Think again if you think being insured = security

Americans love to believe things that are demonstrably untrue - tax cuts equaling increased government revenue and a stronger economy, for starters. Oh, and the whole idea of for-profit insurance companies being an efficient way to finance our health care being another.

So I'm just passing this along - it's not going to make a whit of difference in the debate. The University of Arizona has found that being insured doesn't affect whether you have medical debt.

According to a study published online June 16 by the American Journal of Public Health, after taking age, income and health status into account, simply being insured does not lower the odds of accruing debt related to medical care or medications....

"On average, insurance coverage in Arizona is not protecting families from experiencing medical debt. From other studies we knew that paying medical bills is a problem for a substantial portion of both insured and uninsured Americans. This study helped clarify that the fact of medical debt is an additional and larger barrier to getting needed health care than whether a person is insured or not."

That's according to University of Arizona College of Pharmacy research scientist Patricia M. Herman.

But don't expect the Americans who are swayed by the big-business money that preaches anti-government ideology to take note. (Hell, the mainstream media didn't even take note.)

They're busy admiring Michele Bachmann's poll numbers in Florida, leaving the fact that she's a delusional liar to, at best, the papers' online blogs, to be read by the choir.

Social darwinist Bachmann is quite concerned about a mythical $105 billion "hidden" mandatory spending in the health care reform bill passed last year. That would be the most-debated bill ever passed. Right, Michele.

And the shot heard round the world was fired in New Hampshire. Uh huh. Obviously memory fails us all now and then. But when a third or so of Americans begin to channel the single-minded Walter Sobchak (You're goddamn right I'm living in the fucking past!") from The Big Lebowski, it's hard to know where to begin. As The Dude says, "Walter, I love you, but sooner or later, you're going to have to face the fact you're a goddamn moron."

The scary thing is that these folks aren't just channeling film rage, they and their leaders are unwittingly channeling mass murderers. Bachmann again: “But what I want them to know is just like John Wayne, who is from Waterloo, Iowa – that’s the kind of spirit that I have too.”

As one L.A. Times commenter wrote, "I don't think she was mistaken, she was just speaking in secret code to her minions. She well intends to rape the nation like [John Wayne] Gacy [who was from Waterloo] did to his victims..."

Another commenter offered a SOP right-wing solution: "Let's go to John Wayne's Wikipedia page and change it so that she is right."

McCain's startling proposal

Some overworked and underpaid editor at something called "Newsoxy.com" managed to get nearly everything wrong in providing a synopsis of a well-written piece there. He or she wrote:

John McCain wants to bring healthcare costs under control by actively allowing companies to compete around the world.

While I wouldn't put it past McCain to suggest that U.S. companies be "actively allowed" to compete around the world (huh?), a read of the story reveals that this poor editor garbled the last paragraph here:

Other rich similar industrial nations that offer universal care spend only 11 to 12 percent of their gross domestic product on healthcare. Canada spends even less, a bit more than 9 percent of GDP, on a single-payer government insurance system for all its people.

Healthcare advocates say an ambitious change in the United States healthcare system has become an economic necessity, not just a social desire to offer the service to all Americans.

Regina Herzlinger, an expert at the Harvard Business School in Cambridge, Mass. says that the business community bears for 55 percent of the nation's total health costs, the government just 45 percent. Moreover, many businesses eventually want to get rid of their health costs altogether.

"Bringing costs under control is the only way," Sen. John Mccain said on his website, "allow our companies to effectively compete around the world."

Unfortunately, McCain thinks the way to get costs under control is via insurance companies competing with less regulation and more tax breaks. That's worked so well already, after all.

J. Jonik on the insurance industry...

Would that be called a conflict of interest?

Nathan Wilkes' Story

Health Care for All Colorado is incredibly lucky to have Nathan Wilkes on its board. In this video from the California Nurses Association he explains how he became involved in the battle to reform health care.

Think about the fact that the health insurance industry skims off one health care dollar out of three -- and then think about Thomas Wilkes.

How can they sleep at night?

