Lincoln was for govt-financed health care

James Nowlan, a Republican at the University of Chicago, has a column in today's Chicago Tribune. It's notable both for what it says and what it doesn't say.

"Abraham Lincoln declared that government should do only that which the people cannot do so well for themselves -- defense, highways, public safety, education. And government has done a good job of fulfilling this compact with the public. In recent decades, we have been adding health care to the compact, in increments: first the elderly with Medicare, then the poor, and more recently, children, both through Medicaid. If you're not in one of these categories, you scramble for health care. Everyone in my rural area hustles to find the shelter of health-care coverage. Farmers' wives take jobs at the school in town -- for health coverage for the family. Whenever a job change is contemplated, the biggest question is: 'Will there be benefits [health coverage]?'"

Nowlan addresses the irreconcilable tension between Americans believing that their taxes are too high and at the same time believing that the government should make sure everyone has health care.

Then, as if he can't quite help himself, he points out that Medicaid and Medicare are the biggest chunk of government expenditures on health care - something that is misleading because it doesn't note the other government expenditures on health care, such as the tax breaks for companies that provide health insurance and the cost of paying for private insurance for all municipal, county, state, and federal workers, including the military.

He notes that the cost of Medicare and Medicaid have gone up 7 percent a year, "far outstripping inflation," without noting that the rate of increase of private insurance puts Medicare and Medicaid increases in the dust.

Even so, the quote from Lincoln was nice. The experience of other industrialized democracies fairly proves that government does a better job of managing health care financing than does the private sector. (If, of course, you factor in health of the population as being at all important. If you're willing to write off a substantial portion of your work force - the Darwinian cost of doing business - then our system clearly is more profitable and therefore better, capitalistically speaking.)

Then again the right has so vilified the competence of the American government that it's possible that people think that whereas the Swedish or German or Taiwanese government can competently manage health care financing, our own government cannot.

The question then becomes "Why does the right wing hate America?"

Private insurance hurts U.S. businesses

Len Nichols and the New America Foundation have released a great paper, well sourced and with great charts and tables, showing the private health insurance's effect on global competitiveness.

Here's one of the charts:



Download the pdf for Employer Health Costs In a Global Economy at the New America Foundation website.

What! Innovation in Single-Payer Britain?

Also from Medical News Today, the inexplicable decision to locate a new research center in Manchester. That's Manchester, UK, not Manchester, MA.

MIMIT (Manchester: Integrating Medicine and Innovative Technology) - the first international affiliate of the highly successful [Boston] US centre CIMIT® - will draw together clinicians and scientists from a group of Greater Manchester hospitals, GP practices and the University of Manchester in major collaborations to apply the latest technology to clinical problems and transform healthcare in the UK...

"There are many similarities between the CIMIT® approach to innovation and the organisational components which comprise the bio-medical-engineering research cluster in Manchester," [said CIMIT® founder and Executive Director Dr John Parrish.] "I am looking forward to collaborating with our new colleagues."

Have these people not gotten the word? Single-payer ends innovation. Good grief.

Save the NHS

There will always be a battle on the part of private profiteers to take over services they see could turn a dollar. Globally, there was a fierce war over privatizing water during the 1990s. Maybe that one has ebbed for a while. For-profit health insurance, which is a proven money-maker (and killer), is like a parasitic invader around the world, even in places where the public good has seemingly won out. Like Great Britain.

Keep Our NHS Public is a group publicizing the fact that "vital services and precious NHS resources are being handed over to the private sector, including companies run for profit for shareholders here and overseas." The group was launched in September 2005, and, like the single-payer movement in the United States looks to be led by doctors, academics, health workers and trade union leaders.

Tony Blair forced the group to mobilize, because of market reforms he'd pushed. Gordon Brown recently committed to keep on track with Blair's misguided efforts.

