Will Blog for Food

"Restless Vagina Syndrome": Big Pharma's Newest Fake Disease

By Terry J. Allen, In These Times. Posted November 3, 2009.

The pharmaceutical industry wants you to think that if you don't have sex like a porn star, you're in need of their drugs.

It’s not your fault, ladies (and certainly not your partner’s), that you don’t orgasm every time you have intercourse, or that you lack the libido of a 17-year-old boy. You have a disease: female sexual dysfunction (FSD), and the pharmaceutical industry wants to help.

You are among the "43 percent of American women [who] experience some degree of impaired sexual function," according to a Journal of the American Medical Association article. The FDA’s evolving definition of FSD includes decreased desire or arousal, sexual pain and orgasm difficulties -- but only if the woman feels "personal distress" about it.

So, convincing women to feel distress is a key component of the drug company strategy to market a multi-billion-dollar pill that will cure billions of women of what may not ail them.

By promoting the belief that "normal" women have explosive sex all the time, BigPharma helped launch the disease. However, the FDA has yet to approve a treatment for women who fall short. Until then, they could try the Orgasmatron: a dial-a-delight spinal implant that rarely works -- and risks infection and paralysis. Or, for $60/month, pop LexaFem pills -- containing (how-could-it-not-work) "horny goat weed extract" in order to "feel like a real woman today." Its website promises, "You won’t ever feel unhappy again with LexaFem in your arsenal."

But the big swinging dicks of global FSD marketing (and off-label marketing) are Pfizer -- whose stop-gap strategy is selling women Viagra based on the fact that it works for men, and Procter & Gamble (P&G), which, using the same logic, has put its money on testosterone.

Viagra’s failure in trial after trial to work on women has not stopped doctors from writing 1.4 million off-label prescriptions. FSD is "a classic example of starting with some preconceived, and non-evidence based diagnostic categorization for women’s sexual dysfunctions, based on the male model," said John Bancroft, director of the Kinsey Institute, in an interview with BMJ (British Medical Journal).

No drug follows the male model more literally than testosterone. Despite FDA refusal to approve P&G’s testosterone patch Intrinsa, U.S. doctors wrote 2 million off-label testosterone prescriptions in 2007. Like Pfizer’s little blue pill, the Intrinsa patch doesn’t really work for women. No wonder: Researchers don’t even know what constitutes a "normal" female testosterone level, and women with low levels of the hormone are as likely as those with high levels to be happy with their sex lives. And as filmmaker Liz Canner shows in her excellent new documentary Orgasm, Inc., (www.orgasminc.org), testosterone is usually teamed with estrogen, which increases risks for stroke, cancers and dementia.

The companies and clinics that narrow the range of sexual normality to porn industry standards suffer their own disease. Symptoms include: a compulsion to concoct illnesses and then develop drugs to treat them, and vice versa. Either way, the syndrome is typically accompanied by a rash of conflicts of interest.

A Pfizer survey in Malaysia found that Malay women are even more diseased than their American counterparts, with "69.6 percent experiencing some form of FSD," according to the Journal of Sexual Medicine, which also published an industry-supported supplement on FSD. Journal editor and urologist Irwin Goldstein denies a conflict of interest. "Science is science," he says. "It comes down to the bottom line. What the data shows, the data shows." Actually, no. Drug company-funded studies are more likely than independent studies to find the new drug superior to the old. Perhaps the bottom line Dr. Goldstein refers to is his income as a paid consultant for drug companies, including P&G and Pfizer.

Goldstein established an FSD clinic with Dr. Jennifer Berman, who now heads a Beverly Hills clinic and appears on Oprah. As one of the health professionals on a 1998 panel that received financial sponsorship from eight pharmaceutical companies, she helped define female sexual dysfunction. Some 22 drug companies, including Pfizer, had financial ties to 18 of the 19 authors of that panel’s report, the BMJ revealed.

"Maybe the best approach is not ineffective, over-hyped drugs with nasty side effects, but an end to disease mongering and a strong dose of comprehensive sex education," says filmmaker Canner. Her film hits female erogenous zones that pharmaceutical fixes can’t find: your brain and your funny bone. 
 

Robert Reich on Health Care/Work

Posted on Robert Reich's Blog

Sunday, November 01, 2009

Health Care Reform is Critically Important, But Getting Americans Back to Work is More So

Presidents tend to overcompensate for the errors of their predecessors in the same party and in so doing sow seeds of their own mistakes. Bill Clinton wanted above all to avoid Jimmy Carter's fate -- losing re-election because the economy was heading south on Election Day. So Clinton made a deal with Alan Greenspan to slash the budget deficit and thereby jettison much of his ambitious campaign agenda (that was Greenspan's precondition for lowering interest rates and causing an economic boom in time for the re-election) and then Clinton took direction from Dick Morris, who told him to move to the right. The result: Clinton avoided Carter's failure and won re-election handily. But the Clinton years produced few if any major social reforms. Clinton spent so much of his initial political capital, as well as his time and energy, on deficit reduction that he didn't have enough left to enact health care in 1994.

Barack Obama came to the White House intent on not repeating Clinton's failure to enact universal health care. Did he overlearn the Clinton lesson? Obama seems to have made all the right moves to enact something he can credibly label health-care reform: Rather than spend his political capital elsewhere, he reserved most of it for health care.

I sincerely hope America gets genuine health reform and I hope it's stronger than what's emerging in the Senate. (Whoever voted for Joe Lieberman last time around ought to pray for continued good health.) I worry, though, that Obama's strategy may turn out to be a mistake comparable to Clinton's overemphasis on deficit reduction. Obama's focus on health care rather than jobs, when the economy is still so fragile and unemployment moving toward double digits, could make it appear that the administration has its priorities confused. While affordable health care is critically important to Americans, making a living is more urgent. Yet the administration's efforts to date on this more basic concern have been neither particularly visible nor coherent.

The current rate of unemployment would have been even higher were it not for the federal stimulus package, but the stimulus should have been much larger. Especially with the states still cutting back on spending and raising taxes, the federal stimulus will be barely enough to keep unemployment from hitting 11 percent by the middle of 2010. Yet as the rate of unemployment continued to rise faster and higher than the White House anticipated, Obama could not return to Congress to seek a larger stimulus. He was spending political capital on health care.

The Wall Street bailout, meanwhile, has saved Wall Street but left most regional banks in deep distress. Almost nothing has trickled down. Small businesses still can't get loans. Foreclosures continue to mount largely because jobs continue to vanish and homeowners can't pay their mortgages. Yet at this point, on the eve of a health care bill, it would be difficult for Obama to return to Congress seeking billions more to aid distressed homeowners and small businesses.

While health care reform, if done right, can help American families stay afloat in the economy, the current bills won't offer most Americans any appreciable decline in the cost of their health insurance nor clear improvement in the efficiency or quality of the health care they receive, and those who will benefit won't see the benefits until 2014 at the earliest. All this is partly a result of Obama's sharpest break from Clinton -- whose ambitious health care plan drew immediate fire from Big Pharma, the American Medical Association, and health insurers: The Obama White House bought off the medical-industrial complex by promising it fatter profits, bolstered by tens of millions of new paying customers.

That and other deals cut with industry -- including promises to Big Pharma that Medicare wouldn't use its bargaining clout to reduce drug prices, to the AMA that doctors wouldn't have to face larger cuts in Medicare reimbursement rates, and to private insurers that the White House wouldn't fight hard for a public insurance option -- are likely to make the resulting reform far more costly than it would be otherwise. These extra costs will be borne by those Americans who will be required to buy insurance but won't qualify for federal assistance, along with Medicare beneficiaries who will be paying more and receiving less. These people may not know they're indirectly paying the costs of buying off these industries, but they'll know they're getting shafted (Republicans will be sure to make them aware, even though the GOP has a much longer record of shafting the middle class for the benefit of big business).

The optimist in me says Obama can pivot off a health-care victory and launch some new initiatives that palpably and quickly spur job growth. The realist says there aren't any such initiatives -- at least none that can work fast enough to reverse the tide of unemployment before the midterm elections. Fiddles such as a new jobs tax credit can help but they won't make much of a dent. Even with a larger stimulus, a jobs recovery would still be far off. The tangible benefits of health-care reform are likely to be so elusive in the meantime that the public may become easy prey for demagogues on the right who blame Democrats for the economic insecurities that bedevil the nation next November.

If Obama and the Democrats lose one or both houses of Congress in the midterms, it will be because the president learned only the most superficial lesson of the Clinton years. Health-care reform is critically important. But when one out of six Americans is unemployed or underemployed, getting the nation back to work is more so.

posted by Robert Reich | 4:55 PM

Congress Has Socialized Health Care Paid For by Taxpayers

Published on Wednesday, October 28, 2009 by Creators Syndicate

Healthcare Hypocrites

by Jim Hightower

How do you spell "hypocrisy"?

Try this: "H-Y-P-O-C-O-N-G-R-E-S-S." The hypocongress consists of those Republicans and Blue Dog Democrats who have risen up on their hind legs in recent weeks to snarl and howl at any mention of a government role in meeting America's health care needs. "Socialism," they bark — we won't allow Barack Obama and the liberals to create a Washington-run, big-government intrusion into the hallowed private market. Sen. Jim DeMint, a South Carolina Republican, even pledged to fight so ferociously that the health care battle would be Obama's "Waterloo."

What a stand-up guy for free enterprise! What an ideologically correct appeal to laissez-faire principle! And, let me add, what a crock!

What these bellicose market-purists hope you don't discover is that they are closet socialists. As members of the congressional elite, they and their families are governmentally blessed with their very own gold-plated, taxpayer-financed, Washington-run health care system. And, they loooove it.

Theirs is such an effective system that not a single member of the hypocongress has been willing to give it up — even though they surely realize the political peril of being exposed as rank hypocrites for enjoying the very program they so adamantly reject for you.

Actually, they happily take a double dip in the soothing waters of public health care. First, they enroll their entire families in the Federal Employees Health Benefits Program — and you probably would, too, if it were available to you, for it's the Rolls Royce of health plans.

For example, while even the best employer-provided health policies offer only one or two types of coverage, FEHBP is a Chinese menu, offering dozens of coverage choices that allow its lucky members to assemble a plan that meets their unique needs. Members also need not worry about being denied coverage because of some pre-existing condition — once sworn into office, lawmakers and their families are immediately and fully insured, with total access to a national network of doctors and hospitals.

But here's the sweetest part of their Rolls Royce ride: up to 75 percent of the premiums are paid for by taxpayers, many of whom are lucky if they can afford to buy an old Yugo-level of health coverage in the vaunted private market.

Well, snaps the hypocongress crowd, even if FEHBP is essentially government-paid insurance, at least it's not socialized medicine, with doctors working for the government — so, technically, we're still pure.

Ah, that raises the second bit of secret socialism that lawmakers have mandated for themselves.

Right under the Capitol dome, conveniently situated between the Senate and House chamber, is the Office of the Attending Physician. Inside are more than a dozen navy doctors, nurses, medical technicians, pharmacists and other health professionals, all employed by the government solely to attend to a select clientele: the 535 members of Congress.

Let's say that, after giving a fiery speech on the floor assailing the evils of government-run health care, a lawmaker gets gaseous or has a tongue cramp. He or she can pop right into the OAP for — yes! — some government-run health care. No appointment needed, no pesky insurance forms to fill out, no co-pay — just care.

For this, members pay a flat fee of $503 a year. A year! You and I are taxed to cover the real costs of this elite service. And that's not the end of public health benefits for lawmakers — if they need a specialist, an operation, therapy, rehab or other pricey procedure, it's all free at the government's Walter Reed and Bethesda Naval hospitals.

If it's good enough for them, why not us? The public deserves what the Congress has, and any member who opposes extending it to us should automatically be stripped of their privileges.

For a model of integrity, they might look to Sen. Sherrod Brown, D-Ohio, and Rep. Steve Kagen, D-Wis. — both of whom have rejected taking congressional coverage until everyone in America has coverage of equal quality. I don't think the noisy naysayers are looking for integrity, however — not as long as they can get away with their abominable hypocrisy.

Copyright 2009 Creators.com

National radio commentator, writer, public speaker, and author of the book, Swim Against The Current: Even A Dead Fish Can Go With The Flow, Jim Hightower has spent three decades battling the Powers That Be on behalf of the Powers That Ought To Be - consumers, working families, environmentalists, small businesses, and just-plain-folks.

Obama's Rope-A-Dope Strategy for Health Care Worked!

Finally, there will be a public option in the health care reform bill. Harry Reid is responsible for putting it in. States will individually be able to opt out, but will do so at the peril of their constituents and their jobs. President Obama, while favoring a public option, never appeared to be too concerned about it. He never made it the be all and end all of health care reform. By means of this strategy he defused the harshest criticism and deflected the right's attempt to turn the debate into a pitched battle - the perfect rope-a-dope strategy made famous by Muhammed Ali who let his opponents use up all their energy pummeling him with blows that never found their mark. Don't give the opposition the ammunition it needs as there is nothing to fight against. I always thought that the public option would be slipped in at the last minute. Chuck Schumer deserves a lot of credit for coming up with it apparently just three weeks ago.

It is so much better than a trigger since it sets the status quo as the public option, and therefore, places the burden on the states to change it whereas the trigger sets up no public option as the status quo and places the burden on government to change it. State politicians will have to think twice about opting out if the public option is wildly popular among their constituents. Politicians still have to be democratically elected no matter how much money they take from the health insurance industry. Therefore, they will think twice about opting out of a popular program. We know which states will opt out - southern states like Texas, Louisiana, Mississippi, Georgia, Alabama, North and South Carolina - blue states, states controlled by the Republican party. At the same time some of these states are among the poorest in the nation and could greatly benefit from the public option. That should  lead to a lot of interresting politics.

Just as some states rejected money from Obama's stimulus program thus denying their constituents much needed extended unemployment benefits and other help, these Republican governors and legislators will attempt to do the same with the public option. At some point though their constituents will probably rebel. Why should they stand idly by and watch their health care premiums go through the roof while in a nearby state people are enjoying the same benefits for much lower premiums? It really does put the Democrats in the cat bird seat and stand them in good stead for the 2010 elections.

But Obama would have won either way. If there were to be no public option, he could have still declared victory since he didn't make it a centerpiece of his campaign. Now he can declare victory because he always said he wanted one so he is getting precisely what he wanted. And he is on a roll thus enabling him to proceed with other much needed programs like a jobs program. There is still a way to go though. By all indications they are still a few votes short in the Senate although I don't think Harry Reid would have put it in there if he wasn't sure he could round up the remaining few votes.

But for now Democrats can rejoice. They finally had the balls to use their political power to do something the people wanted handing Republicans and the insurance industry a big defeat in the process. President Obama comes out with a tremendous victory also thus defeating all those like Rush Limbaugh who wanted him to fail. It's Obama 1, Limbaugh 0. The Republican blatherers and fulminators will have to take a back seat as well as all the lobbyists and pay off artists who attempted to use money to control the political process. Although they insisted the public option was dead, it turns out that it wasn't. Paraphrasing Shakespeare, methinks the Republicans protestethed too much, and Obama rope-a-doped them and the health insurance industry by not falling into their trap and giving them something that would have raised their hackles even more!

It's a good day for the Republic!

Health Insurance CEOs Make Millions By Denying Health Care

Playing Monopoly With America’s Health

Posted on Oct 21, 2009

By Joe Conason

Popular disgust over the fat premiums that financial executives bestow upon themselves is burgeoning, and rightly so. Those Wall Street piggy banks are filling up with billions upon billions of government-subsidized dollars.

But anyone infuriated by the grossly inflated compensation of the masters of finance should check out the incredible earnings of the top executives in the health insurance business. They’re among the most highly paid suits in the country—not owing to any skill in providing health care, which they don’t do, but because they have succeeded in denying care, quashing competition, driving up costs and winning federal subsidies for their companies.

Last year, WellPoint, the country’s largest health insurer, paid chief executive Angela Braly just under $10 million in salary, options and bonuses, along with the use of a private jet for herself and her family. That included a raise of about $750,000 over her 2007 salary.

UnitedHealth Group, the second largest, paid CEO Stephen J. Hemsley only $3.2 million last year, but in 2007 he took home $13.2 million. His biggest bonanza got away when he was forced by the Securities and Exchange Commission to surrender $190 million in falsely backdated stock options, but that was nothing compared with the nearly $1 billion in options that his predecessor was required to disgorge. The SEC declined to prosecute anyone for those frauds.

Meanwhile, the CEO of Aetna, Ronald Williams, earned $23 million in 2008, and the CEO of CIGNA, Edward Hanway, brought home a total of $120 million over the past five years, plus nearly $29 million in stock options.

Why are these insurance executives paid such obscene amounts? They might explain that they have improved the processing of claims and managing of risk—happy euphemisms for the notorious corporate practices of denying care wherever possible—or they might insist that their huge salaries reflect their challenging roles in a highly competitive marketplace.

But these companies actually exercise near monopolistic control of local insurance markets, which allows them to drive up costs and reduce access. That is the assessment of the American Medical Association, which has sponsored a series of large-scale studies of insurance markets across the country to determine whether excessive market power affects doctors and hospitals. The very notion of a competitive market and consumer choice is a sick joke in most American cities and towns, where a single health insurer predominates.

Those AMA findings amplified earlier studies dating back to 1995, which even then showed a clear trend toward concentration that has only grown worse. Over the past five years, the largest insurers have followed an imperial strategy of growth through merger and acquisition.

The buying binge has led to bloat, with WellPoint and UnitedHealth Group now covering more than 67 million individuals, or 36 percent of the total American insurance market. That is more than double the market share controlled by the two largest insurers in 2000, Aetna and United.

If the insurance executives get their way, this damaging consolidation will continue unchecked. When Braly isn’t complaining about potential competition from a public option provided by government, she tells shareholders that acquisition of smaller firms will continue to serve as “one of the key drivers of WellPoint’s future growth.”

The other significant “driver” of profitable growth for the insurance monopolies is the federally subsidized Medicare Advantage program, which overpays them by billions of dollars annually to compete with the traditional, government-run Medicare system. Originally billed as a way to reduce the cost of Medicare, that program has accomplished little except to improve the bottom line for the private insurers—and underwrite the excessive compensation of the Bralys and Hemsleys of the industry.

They blatantly curtail competition, lobby for federal subsidies, boost premiums, ration care and cut access, while insisting that a public option would cause all those terrible consequences. Obviously, they believe that the rest of us are chumps. And they may well be right.

Joe Conason writes for The New York Observer.

American Health Care: The Rich Will Live and the Poor Will Die

Published on Saturday, October 17, 2009 by CommonDreams.org

US Healthcare History: Our Very Own Killing Fields

by Donna Smith

Jenny Fritts was 24 years old. Jenny lived with her husband Sean for the past five years, and together they had a little girl named Kylee, 2. Jenny was seven-and-a-half months pregnant with her second child - a beautiful, baby girl.

Jenny is dead. Jenny's unborn baby is dead. They died because they were turned away for appropriate care at a for-profit hospital because they did not have health insurance. Sean rushed Jenny back to another hospital when her symptoms became even more severe, and he lied about having insurance to get her in the door. She was placed on a respirator in intensive care, but she didn't make it. She died. And so did her baby.

They become two more of the more than 45,000 Americans who die preventable deaths due to our broken healthcare system every year. Two more. Mother and child.

And the tragedy doesn't end there. Sean has been very depressed since he lost Jenny and their baby. The rest of his family and friends are worried about him. But he cannot get treatment either. He doesn't have insurance. (You can watch their story here: http://www.youtube.com/watch?v=td802aj-7Sc) Imagine how you might feel. Imagine.

These are our killing fields. In America. In October 2009. In Barack Obama's America. That land full of hope and promise for those who can afford that hope and promise. Yet few in our government offices react as one might think you would when hearing of Jenny and the baby and Sean and Kylee.

I read these stories every day on the guaranteedhealthcare.org website. I read them and clean up a spelling glitch or two and then post them for the world to see. The website belongs to the nurses of the California Nurses Association and the National Nurses Organizing Committee. Patients send their stories to the nurses in cascading waves of anger and frustration and desperation. They want someone to listen and to give a damn. And they want someone to help.

But there are so many. The nurses advocate for their own patients whenever they can. And when it's possible, nurses take to the streets and to the phone to try to protest. But the numbers swell every day.

Many are like Jenny and Sean and have no insurance at all or have lost their insurance when they lost jobs or because an employer cannot afford to offer it.

Some are insured and fighting insurance companies for care that their doctors have ordered.

Rich Zandlo, 38, suffers from Cystic Fibrosis and is currently surviving off just 19 percent of his lungs. Rich, who lives in Phoenix, needs a lung transplant at UCLA, but his insurer will not cover the transplant if it is done out of state.

His family is looking for help raising money to get him temporary housing and care in California so he can be available to be on the operating table when the call comes. Find out more, and what you can do to help, at their website, www.helprichzandlo.com.

Amanda (Tannery) Field, 30, has thrombocytosis and doctors are also working her up for Budd Chiari syndrome which is preventing the liver from draining properly. Simply put, her liver is dying. Amanda and her husband both work full time, and she has a 13 year old son to support. Due to the illness, she has been unable to work recently, due to the hospital stays. Aetna, her insurer, has denied help due to a lapse in coverage while she was unemployed.

Amanda's family also has a website, http://www.giveforward.org/amandafield/ where they are trying to raise the quarter million dollars necessary for a liver transplant. They have raised only 7 percent of the funds needed to be evaluated for a transplant. Doctors are currently working on a variety of interim measures to keep her alive.

So, what is our Congress waiting for? And our President? Have they so detached themselves from Sean's reality, from Rich's struggle for air and from Amanda's failing health that they think this debate is about excise taxes and re-election prospects?

This is no political contest. This is very real life and death. Mothers and babies. Young and old. The profit-takers know no boundaries for their greed, and our killing fields are filling with the innocents.

We apparently do not understand that this is no different than an external enemy attacking our citizens and killing 120 of them every single day. What would we be doing? Would we repel that aggressor? Would we protect civilian lives? I don't know that answer to that as we apparently think it acceptable to allow Jenny and her baby to die. And they were just two that day - 118 others died too just on that day alone.

The media should cover Jenny's death and her baby's death with as much intensity as any boy in a balloon drifting over the Rockies. When we are forced to confront what we are allowing to happen in homes and clinics and hospitals all across this land, we will perhaps find it less easy to dismiss as anomaly.

Healthcare is a basic human right. Whatever stops the human rights transgressions against our citizens - our Jenny's and our babies -- that allow this should be halted immediately and by force, if necessary, and then fixed properly so that all citizens of these great United States have equal protection under the law of their human right to healthcare. Immediately extending care through a Medicare for All like effort would be a less drastic but equally effective fix. A non-profit, single standard of high quality healthcare for all. Jenny would be alive today and so would her baby daughter.

Our government should grant, provide and protect the right to healthcare as if it meant the future of our nation or its failure. Because that is exactly what it does mean.

Donna Smith is a community organizer for the California Nurses Association and National Co-Chair for the Progressive Democrats of America Healthcare Not Warfare campaign.

More Lives Lost Through Lack of Health Care Than From Terrorism

Published on Monday, October 12, 2009 by the Star Tribune (Minnesota)

Of Health Care, War, Costs and Consequences

The ways Americans analyze these two policy issues are incongruous.

by David Morris

In the next few weeks this country will make two decisions of great consequence: Will we send additional troops to Afghanistan? Will we reform our health care system?

It is both instructive and disheartening to see the different ways our policymakers approach these issues.

When it comes to health care, the emphasis is on costs. When President Obama introduced his health care reform initiative, he justified it as a way to lower health care costs and help the economy. Later he pledged to a joint session of Congress, "I will not sign a plan that adds one dime to our deficits -- either now or in the future. Period."

A few days ago the Congressional Budget Office (CBO) gave health reform a green light when it concluded that the Senate bill wouldn't add to the deficit. The $800 billion additional cost would be offset, in large part by cutting spending in another part of the health care sector -- Medicare.

When it comes to the Iraq and Afghanistan wars, on the other hand, talk of costs and deficits disappears. When Obama sent an additional 21,000 to Afghanistan earlier this year, neither party discussed the cost. A few days ago the Senate voted 93-7 to fund those additional troops, bringing to $1 trillion the amount we've spent in Iraq and Afghanistan. No member of either party talked about costs. The CBO was not asked to analyze the impact on the deficit of sending additional troops. And unlike with health care reform, the Pentagon was not required to offset the increased costs of the Afghanistan war by cutting spending in other parts of the military budget.

Why do we approach these two crucial issues so differently? Some would say the answer is obvious: War is a matter of national security. It certainly is. We need to defend ourselves against our enemies. But if protecting American lives is the objective, the absence of health care undermines our national security far more than terrorism.

In the 9/11 terrorist attacks, 2,800 died. According to a study recently published by the American Journal of Public Health, that is the number of Americans who die every three weeks because of lack of access to health care. Since we intervened in Iraq, about 300,000 Americans have died from lack of health care, about the number of American soldiers killed in World War II.

Indeed, the national insecurity resulting from our actual lack of health care is far greater than the number who die from it. Tens of millions of Americans worry about losing their health insurance, or having their insurance company deny their medical claims. Medical expenses significantly contribute to about 50 percent of personal bankruptcies. In about 30 percent they are the primary factor.

We will never achieve real, effective and universal health care until we treat the lack of it as a national security issue. Perhaps we could start by adopting some of the language used to justify war. If Obama chooses to maintain or reduce current troop levels, his opponents will undoubtedly criticize him for adopting a policy of "cut and run."

Consider that the Senate health care bill will still leave 25 million uninsured. By one estimate, that translates into 25,000 avoidable deaths annually. Why then aren't we saying that when it comes to saving American lives, the Senate has adopted a policy of "cut and run"?

Health care is a national security issue. Our policymakers need to approach it that way.

© 2009 Star Tribune

David Morris is vice president of the Institute for Local Self Reliance in Minneapolis.

Lobbyists Control American Political System

Published in Salon:

Washington's revolving doors are bad for your health

Healthcare reform might be easier if so many industry lobbyists didn't once work for legislators like Max Baucus

By Bill Moyers and Michael Winship

Oct. 10, 2009 | On Tuesday, Oct. 13, the Senate Finance Committee finally is scheduled to vote on its version of healthcare insurance reform. And therein lies yet another story in the endless saga of money and politics.

In most polls, the majority of Americans favor a nonprofit alternative -- like Medicare -- that would give the private health industry some competition. So if so many of us, including President Obama himself, want that public option, how come we're not getting one?

Because the medicine that could cure our healthcare nightmare has been poisoned from Day One -- fatally adulterated, thanks to the infamous, Washington revolving door. Movers and shakers rotate between government and the private sector at a speed so dizzying they forget for whom they're supposed to be working.

If you've been watching the Senate Finance Committee's markup sessions, maybe you've noticed a woman sitting behind Committee Chairman Max Baucus. Her name is Liz Fowler.

Fowler used to work for WellPoint, the largest health insurer in the country. She was its vice-president of public policy. Baucus' office failed to mention this in the press release announcing her appointment as senior counsel in February 2008, even though it went on at length about her expertise in "healthcare policy."

Now she's working for the very committee with the most power to give her old company and the entire industry exactly what they want -- higher profits -- and no competition from alternative nonprofit coverage that could lower costs and premiums.

A veteran of the revolving door, Fowler had a previous stint working for Sen. Baucus -- before her time at WellPoint. But wait, there's more. The person who was Baucus' top health advisor before he brought back Liz Fowler? Her name is Michelle Easton. And why did she leave the staff of the committee? To go to work -- surprise -- at a firm representing the same company for which Liz Fowler worked -- WellPoint. As a lobbyist.

You can't tell the players without a scorecard in the old Washington shell game. Lobbyist out, lobbyist in. It's why they always win. They've been plowing this ground for years, but with the broad legislative agenda of the Obama White House -- healthcare, energy, financial reform, the Employee Free Choice Act and more -- the soil has never been so fertile.

The healthcare industry alone has six lobbyists for every member of Congress and more than 500 of them are former congressional staff members, according to the Public Accountability Initiative's LittleSis database.

Just to be certain Congress sticks with the program, the industry has been showering megabucks all over Capitol Hill. From the beginning, they wanted to make sure that whatever bill comes out of the Finance Committee puts for-profit insurance companies first -- by forcing the uninsured to buy medical policies from them. Money not only talks, it writes the prescriptions.

In just the last few months, the healthcare industry has spent $380 million on lobbying, advertising and campaign contributions. And -- don't bother holding onto your socks -- a million and a half of it went to Finance Committee Chairman Baucus, the man who said he saw "a lot to like" in the two public option amendments proposed by Sens. Rockefeller and Schumer, but voted no anyway.

The people in favor of a public alternative can't scrape up the millions of dollars Baucus has received from the health sector during his political career. In fact, over the last two decades, the current members of the entire finance committee have collected nearly $50 million from the health sector, a long-term investment that's now paying off like a busted slot machine.

Not that we should be surprised. A century ago, muckraking journalists reported that large corporations and other wealthy interests virtually owned the United States Senate -- using bribery, fraud and sometimes blackmail to get their way. Jokes were made about "the senator from Union Pacific" or "the senator from Standard Oil."

One reporter in particular was out to break their grip. His name was David Graham Phillips. One day in 1906, readers of Cosmopolitan magazine opened its March issue to discover the first of nine articles by Phillips titled "The Treason of the Senate."

He wrote, "Treason is a strong word, but not too strong, rather too weak, to characterize the situation which the Senate is the eager, resourceful, indefatigable agent of interests as hostile to the American people as any invading army could be, and vastly more dangerous: interests that manipulate the prosperity produced by all, so that it heaps up riches for the few; interests whose growth and power can only mean the degradation of the people, of the educated into sycophants, of the masses toward serfdom."

The public outrage provoked by Phillips and other muckrakers contributed to the ratification of the 17th Amendment to the Constitution, providing for the direct popular election of senators, who until then were elected by easily bought-off state legislators.

Of course, like water seeking its own level, big money finds its way around every obstacle, and was soon up to its old tricks, filling the pockets of sympathetic and grateful politicians.

Today, none dare call it treason. So why not call it what it is -- a friendly takeover of government, a leveraged buyout of democracy.

Outrageous? You bet. But don't just get mad. Get busy.

UnitedHealth’s Hemsley Made $57,000 Per Day Last Year

Posted by David Dayen on October 6, 2009 | 11:44 am on Sick for Profit blog.

Yesterday, 6 protesters were arrested outside UnitedHealth Group headquarters in Minneapolis for blocking the entrance and refusing to leave during a demonstration. Here’s some video of the arrests:

Watch Six Arrested For Stopping UnitedHealth “Business-As-Usual” in News  |  View More Free Videos Online at Veoh.com

Dawn Smith, the brain tumor victim who’s struggles to get CIGNA to cover her treatments have become national news, is headed to the headquarters of CIGNA CEO Ed Hanway in Philadelphia, to get some answers on why she was denied coverage. She is live-blogging the trip and has some video on her site as well.

Stacie Ritter is also headed to confront Ed Hanway at his mansion:

Health Care For America Now has transformed the main homepages of UnitedHealth, CIGNA and WellPoint into virtual crime scenes, and they are mobilizing people to visit the headquarters of all these corporate bad actors with yellow police tape and declare them actual crime scenes. There are dozens of events in over 60 cities scheduled.

It is true that these events, scattered throughout the country, have been organized by health care advocacy groups. Of course, throughout the month of August, corporate front groups organized around town hall meetings, busing in folks from out of town and preparing them with talking points and rules to disrupt the events. Yet, in the eyes of the traditional media, only one of these two actions are seen as authentic:

For several months, HCAN—a national coalition of religious groups, community organizations, unions, senior citizen groups, health care professionals, and consumer advocates—has been organizing polite demonstrations, rallies, and public forums, trying to put faces on an industry that has spent multiple millions of dollars lobbying against reform, while angry protests at town meetings swelled August’s big national story. On Sept. 22, HCAN sponsored about 150 demonstrations at various insurance company headquarters around the country. The Los Angeles Times did not bother to report about the several hundred demonstrators at WellPoint’s California subsidiary office, located a few blocks from the newspaper’s office. Nor did The Philadelphia Inquirer note those who descended that day on CIGNA, nor The New York Times those outside UnitedHealth in midtown Manhattan.

The HCAN rallies did attract print and broadcast coverage in dozens of cities, but most reporters treated them as isolated local events rather than components of a nationally coordinated protest (its slogan, “Big Insurance: Sick of It”) and a burgeoning grassroots movement [...]

With Congress debating extensive health care reform, and companies like CIGNA, WellPoint, and UnitedHealth major protagonists, the organizers supposed that their protests would dramatize the exorbitant profits of the insurance industry and the imposing compensation they pay top executives (UnitedHealth’s Hemsley made $57,000 per day last year) while millions of Americans go without insurance or bankrupt themselves with medical bills.

HCAN was mistaken.

“At a certain point,” Indianapolis Star senior editor Jenny Green told us, the demonstrators are “not adding to the debate. They’re just one side saying exactly what you’d expect them to say.”

Her colleague, Greg Weaver, the Star’s deputy public service editor for business, maintained that the raucous town meetings of August, dominated by conservative activists shouting down Democratic Congressmembers, were newsworthy because they “are more of a public forum where you have many sides of the debate, whereas at the [HCAN] protest [at WellPoint CEO Bray’s house] you have only one side of the debate.”

“I did not think the protest at [Cigna CEO] Hanway’s house was news,” Philadelphia Inquirer business reporter Jane Von Bergen told us. “It was a staged event. It wasn’t real news. I avoid them. I can’t stand them. They don’t add anything. They don’t teach anything. If they go to his house, we don’t learn anything more about the health care debate.” The protest was “too manufactured,” said Von Bergen. “Just a bunch of people going blah-blah-blah.”

By contrast, said Von Bergen, who covered the rowdy town meeting in August where right-wing activists confronted Sen. Arlen Specter, the news value of that event was “readily apparent.” “It involved public figures”—members of Congress. So political reporters picked up the story.

Isn’t Hanway a public figure? we asked. He’s well known in the business community, she said, but not among the general public—a condition that HCAN is trying to change, but can’t do if the media won’t cover their events.

This is a revealing set of quotes, showing the true orientation of corporate-run media. They are willing to blind themselves to the corporate front groups who organize town hall meetings, but call demonstrations of insurance companies “staged events.” This is not the work of a neutral arbiter in the debate; it looks more like one class is being protected while the other is being savaged.

I don’t know what the value of street protests are in the digital age. But I certainly know they have little value if they go unreported. Apparently such protests can get coverage, but only if they feature people with tea bags attached to their hats and guns in their side holsters.

Canadians Prefer Their Health Care System to US'

Published on Tuesday, September 15, 2009 by Globe and Mail

An Inconvenient Truth for the GOP: Canada's System is Better

by Eugene Lang and Philip DeMont

It is rare for Canada to get noticed in the United States. In fact, it is almost unprecedented for anything Canadian to be the focal point of debate in Washington. Yet we have seen just that in recent months during the congressional wrangling over U.S. President Barack Obama's attempts to reform health insurance.

