The Health "Care" Industry

Commentary By Ron Beasley

Over the past two decades the pharmaceutical industry has moved very far from its original high purpose of discovering and producing useful new drugs. ... Now primarily a marketing machine to sell drugs of dubious benefit, this industry uses its wealth and power to co-opt every institution that might stand in its way, including the U.S. Congress, the FDA, academic medical centers, and the medical profession itself.
~Marcia Angell,MD

My mother is 85 years old. She has had some cardiovascular difficulties and a history of high cholesterol. About nine months ago her doctor increased her dose of medication to reduce her cholesterol level. Almost at once her health started to deteriorate. The doctor ran multiple tests in an attempt to determine what was wrong with her all of which came up negative. All the time we told him that her problems started when he increased her medication but he continued to insist that the medication could not possibly be responsible. Finally about three months ago he agreed to take her off of the cholesterol medicine and within days her symptoms disappeared. She feels good and walks one or two miles a day, something unheard of a few months ago. This brings us to a must read article at alterNet:
How Scientific Is Modern Medicine?
The following is an excerpt from The Homeopathic Revolution: Why Famous People and Cultural Heroes Choose Homeopathy, by Dana Ullman.

Conventional medicine adherents have consistently asserted that its methods are scientifically verified, and they have ridiculed other methods that are suggested to have therapeutic or curative effects. In fact, conventional physicians have consistently worked to disallow competitors, even viciously attacking those in their own profession who have questioned conventional treatments or provided alternative modalities.

And yet, strangely enough, whatever has been in vogue in conventional medicine in one decade has been declared ineffective, dangerous, and sometimes barbaric in the ensuing decades. Surprisingly, despite this pattern in history, proponents and defenders of "scientific medicine" tend to have little or no humility, continually asserting that today's cure is truly effective.

The good news about conventional medicine and one of its remarkable features for which it should be honored is its history of consistently and repeatedly disproving its own treatments. The fact that only a handful of conventional drugs have survived thirty or more years is strong testament to the fact that conventional medicine is honorable enough to acknowledge its mistakes.

So what is the truth about these "truly effective cures"?

Medical history uncovers an obvious pattern in the discovery and application of drug treatments. Initially, there is great excitement about a new drug's discovery. Research has seemingly proven its safety and efficacy and leads to widespread appreciation for the drug's ability to provide relief. Over time, there are minor concerns about the drug's side effects, until more research and clinical practice uncover more serious concerns about its side effects. Then, more research and clinical experience lead to more serious questions about the drug's real safety and efficacy, until there is general acknowledgment that the drug doesn't work as well as previously assumed, and there is recognition of an increasingly long list of serious side effects over time. However, these problems are not really problems because a new drug emerges, with short-term research that suggests it is a better drug after all. That is, until new research con- firms that it is neither as effective nor as safe as previously thought. And the cycle has continued like this for a century or more.

Like the fashion industry with its regular changes in style, the drug industry makes its profits on the newest drugs rather than on the older ones -- and not just any profits, but sickeningly high profits.

So go re-read the quote at the top of this post. There is a great deal of talk about the failures of the US health care system. The insurance companies that contribute nothing to health care and make a great deal of profit get much of the attention but the problem goes much deeper than that and even a single payer system won't fix it. The entire system is broken. That includes the pharmaceutical industry which is more about marketing and profit than it is about health care. Big pharma spends millions of dollars on TV advertisements for prescription drugs. Now they really don't expect most of these ads to actually sell drugs - it's primarily a way for them to slip some money to the TV networks in exchange for favorable editorial treatment. Big Pharma spends even more to sell physicians on the latest and most profitable cure and they have to make the profits quick because they never know how soon those cures will be shown to be ineffective or even hazardous. It would be easy to blame the physicians but thanks to the capitalist version of socialized medicine, HMO's, they work longer hours for less pay than they used to and they have those huge student loans to pay off.

The article goes on to point out that there is an alternative to the medical industry, homeopathic medicine. It is under constant attack by the "scientific" medical community and that attack is driven by the profit oriented medical industry. There not a huge profit to made selling fish oil and garlic which is what my mother is taking now to replace the Lipitor that was killing her. And of course there is the fight against medical marijuana.

Related Update
No. 1 Book, and It Offers Solutions

But here was the stunner: Vermonters who lived in towns with more aggressive care weren’t healthier. They were just getting more health care.

Sphere: Related Content

View blog reactions

Louis Pasteur didn't do it for the money

Commentary By Ron Beasley

Jonathan Cohn has a good article on health care today.
Creative Destruction
The best case against universal health care
Before you get upset what Cohn says is that the "best case against" is full of holes. Go read the entire thing, I can't do it any justice with a few blockquotes but it does point out a major difference in world view between conservatives and progressives. The conservatives believe that no one will do anything unless there is money to be made - a lot of money. There is nothing worth doing unless there is profit to be made. Progressives on the other hand have a world view that many people will do a thing because it's the right thing to do. Helping people is enough. There are certainly dedicated people in the health care business but their profit driven employers have them researching profitable drugs to cure erectile dysfunction instead of disease. Research goes into profitable devices and drugs to cure heart failure rather than into attempts to prevent it.

Sphere: Related Content

View blog reactions

Storm Clouds

Commentary By Ron Beasley

The House and the Senate are about to send another SCHIP bill to Bush who will veto it. There is every indication that the veto will be sustained in the house. Now the veto and refusal by the House has nothing to do with children's health, a few million dollars or a cigarette tax. It is all about a growing storm that threatens the bottom line of the insurance industry. In an opinion piece that received little attention the New York Times describes this storm front.
America’s Lagging Health Care System

Americans are increasingly frustrated about the subpar performance of this country’s fragmented health care system, and with good reason. A new survey of patients in seven industrialized nations underscores just how badly sick Americans fare compared with patients in other nations. One-third of the American respondents felt their system is so dysfunctional that it needs to be rebuilt completely — the highest rate in any country surveyed. The system was given poor scores both by low-income, uninsured patients and by many higher-income patients.

