Second Amendment Health Care

Richard Verone had a growth in his chest, ruptured disks, and no health care. Typical 59-year-old American. Not the majority, but typical. He figured his care might take three years. So he robbed a bank.

Not so that he could get the cash to go to India for care, or to buy into the expensive insurance for folks with pre-existing conditions. Both of those options might cost more than the bank even had on hand, and besides, someone might get hurt. Think it through: all kinds of things could go wrong. Just the time in jail would do it, he figured. So he handed a note to the teller that demanded $1. The note said he was armed. Then he sat down and waited for the police.

The fly in the ointment is that, according to news reports, he's very likely to get just 12 months, not three years. He wasn't carrying a gun, so it's a lesser charge. Kind of unAmerican of him, now that I think about it. What - he's not in favor of the Second Amendment?

Geography & healthcare

Consumer Reports has published an article on the Dartmouth Atlas of Health Care - a wonderful thing. Consumer Reports is really on a tear about healthcare, and this article provides our friends and neighbors information about a big part of what's wrong with U.S. healthcare.

Because physicians are paid on a fee-for-procedure, cost-plus basis, the incentives are to do more procedures, rather than just the right procedures. Physicians and nurses are generally ethical people, but they're just human. Add the need to pay for that MRI machine to the old lady's son insisting on "Do whatever's necessary, doc," and you end up with unnecessarily aggressive treatments - something proven out by the crazy regional differences on how many procedures patients are getting some places - without better outcomes.

Geography and health care
The amount of medical care that people get for serious illnesses varies enormously from place to place. In the last two years of life, the average patient spent 11 days in the hospital in Bend, Ore., and 35 days in Manhattan. In those same two years, patients visited the doctor an average of 34 times in Ogden, Utah, and 109 times in Los Angeles.

The Dartmouth Atlas based those findings on the Medicare claims records of millions of patients who died from (in order of prevalence) congestive heart failure, chronic pulmonary (lung) disease, cancer, dementia, coronary artery disease, chronic kidney failure, peripheral vascular (circulatory) disease, diabetes with organ damage, and severe chronic liver disease. Together those ailments account for about 90 percent of deaths of people older than 65.

Over the years, Dartmouth research has yielded some startling insights:

• The local supply of doctors and hospitals has more influence on the amount and type of care that patients receive than their actual medical conditions have. The more medical resources a region has, the more aggressive the treatments are.
• In the regions that deliver the most care, patients have a slightly higher death rate than patients with the same conditions treated in areas that treat less aggressively.
• Patients treated most aggressively are no more satisfied with their care.
• The cost differences are vast. Average Medicare spending over the last two years of life for all hospitals ranged from a high of $81,143 in Manhattan to a low of $29,116 in Dubuque, Iowa.

So the Dartmouth folks are big on best practices, as are other medical systems that keep down healthcare costs - and simultaneously maintain good access. (Note in the Consumer Reports' articles that "Patients in the high-spending, aggressive-care regions waited longer in emergency rooms and doctors' offices than patients in lower-spending regions did.")

Linda Gorman, from the libertarian Independence Institute and a commissioner on Colorado's Blue Ribbon Commission for Health Care Reform, was always vehemently against "best practices." She argued that the science was too soft, that it was subjective, that by God if a patient wants bad care then it's their right to get it - or something along those lines.

These are folks who also consider the science behind global warming to be a bunch of hooey. I don't know whether they also think the moon landing was a hoax.

Part of progress - and survival - comes from measuring cause and effects and paying attention to the answers. Dartmouth has come up with some pretty good answers here - information that's important whether we get a healthcare system or remain stuck with laissez-faire, for-profit healthcare. If we had a healthcare system, we could move more quickly and surely with this information towards more efficient and humane standards. Until that day, we'll muddle through and probably get partway there. Or not.

Commonwealth's proposal

Commonwealth Fund's principal researchers and president have authored an article for Health Affairs with Lewin Group modeling that shows a path to dramatically improving U.S. healthcare. It seems far superior to the flawed Wyden plan.

Health Affairs has a firewall, but you can see a synopsis of the plan at Commonwealth Fund or at Medical News Today.

Here are the basics, from Medical News:

• A national entity known as a "connector" that would offer individuals and small businesses a choice of private plans or a Medicare Extra plan.
  