Canada's medicare system has suddenly been thrust into the spotlight south of the border. It has been pilloried by the Republicans in Congress, the subject of derisive and distorted television advertisements, described variously as a system of medicine by bureaucrat, a statist form of health care afflicted by gross inequities and inefficiencies, one that pales in comparison to the U.S. model. The hysterical tone of the anti-medicare rhetoric among Republicans would make one think Canada is North Korea.

But there is an inconvenient truth that the Republican ideology cannot dispute. Canada's approach to providing citizens with universal health insurance is superior to the U.S. model of private insurance. When we get beyond the anti-medicare ideology and histrionics on Capitol Hill, we can establish this by reference to four basic numbers that give a good sense of our system versus the system in the United States.

Life expectancy is a basic measure of the quality of health care. In the U.S., a citizen will live 77.8 years on average. In Canada, you can expect to live two and a half years longer (80.4 years). Infant mortality is also a vital indicator of health care. In the United States, 6.37 infants die out of every 1,000. In Canada the number is 5.4 out of a 1,000.

But what about the cost differences of the two approaches to health care? Surely our Leviathan-like system, which produces such enviable results, must cost a fortune relative to the U.S. model.

The best measure of health care costs is the percentage a country spends relative to the size of its economy, or its gross domestic product (GDP). Canadians spend about 10 per cent of GDP on health. Americans spend 16 per cent to achieve inferior results on life expectancy and infant mortality.

Finally, it is estimated that there are somewhere around 40 million Americans – about 12 per cent of their population, well in excess of the total population of Canada – who have no medical insurance whatsoever. These unfortunate people are literally on their own in paying for any and all medical treatments they require. That gap in coverage is staggering, making the United States an outlier among all advanced Western nations.

One might ask how many uninsured citizens exist in Canada? The answer is zero – all Canadians are insured. In this country, good-quality, universally accessible medical care is regarded as a basic element of citizenship, kind of like owning a gun is in the U.S.

So to sum up. We live longer than the Americans do. We are less likely to die at or soon after birth than the Americans are. All Canadians have medical insurance, whereas a huge number of Americans don't. And we pay less as a society for health care than they do in the United States. Four numbers paint a stark picture. And when you strip away the anti-medicare ideological rants and falsehoods on display in Washington, Canada's approach to health insurance would probably sound pretty good to many Americans.

To their credit, by putting public insurance on the table as a supplement to private plans, the Democrats in the U.S. Congress are trying to drag the United States into the club of civilized nations when it comes to health care. We've been in that club since the establishment of medicare more than 40 years ago.

Don't get us wrong here. We are not saying medicare is perfect; it is far from that, and it requires constant improvement, as most Canadians understand. But it is not a bad deal for citizens of this country.

The Republican-led anti-medicare lobby in Congress knows these numbers and facts. But they are regarded as inconvenient truths that must be ignored in the crusade to discredit the Canadian approach to health insurance, to ensure no public option creeps into the U.S. system. Anti-government ideology is running amok in Washington, trumping facts and rational debate, distorting one of the most important public policy issues the United States has grappled with in decades.

Ultimately, the U.S. public will pay the price for that.

© 2009 Globe and Mail

 

Eugene Lang is a former senior economist at Finance Canada. Philip DeMont served as a senior policy adviser to Ontario's health minister.

Frank Thomas on Health Care

As you know, I attribtute the major causes of our exceptionally high provider costs primarily to the following:

(1)  According to Joel A. Harrison´s 2007 study, over 1,500 different companies spread over 50 states are offering a multiple of private heath insurance plans with high deductibles and premiums for less than 100% Basic health care coverage.  Each firm has its own marketing program, advertising, CEO salaries, sales commissions, enrollment procedures, paperwork and policies, medical procedure coding techniques, and other non-clinical costs ... on top of state-by-state regulations disallowing the insured or to-be-insured to go outside the state for a better deal. When you add to this an ineffective, non-transparent, non-standardized  Performance Metric reporting state-by-state and locally, and no common coding-definition of medical procedures /drug prescriptions, you have a multi-faceted FRACTIONALIZED system that is wasting over $250 billion annually just in Administrative costs. You have a system where an appendix operation may have a myriad of different prices in any one state and certainly a huge price variation over 50 states (not improved in any way by an effective exchange of comparative best practices).                                                                                                                                

Granted, as you say, that of the 1500 insurer firms, the top 20 probably dominate directly/indirectly over 50% of the business (haven´t seen any good data on this). This means two things are happening (a) the large insurers are closely copying each other´s premiums regionally and state-wide -- thus acting as an oligopoly. The larger firms are not using their leverage to lower provider costs-improve provider quality but focus instead on the better-insured and purge the sick-prone, and (b) the hundreds of smaller insurer firms do not have a balanced actuarial base, i.e., a sufficiently broad group of people for a proper risk pool of relatively healthy vs. more unhealthy enrollees, thereby driving up premiums/deductibles.  Or, alternatively, they purge the sick-prone leaving a very favorable balance of less-sick enrollees to whom they can offer relatively more costly Basic-plus plans and premiums. As mentioned in last post,  the large Non-Profit hospitals are in the Profit business in a BIG way. They are doing less and less for the relatively poor Uninsured and Underinsured and for the Community as required under their Tax Exempt status. 

All this nation-wide, in effect, compounded Uncompetitive system dysfunctions have been Driving Up costs for quite some time and grossly Disincentivizing the over 2700 non-governmental hospitals and related doctor professionals from becoming more cost and quality effective. So odds are stacked against Households and Individuals ever having competitive, reasonable health insurance premium charges (in recent years escalating unsustainably annually at 5 times the rate of inflation). As you and I and others have been saying so often on this blog, only a  Public-Medicare option (ideally a Decentralized Single/Payer system similar to Canada´s decentralized organizational setup)  will Shake Up the corrupt, uncompetitive Private-insurer industry sufficiently to become much more cost-quality effective concerning a Basic standard health care package. This might require More Private-insurer consolidations to achieve cost economies-of-scale and especially the proper actuarial balance in risk pools of healthy vs. unhealthy for each insurer. Of course, this will also require Tight state and central government oversight controls/sanctions for price collusion and monopoly practices. As you have noted, discontinuance of state prohibitions on local residents-employers to purchase health care coverage across state lines is a necessity to stimulate competitive forces now practically systemically non-existent in our private health care programs.

On Trojan Horses and Medicare Advantage

Medicare which is primarily government run health care has a private option, Medicare Advantage, so why shouldn't health care for everyone under 65, which is primarily private corporation run health care, have a public option for reciprosity's sake? If Medicare can co-exist with a private option competing with the public option, private health insurance for those under 65 should be able to co-exist with a public option.

Not only that but private health care corporations have gotten their tentacles around Medicare in other ways. For instance, Medicare Part B only covers 80% of doctor's bills. With some procedures running hundreds of thousands of dollars, many seniors have opted to buy supplementary insurance, which is private insurance from private health insurance corporations, to cover the other 20%. In addition to that they sell private insurance to cover drugs so the typical traditional Medicare recipient pays not only a premium for Medicare Part B but also a premium for supplementary insurance and another premium for drug insurance.

In either case the party in power will try to tilt the table towards their favorite - the Republicans toward the private option, the Democrats towards the public option. The Republicans inserted a Trojan horse inside Medicare which funnels off tax money to private health insurance corporations so why shouldn't the Democrats insert a public option alongside the private options for everyone under 65 and tilt the playing field as much as possible in favor of the public option the way the Republicans have tilted the playing field with Medicare Advantage which pays doctors more for the same procedure than does Medicare?

The Republicans know all too well about Trojan horses having created one themselves with Medicare Advantage. Medicare Advantage looks enticing to many seniors because of the perks it seems to offer that Medicare doesn't. However, they are using the same techniques of denial of service for expensive doctor recommended services. The doctors have to get approval from the insurance companies which refuse to give it for many expensive procedures even though the doctor recommends it. So the senior is left with the feeling of having been sold a bill of goods, having been enticed to buy a pig in a poke when the senior most needs the insurance. Then he or she rues the day they chose Medicare Advantage over traditional Medicare. With traditional Medicare a senior can go to any doctor or specialist EVEN WITHOUT HIS PRIMARY PHYSICIAN'S APPROVAL and surely without the approval of any government rationing board which doesn't exist.

So who does the rationing? It's the private health insurance corporations, of course, within the supposedly government run Medicare program. A Trojan horse within a Trojan horse.

The Democrats should wise up and pass health care reform without begging the Republicans for their approval. They hold the power yet they go to the Republicans hat in hand. Why? This is stupid. As for the Republican fear of a non level playing field, they are the experts in creating those. Just look at Medicare Advantage whose only real advantage is to the bottom line of the health insurance corporations.

Also posted on Robert Reich's blog.

Myths About Foreign Health Care

From Economist's View blog posted by Mark Thoma:

An attempt to "dispel a few myths about health care abroad":

5 Myths About Health Care Around the World, by By T.R. Reid, Commentary, Washington Post: ...I've traveled the world ... to see how other developed democracies provide health care. Instead of dismissing these models as "socialist," we could adapt their solutions to fix our problems. To do that, we first have to dispel a few myths about health care abroad:

1. It's all socialized medicine out there. Not so. ... In some ways, health care is less "socialized" overseas than in the United States. Almost all Americans sign up for government insurance (Medicare) at age 65. In Germany, Switzerland and the Netherlands, seniors stick with private insurance plans for life. Meanwhile, the U.S. Department of Veterans Affairs is one of the planet's purest examples of government-run health care....

2. Overseas, care is rationed through limited choices or long lines. Generally, no. Germans can sign up for any of the nation's 200 private health insurance plans -- a broader choice than any American has. ... The Swiss, too, can choose any insurance plan in the country.

In France and Japan, you ... can go to any doctor, any hospital, any traditional healer. There are no U.S.-style limits such as "in-network" lists of doctors or "pre-authorization" for surgery. You pick any doctor, you get treatment -- and insurance has to pay. ...

As for those notorious waiting lists, some countries are indeed plagued by them. Canada makes patients wait weeks or months for nonemergency care, as a way to keep costs down. But ... many nations -- Germany, Britain, Austria -- outperform the United States on measures such as waiting times for appointments and for elective surgeries. In Japan, waiting times are so short that most patients don't bother to make an appointment. ...

3. Foreign health-care systems are inefficient, bloated bureaucracies. Much less so than here. ...

4. Cost controls stifle innovation. False. The United States is home to groundbreaking medical research, but so are other countries... Any American who's had a hip or knee replacement is standing on French innovation. ... Many of the wonder drugs promoted endlessly on American television, including Viagra, come from British, Swiss or Japanese labs. Overseas, strict cost controls actually drive innovation. ...

5. Health insurance has to be cruel. Not really. American health insurance companies routinely reject applicants with a "preexisting condition"... They employ armies of adjusters to deny claims. If a customer ... faces big medical bills, the insurer's "rescission department" digs through the records looking for grounds to cancel the policy... Foreign health insurance companies, in contrast, must accept all applicants, and they can't cancel as long as you pay your premiums. ...

In many ways, foreign health-care models are not really "foreign" to America, because our ... 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...

This fragmentation is another reason that we spend more than anybody else and still leave millions without coverage. All the other developed countries have settled on one model for health-care delivery and finance; we've blended them all into a costly, confusing bureaucratic mess.

Which, in turn, punctures the most persistent myth of all: that America has "the finest health care" in the world. We don't. In terms of results, almost all advanced countries have better national health statistics than the United States... In terms of finance, we force 700,000 Americans into bankruptcy each year because of medical bills. In France, the number of medical bankruptcies is zero. Britain: zero. Japan: zero. Germany: zero.

Given our remarkable medical assets -- the best-educated doctors and nurses, the most advanced hospitals, world-class research -- the United States ... should be the best in the world. To get there, though, we have to be willing to learn some lessons about health-care ... from the other industrialized democracies.

There are, of course, groups that have a strong interest in perpetuating these myths as part of their attempt to block health care reform.

From Economist's View blog posted by Mark Thoma:

An attempt to "dispel a few myths about health care abroad":

5 Myths About Health Care Around the World, by By T.R. Reid, Commentary, Washington Post: ...I've traveled the world ... to see how other developed democracies provide health care. Instead of dismissing these models as "socialist," we could adapt their solutions to fix our problems. To do that, we first have to dispel a few myths about health care abroad:

1. It's all socialized medicine out there. Not so. ... In some ways, health care is less "socialized" overseas than in the United States. Almost all Americans sign up for government insurance (Medicare) at age 65. In Germany, Switzerland and the Netherlands, seniors stick with private insurance plans for life. Meanwhile, the U.S. Department of Veterans Affairs is one of the planet's purest examples of government-run health care....

2. Overseas, care is rationed through limited choices or long lines. Generally, no. Germans can sign up for any of the nation's 200 private health insurance plans -- a broader choice than any American has. ... The Swiss, too, can choose any insurance plan in the country.

In France and Japan, you ... can go to any doctor, any hospital, any traditional healer. There are no U.S.-style limits such as "in-network" lists of doctors or "pre-authorization" for surgery. You pick any doctor, you get treatment -- and insurance has to pay. ...

As for those notorious waiting lists, some countries are indeed plagued by them. Canada makes patients wait weeks or months for nonemergency care, as a way to keep costs down. But ... many nations -- Germany, Britain, Austria -- outperform the United States on measures such as waiting times for appointments and for elective surgeries. In Japan, waiting times are so short that most patients don't bother to make an appointment. ...

3. Foreign health-care systems are inefficient, bloated bureaucracies. Much less so than here. ...

4. Cost controls stifle innovation. False. The United States is home to groundbreaking medical research, but so are other countries... Any American who's had a hip or knee replacement is standing on French innovation. ... Many of the wonder drugs promoted endlessly on American television, including Viagra, come from British, Swiss or Japanese labs. Overseas, strict cost controls actually drive innovation. ...

5. Health insurance has to be cruel. Not really. American health insurance companies routinely reject applicants with a "preexisting condition"... They employ armies of adjusters to deny claims. If a customer ... faces big medical bills, the insurer's "rescission department" digs through the records looking for grounds to cancel the policy... Foreign health insurance companies, in contrast, must accept all applicants, and they can't cancel as long as you pay your premiums. ...

In many ways, foreign health-care models are not really "foreign" to America, because our ... 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...

This fragmentation is another reason that we spend more than anybody else and still leave millions without coverage. All the other developed countries have settled on one model for health-care delivery and finance; we've blended them all into a costly, confusing bureaucratic mess.

Which, in turn, punctures the most persistent myth of all: that America has "the finest health care" in the world. We don't. In terms of results, almost all advanced countries have better national health statistics than the United States... In terms of finance, we force 700,000 Americans into bankruptcy each year because of medical bills. In France, the number of medical bankruptcies is zero. Britain: zero. Japan: zero. Germany: zero.

Given our remarkable medical assets -- the best-educated doctors and nurses, the most advanced hospitals, world-class research -- the United States ... should be the best in the world. To get there, though, we have to be willing to learn some lessons about health-care ... from the other industrialized democracies.

There are, of course, groups that have a strong interest in perpetuating these myths as part of their attempt to block health care reform.

I Don't Want Socialized Medicine and Keep Your Hands Off My Medicare

The potential health reform legislation is so complex that not even the pundits understand it. This is partly due to decades of subterfuge by the Republicans. Take the statements by Obama that he will recover $177 billion from the Medicare Advantage program. This is probably what teed off the tea baggers who said "Keep your cotton pickin' hands off my Medicare." To compound the misunderstanding, left wing talk show hosts such as Thom Hartmann get a kick out of pointing out the ignorance of the other side when they say they don't want socialized medicine and keep your hands off my Medicare. Hartmann and others like to point out the logical contradiction in this statement because as they say Medicare is socialized medicine.

But wait a minute. Is Medicare really wholly socialized medicine? No, not at all because Republicans have inserted the trojan horse of Medicare Advantage within the Medicare program. As a result, Medicare is now both a socialized and a privatized program with new entrants being lured into Medicare Advantage which is run by private insurance companies who get payments from the government. So when oldsters say they don't want socialized medicine and keep your hands off my Medicare, this statement may not be a logical contradiction after all if what they're talking about is Medicare Advantage which sells itself as part of the Medicare program. After all it has Medicare right there in its name, and the advertising for it doesn't tell the potential enlistees that what they are getting in place of traditional Medicare, which is socialized medicine, is private health insurance.

So when we see the following in the Wall Street Journal, we have to rub our heads to ferret out the true meaning:

The biggest chunk of savings in the budget proposal, estimated at $177 billion over 10 years, would come from changing the pay structure for private managed-care plans that participate in Medicare. Under current law, payments for Medicare Advantage plans are set by a formula, and the result is that private companies are paid, on average, 14% more to care for a Medicare patient than the government would normally spend through the traditional Medicare plan.

If the old tea baggers at the Town Hall meetings have Medicare Advantage, then what Obama is proposing is to indeed put his hands on their Medicare and claw back the advantages - not to the patients - but to the insurance companies and doctors who accept Medicare Advantage patients. And in truth the private insurance companies have indeed given some advantages to the patients over traditional Medicare. For instance, most of them give the oldsters a free annual physical which traditional Medicare doesn't. Of course, Republicans are probably responsible for eliminating the free physical from Medicare in the hopes that not detecting early onset will drive costs through the roof and eventually bankrupt traditional Medicare.

The doctors are paid more for the same procedure under Medicare Advantage than they are under traditional Medicare. This is part of the Trojan horsish stuff Republicnas set up to eventually lure all Medicare participants away from traditional Medicare and onto Medicare Advantage programs which are really private health insurance programs set up by the big health insurance corporations like Aetna, CYGNA, Humana, Wellpoint etc.

So how does the average American figure all this stuff out? In reality there is no logical contradiction in the statement "I don't want socialized medicine and keep your hands off my Medicare" if you assume the speaker has Medicare Advantage. If Obama went into the details of how Republicans stacked the decks in favor of Medicare Advantage in a stealth move to eliminate government run Medicare, people's eyes would glaze over. If Obama went into the details of how doctors are refusing traditional Medicare patients but accepting Medicare Advantage patients because the private insurance companies pay more than the government does due to an unfair reimbursement by the government to the private insurance companies, (hence the $177 billion), people's eyes would glaze over.

And Obama doen't even get into how much money could be saved by eliminating Medicare Advantage altogether. He just wants payments to private insurance companies to be on a par with costs for traditional Medicare. Confused? You have a right to be.

Left wing talk show hosts will continue to snicker over the ignorance of the old lady who said "I don't want socialized medicine and keep your hands off my Medicare" while not realizing their own ignorance in not understanding that Medicare is in part a privatized program, and, if the Republicans had their way, it would eventually replace traditional Medicare.

Alaso posted on Robert Reich's blog.

No Public Option? Medicare for All Who Want to Buy In Instead!

Published on Monday, August 17, 2009 by CommonDreams.org

Dear President Obama: A Modest Medicare Proposal

by Thom Hartmann

Dear President Obama,

I understand you're thinking of dumping your "public option" because of all the demagoguery by Sarah Palin and Dick Armey and Newt Gingrich and their crowd on right-wing radio and Fox. Fine. Good idea, in fact.

Instead, let's make it simple. Please let us buy into Medicare.

It would be so easy. You don't have to reinvent the wheel with this so-called "public option" that's a whole new program from the ground up. Medicare already exists. It works. Some people will like it, others won't - just like the Post Office versus FedEx analogy you're so comfortable with.

Just pass a simple bill - it could probably be just a few lines, like when Medicare was expanded to include disabled people - that says that any American citizen can buy into the program at a rate to be set by the Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) which reflects the actual cost for us to buy into it.

So it's revenue neutral!

To make it available to people of low income, raise the rates slightly for all currently non-eligible people (like me - under 65) to cover the cost of below-200%-of-poverty people. Revenue neutral again.

Most of us will do damn near anything to get out from under the thumbs of the multi-millionaire CEOs who are running our current insurance programs. Sign me up!

This lets you blow up all the rumors about death panels and grandma and everything else: everybody knows what Medicare is. Those who scorn it can go with Blue Cross. Those who like it can buy into it. Simplicity itself.

Of course, we'd like a few fixes, like letting Medicare negotiate drug prices and filling some of the holes Republicans and AARP and the big insurance lobbyists have drilled into Medicare so people have to buy "supplemental" insurance, but that can wait for the second round. Let's get this done first.

Simple stuff. Medicare for anybody who wants it. Private health insurance for those who don't. Easy message. Even Max Baucus and Chuck Grassley can understand it. Sarah Palin can buy into it, or ignore it. No death panels, no granny plugs, nothing. Just a few sentences.

Replace the "you must be disabled or 65" with "here's what it'll cost if you want to buy in, and here's the sliding scale of subsidies we'll give you if you're poor, paid for by everybody else who's buying in." (You could roll back the Reagan tax cuts and make it all free, but that's another rant.)

We elected you because we expected you to have the courage of your convictions. Here's how. Not the "single payer Medicare for all" that many of us would prefer, but a simple, "Medicare for anybody who wants to buy in."

Respectfully,

Thom Hartmann

Thom Hartmann (thom at thomhartmann.com) is a Project Censored Award-winning New York Times best-selling author, and host of a nationally syndicated daily progressive talk program The Thom Hartmann Show. www.thomhartmann.com His most recent books are "The Last Hours of Ancient Sunlight," "Unequal Protection: The Rise of Corporate Dominance and the Theft of Human Rights," "We The People: A Call To Take Back America," "What Would Jefferson Do?," "Screwed: The Undeclared War Against the Middle Class and What We Can Do About It," and "Cracking The Code: The Art and Science of Political Persuasion." His newest book is Threshold: The Crisis of Western Culture.

Health Insurance Giant Corporations Extract Billions in Profits, Pay Executives Millions in Salaries and Bonuses, While Denying Health Care to Customers

The Health Insurance industry has concentrated and consolidated in recent years to form an oligopoly which is controlled by five giant corporations: UnitedHealth Group, Wellpoint, Aetna, CIGNA and Humana. Don't be fooled by the varioous names of companies purporting to sell health insurance which would indicate diversity in the market. UnitedHealth Group owns Oxford, PacifiCare, IBA, AmeriChoice, Evercare, Ovations, MAMSI and Ingenix, a healthcare data company. In 2007 their profits were $4.654 billion. Theses profits were largely made by denying people health care due to denial of enrollment due to preexisting conditions or rescission which is a process of canceling a client's health insurance once they file a really large claim by going back and finding some error in their application. In addition they deny procedures to people left and right on a routine basis without canceling their policies.

Wellpoint owns BLUES across the US, including Anthem Blue Cross Blue Shield, Blue Cross Blue Shield of Georgia, Blue Cross Blue Shield of Wisconsin, Empire HealthChoice Assurance, Healthy Alliance, and many others. The Blue Crosses and Blue Shields used to be non-profits but no more. They have been completely privatized. Their profits in 2007 were $3.345 billion. As for the other three, Aetna's profits were$ 1.831 billion; CIGNA's, $ 1.115 billion; and Humana's, $ 834 million.

According to the data, the five largest groups based on total revenue reported to the National Association of Insurance Commissioners (NAIC) and the  California Department of Managed Health Care were WellPoint, Inc., the Kaiser Family Foundation, UnitedHealth Group, Health Care Services Corporation and Aetna.  Among them, net premiums written grew an average of nearly 6 percent even as total members declined by almost 2 percent.  Total revenue and net premiums written for the health industry as a whole grew 8.7 percent and 8.5 percent, respectively. The five largest publicly traded groups by total revenue reported to the Securities and Exchange Commission — UnitedHealth Group, WellPoint, Inc., Aetna, Humana, Inc. and the CIGNA Corporation — saw an average total revenue increase of 9.4 percent in 2007.

Rounding out the top 10 of health care corporations are the following:

6. Health Net

7. Coventry Health Care 

8. Amerigroup

9. Universal American

10. Centene

Here are the CEO compensations:

2007 Total CEO Compensation

• Aetna Ronald A. Williams: $23,045,834
• Cigna H. Edward Hanway: $25,839,777
• Coventry Dale B. Wolf : $14,869,823
• Health Net Jay M. Gellert: $3,686,230
• Humana Michael McCallister: $10,312,557
• U.Health Grp Stephen J. Hemsley: $13,164,529
• WellPoint Angela Braly (2007): $9,094,271
  L. Glasscock (2006): $23,886,169

2008 Total CEO Compensation

• Aetna, Ronald A. Williams: $24,300,112
• Cigna, H. Edward Hanway: $12,236,740
• Coventry, Dale Wolf: $9,047,469
• Health Net, Jay Gellert: $4,425,355
• Humana, Michael McCallister: $4,764,309
• U. Health Group, Stephen J. Hemsley: $3,241,042
• Wellpoint, Angela Braly: $9,844,212

Former CEO of United Health Group, Bill McGuire walked away with a billion dollar compensation package. On October 15, 2006, it was announced that McGuire would step down immediately as chairman and director of UnitedHealth Group, and step down as CEO on December 1, 2006 due to his involvement in the employee stock options scandal. Simultaneously, it was announced that he would be replaced as CEO by Stephen Hemsley, who has served as President and COO and is a member of the board of directors. McGuire's exit compensation from UnitedHealth, wich was around $1.1 billion, was the largest golden parachute in the history of corporate America.

For more on Health Insurance Corporate salaries and compensation packages, click here. Health care bills are the largest single cause of bankruptcy in the US and most of these people have health insurance and think they are covered. When it comes time to use it, they find out they're really not or are covered inadequately. But since only a minority of American citizens come down with serious medical problems which require serious medical care and are very expensive, the majority of Americans go blithely on their way convinced they are adequately protected in case of an emergency. If they realized that their insurance company is in the business of maximizing their profits by finding ways to eliminate - rather than provide care for - really sick people, they might not sleep so well at night, and in fact might be clamoring for government protection under a public health care system that would not deny them treatment when they really needed it the most.

Wendell Potter is a former CEO of CIGNA. He has turned whistleblower because he could no longer live with himself and participate in a system that placed profits over human needs.

Wendell Potter can remember exactly when he took the first steps on his journey to becoming a whistleblower and turning against one of the most powerful industries in America. It was July 2007 and Potter, a senior executive at giant US healthcare firm Cigna, was visiting relatives in the poverty-ridden mountain districts of northeast Tennessee. He saw an advert in a local paper for a touring free medical clinic at a fairground just across the state border in Wise County, Virginia. Potter, who had worked at Cigna for 15 years, decided to check it out. What he saw appalled him. Hundreds of desperate people, most without any medical insurance, descended on the clinic from out of the hills. People queued in long lines to have the most basic medical procedures carried out free of charge. Some had driven more than 200 miles from Georgia. Many were treated in the open air. Potter took pictures of patients lying on trolleys on rain-soaked pavements. For Potter it was a dreadful realisation that healthcare in America had failed millions of poor, sick people and that he, and the industry he worked for, did not care about the human cost of their relentless search for profits. "It was over-powering. It was just more than I could possibly have imagined could be happening in America," he told the Observer Potter resigned shortly afterwards. Last month he testified in Congress, becoming one of the few industry executives to admit that what its critics say is true: healthcare insurance firms push up costs, buy politicians and refuse to pay out when many patients actually get sick. In chilling words he told a Senate committee: "I worked as a senior executive at health insurance companies and I saw how they confuse their customers and dump the sick: all so they can satisfy their Wall Street investors."

Health care reform is really all about diminishing the influence of the health insurance corporations which are driving up costs due to their relentless pursuit of profits. It is not about the government taking over health care; it is about the government regulating the health care industry mainly the insurance companies. With some luck the Democrats will pass a major health care reform bill which will be paid for, will bring costs down, will cover everyone adequately and will eliminate rescission and non-enrollment due to preexisting conditions. This may well sound the death knell for private insurance companies in the US because their profits are driven by denying sick people health care and by canceling policies of those who might cost them money. If these practices are outlawed, then private health insurance companies will lose most of their profit centers, and, consequently, their stock values will tank. Many will probably get out of the business. This might leave only the public option standing with health insurance companies in the business of selling supplementary insurance which adds an additional layer of protection and/or luxury to the health care process.

Obama Co-opts Big Pharma

Today Obama did a town hall meeting in Montana. A few blogs ago Dr. Reich decried the deal Obama made with Big Pharma. In return for Big Pharma supporting Obama's health care reform and promising $80 billion in rebates, Big Pharma would support Obama's health reform plan. This deal has been decried as a sell-out to Big Pharma. But I see it as Obama having co-opted Big Pharma. First of all with Big Pharma and Big Insurance running ads against Obama's plan, how many of you think it would ever get passed? It was Big Pharma's Harry and Louise ads that sank health care reform during the Clinton administration. This time Harry and Louise are in favor of reform. Buying off Big Pharma buys off one of the two greatest potential adversaries leaving only Big Insurance. The sell-out here is really Big Pharma which has abandoned support of its sister industry - Big Insurance. The ads Pharma will buy supporting Obama's plan will cancel out Insurance's ads opposing it. This is very smart on Obama's part - the difference between getting health reform passed and not getting it passed.

Sure it's a great deal for Big Pharma. For a relative pittance they are assuring tremendous profits for itself for the indefinite future. They are also selling the insurance industry down the tubes. Imagine the chagrin at Big Insurance headquarters. They probably regard Big Pharma as traitors. That $80 billion in support they promised will go mainly to give seniors in the donut hole a 50% decrease in their drug costs. So seniors get a better deal than they're already getting under the current plan, and there will be no more cancellation of policies for preexisting conditions, no more rescission and we will have 45 million more Americans covered. Altogether a pretty sweet deal for the American people when you consider the alternative would have been the defeat of any health care reform at all and the continued rape of the American people by the insurance industry. All in all a masterstroke by Obama and there is no guarantee to Big Pharma that their privileged position will continue to hold indefinitely.

A historic health care reform bill for the American people is vastly more important than the relatively mild suffering caused by the continued high profits of Big Pharma.

One more point: how many people will prefer to keep their present health care plans which will continue to subject them to the possibility of cancellation by rescission when they figure out that they can buy insurance on the exchange which forbids the insurance companies from exercising that option? The way health reform will be set up will virtually guarantee that all present policies will be vacated though not necessarily for the public option. So the "if you like the insurance you have, keep it" refrain will be moot. Everybody will soon be buying insurance on the exchange although they won't necessarily be buying the public option. The offerings by private insurance companies though will not be able to extract huge profits by not accepting clients because of preexisitng conditions or rescission. That is a direct frontal assault on Big Insurance profits which come essentially from denying people health care. So while Big Pharma has been allowed under the plan to keep extracting relatively high profits, the insurance industry will be denied the opportunity for doing so.

Wendell Potter, Health Insurance Corporation Whistleblower

Whistleblower tells of America's hidden nightmare for its sick poor

When an insurance firm boss saw a field hospital for the poor in Virginia, he knew he had to speak out. Here, he tells Paul Harris of his fears for Obama's bid to bring about radical change

Paul Harris The Observer, Sunday 26 July 2009

 

Patients without health insurance get dental care at a free clinic in Wise, Virginia, held every July for the past three years. More than 25,000 were treated in a weekend.

Wendell Potter can remember exactly when he took the first steps on his journey to becoming a whistleblower and turning against one of the most powerful industries in America.

It was July 2007 and Potter, a senior executive at giant US healthcare firm Cigna, was visiting relatives in the poverty-ridden mountain districts of northeast Tennessee. He saw an advert in a local paper for a touring free medical clinic at a fairground just across the state border in Wise County, Virginia.

Potter, who had worked at Cigna for 15 years, decided to check it out. What he saw appalled him. Hundreds of desperate people, most without any medical insurance, descended on the clinic from out of the hills. People queued in long lines to have the most basic medical procedures carried out free of charge. Some had driven more than 200 miles from Georgia. Many were treated in the open air. Potter took pictures of patients lying on trolleys on rain-soaked pavements.

For Potter it was a dreadful realisation that healthcare in America had failed millions of poor, sick people and that he, and the industry he worked for, did not care about the human cost of their relentless search for profits. "It was over-powering. It was just more than I could possibly have imagined could be happening in America," he told the Observer

Potter resigned shortly afterwards. Last month he testified in Congress, becoming one of the few industry executives to admit that what its critics say is true: healthcare insurance firms push up costs, buy politicians and refuse to pay out when many patients actually get sick. In chilling words he told a Senate committee: "I worked as a senior executive at health insurance companies and I saw how they confuse their customers and dump the sick: all so they can satisfy their Wall Street investors."

Potter's claims are at the centre of the biggest political crisis of Barack Obama's young presidency. Obama, faced with 47 million Americans without health insurance, has put reforming the system at the top of his agenda. If he succeeds, he will have pushed through one of the greatest changes to domestic policy of any president. If he fails, his presidency could be broken before it is even a year old. Last week, in a sign of how high the stakes are, he addressed the nation in a live TV news conference. It is the sort of event usually reserved for a moment of deep national crisis, such as a terrorist attack. But Obama wanted to talk about healthcare. "This is about every family, every business and every taxpayer who continues to shoulder the burden of a problem that Washington has failed to solve for decades," he told the nation.

Obama's plans are now mired and the opponents of reform are winning. The Republican attack machine has cranked into gear, labelling reform as "socialist" and warning ordinary Americans that government bureaucrats, not doctors, will choose their medicines. The bill's opponents say the huge cost can only be paid by massive tax increases on ordinary Americans and that others will have their current healthcare plans taken away. Many centrist Democratic congressmen, wary of their conservative voters, are wavering. The legislation has failed to meet Obama's August deadline and is now delayed until after the summer recess. Many fear that this loss of momentum could kill it altogether.

To Potter that is no surprise. He has seen all this before. In his long years with Cigna he rose to be the company's top PR executive. He had an eagle-eye view of the industry's tactics of scuppering political efforts to get it to reform. "This is a very wealthy industry and they use PR very effectively. They manipulate public opinion and the news media and they have built up these relationships with all these politicians through campaign contributions," Potter said.

Potter was witness to the campaign against Michael Moore's healthcare documentary Sicko. The industry slammed the film as one-sided and politically motivated. Secret documents leaked from the American Health Insurance Plans, the industry's lobby group, detailed the plan to paint Moore as a fringe radical. Potter now says the film "hit the nail on the head". "The Michael Moore movie that I saw was full of truth," he admits.

Potter was also working for Cigna when it became embroiled in the case of Nataline Sarkisyan, whose family went public after Cigna refused to pay for a liver transplant that it considered "experimental" and therefore not covered by their policy. Cigna reversed this decision only hours before the Californian teenager died. "I wish I could have done more in that case," Potter said.

Such sentiments are rare in an industry that has given America a healthcare system that can be cripplingly expensive for patients, but that does not produce a healthier population. The industry is often accused of wriggling out of claims. Firms comb medical records for any technicality that will allow them to refuse to pay. In one recently publicised example, a retired nurse from Texas discovered she had breast cancer. Yet her policy was cancelled because her insurers found she had previously had treatment for acne, which the dermatologist had mistakenly noted as pre-cancerous. They decreed she had misinformed them about her medical history and her double mastectomy was cancelled just three days before the operation.