Single-payer & Nataline Sarkisyan

Christopher M. Hughes, MD, has a wonderful post in his blog, Single-Payer Healthcare Blog. Dr. Hughes replies to what has evidently become a backlash against the outcry against what happened to Nataline Sarkisyan. He writes:

The staunchest advocates for Single Payer Healthcare never, ever, disparage American medicine's ability to deliver the best care in the world in areas such as organ transplant, trauma, intensive care and other high tech endeavors. But these areas are only a sliver of overall clinical outcomes. Even at the quoted 18.5 liver transplants per million done in the US annually, this is only 5000 or so patients. So, while not being dismissive of these patients, they are not reflective of healthcare outcomes of our population. They only reflect what we already know: We spend tons of money on advancing high tech medicine and we are darn good at it. As I view the transition to single payer, I see no reason, other than "conservatives" wailing about unnecessary spending on healthcare as the system matures, for us to continue to do well in our "American specialty" of bleeding edge healthcare.

It looks like Dr. Hughes began his blog about the same time I launched Ave Cassandra, maybe a month later, and that he posts about a dozen times a month. And that he's smart. I added his blog to Ave Cassandra links.

In that Wall Street Journal commentary, I was struck by the numbers —

In 2002 -- a year comparative data is available -- U.S. doctors performed 18.5 liver transplants per one million Americans. This is significantly more than in the U.K. or in single-payer France, which performed 4.6 per million citizens, or in Canada, which performed 10 per million.

What about the differences in outcomes between ours and single-payer systems, an issue Mr. Edwards hasn't directly addressed? One recent study 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 Irleand than the U.S. The same study also found that 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.

These findings aren't confined to transplanted livers. A study in the Journal of Heart and Lung Transplantation compared statistics on heart transplants over the mid 1990s. It found patients were more likely to receive hearts in the U.S., even when they were older and sicker. The rate was 8.8 transplants per one million people, compared to 5.4 in the U.K. Over the same period, about 15% of patients died while waiting for new hearts in the U.K. compared to 12% in the U.S. In 2006, there were 28,931 transplants of all organ types in the U.S., 96.8 transplants for every one million Americans. There were 2,999 total organ transplants in the U.K., 49.5 transplants for every one million British citizens.

When you read the Commonwealth Fund studies, the analysts there often say that no one country is better than others in outcomes overall — we're best at some stuff, France is best at some things, Britain for something else... but that the U.S. falls down completely when the fact that we spend so much and exclude so many is taken into account.

Unless there is other data that the WSJ author (a physician and right-wing American Enterprise Institute resident fellow) is leaving out, one would assume that transplants are one of the areas in which the U.S. is ahead in terms of practice and outcomes.

I'd be interested in knowing what else goes into these transplant numbers — for instance, the rate of donated organs and their availability, the need for transplants, whether some of our transplants are done on patients that get some other kind of treatment there, and the average age of transplant recipients in the various countries.

Sarkisyans endorse Edwards

MSNBC reports on Nataline Sarkisyan's family endorsing Edwards today. The story is a truly crappy one, makes it sound as though it were a wee misunderstanding, that's all — about that transplant that Cigna denied, she was "was unable to get one despite being insured." So perhaps there just wasn't a liver available.

The reporter does, however, do a good job of making it very clear that the Sarkisyans sought out Edwards.

Despite that, there are a few predictable comments on Edwards being an ambulance chaser, exploiting, etc.

What's impressive, though, is the unpredictable fact that those comments are drowned out by other readers who defend Edwards, and get it spot-on right about who is the bad guy in this story. That would be the bully Cigna.

And remember, this story is in the mainstream media. These readers may be better informed than most Americans, but they're not the usual suspects.

Insurance Companies' Playbooks

A Cornell doc vents at the LA Times on Cigna's deadly tactics, denying care to its "consumers" until it's too late. This time it was leukemia patient Nataline Sarkisyan's liver transplant.

Nataline, who was 17 when she died, was buried 28 December.

UCLA doctors had put her on a list for a liver transplant earlier in December, and a liver became available four days later. Her doctors told Cigna that Nataline had a 65% chance of living six months if she received a liver transplant. Cigna deemed the transplant experimental and refused to pay for it.

