Health Care Around the World
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The Dirty Little Secret of Health Care Cost Control
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China's American-Style Healthcare Dilemma
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Canadian Healthcare Equality Meets H1N1
Understand Healthcare Reform in 2 Easy Steps
Published November 01, 2009 @ 05:00AM PT
If you’re tired of ignorant political sound bites in the healthcare debate, I have the cure. Better yet, it’s virtually free of public and private insurance discussions, with their associated pointed fingers. The film Money-Driven Medicine explores the reasons why the US spends more than twice what the next developed country does on healthcare, with terrible health outcomes. The story is told by in-the-trenches doctors, patients and their family members, a physician healthcare improvement leader, and a medical ethicist. It’s unique, highly educational and fascinating.
Join the Watch-In! for America’s Health now through November 10 for a systemic look at what’s really driving the cost and quality of our healthcare. Find out what’s compelling our healthcare spending, and why tweaking around the edges of our public health disaster won’t change a thing. In a nutshell, our country is unique in turning patients into profit centers.
Why join the Watch-In? Because Money-Driven Medicine:
“help(s) viewers distinguish between structural change and sham reform. It will convince them that a sound, sustainable medical infrastructure is crucial not just to their personal futures but to the economy and society as a whole – why curing America’s healthcare crisis could be a matter of national life and death.”
I couldn’t have said it better myself. Make a pledge to join the Watch-In! for America’s Health today. Of course, if you can stand more discourse on the insurance industry and public versus private insurers and providers, read and watch on.
I made the mistake of watching T.R. Reid’s special, Can We Really Fix U.S. Healthcare?, about his experience exploring international universal healthcare systems, the night before the House revealed its new bill, HR 3962. As a result, I’m feeling a bit underwhelmed by Nancy Pelosi’s hard-fought victory. The LinkTV special is a summary of Reid’s book, The Healing of America, which explores both the how and the why of these healthcare systems. It’s an excellent primer on the 4 main types of healthcare systems, distinguished by who pays for and who provides the care. Watch it and be both entertained and sobered simultaneously, when you consider how far we have to go to even catch a glimpse of the best ones on the horizon.
Reid is also the creator of PBS’ special Sick Around the World, which gives an excellent summary of 5 international universal healthcare systems. No, it’s not just theory: he took his injured shoulder around the world with him, to see how each healthcare system would treat it.
But remember, before you click over to Reid’s insurer-patient-provider view of true developed nations, join the Medicine For Profit Watch-In for a refreshing, insurance-light look at some root problems in American health "care". Thanks to Change.org member CherokeeGirl for Change, who alerted me to both very worthwhile programs.
Photo http://farm4.static.flickr.com/3174/2689975613_187194cdaa.jpg //CC BY 2.0
Faulty Math in CBO Senate Healthcare Bill Analysis
Published October 08, 2009 @ 06:00AM PT
Well, the CBO definitely got one thing right in its financial analysis of the Senate Finance Committee’s health bill. In commenting on Kent Conrad’s nonprofit co-op idea, it wrote that they "seem unlikely to establish a significant medical presence in many areas of the country." I already shared my opinion on co-ops as destined-to-fail recycling attempts.
Other than that, though, here is their 10 year breakdown of the bill:
- Cost: $829 billion
- Benefit: $81 billion in reduced federal deficits
- Coverage: Increase from 83% to 94% of Americans
- Uninsured Reduction: 29 million
- Missing: $200 billion in Medicare physician payment increases
- Risk: 15% low-income subsidy cuts to abide by Obama’s budget-neutral failsafe mechanism
The SFC bill’s lower cost sent House Democrats scrambling to reduce HR 3200’s cost under the $900 billion limit set by the president, even though their plan would cover 8 million more people than the SFC’s. Part of their strategy may be to move 7 million low-income individuals onto Medicaid instead of providing subsidies for private insurance.
Which brings me to my point. They realized something most of us haven’t. Much of the budgeting exercise has been based on faulty math because the largest cost factor is an unknown – private insurance costs. Higher education provides a useful, though painfully similar, example.
