The Health Care Story You Should Read Today

Medicare spends three thousand dollars more per person here than the average person earns. wow, that's impressive.
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What Gawande describes surely constitutes fraud.
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geez, that piece read like the author was on the insurance company payroll. Here's a hint -- any time a writer frames the goal in the health care issue as "universal coverage", they're (consciously or unconsciously) shilling for AHIP, BC/BS, Aetna, etc.
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But more to the point, the author uses medicare costs to repeatedly state that McAllen has the highest per capita health care costs in the country while simultaneously talking about disease rates among the entire population. Medicare serves a separate and distinct subset of the population, and you can't assume that health statistics for the overall population are the same in all demographic categories.
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And even worse, by using the "extreme" case of McAllen as the basis for an article on high health care costs, you wind up ignoring the key issue that concerns most americans -- rising insurance rates for those whose medical costs are not covered by the government. The costs of providing care under Medicare are completely irrelevant to the problems associated with the private, for profit health insurance industry.
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In other words, not only is this article largely irrelevant, it is a damaging distraction from the real issues involved in the push for health care reform.

whether the doctor is set up to meet the needs of the patient, first and foremost, or to maximize revenue.
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The central tenet in the "Church of Reagan" creed that represents mainstream Republican thought is that anything that maximizes revenue automatically provides a social good as well. The idea is that the market of individuals seeking to maximize their own situations will foster competition among service providers and lead to optimum results.
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So ingrained is this faith, that people no longer see the need to test it for its truth. Here's a clue. It's false. Most Americans are now recognizing that its false and are willing to try out a different theory.
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Personally I'm delighted to be alive and aware during this point in History. I didn't expect to witness a full 40 year pendulum swing of socioeconomic thought.

There were many moments in "Sicko" that really stuck with me. One was a replay of one of the Nixon tapes, captured here:
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How Kaiser Permanente and Nixon changed healthcare in the US...
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This is a transcript of the 1971 conversation between President Richard Nixon and John D. Ehrlichman that led to the HMO act of 1973:
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John D. Ehrlichman: “On the … on the health business …”
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President Nixon: “Yeah.”
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Ehrlichman: “… we have now narrowed down the vice president's problems on this thing to one issue and that is whether we should include these health maintenance organizations like Edgar Kaiser's Permanente thing. The vice president just cannot see it. We tried 15 ways from Friday to explain it to him and then help him to understand it. He finally says, ‘Well, I don't think they'll work, but if the President thinks it's a good idea, I'll support him a hundred percent.'”
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President Nixon: “Well, what's … what's the judgment?”
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Ehrlichman: “Well, everybody else's judgment very strongly is that we go with it.”
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President Nixon: “All right.”
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Ehrlichman: “And, uh, uh, he's the one holdout that we have in the whole office.”
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President Nixon: “Say that I … I … I'd tell him I have doubts about it, but I think that it's, uh, now let me ask you, now you give me your judgment. You know I'm not to keen on any of these damn medical programs.”
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...
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Ehrlichman: “… private enterprise one.”
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President Nixon: “Well, that appeals to me.”
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Ehrlichman: “Edgar Kaiser is running his Permanente deal for profit. And the reason that he can … the reason he can do it … I had Edgar Kaiser come in … talk to me about this and I went into it in some depth. All the incentives are toward less medical care, because …”
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President Nixon: [Unclear.]
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Ehrlichman: “… the less care they give them, the more money they make.”
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President Nixon: “Fine.” [Unclear.]
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Ehrlichman: [Unclear] “… and the incentives run the right way.”
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President Nixon: “Not bad.”

Another moment in "Sicko" that stuck with me was an interview with a group of ex-pat Americans in a French restaurant, where they described their experiences with the French system. One guy noted that when he moved to France, and had to fill in the forms to get in their system, he froze up when he came to the pre-existing conditions part. Until he was told that they wanted to know about any health problems so they could better determine the appropriate health care required. It was to make his health care better, not to deny him coverage.
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And that is the case pretty much everywhere but in the USA. It's about health care, not about insurance. Really a key distinction.
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Of course another key distinction is the net cost to society is lower "there" and here, and the outcomes are better.

One thing is very clear. No business or individual citizen of this country can afford our current private health care system. We can not continue doing business this way it is simply unsubstainable.