The California Nurses Assn., the Armenian community and Daily Kos publicized the case — which resulted in a telephone and e-mail campaign to urge Cigna to reconsider. It did, but too late for Nataline.

Giuseppe Del Priore has some details I didn't know about, such as the fact that denial of coverage always come with "a sentence to the effect that the doctors must provide whatever care is necessary and that the payment is a separate issue."

I agonize over having to choose whether to wait one more day for approval or to go ahead with the surgery and potentially damn the patient, his family, and the institution, to assuming the financial consequences. If I do go ahead without approval, no one comes to my defense when administrators ask me why so many of my patients' insurers are not paying. No one rescues the bankrupted families.

Another nasty bit of work is calling procedures "experimental" in order to avoid paying for them. Nataline's procedure, he writes, wasn't experimental in any sense of the word.

Ironically, this puts the lie to the idea that American health care is so advanced. We predictably call procedures experimental that are routine in Europe.

Del Priore says the third insurance stall used to kill Nataline was the use of "expert" review — their bringing in what is little different than hired killers to deny care.

Insurers that review my denials define any has-been, retired, unemployed failure with a medical license an expert, paid to deny care. This is practicing medicine without examining the patient or seeing all the data. In effect, the licensed nurse or doctor working for an insurer is practicing medicine unprofessionally and criminally.

Edwards knows the enemy

Michael Moore isn't endorsing anyone, but he likes Edwards:

It's hard to get past the hair, isn't it? But once you do -- and recently I have chosen to try -- you find a man who is out to take on the wealthy and powerful who have made life so miserable for so many. A candidate who says things like this: "I absolutely believe to my soul that this corporate greed and corporate power has an ironclad hold on our democracy." Whoa. We haven't heard anyone talk like that in a while, at least not anyone who is near the top of the polls. I suspect this is why Edwards is doing so well in Iowa, even though he has nowhere near the stash of cash the other two have. He won't take the big checks from the corporate PACs, and he is alone among the top three candidates in agreeing to limit his spending and be publicly funded. He has said, point-blank, that he's going after the drug companies and the oil companies and anyone else who is messing with the American worker. The media clearly find him to be a threat, probably because he will go after their monopolistic power, too. This is Roosevelt/Truman kind of talk...

And he voted for the war. But unlike Senator Clinton, he has stated quite forcefully that he was wrong. And he has remorse...

Edwards is the only one of the three front-runners who has a universal health care plan that will lead to the single-payer kind all other civilized countries have. His plan doesn't go as fast as I would like, but he is the only one who has correctly pointed out that the health insurance companies are the enemy and should not have a seat at the table.

Right.

Stopping Reform: Public Thoughts

CNN Money has a piece with advice for health insurance companies and Pharma on what to do about all the talk of health reform. I'm wondering who the target readership is — perhaps mid-level management types?

Hard to say.

The advice boils down to this: Not to worry. Act reasonable, then after the elections lobby as usual.

Tidbits:

In a December report called "Beyond the Sound Bite," PricewaterhouseCoopers compared the health-related policies of seven major presidential candidates: ... Democrats Hillary Clinton, Barack Obama and John Edwards and Republicans Rudy Giuliani, Mitt Romney, John McCain and Fred Thompson. ...

The Democrats propose "broader and more immediate changes, with new mandates, programs and funding."

The Republicans want no new government programs, preferring "indirect approaches such as changes in tax incentives that could move insurance away from an employer-based model."

PWC boiled down the issues to these: covering the growing uninsured population, changing tax rules to support health system changes, controlling health costs, and improving quality of care....

[None of the] candidates propose a single-payer system along Canadian lines. All seven candidates tend to rely on expansion of the existing private insurance market.

But the report notes, "The Democrats say they would also create new public programs to offer more choice and compete with private insurers."

The PWC expert advised the insurance companies needed to devise a strategy to compete with the government, if Clinton's or Edward's plan goes through.

Even if the Democrats don't hold the Congress and/or take the White House, Republicans can't be expected to maintain the status quo, says John E. Calfee, a scholar at the American Enterprise Institute ...

