Interesting overview of American health care: present status, history and causes

[labasta]

Re: Interesting overview of American health care: present status, history and causes

My opinion is that the best (most effective) technology is not necessarily the most expensive. I think that is the crux of the healthcare problem. Ok, insurance companies don't help things, but every industry just sees medicine as an industry to make profit. In Germany, it is common for a doctor or dentist to use the most expensive (but not the best or sometimes entirely unnecessary) treatment to bill the insurance company.

We need good-intentioned (non-corrupt) and well-informed (informed on as many medical ways which are the most effective) doctors and dentists for the condition presented.

At the moment doctors are drug pushers and dentists are drill and fill. Most doctors and dentists won't change their ways because of the system they are in (and some are corrupt). I have encountered doctors who love pedalling fear. "If you don't do this you will get xyz". One even shouted at me for not wanting to take a vaccine.

That's my problem - "who to trust". Who do you trust to have your best interest at heart? That's the number one problem for me at the moment. Too many corrupt professionals.

I believe it is up to patients to be responsible for themselves and use the internet for information. This way, the customer will demand the changes necessary. The changes won't come from the current system in place.

So ultimately you could say patients are to blame. They want the magic pill to cure thier illness. Antibiotics gave the medical industry an awful lot of power in this regard. Antibiotics won't help against all these chronic illnesses exploding all over the place. The family which I married into is still in the drugs-cure-me mentally. Some patients still don't get it.

Drugs alleviate symptoms at best and add a toxic load on the body or cause side-effects, some of which are worse than the original ailment (so they take more drugs to combat the side-effects). Lunancy I know, but a lot of people still believe in the Gods in the white coats (courtesy of antibiotics).

Some medical machines are expensive but the best, e.g. a cavitat scanner. Some cost pennies, e.g. ozone, intravenous mega does vitamin C.

You'll never see the latter as there is no money in it for the industries involved. Sad but true. It's time for us to take responsibilty, inform and stand up for ourselves.

Apologies for the long post.

[ThePythonicCow]

Re: Interesting overview of American health care: present status, history and causes

That's my problem - "who to trust". Who do you trust to have your best interest at heart? That's the number one problem for me at the moment.

That's easy. If I were you, I'd trust "labasta."

[Jim Nickerson]

Re: Interesting overview of American health care: present status, history and causes

Though this story involves documents from 2004, it is possible that such is still and will continue to be taking place.

By GARDINER HARRIS
Published: September 1, 2009
Document Details Plan to Promote Costly Drug

The pharmaceutical industry has developed thousands of medicines that have saved millions of lives, but it has also used its marketing muscle to successfully peddle expensive pills that are no more effective than older drugs sold at a fraction of the cost.
.
In February, federal prosecutors in Boston announced a civil lawsuit against Forest claiming that the company illegally marketed both Lexapro and a closely related antidepressant, Celexa, for use in children and paid kickbacks to doctors to induce them to prescribe the medicines to children.
.
Lexapro had $2.3 billion in sales in 2008 even though generic versions of Celexa and every other drug in the class sell for a fraction of Lexapro’s price. For example, a month’s supply of 5-milligram tablets of Lexapro costs $87.99 at drugstore.com, compared to $14.99 for a month’s supply of a generic version of Prozac. Forest has recently been raising the price of Lexapro to make up for a decline in its use.
.
Many doctors say they believe that Lexapro is the best antidepressant, so they prescribe the drug despite its cost.
It is impossible to unpack all of the reasons for these prescriptions, but some industry critics say one reason could be the money doctors make from Forest. Psychiatrists make more money from drug makers than any other medical specialty, according to analyses of payment data. And Forest gives more money and food to doctors than many of its far larger rivals. Vermont officials found that Forest’s payments to doctors in 2008 were surpassed only by those of Eli Lilly, Pfizer, Novartis and Merck — companies with annual sales that are five to 10 times larger than Forest’s.

[Jim Nickerson]

Re: Interesting overview of American health care: present status, history and causes

From a story last night regarding Sen. Charles Grassley, R, IA

Grassley said Monday he remains hopeful a limited health care reform measure can be negotiated, but that a small bipartisan group of senators working on the issue agrees a government-run public option won't be part of the package. Democrats have said that while they hold out hope for a compromise, an overhaul measure will be presented this year with or without bipartisan support.