The survey, the latest in a series from the Commonwealth Fund, is being published today on the Web site of Health Affairs, a respected health policy journal. Researchers interviewed some 12,000 adults in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom and the United States.

While the American people think the health care system is in need of a major overhaul they are not alone. Many of America's largest corporations agree.

As we have seen on other issues when the Republicans don't have the facts on their side they simply lie and make stuff up. Paul Krugman describes the latest example in:
Prostates and Prejudices

“My chance of surviving prostate cancer — and thank God I was cured of it — in the United States? Eighty-two percent,” says Rudy Giuliani in a new radio ad attacking Democratic plans for universal health care. “My chances of surviving prostate cancer in England? Only 44 percent, under socialized medicine.”

It would be a stunning comparison if it were true. But it isn’t. And thereby hangs a tale — one of scare tactics, of the character of a man who would be president and, I’m sorry to say, about what’s wrong with political news coverage.

Yes it's all about Rudy Giuliani lying and making stuff up.

Let’s start with the facts: Mr. Giuliani’s claim is wrong on multiple levels — bogus numbers wrapped in an invalid comparison embedded in a smear.

Mr. Giuliani got his numbers from a recent article in City Journal, a publication of the conservative Manhattan Institute. The author gave no source for his numbers on five-year survival rates — the probability that someone diagnosed with prostate cancer would still be alive five years after the diagnosis. And they’re just wrong.

You see, the actual survival rate in Britain is 74.4 percent. That still looks a bit lower than the U.S. rate, but the difference turns out to be mainly a statistical illusion. The details are technical, but the bottom line is that a man’s chance of dying from prostate cancer is about the same in Britain as it is in America.

So Mr. Giuliani’s supposed killer statistic about the defects of “socialized medicine” is entirely false. In fact, there’s very little evidence that Americans get better health care than the British, which is amazing given the fact that Britain spends only 41 percent as much on health care per person as we do.

This is not to say the British program isn't flawed, it is. But no one is suggesting the US adopt the British model.

Anyway, comparisons with Britain have absolutely nothing to do with what the Democrats are proposing. In Britain, doctors are government employees; despite what Mr. Giuliani is suggesting, none of the Democratic candidates have proposed to make American doctors work for the government.

As a fact-check in The Washington Post put it: “The Clinton health care plan” — which is very similar to the Edwards and Obama plans — “has more in common with the Massachusetts plan signed into law by Gov. Mitt Romney than the British National Health system.” Of course, this hasn’t stopped Mr. Romney from making similar smears.

Fear Tactics And Lies

At one level, what Mr. Giuliani and Mr. Romney are doing here is engaging in time-honored scare tactics. For generations, conservatives have denounced every attempt to ensure that Americans receive needed health care, from Medicare to S-chip, as “socialized medicine.”

Part of the strategy has always involved claiming that health reform is suspect because it’s un-American, and exaggerating health care problems in other countries — usually on the basis of unsubstantiated anecdotes or fraudulent statistics. Opponents of reform also make a practice of lumping all forms of government intervention together, pretending that having the government pay some health care bills is just the same as having the government take over the whole health care system.

Krugman then goes on to point out that the media has given Rudy a free pass to lie - his bogus data and what that indicates about his character is never brought up.

And much of the coverage seems weirdly diffident. Memo to editors: If a candidate says something completely false, it’s not “in dispute.” It’s not the case that “Democrats say” they’re not advocating British-style socialized medicine; they aren’t.

The fact is that the prostate affair is part of a pattern: Mr. Giuliani has a habit of saying things, on issues that range from health care to national security, that are demonstrably untrue. And the American people have a right to know that.

Sphere: Related Content

View blog reactions

Half the story

Commentary By Ron Beasley

The wingnuts are all excited about this:
Record numbers go abroad for health treatment with 70,000 escaping NHS

Record numbers of Britons are travelling abroad for medical treatment to escape the NHS - with 70,000 patients expected to fly out this year.

And by the end of the decade 200,000 "health tourists" will fly as far as Malaysa and South Africa for major surgery to avoid long waiting lists and the rising threat of superbugs, according to a new report.

Ezra Klein gives us the other half of the story, the British health tourists have a place to go because of even more Americans are escaping the high cost of the US private health system.

Of course, Britain spends 41 percent what we do per capita -- and no one thinks Blair made up that shortfall, or anything close to it. So detractors are probably best served by not making funding the issue. I wouldn't have thought, however, that they'd try to move over to medical tourism as a point of comparison. But we can have that discussion. We can talk about the 50,000 Americans who go to Bumrungrad hospital in Thailand every year for cheaper surgeries. We can go into this article, about the Indian hospitals primarily serving Americans, or this one, about the waves of Americans traveling abroad because they're unable to afford heart surgery. Indeed, there are more Americans -- 100,000 -- traveling abroad for cosmetic surgery alone than there are Britons seeking any type of services in foreign lands.

America is actually driving the medical tourism industry that some Britons are taking advantage of. The growth of foreign treatment centers aren't a result of the failings of the British health care system (of which there are many). They're a result of the cost of American health care, and the huge numbers of sick individuals we price out. You'd think, paying two-and-a-half times what the Brits do for health care, that we could all access care, and wouldn't need to fly to India. But you'd be wrong. The Brits also have a bad health care system, but theirs is, on the bright side, very, very cheap. Ours isn't.

Now you have the entire story.

Sphere: Related Content

View blog reactions

SCHIP Foul

Commentary By Ron Beasley

This is ironic:
GOP cries foul on timing of children's health vote

WASHINGTON (CNN) -- House Republicans are fuming over Democrats' decision to hold the next vote on the State Children's Health Insurance Program on Thursday -- when many Republicans will be in California as President Bush tours areas hit by wildfires.

"Five to seven members are going, all of whom would be 'no' votes, and [Democrats] know it," House Republican Whip Roy Blunt told CNN. "This is clearly designed to minimize the Republican opposition to this bill."