Last month three healthcare executives were grilled about such "rescinding" tactics by a congressional subcommittee. When asked if they would abandon them except in cases of deliberately proven fraud, each executive replied simply: "No."

To Potter that attitude has a sad logic. The healthcare industry generates enormous profits and its top executives have a lavish corporate lifestyle that he once shared. Treating patients for their expensive conditions is bad for business as it reduces the bottom line. Kicking out patients who pursue claims makes perfect economic sense. "It is a system that is rigged against the policyholder," Potter said. The congressional probe found that just three firms had rescinded more than 20,000 policyholders between 2003 and 2007, saving hundreds of millions. "That's a lot of money that will now go towards their profits," Potter said.

A lot of that money also goes into contributions to politicians of both parties - $372m in the past nine years - and in lobbying groups to run TV ads slamming Obama's plans. Many of these ads deploy naked scare tactics. One report said that the industry was spending $1.4m a day on its campaign. In the face of that, it is perhaps no wonder that the Senate has delayed its vote, dealing a massive blow to Obama. "I have seen how the opponents of healthcare reform go to work... they are trying to delay action. They know that if they keep the process going for months, and turn it into a big mess, then the political impetus behind it will lessen," Potter said.

Potter, who now works at the Centre for Media and Democracy in Wisconsin, says the industry is afraid of Obama's reforms and that is why it is fighting so hard. It wants to deal him the same blow as it did Bill Clinton when it scuppered his attempt at reform in the 1990s. Potter admits that he is worried the industry might win again. "I have seen their tactics work. I have been a part of it," he said. He knows he has no chance of ever working again for a major firm. "I am a whistleblower and corporate America does not tend to like that," he said. But there is one thing Potter is not sorry about: leaving the healthcare industry and speaking out. "I have absolutely no regrets. I am doing the right thing," he said.

Comprehensive healthcare reform in the US has been an ambition of many presidents since the early part of the 20th century. None has succeeded in creating a system that gives all Americans the right to coverage. Barack Obama, below, is desperate to avoid the same fate.

 

 

 

Making Sense of the Health Care Debate

Published on Monday, July 27, 2009 by The New York Times

An Incoherent Truth

by Paul Krugman

Right now the fate of health care reform seems to rest in the hands of relatively conservative Democrats — mainly members of the Blue Dog Coalition, created in 1995. And you might be tempted to say that President Obama needs to give those Democrats what they want.

But he can’t — because the Blue Dogs aren’t making sense.

To grasp the problem, you need to understand the outline of the proposed reform (all of the Democratic plans on the table agree on the essentials.)

Reform, if it happens, will rest on four main pillars: regulation, mandates, subsidies and competition.

By regulation I mean the nationwide imposition of rules that would prevent insurance companies from denying coverage based on your medical history, or dropping your coverage when you get sick. This would stop insurers from gaming the system by covering only healthy people.

On the other side, individuals would also be prevented from gaming the system: Americans would be required to buy insurance even if they’re currently healthy, rather than signing up only when they need care. And all but the smallest businesses would be required either to provide their employees with insurance, or to pay fees that help cover the cost of subsidies — subsidies that would make insurance affordable for lower-income American families.

Finally, there would be a public option: a government-run insurance plan competing with private insurers, which would help hold down costs.

The subsidy portion of health reform would cost around a trillion dollars over the next decade. In all the plans currently on the table, this expense would be offset with a combination of cost savings elsewhere and additional taxes, so that there would be no overall effect on the federal deficit.

So what are the objections of the Blue Dogs?

Well, they talk a lot about fiscal responsibility, which basically boils down to worrying about the cost of those subsidies. And it’s tempting to stop right there, and cry foul. After all, where were those concerns about fiscal responsibility back in 2001, when most conservative Democrats voted enthusiastically for that year’s big Bush tax cut — a tax cut that added $1.35 trillion to the deficit?

But it’s actually much worse than that — because even as they complain about the plan’s cost, the Blue Dogs are making demands that would greatly increase that cost.

There has been a lot of publicity about Blue Dog opposition to the public option, and rightly so: a plan without a public option to hold down insurance premiums would cost taxpayers more than a plan with such an option.

But Blue Dogs have also been complaining about the employer mandate, which is even more at odds with their supposed concern about spending. The Congressional Budget Office has already weighed in on this issue: without an employer mandate, health care reform would be undermined as many companies dropped their existing insurance plans, forcing workers to seek federal aid — and causing the cost of subsidies to balloon. It makes no sense at all to complain about the cost of subsidies and at the same time oppose an employer mandate.

So what do the Blue Dogs want?

Maybe they’re just being complete hypocrites. It’s worth remembering the history of one of the Blue Dog Coalition’s founders: former Representative Billy Tauzin of Louisiana. Mr. Tauzin switched to the Republicans soon after the group’s creation; eight years later he pushed through the 2003 Medicare Modernization Act, a deeply irresponsible bill that included huge giveaways to drug and insurance companies. And then he left Congress to become, yes, the lavishly paid president of PhRMA, the pharmaceutical industry lobby.

One interpretation, then, is that the Blue Dogs are basically following in Mr. Tauzin’s footsteps: if their position is incoherent, it’s because they’re nothing but corporate tools, defending special interests. And as the Center for Responsive Politics pointed out in a recent report, drug and insurance companies have lately been pouring money into Blue Dog coffers.

But I guess I’m not quite that cynical. After all, today’s Blue Dogs are politicians who didn’t go the Tauzin route — they didn’t switch parties even when the G.O.P. seemed to hold all the cards and pundits were declaring the Republican majority permanent. So these are Democrats who, despite their relative conservatism, have shown some commitment to their party and its values.

Now, however, they face their moment of truth. For they can’t extract major concessions on the shape of health care reform without dooming the whole project: knock away any of the four main pillars of reform, and the whole thing will collapse — and probably take the Obama presidency down with it.

Is that what the Blue Dogs really want to see happen? We’ll soon find out.

© 2009 The New York Times

Paul Krugman is professor of Economics and International Affairs at Princeton University and a regular columnist for The New York Times. Krugman was the 2008 recipient of the Nobel Prize in Economics. He is the author of numerous books, including The Conscience of A Liberal, and his most recent, The Return of Depression Economics. 

Republicans Declare War On US President

Some Republicans have been saying things that amount to a declaration of war on a sitting US President. They want to defeat him at all costs. They could care less about the constructive role of making the US a better place for the American people. Senator Jim DeMint said that "if the Republicans can stop Obama on health care, it will be his Waterloo, it will break him." Yeah, we must defeat the US President when he is trying to make the US a better place for most non-billionaires. The language of warfare and battle is replacing the language of civil discussion. Talk about defeating Obama, breaking Obama, driving a stake through the heart of Obama's health care - this is the most vitriolic and uncivil use of metaphors in US history. It's suggestive of killing Obama.

In fact Bill Kristol has used precisely that word: "kill."

With Obamacare on the ropes, there will be a temptation for opponents to let up on their criticism, and to try to appear constructive, or at least responsible. There will be a tendency to want to let the Democrats' plans sink of their own weight, to emphasize that the critics have been pushing sound reform ideas all along and suggest it's not too late for a bipartisan compromise over the next couple of weeks or months. My advice, for what it's worth: Resist the temptation. This is no time to pull punches. Go for the kill. The Obama White House and the Democratic congressional leadership shouldn't be underestimated. They're tough. They'll cut deals and twist arms to try to keep their priority legislation alive. They'll certainly attack their opponents, whether their opponents' tone is conciliatory or confrontational. So this is not the time to let them off the ropes. This is the week to highlight every problem, every terrible provision, in the Democratic bills: from taxes and spending to government control and rationing to federal funding for abortion and government-required death-with-dignity counseling sessions for the elderly. Throw the kitchen sink at the legislation now on the table, drive a stake through its heart (I apologize for the mixed metaphors), and kill it.

Drive a stake through "its" heart. "Kill it." Nothing about constructive criticism. Only the language of warfare. It's all about defeating, even killing, Obama; nothing about making the US a better place for its citizens. OK, it's about making the US a better place for billionaires and corporations although they won't come out and actually say that. Talk about not discussing the merits of the health care bill. It wouldn't matter what health care bill Congress came up with. It could be the best thing that ever happened to America. The Republicans would still want to "kill it." Why? Because they want to defeat Obama at all costs.Why? Because they lust after political power. That's all they're concerned about. Make the US a better place for the average American? They could care less.

If the Democrats openly declared war on a sitting US President, the Republicans would be yelling "treason." Treason is in the eyes of the beholder. To paraphrase Nixon, when the Republicans do it, it's OK. When the Democrats do it, it's not. The Democrats should be under no illusions about Republican motives. If they think the Republians are interested in anything other than taking political power by any means necessary, they're crazy. I hope Obama is under no illusions either. I hope his talk of bipartisanship is meant to burnish his image as a nice guy rather than as a realistic approach to passing any legislation. The Republicans will seek to defeat anything Obama attempts to do, and the Democrats hopefully know that and will proceed accordingly. They have the votes and the power. They should use them and it to get the job done with repect to health care or anything else.

NO PUSSYFOOTING!

A Dialog on Health Care

These comments were posted on Robert Reich's blog post, "What Can I Do?":

John Lawrence said...

Angry,

Thanks for your reference to Food, Inc. It is playing locally. I'll try to see it.

Here's a novel idea. Why not tie rates for health insurance (whether public or private) to an individual's willingness to stay healthy? In other words incentivize healthy lifestyles by giving rate cuts on health insurance. Right now some employers are incentivizing employees to exercize. This could be increased by incentivizing healthy lifestyles. With all kinds of devices being computerized and wirelessly networked, I can imagine a teadmill, for instance, wirelessly connected to a doctor's office or a database which clocked the hours spent by a specific individual. Also scales and blood pressure measurements at home can wirelessly transmit crucial health statistics to a central database or doctor's office. Classes in nutrition could count as well as a willingness to consume healthy foods and vitamins. Food purchases could be tracked. Technology is there. This might sound a little Big Brotherish, but the gains in human health, happiness and productivity not to mention cost containment of the health care system would justify encouragement of healthy lifestyles in my opinion.

There are many ways a person's willingness to lead a healthy lifestyle regarding diet and excercise could be tracked, measured and evaluated and that data could be used to determine the rate a person should pay for health insurance. Those not willing to lead a healthy lifestyle should pay more because they will be a greater burden on the overall health care system. Obese people especially are more in danger of heart and kidney problems from Type 2 diabetes, heart attacks etc.

I think this emphasis on healthy lifestyles and incentivizing it by lowering individual rates for health insurance would do a lot for cost containment of the overall health care system and encourage individual responsibility for taking care of one's self and family.

Saturday, 04 July, 2009

Art A Layman said...

John:

This might sound a little Big Brotherish, but the gains in human health, happiness and productivity not to mention cost containment of the health care system would justify encouragement of healthy lifestyles in my opinion.

Jesus! A little?! Maybe we could expand your program to not only charging higher premiums to those not following - whose definition? - a healthy lifestyle but refusing them medical care altogether. This would save scads! The double whammy would be great too. They pay higher premiums but can't get needed care. Priceless!

I guess you're scrapping your "we're all in this together" position.

You present good ideas, from time to time, but going off the deep end might not bode well for your veracity.

P.S. Does that mean that each doctors visit will now require a breathalyzer test to see if I'm smoking?

Sunday, 05 July, 2009

Anonymous said...

Art Layman,

Excuse me. You are the one going off the deep end with a hyped up reaction to John Lawrence's well-meant reminder of the benefits of a healthful lifestyle. Even we who finished high school understand John is merely highlighting the good health positives of nutricious non-fat foods, routine exercise and less pills for every occasion. And that this will also help reduce national health care costs too. Jesus would be pleased if he saw this simple message accepted by more folks like perhaps, who knows, yourself. We can't be too serious about following healthy living habits. It'll save most of us a lot of money and discomfort in our older days.

Sunday, 05 July, 2009

John Lawrence said...

Angry, Art & Others,

I just saw the movie Food Inc. and is it an eye opener. Th number of incidences of e coli are directly related to the factory production of farm animals for slaughter in feed lots or chicken houses. First they feed the cows corn instead of hay which they evolved to eat. Corn produces bacteria in their gut including e coli whereas, if they were fed grass or hay this would not happen. Animals who eat hay produce manure which can be spread on fields as fertilizer, but animals fed corn including cows and hogs produce a toxic sludge. A hog waste pond recently threatened to pollute a major river.

My Grandfather was a farmer, and he grew the hay in his own fields which he fed to his cattle and then spread the manure back on the fields with a manure spreader. They all did this in the 1940s and 50s.

Cows in feed lots have to stand around all day in their own waste products and this translates into more e coli in the slaughterhouse. No wonder there are so many recalls of beef products! Also birds pick up the e coli and transmit it to adjacent crops like spinach.

If you saw this movie you would never eat another piece of beef or chicken from the super market and especially from a fast food place.

Industrialized meat production by just a small number of corporate giants like Smithfield and Tyson is literally killing us because it's laced with growth hormones and the FDA is staffed by former lobbyists from the industries they're supposed to regulate. Poor people can pay less for a fast food meal than if they bought vegetables at the super market, and 1 out of 3 people born since 2000 will have early onset Type 2 diabetes. If you are a minority, it will be 1 out of 2. High fructose corn syrup and industrialized meat production are major contributors to obesity especially from fast foods.

The other interesting thing is that Monsanto has added a patented gene to soybeans that lets the field be sprayed with pesticide without affecting the soybean production. Since it is a patented gene, the farmer can't save seeds for next year's crop because they legally belong to Monsanto. Monsanto sends out investigators to make sure no farmer saves seeds or else they are prosecuted. Even farmers who don't buy Monsanto's genetically modified soybean seeds can be prosecuted by Monsanto if some of the genetically modified seeds happen to cross pollinate in a non-Monsanto farmer's field.

Also posted on Will Blog For Food.

Sunday, 05 July, 2009

notsofast said...

john lawrence: what's next obesity camps in the desert? lol your authoritarian inclination is pretty typical for dems and well-meaning but completely unacceptable. personal, social and economic freedom and justice only exist when coercive power and authority are decentralized and eliminated; genuine socialism.

Monday, 06 July, 2009


Art A Layman said...

John:

If you're going to attempt to enlighten us could you be more specific? E-Coli, in and of itself, is not the problem, we all walk around with E-Coli bacteria in our intestines. It's a particular strain that is the problem, an acid-resistant strain.

The vast majority of UTIs that women get are caused by E-Coli bacteria entering the urethra.

You are tending toward paranoia

Monday, 06 July, 2009

Angry Citizen said...

John,

Glad to hear that you got out to see Food Inc. I've still got to see it; some family thing came up the other night so I couldn't go.

Re: Monsanto, yes, they've become quite a thorn in the side of farmers globally. In Mexico, they train their young to be able to spot genetically modified corn so that the plants can be removed asap. Our genetically-modified imports have been mixing with their generations-in-the-making heirloom corn and they're not so much worried about getting slapped with a lawsuit for having our garbage seeds cross-pollinate as they are having their crops infiltrated with our inferior corn and ruined for posterity. (If you've never watched "The World According to Monsanto," it's worth a watch. Many versions of it are online on both You Tube and Google video.)

People were very worried for a while about Monsanto's development of what folks called "terminator seeds." I don't know if they've stopped R & D on the seeds or not, but basically what they were meant to do was, well, self-destruct so that nobody could save the seeds and harvest them.

@Art, From what I understand, the problem with e-coli, virus strains like swine and avian flu, and factory farming is that when you've got hundreds of animals piled up on top of each other in a factory--standing in their own waste, in the waste of stillborn animals, and all of their other nasty stuff that's supposedly laying in the sludge of factory floors--and in such close-quarters and stench that the quality of air flow is atrocious, strains of all kinds of illness become much more virulent because they have the ability to spread so fast throughout the factories. With a small farm where animals are free to forage, you might still have sick animals infecting others, but the number of carriers for the illness would be much smaller, and presumably, because the animals wouldn't be constantly pumped with antibiotics and other drugs (just to stave off death!)--and their immune systems wouldn't be so incredibly weak due to factory conditions--the strains would not spread so fast or have the same kind of ability, as is true in the case of factory farming, to gain in strength as it spread through hundreds of additional animals.

I posted this article once before, but it's worth re-posting:

Boss Hog.

It's a very-well researched article about Smithfield Foods (there has been a more recent article about Smithfield... I'll have to track it down later if anyone is interested), and explains in much better detail than I can provide the answer to your question about e-coli as well as a bunch of other facts you'd probably rather not know!

@ Anon,

I choose B .

Monday, 06 July, 2009

Art A Layman said...

Angry:

Far as I know all of what you said is true but the E. coli culprit is primarily just one strain which does not affect the animals but can be bad for humans: E. coli O157:H7.

E. coli is a normal bacterium in the gastrointestinal tract of animals and humans, and most types are not harmful (See "E. coli and Cattle" fact sheet, attached). However, disease-causing strains such as E. coli O157:H7 produce toxins that cause bloody diarrhea or even kidney failure in humans. Mature cattle are unaffected by E. coli O157:H7. Only a small number of cattle (estimated at 1 to 2 percent at any one time) shed E. coli O157:H7 in their feces, a rate that is not fully explained.

When beef carcasses are accidentally contaminated by feces at slaughter, the pathogens can enter the human food supply. E. coli O157:H7 can be killed by cooking or irradiation, but the bacterium continues to pose a food-safety risk.

Cattle are fed starch-containing grains to increase growth rate and produce tender meat. Because the bovine gastrointestinal tract digests starch poorly, Russell explains, some undigested grain reaches the colon, where it is fermented. When the grain ferments -- and acetic, propionic and butyric acids accumulate in the animal's colon -- a large fraction of E. coli produced are the acid-resistant type.

"Grain does not specifically promote the growth of E. coli O157:H7, but it increases the chance that at least some E. coli could pass through the gastric stomach of humans," Russell says. "The carbohydrates of hay are not so easily fermented, and hay does not promote either the growth or acid resistance of E. coli. When we switched cattle from grain-based diets to hay for only five days, acid-resistant E. coli could no longer be detected."

In studies performed at Cornell, beef cattle fed grain-based rations typical of commercial feedlots had 1 million acid-resistant E. coli, per gram of feces, and dairy cattle fed only 60 percent grain also had high numbers of acid-resistant bacteria. In each case, the high counts could be explained by grain fermentation in the intestines.

By comparison, cattle fed hay or grass had only acid-sensitive E. coli, and these bacteria were destroyed by an "acid shock" that mimicked the human stomach, the microbiologists report in Science.

My point was that the strain is the problem not just any E. coli.

At that cooking meat thoroughly and following good hygiene practices eliminates most of the risk. Though a serious concern if we look at reported cases versus all who eat pink meat and/or fast food meat John's reaction seems slightly paranoid.

Monday, 06 July, 2009

Anonymous said...

Art Layman and Notsovast,

As I've said, Mr. Lawrence's message about preventive care is not so difficult to understand. Accusing him of paranoia is an easy excuse for not hearing the message. John is only saying, as an example, we don't have to walk around with over-exposure to E-coli bacteria for a lifetime by feeding cows corn instead of hay. The rest of the world doesn't follow this stupid practice, but we in the US are the exception. As science shows, an excess of most things clearly healthwise contradictory comes with very negative risk results. This has been proven with planting corn for ethanol and feeding corn to cows. On the other hand, Monsanto has their own inspectors to enforce by fear of lawsuits their regimen of protecting really questionably unhealthful products. This occurs routinely under heavy-lobbyist influences while John Lawrence gets personally critisized for merely revealing how US health is being endangered by feeding cows corn instead of hay. In addition to the obvious exaggerations of Mr. Lawrence's intentions, he is not calling for an 'authoritarian' response to the shams and abridgement of better-informed choices for healthful living. How cleverly we can manipulate a simple, honest viewpoint. John, is acting out of paronoia? Gibberish! Please look to yourselves, gentlemen. You get upset without any counterarguments when someone speaks common sence and cites scientific evidence about unhealthful livestyle practices. You, innocently perhaps, are blind to realization you are participating in typical Republican
fear mongering. This you do by suggesting Mr. Lawrence is calling for some high authority to enforce his pet good health practices? Get realistic, gentlemen! The Disney fantasy world can't possibly match this silliness. It's the old habits of Democrats at work again in great form, and party men in particular, of undermining each other's best intentions. Republicans just love it.

Monday, 06 July, 2009


Art A Layman said...

Anonymous:

The obscurity of your name does not allow one to know how long you've been reading John's tripe, ooops, common sense. Sorry John.

Speaking of commmon sense, I love the current definition of it. In today's world Common Sense is defined as, if you disagree with me you don't have any.

One could herald the thought that we Dems think for ourselves. Are you suggesting that we all fall in line behind the party line thoughts of the day? If I'm going to do that I might as well be a Republican.

Before you go jumping on the latest healthful news of the day you might want to review history. We have been fed so much bullshit at one time or another just to have it reversed a few years hence. Coffee was bad, now it's good. Overweight is bad, thin is good. Now we find that somewhat overweight is better and offers a better chance for longer life. Vitamin C and E, in large quantities will improve your chances of avoiding heart attacks and cancer. Well, upon review, no it won't. Saturated fats are bad. Well maybe not so much.

Notsofast is right. What John proposed is that we all be monitored - daily? hourly? - to make sure we're eating right, exercising right, doing all the "right" things. That my friend is not freedom.

At that, got any idea the problems we'll create if we all start to live to be 150? Best you follow you're healthful life and life forever and be thankful for we waywards who died sooner rather than later. And Jesus, supposedly, will love us all anyway.

Oh! And I missed the part in the warranty that said if we all do nothing but healthful things we're guaranteed a long life and a quick painless death. Have to pull that damn thing out again.

Monday, 06 July, 2009

Blurtman said...

If you give up smoking, drinking, eating fatty foods and sweets, you will not live longer. It will just seem that way.

Monday, 06 July, 2009

Anonymous said ...

blurtman : If you give up smoking, drinking, eating fatty foods and sweets, you will not live longer. It will just seem that way.

Unfortunately, my own family history conclusively proves that statement false.

Monday, 06 July, 2009

John Lawrence said ...

Art said:

My point was that the strain is the problem not just any E. coli.

At that cooking meat thoroughly and following good hygiene practices eliminates most of the risk. Though a serious concern if we look at reported cases versus all who eat pink meat and/or fast food meat John's reaction seems slightly paranoid.

Art, you just don't get it, my friend. Tell that to the woman who lost her 2 year old son in 12 days after he ate a fast food hamburger. The problem is (and you should have figured this out from reading your own posting) that cows evolved to eat hay not corn! It's the government subsidization of corn that's the primary cause of e coli in the food supply. Free range grass grazing or hay fed beef cows do not introduce e coli into the food supply.The feed lot factory farms find it more convenient and less costly to feed cows corn rather than hay and then they stand around in their own manure which gets into the slaughterhouse and hence into the food supply. The continuing incidences of e coli breakouts testify to the fact that this is a continuing problem. And you're going to solve it by getting Jack in the Box to cook their meat more thoroughly?!?!

You'd be paranoid too if you lost a 2 year old son from eating a Jack in the Box hamburger.

Tuesday, 07 July, 2009


John Lawrence said...

Art and notsofast:

Many people are already wirelessly hooked up to their doctor's office so he can monitor their blood pressure and/or other vital signs on a daily basis. This in fact might save these patients' lives without their having to come into the doctor's office on a daily basis. Many companies are encouraging their employees' to excercise and have better diets in order to cut down health care costs. Some even install gyms at the place of work. Is this authoritarian or simply good sense? You know, you can make these kind of practices out to be whatever you want them to be. What's good sense and voluntary participation to some is seen to be government intervention into our private lives by others. FYI, my suggestions are meant to be on a voluntary rather than coercive basis. Art and notsofast, please eat all the fat, sugar and salt you want, smoke all the cigarettes you want and please be as sedentary as you want. My ideal health care system would still pick up the bill for all your degenerative diseases, but it would require you to pay a little more for health insurance as compared to someone who excercised and ate healthy foods.

And thank you, Anonymous, for putting Art's and notsofast's paranoia in proper perspective.

Tuesday, 07 July, 2009


Art A Layman said...

John:

Good buddy, no I'm afraid that you just don't get it. Life is not fair. Why do things happen to some and not others? Who the hell knows? The loss of any, child especially, is heinous and who can fault the feelings of any parent who has experienced it. I'm against the death penalty but were my daughter ever raped, if left to me, the perpetrator would be pleading for death.

It's the government subsidization of corn that's the primary cause of e coli in the food supply. Free range grass grazing or hay fed beef cows do not introduce e coli into the food supply.The feed lot factory farms find it more convenient and less costly to feed cows corn rather than hay and then they stand around in their own manure which gets into the slaughterhouse and hence into the food supply. The continuing incidences of e coli breakouts testify to the fact that this is a continuing problem. And you're going to solve it by getting Jack in the Box to cook their meat more thoroughly?!?!

The subsidization of corn no doubt is a contributor but my understanding is that corn fed beef also produces less fat per pound than hay fed. That can reduce profits when the fat has to be trimmed off. Another contributing factor?

Now the rest of your comment, if not paranoia, is bullshit. Standing around in their own manure is certainly inhumane. I'm all in favor of treating animals, whatever their eventual plight, humanely. But if that's the cause of E. coli entering the food chain why do we not find E. coli infections coming from eating steak or ribs or rump roasts or even beef tongue (yuck!)?

The problem is in ground beef, more specifically hamburger. Why is that? Because it is made from the garbage residue from the cattle including intestine meat. Do you think that when a cow is slaughtered the E. coli or other bacteria die as well? In the process the intestines get ground up along with other garbage and the E. coli lives on. That's how it gets in the food chain!

The article I posted does say that the E. coli O157:H7 strain does come from the digestive, fermentation, process of the cow from eating corn rather than hay. It also goes on to say that feeding the cow hay for four or five days before slaughter eliminates that particular strain. Even hay fed cattle have E. coli in their intestines and thus, chances are, in the hamburger we eat, but our stomach acids kill all other strains so no infection ever sets in.

I have eaten fast food cheeseburgers since they've been around and never had an E. coli infection. At better restaurants and at home I prefer my cheeseburgers medium rare and have most of my life with no consequences other than getting fatter. In Raleigh, a number of years ago, a law was passed that all ground beef had to be cooked to x degrees in the center, yielding, at best, a medium well patty. If cooking thoroughly was not a solution we would have a plethora of E. coli infections here and everywhere.

Another simple solution would be irradiation in slaughter houses or restaurants but likely that's more expensive than thorough cooking.

People, men, women and children die in car accidents but we don't outlaw cars. Folks get electrocuted but we don't outlaw electricity. People die from choking to death on home garden grown vegetables but we don't outlaw food.

Get a grip John! Enlighten us if you will but give us facts not emotional rants. You saw a movie and thus you feel a need to spread fear and horror to the populace. You didn't learn that in the fine schools you attended. Sounds more like lessons from Sunday school.

Tuesday, 07 July, 2009


Art A Layman said...

John:

An addendum.

You'd be paranoid too if you lost a 2 year old son from eating a Jack in nthe Box hamburger.

I wouldn't be paranoid but I'd be damned angry.

On the other hand I wouldn't be wild about a mother who would feed her 2 y/o fast food in the first place.

Tuesday, 07 July, 2009


Art A Layman said...

John:

FYI, my suggestions are meant to be on a voluntary rather than coercive basis. Art and notsofast, please eat all the fat, sugar and salt you want, smoke all the cigarettes you want and please be as sedentary as you want. My ideal health care system would still pick up the bill for all your degenerative diseases, but it would require you to pay a little more for health insurance as compared to someone who excercised and ate healthy foods.

You presentation smacked more of coercive than voluntary. Have no problem with voluntary but if I volunteer I don't want it used to punish me.

The trade off to your valued hard earned funds is in doing all those dastardly things, notsofast and I will die sooner, perhaps yielding you a refund?

I'm on Medicare. I can live the Epicurean life to the hilt and it won't cost me a dime more than all you health food, exercise addicts.

Tuesday, 07 July, 2009

Anonymous said...

Art :I'm on Medicare. I can live the Epicurean life to the hilt and it won't cost me a dime more than all you health food, exercise addicts.

Your medicare provided lipitor is 100% free?

Tuesday, 07 July, 2009

Anonymous said...

Art Layman,

You apparently enjoy distorting other people's simple statements like, for example, about the obvious benefits of healthful living habits starting young, recognizing also it is never too late. Can one still possibly be struck by a serious illness or breakdown? Of course. Are the chances reduced? Also, of course. Can more healthful lifestyles in long term reduce health care costs? Also, of course. This is all that John Lawrence is saying. You sound like you are in not in an optimum state of physical health yourself, Mr. Layman? If true, have you thought about how you might have also contributed to your disability compared to taking refuge in the forces of bad luck, the wrong time, family genetics, or the unlucky smoker? Your amusing but exaggerated, self-convincing analysis of John Lawrence's remarks seems married to the latter cop-out excuses. Fine for you. But is this wise counsel for all the younger generations? I really don't believe John Lawrence is promoting health warranties or big brother controls or dictums of healthful lifestyles as your 'Artfully' imply. He is simply highlighting a greater awareness in our society of incentivizing and promoting (as do other advanced nations) the obvious quality of life benefits possible from focusing on delicious nutricious foods, being alert to dangerous food processing methods, routinely exercising and avoiding over-reliance on pills and drugs as automatic answers to all our physical, emotional discomforts and pains. You self-rightously appear to suggest this is all nonsense or disguised authoritorian preaching! But your comments are equally indirectly, if not directly, cocky and ironically inflexible. They amount to what I would call Mr. Art Layman's concept of healthful living nihilism. Doctors, of course, profit from people who are in stupendous denial of simple ways to improve chances for good health and longevity on this delicate environmental paradise called earth. By the way, it's a paradise also in a stage of escalating climatic diseases in major part caused by human lifestyles. I hope you are not in denial or pooh-poohing of this reality also?

Mr. Lawrence's preventive care ideas we can disagree with as to how they are formulated. But they are an extremely important part of Obama's real health care reforms which I pray will come.

Tuesday, 07 July, 2009

SMV said...

Art,

Just a couple of comments on food.

1. “The subsidization of corn no doubt is a contributor but my understanding is that corn fed beef also produces less fat per pound than hay fed. That can reduce profits when the fat has to be trimmed off. Another contributing factor?”

I believe that feeding cows corn increases the growth rate. It also increases marbling and fat % in general.

Grass and hay fed beef is leaner. Personally I do not like the taste of grass fed beef as well as grain fed beef, but that is my taste buds.

2. “Standing around in their own manure is certainly inhumane. I'm all in favor of treating animals, whatever their eventual plight, humanely. But if that's the cause of E. coli entering the food chain why do we not find E. coli infections coming from eating steak or ribs or rump roasts or even beef tongue (yuck!)?”

Manure on the outside of the cow makes contact with the meat as the hide is cleaned & removed. Cutting the meat contaminates the outside edges of the meat. High heat on the outside edge of a steak kills the E. coli. The inside of the steak remains uncontaminated.

Grinding meat mixes the E.coli into the center of the burger requiring the entire burger be heated to “X” degrees for “Y” period of time to kill the E. coli.

3. The other issue is using the infected Manure as fertilizer. If you eat vegetables raw that have been fertilized with infected manure and are not sufficiently cleaned you can get sick. (Salad anyone?)

4. Requiring irradiation in slaughter houses may be an acceptable solution, but it does give large processors an advantage over small processors. To me a better solution would be to test the meat as it leaves the processing plant. If it has high contamination them shut them down until the source of the contamination is addressed. This would allow different operations to use different methods to meet the health requirements. If cows raised on grass do not have the contamination issue then they could use lower cost methods for avoiding contamination.

I also support eliminating subsides for corn and soybeans.

Tuesday, 07 July, 2009

Art A Layman said...

Anonymous:

Gracious! I didn't realize he was that JOHN!

But is it my soul he wants to save? Or my waistline?

John doesn't say things. John preaches to us. He gives us the light, ours is but to follow it.

Optimum state of health? Besides the fact that that is relative, I don't know that I have ever known anyone who was in an "optimum state of health". Many thought so only to die of a heart attack a day later. Chances are that whatever the opposite of "optimum state of health" is, that is where you'll find me. So what? I'm alive and still kicking. Not quite as high as I used to but still kicking.

If true, have you thought about how you might have also contributed to your disability compared to taking refuge in the forces of bad luck, the wrong time, family genetics, or the unlucky smoker?

Now most here who know me will tell you that I take personal responsibility for everything that has happened to me in my life. It's nobody else's fault but my own. I need no lame excuses and I make no apologies. I will live until I die. That's it! That's all there is! In the meantime, I have loved and enjoyed my life. Heart attacks, aneurysms, broken bones, flus, acid reflux are minor blips in the grand scheme of things. I have much less a desire in living forever than enjoying what living I get to do. If the options were immortality versus mortality perhaps I'd have a different view. Alas.

If I practice x, as opposed to y, are there guarantees? If I practice y am I guaranteed poor health, a meandering painful death? No! Hence, I'll take my chances. What the hell is life without risks? Humans don't come with cocoons.

But is this wise counsel for all the younger generations?

Fine! Let him find that venue where "young" people aggregate to ponder the wisdom of their elders (good luck finding that one). Ain't a lot of "young" people here. Granted John and I are at an age where many appear as "young" people but in the vernacular most of the folks here ain't "young" people.

I really don't believe John Lawrence is promoting health warranties or big brother controls or dictums of healthful lifestyles as your 'Artfully' imply.

Now you have no idea just how comforting your beliefs are to me. As we speak I'm running them to the bank to see if I can deposit them. On the other hand, "you say either and I say neither". Whose views, beliefs, are the better informed? Even more; do I care what you believe? Does anyone, beyond John, of course, care? Authors always appreciate validation.

He is simply highlighting a greater awareness in our society of incentivizing and promoting (as do other advanced nations) the obvious quality of life benefits possible from focusing on delicious nutricious foods, being alert to dangerous food processing methods, routinely exercising and avoiding over-reliance on pills and drugs as automatic answers to all our physical, emotional discomforts and pains.

Whew! What a sentence! And this is new news? Doctors and every manner of health professional has been telling us this for most of my life, and that's a lot of years. I need John to preach to me more of conventional wisdom? Puhleese!

Continued

Tuesday, 07 July, 2009

Art A Layman said...

Anonymous:

Continuing the enlightenment...

You self-rightously appear to suggest this is all nonsense or disguised authoritorian preaching! But your comments are equally indirectly, if not directly, cocky and ironically inflexible. They amount to what I would call Mr. Art Layman's concept of healthful living nihilism. Doctors, of course, profit from people who are in stupendous denial of simple ways to improve chances for good health and longevity on this delicate environmental paradise called earth.

