Tag: health care

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The Brutality of the American Health Care System

According to a New York Times article [2013-08-03], Michael Shopenn, a man living in Boulder, Colorado, needed a new hip and obtained a rock-bottom price of $13,000 through friends with connections in the industry. Then he tried to arrange the operation at a local hospital: they quoted him $65,000.

That is an unspeakable obscenity.

He chose, instead, to fly to Belgium and have it done in a private hospital there for $13,660. That price included the air fare, surgery, five days in a hospital bed, physical therapy, and the hip itself. The hip came from the same company that offered it to him for that rock bottom $13,000 in the U.S.

How is that possible? America is the greatest country in the universe. All Europeans are lazy, corrupt, and I forget the third one. The American health care system relies on good old capitalism and free market competition to drive prices down give Americans the cheapest health care in the world. The New York Times is lying.

What is the bigger obscenity? That large numbers of Americans continue to believe it, or that doctors and hospital administrators continue to believe that they are good, decent people, with ethics and morals and principles, who do their best to “help” people like Michael Shopenn. They are not like drug dealers, bank robbers, or, God help us, bankers. No, they work very, very hard and deserve to completely ruin your life. Shopenn’s example is a trifling one. I know of cancer patients who were charged $20,000 a day to stay in the hospital after breast surgery.

There is no country in the world where a health care system that charges these rates is sustainable. It is a system designed to deceive Americans into thinking that if they work hard, improve their skills, show up on time, and manage their money wisely, they will be able to retire when they get old.

No, you can’t. You will be robbed of every cent by hospitals and doctors who are unconstrained by morals or laws or regulations. They can charge whatever they want and they do.

The actual cost of manufacturing that hip: about $350. I’m not making this up. And Shopenn was quoted a bargain: many patients pay up to $50,000 or $60,000 for it. Why? Because every agency that handles or distributes or installs the artificial hip takes a huge cut, including the hospital.

There was a time when a man who charged you $13,000 for a device that cost $300 to make was committing “extortion”. I don’t believe for one second that it is not still extortion, and criminal.

But why the hell is the hospital marking up the cost? Why the hell is a hospital in the business of making a profit from a medical device?

Oh. This is America. Cue the anthem. Wave the flag. Get the marching band. Let’s remind the world that we are the greatest country in the universe and anyone who thinks otherwise should go live in North Korea!

It’s the American medical industry that behaves like North Korea. Hospitals are forced by secret agreements to not disclose the price they paid for devices like artificial hips because it would …. er… create competition among the manufacturers. And this is allowed in a Republic that claims to operate on the basic of market competition.

Michael Shopenn didn’t even have to go to India or Indonesia to save money on this operation. He only had to go to Belgium. But the interesting thing about this is that the skills required to safely perform this operation are not worth $65,000. They probably aren’t even worth $13,000. The skill set is not like oil or gold or an automatic transmission: it is something that can be taught to any reasonably intelligent, educated young person in most countries in the world.

Now you should not look at society through the lens of class warfare, but if you did, it would look very much like this: in order to get you to work, in order to make the rich rich, they have to offer you this charade of a “good living”, maybe even health insurance (more likely not), and let you invest in a house and in mutual funds so that when you get old you can retire on your savings. That’s the scam. Once you have actually reached that age, they will take all of the money back through medical costs. Breast cancer? Hip replacement? Heart surgery? It doesn’t matter– you will be charged an incredibly obscene amount of money so the rich can get back all of the money they paid you for your work. God forbid your children should inherit it!

What about insurance? Ah, but that is exactly what the Republicans are working on right now! They will tell you that America cannot afford health care, Medicare, Medicaid, or Social Security. You see, we desperately need that money….. to cut taxes for the rich. Oh– and to buy more F-35 fighters and nuclear submarines. And aircraft carriers, even if a drone from China or Russia or North Korea is going to be able to sink one in the next few years.

No, you couldn’t make that up. Nobody would believe it. But it’s right there in the Republican Party platform and re-election campaigns and policy conferences– that is what they intend to do.

The article about the hip replacement.

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Hurray for Death Panels: I Mean it!

By the Republicans definition, any attempt to prevent people from choosing expensive but ineffective treatments, is a “death panel”.