President Bush vetoed the proposed five-year expansion and $35 billion spending increase for SCHIP on October 3.

House Democrats tried to override the veto last week, but failed to get the two-thirds majority needed for a veto. The bill to be taken up on Thursday is a revised version that Democrats hope will win converts.

At a meeting of Republican House members to discuss the revised bill, Rep. Louis Gohmert of Texas said the Democrats are "taking advantage of a disaster to loot the American treasury."

So let's get this straight; the Democrats are taking advantage of a national disaster to pass a children's health bill while the Republicans are taking advantage of a national disaster to get some cheap photo ops. So what is the real reason the Republicans don't want the vote?

Another Democratic House leadership aide told CNN, "The White House and Republicans would like to postpone this legislation because they don't want a deal. It's that simple."

How different is the new bill? Not much!

Bush said he vetoed the original SCHIP bill to prove he was still relevant. The Democrats are apparently trying to send the message that he's not.
Democrats tweak SCHIP in effort to override veto

After tinkering with their bill, House Democrats believe they have made the necessary concessions to attract a veto-proof majority on legislation expanding the State Children’s Health Insurance Program (SCHIP).


House Democratic leadership aides said that the new bill has addressed the three principle Republican complaints made about the original five-year, $35 billion expansion, which President Bush vetoed earlier this month.

A vote on the legislation is scheduled for Thursday. If it is approved with a veto-proof majority, it would qualify as a huge political victory for Speaker Nancy Pelosi (D-Calif.) as well as Senate Democrats, who already have the votes to override Bush.

[.....]

The revised measure will include provisions prohibiting coverage of adults, preventing families with incomes of 300 percent of the poverty level from qualifying for the program, and making it harder for illegal immigrants to sign up for the program.

Key Bush administration figures on Wednesday signaled a willingness to compromise with House Democrats, but congressional leaders appeared to be moving ahead as though they don’t need to deal with the administration.

Tailoring modifications to the bill to meet the needs of centrist Republicans, if successful, would allow the Democratic leadership to avoid negotiating with the administration entirely.

Sphere: Related Content

View blog reactions

Friday SCHIP-Eds

Commentary By Ron Beasley

Both Paul Krugman and E.J. Dionne address the desperate swift boating of the Frost family this morning.

Paul Krugman - Sliming Graeme Frost

All in all, the Graeme Frost case is a perfect illustration of the modern right-wing political machine at work, and in particular its routine reliance on character assassination in place of honest debate. If service members oppose a Republican war, they’re “phony soldiers”; if Michael J. Fox opposes Bush policy on stem cells, he’s faking his Parkinson’s symptoms; if an injured 12-year-old child makes the case for a government health insurance program, he’s a fraud.

Meanwhile, leading conservative politicians, far from trying to distance themselves from these smears, rush to embrace them. And some people in the news media are still willing to be used as patsies.

Politics aside, the Graeme Frost case demonstrates the true depth of the health care crisis: every other advanced country has universal health insurance, but in America, insurance is now out of reach for many hard-working families, even if they have incomes some might call middle-class.

And there’s one more point that should not be forgotten: ultimately, this isn’t about the Frost parents. It’s about Graeme Frost and his sister.

I don’t know about you, but I think American children who need medical care should get it, period. Even if you think adults have made bad choices — a baseless smear in the case of the Frosts, but put that on one side — only a truly vicious political movement would respond by punishing their injured children.

E.J. Dionne - Meanies And Hypocrites

Conservatives claim to be in favor of stable families, small businesses, hard work, private schools, investment and homeownership. So why in the world are so many on the right attacking the family of Graeme Frost?

Frost is the 12-year-old from Baltimore who delivered the Democrats' reply to a radio address by President Bush in September. The seventh-grader pleaded -- in vain, it turned out -- that the president not veto Congress's $35 billion expansion of the children's health care program known as SCHIP. A car crash in December 2004 left two of Halsey and Bonnie Frost's children comatose, Graeme with a brain stem injury and Gemma, his sister, with a cranial fracture.

The kids were treated, thanks to SCHIP. The Frosts spoke out so the public would know that real people lie behind the acronym.

Their reward was to be trashed on right-wing blogs and talk radio as if they were multimillionaires ripping off the system. The assault on the Frosts apparently began on the Free Republic Web site and quickly spread to National Review Online, Power Line and Michelle Malkin's blog, as well as Rush Limbaugh's radio show.

And of what were the Frosts guilty? Well, they own their own home, which they bought for $55,000 in 1990 and which is now worth about $260,000; they invested in a commercial property, valued at $160,000; Halsey Frost, a self-employed woodworker, once owned a small business that was dissolved in 1999; and Graeme attends a private school on scholarship. I rely here on facts reported this week in the Baltimore Sun and the New York Times, both of which set straight the more outlandish claims made by the Frosts' attackers.

The right is unapologetic. "The Democrats chose to outsource their airtime to a Seventh Grader," wrote National Review's Mark Steyn. "If a political party is desperate enough to send a boy to do a man's job, then the boy is fair game."

Okay, the Democrats are "fair game," but a 12-year-old? No wonder nobody talks about compassionate conservatism anymore.

This event has made it clear What the Republican Party has become! George W. Bush has been quick to use children and members of the military to make a point. Remember the snowflake babies? Did anyone follow them home or try to dig up dirt? I feel sorry for the Frost family but their greatest service has been to demonstrate how vicious the Republican Party has become and how broken the US health care system is. I'm not sure what the Republicans are trying to accomplish with this attack but it seems to have blown back in their face. They didn't want to discuss the issue but that's exactly what everyone is doing and major health care reform is probably a lot closer - just what they didn't want.

Update
John Cole has officially defected from the Dark Side.