That's because the momentum to do something to bring the 47 million uninsured into the system is too strong.

"You know there's going to be heavy action on the Hill over this even if the Democrats don't win," Calfee said.

He suggests that the insurance industry attack head-on the question of its efficiency. Some analysts put the cost of bureaucracy and paperwork at 30% of the $2.1 trillion (in 2006) spent on health care in the U.S.

As for Pharma, a USC professor of pharmaceutical economics says he expects that Medicare Part D will change, and receive the ability to negotiate drug prices. That could hold down prices and bring greater transparency to the market — a worrisome scenario for Pharma stockholders, no doubt.

The good professor's advice: "appear cooperative and happy to get along with a new regime. Then, after the election, lobby vigorously in Congress, as usual."

Conason, Lux on Hillary

Joe Conason, who wrote a great book about the witch hunt against the Clintons, reveals the soft spot he has in his heart for Hillary with this article at Working Assets. Conason ends it with a good point:

Ever since Harry S. Truman first proposed universal health care in 1948, the insurance industry has refused to create a system that would cover everyone, erecting instead a nightmarish edifice of corporate bureaucracy, unaffordable waste and cruel exclusion.

Rather than rant against the constructive alternatives, let them--and their political mouthpieces--explain why we should continue to tolerate their failure.

Mike Lux, who used to work for Hillary, gives his analysis on what's different about this program at Open Left. Lux writes,

But there's one other reason the issue haunts me and drives me. Being part of that health care fight in 1993-94 was an experience that I can never forget. I don't like losing, especially when the stakes are this high, and unlike elections where you have another chance to win just two years down the road, a chance at getting something this big and complicated done comes along only once a generation. So we better get it right this time.

I think Hillary's new proposal is pretty damn good. I still think, have always thought, a Canadian-style single-payer system is the best way to go policy-wise, but that ain't happening absent a miracle, and Hilary's proposal is pretty sound policy-wise in terms of doing the things a health reform policy should do: it covers everybody, cuts costs and improves quality. And there's no one in the country who knows more about health policy than Clinton- she is pretty amazing in that regard.

Lux believes that this plan may work because it:

1. Emphasizes that if you like your health insurance you can keep it.
2. Keeps it simple to explain.
3. Buys off small businesses with no mandates to cover employees.

California Dems cave

Don McCanne has a good column at the California Progress Report on the foolishness of turning in your best cards before you even sit down at the negotiating table. In A Nunez-Schwarzenegger Compromise or Single Payer for California?, he writes,

in a classic example of political irony, Democrats are abandoning their preferred option, single payer reform, in order to reach a compromise with the Republicans and the private insurance industry. They have crafted a model that they believe does not repeat the mistake of the Massachusetts reform program. California Democrats proudly proclaim that they will not require individuals who cannot afford private insurance to be covered by a program that is being inappropriately characterized as universal.

It's sad stuff, in part because it's exactly the same — as 1993. It's like Groundhog Day for healthcare reform.

Not one Republican voted for this compromise, and Blue Cross of California is spending a couple million dollars in an advertising campaign opposing reform. So much for compromise. The Democrats have violated the first rule of negotiation. Before they even seriously sit down with the governor, they have removed from the table the most important polices that would bring comprehensive, affordable, high quality care to everyone.

McCanne notes that underinsurance is the fastest growing problem in U.S. healthcare. It's key in a brilliantly crafted scheme that the health insurance industry has put together. See, you don't usually know you're underinsured until you need your insurance. That happens to less than 10 percent of the insured in any given year. And so most people can be convinced that it was their own foolishness or bad luck, not part of a carefully designed plan in which their health is nothing more than collateral damage in the quest to create wealth for others.

Health insurance up again

The New York Times' health industry reporter Milt Freudenheim reported on the rise of health insurance costs last week. It's up "just" 6.1 percent, a bit less than three times the rate of inflation. It has brought the average cost of insurance for a family to $12,106. This is key:

Because doctor and hospital costs continue to rise at an even faster rate, the modest slowdown in insurance inflation mainly reflects cutbacks in coverage by many health plans, which have found ways to make employees pay more for their care. Industry experts said that without those measures, premium costs would have risen by 9 percent or more.

