On Demand
The "Sicko" Case for Single Payer
Friday, July 06, 2007
David Gratzer, senior fellow at the Manhattan Institute and author of The Cure: How Capitalism Can Save American Health Care, and Dr. Oliver Fein, chair of the New York Metro chapter of Phsyicians for a National Health Program, debate the pros and cons of a single payer health care system.
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I saw a rally organized by Moore and his p.r. machine. It was perhaps the clumsiest rally I've ever witnessed. A few dozen medical professionals turned out and some loudmouth woman at the podium led them in rounds of:
"WHAT DO WE WANT?"
"UNIVERSAL SINGLE PAYER HEALTH CARE!"
"WHEN DO WE WANT IT?"
"NOW!"
Don't get me wrong. I agree with the premise of health care for all. But I think the left knows nothing about getting a party started.
All they did was preach to the choir of nurses and doctors. After several hours of "rallying" not a single average citizen was any more enlightened about the health care debate. Nor did anyone have more tools or information with which to effect change.
I have a friend who has worked for 40 years whose biggest worry these days should be which bait to use while fishing. But he can't retire because he needs coverage for himself and his wife. He had a massive heart attack a few years ago and just had the pacemaker replaced.
Naturally there were complications.
That surgery would have bankrupted him.
So, he's working past his prime, reducing the effectiveness of his company, occupying a space that a younger worker should have only because he needs health coverage.
Alright, that's my rant.
I saw the film last night. Part of me wants to find a way to move to Canada, Europe or Cuba where the govennment takes care of its citizens. The other part wants to organize 100 screenings at churches and other community organizations because this message needs to be heard, particularly during the election season.
I haven't seen the film yet, but I lived in Canada for a year and saw its health-care system in action. On my last day in Canada, I cut myself badly and went to the emergency room. I hadn't memorized my Social Insurance Number, and didn't have my card with me, so I gave my name and address, and within minutes there was a doctor competently sewing up my hand. I walked out half an hour later, and nobody had mentioned money once.
By contrast, every time I've been to a U.S. emergency room, I've sat for hours waiting to be seen, I've gotten misdiagnoses or premature discharge, I've felt like one of a herd of cattle, and I've spent the next three months deciphering insurance statements to figure out which part of the thousands of dollars charged I'm liable for.
I believe strongly in the free market as a terrific way to produce groceries, movies, computers... but not health insurance. The free market depends on individual choice, and the more distinct choices people can make, the more efficiently it works. Insurance is the opposite: it depends on a vast majority of people who don't need insurance at the moment subsidizing the few who do, and accordingly it works most efficiently when everybody is in the same pool and there are NO choices. This is particularly true for things like health care and natural disasters that The Public will end up paying for anyway if a victim isn't insured.
If single-payer leads to governmental debt, I would prefer governmental debt from providing healthcare versus waging war.
While I'm an advocate of universal healthcare, I don't know how to respond to those against the idea who argue that such a system would cut back on the medical industry's (pharmaceuticals) profits and thus decrease the amount of research and development they conduct to keep the medical field advancing with new technology, etc.
Is this true? Where will the funding come from?
How does one argue against that point?
I was involved in strategic planning for both The Harvard Community Health Plan and Blue/Cross Blue Shield of Massachusetts. There were more people employed by BC/BS of Massachusetts than in the entire administration of the health plan in Canada.
We need to get rid of the insurance companies because it is deadweight overhead.
Anyone who doubts the profit motive for healthcare insurance companies need look no further than how much money their top managment is rolling in.
http://www.forbes.com/static/pvp2005/LIRRI3M.html
Something is wrong with the healthcare system when the third highest compensated CEO is an insurance provider.
Brian,
I was surprised by your dismissive capsule review of SICKO. "Insurance Companies are Evil" is an intentionally biased summary of the film. It's not about evil, it's about profit. For profit insurance companies exist ONLY to make money, therefore, they are required by their fiduciary responsibility to deny care as much as possible. It's not about the EVIL nature, it's about the need for profit conflicting with the need for providing health care.