It is a tribute to how badly outfoxed on public relations the Democrats have been: the public associates “Death Panels” not with congressmen determined to prevent them from accessing health insurance, at a sustainable cost, but with the Democrats who want to provide it. That is an amazing accomplishment.

As far as I can tell, the Republicans greatest concern about health care is the rising costs. It has been rising, rising, rising for fifty years under the Republican system: private insurance. Did I say the Republicans are concerned about these rising costs? Yes they are. They have a solution. Do nothing. As Ross Douthat in the New York Times admits, the conservative solution to the uncontrolled cost of health care is “modest reforms that would help the hardest-pressed among the uninsured”. Isn’t that inspiring? That covers a multitude of nothings.

As the health care industry expands to meet it’s central dynamic: we are a society that looks at itself in the mirror and says, “we believe life is more valuable than money”. Therefore, if someone’s life needs saving, we will spend as much as necessary to save it. The health care industry understands this. There is no reason why they should ever find cheaper, more efficient treatments: it is contrary to their fundamental interests.

It is not contrary to the real interests of the government and the people they represent to place some reasonable controls over how much should be spent on any particular disease or injury. But it’s something all the parties have to agree on or else one particularly stupid or ruthless party can exploit the fact that most people appear to refuse to believe what they see. An unfortunately large percentage of the population can be led to believe that one party can provide all the health care they want and need without bankrupting the country while cutting taxes.

So I’ll bet more than a few rational Republicans — if any are left– regret the choice of the word “death panels”. Because they have attached the phrase to the idea of limiting the relentless increase in health care costs. Because the potential cost of health care is infinite. The last twenty years of astonishing increases have proven it.

Come on, Democrats! Seize the term and turn it on the Republicans! They are the party that doesn’t want you to have affordable health insurance. They are the party of war, of unregulated industry, of tort reform: they are the Drop Dead Party.

The Republican approach will inevitably lead to a system where only the rich can afford proper treatment. By the Republicans definition, any attempt to prevent people from choosing expensive but ineffective treatments, is a “death panel”. Any attempt to limit treatments performed on people who are going to die soon anyway is a “death panel”.

Do you want to be the politician who tries to explain to the American people that too much health care is provided to people in the last few months of their lives, and that this is making the whole system unsustainable?

Here’s the naked truth: what the U.S., and most western countries need or already have, is something the Republicans have labeled as “death panels”.

As Douthat correctly noted, health care costs rise at astronomical rates. New treatments come on board constantly, new drugs, new techniques, and pharmaceuticals and doctors and hospitals charge enormous sums for these goods and services. Unfortunately, all this new technology has had the opposite effect that it had on computers: medical costs have risen steadily. Why? Really, in a nutshell, because people will pay anything to get better. Anything. Whatever it costs. People will sell everything they own to pay for it because nothing you own matters to you if you’re dead. And the medical industry knows it.

There really as an infinite amount of money we can spend on health care. Unconstrained, it will eventually consume most of the financial resources of the entire nation.

The health care industry also knows that people don’t go shopping around the cheapest cancer surgery, to see if they can get a discount. They don’t turn down an incredibly expensive operation just because they also have cancer and failed kidneys and diabetes and a heart condition, because they are 80 years old, or because they are Republican.

With this logic in place, there is no ceiling on medical expenditures, and eventually it will consume more and more and more of the economy, until it breaks. Or until Republicans, having created an unsustainable system, declare that no system is sustainable and announce their new policy for the uninsured: drop dead.

Most other developed countries simply negotiate what they will pay for particular treatments, which treatments will be available, and how much over-all spending will go into health care. What the Republicans call “death panels” are really nothing more than educated people trying to balance needs against resources, and so far it works pretty well in Europe, Australia, and Canada.

I have no problem accepting a system that declares that it will not spend an infinite amount of money on health care. I have no problem believing that we can still have a pretty good system that provides effective essential treatments for almost every illness. I accept that when I am 80 years old and suffering from all the ailments a typical 80 year old suffers from that I will not be a candidate for a kidney or heart transplant.

The only way to have a sustainable and effective health care system is with death panels.

The essence of the American debate was captured for once and always in this exchange:

Someone reportedly told Inglis, “Keep your government hands off my Medicare.”