• Requiring that all applicants be given health insurance at standardized rates regardless of their health status.
  
• Tax credits to make sure premiums are affordable. Premium assistance would be available to all to ensure that premiums do not exceed 5 percent of income and 10 percent of income for higher-income tax filers.
  
• Expanding Medicaid and SCHIP to cover all low-income adults and children below 150 percent of the federal poverty level with modest copayments for health care services and no premiums.
  
• Requiring that everyone enroll in a health insurance plan-uninsured individuals who file taxes would be automatically enrolled.
  
• Requiring employers to either provide health insurance or pay 7 percent of payroll up to $1.25 an hour into a pool to help to finance coverage.
  
• Medicare reforms that would extend Medicare Extra benefits to current Medicare beneficiaries, eliminate the two-year waiting period for Medicare for the disabled, and allow adults age 60 or older to buy in to Medicare.

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.

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.

Kuehl's single-payer bill passes in CA

This is big news. Senator Sheila Kuehl's single-payer bill, SB840, for California passed the California Legislature on June 6. The vote was 22 to 14, with only Democratic votes in support and 13 Republicans plus Democratic State Senator Lou Correa voting against the measure. This story from KPBS gives positive but brief and balanced coverage:

The State Senate has approved a measure that would create a single-payer, universal healthcare system in California. Critics call it socialized medicine, but supporters say it’s the gold standard for healthcare reform. KPBS reporter Kenny Goldberg has more.

Under the single-payer system, all private and public money currently spent on health insurance would be pooled. The state would use that money to run one healthcare plan for all Californians.

Donna Gerber is with the California Nurses Association. She says a single-payer system would be run like Medicare.

Gerber: It leaves the private hospital and doctor and other providers in place -- it simply takes the insurance industry out, which also in the process saves 30 percent of every healthcare dollar.

Governor Schwarzenegger doesn’t like the idea. He vetoed a similar measure last year, and says he’ll do the same thing if the bill hits his desk again.

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.

Colorado woman's cameo in Sicko

Donna Smith, a journalist faced with crippling healthcare costs despite being insured, was one of eight Americans who traveled with Michael Moore to Cuba in March for treatment there. Moore filmed the trip for his documentary Sicko, which opens later this month. Donna writes movingly about the experience at Huffington Post and at Healthcare Now.

At Moore's site, there's this introduction to Smith in an AP story about the recent New York screening of Sicko. "Donna Smith, in from Denver with her husband, Larry, was in tears when she spoke. The film opens with their painful story: Plagued with health problems, they were forced to sell their home and move into the storage room of their daughter's house because they couldn't cope with health costs, even though they were insured.

"'Health care is an embarrassment to our nation,' Donna told Moore. 'You give dignity to every American in this film.'"

At the heart of Donna's story is the psychic trauma that our healthcare system inflicts on people like her — people, she says, "who play by the rules" (she's always had health insurance) but are still victimized by our system. From the Healthcare Now piece:

As I walked to where I would stay in the hospital [in Cuba] for my evaluation, I felt something deeply painful beginning to surface. I felt my gut tighten and even a stab of pain in my chest as I flashed over all the incidents of the past 20 years when I struggled to get health care and when I was made to feel disgusting. My brain swirled with images of payment plans (some signed literally at surgical bedside), applications for community benefits, rising health insurance deductions, angry health providers dunning us for small balances not covered by insurance (though many had been paid thousands already), and countless other humiliations in spite of the fact that I had never allowed my family to go without health insurance...

Over the next few days, I began to absorb the healing power of this form of medicine. Just the knowledge that each human being is valuable, that each life is sacred and worthy, began to heal so much of the sickness of my spirit that also caused some of the sickness of my body. And so my journey into a new life was started. For perhaps the first time in my life, I felt that my Creator had given a glimpse of unconditional love and peace.

Donna is articulate and passionate about this issue — she knows first hand that our system is so unjust that it's fair to call it barbaric. It certainly has no relationship to the Christianity that Americans think of as guiding this country.

I always find myself admiring people like Donna for sticking with their faith despite the evidence arrayed against it — mostly evidence about how miserably most individual "Christians" and "Christian nations" fail to live up to their ideals. She's right there with Bill Moyers in terms of being a better example of what a Christian should be.

