health care reform bill: day 5

Friday 2 April 2010

I’ve had some great comments about my series this week on the health care reform bill (though not directly to the blog), so I hope you, too, have enjoyed it.  In case you missed any of my previous day’s topics, here’s the recap:

Day 1 featured my main thoughts on the new health care reform bill. (If you haven’t read it yet, it’s the place to start.)
Day 2 contained multiple views and comments on the health care bill via a link to a NY Times article.
Day 3 contained links to Democracy Now! clips relating to the continuation of the for-profit system and palliative care.
Day 4 featured more of my comments in relation to the cost of health care mixed in with articles and other comments on the same topic.

I want to close out this week thinking about the ethics and morality of the United States’ health care system, especially in lieu of what goes on in other “wealthy” countries around the world.

This week I was keyed into a man named T.R. Reid.  In his article for the Washington Post, 5 Myths About Health Care Around the World, he starts out this way:

“As Americans search for the cure to what ails our health-care system, we’ve overlooked an invaluable source of ideas and solutions: the rest of the world. All the other industrialized democracies have faced problems like ours, yet they’ve found ways to cover everybody — and still spend far less than we do.

“I’ve traveled the world from Oslo to Osaka to see how other developed democracies provide health care. Instead of dismissing these models as “socialist,” we could adapt their solutions to fix our problems. To do that, we first have to dispel a few myths about health care abroad:”

He goes on to share some very interesting facts (see below).

Many other countries provide health care to everyone, though the way it is structured and paid for in each country is a little bit different.  Mr. Reid‘s article debunks some of the myths, as he did in an interview for the program Inter Compass (click and scroll down to episode #1011, Healthcare Around the World, to watch or listen) where he explained things a bit more.  He spoke about the ethics of health care, how the systems in other countries differ from that of the U.S., and many other issues I touched on in my first post.  But there was one exchange that I think is so poignant and powerful that I’ve transcribed it here to make sure you hear it (the total interview is 30 minutes, and this quote comes just at the 20 minute mark)(Thanks to Karen Saupe for sharing this):

Host, Shirley Hoogstra: Well, there’s something [referring to a previous statement] that goes against the grain of the American individualism with that, right: this idea that in Canada, well as long as the rich Canadian has to wait as long as the poor Canadian has to wait…

T.R. Reid: They’re into that, yeah.

SH: Yeah, you know, and I think in America, it’s sort of like, “Look: if I’ve earned it, if I’ve got my own wealth, I want to be able to get to the head of the line, I want to be able to buy what I want.  So would that kind’ve have to change? Would that mentality of, you know, “Look I’ve done it, I get it?”

TRR: Well, there are a lot of commodities where we say, “If you’ve worked hard and have the money or inherited the money, you get it.”  The question is whether health care is that kind of commodity, and the economist term for this is the distributional ethic.  What’s your ethic for distributing goods?  Well, we have a distributional ethic for votes: everybody get’s one.

SH: Right.

TRR: Bill Gates gets one, his chauffeur gets one.  Right? Uh, we have a different distributional ethic for yachts.

SH: That’s true.

TRR: If you have money, you can have ten of ’em; if you don’t have money, tough, and we don’t mind that. So here’s the question: do you think health care is more like voting or is it more like yachting.  Well, what I found in my book is all the other countries have said, “No, this is, this is like voting. This is like education.  This is like equal treatment.  Everybody should have the same.” But the U.S. hasn’t made that commitment.

Isn’t it time the U.S. made that commitment?  Should health care be more like education, where the U.S. provides a basic service to all people, or do we want to keep our current system where only those with certain money or connections obtain basic, life-giving health care?  This reform bill claims to accord everyone care while still letting people make money from it, but I think we’re going to see that you can’t do both, and then we’ll have to choose how we want to more forward.

As Mr. Reid notes in his interview, universal health care — which comes in many shapes and forms around the world — would take a massive overhaul of the system, not just attempts to tweak the system that this health care bill tries to accomplish meaningful change with.  Perhaps this is a good first step, but hopefully more and more people will begin to recognize the moral imperative of universal health care and call for a system that no longer discriminates and kills in the way our current system does.  I encourage you to be someone who does just that.

(Reid also has a book, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, which I think I’m going to look for myself.)

Some of the more interesting facts I found in Reid’s column:

As for those notorious waiting lists, some countries are indeed plagued by them. Canada makes patients wait weeks or months for nonemergency care, as a way to keep costs down. But studies by the Commonwealth Fund and others report that many nations — Germany, Britain, Austria — outperform the United States on measures such as waiting times for appointments and for elective surgeries.  In Japan, waiting times are so short that most patients don’t bother to make an appointment.