Lord Darzi, Brown's health minister, has put forth an interim report on the NHS -- which has been analyzed in turn by the Keep Our NHS Public group. They found Darzi's use of evidence is weak, and without any evaluation of the impact of markets on the NHS so far.

NHS staff and patients are calling for a moratorium on market reforms.

Liver transplant outcomes better in UK

Maggie Mahar, author of one of the best books on our health care mess, Money-Driven Medicine: The Real Reason Health Care Costs So Much, has a good article at her blog on cherry picking numbers to "prove" that the U.S. has best health care in the world.

Mahar researched the numbers behind the Wall Street Journal column on Nataline Sarkisyan, the 17-year-old California girl who died last month after her insurance company refused to pay for a transplant. That column's author referred to an unnamed British medical journal study on survival rates for transplants for people suffering from chronic liver disease and acute liver disease.

Mahar begins her rebuttal by asking whether fact that we perform a greater number of transplants on seriously ill patients is reason to claim that U.S. health care is better — "or does it simply mean that we are more inclined to experiment on our sickest patients?"

It all depends on how well the average patient who is plucked out of the ICU to undergo a liver transplant fares. If he or she goes on to enjoy several years of high quality life, one would be inclined to say “yes”—our more aggressive care equals better care. But if too many patients suffer complications and then die in great pain twelve or 15 months later, it would be much harder to argue that “doing more” makes U.S. healthcare “better”—especially when both the money and the liver could have been spent on another patient who had a better chance of surviving.

She found the study used by the WSJ writer. She writes that indeed it found that patients' five-year mortality after transplants for acute liver failure, the type from which Ms. Sarkisyan presumably suffered, was about 5% higher in the U.K. and Ireland than the U.S. The WSJ author also cherry picked this statistic: "in the period right after surgery, death rates were as much as 27% higher in the U.K. and Ireland than in the U.S., although differences in longer-term outcomes equilibrated once patients survived the first year of their transplant.”

Meaning that by the end of the first year, the differences canceled each other out. Mahar writes:

Begin with how the patients were faring during the first 90 days... during this time, mortality rates in the U.S. were lower (regardless of whether patients had originally suffered from acute or chronic liver diseases.) This is, in large part, the article suggests, due to lower nurse/patient ratios in the U.S. and more intensive care during the first weeks following surgery.

But what Gottlieb omits is the crucial fact that, when the researchers went back and looked at “patients who survived the first post-transplant year,” they discovered that “patients who had suffered from chronic liver disease in the U.K. and Ireland had a lower overall risk-adjusted mortality” than patients in the U.S. In other words, survival rates for patients who had a chronic disease before the transplant were better in the U.K. and Ireland. As for patients suffering from acute liver disease, longer-term survival rates past one year were just as good in the U.K. and Ireland as in the U.S. Moreover, if you checked patients in the interval between 90 days and one year, outcomes were similar in the two health care systems.

So in fact, "Outcomes in the U.K./Ireland were just as good for one group and decidedly better for the second... "

Multi-payer health care plans

At a faith in action conference at Iliff School of Theology yesterday, there were a couple people who supported a certain Selvoy Fillerup, MD, who has written a book urging we adopt a health care system more like France's, which is a multi-payer. They enthused that 80 percent of the French buy private health insurance.

Maybe so. More importantly, private insurance covers 12.4 percent of costs in France, only slightly ahead of the 11.1 percent that people pay out-of-pocket.

What's more, the sicker people are — or the poorer people are — the more the government kicks in to pay.

Here's an OECD study from 2004 on private insurance in France. (Click on the pdf for "Private Health Insurance in France," by Thomas C. Buchmueller and Agnes Couffinhal.)

This is the key from that paper:

Unlike in other countries, private insurance in France is not used to jump public sector queues or to obtain access to elite providers. Rather, it provides reimbursement for co-payments required by the public system and coverage for medical goods and services that are poorly covered by the public system, most notably dental and optical care. Considerable research indicates that by reducing (and in some cases eliminating) out-of-pocket costs, private insurance significantly increases medical care utilisation.

