Posts by Gillian Hubble
-
Senate Health Bill: Less, Later, and Holy Complexity Batman (P2)
-
Senate Health Bill: Less, Later, and Holy Complexity Batman (P1)
-
The Prescription for Revolutionary Healthcare Delivery Reform
5 Steps to Get Americans on Board With Health Reform
Published November 18, 2009 @ 06:00AM PT
The latest AP poll repeated the same tired trends in public healthcare reform sentiment. We are generally for it, until pollsters start presenting aspects as trade-offs. Once they hit one that resonates with one of us, we will promptly be against reform. We really can’t help it. As Change.org members regularly point out, we’re not a country that values solidarity, social worth or even basic human rights when they interfere with profits and self-interest. The United States is the nation of Me, not of Us. So, given we are unlikely to change our basic fabric any time soon, how do we get the public on board with meaningful healthcare reform?
I have the solution, and all it takes is 5 simple steps in public education. Before any of our brethren is allowed to answer another popular opinion poll regarding healthcare reform, they will be required to dig up one simple piece of information and digest 4 more. Follow these steps, and I predict a 99% "for healthcare reform" rating in the next poll.
How to Shame Senate Healthcare Obstructionists
Published November 17, 2009 @ 06:00AM PT
Remember Rachel Maddow announcing a 3-prong Democratic strategy to get healthcare reform passed last month? The audacious “shame them, demote them, and do an end run around them” strategy seemed lifted right out of the Tea Party sensationalistic playbook. The basic approach was to 1) do good while shaming those Congressional representatives who would deny their constituents affordable healthcare, 2) relieve obstructionist Democrats of their committee chairmanships, and 3) use reconciliation as an end run around Republican obstructionism. Well, we haven’t heard much about demotion and reconciliation lately, but the shame part is full steam ahead.
Yes, we’ve asked thousands of times for his removal, but Joe Lieberman’s Senate Homeland Security and Governmental Affairs Committee Chairmanship seems sacred to his Democratic Senate brethren. Even though Lieberman is an Independent, his obnoxious pro-filibuster stance against anything to do with a public option deserves a quick and decisive amputation from his leadership position. Ain’t going to happen, apparently.
Perhaps it’s because, if they are anything like their House counterparts, Senate Democrats knowingly have a tremendous amount of conflict of interest in their policy positions (see Change Congress’ video on Lieberman and Evan Bayh for examples.) Did you see that Genentech managed to insert its pre-scripted language into the House “debate” register via 42 Representatives? It was bipartisan representation too – 22 Republicans and 20 Democrats parroted Genentech’s positions. That’s disgusting.
4 Potential Healthcare Roadblocks in the Senate
Published November 16, 2009 @ 06:00AM PT
What can we expect on the Senate healthcare reform front this week? Besides the usual political shenanigans, I mean, like John McCain telling a bunch of his constituents to tear up their AARP cards because AARP supports the House bill (so proud to live in Arizona.) Well, here is a hint. The Senate may win one of those ‘last runner to cross the finish line’ awards, after its members take many byzantine detours along the way. After seemingly falling into a black hole last week, the Senate’s drafting and debate over its combined healthcare bill won’t be making up any time. Insiders don’t expect a test vote before Thanksgiving, making a bill before Christmas a very faint possibility. So why is that?
There are 4 big issues Harry Reid needs to negotiate around:
Lies, Damned Lies
Published November 14, 2009 @ 11:00AM PT
Many of us acknowledge that the passage of HR 3962 last Saturday was not an altogether positive thing. The bill does provide consumer protections not currently available, and will expand coverage to many currently uninsured. But it also mandates a captive market for private insurers and provides an exceptionally weak public option that’s expected to cover 2% of the population and cost more than outrageously expensive private coverage. Worst of all, Stupak's last minute amendment strikes down women’s rights as a trade-off for universal healthcare coverage. It’s ugly. Not as ugly, however, as the Republican lies that tried to defeat it.
5 Healthcare Lessons in Possible Grocery Workers’ Strike
Published November 13, 2009 @ 06:00AM PT
Whether or not United Food and Commercial Local 99 workers will walk off the job at 6pm today due to contract disputes with Arizona Fry’s and Safeway grocery stores, there are healthcare lessons hidden in the saga. The union has had contract disagreements with management over many salary and benefit issues for a year now, but the main stumbling block is healthcare. More specifically, the disagreement is over “free” healthcare. Welcome to American healthcare drama, union-style.
Until now, the companies have paid all healthcare premiums for their workers. Now they are asking individual workers to pick up $5 per week in premiums, married workers to cover $10, and workers with family coverage to pitch in $15. That’s extremely small potatoes in the world of super-sized US healthcare costs. But for the hourly workers this union represents, including checkers, stockers, meat cutters, and produce workers, it’s not insignificant. For those like a friend of mine who has worked for Fry's for 20 years, is eligible for a pension next year, drives a Porsche convertible and plans to retire with a small beach-based business in the tropics, it actually is insignificant. Plus it doesn’t apply to him (see Lesson #3.)
How NOT to Measure Healthcare Quality
Published November 12, 2009 @ 06:00AM PT
Guess what? Only 1% of hospitals are below average! At least that’s how chairmen of non-profit hospital Boards of Directors see it. Apparently they live in Garrison Keillor’s Lake Wobegon, where all the children are above average. Patients, well, we live in real towns. If you ever wondered why hospitals were such dangerous places to be, we can now give you a big hint.
Of 722 hospital chairmen surveyed in a Harvard study, 99% thought their hospitals performed as well as average. The scariest finding is that fully 100% of hospital chairmen for hospitals that perform the worst think their hospitals perform at least as well as average or typical hospitals. Ironically, that means the 1% who thought they were below average actually underestimated their hospitals. But that still leaves an incredibly significant number of chairmen who seem to live in an alternate universe.
China's American-Style Healthcare Dilemma
Published November 11, 2009 @ 06:00AM PT
As we wait for the CBO to score the special interest-heavy Senate healthcare bill so the wheels of reform can begin to slowly grind again, it’s nice to know the country that owns the US now finds itself in a similar healthcare situation to ours. Largely because it followed our capitalistic, private-enterprise lead, China – which owns the largest share ($797 billion) of the US $3.4 trillion publicly-held debt – has a healthcare system in disarray. While some of the details are different, the themes are eerily familiar. No, we aren’t alone, but we might learn something from China’s dilemma.
China’s now diversified economy has left 300 million and counting of its 1.4 billion residents to rely on a porous government insurance program that only pays 60% of hospital bills. For medication and outpatient services, people have to fend for themselves. Although the government sets prices for all medical services and doctors’ salaries, when per capita income is about $5,000/yr it doesn’t leave people much to pay for healthcare. Take retired hydropower worker Shen Baohou, whose stent implants totaled $15,000.
Before 1980, when market reforms began, state-owned companies offered lifetime care to China’s residents. The benefit was one among many, including education grants and pensions. Chinese National Petroleum Corporation actually owned 50 hospitals to which it sent its 1.5 million workers. Then the workforce aged, retired, and required more expensive care. But younger workers went to work for private companies, leading to highly divergent risk pools. In 1981, 71% of Chinese had access to state health facilities; in 1993, only 21% did.
In 1994 China tried city insurance pools (200 million people are now enrolled) and separated hospitals from company ownership. It used a 6% employer tax and a 2% employee tax to pay for care. But medical inflation greatly outpaced wage and tax inflation. In 2005, people’s out-of-pocket expenses were 100 times what they were in 1980.
So in 2003, the government allotted more money for rural health cooperatives and gave farmers subsidies to buy insurance. Though the program covers 25-30% of hospital care and little outpatient care, 850 million people are enrolled. In 2007 China extended the program to urban workers; 120 million signed up. Some areas provide additional subsidies, and people can buy private insurance policies, if they can afford them. But their benefits are only good where they live – if they travel, they are officially “out of network.”
There is also a growing gap in quality of care. At Peking University People's Hospital there are electronic medical records, GE scanners, elite doctors and a fancy ward where the wealthy pay a princely sum for private suites. Community clinics, on the other hand, in both cities and rural areas, tend to be understaffed and poorly equipped. Worse, Beijing resident Helen Ye says people go to the clinics for colds, “but we don't trust the doctors because they are all being paid by the drug companies and so they over-prescribe. So most Chinese people, if they don't feel really sick, do home treatment and try to cure themselves."
China has an American problem that thankfully doesn’t involve as many profit-driven middlemen as ours. But it’s a lot bigger. What are they going to do about it? Frankly, Chinese leaders don’t know what to do. Some policy experts like economics professor Gordon G. Liu at Beijing University's Guanghua School of Management encourage letting the rich pay more for care, so doctors would work harder to get paid more. This theory relies on rhetoric that more doctors mean more care even for the poor, who can’t pay for it. Better yet, invite Kaiser Permanente to build hospitals in China, bringing in foreign investors. Other experts believe Liu’s theories would lead to doctors seeking out rich patients and ignoring the poor (do you think?)
So the State Council has set up pilot projects in multiple cities, and expects the experts to report back in three years. Some pilots will free up doctors to work at for-profit ventures, some will transfer them to community clinics without losing their government jobs, others will stick to the government-run model of fixed salaries but expanded care. The US could learn from this approach. Our leaders tend to sit on their hands, debating and spreading academic or just plain political rhetoric while some cities, states, and Medicare programs take the initiative. Instead, as a nation we could Get Off Our Buts, as the Roger and McWilliams book says. We just might come out ahead of China.
Photo http://lh4.ggpht.com/_jmb8njXy57I/STAk4D3rz9I/AAAAAAAABow/QxIHHHB-Fuw/s720/DSCF4668.JPG // CC BY 2.0