I guess I really am a card-carrying liberal now, because I think Paul Krugman gets it exactly right in this perfect summation of the last week:

Sphere: Related Content

View blog reactions

SCHIP and the Health Care Panic

Commentary By Ron Beasley

McKinsey & Company, the consulting firm, recently released an important report dissecting the reasons America spends so much more on health care than other wealthy nations. One major factor is that we spend $98 billion a year in excess administrative costs, with more than half of the total accounted for by marketing and underwriting — costs that don’t exist in single-payer systems.
~Paul Krugman, February 16, 2007

So why the right wing panic attack on SCHIP? That's easy, the right sees the writing on the wall - a majority of Americans and an increasing number of major corporation can see the current system is broken and that changes are on the way. We find out today that the swift boating of the Frost family originated in the office of Senate Minority Leader Mitch McConnell (R-KY). The charges against the Frosts turned out to be inaccurate and in fact simple served to point out how broken the health care system is. It also made it clear for all to see that those involved are nothing but vicious thugs with no credibility.

The insurance companies contribute nothing to health care yet manage to syphon off 20% of the health care dollars. Change is coming and the insurance companies and their servants will attempt to influence that change so the cash cow won't disappear all together. In that spirit John McCain introduced his health care plan today.
McCain health plan includes $2,500 tax credit

Republican presidential candidate John McCain outlined a proposal on Thursday to revamp the U.S. health care system by providing Americans with a refundable $2,500 tax credit as an incentive to buy insurance.

McCain's plan offers voluntary solutions to fixing health care in the country, where the high cost of care has meant millions of Americans are unable to pay for health insurance.

McCain warned the U.S. health care system is facing a "perfect storm" of problems that if not addressed by the next president will cause the system to implode.

[.....]

McCain, who is running behind key rivals in the race to be the Republican presidential nominee in the November 2008 election, said he would provide individuals with a $2,500 tax credit, $5,000 for families, as an incentive to buy health insurance.

So, no real change. The insurance companies would still be able to skim 20% off the top but the Federal Government would take some of the hit through reduced revenue.

Expect to see more plans like this as the right attempts to salvage something for the insurance company leaches.

Sphere: Related Content

View blog reactions

Must Read from Digby

Commentary By Ron Beasley

What, Me Worry?
A great follow up to my post this morning.

Sphere: Related Content

View blog reactions

Shooting themselves in the head

Commentary By Ron Beasley

Yesterday I quoted John Cole as to why he was leaving the Republican Party:

I simply can not believe this is what the Republican party has become. I just can’t. It just makes me sick to think all those years of supporting this party, and this is what it has become. Even if you don’t like the S-Chip expansion, it is hard to deny what Republicans are- a bunch of bitter, nasty, petty, snarling, sneering, vicious thugs, peering through people’s windows so they can make fun of their misfortune.

Not only have the Republicans demonstrated what vicious thugs they are they have demonstrated they are not very bright. Their attack on the Frosts has in fact demonstrated how screwed up the current health care system is and probably made national single payer health care more likely.
The Baltimore Sun tells us about the Frosts and the picture on the left of their palatial home.
Frost family draws ire of conservatives

The Frosts say the description of their family's circumstances now circulating is misleading. Halsey, they say, is a self-employed woodworker - he has no employees - while Bonnie works part time for a medical publishing firm. Together, they say, they earn between $45,000 and $50,000 a year.

That would make the Frosts eligible for Maryland's Children's Health Program, which is open to families that earn no more than 300 percent of the federal poverty level, or $82,830 a year for a family of six.

[....]

Halsey Frost purchased the family home for $55,000 in 1990, according to city records, and refinanced in 2005, he says, to make improvements to accommodate the return of Graeme and Gemma from the hospital. The 1936 brick rowhouse, on a side street near Patterson Park, has an assessed value of $263,140.

Halsey Frost purchased a 1920 warehouse in East Baltimore for $160,000 in 1999, according to city records. It is assessed at $160,500. Frost says he is still paying off the mortgages on both properties.

The four Frost children depend on financial aid to attend private school, the Frosts say. In addition, they say, Gemma receives money from the city for special education made necessary by her injuries.

Halsey and Bonnie Frost say they still have no health insurance. Bonnie Frost said she priced coverage recently at $1,200 a month.

As we can see the vicious right wing spin about the Frosts has been misleading at best. An as to why they didn't have insurance; do the math. The $1,200 expense for health insurance would represent 29% of the Frost's pre-tax income. That is assuming that after the accident they could get insurance at all. For profit insurance companies don't like to insure people who have something wrong with them and even if they had insurance at the time of the accident it probably would have been canceled after the accident. The always hate filled and vicious Michelle Malkin accused the Frosts of being irresponsible for not having insurance - that is to say they were irresponsible for not being rich. This will not go over very well with a vast majority of Americans who say health care is one of their major concerns. With their vicious attack on the Frosts they hateful wingers may have made what they fear most, single payer health care, more likely.

This may well turn out to be the Terri Schiavo moment for health care.

Sphere: Related Content

View blog reactions

Hired Guns

Commentary By Ron Beasley

Kevin Peraino of Newsweek has the latest on the September 16 Blackwater incident.
Death From All Sides
An extensive evidence file assembled by the Iraqi National Police after the controversial Blackwater shooting suggests that the private contractors opened fire unprovoked from the ground and the sky.

Sept. 30, 2007 - Since the fatal Sept. 16 Blackwater USA shooting in Baghdad’s Nasoor Square, officials from the private security company have insisted that their guards were responding to fire from “armed enemies.” Yet an extensive evidence file put together by the Iraqi National Police and obtained by NEWSWEEK—including documents, maps, sworn witness statements and police video footage—appears to contradict the contractors’ version of events. A confidential incident report, which has been provided by Iraqi National Police investigators to American military and civilian officials, concludes that the Blackwater vehicles “opened fire crazily and randomly, without any reason.”