Wow! Are you a poet in another life? One could posit that your writing seems similar to another regular poster here. He, who shall not be named, but, no doubt should be obeyed. I self-righteously assert most of what I write here. I am a self-righteous person. However, one could make a strong argument that my self-righteousness doesn't hold a candle to John's or perhaps yours.

Actually I have not disputed John's principle concepts, rather his emphasis in subjecting us all to them and once doing so charging us for the privilege. I have also disputed his "facts" which in political parlance would be labelled spin, at best, and half-truths, at worst.

Preachers make their living by selling salvation or doom. Salvation or Hell and Damnation, take your choice. From laymen I expect a higher standard. If you want to pontificate get your facts correct and don't shortchange me. I want the whole truth! I can handle it!

One more similarity between you and the unnamed one, you both, at times, fail to read or comprehend that to which you take great exception

Tuesday, 07 July, 2009

Art A Layman said...

Anonymous:

It was good though. Took me awhile to figure it out

Tuesday, 07 July, 2009

Art A Layman said...

SMV:

I believe that feeding cows corn increases the growth rate. It also increases marbling and fat % in general.

I stand corrected. Might be I misread what I was reading. Farming is near the bottom of my knowledge base. However improving the growth rate would be an economic reason for corn feeding, which was my main point. It's not all done because the government subsidizes corn.

Manure on the outside of the cow makes contact with the meat as the hide is cleaned & removed. Cutting the meat contaminates the outside edges of the meat. High heat on the outside edge of a steak kills the E. coli. The inside of the steak remains uncontaminated.

Grinding meat mixes the E.coli into the center of the burger requiring the entire burger be heated to “X” degrees for “Y” period of time to kill the E. coli.

Thanks for the "DUH!" moment. What was the point of my assertion?

3. The other issue is using the infected Manure as fertilizer. If you eat vegetables raw that have been fertilized with infected manure and are not sufficiently cleaned you can get sick. (Salad anyone?)

Valid point. Might not tighter restrictions on manure for fetilizer be called for?

4. Requiring irradiation in slaughter houses may be an acceptable solution, but it does give large processors an advantage over small processors. To me a better solution would be to test the meat as it leaves the processing plant. If it has high contamination them shut them down until the source of the contamination is addressed. This would allow different operations to use different methods to meet the health requirements. If cows raised on grass do not have the contamination issue then they could use lower cost methods for avoiding contamination.

Is not, supposedly, the testing taking place now? Could it be that some processors ignore the test results? Surely not in a "free market" laissez-faire economy, we know that all the players follow the regs to a T.

Shut them down? And this offers no advantage to large versus small processors?

How many processors limit the cattle they buy based on feedlots? If they don't, in for a dime, in for a dollar.

Is anyone to be shocked that you would favor eliminating subsidies

Tuesday, 07 July, 2009

Art A Layman said...

SMV:

Would you care to explain or did all the lectures on healthy living make you decide to take pot shots?

Taking pot shots is new from me? Damn! All this time I've been failing.

Think a little bit and maybe you'll begin to understand, even agree

Tuesday, 07 July, 2009

SMV said...

Art,
“Is not, supposedly, the testing taking place now? Could it be that some processors ignore the test results? Surely not in a "free market" laissez-faire economy, we know that all the players follow the regs to a T.”

“Shut them down? And this offers no advantage to large versus small processors?”

One of the complaints in the literature I have read is that the regulations specify equipment and facilities rather than specifying the outcome (i.e. levels of E. coli). If you don’t set limits you cannot shut them down when the limits are exceeded.

The requirements favor the large producers verses the small processors. One requirement often noted is a separate bathroom used only by the inspector. Structuring the requirements this way limits competition and drives up profits.

Tuesday, 07 July, 2009

John Lawrence said...

Art said:

I'm on Medicare. I can live the Epicurean life to the hilt and it won't cost me a dime more than all you health food, exercise addicts.

Yes, but it will drive up the cost of Medicare. But if you don't care about systemic problems, ...

Wednesday, 08 July, 2009

John Lawrence said...

In addition to irradiation, hamburger, or processed meat that passes for hamburger, is being washed with chlorine at some meat packing plants to get rid of e coli. Before long food will bear no resemblance to what nature provided but will be an assemblage of chemicals with the proper components of salt, fat and sugar along with the appropriate "mouth feel" to satisfy consumers. It doesn't take a PhD to figure out that such artificial products loaded with preservatives and bovine growth hormone and vegetables sprayed with pesticides might not be conducive to good health in the long run. But if you're like Art and take the attitude that in the long run we're all dead so what the heck live for the moment and enjoy life while you can, you won't give a dip shit about healthy living. Bring on the cigars and brandy! Hell, bring on the dancing girls too!

Buying food locally from farmers with good farming practices might be an alternative well worth the extra money. But, alas, poor people will still find it cheaper to eat at fast food restaurants which is where most of the homeless eat

Wednesday, 08 July, 2009

Art A Layman said...

John:

Yes, but it will drive up the cost of Medicare. But if you don't care about systemic problems ...

Not if I'm the only one who doesn't follow your advice. I'll just be a drop in the bucket.

And remember I'll die sooner and Medicare costs will go back down.

Wednesday, 08 July, 2009

Art A Layman said...

John:

Bring on the cigars and brandy! Hell, bring on the dancing girls too!

Whoopee!!!! If you gotta go down, why not in flames?

My kinda guy!!!!

Wednesday, 08 July, 2009

The Movie - "Food Inc." - Is an Eye Opener!

I just saw the movie Food Inc. and is it an eye opener. The number of incidences of e coli are directly related to the factory production of farm animals for slaughter in feed lots or chicken houses. First they feed the cows corn instead of hay which they evolved to eat. Corn produces bacteria in their gut including e coli whereas, if they were fed grass or hay this would not happen. Animals who eat hay produce manure which can be spread on fields as fertilizer, but animals fed corn including cows and hogs produce a toxic sludge. A hog waste pond recently threatened to pollute a major river. Corn is subsidized by the government  so the unhealthy production of meat and low prices for fast food are actually subsidized by the government!

My Grandfather was a farmer, and he grew the hay in his own fields which he fed to his cattle and then spread the manure back on the fields with a manure spreader. They all did this in the 1940s and 50s.

Cows in feed lots have to stand around all day in their own waste products and this translates into more e coli in the slaughterhouse. No wonder there are so many recalls of beef products! Also birds pick up the e coli and transmit it to adjacent crops like spinach.

If you saw this movie you would never eat another piece of beef or chicken from the super market and especially from a fast food place.

Industrialized meat production by just a small number of corporate giants like Smithfield and Tyson is literally killing us because it's laced with growth hormones and the FDA is staffed by former lobbyists from the industries they're supposed to regulate. Poor people can pay less for a fast food meal than if they bought vegetables at the super market, and 1 out of 3 people born since 2000 will have early onset Type 2 diabetes. If you are a minority, it will be 1 out of 2. High fructose corn syrup and industrialized meat production are major contributors to obesity especially from fast foods.

The other interesting thing is that Monsanto has added a patented gene to soybeans that lets the field be sprayed with pesticide without affecting the soybean production. Since it is a patented gene, the farmer can't save seeds for next year's crop because they legally belong to Monsanto. Monsanto sends out investigators to make sure no farmer saves seeds or else they are prosecuted. Even farmers who don't buy Monsanto's genetically modified soybean seeds can be prosecuted by Monsanto if some of the genetically modified seeds happen to cross pollinate in a non-Monsanto farmer's field.

A Modest Proposal for Cost Containment of the Health Care System and Encouraging Human Health and Happiness

Here's a novel idea. Why not tie rates for health insurance (whether public or private) to an individual's willingness to stay healthy? In other words incentivize healthy lifestyles by giving rate cuts on health insurance. Right now some employers are incentivizing employees to exercize. This could be increased by incentivizing healthy lifestyles. With all kinds of devices being computerized and wirelessly networked, I can imagine a teadmill, for instance, wirelessly connected to a doctor's office or a database which clocked the hours spent by a specific individual. Also scales and blood pressure measurements at home can wirelessly transmit crucial health statistics to a central database or doctor's office. Classes in nutrition could count as well as a willingness to consume healthy foods and vitamins. Food purchases could be tracked. Technology is there. This might sound a little Big Brotherish, but the gains in human health, happiness and productivity not to mention cost containment of the health care system would justify encouragement of healthy lifestyles in my opinion.

There are many ways a person's willingness to lead a healthy lifestyle regarding diet and excercise could be tracked, measured and evaluated and that data could be used to determine the rate a person should pay for health insurance. Those not willing to lead a healthy lifestyle should pay more because they will be a greater burden on the overall health care system. Obese people especially are more in danger of heart and kidney problems from Type 2 diabetes, heart attacks etc.

I think this emphasis on healthy lifestyles and incentivizing it by lowering individual rates for health insurance would do a lot for cost containment of the overall health care system and encourage individual responsibility for taking care of one's self and family.

Tylenol Can Destroy Your Liver

This is a continuation of an ongoing stream of articles on our health care system and the causes of out of control costs part of which are due to an over reliance on prescription and non-prescription drugs and part of which are the product of the consumption of highly advertised, great tasting but nutritionally deprived foods. The following comment was left by Frank Thomas on Robert Reich's blog.

Frank Thomas said:

In this regard, America seems to be a casual, quick slicking pill of all kinds and a welcoming over-prescribed medicines obsessed society. This compulsive cultural behavior in combination with nutritional bad habits, in excess of course, contributes to reducing or neutralizing the body´s natural immunity system´s development during our 30s, 40s and 50s ... just when a strengthened immunity system is most needed when it naturaly starts to decline in our 65s, 70s
and 80s.

I left the following comments here and here:

One of the aspects of increased health care costs is the veritable barrage of TV and magazine advertising for prescription drugs. This not only raises the cost of those drugs, but creates a culture where every problem seemingly can be solved by taking a pill. America is a culture of prescription and non-prescription drug addicts. Every malady or discomfort, we are told, can be cured by taking a pill.

The dirty little secret is that for every pill taken there are side effects. It has just come to light that the painkiller acetamenophen found in Tylenol and other medicines can cause liver damage even deaths in otherwise healthy individuals because of its destructive effects on the liver. So does it not stand to reason that, even in moderate doses, this drug is not doing any good for the liver? The cumulative effects over time can cause the type of problems in old age that Frank suggests.

With Mother Nature you don't get something for nothing. The cumulative effects of ingesting drugs and food laced with preservatives and other toxic substances leads to failure of various organs if not catastophically when young, then gradually as we age. The liver's function is to get rid of toxic substances. Obviously, as far as the liver is concerned, acetaminophen is a toxic substance. So while Tylenol relieves pain, it overloads the liver which has enough to do to get rid of toxic substances without the added burden of getting rid of acetaminophen. This is what Frank is talking about as far as "compromising the immune system." Compromising the various organs whose task is to eliminate toxic substances is the price paid by pain relief as well as the price to be paid for various other drugs and pharmaceuticals which serve no other purpose than pain relief or lifestyle enhancement. I include Viagra, Levitra and Cialis in this category. Short term enhancement is paid for by eventual breakdown of organs which have to deal with the elimination of toxic substances. This leads to an increased burden and cost on the health care system for people in the last stages of life.

The subsidization of corn products by the government leads directly to the subsidization of fast foods in terms of corn fed beef and high fructose corn syrup which are directly responsible for obesity. The proper combination of sugar, fat and salt in order to get people hooked on processed food products is something that is calculated in food giant chemical labs and even put in place in baby food products. Hooking people on fat, salt and sugar is something that food processors and in particular fast food giants pursue with a vengeance. This in combination with advertising encourages people to not consider the nutritional value of what they're consuming but only the taste value. To jack up the taste content of food products a whole host of unnatural substances are added. Read the contents on any label. This consumption of highly advertised, great tasting foods is largely responsible for much of the added burden to our health care system due to the results it engenders in terms of obesity and health problems related to obesity.

These additional health problems from consuming great tasting but nutritionally impoverished foods, we are told, can be alleviated by consuming prescription and over the counter drugs. So the health care industry and the food industry (particularly fast foods) are essentially in cahoots in producing a country of over medicated and nutritionally deprived people and overly emburdening the health care system which drives up costs.

The educational system is a total farce as it has produced a people who are financially and nutritionally illiterate among other forms of illiteracy. They are taught American history which is a fantasy, and they are not taught anything which might be critical of the large corporations and their hold on the power structure of Washington. We are just pawns of the large corporations whose goal is to turn the middle class into a nation of debtors, docile and complacent consumers of fast food and prescription drug garbage and health care system dependents.

Health Care Showdown: The Alleged 'Center' Must Not Hold

Published on Monday, June 22, 2009 by The New York Times

by Paul Krugman

America’s political scene has changed immensely since the last time a Democratic president tried to reform health care. So has the health care picture: with costs soaring and insurance dwindling, nobody can now say with a straight face that the U.S. health care system is O.K. And if surveys like the New York Times/CBS News poll released last weekend are any indication, voters are ready for major change.

The question now is whether we will nonetheless fail to get that change, because a handful of Democratic senators are still determined to party like it’s 1993.

And yes, I mean Democratic senators. The Republicans, with a few possible exceptions, have decided to do all they can to make the Obama administration a failure. Their role in the health care debate is purely that of spoilers who keep shouting the old slogans — Government-run health care! Socialism! Europe! — hoping that someone still cares.

The polls suggest that hardly anyone does. Voters, it seems, strongly favor a universal guarantee of coverage, and they mostly accept the idea that higher taxes may be needed to achieve that guarantee. What’s more, they overwhelmingly favor precisely the feature of Democratic plans that Republicans denounce most fiercely as “socialized medicine” — the creation of a public health insurance option that competes with private insurers.

Or to put it another way, in effect voters support the health care plan jointly released by three House committees last week, which relies on a combination of subsidies and regulation to achieve universal coverage, and introduces a public plan to compete with insurers and hold down costs.

Yet it remains all too possible that health care reform will fail, as it has so many times before.

I’m not that worried about the issue of costs. Yes, the Congressional Budget Office’s preliminary cost estimates for Senate plans were higher than expected, and caused considerable consternation last week. But the fundamental fact is that we can afford universal health insurance — even those high estimates were less than the $1.8 trillion cost of the Bush tax cuts. Furthermore, Democratic leaders know that they have to pass a health care bill for the sake of their own survival. One way or another, the numbers will be brought in line.

The real risk is that health care reform will be undermined by “centrist” Democratic senators who either prevent the passage of a bill or insist on watering down key elements of reform. I use scare quotes around “centrist,” by the way, because if the center means the position held by most Americans, the self-proclaimed centrists are in fact way out in right field.

What the balking Democrats seem most determined to do is to kill the public option, either by eliminating it or by carrying out a bait-and-switch, replacing a true public option with something meaningless. For the record, neither regional health cooperatives nor state-level public plans, both of which have been proposed as alternatives, would have the financial stability and bargaining power needed to bring down health care costs.

Whatever may be motivating these Democrats, they don’t seem able to explain their reasons in public.

Thus Senator Ben Nelson of Nebraska initially declared that the public option — which, remember, has overwhelming popular support — was a “deal-breaker.” Why? Because he didn’t think private insurers could compete: “At the end of the day, the public plan wins the day.” Um, isn’t the purpose of health care reform to protect American citizens, not insurance companies?

Mr. Nelson softened his stand after reform advocates began a public campaign targeting him for his position on the public option.

And Senator Kent Conrad of North Dakota offers a perfectly circular argument: we can’t have the public option, because if we do, health care reform won’t get the votes of senators like him. “In a 60-vote environment,” he says (implicitly rejecting the idea, embraced by President Obama, of bypassing the filibuster if necessary), “you’ve got to attract some Republicans as well as holding virtually all the Democrats together, and that, I don’t believe, is possible with a pure public option.”

Honestly, I don’t know what these Democrats are trying to achieve. Yes, some of the balking senators receive large campaign contributions from the medical-industrial complex — but who in politics doesn’t? If I had to guess, I’d say that what’s really going on is that relatively conservative Democrats still cling to the old dream of becoming kingmakers, of recreating the bipartisan center that used to run America.

But this fantasy can’t be allowed to stand in the way of giving America the health care reform it needs. This time, the alleged center must not hold.

© 2009 The New York Times

Paul Krugman is professor of Economics and International Affairs at Princeton University and a regular columnist for The New York Times. Krugman was the 2008 recipient of the Nobel Prize in Economics. He is the author of numerous books, including The Conscience of A Liberal, and his most recent, The Return of Depression Economics. 

Rescission: The Health Care Industry Makes Its Profits by Canceling Sick Patients' Health Insurance

The private health insurance industry makes its profits by rescission which is the policy of canceling the medical insurance of policyholders who come down with illnesses which are expensive to treat.

From the LA Times:

An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant Inc. canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period. It also found that policyholders with breast cancer, lymphoma and more than 1,000 other conditions were targeted for rescission and that employees were praised in performance reviews for terminating the policies of customers with expensive illnesses.

It is totally immoral and unethical to cancel a person's medical insurance at the moment of their greatest need and this fact alone should be reason enough to adopt a public national health care plan. At least rescission should be outlawed. The health insurance industry makes its profits by denying people coverage.

When are the American people going to wise up and recognize that the health care insurance industry is at root unethical and demand public health care that isn't canceled after they get sick? No wonder the single greatest cause of bankruptcy is medical expense. It shouldn't be this way. Big Insurance is counting on the fact that only a small minority of its policyholders is affected by policy cancellation and bankruptcy and the rest of relatively healthy policyholders don't give a hoot about the ones who are.

You know, these policies by the health insurance industry are very similar to Enron's energy policies which resulted in "screwing Grandmas in California," as one of the Enron traders said. Unfettered capitalism leads to greed running amok and ruining people's lives while the CEOs and other executives take home obscene amounts of money. Bill McGuire of United Health Care left with over a billion dollars! That money was made by denying sick people their health insurance claims. It is tantamount to a death sentence for many patients and it is ruining the lives of countless others as they file for bankruptcy. Obama's mother herself was a victim of the health insurance industry since, as recounted by Obama, she had to argue with the insurance company over her coverage as she was dying of cancer.

Doctors, nurse and hospitals used to be there to heal and to help sick patients. They were "helpers" dedicated to improving peoples' lives and restoring their health so they could go on to live productive lives. They were "good" people. My father, Clifton Lawrence, served for 20 years as President of the Board of the Alexander Linn hospital in Sussex, NJ. He wasn't paid for his efforts. It was community service. Today it's all about profit and obscene profit at that; it's about lucre. Nothing that's not lucrative is worth doing according to the prevailing economic philosophy. Community service is out the window - defenestrated. Who needs to be defenestrated are the CEOs of the insurance companies whose stock-in-trade is denying people the help they need in order to make obscene profits for their corporations.

More from the LA Times article:

But rescission victims testified that their policies were canceled for inadvertent omissions or honest mistakes about medical history on their applications. Rescission, they said, was about improving corporate profits rather than rooting out fraud. "It's about the money," said Jennifer Wittney Horton, a Los Angeles woman whose policy was rescinded after failure to report a weight-loss medication she was no longer taking and irregular menstruation. "Insurers ignore the law, and when they find a discrepancy or omission, they rescind the policy and refuse to pay any of your medical bills -- even for routine treatment or treatment they previously authorized," Horton said. She and others from around the country accused insurers in testimony of gaming anti-fraud laws to take policyholders' premiums, only to drop people who developed serious illnesses. They testified that they or a deceased loved one had had policies canceled over innocent mistakes and inadvertent omissions on their applications. A Texas nurse said she lost her coverage, after she was diagnosed with aggressive breast cancer, for failing to disclose a visit to a dermatologist for acne. The sister of an Illinois man who died of lymphoma said his policy was rescinded for the failure to report a possible aneurysm and gallstones that his physician noted in his chart but did not discuss with him. The committee's investigation found that WellPoint's Blue Cross targeted individuals with more than 1,400 conditions, including breast cancer, lymphoma, pregnancy and high blood pressure. And the committee obtained documents that showed Blue Cross supervisors praised employees in performance reviews for rescinding policies. One employee, for instance, received a perfect 5 for "exceptional performance" on an evaluation that noted the employee's role in dropping thousands of policyholders and avoiding nearly $10 million worth of medical care. Committee members took turns, alternating Democrats and Republicans, condemning such practices. "When times are good, the insurance company is happy to sign you up and take your money in the form of premiums," said Rep. Bart Stupak (D-Mich.). "But when times are bad . . . some insurance companies use a technicality to justify breaking its promise, at a time when most patients are too weak to fight back."

Robert Reich has a memo to Obama posted on his blog about what the President must do to save public universal health care.

Warning: Health Care Lobbyists Are Winning the Battle to Screw All of Us

By Marie Cocco, Washington Post Writers Group. Posted June 18, 2009.

Lobbyists sense that their chances of protecting big insurers, drug companies, medical specialties, technology companies are improving.

WASHINGTON -- You can't get there from here. Not if there is defined as health insurance coverage for everyone in the United States, lower costs for the millions of insured who are being crushed by its price, and relief for employers who are burdened by an expense many wish they could wipe off their books. And not if here is where the health insurance political debate is stuck.

At the moment, Republicans are gleeful and Democrats glum because of a Congressional Budget Office analysis -- based on an incomplete and early draft of what is likely to be the most liberal-leaning health care proposal to emerge from the Senate -- that shows the measure just won't get the job done. The budget office says the partial draft put together mainly by Sen. Edward M. Kennedy, D-Mass., would reduce the number of uninsured by only about 16 million (out of upwards of 47 million) and cost about $1 trillion over the next decade. That's very little bang for a lot of bucks. But no one should be surprised at either number. For starters, candidate Barack Obama never ran on a platform to provide universal coverage. Of course he always said -- then and now -- that his goal is to cover everyone. But he has never put forward a concrete proposal for doing so, and hasn't endorsed a firm mandate that everyone purchase insurance. Remember those primary-season debates in which rivals Hillary Clinton and John Edwards criticized him for this? Attention should have been paid.

Now President Obama has left the legislative "details," as the White House likes to call them, to our esteemed lawmakers on Capitol Hill. This has fed an every-member-for-himself mentality, an instinct that needs no nourishment. Lawmakers of every political leaning are putting forward their own ideas, none of them as tough-minded or comprehensive as a single administration-initiated proposal might have been. Why? Because senators and members of the House represent discrete districts that are driven by their own local and political imperatives. They don't represent the country as a whole -- nor, when the subject is as complicated and has so many regional differences as health care, should we expect them to.

The result is a raft of proposals that are patch-and-fill jobs on the current system -- a system that pretty much everyone believes is crumbling to the point of collapse. This is an odd way to begin a major reconstruction project.

No one has seriously proposed concrete cost controls such as discount purchasing of prescription drugs by a government entity, which would demonstrably cut costs. In fact, the initial CBO analysis that my fellow liberals are so upset about shows not cost savings but a great deal of cost-shifting: The government would save money it now uses to subsidize tax-free insurance premiums, because some employees would drop workplace plans and purchase insurance through a new "exchange." But this savings would only partially offset the cost of providing subsidies to those who can't afford to purchase a policy outright. Meanwhile, the private insurance industry would continue to be the chief source of coverage -- and the only one, if the industry gets its way and Democrats produce legislation that does not create a public insurance plan as one purchase option.

Advocates of a single, national insurance system that would involve explicit cost controls and guidelines for care -- that might put an end to such wasteful practices as over-testing -- have been shunted aside. This is in part because Democrats quiver when Republicans call them "socialists." But Republicans cry "socialist" even when Democrats promote weak reforms that barely nick the vested interests. That's what's happening now. No one has seriously proposed an overhaul that would achieve what a single-payer system has been shown to accomplish in most other countries: universal coverage with lower costs that delivers better results than we now get in the United States.

Instead, Democrats have all but abandoned the idea that everyone be covered without exception. They've so far avoided endorsing clear cost-containment measures that would pass the budget-scorers' test of legitimacy. The wished-for savings that Obama says he wants the private insurance industry to achieve are exactly that -- wishes. The winners so far are health-industry lobbyists. They sense that their chances of protecting the interests of big insurers, drug companies, medical specialties, technology companies and the like are improving every day. They're probably right.

Marie Cocco's e-mail address is mariecocco(at)washpost.com.

The Flaw in Obama's Logic on Health Care

In his recent Town Hall meeting as well as in his recent speech to the American Medical Association, Obama has reemphasized his call for a public option in a revised health care system. At the same time he has ruled out single payer which would represent a public option for everyone and the elimination of private health care insurance. Obama said essentially that single payer was off the table because it wouldn't work in the US due to American traditions surrounding health care.

Here is the quote from his speech to the AMA:

What are not legitimate concerns are those being put forward claiming a public option is somehow a Trojan horse for a single-payer system. I'll be honest. There are countries where a single-payer system may be working. But I believe – and I've even taken some flak from members of my own party for this belief – that it is important for us to build on our traditions here in the United States. So, when you hear the naysayers claim that I'm trying to bring about government-run health care, know this – they are not telling the truth. What I am trying to do – and what a public option will help do – is put affordable health care within reach for millions of Americans. And to help ensure that everyone can afford the cost of a health care option in our Exchange, we need to provide assistance to families who need it. That way, there will be no reason at all for anyone to remain uninsured.

It is important for us to build on our traditions here in the United States. What does this mean? Is it more important for us to build on our traditions than it is for us to institute the best health care system possible? This is typical American exceptionalism and American arrogance and a misguided appeal to "tradition." Is it more important to build on a traditional policy or to have the best policy?

Rationally, if we are redesigning some system - any system - it should be more important to come up with the best system possible at that time rather than building on tradition. There are a lot of good health care systems out there including single payer in which health care delivery is privatized but health insurance is publicized. Doctor offices and hospitals are privately run, but costs are paid by government run health insurance. There are other systems such as the new Dutch health care system where insurance is provided by private companies which are heavily regulated by the government to provide universal coverage at reasonable cost.

You would think that the US would have studied the health care systems of other countries and then chosen the best or chosen a hybrid or modified the best system at the margins. But, no, we must have an American system rather than the very best system. So, in other words, by building on tradition, by elevating tradition above logic and rationality, Obama is calling for a system that is less than the best possible system devised by the best possible minds and the best possible human efforts. AMERICANS MUST SETTLE FOR A LESS GOOD SYSTEM BECAUSE OF TRADITION.

But when Obama calls for a health care system based on American traditions instead of what is rationally the best system we could devise, he is really pandering to the private health insurance industry. "American traditions" are really code words for "we don't want to fight the private health insurance lobby because they are too powerful." Other countries are free to come up with and revise their health care systems but we Americans are beholden to the health insurance lobbyists and their corporate sponsors. Politicians who take large campaign contributions from health insurance corporations argue vociferously that private health insurance is the way to go even though the private health insurance industry makes its profits by denying needy folks health care. Every dollar in health care denied is a dollar of profit. They make their profits by dropping folks who have health problems and are likely to cost them money. At the very least the government should mandate that private insurance must enroll everyone at the same rates regardless of pre-existing conditions else the private health insurance industry will continue to cherry pick the healthiest folks to enroll and to cover while folks that really need health care go begging. And the public option will have to pick up the rest putting it at a disadvantage.

This need to cater to tradition will probably result in a health care mish mash that really sucks dooming American citizens to a health care system in which costs - both individual and systemic - continue to rise while providing poorer overall outcomes than the rest of the industrialized world. Fee for service medicine rather than fee for health outcomes dooms the American traditional system to a system in which the more fancy tests run and the more fancy procedures used, the higher are doctor profits as well as individual and systemic costs. Universal coverage is one thing but at what cost? The whole thing is very simple. You want quality health care delivery, universal coverage and reasonable individual and systemic cost. All the rest is window dressing.

You would think that the way to go about revising or reforming health care would be to have a think tank composed of the brightest minds come up with a health care system that was laid out for all the world to see before being voted into law. Or maybe several competing think tanks or task forces would come up with several competing health care systems. Then a "conciliation" process would produce one system that retained the best features of the competing potential systems. Such a rational process based upon and built upon what has come before in countries all over the world should produce a better final outcome than a health care system based on American traditions. Taiwan, when it revised its health care system looked at the best systems from all over the world rather than basing its new health care system on Taiwanese traditions.

Taiwan consulted health care experts from abroad to come up with the best possible system. Did the US do any such consultation? No. The US figures it's superior to any other country and has nothing to gain by following their example or consulting their experts. American arrogance and exceptionalism again. Here's a quote regarding the Taiwanese method: 

Hongjen Chang was one of the officials in charge back then. Walking through Taipei's imposing Chiang Kai-shek Memorial Park, he recalls how they did it. "Taiwan is a small island," he says. "We always look abroad internationally for ideas." Chang quotes a Chinese saying: "'The track of the previous cart is the teacher of the following cart.'" In other words, if someone else's oxcart has found a good route to universal health coverage, follow those tracks. "If they were trapped in trouble, avoid that track. Find a new track," Chang says. The government consulted experts from around the world, like Taiwanese American health economist Tsung-mei Cheng. "In the end, the program that they finally set up in 1995 really is like a car that was made of different parts, imported from overseas, but manufactured domestically," Cheng says.

The process undertaken by the American Congress with various committees holding hearings, in which lobbyist drone Congressmen advocate for the corporations that are paying them and for whom they hope to hold lucrative positions once they exit "public service," is a travesty to a democratic process in which the best possible health care plans would be laid before the American people and then debated. This process would insure that the final implementation would be one in which the new health care system was arrived at by a rational process, not one based on American traditions. American traditions is just code for putting private profits above the interests of the American people.

Healthcare Going to Hell?

Published on Thursday, June 18, 2009 by CommonDreams.org

Well, Well... Going to Healthcare Hell

by Donna Smith

We've learned some remarkable things over the past few weeks about healthcare reform in these United States. Remarkable, tragic, sad, disgusting and unacceptable truths about what we've put up with for decades and what we are about to see written into law unless we rise up.

It was Jesus Christ who is credited with saying, "Ye shall know the truth and the truth shall set you free." We'll see about that really soon. Our elected officials aren't really too partial to that comment by J.C.

Here are some truths we've learned:

Those who are protecting the profit-takers in healthcare will say or do anything. You know, the old saw, "Don't let the government get between you and your healthcare," they threaten as ammunition to scare you away from progressively financed, guaranteed healthcare for all - like those scary Canadians or Scandinavians have. But do you know what the reality is in Canada and many of the nations where healthcare is actually valued as a human right? In Canada, it is a crime punishable by up to 10 years in prison for a government bureaucrat to interfere in any way in a patient care issue or decision.

While here in the United States, we let insurance companies not only get in between our doctors and patients but actually block them ever seeing one another. This week we heard testimony in a Congressional committee that the insurance companies our President and Congress want so desperately to protect have no intention of stopping the practice of policy rescissions. Rescissions happen when you get sick, file an insurance claim and then the insurance company searches your records to find reasons they would have denied you coverage before your illness and then retroactively drops your coverage. And their favorite targets? The committee found, according to the Los Angeles Times, "WellPoint's Blue Cross targeted individuals with more than 1,400 conditions, including breast cancer, lymphoma, pregnancy and high blood pressure." Ugly stuff. And talk about getting between you and your doctor...

And while we're looking to enhance these companies by awarding them the business of every American by forcing purchase of their products as mandated in law, take note that women are still targets. Last month in a Senate hearing, the insurance industry said if all of us have to buy insurance they'll stop discriminating against women in the charging of premiums and the determinations of claims payment and pre-existing conditions. Wow. They'll stop killing and injuring women if they get their way and 47 million new customers forced to pay up.

In the bill released by the Senate HELP committee last week, I noted that the Indian Health Service will be exempted from the new law proposed. Really? Guess we just have to make sure those lousy, sickly Native Americans don't actually end up in someone's healthcare insurance pool using benefits to get care for chronic diseases when we can just more easily keep them covered by the seriously underfunded Indian Health Service. Horrible stuff.

And in Senator Baucus' committee, Senate Finance, they'll be OK with it if insurance companies only charge up to five times as much for age-related rating of premiums. Wow. That's shocking, and I'll bet most older people don't even know that their Congressional members are considering allowing that to be done to them. Fives times as much to be paid by older people for health insurance - and no promises about denial of claims or policy rescission. Sweet deals are being made all over the place for everyone but you and me and our neighbors and friends.

It's healthcare, human rights hell, and it going to get worse unless and until we stand up more loudly and clearly for what most of us were taught by our parents about what is decent and what is right. This Congress cannot act on our behalf as decent Americans - apparently - without our righteous demands on behalf of one another.

Step up. Stand up. Speak up. People with cancer, women, and minorities... are you feeling lucky you aren't in one of those groups? Watch out. Tomorrow could be the day you need care and your newly empowered insurance company says, "Go to hell." And your emboldened elected officials who failed to act say, "Sorry, we couldn't pass real reform. Maybe next time."

The time is drawing closer when the Rose Garden ceremony will only feature those who built this purgatory for so many of us and aim to take it a few levels deeper.

Donna Smith is a community organizer for the California Nurses Association and National Co-Chair for the Progressive Democrats of America Healthcare Not Warfare campaign.

Canadian Health Care Mythology

Published on Sunday, June 7, 2009 by The Denver Post

Debunking Canadian Health Care Myths

by Rhonda Hackett

As a Canadian living in the United States for the past 17 years, I am frequently asked by Americans and Canadians alike to declare one health care system as the better one.

Often I'll avoid answering, regardless of the questioner's nationality. To choose one or the other system usually translates into a heated discussion of each one's merits, pitfalls, and an intense recitation of commonly cited statistical comparisons of the two systems.

Because if the only way we compared the two systems was with statistics, there is a clear victor. It is becoming increasingly more difficult to dispute the fact that Canada spends less money on health care to get better outcomes.

Yet, the debate rages on. Indeed, it has reached a fever pitch since President Barack Obama took office, with Americans either dreading or hoping for the dawn of a single-payer health care system. Opponents of such a system cite Canada as the best example of what not to do, while proponents laud that very same Canadian system as the answer to all of America's health care problems. Frankly, both sides often get things wrong when trotting out Canada to further their respective arguments.

As America comes to grips with the reality that changes are desperately needed within its health care infrastructure, it might prove useful to first debunk some myths about the Canadian system.

Myth: Taxes in Canada are extremely high, mostly because of national health care.

In actuality, taxes are nearly equal on both sides of the border. Overall, Canada's taxes are slightly higher than those in the U.S. However, Canadians are afforded many benefits for their tax dollars, even beyond health care (e.g., tax credits, family allowance, cheaper higher education), so the end result is a wash. At the end of the day, the average after-tax income of Canadian workers is equal to about 82 percent of their gross pay. In the U.S., that average is 81.9 percent.

Myth: Canada's health care system is a cumbersome bureaucracy.

The U.S. has the most bureaucratic health care system in the world. More than 31 percent of every dollar spent on health care in the U.S. goes to paperwork, overhead, CEO salaries, profits, etc. The provincial single-payer system in Canada operates with just a 1 percent overhead. Think about it. It is not necessary to spend a huge amount of money to decide who gets care and who doesn't when everybody is covered.