U.S. health insurance companies have the highest administrative costs in the world; they spend roughly 20 cents of every dollar for nonmedical costs, such as paperwork, reviewing claims and marketing. France’s health insurance industry, in contrast, covers everybody and spends about 4 percent on administration. Canada’s universal insurance system, run by government bureaucrats, spends 6 percent on administration. In Taiwan, a leaner version of the Canadian model has administrative costs of 1.5 percent; one year, this figure ballooned to 2 percent, and the opposition parties savaged the government for wasting money.
The world champion at controlling medical costs is Japan, even though its aging population is a profligate consumer of medical care. On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3,400 per person annually on health care; the United States spends more than $7,000.

Overseas, strict cost controls actually drive innovation. In the United States, an MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98. Under the pressure of cost controls, Japanese researchers found ways to perform the same diagnostic technique for one-fifteenth the American price. (And Japanese labs still make a profit.)

The key difference is that foreign health insurance plans exist only to pay people’s medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage.


health care reform bill: day 4

Thursday 1 April 2010

So here we are Day 4 of my week-long focus on the health care reform bill.

On Day 1, I shared with you my thoughts on the new health care reform bill (I’ve heard people say they liked this, but no comments on the blog — I love it when you comment on the blog!)  If you haven’t read it yet, it’s the place to start.
Day 2 contained multiple takes on the health care bill from prominent politicians and such, via a link to a NY Times article.
Yesterday (Day 3) contained links relating to the continuation of the for-profit system and on palliative care.

Today, I wanted touch on the headlines discussing the cost of health care in general, taking special note of the recent headlines related to new costs for businesses.

First, a New York Times article from January, written by David M. Herszenhorn and titled “Why Does Health Care Cost So Much?” (a great article on health costs in itself) started this way:

“People like to live too much.

“This is my favorite, only half-kidding, response when people ask why health care in America is so expensive.”

As I talked about in my original entry, as medical procedures become more advanced, they’re going to cost more overall, especially if we believe we can give everything to everyone.  Without some kind of rationing, costs will continue to skyrocket.  And it must be noted, too, that whatever care is given, someone has to pay for — be it insurance companies, the patient, employers, the providrs, or the government (and probably others).  The question we then need to ask is, “Who’s going to pay?”

As the bill rolled out, we heard news of companies taking financial hits because of new tax structures in the bill:
ObamaCare Day One
(Wall Street Journal)
AT&T Plans $1 Billion Charge For Health Care
(Huffington Post)
Healthcare Reform will “cost” AT&T and friends WHUT? A Liberal vs. Conservative Debate (Really!) (contains quotes from the articles Companies Push to Repeal Provision of Health Law (NY Times) and Henry Waxman’s War on Accounting (The Atlantic))

But there are other voices, too:
Ben Arnon: On Measuring the Cost of Health Care Reform (The Huffington Post)

“So how do we measure the cost of health care reform? The cost of health care reform cannot be measured solely based on absolute monetary cost. Opportunity cost must be factored into the equation. The opportunity cost of remaining with the status quo and avoiding health care reform involved significant costs both in terms of monetary value as well as emotional costs that tear at the human psyche and that ultimately affect macroeconomic factors such as overall work output and productivity.”

Healthcare costs burden more Americans: study (Reuters)

“The percentage of Americans with a “high financial burden for healthcare” rose to 19 percent in 2006 from 14 percent in 2001, according to the Washington-based Center for Studying Health System Change.

“The think tank defines a high out-of-pocket burden for healthcare as spending more than 10 percent of before-tax income on insurance premiums and medical care.”

Ezra Klein: The five most promising cost controls in the health-care bill (The Washington Post – read for more details)

(1) Create a competitive insurance market
(2) The Medicare Commission
(3) A tax on “Cadillac plans”
(4) Medicare “bundling” programs
(5) Changing the politics of reform

So we come back to the question again, “Who’s going to pay?”  As I stated on Day 1, I believe we all need to take care of each other.  I don’t believe there should be profiteering on people’s health, or lack thereof, but the current health care reform bill continues the for-profit system.  How much individuals vs. corporations are left on the hook might be an interesting topic, but that just would end with everyone crying, “Not Me!”  (And we already know insurance companies have been known to find ways to drop coverage to avoid paying for medical costs when people get sick.)