Grassley told The Associated Press he pays little attention to interest group pressure, and that his views on the health care issue hardened after he hosted a series of town hall-style meetings on the issue throughout the state.

"It's not hard for me to conclude from my own town meetings that there's strong opposition to a public plan," Grassley said.

"Opposition was much stronger than what I anticipated," he said.

http://www.wcfcourier.com/articles/2...3224416295.txt

My basic tenet is that all the politicians are dishonest and are owned entirely by monied interest groups.

Above demonstrates to me how a probably highly uninformed public's (the town meeting attendees) sentiments can be readily interpreted to support the status quo with healthcare. What could be better, the people don't want it, and the monied interests don't want it.

What would ever happen if anybody who could command the national stage really sat down and explained who are the parties that most benefit financially from the current system?

[Jim Nickerson]

Re: Interesting overview of American health care: present status, history and causes

All below is a quote. http://www.nytimes.com/2009/08/30/op...ristof.html?em

By NICHOLAS D. KRISTOF
Published: August 29, 2009 Until Medical Bills Do Us Part

A study reported in The American Journal of Medicine this month found that 62 percent of American bankruptcies are linked to medical bills. These medical bankruptcies had increased nearly 50 percent in just six years. Astonishingly, 78 percent of these people actually had health insurance, but the gaps and inadequacies left them unprotected when they were hit by devastating bills.

M. still helps her husband and, quietly, continues to live with him and care for him. But she worries that the authorities will come after her if they realize that they divorced not because of irreconcilable differences but because of irreconcilable medical bills. There were awkward questions from friends who saw the divorce announcement in the newspaper.
“It’s just crazy,” she said. “It twists people like pretzels.”

The existing system doesn’t just break up families, it also costs lives. A 2004 study by the Institute of Medicine, a branch of the National Academy of Sciences, found that lack of health insurance causes 18,000 unnecessary deaths a year. That’s one person slipping through the cracks and dying every half an hour.

In short, it’s a good bet that our existing dysfunctional health system knocks off far more people than an army of “death panels” could — even if they existed, worked 24/7 and got around in a fleet of black helicopters.
So, for those of you inclined to believe the worst about President Obama, think it through. Suppose he is indeed a secret, foreign-born Muslim agent who is scheming to undermine American family values while killing off as many grandmothers as possible.

If all that were true, why on earth would he be trying so hard to reform our health care system? We already know how to prod families into divorce and take a life unnecessarily every 30 minutes — all we need to do is reject reform and stick with exactly what we have.

[Jim Nickerson]

Re: Interesting overview of American health care: present status, history and causes

From an Australian treated in Britain and Australia. http://blogs.abc.net.au/offair/2009/...alth-care.html

09/02/09 Lies, damned lies and health care

Without all of this public medicine [He's writing of British and Australian care for his illness], in the American system for instance, I believe I would be dead, or dead broke, or both. Is that an exaggeration, on a par with Sarah Palin’s “death panels”? I think not.

Why? In the American system, you’re all right in theory if you’ve got a steady job, because your employer sponsors your health insurance.
But what many Americans don’t know is the limitation of that insurance in case of long-term illness.

After 90 days off work, the employer ceases to have any obligation to pay for your insurance. [JN=I don't know for a fact that the previous statement is true, maybe someone else knows] Under an Act called COBRA, you can extend the insurance (at your own considerable expense), but only for 18 months. After that, as I understand it, you are no longer covered by health insurance at all. Nor can you take out a new policy, because insurance companies won’t cover those with ‘prior conditions’.

Small wonder, then, that 62 per cent of bankruptcies in the USA are linked to medical bills.

And small wonder, as Nick Kristof of the New York Times wrote this week, that the American system is wreaking heartbreak on families faced with the choice of health care or poverty.

The USA spends more than 15 per cent of its GDP on health care. Australia and Britain spend just over 8 per cent, When it comes to looking after the seriously and chronically ill, I think I know which nations get better value. Britain’s NHS and Australia’s Medicare are not perfect – far from it. But they’re not the Orwellian monsters of American myth either.