Myth: The Canadian system is significantly more expensive than that of the U.S.

Ten percent of Canada's GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada's. Part of the reason for this is uninsured and underinsured people in the U.S. still get sick and eventually seek care. People who cannot afford care wait until advanced stages of an illness to see a doctor and then do so through emergency rooms, which cost considerably more than primary care services.

What the American taxpayer may not realize is that such care costs about $45 billion per year, and someone has to pay it. This is why insurance premiums increase every year for insured patients while co-pays and deductibles also rise rapidly.

Myth: Canada's government decides who gets health care and when they get it.

While HMOs and other private medical insurers in the U.S. do indeed make such decisions, the only people in Canada to do so are physicians. In Canada, the government has absolutely no say in who gets care or how they get it. Medical decisions are left entirely up to doctors, as they should be.

There are no requirements for pre-authorization whatsoever. If your family doctor says you need an MRI, you get one. In the U.S., if an insurance administrator says you are not getting an MRI, you don't get one no matter what your doctor thinks - unless, of course, you have the money to cover the cost.

Myth: There are long waits for care, which compromise access to care.

There are no waits for urgent or primary care in Canada. There are reasonable waits for most specialists' care, and much longer waits for elective surgery. Yes, there are those instances where a patient can wait up to a month for radiation therapy for breast cancer or prostate cancer, for example. However, the wait has nothing to do with money per se, but everything to do with the lack of radiation therapists. Despite such waits, however, it is noteworthy that Canada boasts lower incident and mortality rates than the U.S. for all cancers combined, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society. Moreover, fewer Canadians (11.3 percent) than Americans (14.4 percent) admit unmet health care needs.

Myth: Canadians are paying out of pocket to come to the U.S. for medical care.

Most patients who come from Canada to the U.S. for health care are those whose costs are covered by the Canadian governments. If a Canadian goes outside of the country to get services that are deemed medically necessary, not experimental, and are not available at home for whatever reason (e.g., shortage or absence of high tech medical equipment; a longer wait for service than is medically prudent; or lack of physician expertise), the provincial government where you live fully funds your care. Those patients who do come to the U.S. for care and pay out of pocket are those who perceive their care to be more urgent than it likely is.

Myth: Canada is a socialized health care system in which the government runs hospitals and where doctors work for the government.

Princeton University health economist Uwe Reinhardt says single-payer systems are not "socialized medicine" but "social insurance" systems because doctors work in the private sector while their pay comes from a public source. Most physicians in Canada are self-employed. They are not employees of the government nor are they accountable to the government. Doctors are accountable to their patients only. More than 90 percent of physicians in Canada are paid on a fee-for-service basis. Claims are submitted to a single provincial health care plan for reimbursement, whereas in the U.S., claims are submitted to a multitude of insurance providers. Moreover, Canadian hospitals are controlled by private boards and/or regional health authorities rather than being part of or run by the government.

Myth: There aren't enough doctors in Canada.

From a purely statistical standpoint, there are enough physicians in Canada to meet the health care needs of its people. But most doctors practice in large urban areas, leaving rural areas with bona fide shortages. This situation is no different than that being experienced in the U.S. Simply training and employing more doctors is not likely to have any significant impact on this specific problem. Whatever issues there are with having an adequate number of doctors in any one geographical area, they have nothing to do with the single-payer system.

And these are just some of the myths about the Canadian health care system. While emulating the Canadian system will likely not fix U.S. health care, it probably isn't the big bad "socialist" bogeyman it has been made out to be.

It is not a perfect system, but it has its merits. For people like my 55-year-old Aunt Betty, who has been waiting for 14 months for knee-replacement surgery due to a long history of arthritis, it is the superior system. Her $35,000-plus surgery is finally scheduled for next month. She has been in pain, and her quality of life has been compromised. However, there is a light at the end of the tunnel. Aunt Betty - who lives on a fixed income and could never afford private health insurance, much less the cost of the surgery and requisite follow-up care - will soon sport a new, high-tech knee. Waiting 14 months for the procedure is easy when the alternative is living in pain for the rest of your life.

Rhonda Hackett of Castle Rock, Colorado is a clinical psychologist.

Obama Starts to Get Real on Health Care

Obama now realizes he has to put more Presidential muscle into the health plan debate and not leave the details up to Congress because Congress is in the process of undermining Obama's key goals and vitiating the health plan to the point of unrecognizability, to the point of making it a ridiculous parody of what Obama intended.

According to the NY Times:

Mindful of the failures of former President Bill Clinton, whose intricate proposal for universal care collapsed on Capitol Hill 15 years ago, Mr. Obama until now had charted a different course, setting forth broad principles and concentrating on bringing disparate factions — doctors, insurers, hospitals, pharmaceutical companies, labor unions — to the negotiating table.

But Mr. Obama has grown concerned that he is losing the debate over certain policy prescriptions he favors, like a government-run insurance plan to compete with the private sector, said one Democrat familiar with his thinking. With Congress beginning a burst of work on the measure, top advisers say, the president is determined to make certain the final bill bears his stamp.

“Ultimately, as happened with the recovery act, it will become President Obama’s plan,” the White House budget director, Peter R. Orszag, said in an interview. “I think you will see that evolution occurring over the next few weeks. We will be weighing in more definitively, and you will see him out there.”

...

But as Mr. Obama wades into the details of the legislative debate — a process that began last week when he released a letter staking out certain specific policy positions for the first time — he will face increasingly difficult choices and risks.

Aides say he will not dictate the fine print. “It was never his intent to come to Congress with stone tablets,“ said his senior adviser, David Axelrod. But he will increasingly make his preferences known.

...

Many Republicans are already angry over the emphasis Mr. Obama placed on the public plan in last week’s letter. Senator Mitch McConnell, the Republican leader, said Friday that “the key to a bipartisan bill is not to have a government plan in the bill.”

Mr. Obama is well aware of these risks, advisers say. “This is what he is now very focused on,“ Mr. Orszag said. “What are the key things that are nonnegotiable? He is asking those sorts of questions: What are the drop-dead things that we need to have in order to have some hope of addressing long-term cost growth?”

Finally, Obama realizes that his strategy of leaving it up to Congress will not get the job done. And there is no popular movement in the US to demand that Congress adopt the public option. So Obama must essentially stake his reputation and his Presidency on his single handed ability to sway the people and the Congress to come up with something that's not a mockery of itself. If Congress has its way, the "reform" health plan will essentially be written by lobbyists for Big Pharma and Big Health Insurance Corporations and will totally favor private over public interests.

He has to forget the notion of bipartisanship, bring his version of a health care bill before Congress as a reconciliation bill thus avoiding a Repoblicon filibuster and concentrate on getting Democrats in line. That's the only way he'll get anything meaningful accomplished. The Repoblicons are playing him for a fool and using "bipartisanship" to put a noose around his neck.

Also posted as a comment on Robert Reich's blog.

Health Care Bastardization

Congress is up to its old tricks again. They are about to water down Obama's health care initiative to the point of a meaningless charade that will only benefit the profit sucking insurance and pharmaceutical industries that the initiative purportedly was supposed to rein in. Now they are talking about a "public option" that would only go into effect several years from now if certain events caused a "trigger."

Robert Reich has summed Repoblicon shenanigans up very succinctly:

So they're pulling out all the stops -- pushing Democrats and a handful of so-called "moderate" Republicans who say they're in favor of a public option to support legislation that would include it in name only. One of their proposals is to break up the public option into small pieces under multiple regional third-party administrators that would have little or no bargaining leverage. A second is to give the public option to the states where Big Pharma and Big Insurance can easily buy off legislators and officials, as they've been doing for years. A third is bind the public plan to the same rules private insurers have already wangled, thereby making it impossible for the public plan to put competitive pressure on the insurers. Max Baucus, Chair of Senate Finance (now exactly why does the Senate Finance Committee have so much say over health care?) hasn't shown his cards but staffers tell me he's more than happy to sign on to any one of these. But Baucus is waiting for more support from his colleagues, and none of the three proposals has emerged as the leading candidate for those who want to kill the public option without showing they're killing it. Meanwhile, Ted Kennedy and his staff are still pushing for a full public option, but with Kennedy ailing, he might not be able to round up the votes. (Kennedy's health committee released a draft of a bill today, which contains the full public option.)

The Repoblicons are up to their old tricks of coopting, vitiating, adulterating, bastardizing and undermining every piece of legislation until it serves the public in name only. Instead it serves the interests of the large corporations with powerful lobbyists. Hopefully, at last, the public will see through this ignominious charade. If this happens to health care this time, it will signal the death knell of the Obama administration. Obama's mistakes were 1) not to come up with a well-defined health care proposal himself instead leaving it to a heavily lobbyed Congress and 2) starting with the "public option" scenario instead of with single payer.

Where's the jawboning and brass knuckles when we really need them? Where's the bully pulpit? Where's the horse trading when you start with a plan that gives half the store away? Max Baucus had a bunch of doctors arrested for simply standing up and asking for single payer to be included in the discussion. They are now facing 6 month jail sentences merely for protesting.

The Repoblicons are masters at this kind of thing: giving some intitiative a good sounding name which is the opposite of what it really is. Remember the Blue Sky Initiative that allowed even more pollution into the atmosphere? No Child Left Behind could have been more aptly named Devil Take the Hindermost, Children Included.

The problem is that the American people are too dumb. They are easily deceived. They are like sheep being led to slaughter. They have no inkling what the rest of the world is doing. Even Sri Lanka has universal health care! The legislation they finally come up with will probably be another bastardization of health care, and it will serve to profit Big Insurance and Big Pharma even more than they profit today. Where's the outrage? Where's the protest?

And Rush Limbaugh will probably lambaste Obama and the Democrats for being socialists all the while smiling to himself because he knows the health care legislation will be meaningless. Meaningless legislation, empty rhetoric, vacuous solutions - this is what our government is all about because it is in the pockets of Big Insurance and Big Pharma. And the American people are too dumb to know the difference. They'll end up having the wool pulled over their eyes yet again.

The Latest from Frank Thomas on Health Care

Potential Administrative cost savings of $90 billion I pointed to are on the LOW side. Overall US health care Administrative costs today are reported to be 31% of total annual costs of say, the $2.4trillion you mention. This amounts to $744 billion in annual Administrative costs.

So my $90 billion cost saving estimate represents a meager 12% cost reduction ... however, still enough to cover the entire expected added cost of $75 billion to insure the uninsured and inadequately insured.

As to what the best system solution is, I'm in no position to say what the best Model mix for the Hodgepoge system MESS described bluntly but truthfully by John and me. The Netherlands has "reinjected market forces" as you propose into its unique managed competition health care program. But it's a simple as well as very sophisticated system where the GP has a key role as the Gatekeeper to insure no overuse of sppecialist care

At the moment, I do favor some CENTRAL and DECENTRALIZED Single Payer program perhaps offered by Medicare as well as private insurers (to maximize competition).
Whatever the final decisions here by Obama's Administration, I believe the final Real Reforms for a BASIC CARE quality-cost effective system should reflect some of the following KEY elements introduced step-by-step as needed:

A....Care based on need, not ability to pay

B....Care based on a reasonably uniform, standard health care benefits package for all

C....Care based on simplifying, harmonizing and coordinating federal and state health care including standarization and computerization of medical treatment coding, billing forms, and billing procedures

D....Care based on NO pre-conditions or risk rationing of clients by insurers

E....Care based preferably on NO deductibles/co-pays for incomes below say, 150% of the poverty level or $30,000, and perhaps income-means graduated deductibles/co-pays beyond this level

F....Care where the insured or to be insured always have free choice of insurers and providers

G....Care based on premium costs deductibles and co-pays preferably being no more than 5-6% of one's income above $30,000 with balance of funding coming from employers and employees through possibly a shared federal/state payroll tax of say, 6% sent directly. This is part of attempt to get at harmonization of 50 state different rules and taxes regarding health care.

H.... Care system that provides uniform high quality standards and tight oversight of same regionally and locally particularly; individual state income and/or tax-base wealth differences would be subsidized by federal government

I....Supplemental insurance coverage by private insurers enriched coverages, for catastrophic or long-lasting chronic illnesses.

The insurer industry also needs extensive Consolidation to reach appropriate health care economies of scale regionally.

Bill Moyers on Health Care

Published on Friday, May 22, 2009 by CommonDreams.org

Rx and the Single Payer

by Bill Moyers and Michael Winship

In 2003, a young Illinois state senator named Barack Obama told an AFL-CIO meeting, "I am a proponent of a single-payer universal health care program."

Single payer. Universal. That's health coverage, like Medicare, but for everyone who wants it. Single payer eliminates insurance companies as pricey middlemen. The government pays care providers directly. It's a system that polls consistently have shown the American people favoring by as much as two-to-one.

There was only one thing standing in the way, Obama said six years ago: "All of you know we might not get there immediately because first we have to take back the White House, we have to take back the Senate and we have to take back the House."

Fast forward six years. President Obama has everything he said was needed -- Democrats in control of the executive branch and both chambers of Congress. So what's happened to single payer?

A woman at his town hall meeting in New Mexico last week asked him exactly that. "If I were starting a system from scratch, then I think that the idea of moving towards a single-payer system could very well make sense," the President replied. "That's the kind of system that you have in most industrialized countries around the world.

"The only problem is that we're not starting from scratch. We have historically a tradition of employer-based health care. And although there are a lot of people who are not satisfied with their health care, the truth is, is that the vast majority of people currently get health care from their employers and you've got this system that's already in place. We don't want a huge disruption as we go into health care reform where suddenly we're trying to completely reinvent one-sixth of the economy."

So the banks were too big to fail and now, apparently, health care is too big to fix, at least the way a majority of people indicate they would like it to be fixed, with a single payer option. President Obama favors a public health plan competing with the medical cartel that he hopes will create a real market that would bring down costs. But single payer has vanished from his radar.

Nor is single payer getting much coverage in the mainstream media. Barely a mention was given to the hundreds of doctors, nurses and other health care professionals who came to Washington last week to protest the absence of official debate over single payer.

Is it the proverbial tree falling in the forest, making a noise that journalists can't or won't hear? Could the indifference of the press be because both the President of the United States and Congress have been avoiding single payer like, well, like the plague? As we see so often, government officials set the agenda by what they do and don't talk about.

Instead, President Obama is looking for consensus, seeking peace among all the parties involved. Except for single payer advocates. At that big White House powwow in Washington last week, the President asked representatives of the health care business to reason together with him. "What's brought us all together today is a recognition that we can't continue down the same dangerous road we've been traveling for so many years," he said, "that costs are out of control; and that reform is not a luxury that can be postponed, but a necessity that cannot wait."

They came, listened, made nice for the photo op. and while they failed to participate in a hearty chorus of "Kumbaya," they did promise to cut health care costs voluntarily over the next ten years. The press ate it up -- and Mr. Obama was a happy man.

Meanwhile, some of us looking on -- those of us who've been around a long time -- were scratching our heads. Hadn't we heard this before?

Way, way back in the 1970's Americans were riled up over the rising costs of health care. As a presidential candidate, Jimmy Carter started talking about the government clamping down. When he got to the White House, drug makers, insurance companies, hospitals and doctors -- the very people who only a decade earlier had done everything they could to strangle Medicare in the cradle -- seemed uncharacteristically humble and cooperative. "You don't have to make us cut costs," they promised. "We'll do it voluntarily."

So Uncle Sam backed down, and you guessed it. Pretty soon medical costs were soaring higher than ever.

By the early '90s, the public was once again hurting in the pocketbook. Feeling our pain, Bill and Hillary Clinton tried again, coming up with a plan only slightly more complicated than the schematics for an F-18 fighter jet.

This time the health industry acted more like Tony Soprano than Mother Teresa. It bludgeoned the Clinton reforms with one of the most expensive and deceitful public relations and advertising campaigns ever conceived -- paid for, of course, from the industry's swollen profits.

As the drug and insurance companies, hospitals and doctors dumped the mangled carcass of reform into the Potomac, securely encased in concrete, once again they said don't worry; they would cut costs voluntarily.

If you believed that, we've got a toll-free bridge to the Mayo Clinic we'd like to sell you.

So anyone with any memory left could be excused for raising their eyebrows at the health care industry's latest promises. As if on cue, hardly had their pledge of volunteerism rung out across the land than Jay Gellert, chief executive of Health Net Inc. and chair of the lobbying group America's Health Insurance Plans, assured his pals not to worry abut the voluntary reductions. "We believe that we can do it without undermining the viability of companies," he said, "and in effect enhancing the payment to physicians and hospitals." In other words, their so-called voluntary "reforms" will in no way interfere with maximizing profits.

Also last week, John Lechleiter, the chief executive of drug giant Eli Lilly, blasted universal health care in a speech before the U.S. Chamber of Commerce. "I do not believe that policymakers have yet arrived at a full and complete diagnosis of what's wrong and what's right with U.S. health care," he declared. "And I am very concerned that some of the proposed policies -- the treatments, to continue my metaphor -- will have unintended side-effects that make our situation worse."

So why bother with the charm offensive on Pennsylvania Avenue? Could it be, as some critics suggest, a Trojan horse, getting the health industry a place at the table so they can leap up at the right moment and again kill any real reform?

Wheelers and dealers from the health sector aren't waiting for that moment. According to the non-partisan Center for Responsive Politics, they've spent more than $134 million on lobbying in the first quarter of 2009 alone. And some already are shelling out big bucks for a publicity blitz and ads attacking any health care reform that threatens to reduce the profits from sickness and disease.

The Washington Post's health care reform blog reported Monday that Blue Cross Blue Shield of North Carolina has hired an outside PR firm to put together a video campaign assaulting Obama's public plan. And this month alone, the group Conservatives for Patients' Rights is spending more than a million dollars for attack ads. They've hired a public relations firm called CRC -- Creative Response Concepts. You remember them -- the same high-minded folks who brought you the Swift Boat Veterans for Truth, the gang who savaged John Kerry's service record in Vietnam.

The ads feature the chairman of Conservatives for Patients' Rights, Rick Scott. Who's he? As a former deputy inspector general from the Department of Health and Human Services told The New York Times, "He hopes people don't Google his name."

Scott's not a doctor; he just acts like one on TV. He's an entrepreneur who took two hospitals in Texas and built them into the largest health care chain in the world, Columbia/HCA. In 1997, he was fired by the board of directors after Columbia/HCA was caught in a scheme that ripped off the Feds and state governments for hundreds of millions of dollars in bogus Medicare and Medicaid payments, the largest such fraud in history. The company had to cough up $1.7 billion dollars to get out of the mess.

Rick Scott got off, you should excuse the expression, scot-free. Better than, in fact. According to published reports, he waltzed away with a $10 million severance deal and $300 million worth of stock. So much for voluntarily lowering overhead.

With medical costs rising six percent per year, that's who's offering himself as a spokesman for the health care industry. Speaking up for single payer is Geri Jenkins, a president of the California Nurses Association and National Nurses Organizing Committee -- a registered nurse with literal hands-on experience.

"We're there around the clock," she told our colleague Jessica Wang. "So we feel a real sense of obligation to advocate for the best interests of our patients and the public. Now, you can talk about policy but when you're staring at a human face it's a whole different story."

Bill Moyers is managing editor and Michael Winship is senior writer of the weekly public affairs program Bill Moyers Journal, which airs Friday night on PBS. Check local airtimes or comment at The Moyers Blog at www.pbs.org/moyers. Research provided by editorial producer Rebecca Wharton.

Single Payer Health Care a Non-Starter in the Senate

Published on Saturday, May 23, 2009 by The Boston Globe

Held Hostage by the Health System

by Dr. Marcia Angell

The Senate Finance Committee's hearings on health reform earlier this month did not include testimony from any advocate for single-payer insurance. Physicians for a National Health Program, which represents 16,000 doctors, asked the committee to invite me to testify, but it chose not to. If I had been invited, this is what I would have said:

The reason our health system is in such trouble is that it is set up to generate profits, not to provide care. We rely on hundreds of investor-owned insurance companies that profit by refusing coverage to high-risk patients and limiting services to others. They also cream off about 20 percent of the premiums for profits and overhead.

In addition, we provide much of our medical care in investor-owned health facilities that profit by providing too many services for the well-insured and too few for those who cannot pay. Most physicians are paid fee-for-service, which gives them a similar incentive, particularly specialists who receive very high fees for performing expensive tests and procedures. Nonprofits behave much like for-profits, because they must compete with them. In sum, healthcare is directed toward maximizing income, not maximizing health. In economic terms, it's a highly successful industry, but it's a massive drain on the rest of the economy.

The reform proposals advocated by President Obama are meant to increase coverage for the uninsured. That is certainly a worthwhile goal, but the problem is that they leave the present profit-driven and highly inflationary system essentially unchanged, and simply pour more money into it - an unsustainable situation. That is what is happening in Massachusetts, where we have nearly universal health insurance, but costs are growing so rapidly that its long-term prospects are poor without cutting benefits and greatly increasing co-payments. Initiatives such as electronic records, case management, preventive care, and comparative effectiveness studies may improve care, but the Congressional Budget Office and most health economists agree that they are unlikely to save much money. Promises by for-profit insurers and providers to mend their ways voluntarily are not credible.

Nearly every other advanced country has a largely nonprofit national health system that provides universal and comprehensive care. Expenditures are on average about half as much per person, and health outcomes are generally much better. Moreover, these countries offer more basic services, not fewer. They have on average more doctors and nurses, more hospital beds, longer hospital stays, and there are more doctor visits. But they don't do nearly as many tests and procedures, because there is little financial incentive to do so.

It is often argued that the first order of business should be to expand coverage, and then worry about costs later. But it is essential to deal with both together to stop the drain on the rest of the economy and the further fraying of healthcare. The only way to provide universal and comprehensive coverage and control costs is to adopt a nonprofit single-payer system. Medicare is a single-payer system, with low overhead costs, but it uses the same profit-oriented providers as the private system and also preferentially rewards specialists for tests and procedures. Consequently, its costs are rising almost as rapidly as those in the private sector. Representative John Conyers introduced an excellent bill that calls for extending Medicare to everyone in a nonprofit delivery system. That could be done gradually, by lowering the Medicare age a decade at a time.

A single-payer system is ignored by lawmakers because of the influence of the health industry lobbies. They raise the specter of rationing and long waits for care. There are indeed waits for some elective procedures in some countries with national health systems, such as the United Kingdom. But that's because they spend far less on healthcare than we do. For them, the problem is not the system; it's inadequate funding. For us, it's not the funding; it's the system. We spend more than enough.

I urge you to consider a nonprofit single-payer system. The economic interests of the health industry should not be permitted to hold the rest of the economy hostage and threaten the health and well-being of the public.

© Copyright 2009 Globe Newspaper Company.

Dr. Marcia Angell is a senior lecturer in social medicine at Harvard Medical School and former editor-in-chief of the New England Journal of Medicine.

More on Dutch Health Care

From Frank Thomas via Robert Reich's blog:

The new Dutch health care system has been explained in vast detail on this blog including prices and benefits covered for Disability and Exceptional Medical conditions ... nothing concerning 'supplemental' coverages has been left out by design as you question.

I´ve summarized the exact benefit coverage of the Basic plan on Reich´s two or three essays ago aas well as a few months ago.

It´s very simple: the required Basic coverage for all has following typical MONTHLY individual premium prices. These prices come direct from current health insurance policy for my wife and me. For the Basic Plan, they vary little among insurers:

___________________________________
BASIC DUTCH PLAN: Monthly Premiums Including Dental Per Individual:

ZERO Deductible.........$137.00
$130 Deductible.........$131.50
$260 Deductible.........$126.00
$520 Deductible.........$115.00
$650 Deductible.........$109.00

___________________________________
UPGRADES: (Monthly)
1 Star..................$30.50
2 Star..................$41.50
3 Star..................$69.75
4 Star.................$113.00

___________________________________
TOTAL PREMIUM COSTS WITH UPGRADES: Assuming ZERO and $650 Deductible:

DEDUCTIBLE.......ZERO......$650
(Monthly Data)

1 Star.........$167.50....$139.50
2 Star.........$178.50....$150.50
3 Star.........$206.75....$178.75
4 Star.........$250.00....$222.00

___________________________________
Cost for Family of Four Assuming ZERO and $650 Deductible:

DEDUCTIBLE.......ZERO......$650
(Monthly Data)

1 Star.........$335.00....$279.00
2 Star.........$357.00....$301.00
3 Star.........$413.50....$357.50
4 Star.........$500.00....$444.00
___________________________________

The most upgraded 4-Star policy for a family of four costs about $5,400 annually or less the ONE-THIRD a comparable US benefit coverage plan that will have a much higher deductible. The Dutch insurer is under no requirement to provide these 4-Star upgrades to everyone. The 'Risk Equalization' provision in the new Dutch health care plan subsidizes insurers for those individuals having a high risk history of chronic illness. I´ve explained all that in great detail on this blog.

So as not to bias John Lawrence´s and my study against US comparable benefit premium costs, our study assumes a Basic monthly premium cost of $300 for a family of four. This reflects a $650 deductible and a 2-Star upgrade to the Basic Dutch plan.

My wife and I, however, are very satisfied with the Basic Dutch Plan coverage benefits with NO upgrades. Based on a $650 deductible, it costs us $218.00 monthly (including dental)or $2,616annually. In addition, there is an employee tax contribution of 12.15% capped on an income of $41,800. This insurance covers special Exceptional Medical expenses for treatment and nursing in recognized institutions and nursing homes and supply of artificial appliances.

The Dutch Basic Plan premium cost of $300 for a family of four compares to a US monthly premium cost of $1,200 or $14,400 annually for a family of four based on a $1,500 deductible and including dental.

SUMMARY:

I think this adequately covers your "supplemental" insurance point. No doubt many Dutch people purchase one of the 4-Star exceptional or exotic upgrades for special medical conditions or unexpected occurences. This is because the added premium costs are very reasonable as is quite evident above.

The standard Dutch Basic plan covers everyone ... and even with the supplemental 4-Star upgrades the annual premium is at least ONE-FOURTH less costly than that for a similar US benefit plan also having a much higher deductible.

As is well-known by those who make the effort, the Swiss, Swedish, and Danish plans are by far quality and cost superior to comparable US benefit health care plans ... whether one looks at data for a family of two or four.

Obama Administration to Rein In Private Medicare Advantage Plans

Medicare Advantage is a privatized form of Medicare which is essentially a trojan horse designed to wean seniors off the government provided Medicare and onto plans provided by private health insurance companies. In order to encourage seniors to switch from traditional Medicare, the Bush administration paid doctors and insurance companies more for Advantage patients than it paid for traditional Medicare patients. We have blogged about this insidious program which represents a stealth privatization of Medicare here.

This is an article from today's Wall Street Journal by Vanessa Fuhrmans and Jane Zhang:

The federal government made good on its plan to cut 2010 payments for private Medicare plans, whittling the subsidies to health insurers sooner than the industry originally expected.

The cuts, announced late Monday by the Centers for Medicare and Medicaid Services, are slightly less severe than the 5% reduction the federal agency signaled in February, but still raise concerns about what has been a critical source of profit growth for many health insurers. Reimbursements to private insurers that administer so-called Medicare Advantage plans would fall by as much as 4% to 4.5% next year.

The agency said it would raise the baseline rate for the private plans by 0.81%, slightly more than the 0.5% it proposed in February, though significantly less than the roughly 4% insurers have seen in recent years. But the payment rates also include a 3.41% reduction as a result of a change in how the government uses a reimbursement scale pegged to enrollees' health.

The move makes clear the Obama administration's intent to swiftly rein in the private plans. More than 10 million Medicare beneficiaries get their medical and drug benefits through Medicare Advantage plans. Republicans during the Bush administration pushed the plans' extra benefits for seniors and subsidies to insurers to promote more private-sector involvement in Medicare. But President Barack Obama has argued that insurers are overpaid to administer the plans, and he wants to finance part of his health-care overhaul by paring their subsidies.

Health insurers, though, hadn't expected cuts to begin until 2011 and were caught off guard by the February regulatory announcement. Last month, the administration also set stricter terms for companies bidding to offer such plans in 2010, including a requirement that they can't charge sick, low-income patients more than what they would pay under traditional Medicare.

Humana Inc., Coventry Health Care Inc. and other insurers that have made big bets on Medicare Advantage are expected to feel the rate cuts the most. With more than 1.4 million Medicare Advantage members, Humana is the second-biggest provider of private Medicare plans, and the business comprises roughly half of its overall revenue. UnitedHealth Group Inc. is the biggest provider of such plans with about 1.5 million members.

Medicare Advantage plans wrap physician and hospital services in one, often with vision and drug coverage. Unlike traditional Medicare, the government doesn't pay physicians and hospitals directly but instead pays insurers to manage care. Currently, though, a patient in these plans costs the government an average of 14% more than if he or she stayed in traditional Medicare.

The cuts mean beneficiaries enrolled in the private plans could see higher premiums or cost-sharing amounts next year, depending on the extent to which insurers try to preserve the 3% to 5% profit margins they usually make on the plans. The Blue Cross Blue Shield Association, for instance, said it had calculated average monthly premium increases of $50 to $80 if the 2010 cuts were to go through. That won't be clear until plans submit bids and benefit designs later this year.

Insurers and Republican lawmakers say the administration's cuts go too far, particularly because they assume a prospective 21% cut in Medicare reimbursements to doctors that Congress is all but certain to override later this year. Medicare officials said that if the physician fee cut is reversed, they would work with Congress to incorporate the change into Medicare Advantage payments then.

Humana declined to comment. UnitedHealth said it was still reviewing the Medicare announcement, but that it would continue to offer affordable plans. "We have long-standing experience with addressing the changing rate environment within Medicare Advantage and we will use all our business levers to make the adjustments necessary to manage these changes for 2010."

Typical American Family Pays Six Times as Much for Health Insurance as Typical Dutch Family

A lively discussion has been taking place among commenters on Robert Reich's blog. We are fortunate to have there an international array of people who are in a position to do some comparative analyses among different countries. In particular we are fortunate to have Frank Thomas, an American expat who lives in Holland and is familiar with both Holland and American social policies. The following comments appeared first on Reich's blog and are presented again here:

Frank Thomas said:

Jack Lohman, John Lawrence:

February 19 I gave a lengthy discription of the Dutch Health Care system on this blog (which appeared also on John Lawrence's blog: Will Blog For Food). The basic package covers 100% of the population for $115 per month per individual with no charge for children up to 18 years.

If you should have the time and interest, I would greatly welcome your comparative analysis/overview of the Dutch largely private system -- ranked the BEST in Europe -- with the US system and your thoughts why our country can't learn something constructively applicable from a society whose basic individual health care monthly premium cost is ONE-FOURTH that of the US! (Of course, nearby Canada has also an excellent system that costs much less).

No rush with this request. Thanks in advance.
Frank Thomas The Netherlands

Thursday, 05 March, 2009

John Lawrence said:

Anon said

If Medicare is so great for everyone, why do many doctors, physical therapists, and other providers not accept patients with Medicare or only allow a capped number of their patients to be Medicare?

Because the Bush administration was doing a stealth privatization of Medicare by introducing the Medicare Advantage program a completely privatized program replacing Medicare for those who chose it (even the name is suggestive) and then paying doctors who accept Advantage patients more for the same service than they were paying doctors who accepted traditional Medicare patients. All the government literature suggested that the Advantage plan was better than traditional Medicare. The Advantage plan offered some additional bennies for the same money as traditional Medicare making it seemingly more attractive. For example, it offered a yearly free physical which Medicare doesn't (but should). So by paying the private health insurance companies more per service so they could offer more bennies, govt colluded with private corporations to wean patients away from traditional Medicare and onto Advantage plans.

The Republican plan was, once everyone was weaned away, then the private corporations' rates could go through the roof and a Repub Congress could legislate that recipients could not go back to traditional Medicare. Medicare would then die.

Obama's plan is just the opposite: introduce a government health care plan for everyone alongside the private corporate plans but with more attractive bennies. So instead of a single payer health care plan, we would have a multi-payer health care plan. But then, eventually, the private plans would die as everyone chose the government plan which supposedly cost less and offered more features. Of course, the whole competition between public and private would depend on who controlled Congress and who was able to rig the multi-payer plans toward either the public or private sectors.

Thursday, 05 March, 2009

John Lawrence said:

The Medicare Advantage plan is only one way the government (under Bush and the Republicans) has stealth privatized Medicare. In addition Medicare Part B (the part that pays for doctors) requires a monthly premium of around $100 while paying only 80% of doctor expenses. Compare this with Holland's plan which Frank Thomas has expostulated here which covers everybody for everything for $115. a month. But that's not all. There is still a deductible - $135 last year - which you have to pay before Medicare kicks in at 80%. A one day stay in a hospital for a broken arm can result in a bill for $25,000. You would pay $5000. out of pocket.

Now another way Bush and the Repuiblicans have sought to stealth privatize Medicare is "supplementary insurance." This is insurance only available from a private company to cover the other 20% of doctors' bills. So it's private insurance for Medicare Advantage plan and also for supplementary plans.

And you still have to pay for Medicare Part D, the drug plan which again is supplied by private insurance companies. And then there's the notorious "donut hole" designed by and for Republicans. According to Medicare and I quote:

Medicare drug plans may have a "coverage gap," which is sometimes called the "donut hole." A coverage gap means that after you and your plan have spent a certain amount of money for covered drugs (no more than $2,700), you have to pay out-of-pocket all costs for your drugs while you are in the "gap." The most you have to pay out-of-pocket in the coverage gap is $4,350 . This amount doesn't include your plan's monthly premium that you must continue to pay even while you are in the coverage gap. Once you've reached your plan's out-of-pocket limit, you will have "catastrophic coverage." This means that you only pay a coinsurance amount (like 5% of the drug cost) or a copayment (like $2.40 or $6.00 for each prescription) for the rest of the calendar year.


So even though you are paying private companies for drug coverage, they can still get you via the donut hole and also copays.

Oh, copays apply to Medicare Part B also. So when you see a doctor, you are paying monthly premiums, a yearly deductible and copays as well as monthly premiums and copays for drugs. And don't forget the donut hole.

This system was designed by sick, twisted misanthropes. Did I mention it was designed by Republicans? In addition if you don't sign up for any of these plans wihtin a specified "window," you will pay penalties (or you may not be able to sign up at all!) and you can only change plans during a 45 day period from November 15 to December 31 in any given year. And the deductibles, copays and premiums keep rising on an annual basis.

Contrast this with the Canadian system where all you do is present your card to any doctor or hospital and you get taken care of without any monthly premiums or deductibles or copays for 100% coverage or with the Dutch system where you get taken care of for a $115 monthly premium. Oh, and they cover everybody not just those 65 and older.

The American Medicare system sucks, it's a piece of crap with no preventable coverage like an annual physical (not covered) but it is cheaper than the health insurance people under 65 are forced to buy which can truly bankrupt you just paying the monthly premiums with huge deductibles.

