Cost doesn't equal quality

The renowned education author Jonathan Kozol tells a story about money and education.

The inner boroughs of New York City spent $8,000 or so per student (more now). The outer boroughs about $12,000. The really tony enclaves spent $24,000 per student. At Andover, where Bush went to school, it's $40,000.

When Kozol's conservative friends told him that the answer to our education crisis wasn't to simply throw money at the problem, he liked to reply, "Why not? It works for your kids..."

(I think we can all imagine where Bush might be today - also a federal facility - if he'd gone to an underfunded school in New Orleans or D.C.)

The impact of cost on health care outcomes is different. The rigorous Dartmouth Atlas of Health Care has shown that spending doesn't necessarily correlate with outcome. Now a survey of Medicare beneficiaries released this week in JAMA "suggests that more regional spending on medical care does not improve patients' perception of the medical care they receive..."

The researchers found that per capita expenditures were highly related to receiving more medical care, such as average number of ambulatory visits to physicians in the past year and more cardiac tests (respondents reporting receiving tests in past year, 40.1 percent [lowest average expenditures quintile] to 63.5 percent [highest average expenditures quintile]). However, 7 of the 10 measures of perceived quality, including perceived unmet needs for tests and treatment (respondents reporting unmet needs, 3.9 percent to 5.0 percent) and spending enough time with physicians (respondents reporting adequate time, 88.7 percent to 87.0 percent), were unrelated to expenditures, while the overall rating of perceived quality of care was higher in the lower-expenditure areas (respondents reporting overall care rating of 9 or 10, 63.3 percent to 55.4 percent).

Coincidence? I think not...

There's an unintentionally funny post at a blog I stumbled over this a.m. regarding Scott McClellan's new book, What Happened. The guy saw a correlation between Bush's falling approval ratings and Scott McClellan's competence as a press secretary. (As if the Bush administration would put an incompetent in a position of importance because of cronyism....) "Even Tony Snow couldn’t reverse the trend," this person wrote.

Somehow I think White House won't go with that. Looks like they've settled on disgruntled former employee sells out for book advance - same as McClellan himself used on Richard Clarke.

A bit of basic logic at Wikpedia gives some other examples of "Correlation does not imply causation":

The more firemen fighting a fire, the more damage there is going to be.
Therefore firemen cause damage.


With a decrease in the number of pirates we have seen an increase in global warming over the same time period.
Therefore, global warming is caused by a lack of pirates.


Since the 1950s, both the atmospheric CO2 level and crime levels have increased sharply.
Hence, atmospheric CO2 causes crime.

Put a Doctor in the House!

Rocky White, M.D., has a website up regarding his run for Colorado House District 62. Rocky's website looks great - single-payer-financed healthcare is front and center. He writes:

I believe in a single risk pool for everyone in Colorado so that everyone shares in the expense of our health care system according to their ability to pay. I believe that every resident should have equal access to a defined benefits package that ensures a minimum standard of health and welfare for all. I believe that everyone should have a certain degree of personal responsibility for their own health care and that the burden of health care financing should not rest exclusively on the back of business.

The transcript from Amy Goodman's show with Rocky is at Alternet, titled, "Evangelical Doctor Touts Better Health Care Plan Than Clinton, Obama."

Rocky got a brief mention in the Denver Post article on the Democratic State Convention:

One of the few surprises of the weekend was the upset of Rep. Rafael Gallegos, D-Antonito, who was seeking a third term in the House.

Gallegos' own District 62 assembly swept him out, picking Rocky White, a doctor from Alamosa, to be on the ballot. The district covers eight counties in south-central Colorado in an area that includes the San Luis Valley.

White attributed his victory to being well-known in the valley and "just campaigning like crazy."

Gallegos, who received 14 votes, and Ed Vigil, another candidate seeking the seat who received 12 votes, can still petition to get on the ballot.

What ever happened to states' rights?