Kaiser's report includes results from a survey of private and public employers.

The article is a good source of factoids, including:

• Health costs have increased 78 percent since 2001, more than four times the pace of prices and wages.


• The 2007 increase was the smallest annual rise since 1999, when health premiums jumped 5.3 percent.


• Insurance company profit margins have been running at 6 percent to 7 percent.

Regarding health savings accounts, they found:

• 3.8 million workers are enrolled in HSAs. That's 5 percent.


• Almost one in five large employers currently offer some sort of health savings option.


• Only about half of the employers that offer HSAs contribute to their workers' plans.

Then there was this: "Kaiser did not try to project 2008 costs for health premiums. But research houses are forecasting increases for next year that include 6.7 percent by Mercer Health and Benefits; 9.9 percent by PricewaterhouseCoopers; 10.5 percent by the Segal Company; and 11 percent by AON Consulting."

I'd say Kaiser was right not to try to project. If the drumbeat for change keeps up, insurance companies will not raise rates much. Hell, they might even freeze the rate increases, eat some losses. Cost of doing business.

Colorado's fifth proposal for reform

The Denver Post's report on the latest 208 Commission news was as good as can be expected. Katy Human is a thoughtful reporter who does her homework.

According to Human, only seven commissioners voted against the commission coming up with their own proposal, including Mark Simon and Linda Gorman. The usual suspects, in other words.

The "208" commission suggested requiring individuals to purchase health insurance and banning insurance companies from rejecting sick applicants.

The group's latest proposal, which resembles the plan Massachusetts started last spring, would levy a tax penalty on anyone who didn't have insurance.

My favorite quote: "The solution is not giving more money to the insurance companies" said Mark Simon, an advocate for the disabled and former business owner on the panel.

There was a "what planet does she live on?" quote from Gorman: "What you are talking about doing is taking a functioning market and ruining it," said commission member Linda Gorman, senior fellow at the Independence Institute.

Let's see, you've got about 15 percent of Americans uninsured, an equal number underinsured, a quarter of Americans on Medicaid, Medicare, the VA, etc., millions of Americans forced into bankruptcy because of medical bills, annual cost increases that double to triple the cost of inflation and you call that a functioning market? Actually, of course it is a functioning market. It's just not a functional market. Another way of looking at this is the fact that government — aka your tax dollars — already pay for 60 percent of U.S. healthcare costs. You pay another big chunk straight out of your pocket. Health insurance pays for very little care compared to how much they take in. This "functioning market" adds nothing of value to the system, but rather only skims the cream off the top.

The Rocky Mountain News' article got the number of commissioners wrong (picky, picky, picky, but there never were 23 — there were 24 before Governor Ritter appointed three more, making 27) but the reporter also got a good quote from Simon: "I have an increasing level of discomfort . . . but I've got to say the solution is not to give more money to the insurance companies," Simon said. "That's outrageous."

HCAC members at the commission meeting report that early in the meeting Lewin went over some detailing on the SEIU proposal specific to their efforts to reduce costs and spread service for long-term care. The strategy results in damaging effects to vulnerable and disabled populations. It was in fact so onerous that it led to a heated exchange between commissioners and may have damaged the SEIU proposal.

However, the Commission is going full throttle towards subsidized mandates. The fight for U.S. reform, in fact, comes down to mandated private insurance vs. publicly-funded single-payer. People need to understand that their tax dollars will be going to private insurance companies through this scheme: mandates will be publicly funded and subsidized, in some cases up to 400% of FPL.

Barry Keene, HCAC's vice president, made a forceful public comment on this issue, telling the commissioners that they were becoming vulnerable to group think about enforced insurance mandates that the public was not going to accept. He noted that when he talks to people about this they're incredulous about mandates, with a uniform reaction of: "They wanna to do what?!? No way I'm going for that!"

But, Barry notes, Massachusetts voters went for mandates.