A nine-minute police video made in the moments after the shooting shows helicopters similar to those used by Blackwater still hovering over the wreckage of charred, smoking and bullet-pocked cars. (For an edited clip of the video, click here.) The graphic images include footage of burned human remains and show the street littered with brass bullet casings. They also show what appears to be a police officer waving a pistol at the scene; the footage was captured by a different police officer, who had run over from the nearby Iraqi National Police headquarters. (Portions of the video have been previously broadcast; it was recorded without sound.)

Iraqi National Police investigators also believe that Blackwater's helicopters fired on the cars from above, according to confidential police documents and interviews with senior police officials. A memo written on Sept. 17 by the lead Iraqi police investigator states that shortly after the shooting began, “helicopters opened fire from the air toward the cars and civilians.” Gen. Hussein al-Awadi, the commander of the Iraqi National Police, told NEWSWEEK that the trajectory of some of the bullet wounds could only have been caused by fire from the air. “If anyone moved—whenever they saw someone leaving—either the convoy or the chopper shot him,” says Ali Kalaf Salman, an undercover Iraqi National Police officer who was working as a traffic cop at the scene. (One of the police documents lists 17 fatalities and many more wounded from the shooting. Other accounts have put the death toll at 11.)

I discussed the problem of Blackwater and other "security" contractors here and yesterday Robert Kaplan wrote in the Atlantic:

The idea of a large American military presence anywhere without contractors is now unthinkable. Without firms like KBR, the support tail in Iraq would be infinitely longer than it is, with tens of thousands of more troops required to achieve the same result. Buildings need to be maintained; chow halls have to be run; showers and restrooms need to be cleaned. Mundane activities like these account for the bulk of what private contractors do.

But as Josh Marshall points out this dependence on military contractors was not inevitable but a choice that was made.

The obvious rejoinder to this argument is, well, what did we do in the old days? As in, in Vietnam, Korea, all over Europe during the Cold War, etc. etc. And the obvious answer is nearly all these things used to be done by the military.

So what happened? Policy decisions were made, largely but not entirely during the 1980s, to privatize big chunks of war-fighting and war-support. It's true that in the short-term these services are indispensable to a mission like Bosnia. But that's only because we made the decision to phase out those capacities in the military. So their indispensability tells us nothing about whether this heavy reliance on contractors is a good idea; it just tells us we've made the decision to rely on them.

I think that a case can be made for contracting at least some of the construction projects but we are seeing the problems that result from unaccountable private armies. And there is this from Josh;

In a lot of cases what you're doing is building up a constituency of private contractors who cherry-pick the best people and then hire them back to the military at exorbitant prices. So the same folks who would be doing Job X for the US Army are now doing it for Blackwater for the US Army -- only now Blackwater CEO Erik Prince gets to pull down a big chunk of taxpayer dollars too.

Now we are getting to what it's all about. The Republicans and probably some who call themselves Democrats dont really think anything is worth doing unless someone can skim 20% off the top and get very rich. This brings us to SCHIP; the Bush administration and many Republicans fear it because they see it as one step closer to a single payer health care system. In the countries that have a single payer system overhead consists of 3% or less of the health care dollars spent - in the US it's 20%. Where does that difference go. It's skimmed off the top to make a few people very rich, that's where.

Sphere: Related Content

View blog reactions

Compassionate Conservatism in a nutshell

Commentary By Ron Beasley

Paul Krugman reminds us today that George W. Bush's "Compassionate Conservatism" is An Immoral Philosophy and that Bush and other conservatives oppose the Schip program because they fear it will work.

It must be about philosophy, because it surely isn’t about cost. One of the plans Mr. Bush opposes, the one approved by an overwhelming bipartisan majority in the Senate Finance Committee, would cost less over the next five years than we’ll spend in Iraq in the next four months. And it would be fully paid for by an increase in tobacco taxes.

The House plan, which would cover more children, is more expensive, but it offsets Schip costs by reducing subsidies to Medicare Advantage — a privatization scheme that pays insurance companies to provide coverage, and costs taxpayers 12 percent more per beneficiary than traditional Medicare.

Strange to say, however, the administration, although determined to prevent any expansion of children’s health care, is also dead set against any cut in Medicare Advantage payments.

So what kind of philosophy says that it’s O.K. to subsidize insurance companies, but not to provide health care to children?

Well, here’s what Mr. Bush said after explaining that emergency rooms provide all the health care you need: “They’re going to increase the number of folks eligible through Schip; some want to lower the age for Medicare. And then all of a sudden, you begin to see a — I wouldn’t call it a plot, just a strategy — to get more people to be a part of a federalization of health care.”

Now, why should Mr. Bush fear that insuring uninsured children would lead to a further “federalization” of health care, even though nothing like that is actually in either the Senate plan or the House plan? It’s not because he thinks the plans wouldn’t work. It’s because he’s afraid that they would. That is, he fears that voters, having seen how the government can help children, would ask why it can’t do the same for adults.
And there you have the core of Mr. Bush’s philosophy. He wants the public to believe that government is always the problem, never the solution. But it’s hard to convince people that government is always bad when they see it doing good things. So his philosophy says that the government must be prevented from solving problems, even if it can. In fact, the more good a proposed government program would do, the more fiercely it must be opposed.

There is no greater enemy to the modern conservative than a government program that works. The six and a half years of the Bush administration has been all about proving government doesn't work. Some of it intentional, the gutting of FEMA - think Katrina, and some of it unintentional - the invasion and occupation of Iraq.

But it has taken the fight over children’s health insurance to bring the perversity of this philosophy fully into view.

There are arguments you can make against programs, like Social Security, that provide a safety net for adults. I can respect those arguments, even though I disagree. But denying basic health care to children whose parents lack the means to pay for it, simply because you’re afraid that success in insuring children might put big government in a good light, is just morally wrong.

Sphere: Related Content

View blog reactions

If you say it enough

Commentary By Ron Beasley

The standard operating procedure for conservatives and Republicans has been to repeatedly tell a lie until people believe it. This has certainly been the case with health care delivery in the US. In order to protect the insurance industry they repeat over and over again that the US has the best health care in the world. As Paul Krugman points out today we don't.
The Waiting Game (TS)

Being without health insurance is no big deal. Just ask President Bush. “I mean, people have access to health care in America,” he said last week. “After all, you just go to an emergency room.”