“I had to politely explain that, ‘Actually, sir, your health care is being provided by the government,'” Inglis told the Post. “But he wasn’t having any of it.”  Huffington Post

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No Historians

There are seven members of the conservative bloc on the board, but they are often joined by one of the other three Republicans on crucial votes. There were no historians, sociologists or economists consulted at the meetings, though some members of the conservative bloc held themselves out as experts on certain topics.

NY Times, March 12, 2010.

This is the Texas Board of Education making decisions about text books for millions of students. This is an important decision: these men are entrusted with a serious responsibility. What should our children study in school? How will their perspectives on life be shaped for years to come? How should their education as citizens be guided?

Well, whatever we do, let’s not get an expert on any of the subject areas were are establishing guidelines for. Heavens no.

I wonder if any citizens of Texas realize how close they have come to the 18th century? The only things missing are signs and wonders. Then I wonder if any of them care about how the state is perceived by outsiders. Well, we know the true believers in this movement certainly don’t care. The question is, does Mr. & Mrs. Mainstream care, as they travel through Europe, and identify themselves, and watch people nod and go, “Oh, you’re from there.” Tell me, have you seen any flying saucers lately? Mr. And Mrs. Mainstream reply, “no. Have you tried to open a business lately. Notice how many restrictions there are? How many permits you need? How long it takes to get approvals from the various bureaucracies?”

And the European says, “and how’s your health care?”

 

 

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No Health Care for You!

Health Care
When will Americans finally begin to realize that there is not a single component of the health care industry that benefits from preventing illness? Are you listening, America? THE MEDICAL INDUSTRY DOES NOT BENEFIT BY KEEPING YOU WELL. This is the fundamental, inevitable flaw in a for-profit health care system: the system profits by keeping you ill.

So it is in the interests of the health care system that you are obese, that you don’t exercise, that you smoke, that you drink, that you watch television, that you biggie-size your meals, that you don’t know what’s in the food you eat, that there is radiation and asbestos, that there are wars and civil disturbances, accidents and sickness.

Sure, the health care reforms just passed by Congress will help lots of people. But some Republicans– not very many of them, obviously– and many Democrats are also right that real reform has to start with the entire system which currently focuses on treatment rather than prevention.

Just one example: the makers of Crestor, a cholesterol medication, are crowing that a recent study concluded that healthy people who take Crestor every day (at more than $3.50 a pop) are 50% less likely to have a heart attack than healthy people taking a placebo. Wow. Let’s get all the healthy people on this drug! Now!

A well-paid doctor who received money from AstraZeneca, says, would you let your patient walk out of your office without signing up? Hell no! The only problem: well, only a very small number of healthy people have heart attacks. Only about 1 in 500. So a 50% reduction translates into a difference of 1 in a 1000, of which a large majority will survive the heart attack anyway. But the cost of providing 1000 people with Crestor for a year is over $1 million. Good deal? Then add in the fact that some cholesterol drugs have now been implicated in causing type 2 diabetes. They know that at the time they signed everyone up to a drug you will never be able to stop taking once you get started on it.

The alternative: walk more, eat more vegetables and less fatty foods.

Thinking of treating somebody like an object? Don’t do it. It sends a bad message that will not be quickly forgotten.

The drug cartels are battling it out in Mexico for… what? For routes into the U.S. In theory, of course, there are no routes. The U.S. government spends $13 billion a year ensuring that there are no routes. Actually it’s more than that: think of all the people incarcerated for drug offenses, or offenses related to drug use.

The idea that America cannot “afford” the health care bill is ridiculous. To believe it, you have to assume that all or most uncovered medical conditions are not treated. That, of course, is not true. They are often treated in emergency wards, and they may be treated– in a different form– later in life in a chronic care facility, but there will be treatment and it will cost somebody and it will have an impact on the economy.

What universal health care coverage does is apply some rationality to the cost of health care. When you think about it, insurance is a marvelous concept. Since nobody knows who will ever get a disease or serious illness, why not commit, in advance, to pool our resources and treat everyone? When John McCain insists that the Republicans will campaign in November on repealing it– he’s dreaming. Since the Republicans have no alternative, his campaign will consist of “we will take away your health care”. About that for a slogan!