The "other" Klein, who is a very very busy boy at his new digs, has been doing excellent reporting on the health care issue. Lots of good text and brilliant graphs, like the one at this post: Health Care Cost Fallacies and described in this paragraph:
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That orange line headed heaven-ward? That's our deficit. All those other lines dipping down? That's our deficit if we had the same health care spending per person as France, Germany, Canada, and the UK (all countries, incidentally, with higher life expectancies than our own). You might say, of course, that even radical reform would not bring us down to their health care spending. We could copy France's system wholesale and still pay more for care. You would be right. But such reforms would bring us much closer than we are now. And to flip Cowen's second fallacy, the fact that we cannot match the health care spending of other nations does not obviate the savings we are forgoing because we refuse to embrace their successful models.

Thanks for the link. The article was a long one but definitely worth the time. The author gave the best explanation for runaway health care costs that I've ever read. One quote from Dr. Dyke really stood out, “Who comes up with this stuff?” he asked. “Any plan that relies on the sheep to negotiate with the wolves is doomed to failure.”

Karen these are just a few of the glaring arguments that this article in and of itself is flawed for the proposal for Universal Healthcare, if we do not first change our practices “universally” across this nation. As I have said many times before, unless we do not first initiate a preventative health care model first, no insurance program will work or become efficient. Sure the universal health record program would be of some benefit that Obama proposes, but is not the root problem with the existing system.
”Doctors order unnecessary tests just to protect themselves, he said. Everyone thought the lawyers here were worse than elsewhere.
There is overutilization here, pure and simple.” Doctors, he said, were racking up charges with extra tests, services, and procedures.
A surgeon has to provide reassurance (people are often scared and want to go straight to surgery), some education about gallstone disease and diet, perhaps a prescription for pain; in a few weeks, the surgeon might follow up. But increasingly, I was told, McAllen surgeons simply operate.
The Medicare payment data provided the most detail. Between 2001 and 2005, critically ill Medicare patients received almost fifty per cent more specialist visits in McAllen than in El Paso, and were two-thirds more likely to see ten or more specialists in a six-month period.
Universal coverage won't be feasible unless we can control costs. Policymakers have worried that doing so would require rationing, which the public would never go along with.”
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For any program to work you must do the following;
1. Provide education to every Man, Woman and Child on preventative medicine.
2. Promote healthy living first by a sensible diet, and promote a nutritionally sound eating habits.
3. Provide education to Physicians that multiple tests are not always necessary, especially if they first ask themselves are they doing the multiple tests to prevent a potential law suit for malpractice.
4. Pass legislation for a cap on litigation on malpractice cases across the country. (This alone will drive down the cost of medical costs immensely if the cap is set low enough that it is no longer financially viable for lawyers to make millions of dollars off of these cases).
5. Provide “Healthy Living Incentives” to all Americans. Tax breaks or even rebates based on how well your health is rated. Lose weight and get a tax rebate if you remain under a certain BMI, then the tax you pay is reduced so long as you remain in that “healthy range”. If you smoke, provide a tax rebate program. If you continue both poor eating habits and/or smoke after a certain period of time you will be penalized with paying a higher tax rate.
6. Provide community incentives to promote a healthier lifestyle. Create government run community recreation and parks systems that promote health. One thing about socialist countries that I do agree with is their foundation of sports and recreation complexes that everyone can enjoy at little to no cost.
7. Retrain all medical professionals to identify at risk individuals and provide them with in the home counseling. If the medical professional does not become intimate with their patient's or consumers. If they do not go into the home to see for themselves how they eat and prepare meals, look at the stressors on the main providers then changes will not occur. Currently most insurances do not compensate Nutritionists who provide home health care. This is one of the first critical steps to effect a nutritionally sound diet and meal planning.
8. Educate the next generation. Eliminate the TV commercials that promote unhealthy eating habits and ban them just like we have cigarette commercials. Put a “cap and trade” like tax on alcohol producers, McDonalds and other fast food providers. Give incentives to fruit and vegetable producers, and to families who want to put out a garden every year. Give away free fruit trees to County Extension Offices to distribute to local families. Pay farmers to produce healthy crops instead of beef and pork, penalize those farmers who grow “fat” producing products.
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This is just a simple list I put together this morning. I am sure there are thousands of other great ideas other people can come up with themselves.
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I hope you consider these options Karen when you write your next article to promote a “universal” healthcare program. This is the universal program we need, not a change in the current system of healthcare delivery.

Rusty,
Your list is indeed a good one. Part of the problem comes though from people who would see your suggestions as unnecessary impediments to their freedom. In particular, number 8, controlling what can be advertised on TV specifically runs against standard RW concernes about Free Speech and government interference with the free flow of ideas.
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This suggest to me that there is indeed room to find 'balance' against competing interests once we dispense with the notion that government has no business being involved in the discussion in the first place.

