We should look to build on and expand Medicare, not weaken or dismantle it. By replacing our patchwork of private and public insurance programs with a single publicly financed system that handles all bills, we would save about $400 billion annually that’s currently spent on unnecessary paperwork and overhead — enough to provide comprehensive coverage to all the uninsured and to improve coverage for the rest of us.
Now is the time to take the path forward to an improved Medicare-for-all health care program.
Melissa Stiles, M.D.
Madison, WI
Monday, August 1, 2011
WARNING: WASHINGTON IS NOT ON OUR SIDE
FDL
Following is an article released today by Massachusetts Green-Rainbow Party co-chairs John Andrews and Jill Stein, in advance of Green Fest, the annual meeting of the Green Party of the United States, which begins Friday in New York State. Stein also serves on the New Progressive Alliance Steering Committee.
The shameful debt ceiling flap that has embroiled Washington in recent weeks has left the American people wondering if they can trust any of their current political leaders to do the right thing. The immediate cause of this manufactured crisis lies with the Republicans holding the American economy hostage to a threatened default if their anti-government demands were not met. President Obama is fully justified in rejecting those proposals which would do enormous harm to essential functions of government.
But President Obama has repeatedly failed to stake out a principled counter position that would force a truly “ balanced” compromise. Instead he has shown his basic agreement with the key Republican positions from the outset. The heated rhetoric and insults that are flying about in Washington today are merely camouflage for the fact that the two dominant parties are occupying a very narrow part of the political spectrum. The bitter arguments are all about who can best accomplish the common goals of protecting the wealthy and well-connected while scaling back programs that ordinary people depend on.
In 2008, Americans elected Barack Obama in the belief that he would reverse the policies of George W. Bush. But he has betrayed the hopes of constituency after constituency. Now Obama’s “balanced” plan elevates deficit reduction to the highest priority, so important that it justifies massive cuts in badly needed domestic programs. He has falsely declared Social Security and Medicare to be too expensive to maintain and proposed a destructive “trimming” – including cuts of up to 9% in Social Security income and a two-year delay in Medicare coverage. Obama’s plan allows the bloated Pentagon budget to trundle along with only minor cuts achieved through “efficiency.” Despite his attempt to label his plan as “balanced,” Obama cuts $3 for every $1 in proposed revenue enhancement. He’s declared tax increases off the table before 2013, and even then advocates only small steps to correct the worst abuses.
Through all this, the President has skillfully deflected attention from the fact that all $4 trillion targeted for debt reduction could be recouped through long overdue measures to restore fairness to a drastically unfair tax system – namely reining in offshore tax dodging, modestly taxing Wall Street speculation, raising income taxes on households earning over $1 million annually, and progressively taxing estates worth over $5 million.
It’s no accident that in his nationwide speech President Obama cited former President Ronald Reagan in support of his position, and emphasized that the Republicans have nothing to object to in his plan because it is pursuing their longstanding goals. The apparent Democratic strategy is to brag about their opposition to the more extreme proposals of the Republicans. And the Republicans are happy to ask for more than they really think they can get, and watch the Democrats move ever further to the right.
Lost in the shuffle are the real concerns of everyday Americans, whose real wages are declining, whose jobs are disappearing, who can’t afford the rising costs of health care and education for their children, who are still losing their homes in record numbers, and who cannot afford lobbyists to plead their case.
The convergence of the two major parties in America has robbed voters of a way to fix a government that is failing them. When you have just two choices on the ballot, neither of which are on your side, your vote loses most of its value. The “hope for change” that drove Obama’s election in 2008 is clearly dead. But the thirst for real change still runs deep in the electorate. This makes us more grateful than ever to be part of an independent third party that consistently stands up for the public interest, and doesn’t need a spin machine to manufacture excuses for selling out. Life becomes much simpler when you just decide to do the right thing.
Following is an article released today by Massachusetts Green-Rainbow Party co-chairs John Andrews and Jill Stein, in advance of Green Fest, the annual meeting of the Green Party of the United States, which begins Friday in New York State. Stein also serves on the New Progressive Alliance Steering Committee.
The shameful debt ceiling flap that has embroiled Washington in recent weeks has left the American people wondering if they can trust any of their current political leaders to do the right thing. The immediate cause of this manufactured crisis lies with the Republicans holding the American economy hostage to a threatened default if their anti-government demands were not met. President Obama is fully justified in rejecting those proposals which would do enormous harm to essential functions of government.
But President Obama has repeatedly failed to stake out a principled counter position that would force a truly “ balanced” compromise. Instead he has shown his basic agreement with the key Republican positions from the outset. The heated rhetoric and insults that are flying about in Washington today are merely camouflage for the fact that the two dominant parties are occupying a very narrow part of the political spectrum. The bitter arguments are all about who can best accomplish the common goals of protecting the wealthy and well-connected while scaling back programs that ordinary people depend on.
In 2008, Americans elected Barack Obama in the belief that he would reverse the policies of George W. Bush. But he has betrayed the hopes of constituency after constituency. Now Obama’s “balanced” plan elevates deficit reduction to the highest priority, so important that it justifies massive cuts in badly needed domestic programs. He has falsely declared Social Security and Medicare to be too expensive to maintain and proposed a destructive “trimming” – including cuts of up to 9% in Social Security income and a two-year delay in Medicare coverage. Obama’s plan allows the bloated Pentagon budget to trundle along with only minor cuts achieved through “efficiency.” Despite his attempt to label his plan as “balanced,” Obama cuts $3 for every $1 in proposed revenue enhancement. He’s declared tax increases off the table before 2013, and even then advocates only small steps to correct the worst abuses.
Through all this, the President has skillfully deflected attention from the fact that all $4 trillion targeted for debt reduction could be recouped through long overdue measures to restore fairness to a drastically unfair tax system – namely reining in offshore tax dodging, modestly taxing Wall Street speculation, raising income taxes on households earning over $1 million annually, and progressively taxing estates worth over $5 million.
It’s no accident that in his nationwide speech President Obama cited former President Ronald Reagan in support of his position, and emphasized that the Republicans have nothing to object to in his plan because it is pursuing their longstanding goals. The apparent Democratic strategy is to brag about their opposition to the more extreme proposals of the Republicans. And the Republicans are happy to ask for more than they really think they can get, and watch the Democrats move ever further to the right.
Lost in the shuffle are the real concerns of everyday Americans, whose real wages are declining, whose jobs are disappearing, who can’t afford the rising costs of health care and education for their children, who are still losing their homes in record numbers, and who cannot afford lobbyists to plead their case.
The convergence of the two major parties in America has robbed voters of a way to fix a government that is failing them. When you have just two choices on the ballot, neither of which are on your side, your vote loses most of its value. The “hope for change” that drove Obama’s election in 2008 is clearly dead. But the thirst for real change still runs deep in the electorate. This makes us more grateful than ever to be part of an independent third party that consistently stands up for the public interest, and doesn’t need a spin machine to manufacture excuses for selling out. Life becomes much simpler when you just decide to do the right thing.
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