Hillary Clinton failed to overhaul the American system when she tried in the early nineties. Was she defeated by the big drug companies, the insurance industry, or just the deep historical suspicion many Americans have for big government in any form? Impossible to say for certain, but what is clear is that Barack Obama now faces the same forces, and the early indications are that he’s not going to find them any easier to deal with.

[Ghent12]

Re: Interesting overview of American health care: present status, history and causes

Unfortunately, given the degree to which financial, insurance, pharaceutical and legal interests control Washington, any "reform" we can produce will likely and properly reinforce the awareness that our political system is capable only of deeper corruption.

Bingo!
If I remember correctly, polls show that most Americans are actually in favor of health care reform. In fact, I think I remember hearing about that in some propaganda snippet in support of the current proposals for health care reform. Yet Americans are significantly against HR 3200 and similar proposals. So Americans want reform, just not the type being offered at the moment.

You can't shift from a system where private insurance companies overcompensate for when the government doesn't pay hospitals to a system where the government is the sole payer for hospitals and call it reform. The means and the ends matter.

[sunskyfan]

Re: Interesting overview of American health care: present status, history and causes

Interesting.

I think there are some points to make:

1. Health insurance is based on the premise of price fixing and cartels and must be made illegal for the same reasons that monopolies are illegal.
2. Mal-practice insurance is as big of a scam as health insurance.
3. You cannot spread exposure to risk of events that are certain to happen to most, if not all, patients and doctors. That is the illusion and makes health insurance ultimately like a Ponzi Scheme with the government the eventual bail-out agent. That is why it is immoral to collect taxes from the uninsured to support the health-care system populated with private insurance.

[iyamwutiam]

Re: Interesting overview of American health care: present status, history and causes

Interesting.

I think there are some points to make:

1. Health insurance is based on the premise of price fixing and cartels and must be made illegal for the same reasons that monopolies are illegal.
2. Mal-practice insurance is as big of a scam as health insurance.
3. You cannot spread exposure to risk of events that are certain to happen to most, if not all, patients and doctors. That is the illusion and makes health insurance ultimately like a Ponzi Scheme with the government the eventual bail-out agent. That is why it is immoral to collect taxes from the uninsured to support the health-care system populated with private insurance.

A couple of points. I am not going into detail about my background except -I did some training in Internal Medicine/Anesthesia in the US. Let's start with Anesthesia because I feel most of these guys are truly over-paid. When I was doing my residency in Anesthesia- in the late 1990s in Boston (St. Elizabeth's) -here is what I saw.

1. 90 percent of the doctors were not in the OR room for the full duration of the procedure. If it was induced by LMA -they were out of there in 10 minutes -letting the resident do all the work -while they checked their stocks/mistresses etc. At this hospital (at the time everyone though no money in Anesthesia-St. Elizabeth's )-95% were foreigners (FMGs). Of these 90 percent were competent practicing doctors (MRCP/FRCS level from other countries) who basically put up with the gross negligence, borderline incompetence and often just plain mean mistreatment and helped cover-up a lot of stuff.

2. Most doctors are NOT qualified. They are a bunch of memorizers who can regurgitate facts. But for the money they charge they should be sued for criminal negligence because they FAIL to keep up their due diligence in keeping up with their field (as do Lawyers).

Whether Internal Medicine/OBGYN/Anesthesia-too many doctors recieve 'further' training too often by diffusion (attending 100s of conferences and retaining 10 percent of it- and very rarely putting in their own time to be sincere to their CHOSEN field). Very few can tell you what a Fischer Exact Test is, Student T test, or worst tell you simple examples of carbxylation/acetylation or any other simple chemical reaction which is the BASIS of being a doctor using chemotherapeutic agents as a way of making a living. Their knowledge of chemistry (real organic chemistry), statistics, physics, pharmokinetic principles based on Physics (no not some 11th grade Boyle's law -which the Anesthetist will puff over but more serious physical prinicples on the whole is abysmal. Here I have to give it to the engineers -becuse they actually have a real science background.

I can not tell you how often I cringed as a resident when the combination of an over-ambitious CAREGIVER (not physican-some fake title to give false social import-when none is needed). First -the hospitals get 100K for every Foreign resident they train, second this has to be the most accepted method of double billing I have ever seen. Basically you have an Albanian surgeon who re-trains to be a anesthetist- who takes care of 65-75 percent of patient care- and you get 100 percent of the bill.