Obama's health plan will hopefully correct these unconscionable "features" of Medicare. As I mentioned previously, his plan would turn the Republican designed Medicare plan which represents stealth privatization on its head, and provide a multi-payer stealth publicization plan. That is, eventually, the private health plans would phase themselves out as more people switched to the government sponsored plan. But it all depends on who controls Congress and the Presidency. There will probably be a tug-of-war between Republicans and Democrats over this one. And of course, the lobbyists for the health insurance corporations will be on the side of the Republicans. The middle class will be on Obama's side, but do they have any money for lobbyists? Perhaps.

See my blog - Will Blog For Food - under the Health Care category for more on this subject.

Friday, 06 March, 2009

Frank Thomas said:

Jack Lohman, John Lawrence,

Couldn't respond to your posts On US Health Care System vs the Dutch system because of work. Haven't proper time now also.

Just want to claify quickly some important points. All operations of any kind and drugs and hospital bed and other services are priced THE SAME througout Holland. A hip replacement operation costs the same in any hospital here ... although some hospitals may be specializing on hip operations.

Want to clarify that the Basic monthly health care premium cost is $115 per individual (excluding dental or $135 including dental), BUT there are Upgrades. Our daughter has one of the highest upgrades that includes psychiatric treatment, for example, and the total monthly cost for her and two children INCLUDING dental care is $275.00 per month.

Let me repeat. Throughout Holland, a drug, an operation, a bed at a hospital has the SAME price everywhere. Hospitals compete on quality of service and specialities. Same for Insurers.

Advise strongly you both see the video I mentioned of the Dutch system.

Would be interesting to compare the monthly premiums I´ve quoted for Holland to some general range of Basic and Upgrade monthly premiums for an individual and children in the US, including and excluding dental care.

We need to bring comparative Facts of Health Care costs in different countries to the attention of the American people, including thsoe for Canada. This might encourage us to look deeper into System differences and LEARN something constructively useful. Presume Obama´s Administration is doing this, but am not sure.

Friday, 06 March, 2009

John Lawrence said:

Frank Thomas said:

Would be interesting to compare the monthly premiums I´ve quoted for Holland to some general range of Basic and Upgrade monthly premiums for an individual and children in the US, including and excluding dental care.

Frank, the monthly premium for a family of four with a $5000. deductible would be about $5000 excluding dental. Even with Medicare for those 65 and older, you are paying here $100. a month premium plus copays every time you go to a doctor plus a one time $135. a year deductible excluding dental care and drugs. And then that only covers 80% of your doctor's bills! There's just no comparison even when comparing US Medicare to Dutch health care for the entire population.

And dental care is another huge rip-off and farce. You have to buy dental insurance separately, but then it doesn't cover anywhere near the price of most dental services. I go to Mexico and without dental insurance the cost is about one third what it is in the states with dental insurance.

Of course, during the last 28 years of Reaganomics, there has been a stealth privatization of the Medicare system.

Please see my series of blog posts on health care in the US here.

Friday, 06 March, 2009

John Lawrence said:

See what Donna Smith had to say about Medicare Advantage. Here's an excerpt:

Good thing Humana and all the other insurance giants got to call the plans "Medicare Advantage," because that's exactly what they do. The insurance plans take advantage of seniors and disabled people. And though President Obama's healthcare policy plans include asking the Humana gang to have to bid for the business in the future, many of the disabled and elderly are suffering and will die waiting for care they thought they had and they thought they paid for under Medicare.

Friday, 06 March, 2009

John Lawrence said:

Jack Lohman said:

From a Harvard doctor:

DR. DAVID HIMMELSTEIN: Well, what we’re hearing is that they’re going to do something like what we have here in Massachusetts, which keeps the private insurance companies right in the middle of the healthcare system, and it can’t work. Basically, you throw away so much money on profit in the bureaucratic waste of the insurance industry and the bureaucratic waste they inflict on doctors and patients in the hospitals that you can’t afford decent care for the American people if you do it that way. And we’re hearing that they’re not really ready to challenge the insurance industry head on. That’s the only way you can make the health system work.

http://tinyurl.com/d3ebwj

But Jack, Holland has a very swell system and it's based on private insurance. Watch the video that Frank recommends.

Go figure! Your response?

Saturday, 07 March, 2009

Jack Lohman said:

I don't like it, John. 50% of costs are picked up by employers, and it should be zero. That makes employers uncompetitive with foreign products and we lose jobs in the process. Also far too much complexity, which leads to higher wasteful spending.

Medicare-for-all is simple. You get sick, you get care, and the caregiver gets paid. Nothing could be more efficient. 100% of the people are covered. When Taiwan studied all systems in the world, they settled on the medicare model, not the Dutch.

Saturday, 07 March, 2009

John Lawrence said:

Jack Lohman:

But why then can the Dutch offer such cost effective health care based on a private system? You haven't answered that.

And as I have pointed out, Medicare as it stands today is an abortion of a health care system and not the idealized single payer system that you seem to be romanticizing. It represents the stealth privatization of public health care.

I hope you don't want Medicare in its present form for everybody.

Saturday, 07 March, 2009

Jack Lohman said:

John, any private system needs CEO salaries and bonuses and shareholder profits. That automatically drains dollars from the providing of patient care. Medicare is not perfect, but after 40 years in the healthcare business, 15-20 as a provider to both Medicare and the privates insurers, I'll take Medicare any day.

But don't you worry, the insurance industry is paying big cash bribes to ensure that single-payer does not pass, and they have enough corrupt politicians on their side to ensure that they get their way. That's all the more reason the people should want it. If the private system was good, bribes would not be necessary. (Good congress we have, what say?)

Medicare is not perfect either. See Ten needed fixes for the health care system

Saturday, 07 March, 2009

Frank Thomas said:

Jack Lohman, John Lawrence:

I may have confused you both about how the new Dutch Health Care system is financed. It's not an easy system to explain.

In brief, the Dutch BASIC Health Plan statutorily required for all citizens is paid 45% by an Employee fixed insurance premium amounting to +-$135 monthly ($1,650annually) including dental care.

In addition, 50% of the funds come from a 6.5% payroll tax withheld on an Employee's monthly income ... up to a ceiling annual income of $37,500. This gives a maximum Employee contribution of $2,500.

Employers must compensate their Employees for half (50% of 6.5%) of this amount or $1,250. Latter is considered taxable income for Employees. So the Employee is paying a total of up to $2,900 annually for the basic package ... plus, in some cases, the cost of complementary and supplementary private health insurance from the same health insurers who provide the statutory required basic insurance. These upgrades can lead to added premiums of $100 - $175 monthly or $1,200 - $2,100 annually.

Dutch law forbids "co-payments" for services provided under the basic health care package unless the insured seeks treatment from an out-of-network provider.

A Risk Equalization scheme (paid by the income-related tax contributions) is used to prevent direct or indirect Risk Selection by insurers. This means the government compensates insurers for expensive customers based on a risk adjusted capitation formula that reflects age, sex, pharmaceutical consumption, and major diagnostic groups. Insurers may compete for applicants on basis of price and quality but are prohibited from distinguishing applicants or charging them a higher premium based on Risk. Each applicant pays the same insurance premium for same coverage under the BASIC plan, irregardless of the individual's personal health history. This scheme also facilitates fair competition among insurers.

Finally, there is a 5% government contribution in the form of an income-related subsidy or "Care Allowance" for low income groups. The government pays this allowance monthly directly to the insured after checking recipient's filed income status.

Physicians practice directly or indirectly under contracts negotiated with private health insurers. GPs receive a capitation payment for each patient on their practice list and a set fee per consultation. One needs a referral from the GP to receive non-urgent medical treatment from a hospital or other specialist health provider. Most specialists are hospital-based ... two-thirds of whom are self-employed, organized in partnerships, and paid on a capped-fee-for-service basis. The remainder are salaried. It's expected that future payments will more and more be related to activity known as Diagnosis Treatment Combinations (DTCs), somewhat the Dutch version of DRGs.

Most hospitals are private non-profit organizations. The remainder (e.g., Academic Hospitals) are government owned. The budgets of hospitals are developed using a formula that pays a fixed amount per bed, patient volume, and number of licensed specialists, in addition to other factors. Added government funds are provided for Capital Investment, although hospitals are increasingly encouraged to obtain capital via the private markets.

SUMMARY:
In 2007, public (meaning non-governmental) sources of finance accounted for approximately 78% of total health care expenditure in The Netherlands.

The main approach enforced by government oversight agencies, under the Health Insurance Act, is to improve Dutch health care efficiency by a system of Regulated Competition among insurers/providers combined with Central Steering on Performance and Transparency about outcomes with the use of performance indicators. As time goes on, most care costs are expected to be increasingly controlled and reimbursed by the new DTC system in which hospitals must also compete on price for specific services. The system already is encouraging some hospitals to become specialized in certain services ... hence improving quality, efficiency, and thus competition.

There's still lots of debate on some aspects of the system and some vulnerable points ... but the Dutch are austere and direct in taking very seriously their control responsibilities for the highest quality at a reasonable price for such critical societal services.

P.S. John: Is your comparative average MONTHLY U.S. health care cost for a family of four $5,000 or $500 ?? I'm stunned if former is true!

Saturday, 07 March, 2009

John Lawrence said:

Frank,

I just checked with my daughter, and for their family of four, non-employer based health insurance was about $500.00 a month for a family of four with a $10,000. deductible. So they got no reimbursement until their medical expenses were over $10,000.

The interesting thing about the Dutch system is that it's based on private health insurtance i.e. multi-payer and not single payer like Medicare. The health insurance industry must be highly regulated to keep costs so reasonable - no multi-million CEO salaries.

Saturday, 07 March, 2009

John Lawrence said:

Jack Lohman:

I've read your Ten Needed Fixes to the Health Care System and Medicare for All. I don't think you're critical enough of the Medicare system as it exists today.

Here are my Ten Fixes for Medicare:

1) Eliminate the Medicare Advantage program which is a stealth privatization of Medicare and makes Medicare NOT a single payer system.

2) Make Medicare Part B, the part that pays doctors, 100% payable instead of 80% eliminating the need for supplementary insurance which again is private insurance.

3) Eliminate the Medicare Part A deductible which is currently $1068. per illness. And it only covers 60 days; after that you pay through the nose.

4) Eliminate the Part B deductible which is currently $135. per year.

5) Eliminate or reduce and standardize co-pays.

6) Make preventive medicine like an annual physical exam payable by Medicare. Currently Medicare doesn't pay for an annual physical exam except for one time when you enter the program. This alone could bring the cost of Medicare down as it would detect illness at an earlier stage.

7) Require doctors to give pricing information and put it online at the Medicare website. This would allow patients to make decisions about their health care taking finances into account. It would discourage doctors from recommending unneeded procedures. Patients should have access to information about recommended procedures for their illness.

8) Include drugs without a separate private drug policy necessitating yet another insurance payment to a private insurer.

9) Include dental within Medicare. Dental insurance in the US is a farce which has just allowed dentists to jack up the price collecting both from insurers and from patients with the result that dentistry is more expensive than it was before most patients had dental insurance.

10) Include visual care within Medicare. Annual eye exams, optometry and ophthamalogy should be included as well as glasses and contacts.

If Medicare was brought up to the standards of the quality of care of other country's health care systems, then it would be something to brag about. In it's current form, it's not. It gives you meager, not all inclusive, coverage, and it costs you a lot more than other country's systems which cover 100% not 80% of doctors' costs, don't charge deductibles, and charge no or very small copays.

And, as the example of Holland shows, it's not the fact of a single payer system that's the panacea since they provide all inclusive care at a cost to the individual less than US Medicare while utilizing private insurance companies. However, they are highly regulated by their government and obviously have little to no lobbying influence.

Sunday, 08 March, 2009

Linda said:

John, Frank

You have an interesting discussion going on health care systems. There is well researched PBS Frontline episode called "Sick Around the World," from a few months back (?) that compares 6 or 7 different health care systems that work. All of them achieve a higher standard of health, greater longevity, at a fraction of the price Americans pay. In Japan (the most efficient system) health care costs were cut to the level that a hospital visit was $10 per night and an MRI just $12.

You can view it here.

Sunday, 08 March, 2009

Frank Thomas said:

John,

Let's now compare your daughter's family of four Basic Health Care insurance premium cost to our daughter's family of three cost, adjusted to four family members.

First, a couple of points. The very maximum range of deductibles (own risk) allowed in The Netherlands is €100 ($125) to €500 ($625). This compares to your daughter's family deductible possibility of $10,000!

Such an extremely high deductible would be considered an utterly obscene and quality care destructive policy in Holland --that can´t be explained by standard of living differences.

For one thing, it makes the system very expensive for those who cannot afford the $10,000 risk exposure and likely results in a substantially higher monthly premium if one were to choose for a $1,000 deductible in the U.S., for example. Maybe you know what the difference would be?

Prudence is further inherent in the Dutch system in the modest 20% lowering in the Basic Plan monthly premium from $135 per individual (including dental care and children up to 18) to $105 using the maximum deductible allowed of $625.

As mentioned earlier, The Basic Plan offered by most insurers has 1to 4 or 5 star Upgrades(complementary-supplementary insurance coverages). These range from a 10% increase in the Basic Plan monthly premium for a one star Upgrade to a 75% increase for a 4 star Upgrade ... bringing the standard $135 premium per individual plus children up to 18 to a monthly premium cost of $240.

I don´t know what your daughter´s family premium cost would be with a $1,000 deductible, for example ... but our daughter´s current four star monthly premium of $275 for a family of three is not based on any deductible being taken.

If I adjust our daughter´s $275 4-star Upgrade rate (her son has a mild form of ADAD requiring specialist docters and special medications) to a family of four the monthly premium would increase to about $475 with no deductibles or $380 with the maximum $625 deductible.

To complicate matters further for you, both of the above rates for our daughter, reflecting some serious upgrades, would reduce to $275 per family of four with no upgrades or deductibles. I will use this figure to compare to your daughter´s plan assuming they represent similar coverage(?).

In summary, the U.S. and Dutch Basic Plan systems appear to differ massively in monthly insurance premium costs for a family of four as follows:

A...Your daughter´s.....$500.00 with a $10,000 deductible or ??? with a $1,000 deductible.

B...Our daughter´s.......$275.00 with no deductible or $220.00 with a $625 deductible (and children free up to 18).

The above comparison omits the Employee 6.5% payroll tax withheld for health care system costs, 50% of which is reimbursed by the Employer. I don´t know what the comparable Federal taxes are per individual wage earner for Medicare in the U.S.

As also mentioned, the Basic Plan cost can be lowered up to 50% in form of a direct allowance from the government depending on an applicant's confirmed income.

Your last remark was that the Dutch system must be heavily regulated to be so cost efficient.

Well, as mentioned, hospital, doctor, drug billing costs are FIXED and agreed in negotiations among the three parties to the Health Care system: the service providers, the doctors, and the insurers with government agencies acting as the final Arbitor and Overseer to assure no monopoly practices, or unfair play take place to the detriment of universal quality basic health care at a reasonable price. The job of achieving these goals in The Netherlands may be easier as the number of qualified, prime insurers is relatively small in 5-6 range.

Thus, the system is based on Regulated Competition where parties are free up to a point to come up with their prices upon which final insurer premiums are set each for the Basic Plans and the 4-5 star Upgrades (i.e., complementary/supplementary insurance coverages).

As also mentioned, competitively developed reasonable premiums are stimulated by fact the Basic Plans provided by all insurers are based on the exact SAME definition of coverage items and services. Hence, competitive insurer premiums for the Basic Plan required for all citizens do not differ much.

This reflects a deep Dutch (and Canadian, for example) cultural value of social SOLIDARITY ... a value we Americans often conveniently bastardize with that attack word, `Socialism´ vs. the European meaning of basic and decent general-welfare thinking.

As I said before, if this Basic Health Plan is Socialism, then I applaud its prudent, cost and quality effective availability for all Dutch citizens. Is it perfect? NO. Will the Dutch constantly take care to correct its rough spots and inequities. YES!

Sunday, 08 March, 2009

John Lawrence said:

Frank,

I will reply in more detail later, but here is a typical policy for my daughter's family:

Insurer: Blue Cross. Type of plan: PPO. Deductible $5000. Premium $397. Coinsurance 30%. Office visit $30. Drug deductible $500.

Coinsurance means that they still have to pay 30% in addition to copays after deductible is met.

You can get this information online.

I'll repond in more detail later.

Sunday, 08 March, 2009

John Lawrence said:

Frank Thomas:

I have done the research and now we can compare the costs of the Dutch health care system with the US for a typical family of four.

First the US plans don't include dental so I will compare the Dutch plans without dental. I assume for a Dutch family of four it would be twice the individual rate of $115 with the two children being free. So it would be $230. for a Dutch family without upgrades with a deductible of $125.

I went to ehealthinsurance on the web and put in my daughter's family's info including one smoker. Here are some quotes:

Insurer: Blue Cross PPO

1) Deductible $1000. Coinsurance 30% Office Visit $30. Premium $513.

2) Deductible $2000. Coinsurance 30% Office Visit $40. Premium $680.

3) Deductible $3000. Coinsurance 0% Office Visit $40. Premium $524.

4) Deductible $2900. Coinsurance 40% Office Visit $40. Premium $255.

5) Deductible $8000. Coinsurance 0% Office Visit $0 after deductible. Premium $309.

6) Deductible $500. Coinsurance 25% Office Visit $30 after deductible. Premium $1557.


Now I assume that your daughter would pay 0% coinsurance and $0. for an office visit.

As far as payroll taxes, here they are 1.45% from each employee for Medicare (but that doesn't go to support my daughter's family's health care). They also pay a 6.2% payroll tax sor social security. The employer matches both of these.

You said:

If I adjust our daughter´s $275 4-star Upgrade rate (her son has a mild form of ADAD requiring specialist docters and special medications) to a family of four, the monthly premium would increase to about $475 with no deductibles or $380 with the maximum $625 deductible.

Your daughter would pay a $380. monthly premium with a $625 deductible with no charge for an office visit and no coinsuirance. My daughter would pay a $1557. monthly premium with a $500 deductible with 25% coinsurance and $30. for an office visit (with no upgrades!). So, after deductibles, my daughter would pay about four times the monthly premium for 70% of the coverage plus $30. every time a family member went to the doctor. Using simple math, my daughter would pay $2224 for 100% coverage plus the $30 for office visits.

I think your daughter is getting the better deal!

I will also put this information on Will Blog For Food.

Monday, 09 March, 2009

John Lawrence said:

Frank:

If I used the $230 figure for the monthly premium for a typical Dutch family of four, then my daughter would be paying almost seven times as much in monthly premiums plus 25% coinsurance and $30. per office visit. For comparable 100% coverage (no coinsurance) she would be paying about 10 times as much for the monthly premium plus the office visits.

One error in previous calculations: my daughter would pay $2076 not $2224 for comparable 100% coverage (I figured 30% instead of 25% coinsurance). So she would be paying about 9 times as much (not 10 times) as your daughter for 100% coverage.

Monday, 09 March, 2009

Silverfox said:

John Lawrence;

I would not pay too much attention to the health insurance premiums quoted on the internet or in prepackaged literature. You don't get the real cost until you actually apply. That's when it gets interesting, particularly if you are an older American with perhaps controlled blood pressure and anything else, also controlled with cheap medication. Then you start to see the actual premiums, with $20,000.00 a year not uncommon and deductabiles running to $5,000.00.
Can't really blame the insurance companies, though. That "end of life" medical care can run into the hundreds of thousands of dollars.

I would rather see a universal healthcare system based on a sliding scale of cost compared to ability to pay. A median income family earning $50,000.00 should be able to pay 4% or 5% of their money for healthcare. Beyond that let the government take over.

That would discourage wasteful spending or over burdening medical facilities, but provide real life sustaining coverage for all.

Monday, 09 March, 2009

Frank Thomas said:

John,

Just one immediate question: your premium quotes for a $1000 deductible (1) vs. a $500 deductible (6) show a monthly premium of $500 sharply increasing to $1557.

Is this correct?

The difference in government payroll taxes for health care is about $75/monthly bringimg my daughter's Basic premium with no deductible of $230 (excluding dental) to +-$305 or a substantial ONE-SIXTH of the cost of your daughter's monthly premium for 100%coverage.

Above assumes same basic coverages which we can easily confirm to be professional in our comparative analysis.

Even my daughter's 4-star package (which is a very lux special health service coverage) is ONE-FOURTH your daughter's monthly premium for a Basic coverage.

SIMPLY DISGUSTING and too unbelievable for words!

But must say I've known about this for years and have written much about it to no listening avail in the states.

Monday, 09 March, 2009

Anonymous said:

Frank and John,

To improve your comparisons, I'd be interested in the following:

1. other funding sources besides premiums (general fund perhaps?) that may contribute to Netherlands healthcare

2. per capita income of Netherlands vs. USA

3. Age demographics and obesity rates of Netherlands vs. USA

4. average malpractice insurance premiums in each country

5. average wait time for major, non-emergency procedures

Monday, 09 March, 2009

John Lawrence said:

 

Frank said:

Just one immediate question: your premium quotes for a $1000 deductible (1) vs. a $500 deductible (6) show a monthly premium of $500 sharply increasing to $1557.


Yes, in order to reduce the deductible by $500. you would have to pay triple the premium. But there is a 5% reduction in coinsurance. It would probably be lower if they offered a policy with a 30% coinsurance in both cases.

Monday, 09 March, 2009

Frank Thomas said:

Anonymous,

You asked some 5 general questions about the Netherlands' Health Care system.

I've written at least three long posts describing the system. So, I have not much time to go into more documented details now except to add some thoughts concerning your questions: (John may be able to fill in the gaps).

1....funding of system is about 45% by fixed premium contributions; 50%by Employees through a 6.5% payroll tax of which 50% is compensated by the Employer; 5% by a government Care Allowance for low-income applicants. That's it, pure and simple.

2....Per Capita Income in US and the Netherlands was about the same at $46,000 in 2007.

3....as of 2005, 13% of Dutch population was above 65; this is expected to grow to 23% by 2040; have no idea what comparable US statistics are.

Some time agoI posted facts about Dutch obesity. Sorry, but I don't have data before me. The Dutch measure overweight statistics according to an international formula. This shows that 46% of the Dutch population exceed a weight average of 175 lbs based on a certain average height. The American % overweight figure would certainly be substantially higher. In this regard, the Dutch Health Care program focuses heavily on Preventative Medicine through good all-around health practices.

4....I don't have any idea of mal-practice insurance law and premium differences between the two countries ... but can assure you the lawsuit culture is at a very low level here for everything. Holland is by far not a lawyers' lawsuit paradise in that
respect.

My brother-in-law was surgeon in urology in Holland for a time and since has been in practice in Florida for many years. His US mal-practice premium exceeds $140,000 a year. He informed me that this would be less than $10,000-15,000 in Holland today.

5....have no idea of average wait times but have heard no big complaints about this; should there be problems the Dutch insured can go to Belgium, for example, or any other country nearby. This is a stimulus for efficiency.

Summary:

Equally if not much more important than above facts is fact that Administrative costs for US Health Care system are about $7200, or +30% of total costs, for each of the current 45 million uninsured Americans (ignoring the +30 million underinsured). These figures compare to less than a 9% Administrative cost as a % of total costs in Holland.

The Urban Institure estimates that the cost of insuring the 45 million unsured would be +-$75 billion versus a conservative Savings of +-$300 billion if the system were streamlined into a "single-payer" one similar to the highly administrative cost-efficient single-payer-setup by province in Canada, e.g., where insurers send virtually all bills to a single payer using a simple billing form.

Similarly in Holland, tight regulation of basic health care insurance markets, with requirements for open enrollment and community rating lead to relatively low overhead costs. Administration and profit margins are reported to account for less than 6% of profit margins.

In 2008, the US spent about 17% of its GDP on health care or +-$7100 per capita. In contrast, Holland spent about 9% of its GDP on health care in 2008, or +-$2900 per capita.

Further, data show that health care expenditures are growing over three times as fast as GDP growth in the US ... compared to a rate slightly less than GDP growth in Holland (and only slightly greater than GDP growth in Canada).

The US complex and fragmented payment structures built around thousands of different insurance plans -- each with its own regulations on coverage, elgibility, and documentation is --intrinsically far, far more costly than a single-payer system.

The Dutch new largely private Health Care system is based on "Managed Competition" among care providers, insurers, and applicants ... including a "risk-equalization scheme" that helps reduce incentives for insurers to seek healthier applicants and prevents the imposition of more expensive premiums on less healthy applicants.

The system combats high costs of private health care insurance through, as mentioned, a well thought out program of "Regulated or Managed Competition" (developed to great extent by Alain Enthoven, a Stanford Professor). Insurers may compete on basis of price and quality, but, under the principle of Solidarity, are not allowed to separate applicants based on risk.

Ultimate result: our daughter's family of 3 pays a monthly premium of $275 for 100% coverage for a family of three including dental care, no deductibles, and no charges for children up to 18 years. This premium level is for a 4 star Upgrade coverage (vs. Basic Plan premium cost for everyone including dental care of +- $135) due to specialists' çare and special medicine needed for our young grandson.

Pretty impressive universal Health Care approach based on a combination of private and public inputs!

See video of program by going to Google under title: "New Dutch Health Care System."

Monday, 09 March, 2009

Also check out this link.

Anonymous said:

 

Frank Thomas ...

Thank you so very much for your work.
also to "John" who also gave the US estimate numbers

I would hope? That the few here would spread the numbers, Maybe Dr. Reich will notice and He can speak on TV and radio, to this wide difference of premium and coverage too.

Hello, Dr. Reich

It seems we in the US pay between 2-4 times what others pay, This not factoring in the dental care, co-pays, and a few other dollar costing pocket book busting problems.
Like 100% of people are covered!
It certainly was long, but the Anon's point of Greed is a factor to be considered.

One word to Frank though,

While the US has been behind on the health care, we certainly have led the way in selling a lot of stuff ( ????) to other parts of the world.

May I mention Fortis Bank, and ???????, Ouch!

So maybe the Europeans will actually be paying for the american's health care in a round about way?

What a sick thought!
Pun intended.

The health Care cost and the issue of just everyone getting care, is a rather large part of our economy's.

Again Thank All
who have been part of this discussion here, I'm sure more facts can arise. More questions to ask?

Monday, 09 March, 2009

KC Thinker said:

Thank you Frank. Your insight into the Dutch healthcare system is much appreciated. From reading your posts, it seems that the Dutch system is a very good compromise with what we currently have.

Unfortunately, misinformation and fear by the right and lack of getting out the message by those truly informed keeps us from moving forward. I hope that Obama will do the right thing when it comes to fixing our system, but so far he has disappointed me. His adminstration, from my perspective, is unwilling to communicate effectively with the American public and his stimulus and budget have failed to impress me (more like depress). So many are confused by what is going on with the economy and the governments' response, I shudder to think what will be lost in translation as he tries to do something for our healthcare system.

Tuesday, 10 March, 2009

Frank Thomas said:

KCThinker,

Thank you.

My wife and I are completely satisfied with the coverage items of Holland's new Basic Care Plan. It costs us a reasonable $275 monthly including dental care and excluding a deductible. We don't need the upgrades as for years we've been blessed with excellent health ... knowing that the known unknowns of medical illness are not guaranteed for the elderly! Should we sometime decide to take a 2 or 3 star upgrade, the added cost is not overwhelming as I've shown in an earlier post.

It's the Dutch proving again their resourcefulness in prudently and humanistically managing their social-net systems ... with a sensible synthesis of public and private initiatives operating freely but under some fair and tight rules on how the game is played.

John Lawrence also summed it well to me recently: ``The Dutch health care reforms point out it´s not whether the health care system is Public or Private, but the way it´s set up that determines whether it works to provide high quality care at a reasonable cost.´´

We can do the same if we ever master the ``MY IDEA or DISASTER´´ cultural fixations that have been parallelizing constructive compromise and creativity on so many core issues affecting the general welfare of all Americans.

An obvious example is our insatiable appetite for debt to consume, consume, consume ... a habit unmoored in any common sense or discipline and also abetted by cheap money and irresponsible banks lending practices. Your gut knows that when the cost of credit, NOT the price of the home or one´s income determines affordability, it´s time to launch the lifeboats!

The Dutch can squeeze comfort out of a penny and they avoid dependence on debt like the plague ... conservative virtues we have left behind 25 years ago.

For many decades, Holland has had a very successful economy enjoying steady, although moderate, GDP growth per capita with respectable unemployment rates. Little wonder the country´s National Debt per capita is HALF ours, even adjusting for our exorbitant Defense expenditures in our role as the world´s sole protector.

I´m going to give Obama´s team a lot of rope given the co-terminous
and multiple dysfunctional social-economic maladies he has to deal with. I´ve been writing in some specificity since November 2007 about the systemic deficiences in our out-of-balance Social-Economic model ... concerning the excessive dependence on Consumption, declining Savings, rampant Debt in all directions, and deplorable lack of internal societal Investment.

So, I´m quite sensitive to what lies underneath the surface of things ... but am trying to find time for exploring solutions more deeply for debate with the awesome likes of Art, John, Linda, Fox, yourself, and others.

As Linda stated, it´s is not about ego, but workable Solutions ... practical instinct and innovation, with nominal time spent on dooms-day scenarios. I share the down-to-earth pragmatic optimism of Warren Buffet who just remarked, ``Five years from now, I can guarantee that the US economic machine will be running fine.´´

And I would add only if we invest wisely and fundamentally change those inherent deficiencies in our system ... like our ungodly expensive, complex, and inhuman health care system where cost savings in the $250 billion range can be realized and deployed for future debt reduction.

Like you, at times I´m clearly not my usual optimistic self ... doubting that certain fundamental system improvements will be made that confront soberly and effectively new world realities.

But, after a few drinks, I still seem able to find some room for hope and real change as welcomed bedfellows.

Tuesday, 10 March, 2009

What Obama Can Learn From European Healthcare

This article is by Steven Hill and appeared in Huffington Post on March 9, 2009:

Imagine a place where doctors still do house calls. When I was visiting my friend Meredith, living in the small rural town of Lautrec about an hour's drive outside Toulouse, France, one day she was stung badly by a wasp, causing a sizable and painful swelling on her hand.

She called her doctor, and to my great surprise within 15 minutes he had shown up at her door -- the famous French doctor's house call. I couldn't get over it. "House calls in the United States went out when Eisenhower was president," I told her, shaking my head.

My father-in-law had a similar experience while vacationing in Switzerland. He awoke one morning with what turned out to be a painful urinary tract blockage. The doctor paid a house call with hardly any wait at all and inserted a cleverly designed catheter that had no drainage bag.

Even though he was a foreigner, my father-in-law paid out-of-pocket only $100 for this emergency service. Back at home in Minneapolis when he had to go to the emergency room a couple of years later, he waited nearly nine hours to receive medical attention, even though he had health insurance.

A U.S. expatriate living in Belgium told me that both he and his sister in Minneapolis had a procedure called a catheter ablation of the heart to eliminate an irregular heartbeat. Even though she had full medical coverage provided by her employer, she spent $2,400 out-of-pocket for the procedure which was performed as an outpatient surgery under a mild sedative.

For the same procedure in Belgium, he paid just under $100 and received full royal treatment, including two nights in the hospital for observation and post-op recovery.

The medicine he now needs to take costs him about $4 for a three-week supply. In the United States that same medicine costs his sister $19 -- nearly five times the price in Belgium.

Even the moderately poor and formerly communist countries in East and Central Europe have universal health care. In the Czech Republic, when the government wanted to introduce a co-payment of less than $2 per office visit, it nearly toppled the government because health care is viewed as a basic right and an integral part of the nation's social contract.

What is truly disturbing, given the vast outlays for health care in the United States, are the various health indicators showing the country's poor performance.

Whether one looks at infant mortality, life expectancy, the number of physicians, hospital beds, medical errors or high out-of-pocket expenses, America underperforms to a shocking degree. Consequently, the World Health Organization (WHO) has ranked the United States 72nd of 191 countries for "level of health."

And it ranks 37th for "overall health system performance" -- just behind Costa Rica and Dominica and just ahead of Slovenia and Cuba, countries with a fraction of the economic wealth of the United States.

France and Italy, which have universal health care coverage for all their residents, even recent immigrants, were ranked first and second in the WHO listing. Most other European nations, who also have universal coverage for all, also were ranked near the top.

Yet despite this difference in performance between U.S. and European systems, somehow Europe manages to spend only a fraction of what the United States spends on health care.

According to the WHO, the United States spends 16.5% of its GDP on health care, or about $6,100 per person. This compares to an average of 8.6% in European countries. France does it for far less, spending just $3,500 per person, or 10.7% of its economy.

Says Dr. Christopher Murray, director of the WHO's Global Program on Evidence for Health Policy, "Basically, you die earlier and spend more time disabled if you're an American -- rather than a citizen of most other advanced countries." That's a highly unsatisfactory state of affairs for the world's lone superpower.

How do the French, Italians and other European countries do it? How do they manage to provide better health care than most Americans receive for about half the per capita cost? While there are differences from nation to nation, there also are some broad generalities to point to, as well as national specifics.

These give us a pretty good snapshot that should be instructive to the Obama administration as it grapples with the inefficiencies that are continuing to hurt American workers, businesses -- and increasingly will hurt U.S. competitiveness in the global economy.

The first overriding difference between U.S. and European health care systems is one of philosophy. The various European health care systems put people and their health before profits -- la santé d'abord, "health comes first," as the French are fond of saying.

It is the difference between health care run mostly as a non-profit venture with the goal of keeping people healthy and productive -- or running it as a for-profit commercial enterprise. It's no coincidence that, as the United States tries to grapple with soaring health care costs and lack of universal coverage, UnitedHealth Group CEO William McGuire received a staggering $124.8 million in compensation in 2005. He is just one of many grossly overcompensated kingpins of the U.S. health care industry.

U.S. health care corporations will spout platitudes about wanting to provide good service for their customers, but there's no escaping the bottom line that the CEOs of giant health corporations ultimately are accountable to one small group -- their stockholders.

If nothing else, the U.S. health care system provides a valuable fable illustrating that corporate profits and affordable, quality universal health care are not a viable mix.

The second major difference between U.S. and European health care is in the specific institutions and practices that flow from this philosophy of "health comes first." Contrary to stereotype, not every country in Europe employs government-run, "socialized medicine."

Unlike single-payer Britain or Sweden, other nations like France, Germany, Switzerland and Belgium have figured out a third way, a hybrid with private insurance companies, short waiting lists for treatment and individual choice of doctors (most of whom are in private practice). This third-way hybrid is based on the principle of "shared responsibility" between workers, employers and the government, all contributing their fair share to guarantee universal coverage.

Participation for individuals is mandatory, not optional, just as it is mandatory to have a driver's license to drive a car.

These health care plans are similar to what Massachusetts recently enacted -- but with two essential differences.

First, in France and Germany, the private insurance companies are non-profits. Doctors, nurses and health care professionals are paid well, but you don't have corporate health care CEOs making hundreds of millions of dollars. Generally speaking, the profit motive has been wrung out of the system.