Mandates have become the default answer for mainstream health care policy thinkers, a way of assuring themselves that everybody is covered. Single-payer supporters must work hard to push Legislators away from this notion. Legislators need to be concerned about the public reaction to subsidizing insurance companies.

"Subsidizing insurance companies." When Barry put it that way to the Commission, reports are that some of them shifted uncomfortably in their seats. Mark Simon also used those words.

Christopher this morning asked me what value health insurance companies add to our healthcare system. What good are they?

If you invite them to the table....

John Edwards has this exactly right.

And it's the problem with his own health care reform proposal, which sure seems to keep the health insurance industry at the table.

His plan is, however, the best of the bunch from the three front runners.

Brookings sets up new healthcare thinktank

Former Bush Medicare director and commissioner of the FDA Mark McClellan will head Brookings' new Engelberg Center for Health Care Reform.

Whoowee.

McClellan is just the guy "to provide practical solutions for high-quality, innovative, and affordable health care."

You betcha. He's the guy, after all, who came up with Medicare Plan D, right? Otherwise known as "the doughnut hole"?

The Industry Veteran, a contributor to The Health Care Blog looked at a 2006 debate between McClellan and Uwe Reinhart:

I offer the following as a useful rule of thumb for THCB readers: whenever someone says more IT represents a principal solution to a better health care system, the red light should flash on one’s shit detector.

As uncle Marcus Aurelius advised, let’s return to first principles. Assuming THCB wishes to address the big issues and not turn into a blog for techie nerds, the problems of health care cost, quality and access in the U.S. result from some basic factors. The first of these is that there are too many middle men extracting too much profit (or, in Marshallian terms, too much economic rent) from the system. Among these, third-party payers are both pernicious and dispensable. Most analysts euphemistically classify payers and the efforts of other sectors to deal with them as “administrative costs.” It seems I’ve been seeing these administrative costs pegged at 25-30% of the health care bill for the past twenty years. Since Bush’s millenarian-oil junta has been running the country, I would guess that figure to be substantially higher because payments to providers have been tapering while premiums keep escalating. Given that the administrative costs for Medicare are approximately 2%, it appears self-evident that the current system, based on employers and insurance companies, should appeal only to Reagan-Bush types who consider the proper role of government to be one of handmaiden to business.

Envy of the World...

Thanks to SadbutTrue of Les Enragés for the heads up on this cartoon — and he found it at Josh Marshall's video site, Veracifier.

17-29-year-olds favor single-payer

The New York Times today reported that poll results show that 62 percent of young people between the ages of 17 and 29 prefer a single-payer system over what we now have. The question was explicit:

Which do you think would be better for the country: 1. Having one health insurance program covering all Americans that would be administered by the government and paid for by taxpayers, OR 2. Keeping the current system where many people get their insurance from private employers and some have no insurance.

Shame on the general public: only 47 percent answered single-payer. However, the conversation is just now starting.

You can read more about it at the New York Times and, once that's blocked, here, at the Scientific Activist. The Scientific Activist links to the pdf that gives the full results of the poll.

I'd give this one caveat. Young people have a dog in this fight. It's their future, and their children's future just as much as it is mine and all the retirees who founded Health Care for All Colorado. Young adults can be incredibly courageous, idealistic and smart. I can't think of a single social movement that succeeded without their leadership. That said, they can also be, ummm — scattered. Easily distracted. This has nothing to do with TV or video, it was ever thus.

College-age and other young adults must see that this is the anti-slavery battle of our time; the civil rights battle that will make America better. "SiCKO" will help.

Yes, Iraq is the Vietnam of our time, and Bushie is the Nixon of our era — but healthcare is the social justice issue that needs passion and persevereance to right.

War declared on Sicko

An editorial at Investor's Business Daily on Sicko and healthcare reform lays out a war strategy:

The Hillary Clinton-led forces that tried to socialize medicine in the U.S. 13 years ago are mobilizing for war. Stopping them requires knowing their strategy before the first shot is fired.

Michael Moore's new documentary, Sicko, which opens June 29, has been screened to the press, and it's powerful propaganda.

