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

[c1ue]

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

Nice graph (other than the detail that the non-zero based axis for "Average Life Expectancy" exagerates that side quite a bit.)

True enough. But even if all the life expectancies were exactly the same, the relative spending is still way out of line.

That is the point which this graph does nothing to exaggerate.

I would feel more confident of being able to help my next door neighbor if he purchased a kit airplane:

...

assembled it while on an LSD trip and then asked me to help him fix it after he crashed it in his first attempt to fly it,
than I feel confident I can unravel the problems or propose solutions for the U.S. health care industry.

Perhaps.

Would you feel the same if you and your family were being charged $5000/year for 'LSD-assembled model airplane flying life and liability insurance'?

In this case perhaps you might take more interest. And perhaps being materially affected you might posit certain requirements despite your relative lack of expertise such as: no flying for you, dumb*ss.

One thing to beware of is the players in the industry attempting to make the problem more complicated than it is.

The reality in my view isn't that complicated.

We as a society need to decide whether some basic level of health care is an American citizen's prerogative.

Whenever someone without insurance is treated in an ER, we're implicitly saying all people have this prerogative.

If said prerogative exists, then there are absolutely steps which can and should be taken to ensure that such a level of health care is provided.

This 'utility' type of view is no different than water, or electricity, or roads.

Should the government ensure that everyone has the latest rainfall showers and 5 band track lighting? no.

But there are standards. There can be service.

To look upon the spaghetti's nest of Medicare, and employer sponsored health insurance, and public/private enterprises, etc etc misses sight of this big picture and is exactly what those presently profiting from the existing system want.

Obama's failure to date is no surprise to me: this is a subject which can easily be pushed as hard as FDR pushed his WWII era reforms.

But that requires someone with the integrity and the determination to do so.

And so far, neither has been forthcoming.

[ThePythonicCow]

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

In this case perhaps you might take more interest.

...

The reality in my view isn't that complicated.

Oh, I'm interested alright. And I acknowledge that many find the reality not that complicated.

But I'm still sitting there staring at it, like an outback bushman after seeing the internals of an automatic transmission for the first time.

Like that movie where the kid says "I see dead people", everywhere I go, "I see sick people."

[santafe2]

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

Clearly the facts of the article were not read - even the nice excerpt I put out for the masses. Read, then criticize.

Fair enough but I only have so much time and a very low boredom threshold. The article set-up sounded like someone selling a perpetual motion machine. Then Jim called me a pseudo-intellectual for making my observation - and he spelled it correctly! - just messing with you Jim, no need to reply...

Given the community response to the post I've been thinking I might want to actually read this thing. I have my doubts but maybe this weekend, thanks.

[c1ue]

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

Like that movie where the kid says "I see dead people", everywhere I go, "I see sick fat people."

:eek::eek::eek::eek:

[Jim Nickerson]

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

Fair enough but I only have so much time and a very low boredom threshold. The article set-up sounded like someone selling a perpetual motion machine. Then Jim called me a pseudo-intellectual for making my observation - and he spelled it correctly! - just messing with you Jim, no need to reply...

Given the community response to the post I've been thinking I might want to actually read this thing. I have my doubts but maybe this weekend, thanks.

I didn't call you a pseudo-intellectual, but the inference was certainly there.

Perhaps in your defense, SantaFe2, the part of the article having to do with the author's father's death, was of little use to me in the article, but I suppose significantly for the author it stirred him enough to apparently research and then write and get published what I thought was a worthwhile article to read given the current debates on health care.

If you were to begin to be like me, hopefuly not, you'll read it and forget most of it unless perhaps some point is referenced by someone in the future.

You are also correct that there are time limitations unless one is young and unwise to recognizing none of us get more time.

[Thailandnotes]

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

Highly recommend Omnivore's Dilemma by Michael Pallan.