Donna's bout with cancer together with her husband's many medical problems forced the two to leave South Dakota, where she had edited a small daily newspaper. She's in suburban Denver now, still struggling with healthcare costs — although in better shape than she had been before Cuba.

I spoke with her tonight, and she says that she arrived in Cuba on nine medications, and left on only four — and feeling much better.

One of the meds she's still dependent on is an asthma inhaler costing $175 — each. Her insurance will pay for it — after she spends enough to cover her deductible. The Smiths' real worries, however, are regarding her husband, Larry, who was too ill to travel safely to Cuba. Donna said that her sense that it should have been Larry there getting treatment was the hard part of her trip to Cuba.

And Moore's fact-checkers. They were tough to take as well. Contrary to mainstream media's depiction of Moore being more interested in telling a good story than he is in sticking to the facts, Donna said that his staff was relentless when it came to insisting on documentation for everything that she and Larry told them about their story.

I'm sorry that the Smiths have had their lives turned upside down by the idiocies of our system. I'm thankful that she's taking this experience and speaking out to make the world a better place. "God gave us brains so we could use them," she told me tonight.

Hope so.

Obama plays it safe

Obama came out with his healthcare plan yesterday — and it wasn't single-payer.

Counterpunch's Corporate Crime Reporter explained why back in February:

The majority of the American people want a single-payer health care system ­ Medicare for all.

The majority of doctors want it. A good chunk of hospital CEOs want it. But what they want doesn't appear to matter.

Why?

Because a single-payer health care plan would mean the death of the private health insurance industry and reduced profits for the pharmaceutical industry.

Presidential candidates John Edwards, Barack Obama, Hillary Clinton, and Mitt Romney and California Governor Arnold Schwarzenegger talk a lot about universal health care.

But not one of them advocates for single-payer ­ because single-payer too directly confronts the big corporate interests profiting off the miserable health care system we are currently saddled with.

Take a look at that entire Counterpunch article, which interviews Dr. Steffie Woolhandler of PNHP.

Back to the present, Edwards estimates his plan would cost $90 billion to $120 billion; Obama figures $50-$65 billion for his. (A nice chunk of protection cash either way for the various powerful insurance families. The Gambinos themselves couldn't have done better.) Obama's plan, like Edwards, includes unspecified employer contributions, cost-saving measures, and specifically coverage for all children. Edwards' plan mandates that individuals have insurance; Obama's doesn't.

Speaking of the families, in particular the bosses, this wouldn't be a complete win. Both Edwards and Obama would pay the insurance families in part by getting rid of some of Bush's tax cuts for the wealthy.

As for the other candidates, Senator Christopher Dodd, who sold out to the insurance industry back in the 1990s, and Governor Bill Richardson also like mandates. Alaska Mike Gravel likes vouchers — which could be single-payer. Sen. Joseph Biden is the most timid. He'd insure children — an increasing number of them orphans and paupers as parents have a harder and harder time covering themselves. Sen. Hillary Clinton also talks a lot about children. She hasn't shown us her cards yet, but she has promised to reduce the power of insurance companies and to computerize medical records — a good start.

Rep. Dennis Kucinich is of course unabashedly for single-payer. He'd pay for it with income and payroll taxes, and a tax on stock and bond transactions.

Kevin Drum doesn't think much of Obama's plan. "Obama's voting record shows him to be, possibly, the most liberal of the three main Democratic candidates. But his record also shows him to be a very cautious liberal. This is not necessarily a bad thing: the time he's spent in the trenches doing community organizing and then as a state legislator seems to have taught him that there are no easy answers; that political coalitions are hard to build; and that real progress often requires a slow but steady approach. He may even be right about that. Certainly I'm no revolutionary myself. Still, sometimes audacity requires audacity. Hope isn't always enough."

Ezra Klein explains the plan, which includes a new regulatory agency called the National health Insurance Exchange — which would both regulate the insurance industry and administer a new public insurance program:

...That's a big deal — one of the real tests of seriousness for the new plans is whether they create a public insurance program, and Obama's does. Unlike Edwards' and Jacob Hacker's plans, he doesn't use Medicare as the basis for the program, but instead creates an entirely new public insurer.