So “Who’s going to pay?” Let’s agree that we all need to take care of each other and thatwe can share the costs of our another’s health based on our economic abilities.  Who’s in?

the purple (ticket) line

Thursday 22 January 2009

If you didn’t know already, I was one of the multiple millions who was in DC for Barack Obama’s inauguration on 20 January 2009.  I hope to share a few stories but lets get started here.  It almost seems a bit redundant after reading and hearing many similar stories already (see links below), but I feel a bit of need to share my experience, too.

I was initially uncommitted to venturing to DC for the festivities, but I had put in a request with my congressman Bob Latta (OH-5), the morning following the election, and when it was confirmed that I would be receiving two “tickets” to the inauguration ceremonies, I committed to go, bringing with me my brother Adam to use the other ticket.  We didn’t know exactly where the tickets would get us until picking them up Monday morning at Latta’s (after a half hour wait outside a congressional office building).  Then we got our programs (great memento, notwithstanding) and learned we’d be in the purple section.  (See this map for ticket holder sections.)

Adam and I debated arrival times based on where in the section we wanted to stand (about 1/2 of it seemed to be obstructed by trees) and gueses on ambitiousness of others with tickets, and we arrived near the purple ticket gate around 7AM, with security scheduled to begin at 8AM and actual section opening at 9AM.  When we took a look at the entrance and found the apparent “line” we were to get into, which extended down the block, turned, and then turned again to enter the tunnel which goes under the mall area between 2nd and 3rd streets.  A police officer asked to see our tickets to get into the tunnel.  (See here an interesting map of the situation.)  After walking for about 15 mintues (to put is now at 7:15), we reached what was then the end of a line (I don’t want to say “the line” because I’m guessing there were more, based on future occurrences), about 80% or 90% of the way down through the tunnel.

And we waited.  Sitting there for an hour without moving was expected, and we slowing moved up in small surges, trying to estimate if we actually were moving fast enough to make the assumed 11:30 cutoff we anticipated for entrance.  We chatted with people around us to pass the time, Adam and I read a bit as well, and we moved ahead.  About 10:30, getting close to the exit of the tunnel but losing hope, the mother of a girl standing near us returned after doing some investigating, with the girl leaving and us learning of the apparent shutting of the gates and no one getting in at this point.  Adam and I decided to stay in line, actually able to move out of the tunnel a bit before 11 as the people were really surging forth to get out of the tunnel and near the entrance.

A bit after 11, Adam and I decided it was most prudent to ditch the line and seek viewing/listening elsewhere — and it seems like that was a good choice based on videos and reports of the non-successes of those who stuck around.  In a bit of luck and irony, after an epic journey walking/jogging for 30 minutes (which I may speak of later), we found what I can only assume to be a breach of security at the 3rd Street entrance to the mall (which means, yes, we did walk all the way around the capital) to allowed us entrance to the mall, with no security to clear, to view the ceremony (post-Biden swearing in) almost directly above the tunnel we had spent about 4 hours in.

In reality, the tunnel experience wasn’t that bad, but the outcome was indeed horrible.  Adam and I were extremely lucky and fortunate to end up with the view we finally held for this historical event, but thousands, likely tens of thousands, who had received tickets they believed (with no reason not to) would grant them access to history.  Instead, many were left to watch it on tape or find a TV to watch it on instead.  I intend to share my disgust with the Joint Congressional Committee on Inaugural Ceremonies at and invite all others who had similar experiences to do the same!

Did I mention there were no police or security in the tunnel with us either?  That could have been disastrous.

Here are some of the MANY pieces I’ve found online relating to this fiasco:
An NPR story (similar to on Adam and I heard on our drive out of DC): A Frustrating Inaugural for Many
Two Washington Post articles: fiasco and subsequent apology and statement by Sen. Diane Feinstein (head of inaugural committee)
A bit from the NY Times: Guided Into Tunnel, Ticket Holders Missed Swearing-In
Politico article: Inaugural woes have members ticked
Two other bloggers: the purple tunnel of doom and Cursed Purple Tickets

YouTube has been a great place for some great video evidence (hundreds more than this if you keep looking):
My favorite: The Purple Ticket of DOOM! (An experience very similar to mine, except for the exact time stamps.)
A close second, a funny, amazing song!: Purple Tunnel of Doom — a Song
One man’s rant: Long Live the Purple Ticket Holders
Near the Purple Gate, probably close to 11:30: People With Purple Tickets Chanting and Useless PURPLE Tickets

And of course, the Facebook group for all of us who were left out in the cold (literally!): Survivors of the Purple Tunnel of Doom