Here Pallan in the NYTimes making a point few other have:

"But these rules may well be about to change — and, when it comes to reforming the American diet and food system, that step alone could be a game changer. Even under the weaker versions of health care reform now on offer, health insurers would be required to take everyone at the same rates, provide a standard level of coverage and keep people on their rolls regardless of their health. Terms like “pre-existing conditions” and “underwriting” would vanish from the health insurance rulebook — and, when they do, the relationship between the health insurance industry and the food industry will undergo a sea change."

http://www.nytimes.com/2009/09/10/op...llan.html?_r=1

[ThePythonicCow]

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

Highly recommend Omnivore's Dilemma by Michael Pallan

For those who prefer not to provide the New York Times with a login, it seems this same article can be found in full text at http://www.commondreams.org/view/2009/09/10 This article points out a hugely optimistic possibility. If insurers have to insure everyone at similar rates, then they will have a huge vested interest in opposing the cheap fast food that is the cause of so much chronic illness. Thanks for finding this article, Thailandnotes.

[santafe2]

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

....but I suppose significantly for the author it stirred him enough to apparently research and then write and get published what I thought was a worthwhile article to read given the current debates on health care.

Thanks Jim. I'll have my original, snap judgment, attitude cleared by this weekend and I'll give it a read. But I wonder if I really know enough about this issue to read a thoughtful argument and filter it in a meaningful way. I suspect most of us in the US don't have the basic background to understand clearly how we should move forward.

In the president's speech last night he started out with several points that almost everyone agreed with. In essence, people should not be red-lined because they have a history of illness and they should not be retroactively booted from the system because they missed a detail in their medical history.

That sounds reasonable and as a small business owner it had great appeal to me. Then he went on to talk about "the public option" and as a business person I started thinking about my business having to compete with a non-profit government entity and I fell into complete social liberal / entrepreneur confusion.

It's not just health care, the government appears to mismanage and under regulate business and after they've not done their job for long enough, offer to come in and compete against business. Government's job is to tax as little and as fairly as possible and to regulate the entities that pay for their existence. Could one of the two political parties back this idea? Maybe then we'll have health care that makes sense.

[Jim Nickerson]

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

Thanks Jim. I'll have my original, snap judgment, attitude cleared by this weekend and I'll give it a read. But I wonder if I really know enough about this issue to read a thoughtful argument and filter it in a meaningful way. I suspect most of us in the US don't have the basic background to understand clearly how we should move forward.

In the president's speech last night he started out with several points that almost everyone agreed with. In essence, people should not be red-lined because they have a history of illness and they should not be retroactively booted from the system because they missed a detail in their medical history.

That sounds reasonable and as a small business owner it had great appeal to me. Then he went on to talk about "the public option" and as a business person I started thinking about my business having to compete with a non-profit government entity and I fell into complete social liberal / entrepreneur confusion.

It's not just health care, the government appears to mismanage and under regulate business and after they've not done their job for long enough, offer to come in and compete against business. Government's job is to tax as little and as fairly as possible and to regulate the entities that pay for their existence. Could one of the two political parties back this idea? Maybe then we'll have health care that makes sense.

Yes, probably you are correct that you do not know enough about the enormity of the problem and my opinion is that none of us really know. One thing you do know I'm rather sure is that the more you understand about most things, the greater appreciation it creates for all that is yet to be understood.

I suppose your small business in not on the order of HCA or whatever HCA may have become, Pfizer, HealthSouth, Humana, you name any big company involved with provision to the needs of providing healthcare, and what they have done is tilt the field in their direction doing all they can to eliminate or gain an advantage on competition. Competition is good, but not in name only if it is getting advantage by lobbying and backing politicians. Does your business own any congressmen/senators? I hope not.

I sometimes think I am the only supporter of government who writes on iTulip. A complex society cannot exist without government. The notion of government is not what is wrong. What is wrong, I believe, is those elected to make the decisions are either not up to it, or are so heavily influenced in their decision making, and thus voting, by monied influences that we get really lousy results. It is a helluva dilemma to my small brain to how better government can evolve.

To me the bottom line is the American healthcare system needs to be less expensive/wasteful and the resources available to everyone. However the country gets to that point will be interesting to see. I doubt it will get there with one fell swoop.

[Jim Nickerson]

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

SantaFe-dos, this is what I am writing about though not specifically dealing with healthcare. God knows how much of this stuff actually exists.

http://www.latimes.com/news/local/la...,3087018.story


Duvall incident spotlights politicians' perks in capital

The case of Michael Duvall, the 54-year-old Yorba Linda assemblyman who resigned Wednesday after the disclosure that he bragged over an open microphone of apparent sexual trysts,[not only are the mothers crooked as a snake's back, some are dumber than dirt] is a window into a world in which those who vie to sit through dreary legislative meetings can be rewarded in more bacchanalian ways.