Even the Republicans are probably not that stupid. They will probably have to come up with some kind of weird alternative plan. The problem is, there is no alternative. They will come up with something that sounds like an alternative, but is really a variation of what the Democrats just passed, but with something that looks more “free enterprise” in it.

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Why Obama Won’t Propose Single-Payer Health Care

It Took a Nixon to Open the Door to China

Why on earth has Obama and the Democratic leadership ruled out the “single-payer” model, the one Canadians love so much?

I’m sure he wants Americans to believe that he is not a fanatic, a radical, who intends to impose a socialist regime on the country. I’m sure he knows that this perception is ridiculous. I’m sure he knows that the insurance industry and some doctors’ organizations and conservative talk radio and Fox News and the Republicans will spend millions and millions of dollars to try to convince Americans that Canadians hate their health care system (in spite of some studies that show up 97% of Canadians would not trade our system for theirs) and that Canadians are dying in unparalleled numbers because we can’t get doctors or treatment (in spite of our longer life expectancy) and that our breast implants are not as firm or ample as good old all-American breast implants.

So why has Obama rolled over on this one? He’s afraid of a brutal, divisive fight. He wants to be bipartisan. He wants to unify America.

I always thought that if a liberal Democrat took George Bush’s approach to the Iraq war and applied it to health care, the U.S. would have a single-payer, universal health care plan in a matter of months. Nobody wanted the Iraq war. Nobody thought it was a good idea. Nobody believed Saddam had anything to do with 9/11. Did that stop Dick Cheney? Not on your life. He just steam-rolled the idea through Congress and the Executive branch and refused to compromise or bend until he got his way. Above all, he threatened to paint every wavering Democrat as an unpatriotic wimp if they didn’t join in.

Now, if an idiot could do that with a bad idea– why can’t a genius like Obama do it with a good one?

To answer my own question: because Cheney’s opponents were intelligent, reasonable people who were not given to hysterics and mudslinging. They wanted to compromise. They wanted to seem even-handed and fair to President Bush.

Obama’s opponents are well-funded shrieking harpies who will lie and distort and stop at nothing to take political advantage of any issue.

Perhaps it is going to take a Nixon (or a John McCain?) to change America’s health care system for the better. (The story is that if a Democrat had tried to establish diplomatic relations with “Red” China the way Nixon did in 1972, the Republicans would have revolted en-masse and created a constitutional crisis of insane proportions. But Nixon, who was trusted by the conservatives, was able to achieve remarkable results because everybody thought that if old arch-cold-warrior Nixon thought it was okay, it must be okay.)

Why doesn’t labour approach the problem of influencing government the way conservatives do? What they would need to do is create a foundation (or several of them, each of which appears to be independent of the others) called the “Ruthless Capitalist Institute” or something, and find some stooge entrepreneurs to staff it and fund some stooge college professors (maybe at Oral Roberts University) to do “research” and then make presentations to Congress on how investors would make even more money if they employed only unionized labour.

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The Cost of Death

From the Washington Post, June 11, 2009

In the final two years of a patient’s life, for example, they found that Medicare spent an average of $46,412 per beneficiary nationwide, with the typical patient spending 19.6 days in the hospital, including 5.1 in the intensive-care unit. Green Bay patients cost $33,334 with 14.1 days in the hospital and just 2.1 days in the ICU, while in Miami and Los Angeles, the average cost of care exceeded $71,000, and total hospitalization was about 28 days with 12 in the ICU.

Some differences can be explained by big-city prices, acknowledged Elliott Fisher, principal investigator for the Dartmouth Atlas Project, “but the differences that are really important are due to the differences in utilization rates.”

Much of the evidence suggests that the more doctors, more drugs, more tests and more therapies given to patients, the worse they fare — and the unhappier they become, said Donald Berwick, president of the independent research group Institute of Quality Improvement.

The kicker here is that there is evidence that the more treatment a patient receives late in life, the less happy he or she is.

I believe it. Anyone who has spent time in a hospital or nursing home can’t help but believe it.

Billions of dollars of health care spending in the United States is guided by a very simple and pernicious logic: don’t you love your mother? (Or father, or grandparent, or…). And if you love your mother, don’t you want to do everything possible to extend her life? Everything? Even if the odds of the treatment actually extending her life or improving her quality of life are not very good?

