30 March 2007

Call to action

First they came for the Jews
and I did not speak out
because I was not a Jew.
Then they came for the Communists
and I did not speak out
because I was not a Communist.
Then they came for the trade unionists
and I did not speak out
because I was not a trade unionist.
Then they came for me
and there was no one left
to speak out for me.
Pastor Martin Niemöller

208 Commission hears about single-payer

Colorado's 208 Commission, which like so many other state commissions is looking into healthcare reform, held its first batch of public hearings earlier this month. In Denver they heard "among the suggestions" about single-payer.

In fact, from what I've heard about the five statewide sessions, the commissioners heard overwhelmingly about single-payer — both from members of organizations and from private individuals. A lot of providers testified.

According to a post-election poll, it's Colorado's providers who are most aware of the crisis that healthcare is now in, most critical of the current system. Most people are OK, but with the ominous sense that they're not really safe, that their personal situation could go bad too easily. For now though, for most, the really bad things are happening to other people.

Don't wait until it's your child or brother or cousin or friend who has inadequate insurance or is uninsured. Don't wait.

It's time for Americans to change our idiotic system. Time for commissioners and citizens alike to go ahead and take a stand for common sense and the golden rule.

24 March 2007

Elizabeth Edwards on loss

Nice piece on Smirking Chimp about Elizabeth Edwards. Here's the key graph for me:

Not long ago I watched an event on Cspan where Elizabeth Edwards discussed her book, "Saving Graces." Elizabeth gave a detailed account of her recovery from grieving the death of her teenage son, Wade. She shed no tears, but the depth of her pain was palpable. She paid minor attention to despair and major attention to healing. Not as a preacher. Or authority. But as a vessel of resolve and understanding. She freed the audience from fear of discussing her child by explaining how his essence is honored whenever they mention his name. She explained that avoiding discussing him was like erasing him and that he should never be erased. A simple lesson, but profound.

I feel that way about Paul, obviously. Sometimes I cry when I talk about him, but tears don't hurt as much as erasure.

Bicyclettes à Paris

Great places don't happen by accident. Paris has had zoning for 600 years. They've got a fabulous metro system. And this year they're putting in 20,000+ bikes at 1,450 stations.

Evidently Lyon has been doing this for a couple years, and it works great. Makes a lot more sense than what my hearttown of Portland, Oregon, tried to do with bikes — just putting out hundreds of yellow ones that kids wrecked and homeless folks commandeered and a few weeks later, voila! No more bikes! Now consider France:
"It has completely transformed the landscape of Lyon -- everywhere you see people on the bikes," said Jean-Louis Touraine, the city's deputy mayor....

The Socialist mayor of Paris, Bertrand Delano, has the same aim, said his aide, Jean-Luc Dumesnil: "We think it could change Paris's image -- make it quieter, less polluted, with a nicer atmosphere, a better way of life."

But there is a practical side, too, Dumesnil said. A recent study analyzed different trips in the city "with a car, bike, taxi and walking, and the bikes were always the fastest."

The Lyon rental bikes, with their distinctive silver frame, red rear-wheel guard, handlebar basket and bell, can also be among the cheapest ways to travel, because the first half-hour is free, and most trips are shorter than that.

"It's faster than the bus or metro, it's good exercise, and it's almost free," said Vianney Paquet, 19, who is studying law in Lyon. Paquet said that he uses the rental bikes four or five times a day and pays 10 euros (about $13) a year, half for an annual membership fee and half for rental credit that he never actually spends because his rides typically last just a few minutes.
Hold the presses. Damn. This turns out to be a no go.

Did you see that? Paris' mayor is a socialist? Forget about it then.

23 March 2007

Gore for single-payer

Al Gore is right about global warming. He's a smart man. He's right about healthcare too:

"I think we've reached a point where the entire health care system is in impending crisis," Gore said. "I have reluctantly come to the conclusion that we should begin drafting a single-payer national health insurance plan."

Health care anecdotes and statistics

Someone named Megan McArdle has a post on why I shouldn't fuss about my brother's death, that "in any system, there will be people who are failed by that system."

She doesn't like
"argument through anecdote", where the data plays a distant second fiddle to the heartrending stories about x person who didn't get good treatment. So single-payer advocates drag out some American woman who didn't get a breast exam until it was too late, and opponents counter with the Canadian guy who died on the waiting list to see an oncologist.
This is infuriating. First of all, 90 plus percent of what I've read since becoming involved in this issue are articles chock full of incredibly boring data — as in Health Affairs. Personal anecdote doesn't convince me. I'm enough of a wonk that data convince me. Not anecdote. Although at a certain level, anecdote becomes data. For the most part, though, the books and articles on single-payer may use an anecdote as a classic WSJ lede style, where the writer "hooks" a reader with a real life example of why this issue is important in human terms. But if that anecdote is not then followed up by facts and analysis it's nothing.

From what I've seen, single-payer advocates do a great job of follow-up with facts and analysis. Single-payer enemies don't. They ignore huge, basic chunks of information, and they explain away any statistic that doesn't go their way. Longer life expectancies in countries that spend half as much on healthcare as we do? Pish posh. Means nothing — because, see, we have more car accidents, or more poor people, or we're fatter.

The fact that a single-payer healthcare system would help save people with all three of those conditions is conveniently ignored.

Ezra Klein has comments on this woman's debate with Jonathan Chait of the New Republic. Chait, by the way, is hardly a single-payer advocate.

Ezra points out another tactic that pro-profit/market people like this woman use: ignorance and/or lies. She suggested that waiting lines are longer on the continent than in the U.S. Which is just not true. Nothing anecdotal about the statistics on this. So is it ignorance or lying? Ezra writes:
She then suggests that moving to a French or Canadian system would require walking back the medicine we actually provide, telling people they can't have MRIs anymore. That's similarly incorrect. Care utilization in France and Germany is as high — and in France, higher — than it is in America. But they pay less per unit of care. And the technology isn't radically different. Germany actually has more CT scanners per million than we do, while the French have three less. The French and the Germans both have more physicians per capita and more acute care beds. Oh, and the French and Germans pay less, and don't have 47 million uninsured.