In it, America is a country where health insurers and hospitals kill people by denying coverage, make obscene profits charging outlandish sums for treatments and drugs, and even dump hapless, gown-clad patients who can't pay their bills on the doorsteps of other hospitals.

Meanwhile, Canada, Britain, France and even Cuba are portrayed as medical fairy wonderlands where doctors, hospitals and medicine are free or cost a pittance. Yet socialism doesn't prevent government-employed physicians from driving Audis or living in million-dollar homes.

Rep. John Conyers, the far-left Michigan Democrat, calls the Sicko release "one of the most important developments in the national debate on our health care crisis since the Clintons attempted to pass universal health care legislation in 1994."

Conyers and Rep. Dennis Kucinich, D-Ohio, are co-authors of legislation to have the government take over the health system and provide "enhanced Medicare for everyone." Sicko producers Harvey and Robert Weinstein have even hired ex-Clinton White House mudslinger Chris Lehane to use the movie as a flash point for organizing political rallies.

Like the bullet that slew Archduke Franz Ferdinand and sparked World War I, Sicko"may one day be looked back on as triggering the great health care war. The next president will likely end that conflict with the momentous decision of replacing our faulty employer-based health insurance system with a reform that empowers one of two interests: the government or patients.

No doubt about the sickness of a current U.S. system that "smothers competition," according to John Goodman, president of the National Center for Policy Analysis.

A Pennsylvania health care agency recently reported that the 60 hospitals performing heart-bypass surgery in that state showed little if any relationship between the price charged for the procedure — from less than $20,000 to nearly $100,000 — and quality of care or mortality rates.

Responding to the findings, Dr. Ronald Paulus, an executive with Geisinger Health System of central Pennsylvania, told the New York Times there's no current financial incentive in the present system for hospitals to provide care leading to better outcomes and lower payments.

Dr. David Gratzer, a Canadian physician, Manhattan Institute senior fellow and author of the new book "The Cure: How Capitalism Can Save Health Care," calls U.S. health care "an accidental system."

... "Federal subsidies enabled managed-care plans to attract customers by offering benefits that other insurers could not," said Regina Herzlinger, a Harvard Business School professor and author of the just-published "Who Killed Health Care?," which makes the case for a new consumer-driven health system.

Herzlinger added that "in its cruelest aspect," the Nixon-Kennedy HMO act "enabled physicians to be paid for not providing health care." The managed-care movement became, as she described it, "the worst kind of business — the kind that injures its customers."

... But is the answer socialism? Many Democrats think so. Chairing a health care panel in Poughkeepsie, N.Y., last month, freshman Rep. John Hall, D-N.Y., a supporter of government-provided single-payer universal coverage, dazzled the audience with a story of how his mother once fell on the steps of a restaurant in the Czech Republic and received a free operation and two free weeks in a hospital....

Herzlinger offers as a model for reform Switzerland's long-standing, market-based, consumer-driven health system. "Individuals in the Swiss system can safely and effectively buy insurance from a large number of competent firms," she said. Universal coverage is required and prices for consumers are not risk-adjusted.

"A sick 60-year-old man pays the same price for insurance as a healthy one," Herzlinger said.

In addition, the Swiss system directly subsidizes the poor. The overall result is that costs and inflation rates are 40% lower as a percentage of the economy than in the U.S....

Interesting. They like the Swiss system, the most expensive system other than our own.

The Swiss generally agree that their system needs major reform — but they've been assaulted by the same barrage of fear-based appeals to scare them off from single-payer that we have. But this is an interesting strategy on the part of the right — to promise a system like Switzerland's, which is indisputably better than ours. It's just not up to par with its neighbors in terms of equity or cost-effectiveness — and does not have better statistics on quality and outcomes.

The only problem with this strategy is that it's hard to imagine the insurance industry money really getting behind it. Switzerland's system depends on regulation that the insurance industry here would never agree to. There are far too many insurance CEO Marie Antoinettes who believe that the peasants can eat cake a while longer — at least until their own own golden parachute comes through.