I’m sure some elderly people simply want to live for as long as they possibly can even if it bankrupts their families, but I don’t believe most of them want that. I think most people in their 70’s and 80’s accept that life comes to an end eventually and probably hope, more fervently than for anything else, to die in peace, close to friends and family, and without unbearable pain. They don’t want to spend their last weeks or months strapped to a bed with tubes going in and out of every orifice, nauseous, drugged out. And they don’t want pallid substitutes for pain killers because the pharmaceutical industry has succeeded in establishing a monopoly over drugs.

The average American works hard all of his life, buys a house, builds up his assets, sends his children to college, saves something for retirement, spoils the grand kids, and then, just when he thinks he’s survived the economic snake-pit of American capitalism, the health care system sinks its fangs into him and sucks him dry. If you want to leave something for your grandchildren, you need to drive your car off a bridge before you become incapacitated.

Perhaps one of the most depressing facts of American life is that the medical-industrial complex has managed to convince many Americans– and almost all talk radio hosts– that the cruelest, least fair, and least efficient health-care system in the Western World is actually the best. They stand there bankrupted and ruined, dropped by their insurance companies, buried under piles of arcane incomprehensible forms, denied critical treatments because their insurance companies simply refuse to pay out… and they look at us Canadians and go, “Oh my god! You have to wait three weeks for an MRI?”

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Dear George Will: About Canadian Health Care

George, I know you strive to be fair and balanced though your basic worldview is conservative.  As a Canadian who “suffers” under our single-payer system, I would ask a very simple, very important question: having lived under a single-payer system for almost fifty years now, could you persuade a majority of Canadians to give it up, and let a “market-based” system prevail?  Do you think most of us believe that will drive down health care costs and give us more “freedom”?

George Will on Health Care

Most Canadians I know can’t even believe that there is a debate on this issue in the U.S.  We are all mightily impressed that America believes it’s system is better and everyone else is wrong even though Americans seem to know nothing about any system but the one that is failing them now.  It’s possible that everyone else is wrong.  Sometimes everyone else is wrong.  It’s also possible that the sun orbits the flat earth.

Anybody can find a few Canadians who don’t like our system, and few horror stories of delayed care and inept management.  No reasonable person can deny, however, that the U.S. system costs astronomically more to administer, and that almost all Canadians receive basic health care without the slightest impediment, and that the actual results in Canada are better than in the U.S.

Furthermore, I have no idea of where you would find any proof that Canadians do not have a choice of doctors or hospitals or treatments.

True– we can’t choose to opt out.   But Americans can’t really opt out either.  They can’t!— an American without insurance will still receive treatment at any nearby hospital.  Who pays for it?  Everyone, through taxes and astronomical charges for treatment for the insured.

Isn’t that the basic principle of insurance?  Any of us could suffer a serious illness or injury.  Why not agree to contribute to a plan that covers everyone?  Especially since we all know that those who “opt out” will still receive medical care one way or the other, but certainly less efficiently.

Finally– this is one gripe I do have about conservatives in general:  I think they are far more likely than liberals to persist in believing something long after it has become overwhelmingly clear that the results show they are wrong.  Example:  McCain actually stated at one time that Obama’s idea of talking to Castro was ridiculous because, with his long experience, he knows that it wouldn’t work.  Excuse me!  Exactly how many more years must the embargo continue before it “works”?  That is absurd.  Why not just admit that the embargo has failed and try something new?  Liberals, who have a mind-set that entertains alternative realities, are by nature more inclined to consider other possibilities.  McCain would still be in Viet Nam.  McCain will be in Iraq for 100 years (a joke really– the oil won’t last that long and then we will go back to indifference to human oppression).  And McCain will continue to believe that through some miracle, health care costs can be reduced by letting it “compete in a free market”, as if  dying of cancer is a commodity that could be sold to a hedge fund.

For the record, I’m not sure the Canadian system couldn’t stand a few modifications, and I am very interested in Obama’s hybrid ideas.  Not sure about them– but– as a liberal– I can consider the possibility that different points of view have something to contribute to our ultimate success on any issue.  Hey George, why not be the first reasonable conservative to admit that, as a family values kind of guy, you would like to see all of the nation’s children covered, and it clearly– the results show!– isn’t happening under your free market system.