Your other point about the film not addressing costs seems misdirected at best. At least 15% of all medical costs in the US are due to administrative overhead and insurance company profit. Since these costs do not contribute to providing healthcare, these are the easiest costs to control. In addition, the evidence is clear that HMOs and other insurance programs have NOT succeeded in controlling healthcare costs. Don't believe me, please take a look at Paul Krugman's recent columns on this. I'm sure you'll agree he's a credible analyst of the cost issue.
It seems like your personal distaste for Michael Moore (or at least his style of filmmaking) has gotten in the way of your normal smart and reasonable analysis.
Brian,
I worked for a law firm that represented insurance companies involved in the area of no-fault auto coverage which involved payment of medical expenses. There is certainly a great deal of fraud in the area of no-fault, however the system in all areas of health related insurance coverage sets up an unnatural adversarial relationship where doctors have incentive to prescribe excessive care in order to recover their own costs and make money and insurance companies have great incentive to deny coverage.
I can tell you from experience that insurance companies will continue to deny coverage even where it is clear that they will not win in court for the sole purpose of cash management. It is a broken system that serves no one well other than insurance companies who profit handsomely.
Robert
Manhattan
Healthcare should be a human right, and single payer is the most just way of delivery. Your panelist Dr. Grazer is obsfucating that by spinning numbers; which proves Mr. Moore's point.
Brian,
Why are you being SO disingenious? I am EXTREMELY disappointed in you. Yes there are a lot of things that are for profit which we don't write off as "evil" (an extremely simplistic and biased way to sum up the film by the way...)
However, do you really think that healthcare is any different than a life saving service like the fire department or something as essential as the police department? C'mon....be honest...do you really think it's acceptable that the care of the health for people be FOR PROFIT? For PROFIT?
There is something fundamentaly wrong with this concept and it's obvious that anything for profit will be measured by keeping profit down. It doesn't take a brain surgeon (pun intended) to figure that out.
You also are being disingenious about the argument you made about costs. Perhaps costs are going up everywhere but it's funny how you neglected to point out how much it is drasticaly cheaper in other countries (as shown in the movie...did you fall asleep at that part?????)
And why do we have a Canadian activist against their system...how about also a Canadian doctor for it? So much for a balanced discussion. Puh-leeease...
Privatization always leads to abuse and inequity because corporations are bottom line only about profit (and corporations structurally are NOT democratic egalitarian institutions). This is fine with many things but NOT life and death! This is a no brainer argument. Only country in the western world without universal coverage....and our system fares poorly against many others. Ridiculous. There is no argument. Morally, medical care should not be a for profit enterprise. It's not that the companies are "evil" (such a simplistic summary of the movie--I saw a LOT more in this movie, apparently much of it went over your head) it's just, is this an arrangement that makes sense? Is it a moral arrangement? Life or death....for PROFIT??? Come on.....
It's just more Moore bashing by NPR. We obviously didn't watch the same movie. I hope you do a better job next time Brian. Your bias is on your sleeve this time, I'm afraid.
Is this about saving a life? Or just extending it?
Only the very rich have the money to extend and extend without limit, depending on the generosity of relatives and heirs. Somewhere in any real-world system for the rest of us there will be a means for setting limits, that is, rationing of expensive care.
Who should do that? Privately run insurance companies, or governmental agencies? Either will protect and feed itself unless there is transparency and vigorous oversight.
Reduce costs for maintaining the un-rich elderly? Send us to Alaska with a ticket for an ice floe. The luckiest could take an i-pod along playing religious hymns.
It was interesting to learn how Britain's NHS came about in the ashes of WWII.
I wondered to myself: if the US had also suffered such great losses, we probably would also have adopted a policy of health care for all.
Then today Universal Health Care would be a moot issue. If we had grown up with this system of health care, can you imagine ANYONE advocating privatizing it (think Social Security)? I don't think so.