"I Think Your Mom Probably Did": The Best of the Weekend
Published September 27, 2009 @ 10:46PM PT
Every weekend, I share my three favorite videos or stories that helped enhance my own understanding of the health care debate. In Washington, the focus is almost entirely on the machinations of the Senate Finance Committee, the House’s preparations for a full floor debate, and the looming question of what package can or will survive in the Senate. But with such a focus on the politics, there’s not quite enough on the policy. Luckily, the first two articles helped me fill in the gaps.
1.) Kaiser Health News, “Canadian Doctor: Dutch Health Care System Could Work In U.S.”
Dr. Robert Ouellet, until recently the president of the Canadian Medical Association, was also recently on a fact-finding mission to several European countries to assist the Canadian government in finding ways to improve their own universal health care system. This interview really has it all – musings on where the American health care system needs to go, comparisons to the Netherlands and several other countries, and myth-busting about the much-maligned Canadian system.
As mentioned before, those looking to blacken the name of Canadian medicine need to spend more time talking to Canadian doctors.
Q: In the United States, we’ve heard a lot of negative things said about the Canadian health care system. How do you respond?
A: First, people are not dying on the streets in Canada. I think there is a lot of exaggeration in what we have seen in the ads in the United States about the Canadian system. We have a problem of access and we want to fix that, that's for sure. We're not denying patients care because they don't have money. We have good quality. Many doctors, I am one of them, went to the United States for training. So it's not fair to say our system is so bad. That's not true.
Q: Would the United States be well-advised to adopt some of the Canadian ways of doing health care?
A: I think so. The most important thing for us is to keep our system universal. If it is one value that you want to import, that's fine. But it doesn't mean you need to import all [of our system] because it won't work in the States. And it's the same for us. You have good things in your system. But we don't want to have your system here in Canada. This is why we went to some European countries, to look at something different. And the first value we were looking for is universal access.
Read the whole interview at Kaiser Health News.
2.) The New York Times, “Medicare Scare-Mongering”
If we’re having a health care debate, then it must be time for someone somewhere to be darkly warning that Medicare is about to face massive debilitating cuts! If I was a senior citizen, I'd be ticked that my presumed gullibility had become such a political target. As this New York Times editorial illustrates, the reality is that a major goal of health care reform is to strengthen the Medicare program to increase its solvency and quality.
What the Republicans aren’t saying -- and what the Democrats clearly aren’t saying enough -- is that in important ways, coverage for a vast majority of Medicare recipients, those in traditional Medicare, should actually improve under health care reform.
The House legislation, the only bills in near-final form, would reduce and ultimately eliminate a gap -- the so-called doughnut hole -- in Medicare drug coverage that currently forces more than three million beneficiaries to pay for drugs entirely out of their own pockets once they hit specified spending levels. That would also benefit many other beneficiaries who pay high premiums for coverage in the gap that they never end up using.
The House bills would also waive deductibles and co-insurance for preventive care that can head off serious illness, expand eligibility for programs that assist low-income beneficiaries and provide incentives for doctors and hospitals to coordinate care, improve quality, and lower costs. All that should benefit many if not most Medicare beneficiaries. And delivery system reforms should benefit the private plans as well.
Read the full editorial at New York Times.com
3.) Stabenow Replies To Kyl: You Don't Need Maternity Benefits, 'But Your Mother Did'
My favorite video from the Senate Finance Committee mark-up (with a big h/t to Igor Volsky over at Think Progress). Once again, a conservative member of Congress is making the case that legislatures should not create minimum standards for coverage (a la, a mandate). I don’t buy that argument, but if you’re going to make it, I’d avoid citing a class of medical care that half of the population had an excellent chance of needing at some point in their lives.
Plus, it’s basically a video of a United States Senator making a “Your Mama” joke. What’s not to love?
The View of American Health Care from Canada and China
Published September 16, 2009 @ 07:28AM PT
If it’s time to debate reforming an American health care system that leaves too many behind, bankrupts individuals, businesses and bust government budgets, and doesn’t yield results commensurate with what we’re paying for it, then that must also mean it’s time to beat the crap out of other countries' health care systems! All politics is the same, I suppose. When you’re running behind, distract by going negative on your rivals. But what’s good for the goose is good for the gander. Other countries are talking about our health care system as well -- and not in a good way.