All this information — and more! — can be found in various data-heavy books on the subject, like Thomas Bodenheimer and Kevin Grumbach's wonderful Understanding Health Policy. The thing is, they tend to point towards the same conclusions Jon Cohn's book does, albeit with fewer anecdotes. One reason I spend less time arguing health care with libertarians these days is that it doesn't seem productive. If you really don't want to believe that other system's in the world are better, you won't.
One of the comments for Ezra's post is so funny and right on that I want to share it:
The conservative argument goes like this:

We can't have national health care because in countries that do, they have to wait 40 years for a hip transplant!

Liberal: No, as you can see, from the statistics here, not only are there not significant wait times, but wait times for those surgeries in America are larger.

Conservative: But what about the fact that in socialist countries there is only 1 MRI in the entire country, located in the basement belonging to the Prime Minister's mistress, requiring a 500 mile commute that grandmothers with cancer have died waiting to get access to? That's why we should never have national health care in America!

Liberal: No, actually, in many countries with national health care systems, the number of available MRIs per capita is equal or close to the number available in the United states.

Conservative: Oh yeah? Well look, Stalin was a socialist, and that resulted in the gulags and the deaths of millions? Is that what you want?

At the point, the average liberal will realize that no amount of facts marshaled in the defense of national health insurance is going to convince the conservative/anarcho-capitalist of the wisdom of the program and that the entire discussion is going to revolve around the conservative throwing out fallacious claims and the liberal correcting them with actual facts.
That's from Dean Christakos.

21 March 2007

Hospital CEO sees single-payer solution

The Indianapolis Business Journal interviews Robert Brody, the CEO and president of St. Francis Hospital and Health Centers in their March 20 edition. Brody won't actually come out and say that single-payer is the only solution, but he comes damn close.
IBJ: Why do you think it’s wrong to build a for-profit hospital?

BRODY: One of our principal failings, I think, is the emergence of the for-profit hospital and what it does to the existing network of not-for-profit hospitals. In my mind, there is an obligation that we have to provide for the poor and the underserved in our communities. What we are seeing is that this entrepreneurial spirit is undermining the traditional not-for-profit hospital’s ability to serve as the safety net in their community. It erodes our ability to generate the [profit] margin necessary to continue operations in [unprofitable] services. So you find hospitals cutting back....

IBJ: With all these problems, you’ve said in the past that we’re headed for a single-payer health care system, where tax dollars, funneled through the federal government, pay for everyone’s health care.

BRODY: I don’t know that I’ve ever subscribed to a single-payer approach. I think universal health care is something that we need and desperately. How we get there remains to be seen.

IBJ: Actually, during a panel discussion in September 2005, you said, “We have so many vested interests at stake here trying to protect the status quo that the inevitable answer, the ultimate answer, is a single-payer system that takes care of everybody and lets the providers compete for that business as necessary. It works in other countries around the world. It can work here.”

BRODY: Ultimately, I think we’ll end up like the education system. We’ll provide health care services for the entire population. And my guess is, given the nature of our society, we’ll allow for a two-tier system to evolve, where those with means or interest [are] accessing a different model than that available to the mainstream public. It’s a little bit different than the single-payer system. The single-payer is something like the post office [with] no UPS.

IBJ: Do you think that’s the best solution?

BRODY: I don’t know what the best solution is. I’m only one person. I think that there has to be a better solution than we have today. We’re one of two developed nations in the world without universal coverage. That’s a travesty. In effect, we offer health care services for everyone, but they have to access it through the emergency room or some other means. And everyone is paying for it through this cost shift that occurs.

Big bucks to keep us in the dark

Pennsylvania is in the same position as California, with a governor pushing so-called universal healthcare that enshrines junk insurance, while a good single-payer bill languishes in the state legislature.

The Philadelphia Inquirer ran an op-ed by an English prof yesterday laying the story out.

I'm just a lowly English B.A., but to me her first paragraph could have used a wee touch of editing:
It is no secret that health care in this country needs a fix. About 47 million people don't have any health insurance, including more than a third of families with incomes of $40,900 or more.
I think what she means is that a third of the uninsured have household incomes of $40,900 or more, which is rather different than what this reads.

I like the way she describes why the private insurance model doesn't work. She writes: "Administrative expenses, created largely by the many layers of the health-insurance system, and insurance-company profits take one out of every five health-care dollars."

Although there again there's a misplaced comma. Picky, picky, picky. This is better:
We in the United States are unfamiliar with the single-payer option because tremendous amounts of money are spent by the medical-insurance and pharmaceutical industries to keep us in the dark. They would lose big bucks if we chose to go this route...

The corporate opposition to single payer exaggerates flaws that some systems have, or had, ignoring the fact that our health care is rationed by income. If you are poor, you may well get inferior health care all of your life. We could learn from problems elsewhere and thus develop the best truly universal health-care system of all.
That's exactly right.

20 March 2007

Be safe, Josh

Uninsured just as misguided

This USA Today story on the uninsured does a good job of illustrating some of the wrong-headed notions we Americans have about healthcare, and paying for it.

The reporter focused on middle-class people who aren't stereotypes of the uninsured.

She didn't do a good job of describing possible solutions. You have to go all the way down — way down — into the comments to find mention of the only way most other industrialized nations have discovered works to cover their citizens with quality affordable care. Single-payer.

Her depiction of people's attitudes towards the question of whether they agree philosophically with "we're in this together" or "you're on your own" was great, though.

Take her interview subject Diane Stewart, a 57-year-old woman who "says she made a six-figure income" working as a marketing person for a Charlotte television station. Stewart quit that job in 2000, worked for a smaller firm for a couple years, then quit that job and lived off her savings while she unsuccessfully looked for another job — and insurance.

"For a while I had a policy and was paying $400 a month," says Stewart, who is relatively healthy but takes a thyroid medication and drugs for blood pressure and cholesterol. "I paid them more than they paid back in benefits."

Now I agree that $400 a month is high — and it's high because it was rated in a for-profit, cherry-picking, falling-apart system for a woman her age — but in order to make ANY system work, we all have to most of the time pay a bit more than we receive in benefits.

In a single-payer system — or a multi-payer system like France's or even a healthy private insurance system like the U.S. had back in the 1950s and '60s — you pay more than your typical monthly health expenditure because you understand that one day you'll be the sick one needing extra care. And in the meantime, your extra dollars go to help take care of the little hemophiliac kid down the street, or the klutzy woman who slipped on the ice and broke her ankle, or that grampa who had a heart attack. We're in this together. One day, it will be you needing the help.

Stewart, however, that former 6-figure lady who didn't believe in paying out more than she was getting back during a healthy time:
is studying for a health and life insurance broker license. She takes the test next week and hopes to start selling health insurance to small businesses...

For medical care, her lifeline has been the support of two services in town. One is called Physicians Reach Out, a group of physicians who offer low-cost health care to low-income residents. The other is MedAssist, a free pharmacy for uninsured and low-income residents of Mecklenburg County, N.C.

Without them, she says she would have had to file for bankruptcy. "I had to have surgery to remove my parathyroid gland three months ago," Stewart says. "We tried to treat it with medication, but it got worse."

Although the hospital tab easily topped $7,000, Stewart says the payments were waived through the program, and she had only small doctors' bills to pay. Every few months they check her income to make sure she still qualifies.

"I thank them from the bottom of my heart," she says. "Because of my medication, hopefully I will live to be 80 at least."

She plans to buy health insurance as soon as her earnings as an insurance broker allow, and no, she doesn't expect to get a break on the cost because she's a broker.

"I'll have to pay the same as everyone else," Stewart says. "Health and life insurance is not something everyone wants to buy, but it's something you have to buy."
I hear now and then that single-payer healthcare supporters really just want something for nothing, and think that they won't be paying for their healthcare "because the government is going to pay for it."

What nonsense.

This woman's attitude is the closest I've seen on that continuum.

It's the private insurance folks — like Stewart — who think they're going to outsmart the system and get something for nothing. The same USA Today article ends with an even more explicit example.

The reporter notes that some of the uninsured, in particular those who are young and healthy, "tend to see health insurance as an expense with little payback, rather than a hedge against financial disaster. So they don't buy it."
Kevin Wurtzbacher, 31, has been diabetic since 14, taking insulin shots. That makes the Valley Grove, W.Va., man an unlikely candidate for private insurance, and his job as a concrete worker is seasonal and doesn't come with health insurance. His wife, Julie, works as a waitress, and the restaurant does not offer health coverage.

Together, the couple make about $39,000. He now relies on a free clinic.

The couple's income qualifies them for low-cost care from Wheeling Health Right, in Wheeling, W.Va., which is funded by state, city and county governments, grants from foundations and donations. It is a popular spot and even draws patients from across the river in Ohio.

Their 4-year-old daughter is covered by a state program. Wurtzbacher's insulin and supplies cost him only $2 a prescription through the clinic. He's appreciative of the program, which also provides him with eyeglasses.

One of his co-workers, a man in his 20s, buys insurance on the private market, a move Wurtzbacher says doesn't make much sense.

"There's nothing wrong with him, and he's paying for health insurance," Wurtzbacher says.
With a single-payer system, every young person working on the books would have a percentage — an affordable, reasonable percentage — of their paycheck taken out for a national health insurance program. Wurtzbacher's attitude would be seen as needing some educating, and his co-worker would be paying less and getting more.

19 March 2007

A doctor explains why

This was at Glorfindel of Gondolin: Medical Archives, written by a young doctor who seems to have a lot of debt from school and a good sense of humor. Here's part of a post he wrote about HSAs, from a couple years ago:
I've decided that as a healthy young person, I resent the elderly and the sick. They're the reason health insurance costs so much! If those people with diabetes, cancer, and other chronic diseases would take responsibility for their own health, instead of relying on the same insurance that I have to pay their medical bills, I wouldn't have to pay so much for my health insurance! Their presence in the same insurance risk pool as me is unfair.

In fact, I'm fed up with the whole concept of health insurance. It's really just a cross-subsidization of the sick by the healthy, and in America we shouldn't have to tolerate these collectivist wealth-transfers. So I'm gonna get myself an HSA!

They're a great way for people like me to stop subsidizing the old and the sick with my hard-earned money. If I go out and buy some health insurance with a really high deductible--more than $1000--then I can go to the bank and open an HSA. I can contribute $2600 or the amount of my deductible, whichever is less, every year to my HSA tax-free! The money rolls over each year, and I can withdraw it to pay for medical bills without any tax liability. That way, if I ever sprain my ankle playing Ultimate Frisbee, I can use the money in my HSA to pay the bills. But the best part is, I won't be in the same insurance risk pool with all those costly old and sick people anymore! They're not going to go for a plan with such a high deductible--it would cost them way too much, seeing as how they're always going to see their doctors for med refills and chronic pain.

Now, I know that when I drop my regular insurance plan and get an HSA instead, I'll be driving up the price of the old plan. But I don't really care. This is America, and if the old and the sick can't afford their insurance premiums, that shouldn't have anything to do with me.

Reform at the state level

Becoming more involved in Health Care for All Colorado has been a real education in the actual doing of citizen activism, rather than just the writing about it. Big difference.

I'd seen some of this with environmental and women's issues — and at the newspaper as well in a way, now that I think about it. Questions of how closely to ally your group with others, who have different priorities and strategies but the same values. Questions of strategy. Questions of personality and prioritizing.

Health Care for All Colorado's board decided last year to focus on Colorado's 208 Commission and to submit a single-payer proposal to them for consideration.

I agree with the decision, but it's one that members seem to frequently come back around to.

Can single-payer healthcare reform really take place at a state level? It did in Canada — so why not here?

There are a few good answers about why not. The best one seems to me to be because the insurance industry isn't going to let it happen — period. They're 5 percent of the U.S. economy, and they're too powerful to let anyone say they can't skim their shocking profits off an industry that they make inefficient by their very setup.

It's kind of like living in Sicily and wondering why the hell we can't get rid of the Cosa Nostra.

The insurance industry may be able to focus its amazing firepower on us more easily state by state, but it's so powerful that it can do the same at the national level — as it demonstrated in 1994 with the Clinton plan.

The statewide initiatives, however, allow more people to become educated about single-payer, get more people involved at a local level, and allow more people to become truly invested. That makes us more powerful, not less.

An equally powerful argument against trying to get a single-payer proposal passed in Colorado is TABOR. Then again, Oregon has a God-awful super-majority requirement for getting new taxes passed. So it's not just Colorado where the "drown-government-in-a-bathtub" forces have been able tilt the playing field in their direction. And then again, Colorado isn't Oregon. Liberal Denver can't hold a candle to Progressive Portland — which Bush I called "Little Beirut."

I'd be curious to know what the national organizations say about it. Does PNHP think we're wasting our time? There is only so much time and energy, after all. Should all the state organizations give it up, and just write letters to the editors and their representatives, calling for passage of John Conyers' and Dennis Kucinich's bill?

18 March 2007

A bad deal

Unaffordable & unavailable

This cartoon by Jonathan Richards is from 2005, but it's even truer today than then.

Now for something completely different

Is this real? Watch about 1 minute 10 seconds into this, at the parallel parking sequence.

17 March 2007

Celebs for single-payer

Ed Asner has always been one of the good guys. It figures that he'd be for single-payer.

Americans retire early for health reasons

Nearly a fourth of workers retire early because of health issues, according to a survey released by Fidelity Investments earlier this week.

The Boston Globe ran this as a story about whether people were saving enough for retirement (no, says Fidelity). I'd say it says at least as much about U.S. healthcare.

Canada has better numbers:

"The Fidelity Canadian Retirement Survey also surveyed Canadians over 45
years old who consider themselves retired. The survey found that the majority
(80%) of retirees stopped working before they turned 65 years old. Only 13 per
cent retired at 65 with the remainder (seven per cent) continuing working past
65 years. The main reasons stated for retiring are health or medical reasons
(21%), tired of working (14%) and they were offered a retirement package (6%)."

Fewer employers offer insurance

Only about 46 percent of working families earning moderate salaries now can get health insurance through their employers. That's down 9 percent from a decade ago. Meanwhile, those earning $80,000 a year hold steady with 78 percent of them getting insurance through their employer.

That news comes from the Robert Wood Johnson Foundation, in a report coinciding with Bush's threat to defund SCHIP — the State Children's Health Insurance Program.

Here in Colorado, that's 14.3 percent of the state's children uninsured. More than 70 percent of them live in families at or below 200 percent of poverty ($40,000 annually) and more than 75 percent of them live in households where at least one adult is employed full time. The fact that Colorado's numbers are among the worst rather than among the best is especially disgraceful considering that this state is in the top ten per capita in earnings.

Elsewhere in the report:

• Nearly 9 million children in the United States are uninsured - that's an average of 11.5 percent, or about one in every eight kids.
• States with the highest percentage of uninsured children include Texas (20.3 percent), Florida (16.9 percent), New Mexico (16.6 percent), Nevada (16.4 percent) and Montana (16.2 percent).
• States with the lowest percentage of uninsured children are Vermont (5.6 percent), New Hampshire (6.0 percent), Michigan (6.1 percent), Hawaii (6.2 percent), Minnesota (6.5 percent) and Nebraska (6.5 percent).
• For uninsured children in families that earn modest incomes, the situation is even more dire. The analysis shows nearly two out of three uninsured kids in the United States (64 percent) live with adults who earn modest incomes, calculated at roughly $40,000 or less for a family of four.
• States with the highest percentage of uninsured children who are in families with modest incomes are: the District of Columbia (73.9 percent), Mississippi (73.7 percent), Kentucky (73.4 percent), Arizona (72.3 percent) and North Dakota (71.5 percent).
• States with the lowest percentage of uninsured children who are in families with modest incomes are: Vermont (36.2 percent), New Hampshire (41.3 percent), Hawaii (42.5 percent), Wyoming (46.2 percent) and Massachusetts (48.0 percent).
• Last fiscal year, more than 6 million children in the United States were enrolled in SCHIP.

16 March 2007

Connecticut single-payer to get hearing

Wouldn't it be something if single-payer in the U.S. began in Connecticut?

Connecticut’s Insurance Committee of the Connecticut General Assembly voted earlier this week in unexpected support of a bill modeled on research done by the Connecticut Universal Health Care Foundation.

The bill, SB 1371, the “Connecticut Saves Health Program,” insures Connecticut residents through a single insurer serving as a statewide claims administrator.

Eleven committee members voted in favor of putting this single payer option on the table for ongoing consideration, while six legislators sought to kill the proposal in committee.

Here's Connecticut Universal Health Care Foundation's description of the plan:
S.B. 1371 would insure all residents of Connecticut through a single, statewide health plan covering comprehensive health services typical of private employers in New England. A single insurer would serve as statewide claims administrator, in the same way that regional insurers administer claims for the Medicare program today. Individuals and employers could purchase additional coverage, but everyone would be enrolled in the statewide plan.

To fund the plan, each employer above a certain size would contribute a certain percentage of payroll. Individuals would make contributions on a sliding scale, based on income.

This plan is called “Connecticut Saves,” because it would lower health care spending while covering all the state’s residents. Large administrative savings would result if health care providers have only one major insurer for all patients under age 65, rather than multiple insurers, each with its own unique system for submitting, processing, and evaluating claims. Savings would also result through eliminating the majority of health insurers’ administrative costs.

Low-income residents previously eligible for other programs would receive the bulk of their care through this state plan, giving them access to the same reimbursement levels and the same health care providers that serve middle-class residents. In addition, low-income families would receive supplemental services and protection against cost-sharing.

A prior version of this proposal was analyzed by Dr. Jonathan Gruber of the Massachusetts Institute of Technology, who found that it would lower employers’ health care costs by $600 million a year and give households more than a billion dollars a year in additional resources that could be devoted to purposes other than purchasing health care. As a result, based on the REMI macroeconomic model for Connecticut, the earlier version of this proposal was projected to add 6,000 to 11,000 new jobs to the state’s economy and to increase state GDP by $660 million to $830 million a year.

White House responds to citizens group

Michael Leavitt, Secretary of Health and Human Services, has responded to the Citizens Health Care Working Group and its proposal to bring universal healthcare to the United States.

"Well isn't that nice for you?" he said. Or words to that effect.

The working group was a massive, cross-country effort to collect input from Americans about what kind of healthcare system they'd like to see. The group did not originally offer the choice of single-payer universal healthcare, didn't include it in discussions — but people wouldn't shut up about it, and so single-payer got through the door after all.

According to Leavitt, in a letter reporting to Cheney regarding the administration response to the group: "The Working Group chose an approach based on mandates and government intervention rather than an approach emphasizing consumer choice and options."

"The major areas of disagreement," wrote Leavitt "include the establishment of a national commission to define a core health benefit — an idea that the Federal Government can choose the best set of benefits for all Americans."

Leavitt returns to this several times — the insurance industry and their political toadies evidently think it's a good talking point. "The Administration believes it would be impossible for a federally appointed board to define a single benefit package that is able to address the diverse needs of Americans in their different income, family, geography, and health circumstances."

What does that mean? Could it be that Congressmen in Washington, D.C., after the birth of, say, a child with hemophilia, would expect his baby to be cared for, but that a poor father in Montana wouldn't want the same thing?

Or does it mean that a healthy, married Virginia socialite, after suffering major injuries in a car accident, would prefer to have all her medical needs seen to, but that a diabetic single mom wouldn't want the same?

"It would be impossible for a federally appointed board to define a single benefit package that is able to address the diverse needs of Americans in their different income, family, geography, and health circumstances."

I find it difficult to come up with the words that can express my outrage at that idea.

Business healthcare costs up 8%

Kaiser Daily Health Policy Reports notes that healthcare costs for big companies rose 8 percent in 2006, nearly double the inflation rate. That's according to a survey conducted by Watson Wyatt Worldwide and the National Business Group on Health.
The survey also found that 9% of U.S. employers plan to offer only a high-deductible health insurance plan next year to employees, compared with 5% in 2007, Reuters reports.

The survey included 573 large companies, defined as companies with greater than 500 employees (Dixon, Reuters, 3/15). The companies employ a total of 11 million people (AP/Chicago Tribune, 3/16). The survey found that 38% of companies offered a high-deductible plan among several different options in 2007, up from 33% in 2006.

The median percentage of employees enrolling in these plans was 7% in 2006 and 8% in 2007. Ted Nussbaum, director of health consulting at Watson Wyatt, said, "Employers can offer these plans, but it takes more than that to get employees to enroll." The study also found that companies with at least 10% of their employees enrolled in high-deductible plans coupled with health savings accounts saw health care cost increases of approximately 6.5%, compared with an average increase of 8% across all employers surveyed. Gail Shearer of Consumers Union said, "There is a concern about whether we are working our way toward a system where high deductibles are the norm and consumers don't have a choice," adding, "If you are a person of low or moderate income, if the deductible is very high, there will be financial barriers to care" (Reuters, 3/15).

In addition, the survey found that 33% of new hires will receive financial support for medical coverage during retirement from their employers, compared with 43% of current workers (AP/Chicago Tribune, 3/16).
How about that quote, that it's one thing to offer the junk insurance plans, but "it takes more than that to get employees to enroll."

Desperation, for beginners.

Strong support for universal health care in Colorado

When asked to choose between the present health care system based primarily on private insurance and “A universal health insurance program, in which everyone is covered equally under a program like Medicare that is financed by taxes and pays private health care providers for medical services,” fully 89 percent of Colorado respondents at the most recent Colorado Progressive Coalition's health care forum preferred the latter.

The coalition has been holding forums around Colorado, nearly a dozen now, to survey public opinion regarding health care in conjunction with spreading the news about Colorado's Blue Ribbon Commission for Health Care Reform (aka the 208 Commission).

The most recent was hosted by Fort Lupton City Councilman Robert McWilliams, and Mark Wallace, vice chairman of the 208 Commission.

This time around, although 78 percent of the participants had employer-sponsored health insurance, in the last two years 28 percent said they had to postpone medical care, 22 percent went without medical care, 72 percent worry about rising health care costs, and 40 percent worry about losing their health insurance. "These figures are striking for a well educated, middle class group," writes Francoise Mbabazi of the CPC in the press release of these numbers.

When asked about those without health insurance, forum attendees almost unanimously rejected the current system of relying on hospital emergency rooms to provide medical care to the uninsured. They also overwhelmingly favored using public health programs rather than private insurance to provide the uninsured with medical care. They strongly emphasized asking the recipients to pay for the cost, according to their ability.

When asked about the general principles on which health care should be based, they unanimously rejected the notion that “health care is a service like any other and should be left to the free market.” A majority (56 percent) believed that “health care, like education, is so vital to individuals and the community that it should be guaranteed to all,” and another 28 percent believed there should be “equal access to health care services for all” — a total of 84 percent who supported universal health care.

These responses are impressive — still more impressive is that they closely match the responses of the participants in other forums. "We have been surprised to find such a uniformity of opinion on health care among different groups in the public," writes Mbabazi. "This is especially evident in the agreement that health care is a right, in their greater faith in public rather than private insurance, and their overwhelming support for a universal health program."

The coalition warns that because the session was held during normal working hours, participants were not typical of the general public. Many attendees were active in the health care field, in a variety of positions.

15 March 2007

Dennis Kucinich on healthcare

We're already paying for universal healthcare. We're just not getting it.

13 March 2007

Des Moines Register solid

Thanks to Over My Med Body! for this, which I'd missed, being as doped up on pain killers as I was brave enough to be.

(They warn you that the narcotic depresses respiration, and so you might die if you take too much. The advice nurses get pretty exercised about it. Somehow I'm thinking that I was at more risk from the excess tylenol in the four percocets I took in two hours than from the oxycodone, but whatever. I'm on the mend now.)

The Des Moines Register referred to a story they'd evidently told before, of a couple who bought AARP-sanctioned insurance for $700 a month, then found themselves owing $200,000 after one of them came down with cancer. The
Register gets it exactly right:
Private is not better than public when it comes to health insurance.

Private health-insurance companies spend a greater percentage of dollars on administrative costs than government programs such as Medicare. Private companies also use health dollars to pay outrageous CEO salaries. UnitedHealth Group Inc. paid a former CEO $8 million a year. He also had unrealized gains on company stock options totaling nearly $1.6 billion.

Try finding a government worker with a personal jet.
And yet the commenters don't get it — many of them, anyway.

One guy notes that Americans would rather pay their cell phone bills than health insurance. Well — yeah. My cell phone offers a palpable daily benefit — and I know I'm getting a decent deal. For most people most of the time, health insurance offers a theoretical benefit and we know we're getting ripped off. Of course we'd rather pay our cell phone bills. And if we're young, we typically make that calculated choice that we'll be all right, and we forgo the health insurance and buy a cell phone plan instead.

Sure it's stupid. But it's a stupidity engendered not only by human nature but by a system that exacerbates the problem, by rewarding the worst of human nature and giving a shoulder shrug to the best.

Blaming human nature under those circumstances is short-sighted.

Where's the profit motive?

One of the best parts of working for a Catholic paper, which I did for about 16 years, was hearing stories of people doing good. The profit motive was rarely involved.

OK. Never.

I remember marveling about the farmers who would give so much time and treasure to build churches — and hospitals, as in this corny Canadian promo for universal healthcare being part of their traditional values — their heritage.

In any case, I'd look at how magnificent Mount Angel's church was, for instance, and I could see that although communities working together was also part of our heritage, we, their descendants, weren't likely to give so much.


Could the conservatives be right? Has there been a disintegration of values? What did happen to our community values? Our "We're in this together," golden rule values?

Now here's another question. Could it be that the Right is actually more to blame than the Left for this? Did they get so scared of communism that they tossed the baby right out with the bathwater?

Yep — even Republicans

David Moberg, an editor of In These Times, has a good essay on AlterNet titled, "Even Republicans Hate Our Health Care System."

For the most part, yes, although they're not necessarily inclined to see the same solution that we are. A neighbor stopped by yesterday — you couldn't find a nicer person. Republican. Her husband's daughter doesn't have health insurance. I told her I thought Paul would still be alive if we'd been Canadians, and he'd been insured. Explained why.

Now this woman is far too polite to argue, so I don't really know whether I planted a seed. But she did nod and seemed to agree.

Moberg makes the great point that there's no use in going for reform that keeps for-profit insurance companies in the mix.
Like the creature from the Black Lagoon, the health insurance monster has returned, creeping back onto the public stage. After President Clinton's jury-rigged pen to contain the monster collapsed in 1994, it never really went away. Political leaders tried to ignore the beast or deal piecemeal with its ravages, but it pushed more unsuspecting civilians into the uninsured pit, devoured more family budgets, squeezed even giant corporations' ability to compete globally, and raised fear and insecurity among the populace.

Now its depredations have become too loathsome to ignore for even cautious politicians and business executives -- who still are inclined to see the monster as one of their own
He quotes economist Jared Bernstein of the Economic Policy Institute in describing the Right-wing's philosophy of healthcare (and everything else) YOYO (you're on your own) economics.

Lefties get a better acronym: we're WITT (we're in this together) adherents.

Madeleine Bunting wrote yesterday in the Guardian's Comment Is Free about this philosophical divide. In "This cynical ideology of individual selfishness is a relic of the cold war," she traces the insidious rebirth of social darwinism — which is a wrongheaded albeit logical line of thought for atheists but completely misbegotten for Christians, who are its major adherents.

For healthcare, the argument comes down to whether we get universal healthcare that is "a sliding scale health care plan where everyone is entitled to first class health care, or a flat tax to sell junk insurance?" That's from Don Bechler, chair of the California Universal Health Care Organizing Project.

Moberg argues that the Clintons tried to insulate their plan from the insurance industry's might by including the industry in writing it. Fat lot of good that did.

At this point, the crisis has gotten to where people are open to the debate. Maybe — like my Republican neighbor — they'll consider uninsured family members when they vote on this. Polls seem to show that Americans would consider it. Moberg concludes:
No plan worth having will win without a massive grassroots organizing and education campaign. And Medicare for all is the one most likely to do so, while simultaneously strengthening progressives politically....

Eventually, Medicare-for-all advocates might have to settle for a compromise. But the opportunity for major change in the health care system doesn't come around very often. Since any change will require a massive effort, why not fight for the best?

11 March 2007

I'm back

Although I'm flat on my back is just as descriptive.

Ankle surgery sucks.

SOP in America is to send you home pretty soon after you open your eyes after surgery, which also stinks.

Tuesday night around midnight I awoke — at home — to find that the pain block that they'd separately administered had been doing far more than I'd given it credit for doing. I'd taken the oxycodone, as the doctor had said to do, but it didn't seem to be touching the pain, which now felt a bit as though someone had inserted a frozen — or burning — plate of steel in my ankle. The pain did not let up, and it was exacerbated by my ankle being swollen against the split/cast.

We went in, and after a couple hours I was seen and got morphine in an IV. I told them that I didn't want to go home, that I wanted to keep the IV, but they assured me that the hydromorphone they were giving me was good stuff, and that together with the oxycodone I'd be just fine.

Not true. The next morning I was in pain again. It wasn't as bad as it had been the night before, but it was still a lot of pain, enough that I couldn't imagine enduring it for hours or days.

I called the doctor's nurse, who had a bedside manner akin to Nurse Ratchett. "Why didn't you have them admit you, if you were in so much pain?" she asked me.

It was my fault! I just hadn't realized it.

The pain the night before had also been my fault: even though I'd taken the painkiller as ordered, the ER PA suggested that what had happened was that I'd let the pain get out of hand, and that if you let it get out of hand, it's hard to rein in again.

This was the exact opposite information than I'd gotten from the Kaiser advice nurse, who had been alarmed that I'd taken 20 mgs of oxycodone in a couple hours. I was only supposed to take 10 mgs every four hours. The PA was quite a bit more laissez-faire. He thought I'd be fine up to 80 mgs.

So Wednesday morning I was indeed taking more and more and more drugs, enough to horrify the nurse. So what was I supposed to do?

I also got her test question wrong, about where was my pain on a scale from one to ten. I told her four — having a personal acquaintance with the fact that pain can actually climb to far higher spheres than most of us imagine possible.

Four, she sniffed. That's not so bad.

I began crying, and she then questioned how I could be crying with a pain level of just four.

Indeed. How could I be? After being so well taken care of, and with all the faith in the world that this primo care would continue, how could I have cried?

The ER on Tuesday night complained about orthopedic surgeons in general, saying that they under-medicated their patients and that about 30 percent of post-surgical send-homes like me ended up back in the ER needing more pain meds.

If I'd been in a civilized country, from Bolivia to Belgium to Botswanna, they wouldn't have sent me home in the first place.

Not that I'm bitter.

Fox Attacks

Go to Fox Attacks to check out what you can do to help bring accountability back to the media. Fox has its place in the virtual universe, no doubt, but they've got less business hosting a Democratic debate than Air America would have hosting a Republican debate.

The Democratic Party of Nevada has cancelled Fox's deal to host that debate — what the hell were they thinking? — but more is warranted. Fox Attacks urges people contact Fox advertisers and let them know what they think.

Workers comp a problem too

By Christopher Juniper
Where does that approximately $.20 of every dollar spent on healthcare that is wasted in administration (rather than actual health care) go? While it may take somebody with greater power than Sherlock Holmes to track it all down, the column published by astute business observer Al Lewis of The Denver Post sheds some light. A woman who was injured while on the job received poor health care treatment for her injuries and now it is a legal mess. Part of the problem seems to come from the fact that Colorado, along with eight other states, allows employers to designate a single provider for workers compensation claims; the injured party in this case is convinced her care would have been adequate if seeing her own physician.

The alleged reason that allowing employers to designate their own health care providers for workers comp injuries is to help keep their costs down - and therefore perhaps presumably consumer prices down for their products - resulting in greater competitiveness.

However, this possibly worthy goal was clearly subverted in this case, and likely in thousands more. First - consider all the fuss of figuring out who pays for what - depending on whether the injury was job related or not. A single payer system has the potential to do away with most of that fuss and confusion. Second - consider how much better our own physican would be able to treat us for injuries on the job than somebody who has never seen us before, and furthermore may be working for an organization that is rewarded by the employer for keeping costs down as it tries to compete for that employer's designation as workers' comp provider.

Little of all the administrative burden of figuring out who pays for what (personal vs. employer vs. systems like workers comp. vs. medicare vs. medicaid etc.) is actually value added. It is a cost without much benefit. This article is just one more illustration of that silly cost - not only cost to people's pocketbooks, but also to their health, and productivity.

06 March 2007

Canadian system works

Brilliant at Breakfast ran a link to the NYT story below with a nice commentary. BaB writes:
Health care is not something that can be left to "market forces", because such market forces leave people with illnesses or chronic conditions out in the cold. It's impossible to comparison-shop for coverage when your choice is among premiums that are Exorbitant, Preposterous, and You've Got To Be Fucking Kidding Me -- and that's assuming you can find coverage.
Brilliant at Breakfast, by the way, is a great blog name, isn't it? The site begins with a quote from Oscar Wilde: "Only dull people are brilliant at breakfast."

Ha. Indeed.

There is this wonderful comment there, from AnoCan:
I'm a Canadian. Despite what you might hear in the US, the health care system here has never let me down, nor let down anyone I know.

Sometimes you have to wait -- and if you go to the emergency room for a sniffle you will surely wait -- but I've been seriously ill a few times and been treated promptly and professionally. And I have never paid a dime for it. And when I go to a neighbourhood clinic for my sniffle I wait 10-20 minutes and am seen by a friendly professional who treats me. If I need a specialist I am referred. Everything works as it should and I don't pay a dime for any of it.

File the boogeyman stories you hear about Canadian medical care in the same file as the "Global War on Terror": manufactured facts to sell an agenda that does not benefit you.

U.S. system failing NC woman

Bravo to the New York Times for beginning to do a better job covering healthcare. These stories write themselves — they're David vs Goliath; they've got pathos; this is an important philosophical issue, a vital matter of how values are a matter of life and death in the material world; they've got storylines that average readers can relate to. I predict that some paper will in the next couple years pull together a series that will win a Pulitzer for exposing and explaining the healthcare fiasco.

Part of the story will be how the for-profit U.S. medical system with its powerful lobby proved too successful for its own good — like a killer virus version of the auto industry. By insulating themselves from real market forces and by being too greedy, they've "sh&%^ in their own messkit," as Bob Pfohman would say.

The free-market competition that was supposed to bring down costs for consumers instead went to work to bring down costs for the true consumer in our system. That would be the insurance companies. Patients are an afterthought — a product, in a way. The insurance companies began to compete for the least-cost product — the healthiest populations to insure. They excluded higher cost products from the scheme. But by doing so, their administrative costs went up, and the risk pool shrank. Once begun, this paradigm was like a truck without brakes on a mountain decline.

At first it was wiping out only the weakest links. No longer. It's now smashing and damaging solidly middle-class families — families who had just a dozen years ago bought into the lie that forcing those out-of-control for-profit trucks onto escape ramps was just too dangerous, too hard on the economy, and that the government couldn't be trusted.

OK, OK. Enough with the metaphor.

Here's the Times story, about a Realtor making $60,000 a year who couldn't get get insurance for less than $27,000 a year because she'd had cancer.
Ms. Readling said she often woke up at night, terrified of the cost of getting sick without insurance.

“Anything that goes wrong with my health could destroy me financially,” Ms. Readling said. “I could be ruined.”

She said she had never voluntarily allowed her insurance to lapse and could not understand why she was being blackballed.

“What did I do wrong?” Ms. Read-ling asked. “Why am I being punished? I just don’t understand how I could have fallen through this horrible, horrible crack.”

Knowing her health benefits from her prior job would expire in January 2006, she began shopping for a new policy in May 2005. But in June 2005, she learned she had cancer.

“At that point,” Ms. Readling said, “I called everybody I could think of, begging for help. But no insurer would touch me.”

Barbara Morales Burke, the chief deputy insurance commissioner of North Carolina, said state law did not guarantee the availability of health insurance for individuals. “Most insurers decline to issue policies to those individuals whom they deem to be too risky because of their medical history,” Ms. Morales Burke said.

NY family docs call for single-payer

The New York State Academy of Family Physicians yesterday called on Gov. Eliot Spitzer and the state Legislature to bring a single-payer healthcare system to New York.

Family physicians told legislators that dealing with multiple insurance plans, with their different rules, forms, and procedures, wastes 20 to 30 percent of health care dollars and leaves 3 million New Yorkers without coverage.

The Academy calls for all payments funneled through a single payer, eliminating multiple rules and procedures, enrollment and eligibility problems.

Dr. Linda Prine, chair of the Academy's Commission on Public Health, told the Albany Business Journal that tinkering won't help. "The current system is not working; we should not take a failed system and make it a bigger failure."

05 March 2007

Waiting lists in the U.S.

I fell on an icy sidewalk last Friday and broke my ankle. I heard the pop, pop, felt my ankle collapse under me, and I knew it was bad.

The last time I had a major break I also heard it. I was skiing in Park City, Utah, and idiotically had insisted to Paul that I was fine on the black diamond slope. First run of the season and on rented skis. Right. No problem. We were supposed to meet someone, and he went off to ski under a chairlift — not a real slope — to see if he could find them. I would ski down the slope and meet him at the lift line. Except I never made it. I negotiated two, maybe three moguls and went down — pretty softly, really. But twist, pop! went my knee, and one of the rented skis shot down the steep, white mountain, catapulting itself into the air and skittering to a stop 100 feet down.

It didn't hurt. I figured I could stand and slide down to that ski — except I couldn't The knee wouldn't hold me up. And it was so steep that getting to the ski on my butt was hard. If only I could get to it, I thought, I'd slide the rest of the way down, then ski on my right ski and carry my left on the flat.

I got halfway down the slope before Paul showed up, feeling terrible — as if it were his fault.
Paul, me and Curtis — the Hannum siblings

I'd shattered my tibial plateau, and it needed surgery.

I stayed in bed for the rest of the Sundance Film Festival and flew back to Portland for pins and a metal plate.

This time there was no question of getting up and skiing anywhere. It hurt, and my foot had slid to the side as I moved it out from under my butt. It moved to the side again when we tried to put my lower leg on a board to stabilize it in order to get me onto the wheelchair and inside. I don't think Christopher has ever heard me as panicky as when I called him a minute or so after falling. He was supposed to have presented to a conference that morning but he passed off his powerpoints and notes to someone and rushed over to where I was sitting on the sidewalk, snow falling on me and the group around. After he got there I could feel the world settling back into place. And yet I still couldn't even get up into a wheelchair. When the paramedics came, I pleaded with them to keep my foot from again sliding sideways off the axis of my leg.

The paramedics were wonderful: I was grateful for pain medication and competent, experienced touch, and relaxed as we drove — watching Christopher pace us through the ambulance's back window.

In the emergency room, however, it was a good thing Christopher was there advocating for me — going out three times at one point to get a nurse in to give me some more painkiller through the IV. There just didn't seem to be much urgency or concern. The nurses were friendly enough, but I felt as though I were in an episode of ER where the staff's interpersonal relationships are the main plot point, not the patient.

They couldn't get me into surgery that day. The only opening was at 5 p.m., and there would surely be a case that would have priority over my ankle, which wasn't life threatening.

I'm OK with that. It would be better if they could have gotten me in, but that's life, right? It turns out that it's also standard. Yesterday, a nurse in Boulder mentioned in an email that she had a patient who also fell and broke his ankle last week, and that she hadn't been able to get him in for surgery until Tuesday as well. Today someone else told me that he'd broken his ankle earlier this winter and that he'd waited a week for surgery.

Fine. Maybe that's the way it has to be. Character-building, no doubt. I just don't think I'm going to be as friendly next time someone tells me that they've heard that the waiting times in Canada are terrible.

After all, I've got two broken bones here (my tibia and fibula), torn ligaments, miserable pain that is only controlled by a dizzying amount of percocet (me and Rush, old buddy), a foot that doesn't remember that it's supposed to be at the end of my leg — not an inch or so to the right — and although Christopher's able to work from home, unlike many people, but he's not as productive because he's taking care of me.

So give it a break about Canadian knee surgery. Insured people in the U.S. may wait marginally less for elective surgery than people do in Canada. But we do wait. And if you're an uninsured American, you can schedule your elective surgery to coincide with Britney earning that PhD. You can wait until Cheney grows a heart or til George grows a brain. It's not going to happen.

04 March 2007

NYT poll on healthcare

The New York Times published a new poll on Americans' views towards healthcare. These polls are hopeful, although it will always be the case that people can be swayed by advertising and other propaganda. A concerted assault by the insurance industry could certainly convince many of these people now in support of guaranteed healthcare that the specter of socialized medicine — whatever that is — is even more fearful than your child dying of a lack of insurance.