My beef is with our orientation toward big pharma and acute care - why don't we get educated about all the things we can do without any MDS - i.e. nutrition and exercise (I mean really become our own doctors and stop being cowed by the pure BS we are being fed about so many aspects of our health!!!)
We need to realize many problems are with the food chain AND why is my NP not authorized to track the REAL indicators of heart disease - why can't i have a test for c-reactive protein and homocysteine (the real indicators of my potential for heart disease) rather than being fed BS about cholesterol, which my physician friends (and others) tell me is not even an issue for me! No No No we are just too sold out to big pharma and we all have to go out of our way to get useful information.
No one is saying that universal coverage will cure everybody; but rather that everybody will have coverage.
I spend $1500 a month to insure my family. Companies are less willing to cover and prefer to employ independent contractor. This amount to more than our mortgage and impact our ability to save, adding massive pressure to our quality of life. We are healthy and rarely use this care, but are afraind to not carry adequet converage. Don't you think that our country could spend even a fraction of our tax dollars to ensure a baseline coverage for all American, considering we spend 10 times more on defense than any country on the planet.
I gather that every single medical system in the world features some kind of denial of care, if only through the existence of waiting lists that frequently outlive the patients. Perfect medical care -- where all reasonable procedures are available to everyone -- seems to be an impossibility.
If insurances companies are unsuited to deny care -- and I tend to agree they are -- who should have that right?
I saw Sicko a week ago ; I also thought it
was simplistic, but still an important film.
My two main issues:
1 -- can we ever have a cover-everyone healthcare system as long as insurance co. lobbyists have the politicians in their pocket? Don't we need campaign finance reform first?
2 -- what role did the cuban government play in getting such fantastic healthcare and treatment for the sick 9/11 workers?
Here is the email Michael sent out this morning containing a leaked internal memo from Blue Cross reacting to the Movie.
http://www.michaelmoore.com/sicko/news/article.php?id=9996
The issue is not whether care will be denied more or less frequently in any system...the discussion is more complicated and has to do with medical necessity determination - the reality is that any system needs to address medical necessity determination as a component of cost control. What's critical is that it NOT be used as a profit generating mechanism...
Tragic anecdotes on both sides simply polarize the debate. Clinical necessity determination, which is spun in the negative as "rationing" is in fact a reasonable and humane way to allocate finite resources equitably and cost effectively. That is how it's done under a single-payer system - and it delivers better outcomes for less money than private, for-profit systems - which means we can provide health care, rather than insurance, for everyone!
I'm sure there are thousands of arguments based on economics, politics and the capitalist system. However, I felt that Moore's point -- that Universal Healthcare is a moral issue -- is what struck me most about the movie. The saying "If you don't have your health, you don't have anything" is all too true. Doesn't every single person deserve every opportunity for a long and healthy life? Is there anyone who can argue with that logic?
The difference between Microsoft's profit and a medical insurance company's profit is that the later is made at the expense of peoples health, life or quality of life. We don't allow profit at human expense.
...and interestingly most of the comments here are against your summing up and yet you are not reading any like you often do....hmmmmmm...
Attack the messenger all you want, the message is still true. Our healthcare system is profit motivated, it should be renamed profitcare.
Brian,
Why dod you always sit on the fence - a true mugwamp. This is a terribly serious discussion and you seem to know very little about this issue and don't ask the very hard questions of the for profit health care industry.
My son just graduated from college so he is no longer under out umbrella and we have to pay $350. mo for his health care policy now.
Why don't you see that very intelligent countries DO manage to have FREE health care. I've lived in the UK and the health care is better than I pay for here.
The verbiage here is all propaganda - including what I'm hearing now from your capitalist doc on your show - hey,, he likes his $500,000 per year.
What about that? Try getting tough for a change and ask the hard questions of the doctors.