The Republicans have been so amazingly nimble politically from - what would you say? - 1995 to 2005? - that books will be written a hundred years from now on what they wrought during this crucial time. If, of course, their anti-family-planning, anti-environmental, pro-sprawl, pro-greed, you're-on-your-own polarizing policies haven't precluded publishing.

A NYT opinion piece on states rights offers a chapter of examples on how the right wing, that mighty protector of states rights, has been studiously and quietly stripping the states of their right to protect their citizens.

In February, the day after his infamous encounter at Washington’s Mayflower Hotel, Eliot Spitzer, then the governor of New York, published a remarkable opinion piece in The Washington Post.

He wrote that several years earlier, state attorneys general noticed a spike in predatory lending that the federal government was doing nothing about. When the states tried to rein in abusive mortgage lenders, the Bush administration finally did something. The Office of the Comptroller of the Currency issued rules nullifying state predatory lending laws over the objection of all 50 state banking superintendents.

The clampdown, which paved the way for the subprime mortgage crisis, was done by “pre-emption,” a little-understood doctrine that allows the federal government to wipe away state laws. The Constitution’s supremacy clause says federal law can trump state law. But the federal rule should be a floor, not a ceiling. It should set a minimum level of rights, not stop states from doing more to protect their citizens.

That's just one of 50 examples in an Associated Press report that also includes safety rules for chemical plants, head restraints in autos, abusive Medicare marketing, and curbing greenhouse gases.

One would assume the current makeup of the Supreme Court backs these new rules. That's a Supreme Court John McCain has said he'd strengthen.

Time predicts healthcare reform

Last week's Time Magazine's cover story was on the economic mess that the next president will need to clean up. The piece ends with a couple paragraphs on healthcare:

Then there's health care, which has become perhaps the biggest source of financial worry and occasional disaster among middle-class Americans. A 2005 study found that half of all personal bankruptcies in the U.S. were attributable at least in part to medical costs.

But there's real hope on this front. It is possible to conceive of a system that brings the 47 million uninsured into the fold, improves medical outcomes and costs less than what we've got now. It's possible to conceive of because many other wealthy countries already have such systems. Figuring out exactly how to make universal health care work in the U.S. is a matter better left to its own lengthy magazine article. But if you're looking for big economic change from the next Administration, this is the form it's most likely to take.

I find that comforting. It means that mainstream journalists, who aren't likely to be single-payer advocates but who are likely to be better read than the average American (not all, but it is part of the job) now get it. This writer, in any case, knows that the data is there. Other countries have shown that healthcare investment can be managed far better than we've accomplished.

There is a real chance that we'll see change in the next five years - perhaps not true universal healthcare via single-payer, but surely steps in that direction.

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.

State-Based Health Care Reform Act

Talk about a buried lede. Or the mainstream media not paying attention to an important story. The Milwaukee Small Business Times reports that a bipartisan proposal would let states reform health care - "States could use single-payer systems, expansion of current programs, market-based reforms or adopt completely new ideas in their efforts to cover the uninsured."

U.S. Sen. Russ Feingold (D-Wis.) and Sen. Lindsey Graham (R-S.C.) are authors of the State-Based Health Care Reform Act. Sen. Susan Collins (R-Maine) signed on today.

You can read the bill at the Library of Congress's Thomas.

There's a longer article on the bill at Psychiatry Online from October 2007.

S 1169... would establish the Health Care Coverage Task Force to approve grants to states whose proposals mandate minimum requirements in coverage and quality measures and meet cost guidelines. The bill would provide about $40 billion for state matching grants to expand health care coverage, while mandating certain "cost-sharing" limits to keep the coverage affordable for beneficiaries...

Another state-based approach would authorize grants for states to create universal health care pilot programs that could become models for other states and the country. The legislation, sponsored by Sen. Bernie Sanders (I-Vt.) and known as the States' Right to Innovate in Health Care Act of 2007 (S 2031), would authorize five, five-year grants to states committed to developing plans for universal, comprehensive, cost-effective health care. The states would have to provide comprehensive benefits, including coverage for long-term care, diagnostic services, preventive care, prescription drugs, dental and vision services, and mental health treatment including that for substance abuse.