Anyway -the point is the 'quality' of US physicians is truly over-rated. Sure there will be a Jordan -but saying that a guy who went to Duke's basketball program is equivalent to an NBA superstar in Europe/China or Eastern Europe has ALREADY been disproved not just in medicine but basketball/soccer/baseball etc. The point is stop being a B*TCH. Being a physican should not be a lifestyle choice, a "how much debt/return' choice etc. It is rightfully called a Noble profession and if you have none -get out and make money honestly (like go into business). But to disguise yourself as a servant of public good/health/care etc and not having the backbone to live simpler, be more sincere to your responsibility of a purveyor of a complex and integrated science. What can I say.

Analysts/CEOs/Mechanics/Doctors/Lawyers/Teachers/Government workers- do we really expect quality when its basically a disguised gold rush wrapped in the specious arguments of cost, access, job security and profit.

At the end of the day -many physicians have lost their moral compass so long ago -that they have no totally lost the respect of society at large.

Healthcare can be done for much less. Health care is a by product of societies mores. If we have this kind of health care -it is only because our moral foundation has changed from viewing each other in a more realistic ecological framework and abandoning it for a synthetic unreal mode of Darwinian socialism-which is not based either on Darwin or Socialism. Such as become the penury of our society to educate.

[Jim Nickerson]

Re: Interesting overview of American health care: present status, history and causes

http://news.yahoo.com/s/nm/20090903/..._settlement_36

Pfizer to pay $2.3 billion, agrees to criminal plea 9/2/09

• NEW YORK/WASHINGTON (Reuters) – Pfizer Inc agreed on Wednesday to plead guilty to a U.S. criminal charge relating to promotion of its now-withdrawn Bextra pain medicine and will pay a record $2.3 billion to settle allegations it improperly marketed 13 medicines.
• Pfizer said it will pay $503 million to resolve practices involving Bextra, $301 million related to its schizophrenia drug Geodon, $98 million for Zyvox and about $50 million for its blockbuster Lyrica used to treat nerve pain and seizures.
• The settlement includes a $1.3 billion criminal fine related to methods of selling Bextra, which was withdrawn from the market in 2005 on safety concerns. Pfizer acquired Bextra in its 2003 purchase of Pharmacia Corp.
• In the 2004 case, Pfizer agreed to pay $430 million to federal and state governments and pleaded guilty to criminal charges of illegally marketing epilepsy drug Neurontin for migraine headaches, pain and bipolar disorder. Pfizer obtained Neurontin in its 2000 acquisition of Warner Lambert Corp.

No where does the article mention how much was made from the sale of these drugs. It must have been gargantuan in order to pay fines like these plus whatever it is on the hook to pay its congressmen and senators and still remain in business.

[Thailandnotes]

Re: Interesting overview of American health care: present status, history and causes

A study reported in The American Journal of Medicine this month found that 62 percent of American bankruptcies are linked to medical bills. These medical bankruptcies had increased nearly 50 percent in just six years. Astonishingly, 78 percent of these people actually had health insurance, but the gaps and inadequacies left them unprotected when they were hit by devastating bills.

thanks for keeping this thread going

your house is paid off and you have a million $,
but it don't mean a thing

[Jim Nickerson]

Re: Interesting overview of American health care: present status, history and causes

http://robertreich.blogspot.com/

Thursday, September 03, 2009

What Obama Must Demand from Congress on Health Care



Congress returns next week to one of the fiercest and most important debates in recent memory -- whether and to what extent the nation will provide health care to all Americans, and how we will reign in the soaring costs of health care overall. But do not expect unusual courage from this Congress in standing up to demagogic lies and money-toting lobbyists. An unusually large portion is facing close races in 2010, both in primaries and in the general election. Republicans have many primary challenges from the right. A record number of Democrats, who took over Congress in 2006, hail from traditionally Republican or swing states and districts.

In order to get anything meaningful through this session of Congress, then, the President will have to give congressional Democrats far more leadership and more cover. Doing so is harder now than before the recess, when he was still basking in the afterglow of a honeymoon and 60 percent favorabilities.Yet it's not too late. Addressing a joint session of Congress next Wednesday is a good idea but Obama can't rely solely on his exceptional rhetorical skills. He'll need to twist arms, cajole, force recalcitrant members to join him, threaten retribution if they don't come along.