I think this film is crucial for every American to see. How is it possible that the personality of this country is to neglect the basic health care needs of the majority of its population? I feel manipulated by our government, I feel used and not properly taken care of. It was embarassing to see citizens from other countries getting treated with honest concern while our sick people who do not have health insurance get thrown onto the streets in Skid Row by city taxis. We have a diseased system that desperately needs to be fixed. It is frightening.
Watching the film, I did not feel that it was a n even-handed, research-buttressed attempt to suggest an alternative to the current health care system. Moore does great agitprop. However, I watched the film not really knowing what it was about ahead of time and I was OVERJOYED to see someone shining a light on our dysfunctional health care system. To me, I thought that everyone had forgotten about this issue, that it had been overshadowed by the Iraq debacle.
About the wait for procedures that's being bandied about: how many people here in the US delay or deny themselves treatment because they can't afford it? How many people are forcing themselves to go without because of the costs???
The point of Moore's brilliant movie is not really "health care" per se. It's about the fact that a country which insists on running EVERYTHING on the profit motive CANNOT take care of its people. That's a fundamental issue with our country and our culture. How can this be disputed? It is obscene for anyone to try to make a profit from healing sick and wounded people. Period.
Susan Brockman, Brooklyn
What benefits are brought to our healthcare system by insurance companies? What actual value do they add? Do they add positive elements to the equation that other solutions could not match?
I have health insurance and have thyroid problems. I have found that most of the best endocrinologists no longer accept insurance. It's $600-700 to see one of these doctors. My Obgyn has also removed her practice from insurance. It's $500 to go to her office. It seems that the top doctors are getting out of the system, and that the very best care is truly for the very rich, who can pay these elite doctors who do not accept insurance anymore.
I have not seen Sicko, but heard about it from family. I am retired, with MEDICARE AND Horizon Tradition Plan which costs me over $4000. annually. Medicare is primary, hence they pay only the difference after Medicare. I have had to threaten law suits for them to pay for orthodics for a foot deformity, which is routine payment for a diabetic. My doctor recommended acupuncture instead of chiropractic manipulation, after an injury. Medicare pays the former, not the latter, hence it was denied. While I was working and my employer paid the insurance, I had better coverage for less money.
I would rather have support for preventive care than just curative.
One needs only to look at the behavior of the insurance industry in wake of the Katrina disaster to get a glimpse of the “modus operandi “ of insurance companies. The healthcare insurance industry is merely a microcosm of that behavior.
For a market based system to work, you need consumer choice. The efficiencies people talk about are driven by the idea that sick people will go to another insurer if they don't like the one they have. The idea of consumer choice is a farce in healthcare. Doctors don't have time to keep up with the medical literature, how can a consumer? We just take whatever the docs prescribe or the insurer that our company offers.
I'm originally from Japan. Japan has a national health insurance as well as employment based health insurance,and even the poorest in the society can get necessary treatment whether the case is minor or major.
To give you an idea of price for the medical expense there;
if you stay in the hospital, it costs only $50 per night. Also, it is free to call 911 (119 in Japan),and ask for ambulance. I was shocked to know that the U.S ambulance costs money!
I'm 80 years old. I have
1 Medicare
@ Horizon Bluie Cross,B.S.
3 Empire (my wifes plan.(
4 Vetetrans medical and drug
Medical claims and payments have been a nightmare. Anyone that doesn't beleive that a
"socialized" system isn'tyhe way to go,has to
feeding from the government treasury.By the way i worked for a drug company for thirty years
Do you really think the American government could manage health care for over 300 million people? What other country in the world gives free health care to that many people? What does the American government manage correctly already for 300 million people? What about the hospitals and drug companies? How are you going to create a system that works with all the lobbyists that already have the government under its thumb?
You need to get special interest groups out of the picture. Then you could effectively regulate the private insurance and drug companies to benefit the people and not always the private companies that are ripping off the American public. And if you can get rid of special interest groups, I think you could solve most of America’s problems with health care and everything else that’s wrong with this country….
-Jon Pope
One question...