This is what you might call callousness with consequences. The White House has announced that Mr. Bush will veto a bipartisan plan that would extend health insurance, and with it such essentials as regular checkups and preventive medical care, to an estimated 4.1 million currently uninsured children. After all, it’s not as if those kids really need insurance — they can just go to emergency rooms, right?

O.K., it’s not news that Mr. Bush has no empathy for people less fortunate than himself. But his willful ignorance here is part of a larger picture: by and large, opponents of universal health care paint a glowing portrait of the American system that bears as little resemblance to reality as the scare stories they tell about health care in France, Britain, and Canada.

The claim that the uninsured can get all the care they need in emergency rooms is just the beginning. Beyond that is the myth that Americans who are lucky enough to have insurance never face long waits for medical care.

I have had two friends, who had health insurance, who suffered and eventually died because they could not get required medical attention when it was needed. This was the result of insurance company beauracrats refusing care that had been requested by their physicians. That is representative of the myth of US health care.

Actually, the persistence of that myth puzzles me. I can understand how people like Mr. Bush or Fred Thompson, who declared recently that “the poorest Americans are getting far better service” than Canadians or the British, can wave away the desperation of uninsured Americans, who are often poor and voiceless. But how can they get away with pretending that insured Americans always get prompt care, when most of us can testify otherwise?

A recent article in Business Week put it bluntly: “In reality, both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems.”

A cross-national survey conducted by the Commonwealth Fund found that America ranks near the bottom among advanced countries in terms of how hard it is to get medical attention on short notice (although Canada was slightly worse), and that America is the worst place in the advanced world if you need care after hours or on a weekend.

We look better when it comes to seeing a specialist or receiving elective surgery. But Germany outperforms us even on those measures — and I suspect that France, which wasn’t included in the study, matches Germany’s performance.

Besides, not all medical delays are created equal. In Canada and Britain, delays are caused by doctors trying to devote limited medical resources to the most urgent cases. In the United States, they’re often caused by insurance companies trying to save money.

This can lead to ordeals like the one recently described by Mark Kleiman, a professor at U.C.L.A., who nearly died of cancer because his insurer kept delaying approval for a necessary biopsy. “It was only later,” writes Mr. Kleiman on his blog, “that I discovered why the insurance company was stalling; I had an option, which I didn’t know I had, to avoid all the approvals by going to ‘Tier II,’ which would have meant higher co-payments.”

He adds, “I don’t know how many people my insurance company waited to death that year, but I’m certain the number wasn’t zero.”

To be fair, Mr. Kleiman is only surmising that his insurance company risked his life in an attempt to get him to pay more of his treatment costs. But there’s no question that some Americans who seemingly have good insurance nonetheless die because insurers are trying to hold down their “medical losses” — the industry term for actually having to pay for care.

On the other hand, it’s true that Americans get hip replacements faster than Canadians. But there’s a funny thing about that example, which is used constantly as an argument for the superiority of private health insurance over a government-run system: the large majority of hip replacements in the United States are paid for by, um, Medicare.

That’s right: the hip-replacement gap is actually a comparison of two government health insurance systems. American Medicare has shorter waits than Canadian Medicare (yes, that’s what they call their system) because it has more lavish funding — end of story. The alleged virtues of private insurance have nothing to do with it.

The bottom line is that the opponents of universal health care appear to have run out of honest arguments. All they have left are fantasies: horror fiction about health care in other countries, and fairy tales about health care here in America.

Don't believe the lies. Insurance companies kill people to protect the bottom line and waste 20% of the US health care dollars doing it.

FAIR USE NOTICE

This article contains copyrighted material, the use of which has not always been specifically authorized by the copyright owner. I am making such material available in my efforts to advance understanding of democracy, economic, environmental, human rights, political, scientific, and social justice issues, among others. I believe this constitutes a 'fair use' of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, the material in this article is distributed without profit for research and educational purposes.

Sphere: Related Content

View blog reactions

America's broken health care system

Commentary By Ron Beasley

Americans pay more for health care than any other country in the world. At the same time the outcomes are worse and they have more people who don't receive health care coverage than any other developed nation. Why is this? Much of the the American health care dollar is spent trying to avoid paying claims and trying to avoid covering people who need it. In other words a large portion of the money spent on health care doesn't have anything to do with health care. Paul Krugman explains in
The Health Care Racket

But it’s a fact that insurers spend a lot of money looking for ways to reject insurance claims. And health care providers, in turn, spend billions on “denial management,” employing specialist firms — including Ingenix, a subsidiary of, yes, UnitedHealth — to fight the insurers.

So it’s an arms race between insurers, who deploy software and manpower trying to find claims they can reject, and doctors and hospitals, who deploy their own forces in an effort to outsmart or challenge the insurers. And the cost of this arms race ends up being borne by the public, in the form of higher health care prices and higher insurance premiums.

Of course, rejecting claims is a clumsy way to deny coverage. The best way for an insurer to avoid paying medical bills is to avoid selling insurance to people who really need it. An insurance company can accomplish this in two ways, through marketing that targets the healthy, and through underwriting: rejecting the sick or charging them higher premiums.

Like denial management, however, marketing and underwriting cost a lot of money. McKinsey & Company, the consulting firm, recently released an important report dissecting the reasons America spends so much more on health care than other wealthy nations. One major factor is that we spend $98 billion a year in excess administrative costs, with more than half of the total accounted for by marketing and underwriting — costs that don’t exist in single-payer systems.

And this is just part of the story. McKinsey’s estimate of excess administrative costs counts only the costs of insurers. It doesn’t, as the report concedes, include other “important consequences of the multipayor system,” like the extra costs imposed on providers. The sums doctors pay to denial management specialists are just one example.

But they don't always say no.