Here's the catch: The Obama plan does not set the public and private plans in competition with each other, as the Edwards plan does. Rather, the best way to think of it is as a two-track plan. The first track extends the new public program to the self-employed, small businesses, and the uninsured. In other words, the public plan is open to those who are currently disadvantaged in the insurance market — it is not a new insurance market unto itself. That said, if it proves popular and effective, it would be trivial to expand it in the future, letting all businesses, or all individuals, buy in.

The second track is a restructured insurance market. Participating insurers ... will have to offer minimum benefits, spend a certain portion of their budget on patient care (rather than profits and advertising), be barred from discriminating on health history, and be forced to justify large premium increases. Employers will have to either pay into this market, or pay into the national plan.

...The Obama campaign's decision to omit a mandate is a puzzling one, both from a policy perspective -- you want the largest possible risk pool -- and a political one. His plan, unlike others, is not truly universal, it's simply possibly universal.

RJ Eskow predictably puts down criticism of incremental plans that funnel tax money to the private insurance market:

Rose Ann De Moro, for example, has done terrific work as leader of the California Nurses Association. But she drips with contempt for anything less than immediate single-payer reform. Barack Obama is "rearranging deck chairs on the Titanic," she writes. Really? Someone who receives coverage for the first time under the Obama plan, or who gets better care, might feel more like they'd been rescued from a shipwreck. The John Edwards plan, which forces private insurers to compete with a public program, would lead inevitably to single payer unless private insurers could offer something else that some part of the public might want. Nevertheless, to Ms. De Moro the Edwards plan is a "soggy mix and match."

"Edwards does deserve some credit for proposing that at least one plan in each health market be a public program based on Medicare," she writes. "But, if a public program, as he implies, is more likely to assure affordable alternatives to the private insurance model, why get off in Chicago when your plane is going to New York?" Here's why: If the plane doesn't have enough fuel to get to New York, you stop off in Chicago. If some passengers want to get off there, that's fine too. But Ms. De Moro, like other single-payer absolutists, gives this aspect of the Edwards plan only a passing glance before dismissing him by saying he "should go back to being a populist."

Eskow claims he'd switch our system in a heartbeat for Britain's — but, since that won't work, he's for the incremental steps. Which is a bit of a self-fulfilling prophesy...

MSNBC rounds up of mainstream coverage of Obama's announcement. Here is the quote there from the LAT: "Like the other top Democratic presidential contenders, he rejects the left's growing support for a government-run, single-payer healthcare system. Instead, he proposes to reinforce the existing system, under which the vast majority of Americans receive coverage either through their employers or through government programs such as Medicare and Medicaid."

Rationing care

I heard a story yesterday that renews my belief that so many Americans have been affected by the slow-motion disaster of our current healthcare system that we will be able to change it.

I was at the Denver Conference on Homelessness, handing out brochures and talking with people about single-payer financed healthcare. I was with a sharp, intelligent and lively Health Care for All Colorado volunteer, Ruth Gilbert. It was Ruth's 84th birthday.

We heard about homelessness from the people with whom we shared a lunch table, and we told them about the need for universal healthcare. As if they didn't know.

One of the women at the table had lived in Britain for a time. She spoke with awe and respect for their system.

Another women at the table then spoke up. She said her 30-year-old daughter had been diagnosed with Hodgkins Disease — cancer that starts in the lymphatic tissue. The ill daughter missed a lot of work during the course of her treatment and lost her job.

When the daughter lost her job, she lost her insurance. And here her mother stumbled a bit in the telling — her family had been under a lot of stress with the illness, and they hadn't managed to do what, perhaps, might have been done so that the ill woman's coverage could have continued. Perhaps.

So should that be a death sentence? Add into your consideration the fact that the daughter has three children. She completed her chemo, but not her radiation.

We are the wealthiest country in the world. Should this woman's children be motherless because their mother cannot pay for cancer treatment? Should scrambling for a way to pay for treatment, should the humiliation of losing her job and not being able to pay, should potential bankruptcy — hell, potential homelessness — be a part of her reality now? How might that stress be affecting her chances for survival?

How is depending on charity in a situation like this, rather than according this woman and her family the dignity of healthcare justice, a conservative or American value?