Does anyone think we could figure out universal health care with the 510 billion (yes half a trillion) we spent on this illegall war???
I saw Sicko this weekend. It infuriates me when people say "most Americans have insurance through their place of employment," as one of your guests is saying. I am self-employed and so is my husband. We buy what is essentially "catastrophic only" insurance, with a $5000 deductible, for $665 a month, for a family of four -- and we consider that a really good price after years and years of buying our own insurance. In addition to self-employed people, there are many, many people in America that work for small employers that do not provide health insurance because they cannot afford to. Do we want ALL Americans to work for big corporations? Is that what we want for this country>
Another point that infuriates me is the black-or-white view of a socialized medical system. Our public school system is a socialized system. In addition, we have charter schools (some of which are for profit, but are still public schools) and we have private schools. Why can't we have a health care system that's a combination of options and choices, similar to our SOCIALIZED public school system?
Brian,
I'm disappointed by the fact that you did not reveal the ideological position of the Manhattan Institute (and I am asuming by extension that of Dr. Gratzer) of deferring to free market forces to equalize and distribute resources/benefits in society. It is clear from the short bio where Dr. Fein stands, but identifying Dr. Gratzer as a fellow of the Manhattan Institute is disingenous, it implies some sort of "objectivity" to his observations. Dr. Gratzer is not offering unbiased, nor objective, critique of the American health care system. Be honest, both doctors have political perspectives that they bring to this discussion. Be honest and IDENTIFY them equally. jan
i wonder why western europeans live longer than people living in the USA?
I saw the film, and think it should be MANDATORY in every high school classroom. Why are we even debating this?? It's absurd that we have no national health care plan in the wealthiest country in the world. For those who think it can't work-why does it work in France, England, Canada and many many other countries?? I would GLADLY double my tax rate to be assured of health insurance coverage, paid sick leave, and the like.
The most important message is that we are FEARFUL of our Government. Our unneccessary standing army could pay for health care and then some.
joan
I've had a baby in Toronto; I've had a baby in New York City. Toronto was much better. In NYC I was kicked out after 1.5 days while in TO I was able to stay in hospital for five days to rest, get to know my baby, learn how to care for the baby and to make sure that we both were healed from the childbirth.
The wait time in Canada is not so terrible when you factor in that since ALL Canadians have health care, they are not as ill as Americans by the time they book their doc appts.
In single payer systems there is more concern about the greater good, which leads a more productive work force that is not traumatized by whether or not a catastrophic illness or accident will wipe them out financially.
Single payer would raise the quality of life for all Americans. Let's make it happen!
Lynda
Why don't we have more doctors trained in this country? Wouldn't that help? Why is it so HARD to get into medical school in this country? Is it simply standards are high? I don't think so. It is a way to keep the supply of doctors low, hence their fees high? Of course.
I have nothing against doctors earning a great living. They should after all that training. But why is there such a shortage of doctors and nurses in this country? Could you address that?
Thanks
James Ryan
New York
212-374-9440
i would be interested to hear what "health-care" providers have to say about this issue. many people who offer their opionions have little-to-no knowledge of what it is actually like in the hospital and extended care settings. BTW-- the vast percentage of health care spending is spent on the last 5 years of a persons life.
Maybe I've gotten cynical but, perhaps this war was fought partially to "starve the beast" or ruin the Federal Gov't to such a degree that any expansion of social programs will be either impossible to institute or short-lived.
Please have your guests comment on studies which show that there is a direct relationship, in countriers where there is a single payer system, between the length of wait times and the percentage tax rate for the health system per person. It appears that you get what you are willing to pay for, which is not the case in the US. Canadians pay one of the lowest and French one of the higher.
Good morning Brian,
Yesterday, I saw the film. It's appalling what has been happening to Americans trying to get the best possible health care. The health care insurance industry in our nation has no shame. Every member in both houses of Congress needs to see Mr. Moore's film, especially President Bush, VP Cheney and the entire White House administration.