Beyond lavish meals with fine wines, special interests offer overseas junkets, pro basketball games and weekends at spas and golf resorts that pair their lobbyists with lawmakers.

"When you're in Sacramento, the entire city is dedicated to making you feel important and special," said Don Perata, a former state Senate leader.

An investigation of Duvall's actions is under way. He was vice chairman of a utilities committee, and the probe centers on his alleged relationship with a lobbyist for Sempra Energy -- possibly one of the women referred to in the videotape that captured him graphically describing his sexual encounters.

Sempra said its employee has denied an affair but the company is investigating. Duvall issued a statement Thursday saying that his resignation did not amount to an admission of an illicit relationship.

[Jim Nickerson]

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

http://www.cbpp.org/cms/index.cfm?fa=view&id=2914

Employer-Provided Health Insurance Expected to Continue Dropping in 2009 and Beyond Some 46.3 million U.S. residents lacked health insurance in 2008, an increase of 682,000 over the previous year and 6.6 million more than in 2001. ...

The percentage of people with employer-provided health insurance, the principal source of coverage for the non-elderly, has been trending downward since 2001 and is the leading contributor to the increase over time in the number of uninsured. ...

Employment-based coverage is likely to drop significantly in 2009, due to the loss of jobs. In the short term, some families losing their jobs and health insurance may become eligible for Medicaid or qualify for other assistance such as temporary COBRA subsidies for formerly employed workers, which the recovery act temporarily strengthened. But, the long-term decline in private coverage is likely to continue to drive up the number and percentage of uninsured.

The Congressional Budget Office projects that under current law, the number of uninsured will continue to rise and reach 54 million by 2019. The health reform bill currently moving through the House of Representatives, as well as health reform bills in the Senate, would seek to reverse the sizable increase in the number of uninsured people that has occurred in recent decades. ...

The point has been made no telling how many times, that people who consider themselves covered with "good" health insurance fail to consider, I believe, the possibility that if they lose employment what then will happen. Cobra is a stop-gap measure.

[Jim Nickerson]

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

Medical Malpractice System Breeds More Waste
By DAVID LEONHARDT
Published: September 22, 2009
http://www.nytimes.com/2009/09/23/bu...leonhardt.html

The debate over medical malpractice can often seem theological. On one side are those conservatives and doctors who have no doubt that frivolous lawsuits and Democratic politicians beholden to trial lawyers are the reasons American health care is so expensive. On the other side are those liberals who see malpractice reform as another Republican conspiracy to shift attention from the real problem.

Yet most people, I suspect, still aren’t sure exactly what to think. For them, the good news is that the issue has inspired a lot of research by economists and others with no vested interest. And after sifting through years of data, these researchers have come to some basic factual conclusions.

The findings are especially useful now that President Obama is promising to finance malpractice reform pilot projects, and Republicans are urging him to go further. Here, then, is the brief version of the facts:
The direct costs of malpractice lawsuits — jury awards, settlements and the like — are such a minuscule part of health spending that they barely merit discussion, economists say. But that doesn’t mean the malpractice system is working.

The fear of lawsuits among doctors does seem to lead to a noticeable amount of wasteful treatment. Amitabh Chandra — a Harvard economist whose research is cited by both the American Medical Association and the trial lawyers’ association — says $60 billion a year, or about 3 percent of overall medical spending, is a reasonable upper-end estimate. If a new policy could eliminate close to that much waste without causing other problems, it would be a no-brainer.

At the same time, though, the current system appears to treat actual malpractice too lightly. Trials may get a lot of attention, but they are the exception. Far more common are errors that never lead to any action.
After reviewing thousands of patient records, medical researchers have estimated that only 2 to 3 percent of cases of medical negligence lead to a malpractice claim. For every notorious error — the teenager who died in North Carolina after being given the wrong blood type, the 39-year-old Massachusetts mother killed by a chemotherapy overdose, the newborn twins (children of the actor Dennis Quaid) given too much blood thinner — there are dozens more. You never hear about these other cases.
So we have a malpractice system that, while not as bad as some critics suggest, is expensive in all the wrong ways.

Medical errors happen more frequently here than in other rich countries, as the Robert Wood Johnson Foundation recently found. Only a tiny share of victims receive compensation. Among those who do, the awards vary from the lavish to the minimal. And even though the system treats most victims poorly, notes Michelle Mello of the School of Public Health at Harvard, “the uncertainty leads to defensive behavior by physicians that generates more costs for everyone.”

Something else that’s expensive in all the wrong ways, of course, is the rest of the health care system. That’s no coincidence.
•
If you talk to doctors about malpractice, you come to realize that the root of their objections isn’t financial. Yes, the money matters, and, yes, there are horror stories about $200,000 premiums for malpractice insurance. But most premiums are nowhere near that high.

All told, jury awards, settlements and administrative costs — which, by definition, are similar to the combined cost of insurance — add up to less than $10 billion a year. This equals less than one-half of a percentage point of medical spending. There have been years when malpractice payouts rose sharply, but there have also been years when they did not. Over the last two decades, the amount has increased roughly in line with total medical spending, according to a study in the journal Health Affairs, based on a national database.

This being said, the malpractice system does affect the morale of doctors. It leaves them wondering when they will be publicly accused of doing the very thing they’ve sworn not to do: harm patients. Dr. S. Anthony Wolfe, the chief of plastic surgery at Miami Children’s Hospital, told me he had been to court three times in the last 34 years and won all three times. “But it was a Pyrrhic victory,” he said. He spent weeks in court, enduring “rude, demeaning and endless depositions and badgering.”

You can understand why such experiences would lead doctors to order extra tests and treatments.

Perhaps the best-known study of defensive medicine — by Dr. Mark McClellan, who later ran Medicare in the Bush administration, and Daniel Kessler — compared cardiology treatment in states that had capped malpractice awards in the 1980s and early ’90s with those that didn’t. In the states without caps, stenting and other treatments were more common, but the outcomes were no better.

Later research — into various surgical operations, for instance — has found less of evidence of defensive medicine. But Mr. Chandra points out that this later work (including some of his own) is not as elegant as the cardiology paper. States have not made as many changes to malpractice law in recent years, which makes research tricky. That’s why Mr. Chandra’s estimate of the cost of defensive medicine, up to $60 billion a year, stems largely from the cardiology work.

Obviously, the precise amount of defensive medicine can never be known. Anyone who sets out to find a certain answer will be able to cite one study or another. (One good example of ideology dressed up as economics: the American Medical Association does not adjust for inflation when claiming that malpractice costs are soaring.)

Still, the researchers in the field tend to agree about the scale of the problem — and how much malpractice reform might accomplish.

Dr. McClellan puts it this way: “By itself, it’s not comprehensive solution. I do think it’s an important element.” Katherine Baicker, another economist who served in the Bush administration, says, “reforming the malpractice system wouldn’t be a bad thing, but it wouldn’t solve the crisis of mounting health costs.” Dana Goldman, director of the Schaeffer Center for Health Policy at the University of Southern California, adds: “It is one of the things we need to address if we want to bend the cost curve. But it’s not going to solve the problem.”

The problem is that just about every incentive in our medical system is to do more. Most patients have no idea how much their care costs. Doctors are generally paid more when they do more. And, indeed, extra tests and procedures can help protect them from lawsuits.

So the most promising fixes are the ones that don’t treat the malpractice system as an isolated issue.

Imagine if the government paid for more research into which treatments really do make people healthier — a step many doctors don’t like. Such evidence-based medicine could then get the benefit of the doubt in court. The research would also make it easier to set up “health courts,” with expedited case schedules and expert judges, which many doctors advocate.

Similarly, you would want to see more serious efforts to reduce medical error and tougher discipline for doctors who made repeated errors — in exchange for a less confrontational, less costly process for those doctors who, like all of us, sometimes make mistakes.

A grand compromise along these lines may be unlikely. But it’s a lot more consistent with the evidence than narrower ideas. The goal, remember, isn’t just to reduce malpractice lawsuits. It’s also to reduce malpractice.

[MulaMan]

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

The American Medical Association is a monopoly.

The American Health Insurance Industry is a cartel.

The FDA is corrupt central planning communist organization.

The American Bar Association is a monopoly.

Any change to the US health system is positive.

Ideally you could walk into a doctors office and ask for thier "price list" - try it and see what you get.

[Jim Nickerson]

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

Robert Reich 9/28/09 discussing the deals our or actually your politicians have made with those who reap perhaps obscene profits in healthcare.

Obama seems to have changed the way "change" is spelled to "s-a-m-e."

Monday, September 28, 2009

The Public Option Lives On



Tomorrow (Tuesday) is a critical day in the saga of the public option. Democrats Charles Schumer (New York) and Jay Rockefeller (West Virginia) are introducing an amendment to include the public option in the bill to be reported out by the Senate Finance Committee -- the committee anointed by the White House as its favored vehicle for getting health care reform.

Before you read another word, call and email the Senate offices of Democrats Max Baucus (Montana), Tom Carper (Delaware), Robert Menendez (New Jersey), Kent Conrad (North Dakota), and Ben Nelson (Florida) -- telling them you want them to vote in favor of the public option amendment. And get everyone you know in these states to do the same. Hell, you might as well phone and email Republican Olympia Snowe (Maine) and make the same pitch.

Background: Every dollar squeezed out of Big Pharma and Big Insurance is a dollar less that you'll have to pay either in healthcare costs or in taxes to cover healthcare costs. The two most direct ways to squeeze future profits are allowing Medicare to use its huge bargaining leverage to negotiate lower drug prices, and creating a public insurance option to compete with private insurers and also use its bargaining clout to get lower prices and thereby push private insurers to offer lower rates.

But last January, the White House made a Faustian bargain with Big Pharma and Big Insurance, essentially scuttling both of these profit-squeezing mechanisms in return for these industries' agreement not to oppose healthcare legislation with platoons of lobbyists and millions of dollars of TV ads, and Pharma's willingness to cut drug prices by some $80 billion over the next ten years. The White House promised these industries they'd come out way ahead -- getting tens of millions of new customers who'd be buying private health insurance policies and thereby paying for an almost endless supply of new drugs. Healthcare reform would be, in short, a bonanza.

Big Pharma and Big Insurance have so far delivered on their side of the deal. In fact, Big Pharma has shelled out $120 million in advertisements in favor of reform. Now the White House is delivering on its side.

Last Thursday, for example, the Senate Finance Committee rejected Ben Nelson's amendment to require Big Pharma to give some $160 billion in discounts to Medicare -- thereby reducing the bonanza Pharma would reap from the healthcare bill. Not surprisingly, all Republicans voted against the amendment. But it was defeated only because Dems Baucus, Carper, and Menendez voted with the Republicans.

Carper later explained to the New York Times why he voted with the Republicans. The amendment, he said, would "undermine our ability to pass" health care reform, because the White House had made a deal with Big Pharma by which the industry wouldn't oppose healthcare reform -- and White House officials had told him "a deal is a deal." The Times described the vote as a "big victory" for the White House.

Schumer voted for the amendment. He said he was "not at the table" when the White House and Big Pharma made their deal so didn't feel bound by it. But even if he had been at the table, he wouldn't be bound. No member of the Senate is bound to a deal made between industry and the White House. Congress is a separate branch of government.

Big Pharma and big insurance hate the public insurance option even more than they hate big Medicare discounts. And although the President has sounded as if he would welcome it, political operatives in the White House have quietly reassured the industries that it won't be included in the final bill. At most, the bill would allow the formation of non-profit "cooperatives" that wouldn't have the scale or authority to squeeze the profits of private industry, or a "trigger" that would allow states to form public insurance options eventually if certain goals for cost savings and coverage weren't met.

But the public option lives on, nonetheless. It's still in the Senate Health, Education, Labor, and Pension bill. It still headlines the House bills, and Speaker Nancy Pelosi says she's still committed to it. The latest Times/CBS poll shows 65 percent of the public in favor of it.

Now, Schumer and Rockefeller are introducing a public option amendment in the Senate Finance Committee. Carper, Menendez, Baucus, and other Dems on the Committee should vote for it, or be forced to pay a price if they don't.