Incidentally, while insurers are very good at saying no to doctors, hospitals and patients, they’re not very good at saying no to more powerful players. Drug companies, in particular, charge much higher prices in the United States than they do in countries like Canada, where the government health care system does the bargaining. McKinsey estimates that the United States pays $66 billion a year in excess drug costs, and overpays for medical devices like knee and hip implants, too.

More is spent trying to avoid paying claims than it would cost to insure all of the uninsured.

To put these numbers in perspective: McKinsey estimates the cost of providing full medical care to all of America’s uninsured at $77 billion a year. Either eliminating the excess administrative costs of private health insurers, or paying what the rest of the world pays for drugs and medical devices, would by itself more or less pay the cost of covering all the uninsured. And that doesn’t count the many other costs imposed by the fragmentation of our health care system.

The health insurance industry gives no health care, it is only a leech that draws money that could be spent healing people paying large salaries to executives. The only answer is a single payer system. The free enterprise system is best for many things but contributes nothing to health care and in fact results in a health care system that is in fact dysfunctional.

FAIR USE NOTICE

This article contains copyrighted material, the use of which has not always been specifically authorized by the copyright owner. I am making such material available in my efforts to advance understanding of democracy, economic, environmental, human rights, political, scientific, and social justice issues, among others. I believe this constitutes a 'fair use' of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, the material in this article is distributed without profit for research and educational purposes.

Sphere: Related Content

View blog reactions

Krugman on Edwards on Health Care

Commentary By Ron Beasley

Since I am convinced that civilization as we know it will end before Bush Cheney leaves office it's hard to get too excited about many progressive issues. In spite of that Paul Krugman says some things about John Edwards health care plan.
Edwards Gets It Right

What a difference two years makes! At this point in 2005, the only question seemed to be how much of America's social insurance system - the triumvirate of Social Security, Medicare and Medicaid - the Bush administration would manage to dismantle. Now almost all prominent Democrats and quite a few Republicans pay at least lip service to calls for a major expansion of social insurance, in the form of universal health care.

But fine words, by themselves, mean nothing. Remember "compassionate conservatism?" I won't trust presidential candidates on health care unless they provide enough specifics to show both that they understand the issues, and that they're willing to face up to hard choices when necessary.

And former Senator John Edwards has just set a fine example.

It's like other plans:

Like Mr. Schwarzenegger, Mr. Edwards sets out to cover the uninsured with a combination of regulation and financial aid. Right now, many people are uninsured because, as the Edwards press release puts it, insurance companies "game the system to cover only healthy people." So the Edwards plan, like Schwarzenegger's, imposes "community rating" on insurers, basically requiring them to sell insurance to everyone at the same price.

Many other people are uninsured because they simply can't afford the cost. So the Edwards plan, again like other proposals, offers financial aid to help lower-income families buy insurance. To pay for this aid, he proposes rolling back tax cuts for households with incomes over $200,000 a year.

Finally, some people try to save money by going without coverage, so if they get sick they end up in emergency rooms at public expense. Like other plans, the Edwards plan would "require all American residents to get insurance," and would require that all employers either provide insurance to their workers or pay a percentage of their payrolls into a government fund used to buy insurance.

But it goes further:

People who don't get insurance from their employers wouldn't have to deal individually with insurance companies: they'd purchase insurance through "Health Markets": government-run bodies negotiating with insurance companies on the public's behalf. People would, in effect, be buying insurance from the government, with only the business of paying medical bills - not the function of granting insurance in the first place - outsourced to private insurers.

Why is this such a good idea? As the Edwards press release points out, marketing and underwriting - the process of screening out high-risk clients - are responsible for two-thirds of insurance companies' overhead. With insurers selling to government-run Health Markets, not directly to individuals, most of these expenses should go away, making insurance considerably cheaper.

Better still, "Health Markets," the press release says, "will offer a choice between private insurers and a public insurance plan modeled after Medicare." This would offer a crucial degree of competition. The public insurance plan would almost certainly be cheaper than anything the private sector offers right now - after all, Medicare has very low overhead. Private insurers would either have to match the public plan's low premiums, or lose the competition.

And Mr. Edwards is O.K. with that. "Over time," the press release says, "the system may evolve toward a single-payer approach if individuals and businesses prefer the public plan."

So this is a smart, serious proposal. It addresses both the problem of the uninsured and the waste and inefficiency of our fragmented insurance system. And every candidate should be pressed to come up with something comparable.

Yes, what the US needs is a single payer system but the best way to get that is to show that the greed driven insurance companies can't compete.

While my gut feeling is that America's domestic issues are irrelevant I think this is about right:

But America's crumbling health care system is our most important domestic issue, and I think we have a right to know what those who would be president propose to do about it.

Sphere: Related Content

View blog reactions

Out of touch and clueless

Commentary By Ron Beasley

We know that George Bush (both of them) and the Republican power players don't give a rats ass about anybody that isn't a millionaire. They think the economy is booming because it is for the only people they see or talk to, yes, the millionaires. Yes Bush and his "advisors" are out of touch with 95% of the American people. His health care "fix" is just the latest example of how clueless and out of touch they are and one can only wonder if they think the American public is really stupid or if they are really that clueless and out of touch. That is the subject of Paul Krugman's commentary today,
Gold-Plated Indifference

President Bush’s Saturday radio address was devoted to health care, and officials have put out the word that the subject will be a major theme in tomorrow’s State of the Union address. Mr. Bush’s proposal won’t go anywhere. But it’s still worth looking at his remarks, because of what they say about him and his advisers.

On the radio, Mr. Bush suggested that we should “treat health insurance more like home ownership.” He went on to say that “the current tax code encourages home ownership by allowing you to deduct the interest on your mortgage from your taxes. We can reform the tax code, so that it provides a similar incentive for you to buy health insurance.”

Wow. Those are the words of someone with no sense of what it’s like to be uninsured.

Going without health insurance isn’t like deciding to rent an apartment instead of buying a house. It’s a terrifying experience, which most people endure only if they have no alternative. The uninsured don’t need an “incentive” to buy insurance; they need something that makes getting insurance possible.