Most importantly, he'll need to be specific about what he wants -- especially about three things. I hope says the following next Wednesday, and makes clear to individual members that he means business.

1. I will not stand for a bill that leaves millions of Americans without health care. It's vitally important to cover all Americans, not only for their and their childrens' sakes and not only because it's a moral imperitive, but because doing so will be good for all of us. One out of three Americans will experience job loss and potential loss of health insurance for themselves and their families at some point. One out of four of us who have health insurance is underinsured --unable to afford the preventive care we and our kids need on an ongoing basis. And those of us who don't get preventive care can get walloped with diabetes, heart disease, and other major illnesses that wipe us out financially, or force us into emergency rooms that all of us end up paying for.

2. The only way to cover all Americans without causing deficits to rise is to require that the wealthiest Americans pay a bit extra. The wealthy can afford to make sure all Americans are healthy. The top 1 percent of earners now take home 23 percent of total national income, the highest percentage since 1928. Their tax burden is not excessive. Even as income and wealth have become more concentrated than at any time in the past 80 years, those at the top are now taxed at lower rates than rich Americans have been taxed since before the start of World War II. Indeed, many managers of hedge funds, private-equity partners, and investment bankers -- including those who have been bailed out by taxpayers over the last year -- are paying 15 percent of their income in taxes because their earnings are, absurdly, treated as capital gains. We should eliminate this loophole as well, and use it to guarantee the health of all.

3. Finally, I want a true public insurance option -- not a "cooperative," and not something that's triggered if certain goals aren't met. A public option is critical for lowering health-care costs. Today, private insurers don't face enough competition to guarantee low prices and high service. In 36 states, three or fewer insurers account for 65 percent of the insurance market. A public insurance option would also have the scale and authority needed to negotiate low drug prices and low prices from medical providers. Commercial insurers now pay about 30 higher rates to providers than the government pays through Medicare, because Medicare has the scale to get those lower rates. A nationwide public option could get similar savings. And those savings would mean lower premiums, deductibles and co-payments for Americans who can barely afford health insurance right now.

We'll see.


posted by Robert Reich | 9:45 AM

Monday, August 31, 2009

The Guns of August, and Why the Republican Right Was So Adept at Using Them on Health Care



What we learned in August is something we've long known but keep forgetting: The most important difference between America's Democratic left and Republican right is that the left has ideas and the right has discipline. Obama and progressive supporters of health care were outmaneuvered in August -- not because the right had any better idea for solving the health care mess but because the rights' attack on the Democrats' idea was far more disciplined than was the Democrats' ability to sell it.

I say the Democrats' "idea" but in fact there was no single idea. Obama never sent any detailed plan to Congress. Meanwhile, congressional Dems were so creative and undisciplined before the August recess they came up with a kaleidoscope of health-care plans. The resulting incoherence served as an open invitation to the Republican right to focus with great precision on convincing the public of their own demonic version of what the Democrats were up to -- that it would take away their Medicare, require "death panels," raise their taxes, and lead to a government takeover of medicine, and so on. The Obama White House -- a veritable idea factory brimming with ingenuity -- thereafter proved unable to come up with a single, convincing narrative to counteract this right-wing hokum. Whatever discipline Obama had mustered during the campaign somehow disappeared.

This is just the latest chapter of a long saga. Over the last twenty years, as progressives have gushed new ideas, the right has became ever more organized and mobilized in resistance -- capable of executing increasingly consistent and focused attacks, moving in ever more perfect lockstep, imposing an exact discipline often extending even to the phrases and words used repeatedly by Hate Radio, Fox News, and the oped pages of The Wall Street Journal ("death tax," "weapons of mass destruction," "government takeover of health care.") I saw it in 1993 and 1994 as the Clinton healthcare plan -- as creatively and wildly convuluted as any policy proposal before or since -- was defeated both by a Democratic majority in congress incapable of coming together around any single bill and a Republican right dedicated to Clinton's destruction. Newt Gingrich's subsequent "contract with America" recaptured Congress for the Republicans not because it contained a single new idea but because Republicans unflinchingly rallied around it while Democrats flailed.