Happy to see Rusty offering more serious input. It's a good reminder that the health care discussion needs to focus on what works, not what's best promoted or which interest group wins.
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My only overall problem with Rusty's contribution is the notion that health care reform needs to be an either-or proposition. Making/keeping Americans healthier should undoubtedly be a big – likely the biggest – piece, but I don't think we can write off attention to the delivery system quite so easily. If Gawande's article teaches us anything, it's that there are those in the system attuned primarily to profiteering however good or poor the collective health of the populace may be. Health care providers should be compensated well, but we need safeguards against the potential for "Dr. AIGs" gaming the system for short-term gain.

Rusty,
I agree (almost) completely . . . this post, combined with your welcome post on the Memorial Day thread, sets a benchmark for right-leaning posters around Swampland. Now just get spob and textee on board, and you may actually end up persuading some of us lefty loons to your cause!

KT, I think there is a distinction between a discussion of the "why" of HMOs in theory, and that particular conversation with Nixon and Erlichman that noted: “All the incentives are toward less medical care, because … the less care they give them, the more money they make.”
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The correct incentives for a health care system should always be toward the appropriate medical care.
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Ditto on rusty's list - really good job. I like the tax incentives promoting healthy behavior. The French system is notably good a prevention, I understand, one of the reasons they are doing so well in any cost:benefit analysis.

Having lived in Germany for 5 years last decade, I can vouch for a number of items on Rusty's list and add the following:
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7. Doctors, risk and employment. And excellent feature of the German health system was that health policy was backed up with employment policy. If you got sick, your Doctor gave you a note to take to your employer allowing you to stay home and recover, with pay. If you were expecting a child, the mother could take at least 12 weeks of leave, and, more recently, the father could take up to 4 weeks.
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3+4. Malpractice and litigation. While Germany and other European countries limit damages, they also have systems which emphasize care rather than profit. As long as insurance companies are getting rich by denying care, litigation is the only recourse we have as health service consumers. Two sides of the same coin. We can't fix one without the other.

Thank you for your reponses Karen. But responding back to your two posts, in particular to this one below;
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Karen Tumulty Says:
Wednesday, May 27, 2009 at 10:32 am
Rusty and PD: Also, here's one idea that someone in the White House suggested to me as a way of bridging the ideological divide for docs who hate comparative effectiveness research and conservatives who say it is the heavy hand of govt getting between you and your physician: Do the research, and don't require docs to follow it, but make "best practices" a defense in malpractice lawsuits."
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The statement that "conservatives who say it is the heavy hand of governemtn" I believe is a little shallow and condesending. The conservatives I know are not against reform. The reform they are looking at, and which makes the most fesible sense in cost effectiveness is changing behaviors. Yes this will take a rather long time to do because we are asking people to change behavior. But, in the long run if this is not done it will bankrupt any system put into place.
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I agree that those without any health insurance at all are utilizing our ERs as basic medical care facilities instead of cheaper clinics and the like. Why can't we have clinics funded by Government money paid by the tax payers? What is wrong with providing that service, rather than initiating a whole new insurance program that will eventually destroy the entire system? People will recieve basic medical care, and the rest of us who are out there will continue with the type of care we have come to not only expect, but enjoy.
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I do believe that the majority of people who are un-insured or under insured are illegals in our country. The rest, if they choose to do so could apply for government insurance programs that already exist, and those that fall just above the limits should be given the opportunity for a different insurance program based on their range of income that does not already exist. That in my mind would solve alot of the concerns you have expressed.
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Change for the sake of change is not always the best fix for the problem. This is where I disagree with most liberals. They want to "throw the baby out with the bath water" before looking at it all comprehensively, throughly to come up with a better solution. I predict this issue will become as divisive as abortion soon, once the vast majority see what impacts a universal healthcare program will have on the majority of people in this country with adequate health insurance.
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There is what 40 million or so un/under insured? While there are well over what 200 million citizens in the US? So what you are saying is 20% of the population is causing 90% of the problems, right?
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Just pass legislation to assist the 20% as a temporary fix, and then address the more serious long term problems.

A "for profit" health care system is immoral. As long as you have insurance companies and medical corporations skimming money off the top nothing will change. The folks in Washington - the politicians and those who guide our "discourse" like to talk about "political viability" when they talk about a "single payer" system. It would be beneficial to all if all options were on the table and we can speak the truth. That is we need to admit that the corporate medical lobby (insurers, pharmaceutical companies, etc) OWN our politicians. Bribery is legal in DC and it's the issue that dare not be spoken in our discourse.

Bill Moyers had an excellent and informative show on the topic this past week. It was refreshing to see a point of view that is surprisingly absent in our so-called "liberal" media.

http://www.pbs.org/moyers/journal/05222009/profile.html