Sicko at Cannes and HCAC on KRFC

Tomorrow night's "Imagine Action" program, 6 - 7 p.m. on Fort Collin’s KRFC (88.9 FM or online here), will focus on health care reform. Guests will be Health Care for All Colorado and Physicians for a National Health Program member Dr. Cory Carroll, a local family practitioner and president of the Larimer County Medical Society; Rudy Deutschmann, president of the State Association of Health Underwriters; and HCAC board member Eliza Carney, who will discuss the 208 Commission and the political process around health care reform.

The call-in number is 970-221-5065.

In more international single-payer news, take a look at Salon’s feature article on Michael Moore’s new film Sicko. It will do your heart good.

Author Andrew O’Hehir writes that Sicko is

both a more finely calibrated film and one with more far-reaching consequences than any he's made before. Moore is trying to rouse Americans to action on an issue most of us agree about, at least superficially. You may know people who will still defend the Iraq war (although they're less and less eager to talk about it). But who do you know who will defend the current method of healthcare delivery, administered by insurance companies whose central task is to minimize cost and maximize shareholder return? Americans of many different political stripes would probably share Moore's conclusions at the press conference: ‘It's wrong and it's immoral. We have to take the profit motive out of healthcare. It's as simple as that.’

Sicko purposefully does not focus on the 50 million or so Americans who don't have health insurance, as scandalous as that is, but on the horror stories of middle-class working folks who believed they were adequately covered. There are so many of these they begin to blur into each other: the woman in Los Angeles whose baby was denied treatment at an emergency room outside her HMO network, and died as it was being transferred hours later; the woman in Kansas City whose husband was repeatedly denied various drugs his physician prescribed for kidney cancer, and who in the last stage of life was denied a bone-marrow transplant that could have saved his life; the woman who was told her brain tumor was not a life-threatening illness, and died; the woman who was told her cancer must have been a preexisting condition, and died.

If the Salon article whetted your appetite for more reviews, here’s one from The Guardian:

His question: what has happened to the idea of universal healthcare in the United States?

In four tidy acts, Michael Moore spells out the facts. Act one: 50 million Americans have no health cover, and 250 million who think they do, through costly health insurance schemes ($2,000 per person a year), are often denied treatment when they need it….

Act two: when did it all start going wrong, asks Moore. The answer: in August 1971. President Richard Nixon and his adviser Edgar Kaiser plot to break the system. "The less care they give, the more money they make," says Nixon, caught on tape….

Meanwhile astute national publicity campaigns have demonised the concept of universal healthcare by associating it with "socialised medicine", which in American English translates as "Soviet medicine" - the kind such oppressive regimes as Canada, Britain and France have adopted for their citizens….

Act three: Moore pays these regimes a visit….

Act four, the most powerful: Moore decides to test the US administration's claim that Guantánamo Bay prisoners get the best free healthcare in the world. He takes 9/11 volunteer rescue workers, whose health problems were not covered by the state because they weren't on its payroll when they ran to help, to Guantánamo Bay in Cuba….

And lastly, the news, also in The Guardian, that the U.S. government is trying to impound Moore's film – a claim that’s hard to dismiss considering everything else in our country’s recent past. “Now, according to movie mogul Harvey Weinstein, whose Weinstein Company is behind the film, the US government is attempting to impound the negative.”

The pretext would be Cuba. Moore had applied for permission to travel there but received no reply until this month, when “the treasury department notified Moore that it was investigating him for unlicensed travel to Cuba.

Watch a trailer for Sicko and more on Moore's website.

Understanding healthcare financing

I've been waking up mornings thinking about this powerpoint slide from AMSA. Except I didn't remember it was from AMSA — the American Medical Student Association, a strong supporter of single-payer.

Check out their powerpoint presentation page, and click on "Overview of the U.S. Healthcare System" for the powerpoint source for this slide -- and it's far better seen that way.

Note the arrow that goes to individuals/businesses from the government — that's the $100 billion in tax subsidies for employer-based insurance. Employees, through those subsidies, receive health benefits as a tax-free compensation, and employers can deduct the cost of the benefits because they're a cost of doing business.

Also note the government payments to private insurers — for the health benefits of millions of public employees and their families. The subsidies and the payments to private insurers are two elements of government funding that often get left out of people's conception of what the government pays for.

Now see how easy it would be to just eliminate the "private insurers" element of the diagram. Just erase it — so that the arrow coming from individuals/businesses went to the government instead. Much simpler diagram, eh?

That's what single-payer would look like.