You want to know why the left has ideas and the right has discipline? Because people who like ideas and dislike authority tend to identify with the Democratic left, while people who feel threatened by new ideas and more comfortable in a disciplined and ordered world tend to identify with the Republican right. Democrats and progressives let a thousand flowers bloom. Republicans and the right issue directives. This has been the yin and yang of American politics and culture. But it means that the Democratic left's new ideas often fall victim to its own notorious lack of organization and to the right's highly-organized fear mongering.


I suppose I'm as guilty as anyone. A few weeks ago I casually mentioned in a web conversation on Politico's web page that if supporters of universal health care and a "public option" felt their voices were not being heard in our nation's capital they should march on Washington. A few moments later, when someone wrote in asking when, I glanced at a calendar and in a burst of unreflective enthusiasm offered September 13. I didn't check with anyone, didn't strategize with progressive groups that have been working on health care for years, barely checked in with myself.

I was deluged with emails. Many people said they were planning to march. Someone put up a web page, another a Facebook page, a member of Congress announced his support. But most people said they couldn't manage September 13. It was too soon. It conflicted with other events. It followed too closely behind a right-wing march against health care reform already scheduled for September 12. It was a day AFL leaders were out of town, so couldn't lend their support. Many who emailed me wanted another day -- September 20, or the 27th, or early October. Others said they'd rather march on their state capital, in order that local media cover it. When I finally checked in with the heads of several progressive groups and unions in Washington -- all with big mailing lists and the resources to organize a big march -- they said they were already planning a march, for October. But they still haven't given me a date. (I will pass it on as soon as I hear.)

August is coming to a close, and congressional recess is about over. History is not destiny, and Democrats and progressives can yet enact meaningful health care reform -- with a public option. But to do so, we'll need to be far more disciplined about it. All of us, from Obama on down.







posted by Robert Reich | 6:53 PM

Friday, August 28, 2009

Beware Authoritative "Inside Washington" Sources Who Say The Public Option is Dead



Washington, D.C. is an echo chamber in which anyone who sounds authoritative repeats the conventional authoritative wisdom about the "consensus" of inside opinion, which they've heard from someone else who sounds equally authoritative, who of course has heard it from another authoritative source. Follow the trail to its start and you often find an obscure congressional or White House staffer who has seen some half-assed poll number or briefing memo, but seeking to feel important hypes it a media personality or lobbyist who, desperate to sound authoritative, pronounces it as truth. In any other place on the planet it would be called rumor, gossip, or drivel. In our nation's capital it's called "inside information." The process would be harmless except that it creates self-fulfilling prophesies. Since most of our elected representatives would rather not stick their necks out lest they lose their heads, they tend to rush toward whatever consensus seems to be emerging -- which, of course, is based on authoritative reports about the emerging consensus.

In the last few days authoritative sources have repeatedly told me that the public option is dead, that the President won't be able to get a comprehensive health care bill, and that the White House and congressional leadership already know the best they'll be able to do now is move incrementally -- starting with insurance reforms such as barring insurers from using someone's preexisting health conditions to deny coverage -- with the hope of more reforms in the years ahead. The rightwing media fearmongers and demagogues have won.

Don't believe it. The other thing about Washington is how quickly conventional authoritative wisdom changes, especially when the public is still in flux over some large matter. Rightwing fearmongers and demagogues thrive only to the extent the mainstream media believes they're thriving. Although polls continue to show that while most Americans like the health care they're getting, they also dislike their insurance companies, worry that they or their families will be denied coverage, and are anxious about the increasing co-payments, deductibles, and premiums they're facing. Most are still eager for reform.

In addition, we've come to the point where health-care incrementalism won't work. To be sure, the health-insurance industry is powerful and will fight reforms that threaten their profits. But they won't fight if they know their profits will be restored when everyone is required to have health insurance. (This isn't just conventional authoritative wisdom; it's political fact.) Obviously, in order to require everyone to have health insurance, tens of millions of Americans will need help affording it. The only way the government can possibly pay that tab is to raise taxes on the rich while also getting long-term health-insurance costs under control. And one of the surest ways to get long-term costs under control is to force private insurers -- which in most states and under most employer-provided plans face very little competition -- to compete with a public insurance option that can use its bargaining clout with drug companies and medical providers to negotiate lower prices.