What's PNHP's position on these bills?

Howard Dean on single-payer

Time Magazine offers up 10 Questions for Howard Dean, DNC chair:

As a former physician, what are your thoughts on the Democratic candidates' health-care plans vs. a single-payer system? Megan Prouty CARROLLTON, TEXAS

I think while someday we may end up with a single-payer system, it's clear that we're not going to do it all at once, so I think both candidates' health-care plans are a big step forward. Certainly compared to Senator [John] McCain, who represents a big step backward.

Unions & Kay Tillow

Kay Tillow keeps plugging away - I get an email from her a couple times a week saying that this or that union has joined the movement and endorsed HR 676, Rep. John Conyers' bill that would create an American single-payer healthcare system by expanding an improved Medicare system.

Four hundred and twenty union organizations in 48 states have endorsed it, including 107 Central Labor Councils and Area Labor Federations and 33 state AFL-CIOs (in the order in which they endorsed: KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO, MN, ME, AR, MD-DC, TX, IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA & AK).

Today Kay's email reads:

IBT, APWU Locals and Building Trades Council Endorse HR 676

Teamster and Postal worker local unions and another building trades council have all endorsed HR 676, single payer healthcare legislation introduced by Congressman John Conyers (D-MI).

In New York City, Teamster Local 805 (IBT) has endorsed HR 676, reports Local President Sandy Pope.

In Medford, Oregon, the Southern Oregon Area Local of the American Postal Workers Union (APWU) has also endorsed the Conyers legislation.

In San Diego, California, the San Diego Building and Construction Trades Council unanimously endorsed HR 676, reports Council President Tom Lemmon.

#30#

So how improved would this "improved" Medicare be? Sounds pretty good. As Kay puts it, HR 676 would cover every person in the U. S. for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care, chiropractic and long term care.

HR 676 ends deductibles and co-payments. HR 676 would save billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs. The resolution currently has 90 co-sponsors in addition to Conyers. Co-sponsors and bill text are at the Library of Congress's "Thomas."

The Kennedys and faith

The world at our fingertips can be too much when added to each day's demands. Then comes a reminder of what is actually important. Ezra Klein posted this yesterday. I post it here - selfishly, in hopes that I'll remember to return to it when I'm in the midst of giving up. It's Ted Kennedy's eulogy for his brother Robert F. Kennedy, 8 June 1968 at St. Patrick Cathedral. An excerpt:

"Our future may lie beyond our vision, but it is not completely beyond our control. It is the shaping impulse of America that neither fate nor nature nor the irresistible tides of history, but the work of our own hands, matched to reason and principle, that will determine our destiny. There is pride in that, even arrogance, but there is also experience and truth. In any event, it is the only way we can live."

This is the way he lived. My brother need not be idealized, or enlarged in death beyond what he was in life, to be remembered simply as a good and decent man, who saw wrong and tried to right it, saw suffering and tried to heal it, saw war and tried to stop it.

Those of us who loved him and who take him to his rest today, pray that what he was to us and what he wished for others will some day come to pass for all the world."

The pope chooses saints depending on what he believes are life stories he'd like his flock to emulate. Saints aren't perfect, nor do they necessarily perform miracles in their own lifetimes. Their purpose is inspiration.

For myself and so many others, the Kennedys embody the nobility of spirit and purpose that inspires hope for tomorrow - and thus encourages action, faith and good will today - and forgiveness for yesterday. Judging by the world's response to the news of Ted Kennedy's tumor, most of us have paused during the past day to give thanks for the gift of public service and centered purpose that Ted Kennedy has given. He is truly a lion of a man, a patriarch in the very best sense of the word. He is a father of fathers, to his brothers' children, and a father figure to countless more.

May his remaining years be blessed.