One size does fit all

We now know part of the health insurance industry's talking points regarding what's the matter with U.S. healthcare: It's that one size doesn't fit all when it comes to health insurance.

What a crock.

How does one size not fit all? Which one of us doesn't want care when we're sick or injured? This was the answer that the journalist bought in the New York Magazine article on "the young invincibles" and here's a reporter for the Indy Star giving a platform to Wellpoint to make the same point.

Jude Thompson, president of individual markets for WellPoint, the nation's largest health insurer, said the traditional one-size-fits-all approach to marketing insurance no longer works.
"That's one of the big reasons why we're where we are today with the uninsured," he said. "Companies need to change the way they are talking about insurance and offer different products with different price points. We need products that resonate with the different age and income groups and hit the mark with people who can and want to purchase insurance."

What Jude is talking about, of course, is actually "the choice" to pay less for a higher deductible and catastrophic coverage only — which hardly makes insurance more cost effective. It's still "playing the odds," just as people without insurance do. It still essentially takes people out of the risk pool, meaning that someone with a chronic condition who needs care will certainly be left in a market where that care is unaffordable — unless the government picks it up.

And that is OF COURSE the end game for the health insurance industry. They'll insure all the healthy people, and the government can take care of all the sick people. What a deal.

Don McCanne, former president of Physicians for a National Health Program, had a good post on this today. Sign up for those posts through this link from the PNHP website.

Blackout on the truth

The National Education Association supports single-payer, universal healthcare. Who knew?

And that's the point. We didn't know. The media has effected such an effective blackout on single-payer that it seems like a silly, socialist, pie-in-the-sky idea. Then you dig in a bit and find out that the former head of Caterpillar has said single-payer's what we need, it's the only thing that makes sense; you find out that Ford Motors' former CEO has said much the same thing; that the nurses associations are for it and that the NEA backs single-payer.

But common wisdom still would have it that anyone who thinks single-payer is the solution to our healthcare Catch-22s is unrealistic — when in fact it's unrealistic to think that anything other than single-payer will contain costs and provide healthcare justice.

That doesn't mean that rich people don't get more healthcare under single-payer systems. That's just life. Rich people will always get more. As it turns out, however, more isn't always better. Too bad for them. No doubt when they figure out how to stay young for 50 extra years it won't be covered. That's fine — we're just looking for a normal life-span, like not dying at age 45.

I talked with a woman (we'll call her Julie) from Pueblo, Colorado, tonight. Julie's worried sick about her mother's health. Her dad gets health insurance through the government because he's disabled. He makes $7 and some change an hour. Julie says her mother's salary always supported the family, and that her mom has always gotten her own healthcare through a clinic for the indigent. Now Julie doesn't know what to do, because her mother is sick. Julie herself is a single parent, a junior in college on a scholarship that doesn't pay for her mother's healthcare.

Julie says that politicians keep talking about covering the kids. Good, she says, but it's not enough. "What are people supposed to do between the ages of 18 and 65?"

Julie says that she's heard the horror stories about people having to wait for surgery in countries that have healthcare justice, but that she's talked with people from Britain and elsewhere, who tell her it's not like that at all. "They say it's us that have the crazy system."

Ezra on patient incentives

Maggie Mahar wrote yesterday on perverse incentives for physicians that drive up costs; Ezra Klein writes today in American Prospect about perverse incentives for patients.

This again offers Bush & co. an opportunity to take real facts and twist them so they'll become ammunition for their class warfare against the middle class. C'est la vie, I suppose. Iron can be used for good — plowshares, say — as well as being potential death dealers as swords. We shouldn't turn our backs on the stuff.

Klein writes that RAND's 15-year study showed that "gold-plated" healthcare coverage that gave 40 percent more care than basic coverage offered no better outcomes.

This is actually an argument in favor of single-payer. Denver Dave of HC Talk has mused that the average person, when thinking about single-payer, pictures U.S. healthcare being a finite entity that he or she has a part of through his or her insurance. If we split the pie differently in order to give some of that healthcare to people who have none now, that seems to mean that he or she would have less.

The RAND study shows that less can be better. What's more, the study also showed this: "The only exception was for the poor, whose health outcomes were hurt by cost-sharing and improved by more generous plans."