When you go through the logic, it starts to look a lot like comprehensive reform.

Years ago, as the story goes, Britain's Parliament faced a difficult choice. On the European continent drivers use the right lanes, while the English remained on the left. But tunnels and fast ferries were bringing cars and drivers back and forth ever more frequently. Liberals in Parliament thought it time to change lanes. Conservatives resisted; after all, Brits had been driving on the left since William the Conquerer's charriot. Parliament's compromise was to move from the left to right lanes -- but incrementally, on a voluntary basis. Truckers first.

Lest anyone in Washington repeat this story authoritatively, it's a joke -- but with a kernel of truth. Sometimes reform has to occur in a big way, everything or nothing, if it's to happen at all. That's the way it is with health care reform at this stage. Every moving piece is related to every other one. That's also why a public option is necessary.

So forget the authoritative sources. Mobilize and organize. We can get comprehensive, meaningful health care reform if we push hard enough. And we must.


posted by Robert Reich | 6:57 AM

[Jim Nickerson]

Re: Interesting overview of American health care: present status, history and causes

By NICHOLAS D. KRISTOF

Published: September 2, 2009 Op-Ed Columnist

Health Care That Works

Health care reform may be defeated this year in part because so many Americans believe the government can’t do anything right and fear that a doctor will come to resemble an I.R.S. agent with a scalpel. Yet the part of America’s health care system that consumers like best is the government-run part.

Fifty-six to 60 percent of people in government-run Medicare rate it a 9 or 10 on a 10-point scale. In contrast, only 40 percent of those enrolled in private insurance rank their plans that high.

Multiple surveys back that up. For example, 68 percent of those in Medicare feel that their own interests are the priority, compared with only 48 percent of those enrolled in private insurance.

In truth, despite the deeply ingrained American conviction that government is bumbling when it is not evil, government intervention has been a step up in some areas from the private sector.

Until the mid-19th century, firefighting was left mostly to a mishmash of volunteer crews and private fire insurance companies. In New York City, according to accounts in The New York Times in the 1850s and 1860s, firefighting often descended into chaos, with drunkenness and looting.
So almost every country moved to what today’s health insurance lobbyists might label “socialized firefighting.” In effect, we have a single-payer system of public fire departments.

We have the same for policing. If the security guard business were as powerful as the health insurance industry, then it would be denouncing “government takeovers” and “socialized police work.”

Throughout the industrialized world, there are a handful of these areas where governments fill needs better than free markets: fire protection, police work, education, postal service, libraries, health care. The United States goes along with this international trend in every area but one: health care.

The truth is that government, for all its flaws, manages to do some things right, so that today few people doubt the wisdom of public police or firefighters. And the government has a particularly good record in medical care.

Take the hospital system run by the Department of Veterans Affairs, the largest integrated health system in the United States. It is fully government run, much more “socialized medicine” than is Canadian health care with its private doctors and hospitals. And the system for veterans is by all accounts one of the best-performing and most cost-effective elements in the American medical establishment.

A study by the Rand Corporation concluded that compared with a national sample, Americans treated in veterans hospitals “received consistently better care across the board, including screening, diagnosis, treatment and follow-up.” The difference was particularly large in preventive medicine: veterans were nearly 50 percent more likely to receive recommended care than Americans as a whole.

“If other health care providers followed the V.A.’s lead, it would be a major step toward improving the quality of care across the U.S. health care system,” Rand reported.

As for the other big government-run health care system in the United States, Medicare spends perhaps one-sixth as much on administration as private health insurers, although the comparison is imperfect and controversial.

But the biggest weakness of private industry is not inefficiency but unfairness. The business model of private insurance has become, in part, to collect premiums from healthy people and reject those likely to get sick — or, if they start out healthy and then get sick, to find a way to cancel their coverage.

A reader wrote in this week to tell me about a colleague of hers who had health insurance through her company. The woman received a cancer diagnosis a few weeks ago, and she now faces chemotherapy co-payments that she cannot afford. Worse, because she is now unable to work and has to focus on treatment, she has been shifted to short-term disability for 90 days — and after that, she will lose her employer health insurance.