For example, China is not at all amused at our big spending on health care. As gets frequently mentioned, China has purchased a significant portion of the American national debt. That debt outlook has been looking worse for years, increasingly because of the three-times-the-rate-of-inflation march of our health care costs. But as the current efforts to begin to rein in costs has hit a bumpy patch, the country holding a large share of our debt is moving from concerned to alarmed. So much so that Chinese officials grilled White House Office of Management and Budget Director Peter Orszag on a recent visit to the White House. The topic: health care costs and how our efforts at reform are looking.
With nearly half of their $2 trillion in foreign currency reserves invested in U.S. bonds alone, the Chinese are understandably concerned about our creditworthiness. And this concern has brought them ineluctably to the issue of health care. "At some point, if you refuse to contain health care costs, you'll go bankrupt," says Andy Xie, a prominent Shanghai-based economist, formerly of Morgan Stanley. "It's widely known among [Chinese] policymakers."
Not encouraging words from a country that gets colloquially referred to as “America’s banker.”
Meanwhile, Canadian political scientist Jonathan Malloy penned a witty editorial entitled, “The Health-Care Debate, Up North.” Have Canadians’ psyches been damaged by the tough talk in advertisements from know-nothings like Rick Scott of Conservatives for Patients Rights? Not at all, suggests Malloy. In fact, it seems to have boosted national confidence: “Every Republican fulmination against Canadian health care gets big play in the Canadian media, because it reinforces our sense of difference with the States. (When Democrats criticize our system, we're hurt but keep quiet.)” While conservatives in the U.S. are blasting Canadian health care -- despite the fact that the proposal on the table bears scant resemblance to Canadian health care -- conservative Canadians are joining progressives to blast American health care.
The slogan “An admitting nurse doesn't check your credit card -- she checks your pulse” might not be as catchy as “Don’t put senior citizens to death,” but there are two sides to every story.
(Photo credit: http://www.flickr.com/photos/jeffsand/ / CC BY 2.0)
American Health Care Is Number 37 (and Proud!)
Published September 12, 2009 @ 12:22PM PT
Not since the immortal “Boyfriend with Heath Benefits” has someone made an argument for reform that is not only substantive but also eminently danceable. More rock & roll than R&B, “We’re Number 37” provides just about the funniest commentary I’ve seen on the 2000 World Health Organization ranking of health care systems that found France to be #1 and the U.S. health care system to be, yes, #37.
As Tom Daschle famously said, “If we came in number 37 in the Olympics one year, there would be a huge uproar.” Yet not only are we largely ignorant of our medical mediocrity, some of us are fiercely proud of it.
I actually prefer not to use the WHO ranking because it doesn’t even tell half the story. It doesn’t mean that every medical procedure and quality measure is 37th. For example, the U.S. invests a lot more and has a better track record for early cancer screenings than most countries. If you want to find your own personal plastic surgeon, then yes, royalty and the rich and famous will want to come get top-notch facelifts from the U.S. But the good news ends roughly there. In amenable mortality -- the statistic that measures specifically deaths that could have been avoided through medical care, especially preventative care -- we’re last among all first world countries. The Commonwealth Fund did a study of six industrial countries on access to care and found that we were last in having a regular doctor, keeping our doctor once we had one, getting care on nights weekends and holidays without going to the ER, and having unmet health care needs because of cost. And, of course, we lead the industrialized nation of the world in medical bankruptcies.
So actually, the WHO number tells you nothing. The details tell you a lot more about what’s working OK, and what urgently needs to be fixed.
But for a melodic line like this, I’ll make an exception!
Canada's Rebuttal to Our Health Care Ghost Stories
Published August 25, 2009 @ 04:17PM PT
For the country that gave us William Shatner, Wayne Gretzky, and Celine Dion, Canada sure turns into a punching bag quickly whenever we talk about reforming American health care. All of a sudden, we hear about the horrors of Canadian socialized medicine (even though, since hospitals and doctors are mostly private, Canada doesn’t even have socialized medicine – they have single-payer, which only deals with financing.) Somehow, all the scary stories – most of them debunked long ago – surface even when we’re not talking about following the Canadian model at all. Well it seems our brothers and sisters to the north have a message for us about the difference between Canadian and American health care.