Sincerely,

Bill Van Dyk

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All of the Health Care we can Afford

A nurse recently told me that we could no longer afford our current health care system. I was just starting to think about her point when we were sidetracked by other people and other conversations. I wanted to ask her, though, what exactly she thought the solution was. She’s a nurse. She sees first-hand the health care system in action.

Our health care system here in Ontario, and in Canada, is a publicly-funded, universal, regulated system. Every citizen of Canada is covered, automatically, for all necessary health care, except for prescriptions, and experimental or unapproved treatments. That part is great. You get sick, you go to your doctor and she recommends treatments and books you into the hospital and, if you’re lucky, you get cured and get home. All without having to reach for anything in your wallet except your OHIP card.

For certain procedures, like MRI scans, you might have to wait a few weeks or months, because the system is a little over-loaded.

Some people really hype the issue of waiting periods. I personally feel we should be concerned about them, and we should try to do better, but in most cases people do receive decent treatment on time. I believe the advantages of our publicly funded system far outweigh the disadvantages of the U.S. system, which is more efficient– if you have money– but leaves about 50 million people with no coverage at all.  And by efficient, I mean quick– not cheap.  The American system is the most expensive system on earth.

For one thing, it seems logical that people who visit doctors regularly (because it’s free) will be healthier than people who don’t, and therefore, less costly over-all to the system. Pre-natal care in the U.S. is ridiculously inadequate for a “developed” country. They pay sooner or later, with the higher costs of premature births and complications.

But in the U.S., you wouldn’t have to wait for certain treatments. You could have your hip-replacement or MRI or triple-bypass immediately.

But if you got cancer, for example, your private insurance company could discontinue your coverage and you could be forced to sell your car and your home and then declare personal bankruptcy. That might sound like a harshly exaggerated scenario, but, in fact, it’s not. The largest cause of personal bankruptcies in the U.S. is catastrophic health problems. It’s not an exaggeration. It’s not.

I thought about the comment, “we can no longer afford our health care system”. What exactly is the alternative?

Think about it. Our system is expensive, and it has it’s shortcomings. But right now it provides decent care for the vast majority of people. We absolutely can afford it because right now we absolutely are affording it, and paying for it. It works.

What my friend meant was that costs are escalating so much that soon we will not have enough money to pay for all the treatments available for all the possible diseases or injuries we could ever have.

So think about this: when you get really old and your organs start failing you and your hips need replacements and your eyes are filled with cataracts and your bones are brittle and you can’t process food and you need dialysis and a respirator, and so on and so on, and nobody but nobody has the courage to “pull the plug” and we decide to keep you alive forever– then yes, it’s going to get very, very expensive. I recommend the movie “Coma” for an interesting discussion of the issue.

It is possible to spend an infinite amount of money on health care.

A very large percentage of the U.S. health care dollar is spent on people who are in the last few months of their lives. I forget the portion– was it 30%?

I think she’s right in this sense. We will have to learn, as a society, that there is a time to let go. And so far, in the entire world, it appears that the Dutch are the only people to have faced this problem squarely.

At it’s heart, our system relies on a very simple concept. Most health care problems are the result of chance or accident or diseases over which we have little control. As citizens, we band together and pool our resources and agree that if any of us becomes seriously ill, we will all contribute to the costs of making him or her better.

Since the total cost of providing health care for everyone is theoretically the same no matter how the system is paid for, the Canadian system makes a lot of sense. It makes even more sense when you realize that the government has a lot more control over costs in the Canadian system, because it can regulate doctors’ fees, and it can choose to not fund treatments that have no proven medical benefits.  The truth is, it is more efficient anyway.

The only obvious alternative– if we really can’t “afford” our system, is to drop people off the map. In other words, poor people will no longer receive health care. That has a cheeky kind of appeal to some people, but it’s never going to happen.

Or…. or you start charging people who can afford it for the health care they receive. But since these are the same people that would pay most of the taxes for a publicly funded system, I fail to see how that changes anything– except this: if you are reasonably well-to-do and you get cancer and require very expensive treatments, you are going to be impoverished. If you are really poor, you will probably be covered by some government plan.

And if you are really rich, you will be able to afford extended private insurance coverage.

But if you are in the middle, you will be screwed.