The second key difference is in the area of cost controls. In France and Germany, fees for services are negotiated between representatives of the health care professions, the government, patient consumer representatives and the private non-profit insurance companies.

Like in the U.S. system for Medicare, together they establish a national agreement for treatment procedures, fee structures and rate ceilings that prevent health care costs from spiraling out of control. And this is good for businesses because it doesn't expose them to the soaring health care costs that have plagued U.S. businesses and created bitter labor strife between business owners and their employees.

So if the United States' privatized system is at a dead end, which would be better to adopt in the United States, either the single-payer type of Britain, Sweden and Canada -- or the shared responsibility system of France, Belgium, Germany and Japan?

Either would be vastly better for most Americans than what the country currently has.

But in talking to different people in Europe in many countries, including doctors, nurses and consumers, I came to the tentative conclusion that the shared responsibility systems seem to offer a few advantages over single payer, including shorter waiting periods for surgery and other procedures.

Generally speaking, their health care systems had a better reputation among the people who used them, I found. In fact, it is not uncommon for those who live in single-payer countries like Britain to travel to the shared responsibility countries like France or Belgium for treatment.

That way, they avail themselves of certain health care services and surgeries because the lines are shorter and the care just as good if not better (individuals from EU member nations have reciprocity to use each other's medical services).

This trend seems noteworthy and worth further investigation. Instead of relying on the assumption that universal health care is synonymous with single payer, U.S. proponents of quality, affordable health care should examine the shared responsibility systems of France, Belgium, Germany and elsewhere.

President Barack Obama, to his credit, is doing what he can in difficult times to extend health care coverage to some of the 47 million Americans currently lacking it. Recently he signed legislation, previously vetoed by President Bush, to expand the State Children's Health Insurance Program (SCHIP), which will provide subsidized health care to up to four million mostly low-income children.

And his fiscal stimulus package included $25 billion for subsidizing 65% of health care premium costs for laid-off workers for up to nine months. Yet for many of the unemployed, even that subsidy will not be sufficient to allow them to afford health care coverage, an increasing concern as the ranks of the unemployed rise. And none of these measures do anything to bring down the cost of health care, which slowly is crippling the U.S. economy.

Americans love to be number one and win the gold, whether in Olympic skiing, the World Series, Super Bowl or the Tour de France. But I am still waiting for the day when Americans decide they want to be number one in health care. Wouldn't it be grand to beat the French for a change at something that really matters.

Steven Hill is a program director with the New America Foundation and his book Europe Rising comparing the Europe Way to the American Way will be published by the University of California Press in September 2009.

 

US Medicare Provides Less Care at Greater Cost Than Universal Care in Other Countries

US Medicare, which only covers individuals age 65 and older, has been proposed as a system that should be extended to all citizens thus providing universal, single payer health care by Jack Lohman on his website Moneyed Politicians and others. There has been a running discussion on Robert Reich's blog about health care by Jack, Frank Thomas, myself and others. It seems health care insurance in Holland costs the individual $115 a year. I maintain that that is cheaper than US Medicare's cost to the individual and provides more coverage. Therefore, if US Medicare were extended to everyone as a way to provide universal health insurance, I maintain that it would have to be reformed to even come up to the standard of health insurance in other countries. I left the following as a comment on Robert Reich's blog:

Jack Lohman:

I've read your Ten Needed Fixes to the Health Care System and Medicare for All. I don't think you're critical enough of the Medicare system as it exists today.

Here are my Ten Fixes for Medicare:

1) Eliminate the Medicare Advantage program which is a stealth privatization of Medicare and makes Medicare NOT a single payer system.

2) Make Medicare Part B, the part that pays doctors, 100% payable instead of 80% eliminating the need for supplementary insurance which again is private insurance.

3) Eliminate the Medicare Part A deductible which is currently $1068. per illness. And it only covers 60 days; after that you pay through the nose.

4) Eliminate the Part B deductible which is currently $135. per year.

5) Eliminate or reduce and standardize co-pays.

6) Make preventive medicine like an annual physical exam payable by Medicare. Currently Medicare doesn't pay for an annual physical exam except for one time when you enter the program. This alone could bring the cost of Medicare down as it would detect illness at an earlier stage.

7) Require doctors to give pricing information and put it online at the Medicare website. This would allow patients to make decisions about their health care taking finances into account. It would discourage doctors from recommending unneeded procedures. Patients should have access to information about recommended procedures for their illness.

8) Include drugs without a separate private drug policy necessitating yet another insurance payment to a private insurer.

9) Include dental within Medicare. Dental insurance in the US is a farce which has just allowed dentists to jack up the price collecting both from insurers and from patients with the result that dentistry is more expensive than it was before most patients had dental insurance.

10) Include visual care within Medicare. Annual eye exams, optometry and ophthamalogy should be included as well as glasses and contacts.

If Medicare was brought up to the standards of the quality of care of other country's health care systems, then it would be something to brag about. In it's current form, it's not. It gives you meager, not all inclusive, coverage, and it costs you a lot more than other country's systems which cover 100% not 80% of doctors' costs, don't charge deductibles, and charge no or very small copays.

And, as the example of Holland shows, it's not the fact of a single payer system that's the panacea since they provide all inclusive care at a cost to the individual less than US Medicare while utilizing private insurance companies. However, they are highly regulated by their government and obviously have little to no lobbying influence.

 

Obama's Health Care Challenge: Reverse Stealth Privatization of Medicare

I left a couple of comments on Robert Reich's blog recently about Medicare and health care in general which is in an extremely unsalutary state in the US right now.

Here is the first one:

Anon said

If Medicare is so great for everyone, why do many doctors, physical therapists, and other providers not accept patients with Medicare or only allow a capped number of their patients to be Medicare?

Because the Bush administration was doing a stealth privatization of Medicare by introducing the Medicare Advantage program, a completely privatized program replacing Medicare, for those who chose it (even the name is suggestive) and then paying doctors who accept Advantage patients more for the same service than they were paying doctors who accepted traditional Medicare patients. All the government literature suggested that the Advantage plan was better than traditional Medicare. The Advantage plan offered some additional bennies for the same money as traditional Medicare making it seemingly more attractive. For example, it offered a yearly free physical which Medicare doesn't (but should). So by paying the private health insurance companies more per service so they could offer more bennies, government colluded with private corporations to wean patients away from traditional Medicare and onto Advantage plans. After all health insurance lobbyists wrote the legislation. Are you surprised?

The Republican plan was, once everyone was weaned away from the government plan, then the private corporations' rates could go through the roof and a Repub Congress could legislate that recipients could not go back to traditional Medicare. Medicare would then die.

Obama's plan is just the opposite: introduce a government health care plan for everyone (not just 65 year olds) alongside the private corporate plans but with more attractive bennies. So instead of a single payer health care plan, we would have a multi-payer health care plan. But then, eventually, the private plans would die as everyone chose the government plan which supposedly would cost less and offer more features. Of course, the whole competition between public and private would depend on who controlled Congress and who was able to rig the multi-payer plans toward either the public or private sectors.

Thursday, 05 March, 2009  

I made a following comment the next day.

The Medicare Advantage plan is only one way the government (under Bush and the Republicans) has stealth privatized Medicare. In addition Medicare Part B (the part that pays for doctors) requires a monthly premium of around $100 while paying only 80% of doctor expenses. Compare this with Holland's plan which Frank Thomas has expostulated on this blog which covers everybody for everything for $115. a month. But that's not all. There is still a deductible - $135 last year - which you have to pay before Medicare kicks in at 80%. Doctors' bills for a serious illness or accident can be very expensive. Your 20% could run into the tens of thousands of dollars.

Now another way Bush and the Republicans have sought to stealth privatize Medicare is "supplementary insurance." This is insurance only available from a private company to cover the other 20% of doctors' bills. So it's totally private insurance for Medicare Advantage plans and also for supplementary plans.

And you still have to pay for Medicare Part D, the drug plan which again is supplied by private insurance companies. And then there's the notorious "donut hole" designed by and for Republicans and their lobbyists. According to Medicare and I quote:

Medicare drug plans may have a "coverage gap," which is sometimes called the "donut hole." A coverage gap means that after you and your plan have spent a certain amount of money for covered drugs (no more than $2,700), you have to pay out-of-pocket all costs for your drugs while you are in the "gap." The most you have to pay out-of-pocket in the coverage gap is $4,350 . This amount doesn't include your plan's monthly premium that you must continue to pay even while you are in the coverage gap. Once you've reached your plan's out-of-pocket limit, you will have "catastrophic coverage." This means that you only pay a coinsurance amount (like 5% of the drug cost) or a copayment (like $2.40 or $6.00 for each prescription) for the rest of the calendar year.


So even though you are paying private companies for drug coverage, they can still get you via the donut hole and also copays.

Oh, copays apply to Medicare Part B also. So when you see a doctor, you are paying (1) monthly premiums, (2) a yearly deductible and (3) copays as well as monthly premiums and copays for drugs. And don't forget the donut hole.

This system was designed by sick, twisted misanthropes. Did I mention it was designed by Republicans? In addition if you don't sign up for any of these plans wihthin a specified "window," you will pay penalties (or you may not be able to sign up at all!) and you can only change plans during a 45 day period from November 15 to December 31 in any given year. And the deductibles, copays and premiums keep rising on an annual basis.

Contrast this with the Canadian system where all you do is present your card to any doctor or hospital and you get taken care of without any monthly premiums or deductibles or copays for 100% coverage for any age range or with the Dutch system where you get taken care of for a $115 monthly premium (except there's no charge for children). Oh, and they cover everybody not just those 65 and older.

The American Medicare system sucks; it's a piece of crap with no preventable coverage like an annual physical (not covered) but it is cheaper than the health insurance people under 65 are forced to buy which can truly bankrupt you just paying the monthly premiums with huge deductibles. The "no annual free health examination" is a nice Republican feature designed to run up the cost of Medicare until it bankrupts government. Anyone with an ounce of brains knows that prevention of disease lowers costs in the long run, and an annual physical exam is the essence of early detection, prevention and lowered costs for the system as a whole in addition to the misery it could prevent actual citizens by catching diseases in early stages.

Obama's health plan will hopefully correct these unconscionable "features" of Medicare and extend health care insurance to everybody not just to those who can afford to pay. As I mentioned previously, his plan would turn the Republican designed Medicare plan which represents stealth privatization on its head, and provide a multi-payer stealth publicization plan. That is, eventually, the private health plans would phase themselves out as more people switched to the government sponsored plan. But it all depends on who controls Congress and the Presidency and who tweaks the plans so that either the public or private plan looks better at any given time. There will probably be a tug-of-war between Republicans and Democrats over this one. And of course, the lobbyists for the health insurance corporations will be on the side of the Republicans. The middle class will be on Obama's side, but do they have any money for lobbyists? For ads? Remember Harry and Louise? Perhaps.

Friday, 06 March, 2009  

Here is a video on the new Dutch Health Care System implemented in 2006. It is a combination of private health insurance and hospitals with government participation especially in setting the rules. It features "risk solidarity" which means that no insurance company can refuse to cover anyone regardless of their health, but the government will pay them extra to cover someone who requires a lot of care. The Dutch system will cover you if you want to go abroad for health care so you are not confined just to the doctors and hospitals within the Netherlands. It covers children for free up to 18 years of age. It will provide financial assistance to people who can't afford the $115. a month premiums. And you can change insurers at any time simply by giving notice. Compare this with the US where you are given a "window" within which you can change plans. The Dutch system combines the best of social insurance with market incentives in my opinion.

Discussion on Health Care in US and Holland

The following is an interesting discussion that appeared on Robert Reich's blog recently:

Frank Thomas said:

I have described the Dutch Health Care System a couple of times on this blog many months ago. I cited actual case costs for specific case operations in selected European countries versus the States. The reality results were and remain shocking.

Suggest you go to Google and search for the video entitled, "The New Dutch Health Care System." There are English under-titlings. It´s an excellent summary of a class care AND cost-effective health care system

Everyone must have and is entitled to have the Dutch standard Basic package, without any right of "cherry-picking or screening out of undesirables by health insurers. Insurance firms are obligated to accept EVERYONE regardless of age, gender, or health.

System has a standard premium cost for EVERYONE of about €95,00/month ($115,00 or $1,375 annually). Children up to 18 years of age are covered by this basic premium fee FREE of charge.

The €95.00/monthly charge is automatically REDUCED if one's income lies below a certain level.

You can also take out
'additional' health insurance if you want to cover more than standard medical care. However, there is no acceptance obligation for insurance companies in the case of this type of insurance. Insurers generally offer an `above standand´ package of specific coverages at a reasonable added monthly fee not exceeding 10-15% of the basic monthly premium.

Rates or cost prices billable to insurers for prescription medicines, hospital treatment procedures and operations are fixed by the Ministry of Health.

Monthly premium costs even including extra coverages are at least ONE-HALF those in the US today! Operations for almost any procedure here are anywhere from 40-60% less than in the States. That´s true for health care systems in most other mature European countries, e.g., Denmark, Sweden, Germany, Belgium Switzerland, etc.

The employer pays 50% of the cost, the employee, 45% and the government 5%.

You should definitely look up a published Index called the `EURO HEALTH CONSUMER INDEX´ for a recent comparison of European health care systems.

You will find that in 2008 the Netherlands health care system was ranked number ONE or the BEST in Europe (and Holland has been in the top three rankings for years.)

America´s social insurance systems are light years behind Europe. Our health care, particularly, is by far more costly, and for less quality, compared to Europe. Most countries here are also sharply and constantly focused Preventative health care actions, i.e., diet, exercise, less use of antibiotics, less stress (for example, by insuring prudent but human social nets in tough times, etc.).

Frank Thomas, The Netherlands

Thursday, 19 February, 2009

 Frank Thomas said...

Michael,

You should look up the 2008 EURO HEALTH CONSUMER INDEX for latest rankings and comparative review of health care systems in Europe.

Thursday, 19 February, 2009

Anonymous said:

Frank, the Netherlands Health system works well in Holland, because only 1% of the Dutch citizenry is obese.

Try and introduce the Dutch system into the USA, where 48% of the US citizenry is obese,and, lets see what happens.

Lifestyle induced illnesses caused by obesity, in 48% of the US population, will never be covered by 95 Euro a month per person.....

950 Euro per month sounds more like it for all of us US Fatties and our Fat kids.

Thursday, 19 February, 2009

Anonymous,

Your statement that only 1% !! of Dutch citizens are overweight is QUITE off the mark.

The measure here whether a person is overweight is based on the BODY MASS INDEX (BMI).

The is one's Weight in kilos Divided by the Square of one's Height in Meters.

According to the World Health Organizarion, adults with a BMI of 26.7 (= 71 kilos Divided by 1.63 x 1.63) are considered overweight.

Based on this measure, about 42% of the Dutch population is overweight.

But I agree this % is far higher in the States.

Thursday, 19 February, 2009

 Jordan said...

There are number of reasons why our health care system is more ineficient and more costly then universal health care systems.

Insurance companies work on pooling premiums from large number of insurees to spread cost of caring for some that need expensive treatments in order to have a life.

Bigger the pool of insured, cost is spread over more people. In our system you have insurers for profit and other insurers for care. Over the years, insurers for profit, tend to deny the pool entrance to costly claimers so it will keep total cost down. Denied ones go to only ones that will care for them; state providers. Denied ones are usualy costly ones, so states cover most of diabetics, cancer patients and other chronic patients.

You might think that if you belong to profit insurers that you pay less in premiums due to denied chronic entrees, but you pay for higher taxes needed to cover those chronic ones that treatment is covered with our taxes. So you come out the same, wheather you pay it up front or in the back. Only thing is you are tricked into believing that there are no back expenses, or as RR calls it externalities.

Other reason for higher cost of our system per person, is that insurers are for "PROFIT". Much of the premiums go to pay outrageous CEO bonuses, dividends, advertising, and worst of all is insurance agents that get commisions.

In universal health care there are no such expenses as above mentioned. Because everyone is automaically included. I would estimate cost of those as 50% of premiums we and corporations pay. It is all wasted on non-care costs of operations. Not to mention, all malpractice insurance coverage and lawsuits that are paid out of premiums, which rarely happens in univeersal health care systems. Not to mention health insurance cost that our corporations bare, while other nation's corporations do not. There is a competitive advantage for outsourcing to other universal care country companies.

All aforementioned is obvious once you became chronic patient, do we all need to become chronic patients to learn how fake our insurance system is, and all those lies from insurance corporations and repugs about "we have best hospitals so we have best system"
Only they are afraid to mention who is able to enter those best hospitals. And why there is so many unqualified doctors practicing in our country? Because there is no centralised system for pateints, and also no centralised system for doctors. Unqualified doctors cause malpractice insurance to skyrocket and take about 25% of surgeons salaries, which raises the cost of treatments.

Not to mention the pharmaceuticals that are totaly twisted story on its own.

Thursday, 19 February, 2009

Frank Thomas said:

As I mentioned, people who are unable to pay the fixed premium (of about $1,400 per person per year) for the standard benefits package, due to a low income, can apply for a government Care Allowance.

This Safety Net makes certain that SOLIDARITY between income groups is a fundamental aspect.

Alongside the insured's fixed premium contribution, the insured also pays an income -dependent contribution to the government of 6.5% of income up to an income maximum of €30,000($36,000) or a maximum contribution of about €2,000 ($2,400) annually.

Employers are obliged to reimburse this contribution to their employees. This income is used to even the risks between insurers with expensive customers ... so it is in effect a Safety Net for insurers.

Thus, this largely private system with government setting competing conditions and limiting its funding is paid for in three ways: 45% by the Employee Fixed Premium contribution; 50% by the Employer income-dependent contribution; and 5% by the government's Care Allowance.

The government remains responsible for Accessibilty, Affordability, and Quality of health care. The government does not participate directly in the actual provision of care as latter is in the hands of private care suppliers.

Citizens can change insurer every year. Insured parties can choose their own care if they wish and have the costs they pay to the Care Provider reimbursed by the insurer.

The insurer sets the level of the fixed premium but is required to provide the same care to Everyone for the basic benefits package.
The insurers are legally not permitted to select on the basis of prior medical disorders, risks, and "expensive" customers.

This reformed system introduced in Jan. 2006 was implemented to correct following deficiencies in the old system:

1....too many different schemes: social health insurance; private health insurance; civil servants' health insurance

2....little or no choice for insured parties

3....ineffective or no competitiive incentives for insurers

4....little or no pressure on suppliers/care providers to achieve better performance

5....unfair premium and income effects

6....final element introduced is what has been termed "government constraints", i.e., market competition and system equity has to be regulated.

Sound familiar to a few of our US health care problems noted by Jordan?

Making the health care system more Efficient and Affordable have been the primary goals. The Dutch government's Care Expenditures are growing steadily from 3.9% of GDP in 1960; to 7.6% in 1980; to 8.3% in 2000; to 9.7% in 2005; to 10.2% in 2008.

The future aging of Dutch society (like in the US) spells further accelerations of health care costs as a % of GDP despite the significant efficiences introduced in 2006.

The following forecast illustrates this challenge:

Senior Citizens.......% Above 65

1950.....................7.5%

1970....................10.0%

1990....................13.0%

2010....................15.0% !

2030....................22.0% !

2050....................21.5%

Constant intelligent reform is a must to contain costs and insure quality throughout the system

Thursday, 19 February, 2009

I forgot to mention that US health care costs reached a high 17% of GDP in 2008 ($2.4 billion)compared to the plus 10% of GDP range for Holland and many other European countries. Further, this 17% is based on facts over 45 million Americans have no insurance while Holland's population is 100% covered with basic health care insurance.

Quite amazing difference when you think about it!

Thursday, 19 February, 2009

Michael says;

Frank T.:

I believe your decimal point off--as the GDP--a bit bigger than 6 times the 2.4 billion --

But, your not a math prof. correct? joke!

Amazing? Ha--that may qualify for entry into the G. book of records!

Getting towards your bed time--

Thank you for the as you say --maybe amazing info. for a few here!

Yes, and just how many holidays are taken and vacations too?

Point being you work a bit less a year too--so based on a per hr. worked the difference grows more amazing?

Michael

Thursday, 19 February, 2009

Michael,

Thanks for correction:
Math was a strength until I passed 70; been in decline since then in many areas, as Art will confirm with my spelling proficiency (billions vs. trillions). Of course, I assumed a 2008 GDP of $14.3 Trillion with a 2008 health care expenditure of $2.4 trillion (= +- 17%, I believe);-).

Thursday, 19 February, 2009

Even a Third World Country Like Sri Lanka Has Universal Health Care

The US with its costly yet inefficient health care system is rapidly degenerating into a third world country which by definition is a country with poverty for the masses and wealth for a narrow elite. Bill McGuire CEO of United Health Care averaged almost $60 million a year in salary while 40 million people in the US went without health care at all, and even those with health insurance went bankrupt trying to pay their copays. McGuire left the company with over a billion dollars in stock options. But an impoverished country like Sri Lanka (formerly Ceylon) can afford universal health care. Why can't the US? It's simple: greed.

This is from a report by Dr. Sarath M. Samarage:

Sri Lanka holds a unique position in South Asia as one of the first of the less developed nations to provide universal health, free education, strong gender equality, and better opportunity to social mobility. Since its independence, successive governments have implemented welfare-oriented policies and programs which have allowed Sri Lanka to achieve relatively high standards of social and health development in comparison with countries of similar levels of economic development. As a result of this, the country has made significant improvements in social welfare, both in the development of public health care and education systems. The attainment by Sri Lanka of a high Human Development Index (HDI=0.74) with a life expectancy at birth of 72.5 years, and a literacy rate of over 90%, has thus been a well celebrated success for a less developed country. The health system in Sri Lanka is enriched by a mix of Allopathic, Ayurvedic, Unani and several other systems of medicine that exists together. Of these systems allopathic medicine has become dominant and is catering to the majority of the health needs of the people. As in many other countries Sri Lankan health system consists of both the state and the private sector. The Health Ministry and the Provincial Health Services provide a wide range of promotive, preventive, curative and rehabilitative health care. Sri Lanka has an extensive network of health care institutions.

The Sanskrit meaning of "Sri Lanka" is sacred island. Sri Lanka is an island located in the Indian Ocean off the coast of India. Sri Lanka was the first country in the world to establish a wildlife sanctuary. European colonists established a series of tea, cinnamon, rubber, sugar, coffee and indigo plantations. The British also brought a large number of indentured workers from Tamil Nadu to work in the plantation economy. The city of Colombo was established as the administrative centre, and the British established modern schools, colleges, roads and churches that brought Western-style education and culture to the native people.

Since 1983, there has been on-and-off civil war, predominantly between the government and the Liberation Tigers of Tamil Eelam (LTTE, also known as the Tamil Tigers), a separatist militant organization who fight to create an independent state named Tamil Eelam in the North and East of the island.

President Rajapaksa's broad economic strategy was outlined in his election manifesto Mahinda Chintana (Mahinda's Thoughts), which now guides government economic policy. Mahinda Chintana policies focus on poverty alleviation and steering investment to disadvantaged areas; developing the small and medium enterprise (SME) sector; promotion of agriculture; and expanding the already enormous civil service. The Rajapaksa government rejects the privatization of state enterprises, including "strategic" enterprises such as state-owned banks, airports, and electrical utilities. Instead, it plans to retain ownership and management of these enterprises and make them profitable. The influence of the World Bank and IMF towards privatization has waned here as it has in other parts of the world.

Exports to the United States, Sri Lanka's most important single-country market, were estimated to be around $2.1 billion for 2007, or 27% of total exports. As a result of the GSP Plus program, the EU as a whole is Sri Lanka's biggest export market. For many years, the United States has been Sri Lanka's biggest market for garments, taking almost 50% of total garment exports. India is Sri Lanka's largest supplier, accounting for 21% of imports valued at over $2.6 billion. United States exports to Sri Lanka were estimated to be around $230 million for 2007, consisting primarily of wheat, electrical apparatus, textiles and specialized fabrics, medical and scientific equipment, plastics, and paper.

Sri Lanka is highly dependent on foreign assistance, with the World Bank, the Asian Development Bank, Japan, and other donors disbursing loans totaling $1.4 billion in 2007. Iran is becoming the largest provider of foreign assistance. During the Iranian President's visit in April 2008, Iran committed $450 million for the Uma Oya multipurpose irrigation project. Iran is also a major lender to Sri Lanka and has provided infrastructure project loans and an interest-free credit facility for oil imports. Under this facility, Sri Lanka has imported  a substantial amount of oil (valued at $700 million as of June 30, 2008). Iran promised assistance for modernization of Sri Lanka's only oil refinery, though no firm commitments are in place. China has also become a major lender for infrastructure projects, such as a new port and a coal power plant. Foreign grants amounted to $275 million in 2007.

Sri Lanka's political system has also supported the development of a welfare state, with universal franchise since 1931. Visionary social policies introduced in the 1940s included sizeable and universal food subsidies, free and universal health care and free education. Such policies provided minimum levels of consumption for the entire population and helped to remove destitute poverty.

A Tipping Point for Medicare?

Congress has passed a bill demanding a draconian 10% cut in payments to doctors who accept Medicare patients. Now Congress is trying to repeal it to not much avail since, although the Democrats control the House and the Senate, the Republicans still have enough maneuvering room via the filibuster and other parliamentary procedures, to squelch any legislation that might threaten corporate interests. And Bush can always veto. Republicans have been trying to get rid of Medicare and social security for years in a virtual vendetta. By reducing payments to doctors accepting Medicare, the Republicans are encouraging patients to switch to the Medicare Advantage plans which are offered by private insurance companies and at the same time discouraging doctors from accepting any Medicare patients at all. Doctors can choose whether or not to accept a patient on Medicare, and patients can choose whether to go on Medicare or Medicare Advantage. 

Medicare Advantage plans seemingly offer increased benefits over traditional Medicare like no deductible, annual free medical exam, dental plans and much more. The fly in the ointment is that the primary doctor acts as a gatekeeper denying patients access to specialists. With Medicare the patient can go to any doctor he or she chooses. Most new patients, offered all the seeming "advantages" of Medicare Advantage, however, will sign up for that. And as Republicans in Congress are successful in cutting back or reducing payments to doctors who accept Medicare patients while increasing payments to doctors for the same procedures applied to Advantage patients, it's not hard to predict that there will come a tipping point where too few doctors are accepting Medicare and most patients will be on Advantage. Medicare patients will be forced and encouraged to switch to Advantage plans in order to find a doctor. Then the Republican victory will be complete. Complete corporate control of the US health care system for the elderly and at taxpayer expense.

The main goal of the corporate controlled Congress is to funnel American taxes into corporate coffers, to see government as a tax delivery vehicle to private corporations, just as cigarettes are a nicotine delivery vehicle or TV is an ad delivery vehicle. We see this again and again from the military industrial complex to education to health care to energy policy. Instead of government of the people, for the people and by the people, we have government of the corporate shills (the Republicans mainly but some Democrats too), for the corporations, and by the lobbyists. Huge amounts of money are given to the political campaigns of those who promise to represent corporate interests and the revolving door is there to give politicians a lucrative job after they get elected, serve corporate interests and retire to "spend more time with their families," that is to cash in their reward by accepting a job at a corporation whose interests they served while in "public" service.

WASHINGTON — Congress returns to work this week with Medicare high on the agenda and Senate Republicans under pressure after a barrage of radio and television advertisements blamed them for a 10.6 percent cut in payments to doctors who care for millions of older Americans. The advertisements, by the American Medical Association, urge Senate Republicans to reverse themselves and help pass legislation to fend off the cut. How to pay doctors through the federal health insurance program is an issue that lawmakers are forced to confront every year because of what is widely agreed to be an outdated reimbursement formula. But the dispute, which showcases the continued potency of health care issues, has reached a new level of urgency this year. Some doctors are reassessing their participation in the program and powerful interests on all sides are in a lobbying frenzy. Just before the Fourth of July recess, the House passed a bill to prevent the Medicare pay cut by a vote of 355 to 59. In the Senate, Republicans blocked efforts to take up the bill, so the cut took effect on July 1, as required by the formula. But the Bush administration has delayed processing of new claims to give Congress time to come up with a compromise. Senator Harry Reid of Nevada, the majority leader, said he planned to force another vote this week, and Democrats pressed their case over the weekend in their national radio address. Democrats need just one more vote to pass the bill, and they hope to win over Republicans who were hit by advertisements over the recess. The advertisements assert that Republicans have been protecting “powerful insurance companies at the expense of Medicare patients’ access to doctors.” The commercials were aimed at 10 Republican senators, including seven up for election this fall. But President Bush has vowed to veto the bill, so the fight — and the uncertainty — could continue for weeks. Mr. Bush and many Republicans oppose the bill because it would finance an increase in doctors’ fees by reducing federal payments to insurance companies that offer private Medicare Advantage plans as an alternative to the traditional government-run Medicare program. Insurance companies and the White House argue that the bill would hurt beneficiaries who rely on private Medicare plans. America’s Health Insurance Plans, a trade group, ran television advertisements last week, urging Congress to “stop cuts to Medicare Advantage.”

As usual, this issue is barely understood by the American public because it is so convoluted and not sufficiently reported on in the mass media. So the average American's understanding is reduced to a TV commercial which attempts to obfuscate even further and persuade the viewer to the view of the corporate interest that bought the commercial. Health care in this country is about to be totally privatized and corporatized unless the next (Democratic) administration can change course. Unfortunately, the course won't be changed until the Democrats have a filibuster proof Senate which will be no time soon even if Barack Obama is elected. The Republicans will hold the line by means of filibuster. The only way out of this dilemma is to attack the filibuster rule itself or else the Republicans alled with corporate interests will continue to use government as a means to funnel tax payer dollars into corporate coffers in such a way as to increase medical costs while decreasing medical service. Such is the way to increasing corporate profits.

But the Medicare issue has been a sticking point for years. The question is how to rein in the rapidly rising cost of the federal health program. Members of both parties say they want to change the formula, which defines a “sustainable growth rate” for spending on doctors. But Congress is nowhere near agreement. The pending bill offers a short-term fix. It would reverse the 10.6 percent cut and increase Medicare payments to doctors by 1.1 percent in January. Under the current formula, doctors would still face cuts of more than 5 percent a year from 2010 to 2012. Despite the president’s veto threat, many House Republicans bolted and voted for the bill, putting added pressure on their colleagues in the Senate. As the maneuvering goes on in Washington, doctors around the country have begun to reassess their participation in Medicare. Dr. David D. Richardson, 40, an ophthalmologist in Los Angeles County, closed his practice last week to all but emergency patients and those needing surgery. “I love practicing medicine,” Dr. Richardson said, “but I would lose more money by keeping my office open than by pulling it back to a skeleton crew. Just like a physician in the emergency room, I try to reduce the hemorrhaging.” In Topeka, Kan., Dr. Kent E. Palmberg, senior vice president and chief medical officer of the Stormont-Vail HealthCare system, said its 70 primary care doctors were “no longer accepting new Medicare patients as of July 1 because of the draconian cut in Medicare reimbursement.”

Independent studies have shown that the Medicare Advantage program costs the government (i.e. the tax payers) more money per patient than does traditional Medicare. But the goal here is not to save the tax payers money or to provide decent health care. The goal is to use government to increase corporate profits at tax payers' expense, and since Ronald Reagan proved that deficits don't count, it doesn't matter if the government has to drive up the national debt to do it.

The Rapacious Prescription Drug Industry

There are two recent books that expose the unsalutary practices of the drug industry. One is "Our Daily Meds," by Melody Peterson  (left) and the other is "The Truth About the Drug Companies," by Marcia Angell (below). A recent study found that half the Americans that have health insurance are on some kind of prescription drug! Ever since drug advertising became legal in the US in 1997 (one of two nations in the world that allow it), the drug industry has beaten a drum to the tune that there is a prescription drug for every malady perceived or otherwise that will take care of the problem. They have even created diseases for which there was no prior awareness.

USA Today on Tuesday examined the "political clout of the pharmaceutical industry," which since 1998 has spent $758 million on lobbying efforts -- more than any other industry, according to the... Center for Public Integrity. The pharmaceutical industry in 2003 spent $143 million on lobbying activities. At that time, there were 1,274 registered pharmaceutical lobbyists in Washington, D.C. -- more than two for every member of Congress, USA Today reports. Of those, 476 were former federal officials, including 40 former members of Congress. Former Rep. Billy Tauzin (R-La.) earlier this year was named CEO and president of the Pharmaceutical Research and Manufacturers of America. According to USA Today, Tauzin's move to the private sector is "testament to the industry's power." Prior to taking his position with PhRMA, Tauzin helped pass the Medicare prescription drug benefit as chair of the House Energy and Commerce Committee. Currently, Senate Majority Leader Bill Frist (R-Tenn.) -- the "gatekeeper for legislation that comes to the Senate floor" -- is a "key lobbying target" for the industry, USA Today reports. During the 2004 election cycle, the drug industry contributed at least $17 million to federal candidates, including $1 million to President Bush and $500,000 to former Democratic presidential nominee Sen. John Kerry (D-Mass).

The pharmaceutical industry would have you believe that they need to charge such high prices for their wares so that they can do research to come up with more and better drugs. In point of fact their research budgets are meager compared to their outlays for advertising, lobbying and executive compensation packages. They've found that a "me too" drug can make them more money than a drug that they've developed from scratch. A "me too" drug is one that they've copied from a success by another drug company, but offers nothing new or original. As for research, they won't hesitate to put a drug on the market whose negative side effects almost outweigh the positive effects of the drug, and those positive effects may be little more than a placebo. As a result, US citizens are loading up on drugs in their systems which may be doing them more harm than good.

Doctors are totally in bed with the drug industry which offers them all kinds of money and perks to go along with the program. The drug industry will even ghostwrite the research papers for them (as well as the congressional legislation) and see that they are published in what used to be independent, unbiased journals. All the doctor need do is put his name on it. (All Congress need do is pass the legislation.)

The newer and scarier material in “Our Daily Meds” concerns the increasingly serious consequences of Americans’ dependency on prescription drugs. Disagreeing with Iowa’s nosologist, Ms. Petersen says the lethal consequences of overprescribed or misprescribed drugs are too readily accepted as “natural” death. She cites the unwillingness of pathologists to question the wisdom with which doctors dispense medications. The reluctance of hospitals to perform autopsies, she says, has impeded medical research into what these interactions can do.

So the accumulation of drugs is a person's system and the encouragement by the drug companies to increasingly rely on pills to cure every perceived pain or ailment goes hand in hand with the public's laziness and unwillingness to take responsibility for their own lives and to seek a panacea by altering their lifestyles - in particular diet and exercise. Dieting and excercise require work and a willingness to undergo pain and discomfort. Instead why not avoid the pain and discomfort by taking a pill? And if a particular drug does not solve the problem ... ? Not to worry, the doctor will simply prescribe another drug. If that one doesn't work, then another and another... In this way the profits are multiplied. So a failure is actually a success ... in terms of profits.