She can keep her insurance if she makes Cobra payments on her own, but she can’t afford this. In her case, her company will voluntarily help her — but I just don’t understand why we may be about to reject health reform and stick with a dysfunctional system that takes away the health coverage of hard-working Americans when they become too sick with cancer to work.

On my blog, foreigners regularly express bewilderment that America may reject reform and stick with a system that drives families into bankruptcy when they get sick. That’s what they expect from the Central African Republic, not the United States.

Let’s hope we won’t miss this chance. A public role in health care shouldn’t be any scarier or more repugnant than a public fire department.

•

[ThePythonicCow]

Re: Interesting overview of American health care: present status, history and causes

Health care reform may be defeated this year in part because so many Americans believe the government can’t do anything right and fear that a doctor will come to resemble an I.R.S. agent with a scalpel. Yet the part of America’s health care system that consumers like best is the government-run part.

The existence of a more or less working government program does not demonstrate that the current government can initiate a major new program that works.

[Jim Nickerson]

Re: Interesting overview of American health care: present status, history and causes

The existence of a more or less working government program does not demonstrate that the current government can initiate a major new program that works.

I suggest that if there is evidence for something not working, it is the current system.

http://www.nchc.org/facts/cost.shtml


This document is also available as a printable .pdf file.
Health Insurance Costs
Facts on the Cost of Health Insurance and Health Care
Health care spending continues to rise at a rapid rate forcing businesses to cut back on health insurance coverage and forcing many families to cut back on basic necessities such as food and electricity and, in some cases, shelters and homes.

Experts agree that our health care system is riddled with inefficiencies, excessive administrative expenses, inflated prices, poor management and inappropriate care, waste and fraud. These problems increase the cost of medical care associated with government health programs like Medicare and Medicaid, and health insurance for employers and workers and affect the security of families.

https://www.cia.gov/library/publicat.../2102rank.html

LIFE EXPECTANCIES Note US is NO. 50, that is number fifty.

Rank country (years) Date of Information

1 Macau 84.36 2009 est. 2 Andorra 82.51 2009 est. 3 Japan 82.12 2009 est. 4 Singapore 81.98 2009 est. 5 San Marino 81.97 2009 est. 6 Hong Kong 81.86 2009 est. 7 Australia 81.63 2009 est. 8 Canada 81.23 2009 est. 9 France 80.98 2009 est. 10 Sweden 80.86 2009 est. 11 Switzerland 80.85 2009 est. 12 Guernsey 80.77 2009 est. 13 Israel 80.73 2009 est. 14 Iceland 80.67 2009 est. 15 Anguilla 80.65 2009 est. 16 Cayman Islands 80.44 2009 est. 17 Bermuda 80.43 2009 est. 18 New Zealand 80.36 2009 est. 19 Italy 80.20 2009 est. 20 Gibraltar 80.19 2009 est. 21 Monaco 80.09 2009 est. 22 Liechtenstein 80.06 2009 est. 23 Spain 80.05 2009 est. 24 Norway 79.95 2009 est. 25 Jersey 79.75 2009 est. 26 Greece 79.66 2009 est. 27 Austria 79.50 2009 est. 28 Faroe Islands 79.44 2009 est. 29 Malta 79.44 2009 est. 30 Netherlands 79.40 2009 est. 31 Luxembourg 79.33 2009 est. 32 Germany 79.26 2009 est. 33 Belgium 79.22 2009 est. 34 Saint Pierre and Miquelon 79.07 2009 est. 35 Virgin Islands 79.05 2009 est. 36 United Kingdom 79.01 2009 est. 37 Finland 78.97 2009 est. 38 Jordan 78.87 2009 est. 39 Isle of Man 78.82 2009 est. 40 Korea, South 78.72 2009 est. 41 European Union 78.67 2009 est. 42 Puerto Rico 78.53 2009 est. 43 Bosnia and Herzegovina 78.50 2009 est. 44 Saint Helena 78.44 2009 est. 45 Cyprus 78.33 2009 est. 46 Denmark 78.30 2009 est. 47 Ireland 78.24 2009 est. 48 Portugal 78.21 2009 est. 49 Wallis and Futuna 78.20 2009 est. 50 United States 78.11 2009 est.