Further showing that denying healthcare to the poor (and increasingly to the middle class) is foolish, Klein links to this:

The New England Journal of Medicine... compared Medicare patients who faced heavy cost-sharing for pharmaceuticals with those who had nearly unlimited benefits. The seniors with cost-sharing cut back on pharmaceutical spending (and thus, use) by about 31 percent. The results? More visits to the emergency room, more hospitalizations, and higher rates of death. And the upshot of all this is that the costs incurred by the deterioration in health completely erased the savings from the cost-sharing.

Klein agrees with cost-sharing by patients except for chronic conditions where generous care has been proven to pay for itself and more.

"One-size-fits-all high deductible policies associated with Health Savings Accounts (HSAs) require costly tax breaks for the most affluent while unnecessarily increasing financial and health risks for low- and moderate-income families," Klein writes. He instead likes a plan from his favorite economist, Jason Furman at the Hamilton Project, who has come up with a system that he claims could save 30 percent immediately by charging co-pays adjusted by income.

Of course the only realistic way to do that would be through a single-payer system.

TPMCafe with more single-payer

Maggie Mahar's post at TPMCafe kept me up until 1 in the morning last night, reading it and all its links.

I decided to buy her book on the spot — Money-Driven Medicine is a great deal for $8 at Amazon. Here's how she begins the TPM piece:

I understand why some believe that radical reform is politically impossible. But they remind me of those who said that we could never pass Medicare. Eventually, the pain became too great. Too many seniors could not afford care, and popular support trumped the then-powerful AMA. In 1962, Gallup polls showed public support at 69% and President Kennedy called for Medicare in front of crowd of 20,000 in Madison Square Garden.

Still, it wasn’t easy.

After Kennedy’s speech, the Medicare bill was defeated 52-48. This did not stop the Democrats—they understood what was at stake. They knew that the opposition would be fierce, but they also understood that this was like civil rights. It was not a time for caution. It was a time for politicians who cared about issues....

Great stuff.

Mahar seems to say, however, that even if we did institute a single-payer system that costs could still be out of control unless we fixed provider reimbursement: "The most honest physicians admit that in our system, over-treatment is driving healthcare inflation."

This sounds like the conservative argument that overuse is the problem, but in fact overtreatment and overuse are different creatures — although they're both created by the perverse incentives of our current system's for-profit market structure. Both would be most easily rectified via a single-payer system.

She criticizes fee-for-service — which seems to be a sacrosanct part of the single-payer deal for many physicians who support reform.

To support her position, Mahar links to a wonderful piece she did for Dartmouth Medicine Online about their research on costs.

In study after study, the Dartmouth team has shown that Medicare spends twice as much, per patient, in some regions of the country than in others--for reasons that have absolutely nothing to do with medical science, the severity of the patient’s illness, or even his or her preferences.

What’s driving the higher costs? Supply.

“Build the beds and they will come.”

Based on their research, the Dartmouth team estimates that one out of three of our health care dollars are squandered on redundant tests, unnecessary hospitalizations, unproven bleeding-edge procedures and over-priced new drugs and devices that are no better than the products that they have replaced.

Some hospitals spend two-and-a-half times what others do, without better outcomes. In fact, outcomes are worse.

Both pieces are thought-provoking. Single-payer will only be part of reining in costs. If we have single-payer and continue pharmaceutical advertising, or single-payer Plan D, shackling government's ability to negotiate for better costs, or single-payer with physicians still over-utilizing questionable pharmaceuticals, lab tests, technology, etc. — we'll still have problems. Other countries are so far ahead of us on all of this.

One way to pay for single-payer

The McKinsey Report suggests that savings would be greater than this pie chart shows.

In Ohio, they're proposing a payroll tax increase — but only by eliminating the $90,000 cap. They'd collect it on all payroll income, plus a 5 percent surcharge on income earned beyond $200,000.

They would also have an employer tax of up to 3 percent and an income tax increase of up to 3 percent — depending on what costs actually were. Because despite all the modeling, we don't know how much we'd save by eliminating the gross inefficiencies of our current system. It might be just 1 percent in both catagories.

I've seen another model recently that showed that if a person made more than $200,000 a year they'd pay more for healthcare under that single-payer system. Everyone else would pay less.

Which would you prefer: People who earn $250,000 a year paying perhaps $4,000 more annually for healthcare, or people dying because they can't afford it at all?