Far better than that study, the American Journal of Public Health has a great article from 2003 on how the French system works. (Click on full text for the pdf.) The editors note that "Lessons for the United States include the importance of government’s role in providing a statutory framework for universal health insurance; recognition that piecemeal reform can broaden a partial program (like Medicare) to cover, eventually, the entire population; and understanding that universal coverage can be achieved without excluding private insurers from the supplementary insurance market."

Another, harder lesson: "In France the commitment to universal coverage is accepted by the principal political parties and justified on grounds of solidarity--the notion that there should be mutual aid and cooperation between the sick and the well, the active and the inactive, and that health insurance should be financed on the basis of ability to pay, not actuarial risk."

Medical bankruptcies in Britain

I saw something yesterday that a Brit had written warning that there were medically caused bankruptcies in Britain too, so not to think that single-payer would be the end of the approximately 2 million medically caused bankruptcies a year that occur in the U.S.

After a bit of poking around, I understand his point. When the British can't work because of an illness, they may get into financial troubles. They're cared for medically, but their credit card debt for that trip to EuroDisney and the fancy clothes isn't covered.

At the Bankruptcy Information Centre, there's the story of a single mom raised in the projects who'd gotten herself a nursing degree and began spending more than she earned. Quite a bit more. Here's the key to her story:

She had started a relationship with a friend she had known for 10 years, but after a year that broke up. That was her trigger.

"Maybe it's being a single parent, a strong Cypriot woman, but we've all got a face, you know what I mean? I was like, 'I'm fine, everything's fine', and then it was like a domino effect. I just crashed, in my abilities as a mum, as a nurse, as a person." In May 2005, she went to her GP and said she needed help. He diagnosed stress and clinical depression, and ordered sick leave.

Staying at home, on statutory sick pay, then, after two months with no income at all and on incapacity benefit, didn't improve things. She felt immensely guilty, a failure in the eyes of her colleagues, whom she would bump into whenever she had an appointment with the mental health services. She drank, three or four bottles of vodka a week. She spent more. "Spending is very, very addictive. It's definitely an adrenaline rush, as well." And then she got a letter from the tax credit agency. Strudwick would be first to admit that she finds applying for benefits an incomprehensible morass, but obviously Revenue & Customs find this, too. Last June, they admitted they had miscalculated child tax credits, overpaying recipients by more than £2bn. They demanded Strudwick repay £4,200 that she didn't have - then, on investigation, revised it up to £9,500. Her debt shot up to nearly £50,000. Unpaid utilities meant that the final bankruptcy statement had her owing £52,000.

That's hardly the kind of bankruptcies that happen here because of trying to pay for a cancer treatment.

Healthcare in Norway for conservatives

Merete Cunningham, a Health Care for All Colorado supporter, wrote earlier this week for the Fort Collins, Colorado, Coloradan about single-payer healthcare in Norway. Despite the drums of fear from the right, it doesn't sound too scary.

She wrote, "My parents (my mother was a Conservative member of the Norwegian Parliament) lived and died under this system. As they grew old, I could not ask for more humane and decent treatment, at no cost to them, and without the need to sell off their assets. They were able to leave their estate to their heirs while living in a state-run facility. This is what I would like to see here, because I know that it is possible if the profit motive is removed.

"When a for-profit company in the United States is in charge of your health care insurance, company and health care goals must clash. A company's dedication to maximize profits is in direct opposition to its claim to provide health care for its members.... They are doing a great job for their shareholders. However, they are doing a horrible job of providing our health care. Nobody should profit from illness and death."

The first comment was an anti, ranting on about something about Lasik eye surgery. Thank God for Lasik eye surgery. If it weren't for Lasik the right would have nothing to point to as an example of why the free market will save medicine in the U.S.

Nothing.