Legislative malpractice

Two physicians, Eugene and Linda Farley (related by marriage, presumably) have a great lead in "Farley and Farley: Single-payer health care is just the right prescription" in the Madison, Wisconsin, Capital Times:

What if a doctor knowingly rejected a proven cure despite years of successful tests among diverse nations, a cost that is just half of the existing treatment and is hugely popular among patients who have experienced it?

Wouldn't that be a shameful lapse in medical ethics?

If so, how will we label those state legislators who appear afraid to seriously consider the Health Security Plan model of "an expanded and improved Medicare for all"? If legislators won't thoroughly debate a proven answer for our health crisis, wouldn't that be a cowardly case of "legislative malpractice"?

This piece could be applied word for word in Colorado, regarding the 208 Commission and Health Care for All Colorado's proposal here:

The Wisconsin [Colorado] proposal would make three key differences in our system:

1. A publicly accountable body would replace the rapacious "middleman" insurers in collecting revenues and paying benefits, thereby shrinking the enormous costs of insurance bureaucracy.

2. Citizens, not an HMO, would have the right to choose their doctor and their hospital. (Both doctors' practices and hospitals would remain in private hands.)

3. Every citizen of Wisconsin would have health care coverage.

Sadly, the first comment in response to this is incredibly ignorant. Insurance propagandists can pat themselves on the back for this one. Purplepenguin writes: "People are already using our current insurance-system to call out for bans on doughnuts & smoking. If this sort of thing is passed, that will only get worse..... Sorry...as good as it sounds, it's not worth the trade-off in freedoms."

Right. Just like smoking and pastries have been banned in all the countries now offering their citizens single-payer, universal healthcare. Right.

Christianized medicine

Donna Smith, who appears in Michael Moore's new film Sicko and who is very much a Christian, sent along these quotes from the end of a story in the Detroit News.

"This film comes from a spiritual place," Moore says, "so I wanted to go to the headquarters of the sisters who taught me in my early years. They had a profound impact on me."

The idea that it's about "the we, not the me," came from the nuns. "Instead of calling it 'socialized medicine,' it should be called 'Christianized medicine.'"

"This was one of the ground rules that was laid down by Jesus. He said, 'I'm going to ask you a bunch of questions when you get to the pearly gates. When I was hungry did you feed me? When I was homeless, did you give me shelter? When I was sick, did you take care of me? And if you didn't do these things, and you didn't do these for the least of my people, then I'm going to have to say that you can't come in the big house.'"

Michael, according to Maryknoll Father Charlie Dittmeier, is probably a Matthew 25 Christian — a verrry different species than a Matthew 28 Christian.

Here's the difference:

In Matthew 25:31-46, Jesus told his disciples that those who fed the hungry and gave water to the thirsty, those who clothed the naked and visited the sick or in prison will go to heaven. “I tell you the truth, whatever you did to one of the least of these brothers of mine, you did to me,” said Jesus.

Those who don't will go to hell: “Depart from me, you who are cursed,” he begins. “… I was a stranger, and you did not invite me in, I needed clothes, and you did not clothe me, I was sick and in prison and you did not look after me.”

Now Matthew 28: “Go, therefore, and make disciples of all nations, baptizing them in the name of the Father, and of the Son, and of the Holy Spirit, teaching them to observe all that I have commanded you.”

















I wrote last year in the Catholic Sentinel about what a difference that makes in real life:

PHNOM PENH, Cambodia — The middle-aged woman waiting for a connecting flight is an Evangelical Christian, proud of what her church is doing in Cambodia. There is an orphanage for 30 children and a school for more than 200. But most important, they were building churches so fast that she couldn’t keep track of them: A dozen just this year.

The Catholic Church, she said, doesn’t have much of a presence in Cambodia.

How about Catholic Relief Services, Caritas, the Jesuits, the Maryknollers, the PIME fathers and all the other Catholic NGOs and orders?

She shook her head. “All they do is help people,” she said. “They’re not really spreading the Good News.”

Bless that woman for giving me such a great lead.

That great photo, by the way, is from Rick D'Elia, who has recently emailed from Rwanda.