"Georgia", above, wrote: "The difference between Microsoft's profit and a medical insurance company's profit is that the later is made at the expense of people's health, life, or quality of life. We don't allow profit at human expense." HOW VERY TRUE! We don't deny someone a (public school) education because it's not profitable enough; similarly, we shouldn't deny someone health care because it doesn't make a profit!
Also, with regard to what was said about "experimental" procedures, you can't go back in time and use 20/20 vision to say, "see, that procedure proved to be ineffective so it's a good thing that insurance companies were suspicious of it." That's absurd! What about all the "experimental" procedures that proved valuable??? In addition, without these "experimental" procedures allowed, we wouldn't find out which ones worked and which ones didn't.
I saw the movie Sicko. Now that I have seen the positive side of European health care I would like to see what the negative side is. The medical care in the USA is controlled by capitalism which is another term for corporate greed. Medical care like a military force, firefighter services, police officer or law enforcement services, and sanitation services should not be privatized or run on a for profit basis. These are services a country should freely and automatically provide to its’ citizens without question. Just like our democracy should not be controlled by capitalistic influences our medical care should be free from this capitalistic goal of profit. The profit of a company should not be involved in the decision to treat or save the life of a citizen. A country has an obligation to care for the safety and well being of its' citizens. This country has failed in this regard and is getting worse. This democracy of ours both at the Federal and Local level has been taken over by corporate lobbyists who have the ability (with their cash cows) to get our elected officials to respond to their corporate capitalistic needs over and above the democratically expressed needs of the people. What a shame our democracy is failing so bad. Take the money out of politics and health care and we will have a better democracy that represents and treats the needs of its’ citizens.
Why did Laura (#30) not go to a doctor who DID accept her insurance? Does she think that under national health care she would have choice of specialists? Would everybody be able to see the "best" doctors? All three-hundred million?
Jan wrote:
>I'm disappointed by the fact that you did not reveal the ideological position of the Manhattan Institute (and I am asuming by extension that of Dr. Gratzer) of deferring to free market forces to equalize and distribute resources/benefits in society.
Jan, that's an important point. Let me put it another way.
The Manhattan Institute doesn't reveal its sources of financial support. But occasionally it's slipped out. Unsuprisingly, they're funded by corporations like Bristol Myers-Squibb (which makes drugs) and General Electric (which makes CAT scans).
David Gratzer is getting paid by the same companies that will benefit from his policy recommendations. GE would make a lot of money if Canadians could get CAT scans on the free market, as he advocates.
We, as citizens and WNYC listeners, should know that so we can discount for his financial stake in the debate. Dr. Gratzer never publishes in medical journals. Medical journals require authors to disclose financial conflicts of interest. Newspapers usually identify such conflicts of interest. I think WNYC should also identify such conflicts of interest. It's WNYC's duty to its listeners.
Right, Brian?
Brian,
On this debate about our health care system, we can analyze and over analyze this, but the first fact is that with the money we have squandered in our misguided (and irresponsibe - i will refrain here to call it something else much more serious) neo-conservative adventure in Iraq, we could have resolved many of our aflicting social problems, including health care. In any case, with respect to having a fair and more efficient health care system (founded in desirable principles of equality), why not follow the best proven system that exists in the world? If that system is the French, why shouldn't we focus on understanding how that system works and implement a similar comprehensive program? Why do we have to persist putting band-aids in our current system, if we know that is full of flaws, inefficient, ineffective, and unequal? Why don't we spend our energy and resources instead on implementing a model (let's say, the French model) that we know works desirably? Let's not be defrayed by the vested interests of the institutions that benefit from our existing system. The best system should be designed to benefit the people (it's our collective right), not the economic interests of institutions. With respect to the costs that a single-payer system, such as the French system, would require, we can fund such costs with specific taxes to be paid progressive by those with higher income in the population.
Thanks,
Two comments:
First, the statement was made that our problem is not with the people who have insurance, mostly through their employers. What happens when employment is terminated? If a person witha medical condition does not find another job with benefits, he or she will never be able to buy coverage in the commercial market.
What happens when he finds a job? Can he be refused coverage for a pre-existing condition in the new group policy?
Have you looked at the cost of COBRA? My daughter considered it when she took a job with no medical coverage, having recently been covered under my policy. For a young single woman (under 30) with no medical problems, COBRA would have cost $3000 per year.
Second, regarding the French health care system --
I lived in France 25 years ago, and was employed by a French organization. I was covered under the French Social Security system. But as I recall, this coverage is not available to everyone. I think that once you become unemployed, your coverage lapses after two years on unemployment. Maybe this has changed in the intervening years.
Brian said that the basic point of Sicko was, "Insurance companies are evil."
I disagree. I think the basic point was:
"Other countries have health care systems with outcomes that are equal to ours or better, and cost half as much or less."
"Even Cuba."
This point is supported by hundreds of studies in major peer-reviewed medical journals. I liked Sicko because I could see that Michael Moore was dramatizing those studies.
David Gratzer claimed that people get better care in the U.S. than Canada, that cancer patients survive longer in the U.S. than Canada, but according to the medical journals, that just isn't true.
Bertrand Russell said, "When all else fails, look at the data." Here are 3 major studies:
1. Open Medicine, Vol 1, No 1 (2007)
Research: A systematic review of studies comparing health outcomes in Canada and the United States
Gordon H. Guyatt, et al.
http://www.openmedicine.ca/article/view/8/1
"Health outcomes may be superior in patients cared for in Canada versus the United States, but differences are not consistent." In 2004, per-capita spending for health care in the U.S. was more than double that in Canada: in the U.S., it totaled US$6,096; in Canada, US$3,038.
2. Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care, The Commonwealth Fund, May 2007
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=482678
Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives.
3. Health Affairs, 23, no. 3 (2004): 89-99
Quality: How Does The Quality Of Care Compare In Five Countries?
http://content.healthaffairs.org/cgi/content/full/23/3/89
Australia, Canada, New Zealand, England, and the United States, studying five-year cancer relative survival rates, thirty-day case-fatality rates after acute myocardial infarction and stroke, breast cancer screening rates, and asthma mortality rates. "No country scores consistently the best or worst overall. Each country has at least one area of care where it could learn from international experiences and one area where its experiences
could teach others."
This Health Affairs article in particular shows how Gratzer is cherry-picking his data when he says that cancer patients survive longer in the U.S. They survive longer for some cancers (such as breast cancer), but not for others (such as leukemia), but the difference is so small that it isn't clinically significant.
I could give more studies but my train is coming.
The devil is in the details. Don't just look backward, but look forward at what may be coming up in the future.
I read the memo from a Blue Cross person on Moore's site (link provided by a listener above). On the second page, it the writer makes reference to the "true" cause of a rise in costs in health care, and blames it on the usual suspects (obesity, lack of fitness, etc.). Never on the fact that we are not promptly dying at 65, that we are not dying of childhood diseases (or any other contagious disease that wiped out large numbers of folks in earlier generation). Never on the fact that many medications, today, are actually effective (unlike many medications in the past which -- if you were lucky -- might be a palliative but often did not work).
So... The guy's slip is showing. Denials for "lifestyle" or "moral" issues (obesity, primarily) may very well become routine relatively soon due to the moral panic we are all in about our collective avoidupois.
Is it all supported by the facts? Well, here's a website where you can find (amongst other health news) the lowdown on all these studies purporting to show the link between obesity and ill health(the good ones, the bad ones, and the ugly ones), as well as their unintended consequences (rise in anorexia amongst teenagers).
The short story -- the hype against obesity is not really supported by evidence. The real story is in movement and keeping fit and healthy at every size. Note that this is not especially newsworthy since it won't sell a diet plan, and it won't get you to buy a health club membership. Warning -- in some of the articles referenced, the math can get a little heavy. Also, many of the links are to websites that express political/environmental/health opinions with which you may disagree.
http://www.junkfoodscience.blogspot.com/
You don't need to believe everything you see there (the website's message is to read about the topic, become informed, and make your own informed decisions), but it gives a lot of food for thought.
Pay special attention to articles on developments in countries with national health care plans. It's not all roses out there folks. As part of becoming informed participants in this discussion, we need to look at all aspects of the situation. It's no use throwing out babies with bathwater.
--AA--
Several issues that were not acknowledged by Dr. Grayzer (the doctor from the conservative think tank)...these issues undermine his argument for the for-profit health insurance system.
1. Employer-sponsored insurance is eroding. Even big business wants to be relieved of the burden of paying for their employees insurance. Business argues that the cost of paying for health insurance for their employees makes them less competitive. The trend is for fewer full-time positions to include health benefits.
2. More and more people are spending all or parts of their working lives as contract workers, not employees. Even if a company offers a health insurance plan, the many freelance workers they use will not have access.
3. Insurance plans available to self-employed contract workers are much more expensive, and DO deny coverage to people with a whole list of chronic or pre-existing conditions.
4. The struggle that self-employed people go through in regard to health insurance coverage strongly discourages entrepreneurial initiatives.
I have worked as a freelancer for most of my adult life. Anyone who has will tell you the same thing: we end up with access to expensive, poor-quality health insurance plans, with years-long stretches when I was uninsured. I'm currently on the Healthy New York HMO plan, which does not cover dental care at all, BTW.
It's been proven that one can combine socialized systems with for-profit enterprises. The US school system is an example. It combines regular public schools, public charter schools (many of which are private, for-profit enterprises), and private schools (some of which are for-profit and others of which are "non-profit"). Having myself attended both a regular public school and a private school, and having sent my two children to both regular public schools and charter schools, I think I speak from experience when I say that THIS WORKS WELL. Why can't we do something similar in the US with health care? I WOULD LOVE TO HEAR OTHER PEOPLE'S THOUGHTS REGARDING THIS.
One caller addressed the concerns of insurance companies footing the bill for experimental procedures (but then again, how can you fully determine such things if you don't have enough test cases?!)...I believe brian countered with the question of whether the government should subsidize this.
If you think of healthcare as you would any other tax-based government maintenance, this is a NO BRAINER. The health of a nation as a whole is not unlike a funtioning interstate, and should be kept in good shape.
Also? All procedures were once "experimental."
Oh, and please don't get me started on freelance health insurance. Just don't.
For people interested in learning more about Physicians for a National Health Program, NY Metro Chapter as well as about the pending Congressional bill (H.R.676) that would provide all U.S. residents with health care services and remove the private health insurance companies from our system of health care you can go to: http://www.pnhp.org/pnhp-ny/
You can read about HR 676, read fact sheets addressing many of the questions people have about a single-payer health care system and find resources about various studies and reports on the issue.
Brian, Brian, Brian,
Once again I'm sorry I pledged money to
WNYC only to listen to the same lame seesaw debating style you get on the NEWS HOUR, and hear the same soft ball questions from Brian. WNYC is a PUBLIC
station, and I'm sure most of the listeners who actually support it with money, would like to hear a real debate about how to solve the problems in the Health Care System. I wonder if Brian would be happy at a for-profit station.
Thank you, Leigh, for discussing the situation with regards to medical insurance for freelance workers! As an example, I thought I was developing carpal tunnel. Since I was employed at a big corporation at the time and had good coverage, I went to the doctor to get it checked out. He said it was NOT carpal tunnel and also NOT anything serious (heart-related or anything like that). He said, most likely, that I had a minor nerve pinched in the elbow or shoulder that will come un-pinched by itself. Years later, when I was self-employed, I applied for individual health insurance and, after a lengthy application process, was told that anything related to that arm would not be covered. Now, it's bad enough that if it had been carpal tunnel, they would've excluded that condition, but... come on, this is ridiculous!!!
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