But while the rhetoric is stirring, it has very little to do with reality. First, research and development (R&D) is a relatively small part of the budgets of the big drug companies—dwarfed by their vast expenditures on marketing and administration, and smaller even than profits. In fact, year after year, for over two decades, this industry has been far and away the most profitable in the United States. (In 2003, for the first time, the industry lost its first-place position, coming in third, behind "mining, crude oil production," and "commercial banks.") The prices drug companies charge have little relationship to the costs of making the drugs and could be cut dramatically without coming anywhere close to threatening R&D. Second, the pharmaceutical industry is not especially innovative. As hard as it is to believe, only a handful of truly important drugs have been brought to market in recent years, and they were mostly based on taxpayer-funded research at academic institutions, small biotechnology companies, or the National Institutes of Health (NIH). The great majority of "new" drugs are not new at all but merely variations of older drugs already on the market. These are called "me-too" drugs. The idea is to grab a share of an established, lucrative market by producing something very similar to a top-selling drug. For instance, we now have six statins (Mevacor, Lipitor, Zocor, Pravachol, Lescol, and the newest, Crestor) on the market to lower cholesterol, all variants of the first.

Not only that but when a study shows that a drug such as Vioxx causes more harm than good or has disastrous side effects, the FDA allows them to keep it on the market, to keep selling it and to keep endangering peoples' lives. A conclusive study found that Vioxx was causing heart attacks and strokes, but it's still being sold as well as other drugs which have been found to be harmful.

The moral is profits first, human lives second and our government is in the pockets of the drug lobby.

France Best, US Worst in Preventable Death Ranking

A recent study has found that France is best and the US worst in rankings focusing on preventable deaths due to treatable conditions in 19 leading industrialized nations. This is considered an overall gauge of the quality of health care in the countries involved.

France did best -- with 64.8 deaths deemed preventable by timely and effective health care per 100,000 people, in the study period of 2002 and 2003. Japan had 71.2 and Australia had 71.3 such deaths per 100,000 people. The United States had 109.7 such deaths per 100,000 people, the researchers said. After the top three, Spain was fourth best, followed in order by Italy, Canada, Norway, the Netherlands, Sweden, Greece, Austria, Germany, Finland, New Zealand, Denmark, Britain, Ireland and Portugal, with the United States last. A key factor in the poor showing of the US is that 47 million US citizens lack any kind of health insurance while in every other case all citizens are fully insured by national health care insurance. If the US health care system performed as well as the top three countries, there would be 101,000 fewer preventable deaths per year.

But these studies miss the point. The US health care system is excellent for those who can afford access to it just as the education system is excellent for those who can afford access to it. The US is committed to a way of life that provides excellence for those who can afford it and crap for those who can't. This, of course, brings the averages down when people conduct studies based on overall measures of goodness or performance. Other advanced industrialized nations provide health care and education as a matter of course for all their citizens and hence are more egalitarian than the US. The US way of life is "Money talks; merde walks." In other words the US is based on privatized solutions to social welfare which are inherently unequal while other advanced countries are more socialist in nature. There is more of a welfarist component and a concern for the average citizen. The US government, at least under the Republicans, is committed to privatizing everything. Therefore, all welfare will be privately commodified and bought and sold with those who can't afford it forced out of the welfare market whether that market is for health, education, recreation, retirement or what have you.

In France education is free or almost free from the age of 2 through graduate  studies.

Education is almost free at all levels (tuition $100 a year at Sorbonne) except for private schools and business schools. 26% of university students receive scholarships. But it is a fact that French Universities do not offer as many services and facilities as American univeristies and from this standpoint, only Grandes Ecoles compare to the US system.

Annual costs for a student at the prestigious Sorbonne are less than $300! Meanwhile, in the US students are paying $50,000. to $100,000. per year and have to borrow huge sums of money from predatory loan operations like Sallie Mae which used to be government owned but now is completely privatized and corporatized complete with huge CEO salary. Administrative costs (read CEO  salaries and advertising) for private corporations are much higher in the US than in Europe whether it be for health care or education. The profit motive drives up these costs and makes the operations much less efficient than when the service is government provided to the public.

Unheard of in the US is the way the French support families:

The Family system (Allocations Familiales) is a financial help to all families (whatever their income) plus various services such as day-care or vacation centers (according to income) ; when a family is expecting a child, it gets approximately 2,000 Euros in three installments (the first two of them corresponding to a mandatory medical visit, the third to the birth) ; then the family receives a monthly allowance till the child is 20 (for two children or more, around 100 Euros/month/child).

And the retirement system is provided by the state not by private employers or the stock market. In fact French funding for retirees is not invested in the stock market so it is independent of market fluctuations and boom or bust cycles. In the US employer provided pensions have been largely replaced with employee funded 401ks. The difference is that the employee must now bear the risks associated with the market and could well end up with nothing at retirement even though he or she has invested consistently over the course of a lifetime. Risks have been shifted from employer to employee.

In France social security provides about 750 euros per month (about $1125.) to anyone who has worked 40 years. Note that it does not depend on the amount of money you have made as in the US system where high wage earners who have paid more into the system receive more than low wage earners. Everyone receives the same amount.

Contrary to what most Americans believe, the French government run social security system is more efficient than US privatized corporate provided systems with the administrative cost of the health care system being around 4.5% (for US private insurance companies it's 10 to 13%) and 1.2% for the retirement system (vs. around 10% for most pension funds).

Finally, consider what kind of society you want to live in: one that exhibits compassion towards its citizens, one where there truly is a social contract, or one that is devoted to the private pursuit of profit at all costs including leaving a substantial number of its citizens by the wayside and out in the  cold. Michael Moore dramatized the contradictions in US society contrasted with the beneficence of the French most effectively in his movie Sicko.

Health : by all standards the French health system compares very favorably to the US system. It is based on a moral and political consensus that protecting the health of citizens, and keeping them from what can be avoided in the trauma of illness and death, is one of the major responsibilities of the Society as a whole. Therefore, the State ensures that everybody is protected and people consider it to be in charge of controlling the quality of the health system and of regulating all its private and public players, including corporations which must contribute equally to it. The results : 100% people covered (see CMU), for a cost 30 or 40% [less than] America's (11,1% of GNP vs. more than 14% in the US) and with better results (see better ratios : life expectancy, infantile mortality, obesity, etc). The French are astonished when they are told that more than 40 million Americans have no health coverage (and even more no dental coverage). Being worried about the health bill does not exist in France. The social consensus is : "it is sad enough to be sick and one must not have an additional money problem about it". Saying "it is socialized medicine, therefore bureaucratic and inefficient" is ridicululous and wrong : look at the facts! See the WHO ranking : France comes first and read a column in the IHT ("French Lesson").

Privatizing Medicare: The Medicare Advantage Plan

The Republican goal is to privatize social security and medicare. But this doesn't necessarily have to happen in one fell swoop. It's happening quietly already with no fanfare, no outcry and right under our noses. When I signed up for Medicare  in 2006, I  was given the choice of signing up for traditional Medicare or the so-called  Medicare Advantage plan. I should point out that this only has to do with Medicare Part B, the part that covers doctors' visits and not Part A, hospitalization, which is free. To make matters more confusing, there is Part D, the drug part, which was enacted in 2003 when they also revamped the Advantage plan which had been laying around dormant, I guess. The Advantage plan, seemingly, offers additional benefits that traditional Medicare doesn't for the same amount of money. For instance, you get a free annual physical exam which you don't get under traditional Medicare. Why not? If preventative medicine and early diagnosis save the system money in the long run not to mention human misery, you'd think the government would want every enrollee to have a free annual check-up as part of Medicare. In addition, the Advantage plan I signed up for (there are  several available offered by different for profit, private corporations), Secure Horizons (part  of  United  Health Care whose CEO Bill McGuire made $100  million last year), offered free eyeglasses every two years, an optional dental plan etc. 

All these enticements were offered to get people to sign up for the Advantage plan which is privatized corporate sponsored health insurance rather than traditional government sponsored, single payer health insurance which is what  Medicare is.  So who wouldn't sign up for a plan that offered everything Medicare offered, but more!  So what's the catch? When I signed up, I had to choose a primary physician and a hospital.  I got to keep the doctor I was already going to and the hospital I would have prefered anyway so, seemingly, I was ahead of the game. I had also been going to a podiatrist for toenail fungus who was in the same network so I should have been able to keep seeing him, right? Not so fast. I needed a "referral" from my primary doctor or in other words, permission, to see the podiatrist and get reimbursed by Secure Horizons. He wouldn't give it to me because he didn't consider toenail fungus a serious enough problem to warrant my seeing the podiatrist. Neither would he treat it. So he was acting now as a "gatekeeper." Another ongoing situation was also now considered benign and nothing  should be  done about it. So I was denied seeing a specialist twice in a few short months. Now, granted, toenail fungus isn't life threatening, but it was covered under my Blue Cross health insurance prior to going on Medicare or Medicare Advantage. But a number of other life threatening problems have been denied to other people. That's how CEO Bill McGuire makes his $100 million, by denying people health care.

The advantage  of  traditional Medicare is that you can see any doctor or specialist you  choose for a  small co-pay. You don't need your primary  physician's approval. So you can get second opinions. Another thing I found was that, as soon as I was signed up for Secure  Horizons, I started getting tons of literature which, after I had waded through it, I discovered that its main purpose was to start rescinding some of  the "advantages" I was enticed into signing up for in the first place. Like, for example, the "free" eyeglasses every two years. That little benefit was unobtrusively dropped. I started getting the feeling that, as time went on, any link with Medicare would be broken and I would be fully privatized right out of the system. Then my benefits would be reduced and my premiums would skyrocket.

There has been much criticism of the Medicare Advantage plans. For instance, the government literature and Medicare.gov website  seems to make the Advantage plan much more attractive than  traditional Medicare. The  health care corporations pay the doctors more than traditional Medicare does for the same service making it more profitable for doctors to take on Advantage patients while rejecting traditional Medicare patients. Medicare Part B premiums keep going up so that the  government, which pays the  private corporations what they would normally charge the traditional Medicare recipient on a monthly basis, can pay them more each year making the advantage not to the patient but to the health care corporations. However, the more Medicare patients the government can off-load onto Advantage programs, the more money the government actually saves because neither the monthly premiums nor the payroll taxes that fund Medicare actually pay the full costs. It requires serpentine logic to make any sense of this but this is from the President's Executive Office of Management and Budget:

There is a common misperception that there is a Medicare surplus and that Congress must take action to preserve its assets. There is no Medicare surplus. Any excess cash collected from the payroll tax that is not used to provide hospital insurance is used for other Medicare spending such as doctor bills, which are not fully covered by premiums paid by beneficiaries. These premiums cover only about 25 percent of doctor bills and other costs paid from Medicare's other trust fund, the Part B, or Supplementary Medical Insurance trust fund. Additional funds come from the general fund of the government to cover Medicare's remaining costs. In fact, in 2002, without this general fund transfer, Medicare would face a $48 billion shortfall.

So the money essentaily comes from the government's general fund just as social security does (since the government borrows against payroll tax money collected for social security) making payroll taxes simply a farce. They are just a regressive excuse for burdening the middle class and poor while letting the rich off the hook tax wise. The increasing monthly premiums for Medicare Part B are wiping out cost of living social security increases for seniors:

Many Medicare beneficiaries could see next year’s cost-of-living increases in their Social Security checks much reduced by higher Medicare premiums that will grow by $11.60 a month in 2005, the largest annual dollar hike in Medicare’s history. The Part B premium, which covers doctors’ and outpatient services, will rise from $66.60 to $78.20 a month, a 17.4 percent increase. Next year’s Social Security benefits, not yet announced, are expected to rise only 2 to 3 percent, the rate of general inflation. Someone receiving a $600 check, for example, would get an extra $15 a month next year under a 2.5 percent cost-of-living increase, but the new Medicare premium would wipe out all but $3.40. "A 17 percent increase is alarming," says John Rother, AARP’s director of policy. "If that pattern repeats itself in future years, it means that nobody will get Social Security benefits that keep up with inflation."

The government under the Bush Administration is actually paying more to the private insurers per person than it's allocating for traditional Medicare. This allows the private insurers to pay its doctors more than they're paid for the same service by traditional  Medicare and undermines the whole government program:

AARP's support of Medicare Advantage doesn't benefit seniors Call it the riddle of AARP. It's truly puzzling why an organization that represents 38 million individuals 50 and over, many of whom depend on Medicare, would endorse a Medicare offshoot -- Medicare Advantage -- that siphons money from traditional Medicare and is seen by many as part of an effort to privatize Medicare. AARP says in ads, "Discover the only Medicare Advantage health plan that carries the AARP name." The plan is provided by United Healthcare, among the nation's largest for-profit health insurers. The particular plan AARP has put its name to is a private fee-for-service plan, the fastest growing segment of Medicare Advantage, up nearly 300 percent in a recent 18-month period. Why should anyone drop out of popular, tried and true government-run Medicare and opt for a private insurance plan? The chief reason is that Medicare has been grossly overpaying the private plans to cover seniors who desert traditional Medicare. The generous payments make it possible to lure seniors with attractive premiums and benefits. In some places they even rebate the $93.50 monthly Part B premium. It's not unusual for Medical Advantage plans to offer enrollees free health club membership and zero premium for coverage that includes the Part D drug benefit without extra cost. Of course, there is cost, including profits to the private insurer, but seniors are willing to enroll because it seems like such a good deal and because they may not realize that leaving traditional Medicare in the lurch weakens it for other seniors.

It seems clear that Republicans are trying to discourage seniors from enrolling in traditional Medicare and to discourage doctors from accepting traditional Medicare  patients by reducing their payments for services under traditional Medicare:

The Medicare Payment Advisory Commission (MedPAC), Congress’ expert advisory body on Medicare payments, reported this month that Medicare is losing billions of dollars each year because of excessive payments to private insurance plans through the Medicare Advantage program.  (Under that program, Medicare beneficiaries may elect coverage through private “Medicare Advantage” plans rather than through traditional fee-for-service Medicare.)  Although private plans ostensibly were brought into Medicare to introduce competition and reduce costs, MedPAC has found that, on average, the federal government is paying the private plans 12 percent more than it costs to treat comparable beneficiaries through traditional Medicare.

This year I decided to convert back to traditional Medicare starting in 2008 for several reasons: 1) I can go to my foot doctor again for a reasonable co-pay instead of his normal $140. charge for an office visit; 2) I don't want to support Bush's privatization plan for Medicare; 3) I don't want to support CEO Bill McGuire's $100 million annual salary and 4) if I did develop a serious medical condition, I don't want to be denied health care by my primary doctor acting as gatekeeper, the gate being to Bill McGuire's continued profits and fortune. At least at this point you can convert back. If the Republicans had their way - and some day they may - that link would be broken and once on the Advantage plan it would be impossible to go back. Then watch your benefits reduced and your premiums rise. I was told that I would have to get a supplementary "private" drug plan since traditional Medicare doesn't have an inherent drug plan while the Advantage plan does (another one of its "advantages"). Since I don't use any prescription drugs, I hesitated to pay additional for one, but then I was told there would be a penalty if I didn't sign up right then but wanted to later - another little tool to funnel money to private  corporations. So I signed up for the least expensive at $20 a month with Humana. This is another disincentive for traditional Medicare - you have to pay extra for Medicare Part D, the drug part. So traditional Medicare will cost me more each month for less benefits than the Advantage plan, and I may be rejected by some doctors who won't even service traditional Medicare patients because they don't get reimbursed enough.

The whole Advantage program, like Medicare Part D, is nothing more than a plan to privatize and corporatize Medicare. At the same time health care corporation CEOs like Bill McGuire are making obscene $100 million salaries and sitting on a billion dollars in stock options. Once seniors are on private plans and government sponsored health care is undermined till it collapses, seniors will be  forced to pay through the nose for less service. And the private health care corporations will do it like they do right now by denying people who really need them expensive health care procedures.

One of President Bush’s reasons for threatening to veto the expansion of the State Children’s Health Insurance Program, known as SCHIP, is that it would be financed partly by a cutback in something called "Medicare Advantage." If you don’t know about Medicare Advantage, that’s no surprise. It is popular in California, Florida, New York, Ohio and Pennsylvania, where more than 30 percent of Medicare beneficiaries have signed up for it. But in Maine, New Hampshire and Vermont, fewer than 3 percent belong, and some doctors have never heard of it. Medicare Advantage, heavily promoted by the Bush administration as an alternative to "socialized medicine," is a program that pays various private health plans to provide service less available under ordinary Medicare. Critics see it as an administration wedge intended to privatize Medicare, which now serves 44 million elderly and disabled people. About 8.7 million of them, 20 percent, get expanded Medicare benefits through these private plans. Mainers are well off to avoid these Medicare Advantage plans, as shown by a chorus of criticism and condemnation. The American Medical Association reported in May that its survey "paints a bleak picture of physicians’ experience with Medicare Advantage plans." More than half of the physicians surveyed said their patients had been denied coverage of services covered by the traditional, government run, Medicare plan. Eighty-four percent said their patients couldn’t understand how the private plans worked. AMA’s board chairman, Dr. Cecil Wilson, said: "The private health plans were supposed to inject competition into the Medicare program, but instead we’ve ended up with a federal handout to the insurance industry." He quoted government figures to show that eliminating overpayments to insurance companies will save Medicare $65 million over five years.

Medical Tourism

The following article entitled "US Patients choosing Mexican Hospitals for Price, Quality" by Alfredo Chorchado and Laurence Iliff appeared in the Dallas Morning News, July 28, 2007.

When Carrollton resident Brian Woods needed laser eye surgery last year, he scrutinized options in North Texas for the best deal. McAllen resident Cesar Vega was concerned about the long wait he faced to treat his broken leg after a motorcycle accident during the weekend leading into the July 4 holiday. Both ended up in Monterrey, Mexico. Traditionally, the city affluent residents have traveled to Dallas, Houston or San Antonio for their medical needs. "All around I was very impressed, and the experience surpassed any expectation I had," Mr. Woods said. "I could have been in Zurich, Switzerland, but it was Mexico. I found the care to be top quality, what you would expect at a U.S. hospital and more." Like vacations in sparkling Cancún or Cabo San Lucas, health care in Mexico is becoming high-quality, cheap and convenient, advocates say. As more Americans go without heath insurance or feel the pinch of managed care, some are making a run for the border for treatment ranging from routine care to live-saving procedures. Two North Texas-based hospital chains, Christus Health of Irving and International Hospital Corp. of Dallas, are tapping into a need and an opportunity by providing in their hospitals in Mexico what their executives say are the best of both worlds – U.S.-quality health care and relatively low Mexican prices. "Our goal is to have the safest hospitals in the international market," said Cliff Orme, CEO of International Hospital Corp. "We're implementing U.S. standards into these hospitals so you won't notice the difference going to a hospital in Dallas than one in a Latin American country." Some experts, including Peter Maddox of Christus Health, see Mexico as an answer to the complex question of how to treat aging and underinsured Americans at a time when the retirement of baby boomers will further tax the U.S. health care system. An estimated 43 million Americans, about 15 percent of the population, are uninsured, according to a Census Bureau study. "Our country will go broke unless we find a health care alternative," said Mr. Maddox, Christus' senior vice president for business, strategy and corporate development. "Mexico is a wonderful alternative with incredible potential." A New Kind of Tourist Indeed, Mexico is becoming a top destination for the multibillion-dollar "medical tourism" industry, joining countries including India, Thailand, Singapore and Malaysia. Experts estimate as many as 150,000 Americans travel abroad every year for lower-cost medical care. Although care in Mexico may not be as inexpensive as care in some Asian nations, the proximity to the U.S. is a big advantage to patients. Some U.S. companies are now sending employees to Mexico for their annual checkups. Underscoring the trend, Mexican state governments are spending money to refurbish communities near these hospitals, hoping visiting patients will stay there while receiving medical care or even move there permanently. Such is the case in Santa Eulalia, Chihuahua, and Villa de Santiago, near Monterrey. "We think that Villa de Santiago could also be an area for the retirees from the United States," said Alejandro Paez Aragón, secretary of economic development for the state of Nuevo León. "Our aim is to turn Monterrey into one of the world's medical tourism leaders in the next five to 10 years, and we're well on our way." David Warner, a health researcher at the LBJ School of Public Affairs at the University of Texas at Austin, said the hospitals run by U.S. companies are primarily for Mexicans, but they also hope to attract medical tourism, Americans without insurance and Mexicans living in the U.S. "And they'd like to get some U.S. insurers to cover them," he added. But Mexico faces serious challenges in trying to become a world leader in the medical tourism industry. A turf war among drug traffickers is keeping some tourists away. Monterrey, in particular, has seen a surge of drug-related killings in recent months. "Their plans aren't worth a thing if it's not safe to come here," said Luis Moreno, U.S. consul general in Monterrey. And Dr. Warner, the UT health researcher, said that surveys done by his students show that many Americans are pleased with the "tender loving care" they received in Mexico, but others have found services to be substandard. Nonetheless, over the next 10 years, Christus Muguerza, a partnership of Christus Health and Monterrey-based Muguerza, has identified 40 communities along the U.S.-Mexico border where it plans to expand. And International Hospital Corp. is finishing a new hospital in Puebla, near Mexico City. "I have patients coming here from Houston, Dallas, Austin, San Antonio," said Michael Tarabay, director International Hospital Corp.'s Santa Engracia hospital in Monterrey. "Whether you leave from Dallas, San Antonio, Houston or Austin, it's about an hour plane ride, a 20-minute taxi ride, and you're here." Cheaper Care Mr. Orme, International's CEO, said that his company's hospitals served "several hundred" American clients last year and that Santa Engracia has served about 300 so far this year. Mexico is on average 40 percent cheaper for basic surgical procedures, Mr. Warner and officials for both hospital companies said. A bill in the Texas Legislature sponsored this year by Sen. Eddie Lucio Jr., D-Brownsville, would have allowed U.S.-based insurers to cover health services in Mexico with the goal of making policies affordable for uninsured groups like the working poor. There was also a House version of the bill. Coverage would have been limited to Texans who live within 75 miles of the border. The bill did not get out of committee. "We have a crisis right now," Mr. Lucio said in an e-mail. "There are simply too many residents in Texas lacking health care coverage. Cross-border health plans present an opportunity to increase our rates of private health insurance coverage, particularly in an area of high poverty and greatest need." Cross-border health insurance plans typically cost 40 percent less than traditional policies, he said. "Cross-border health plans have been effective in California, and the primary concern for me is how we can address the lack of health care coverage along the border," he said. For now, most Americans coming to Mexico for health care are considered "medical refugees," as in the case of Mr. Woods, 43, a network engineer. He visited a Christus Muguerza hospital in Monterrey last Christmas and stayed with his wife's relatives there. He had looked into getting laser eye surgery close to home, but the cost made that impossible, he said. U.S. doctors wanted to charge him $4,000, Mr. Woods said, but he paid $1,500 in Mexico. "People were very cordial, warm," Mr. Woods said of the experience. "They treated me very well, and I wouldn't hesitate returning for other medical procedures." Mr. Vega's wife, Adriana, said the couple had a similar experience. She frantically checked South Texas hospitals after her husband's motorcycle accident, but was told hospitals were short-staffed before the holiday weekend. When Mr. Vega was examined, he was told he would have to wait more than 72 hours for treatment for his broken leg, she said. The exam alone cost $1,000, she said. Furious, Ms. Vega told her husband, "We're going to Monterrey." Once there, he was immediately admitted and operated on, she said. "I drove back to Texas two days later." The couple paid about $4,000 – one-third of what she was told the treatment would cost in Texas. "I thought the quality was the same as any U.S. hospital," she said. "What really stood apart, however, was the service. The Mexicans were much more cordial, warmer. Here in the U.S., everyone is worried about being sued, especially doctors. No one seems to smile." Impossible in the U.S. Christus Murguerza's specialties include cardiology, orthopedics, oncology, transplants and plastic surgery. Its hospitals in Monterrey boast state-of-the-art telemedicine systems, which allow doctors to monitor and follow up with patients anywhere in the world in hospitals that share this technology. International Hospital Corp.'s Santa Engracia hospital is in an upscale neighborhood, near hotels that give a preferential rate to hospital patients. In the hospital itself, a private room looks more like a hotel suite, with a separate living room, two televisions and space for an entire family for $300 per night – something unthinkable in the United States, said hospital director Mr. Tarabay, who has managed U.S. hospitals. About 90 percent of Santa Engracia patients are well-off or well-insured Mexicans, many of whom used to go to Texas for top-notch health care. Mr. Moreno, the U.S. consul in Monterrey, said he bought a home for retirement in San Antonio, in part to be close to the medical facilities in Monterrey, a four-hour drive away. "They have a cultural thing here in Mexico where you're not treated like a number," said Mr. Moreno. "Without a doubt, these are the best medical facilities that I've ever seen in my foreign-service career."

Dentistry in San Diego and Tijuana

A few years ago I broke off a front tooth eating an English muffin that was as hard as a rock. When I took it out of the freezer, I defrosted it in the microwave too long. That's how it got that way. I made one for myself and one for my girlfriend. I ate mine, but she said, "This is too hard for me." "Here," I said, "I'll eat it" and I promptly broke off my tooth. The dentist removed the part of the tooth that was hanging by a thread which was most of the tooth down to the gum line and gave me a flipper. I think the flipper cost $300. This was a while back and I don't remember what alternatives the dentist gave me, but I'm sure they were all expensive so I decided to keep the flipper as a permanent solution. This lasted a few years; then the flipper broke. I had it repaired; then it broke again. Finally, I gave up on the flipper and decided to seek a permanent solution.

The dentist I was going to in San Diego suggested a bridge cap as a more reasonable alternative to an implant. (Actually, I had gone to two dentists before that including the one who gave me the flipper and neither of them had proposed a reasonable solution.) What they would do for the bridge cap is grind down the two adjacent teeth, cap them and then those caps would support a third cap over my missing tooth. First they would extract what remained of my missing tooth below the gum line. This solution would cost $995. per cap or $2985. plus the extraction. I forget how much that was. And this was with my Secure Horizon high option dental insurance! So two front teeth would be destroyed, and one wouldn't be rooted in anything. And the dentist said she didn't know how long it would last.

After considerable thought and seeing some ads in the Reader which said that implants in Tijuana could be had for $1500., I decided to look for a dentist in Tijuana. I had been thinking about this for some time as a more economically feasible alternative to US dentistry which had been costing me more and more as time went on, and I was getting less and less satisfied with the quality and the way they treated patients as well as all the subterfuges surrounding how they dealt with insurance. Dental insurance was pretty much of a joke anyway as the dentists always seemed to find a way around it either by shorting the service or charging you for additional items the insurance didn't pay for.

As was my wont, I googled "dentistry in Tijuana" and checked out somewhat thoroughly what was available which was a lot. In fact I devoted an afternoon to it.  A lot of dentists had websites, and a ton of information was available. I had several criteria: qualifications and background of the dentist; quality of the website; location and appearance of the dental office. Some of these criteria are somewhat superficial, I admit, but I wanted a dentist with a nice office in a good neighborhood, not somebody who worked out of his house in a bad neighborhood. I finally settled on Baja Oral Center. I was impresssed with the qualifications of Dr. Martinez who did the dental implants. I called a local San Diego number (they have an 800 number too) and set up an appointment with Dr. Martinez to see about a dental implant. Everyone in the office speaks fluent English including the office manager and phone answerer, Berniece. They cover all the bases at Baja Oral Center. The general dentist there is Dr. Garcia. I was impressed with his credentials too. Their equipment is the latest and most modern. And their offices and waiting rooms are immaculate.

The day of my appointment at 11 AM, I  took the San Diego trolley from downtown. I allowed an hour and a half to get down there. My plan was to take the trolley to San Ysidro, walk across the border, then get a taxi to Jose Orosco St. where the offices are located in the Plaza Pacifico building, a relatively recently constructed high rise. It actually took me an hour and fifteen minutes including a fifteen minute walk to the trolley station from my apartment.  The taxi ride cost "cinco" dollars and took less than five minutes. The offices are located in the Zona Rio section of Tijuana, near Paseo de los Heroes and a huge modern shopping mall. There's a large statue of Abraham Lincoln (among others) nearby on Paseo de los Heroes.

I went up the elevator to the fourth floor and found the Baja Oral Center office. It seemed like the whole building was devoted to doctors and dentists. I met with Dr. Garcia who checked me out first, had a panoramic Xray which cost $27.00, and then Berniece escorted me up to Dr. Martinez' office in the penthouse. Dr. Martinez' office is truly stunning with fantastic views.  Everything about this building and the offices I've  seen is first class. Much nicer than most US dental offices that I've been in with much better "wall-of-glass" views. By the way Dr. Garcia, Dr. Martinez and Berniece all speak perfect English.

I told Dr. Martinez I was interested in an implant. As he examined me, he pulled and tugged on what was left of my front tooth. I couldn't figure out what he was doing. Finally, he  said, "I could give you an implant if you want it, but a better and less costly solution would be to put a post on your tooth since you still have part of one there and then a crown." Dr. Martinez pointed out that I had already had a root canal in that tooth so there should be no pain or complications. Why waste a perfectly good root canal? He would do some minor gum surgery first in order to expose more of the tooth and Dr. Garcia would do the rest. The total cost would be $850 including the gum surgery and a gold crown (gold on the inside, regular looking tooth on the outside). It would be a better solution than the bridge cap or the implant and would cost me $2135. less! We set up an appointment for the following week.

I wondered why no US dentist had proposed this solution. Was it because it was more labor intensive and less lucrative than the solutions they proposed? As it happened, I had an appointment the next day with my San Diego dentist for scaling and root planing, otherwise known as deep cleaning, for two quadrants of my mouth. My former, former dentist had told me I needed this 4 times a year. Then when I changed from Blue Cross to Secure Horizons (when I went on Medicare) the dentist told me I didn't need it at all. Blue Cross didn't cover this procedure at all but Secure Horizons did with a $50.00 copay. Seemed strange to me that one dentist would recommend it so often when it wasn't covered by insurance, and then the next one would not recommend it when it was covered by insurance. But they told me they would perform it if I wanted to pay the full freight! I guess he was fulfilling his role as gatekeeper for Secure Horizons! That's why I changed dentists again. This time they were pleased to do the deep cleaning under the insurance.

I was prepared to pay the $100.00 copay for half my mouth, and then there would be a follow-on appointment for the other half. The dentist jabbed me, and I mean jabbed, several times with novacaine, no topical anesthetic first (as a contrast Dr. Martinez applied a topical and I never even felt the novacaine needle), then proceeded to work on the two quadrants for less than an hour. This is something else I had noticed with US dentistry. When it was an insurance prodcedure, it always took far less time than when you were paying out of your pocket. I guess this is how they made up for the lesser payment from the insurance company. When I got out to the desk they told me the bill was $430! This included my $100.00 copay which I expected and then two charges of $55.00 each for an "unspecified perio procedure." There were also five $44.00 charges for arestin which is something they stick down below the gum line which is supposed to heal infection. I had agreed to the arestin, but they had not told me it was $44.00 a shot! It just took her seconds to put each one in so I felt the cost was ridiculous but I had agreed to it. Fool me once... but what really bothered me was the two $55.00 charges for an "unspecified procedure." I guess they are so brazen they just blow off the expected copay and charge you whatever they want. Right there I decided that I was going to have all my dentistry needs taken care of in Tijuana and not just the big items. I had contemplated having my routine work still done under my insurance in San Diego, but I came to the conclusion that dental insurance is a joke, and dentists would do whatever they had to do to work around it and still charge you exhorbitant prices or give you less than the standard service in terms of their time.

I called and canceled my second $400. plus dental appointment with my San Diego dentist, and after three visits to Dr. Garcia I had my front tooth back again with which I'm very happy. I guess I had gone toothless for about three months, but I'm happy with the final result and what I paid for it. By the way Dr. Garcia worked on me for about two hours putting in the post and the temporary tooth. Before that Dr. Martinez did some minor gum surgery to expose the tooth more. No separate appointments necessary for the two procedures! And I never had any pain during or after the procedure. Maybe the time it took for this procedure is why no San Diego dentist recommended it although I do believe it's preferable to either the bridge cap or the implant and far less costly, but it was labor intensive and US dentists want you in and out of the chair as quickly as possible. I credit Dr. Martinez' honesty for the less expensive diagnosis when he could have given me an implant and charged me a lot more, and Dr. Garcia's and Dr. Martinez' hard work for a very reasonable charge compared to the time they put in. Finally, they did all this for over $2000.00 less than what the San Diego dentist had proposed!

Subsequently, I took my daughter and two granddaughters to see Dr. Garcia. My granddaughters were worked on by Dr. Lizeth Fajardo, who specializes in pediatric dentistry, and Dr. Garcia saw my daughter. My daughter needed to see another specialist to get braces even though she's 36. She has some serious problems, but will save some serious money by not going to a San Diego dentist for her dentistry needs. Dr. Lizeth did a great job with the granddaughters. I found that all the dentists and assistants in Dr. Garcia's office were polite and kind and seemed to really care about our welfare as opposed to the arrogant and uncaring attitudes I found with some dentists and some office staff in San Diego. In fact some of the office staff I dealt with in San Diego were downright rude.

Today my daughter is taking her husband to see Dr. Garcia. He's a really nice guy, and I've been recommending him to everyone. If you require a specialist one is ususally available in the same building and will see you at the same time with no need for a separate appointment and two trips to Tijuana. A lot of people, including me, have given up completely on the exhorbitant prices and less than caring attitudes found in US dentistry, and some travel great distances to have their dental work done in Mexico. They are in fact "dental tourists." You hear a lot about the high cost of medical care in the US while the high cost of US dentistry slips under the radar. It's a scandal as big as US health care, I  think.

I found that the Tijuana dentists I dealt with were very professional and highly competent and used the latest equipment and techniques. More importantly, they seemed to really care about their patients as opposed to a lot of US dentists who, when you open your mouth, only see dollar signs.

Calling Michael Moore...

Waiting Times in US for Cancer Treatment Exceed Canadian Waiting Times for Elective Surgery

See here.

Business Week, no great fan of a national healthcare system, reported in late June that "as several surveys and numerous anecdotes show, waiting times in the U.S. are often as bad or worse as those in other industrialized nations -- despite the fact that the U.S. spends considerably more per capita on health care than any other country." A Commonwealth Fund study of six highly industrialized countries, the U.S., and five nations with national health systems, Britain, Germany, Australia, New Zealand, and Canada, found waiting times were worse in the U.S. than in all the other countries except Canada. ... Statistics Canada's latest figures show that median wait times for elective surgery in Canada is now three weeks -- that's less time than Aetna's chief medical officer says Americans typically wait after being diagnosed with cancer. Canada also has no waits for emergency surgeries. It also doesn't have 44 million people who are uninsured because everyone has a national healthcare card guaranteeing health care from any doctor or hospital they choose. And it doesn't burden those with insurance with rising deductibles or co-pays.

Michael Moore takes on Wolf Blitzer on CNN.

And more MIchael Moore with Wolf Blitzer: