Friday Animations: Why is health care reform so difficult
by Linda Beale
Friday Animations: Why is health care reform so difficult
crossposted with Ataxingmatter
If you think about it, health care surely is one of the basic human needs that we should try to ensure is met for every person, if at all possible. That’s the idea behind universal health care–that is, that the US should have a system that covers everyone, not just the wealthy. That no one should have to give up home or job to have health care. That no one should die from an easily treatable illness simply because they didn’t have enough money to pay a doctor. That our health system should work for the people, and not for corporate interests. That health insurers, if they are to be involved, should only be making a reasonable profit out of guaranteeing that the services we want are available–they should not be able to deny care, they should not be able to decide what kind of care is available, they should not be able to rip people off for exorbitant profits. Because they are providing a service that meets basic human needs, they are a quasi public utility and must be regulated as such, if they are to exist at all.
Other countries seem to have managed this much better than we have. Canada’s health care system costs about half what ours does yet provides better service. Same in Europe. We have missed the boat.
The health care reform act is just a first step in the right direction. It involved way too much payoff for the health insurers, and not enough reform. But it is a start. The new rules about pre-existing conditions are very important. The mandatory coverage is very important. Eventually maybe we’ll finally be able to enact a public option. And then, who knows, maybe we’ll finally enact a single-payer system that will provide to Americans the quality of health care, at the lower expense, that Europeans have enjoyed for decades.
So here’s today’s animation feature–a reminder that health care reform made some progress, but that we have a long way to go. What we don’t need, however, is gutting of the little progress we did make.
Linda:
Why do you believe such?
“The health care reform act is just a first step in the right direction. It involved way too much payoff for the health insurers, and not enough reform.”
Unless they are able to weasel out of the ratios, I think we have them in a reasonable spot in that they must insure all and base their rates on the cheapest insureable person.
On the issue of fat, sugar, and salt:
“Jan Perry, a Los Angeles city-council member, is spearheading legislation that would ban new fast-food restaurants like McDonald’s and KFC from opening in a 32-square-mile chunk of the city, including her district. The targeted area is already home to some 400 fast-food restaurants, she says, possibly contributing to high obesity rates there — 30% of adults, compared with about 21% in the rest of the city. Nationally, 25.6% of adults are obese, according to the Centers for Disease Control and Prevention.” http://online.wsj.com/public/article/SB121668254978871827.html “Exiling ‘The Happy Meal’”
400 “fat and fast” drive-thrus, walk-ups, and carts or ~ 12 per square mile, or 1 per an ~ 2.4 million square feet, or 1 per 1250 people. Anyone still think we are stomping on the rights of people to get their “hot and greasy” when so many exist already? Think any of those fast food places are providing healthcare insurance to their workers as they delve out and into those chunks of fat? Think there is a correlation here between fast food, poverty, and obesity?
Ray:
Phillip Longman in his book “Best Care Anywhere” (which I owe Angry Bear a post) points out you are probably more likely to die in the nation’s best hospitals, with the most specialists, and access to numerous procedures than you are in less costly hospitals which are more likely to utilize and administer proven and more ordinary procedures. This does not deny your stance on hot and greasy but it does point a condemning finger at hospitals and our access to procedures and meds less likely to produce a cure statistically.
The costs of healthcare are more directly tied to our access to more specialists, meds, and procedures which do not deliver as high a result than more ordinary measures (a tad redundant but worth repeating). Furthermore the mistake rate in hospitals is significantly higher than what much of the industry is willing to admit too. As a precursor ro lowering healthcare costs, we would be better to concentrate on the quality of care in hospitals and the results achieved from “new and improved.”
There is more and I will get into it later.
Plus, if we are to revisit the health-care debate, what also received too little attention has to do with the mandate.
As healthier citizens are mandated to pay for insurance so as to offset the cost of less healthy citizens, whether subsidized or not, this spending must come at the expense of other spending. Some healthy young citizens who would otherwise not buy, or in many cases not need, medical insurance, will in fact be spending money on insurance that they would otherwise spend on something else, or save.The mandate therefore has nothing to do with finding ways to make the system more efficient, it is simply redirecting consumption from one part of the economy to another.
Same holds true with the subsidized costs, that is the government spending funds on health-care that could be used for other purposes. Not to suggest that health-care spending is a poor use of those expenditures, but instead to make it clear that the mandated spending ‘adds’ to cost as measured in GDP terms. Which, is in conflict with the initial arguments from reform proponents who emphasized the importance of lowering health-care costs so as to make the US more competitive with foreign producers in terms of labor-related costs.
That said, it seems unlikely that the reform bill will make any significant difference in overall health-care costs as a percentage of GDP. Nor does it seem likely that the reforms will make the US any more competitive where exports are concerned.
health care surely is one of the basic human needs
At their core, basic human needs don’t change all that much with technological innovation. They also typically don’t require government coercion of the labor of others.
Run,
This might seem blunt and bitter if I don’t qualify it some, so let me first say that each of my parents were ill to begin with, my mother had cancer, and my dad had had a stroke, but in each case their lives were shortened significantly by ‘mistakes’. My mother was misdiagnosed twice, during the first 2 months that she was feeling ill, which turned out to be the 2 month window when chemotherapy could have made a difference. She was only 49.
And my dad was showing-off in his wheelchair, by doing a ‘wheelie’ while going down a small stairway at a hospital where had gone for a routine check-up. His escapades ended with a crash that left him unconscious and that night, an ‘undisclosed’ person put a feeding tube down into his lungs. He was 63.
Then, my first child was born 3-months-premature because my wife’s obstetrician didn’t know that there were drugs which could stop labor. Eventually he sent us to a hospital in Sacramento, which is about an hour and a half from where we then lived (Truckee), but by the time we arrived at the hospital it was too late for the drugs and so our Sarah was born weighing a whopping 1 and half pounds. She is about to graduate from college.
The point being of course that I know quite a bit about ‘mistakes’ and incompetent medical personnel.
“They also typically [sic] don’t require government coercion of the labor of others.”
Name an industrialized nation in which the government doesn’t ‘coerce’ (the right-wing euphamism de jour for ‘taxes’) the labor of others to pay for basic human needs of its citizens.
The only places where governments don’t ‘typically’ tax citizens are failed states where centralized government doesn’t exist.
“They also typically [sic] don’t require government coercion of the labor of others.”
Name an industrialized nation in which the government doesn’t ‘coerce’ (the right-wing euphemism de jour for ‘taxes’) the labor of others to pay for basic human needs of its citizens.
The only places where governments don’t ‘typically’ tax citizens are failed states where centralized government doesn’t exist.
My take on “why health care reform so difficult” is quite simple, but I doubt will ever be implimented until the country is allowed to vote on the subject & the S.C.O.T.U.S. doesn’t strike it down. Ban the “Lobbyist’s. Make it a crime to be one, perhaps with a starting sentence of 20 years at hard labor. Financial reform of our election system would go a long way towards achieving that goal. Again, the courts have taken an activest agenda which is too highly partisan, as their recent action about Corperations being people, therefore they can give unlimited sums of money in secret.
The government coercion in the health care labor market goes far beyond taxes. There is price fixing in Medicare, there is a “take all comers” regulatory aspect to emergentre, even when it’s clear the case is not emergent, and now we are in the process of regulating the profits of a low profit margin industry through the MLR. We also regulate what must be covered through state insurance regulations, e.g., chiropractic care in CA and have now instituted a mandate to purchase something that an individual may not want.
This goes far beyond euphemisms.
Basic human needs are presumably universal and not bounded by nation-states.
Linda:
Why do you think American healthcare is poor compared to other countries? The poor in the US is very well covered. The exception is the lower middle class and the newly unemployed whom run out of cobra coverage.
I challenge you to actually live in one of those wonderful countries that have “better” healthcare than the US.
USA have already passed a “landmark” healthcare law. It is the law of the country. So is it not good enough for you? Having second thoughts? Being upset/defensive about partisan legislation?
F.Y.I. The USA really takes care of it’s “poor.” I have lived/worked in the U.K. And France- universal healthcare countries. I have never doubted USA is a better country.
Since when are “basic human needs” bounded by nation-states or restricted to industrialized nations?
You also may want to look at what the credit spreads of those other industrialized nations have been doing lately.
The government coercion in the health care labor market goes far beyond taxes. There is price fixing in Medicare, there is a “take all comers” regulatory aspect to emergent care, even when it’s clear the case is not emergent, and now we are in the process of regulating the profits of a low profit margin industry through the MLR. We also regulate what must be covered through state insurance laws, e.g., chiropractic care in CA and have now instituted a mandate to purchase something that an individual may not want or can pay for through more efficient means, or could have if not for government intervention and subsequent crowding-out.
This goes far beyond euphemisms for taxation.
Pax Romana, by your standards, perhaps that is possible? But in the real world here in the U.S.of A. there are untold millions who don’t have health care, who are routinely turned away from even the emergency rooms, if they are available. It’s also obvious that you haven’t experienced having been there. Until you have, then you really shouldn’t start throwing rocks at other peoples green houses while living in one yourself. You can start by living under the freeway, in some vacant field, in an ally way. an ababdoned house with rats running around. Go dumpster diving for your daily meal, panhandle, collect cans & bottles, go to a shelter at night. I can go on, but it doesn’t do any good, because the mindset here in the U.S.of A. turns a blind eye to those who for what ever reason are out of the loop. Until that mindset is changed, then we will have this problem. By the way, I take it that you are of mreans having lived in the European countries that you diss, so try living on below the poverty/mimium wage standard for a couple of years, then come back & tell your viesw.
Pax:
Minimalist. That the poor get the weakest of helthcare actually benefits them as they are not exposed to the specialists because of ack of money and are more prone to the most ordinary of care which brings them close to what we all over pay for tosiing in the specialists and the upper crud hospitals.
Okay, well, as a health policy analyst, I can’t help but to weigh in here. It is true that we have higher rates of disease, but even considering this, it cannot explain the at least four fold number of procedures done here, the higher spending per person, and the excess capacity we have. We trail the other OECD countries in live expectancy, outcomes on most illnesses, and infant mortality. We are number one however in spending. We are fairly close to the median in visits per physician, number of physicians per 1000, and physician visits per capita. Bottom line, is, we spend a LOT more, and get less. Even if we were to adjust the spending, which is significantly greater, by using the average wealth of the population, we are still spending close to 2,000 dollars more per person than what should be expected. We cannot simply explain that away with claims of higher disease occurence.
Oh, and additionally, I practice Emergency Medicine…I am the last person you want to see for chronic disease management. I don’t do it, and the ED is expensive.
For example, in my health system, it costs about 125.00 for an outpatient primary care visit. To see me in the ED, well, it’s at least 600 dollars for me to open the door and say hello. That is not an efficient or appropriate use of resources.
Of course, I will also state that while I have an economics background, I am not an economist, as 1/2 of my time is spent as a Healthcare Workforce Researcher.
Norman:
I used to lived at minimum wage leve, working two jobs to support myself through college for over seven years.
I did not have the money for insurance during the first three years of college. I had one major illness (cracked my skull) during this time period. I went to the county hospital(USC) and I recieved first class treatment for someone that did not have money/did not pay into the system. Yes the follow up appointment were painful. I had to wait in line sometime 7-8 hours, but for anything really urgent, I got what I needed.
European Universal Healthcare system works- up to a point. I worked for the British National Health System for several years… They decided to do an excellent job at primary care level, but does not spent any money at the hospital level. At hospital level, you loose money…
In the USA, not everything is peachy… Depends on the State, County, the uninsured can be turned away, millions do not get adequate coverage… There is no denying the fact there is a major issue. How to you decide what the problems, issues can be quite a challenge. American patient’s wants the latest and the greatest… Even if there is no hope healthcare will persist… That’s one of the major cost difference between universal healthcare in Europe in contrast to healthcare in the US.
USA is uncompromising in terms of not assigning a number to a human life. In European countries there is a number. Just google “QALY” to understand the concept. There are many instances where a foreign “tourist” with heart disease with need for heart surgery will land at “LAX” and immediately ask for an ambulance to county USC to get heart surgery done… So aren’t we not a great country to help those in need???
For such a generous country, there is a human cost, we can agree disagree if someone uninsured can/cannot get healthcare. There is always a way in the USA if one looks at the right places… In Europe, if the number needed to treat is not compatible with cost, then you will get palative care….
Micheal,
I think if you were to give my example above a little thought, the one comparing a Japanese patient and an American with heart disease, you will see that it explains away most of what you brought up here. Naturally, that comparrison says nothing about infant mortality. But as for your conclusion, I say you need to give that some more thought. And if you think your being a doctor gives your argument weight, I study statistics day after day.