It can be summed up as, “Knock yourself out – as far as we’re concerned, the joke’s on you!”
Let’s make one thing clear. The health care bills moving in Congress would leave about 160 million Americans right where they are in employer-sponsored insurance, and add about 20-30 million more people into a transparent marketplace (the Exchange or the Gateways) where they’re given subsidies to purchase insurance sold either privately or publicly. That’s the structure that people are yelling about – one that leaves maybe 160, maybe 185 million Americans in private insurance. We can and will debate that, but let’s be honest: it really looks nothing like the health care system in Canada.
What does look like Canada is the health care system that every American over 65 enjoys – and which it seems Republicans are heavily resistant to change (today, at least). Who knew there’d be so much American love for single-payer health care?
Health Care Is the Anti-Melting Pot
Published August 24, 2009 @ 11:39PM PT
Every culture has its own narrative, but few are as compelling as the American melting pot – the notion that people of different nationalities made the journey to these shores to make a better life for themselves, and enrich our culture with their own contributions. We imagine that we have learned the best parts of all cultures, and that American culture is continually evolving into a more perfect synthesis. Whether this is true or not is beside my point today. Instead, I’m struck by how so for so many people, health care is the exact opposite – if it didn’t start here, we want nothing to do with it and have nothing to learn from it.
To be clear, we’re only talking about a minority - but it's a damn loud minority. The last poll I saw on this topic was from last year, when only 45 percent thought the U.S. had the “best health care”, and even fewer thought we did the best at controlling costs. But somehow, there’s an undertone that we have nothing to learn from those outside our borders on how to make our own health care better. I was thinking this while reading T.R. Reid’s column for the Washington Post “5 Myths About Health Care Around the World.” Reid, of course, knows of what he speaks, being the lead reporter for Frontline’s “Sick Around the World,” a fascinating program of firsthand explorations of the healthcare systems of the U.K., Switzerland, Germany, Taiwan and Japan. What I was struck by was not Reid’s debunking – although his section on how the Germans, Swiss, French and Japanese have freedom of choice of insurance plans and doctors the likes of which are unheard of in the U.S. should be required reading for anyone trying to make the argument that universal health care systems “ration” care more than we do today in the U.S. – but by his synthesis.
Peppered throughout his column are throwaway references to mental health approaches in Austria and Germany; the miniscule wait times that put even ours to shame in Germany, Britain, Austria and especially Japan; a streamlined bureaucracy in Taiwan whose administrative costs are half that of Medicare, let alone the bloated waste of the for-profit insurance industry; and the marvels of innovation in French, British, Swiss and, yes, even Canadian health care – creating techniques and pharmaceuticals that are now in broad use on our shores. Reid even points out that it shouldn’t be difficult to take the best of what works – after all, we already have so many elements from other countries in use already:
In many ways, foreign health-care models are not really "foreign" to America, because our crazy-quilt health-care system uses elements of all of them. For Native Americans or veterans, we're Britain: The government provides health care, funding it through general taxes, and patients get no bills. For people who get insurance through their jobs, we're Germany: Premiums are split between workers and employers, and private insurance plans pay private doctors and hospitals. For people over 65, we're Canada: Everyone pays premiums for an insurance plan run by the government, and the public plan pays private doctors and hospitals according to a set fee schedule. And for the tens of millions without insurance coverage, we're Burundi or Burma: In the world's poor nations, sick people pay out of pocket for medical care; those who can't pay stay sick or die.
I suppose that’s the problem with turning our back on a “melting pot” vision of health care in favor of a notion that because we’re the only ones who make a profit based on denying care to those who need it and by measuring success not as the best health but the most expensive care, only we have “figured out” how to do health care best. That may be many things, but “then envy of the world” it is not.
(Photo credit: Mike Licht, NotionsCapital.com on Flickr.)