I must admit that De Krugman is perhaps a bit out of touch as well. There is nothing terrifying about making the decision to rent an apartment instead of buying a house. There are some of us who simply don't want a house. But I digress. As Krugman points out Bush's proposal is absurd because it will have no impact on the majority of those without health insurance. Once again the question, how dumb are they or how dumb do they thin the American people are?

Most people without health insurance have low incomes, and just can’t afford the premiums. And making premiums tax-deductible is almost worthless to workers whose income puts them in a low tax bracket.

Of those uninsured who aren’t low-income, many can’t get coverage because of pre-existing conditions — everything from diabetes to a long-ago case of jock itch. Again, tax deductions won’t solve their problem.

The only people the Bush plan might move out of the ranks of the uninsured are the people we’re least concerned about — affluent, healthy Americans who choose voluntarily not to be insured. At most, the Bush plan might induce some of those people to buy insurance, while in the process — whaddya know — giving many other high-income individuals yet another tax break.

While proposing this high-end tax break, Mr. Bush is also proposing a tax increase — not on the wealthy, but on workers who, he thinks, have too much health insurance. The tax code, he said, “unwisely encourages workers to choose overly expensive, gold-plated plans. The result is that insurance premiums rise, and many Americans cannot afford the coverage they need.”

Again, wow. No economic analysis I’m aware of says that when Peter chooses a good health plan, he raises Paul’s premiums. And look at the condescension. Will all those who think they have “gold plated” health coverage please raise their hands?

According to press reports, the actual plan is to penalize workers with relatively generous insurance coverage. Just to be clear, we’re not talking about the wealthy; we’re talking about ordinary workers who have managed to negotiate better-than-average health plans.

So of course what Mr Bush's health care plan really is is another tax break for the wealthiest Americans while shafting those who work.

Now I am a firm believer in the free market system but their are places where it doesn't work and regulation is required or we will return to feudalism. But to the laissez-faire Republicans the free market is the solution to everything.

Mr. Bush, on the other hand, is still peddling the fantasy that the free market, with a little help from tax cuts, solves all problems.

What’s really striking about Mr. Bush’s remarks, however, is the tone. The stuff about providing “incentives” to buy insurance, the sneering description of good coverage as “gold plated,” is right-wing think-tank jargon. In the past Mr. Bush’s speechwriters might have found less offensive language; now, they’re not even trying to hide his fundamental indifference to the plight of less-fortunate Americans.

So, are they clueless, indifferent or out of touch. If you answered all of the above you would probably be correct.

Technorati Tags

Paul Krugman, Bush, Health Care

FAIR USE NOTICE

This article contains copyrighted material, the use of which has not always been specifically authorized by the copyright owner. I am making such material available in my efforts to advance understanding of democracy, economic, environmental, human rights, political, scientific, and social justice issues, among others. I believe this constitutes a 'fair use' of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, the material in this article is distributed without profit for research and educational purposes.

Sphere: Related Content

View blog reactions

Universal Healthcare - is it coming? Part II

Commentary By Ron Beasley

Below I discussed the changes that are overdue and inevitable in the distribution and management of health care in the US. In the comments section Kari Chisholm reminded us that Oregon's own Senator Ron Wyden has a proposal and you can see what it is at Stand Tall for America.

There are, of course, many details. Here's a few of the highlights.

The Healthy Americans Act:

• guarantees you private health care coverage that doesn't go away, even if you change jobs, lose your job, retire, go to school, or become too sick to work.


• provides a generous benefit equal to those of Members of Congress


• ensures that everyone has affordable health care coverage, including meaningful assistance to low-income Americans.


• puts you in charge of your health care choices, not your employer


• makes sure that everyone has the same affordable coverage options, no matter your age, gender, genetic information, or pre-existing health conditions


• saves $1.48 trillion over 10 years through tough cost containment


• provides incentives for individuals and insurers to focus on prevention, wellness and disease management


• creates meaningful and easy-to-understand wellness statistics so that Americans can compare health care plans


• is fully paid for by spending the $2.2 trillion currently spent on health care in America

An easy-to-understand summary of how it works.

I don't know if this is the answer but it's a start and better than what we have now. Check it out and let Ron Wyden know what you think. I'll pass on any comments here to Kari and Senator Wyden.

Sphere: Related Content

View blog reactions

Universal Healthcare - is it coming?

Commentary By Ron Beasley

Almost two years ago I wrote about an article in The New Republic by Arnold S. Relman, Medicine and the Free Market. Mr Relman opened with this:

During the past four decades our health policies have failed to meet national needs because they have been heavily influenced by the delusion that medical care is essentially a business. This delusion stubbornly persists, and current proposals for a more "consumer-driven" health system are likely to make our predicament even worse. I wish to examine these proposals and to explain why I think they are fundamentally flawed. A different kind of approach could solve our problems, but it would mean a major reform of the entire system, not only the way it is financed and insured, but also how physicians are organized in practice and how they are paid. Since such a reform would threaten the financial interests of investors, insurers, and many vendors and providers of health services, the short-term political prospects for such reform are not very good. But I am convinced that a complete overhaul is inevitable, because in the long run nothing else is likely to work.

At the time Mr Relman didn't think it was going to happen any time soon because those with a vested interest in keeping the current system owned to many politicians. Well less than two years later Ezra Klein thinks that enough people and organizations now realize how broken the US health care system is and think it might be time to be
Going universal

THE STATISTICS, by now, are well known. Forty-seven million uninsured Americans. Premium increases of 81% since 2000. Small businesses failing, big businesses foundering, individuals priced out and, amid all this, skyrocketing profits for insurers, hospitals and pharmaceutical manufacturers.

The American health system, put simply, is a mess. An expensive one. Indeed, in 2002, we spent $5,267 per capita on healthcare — $1,821 more than Switzerland, the nearest runner-up. And yet we had higher infant mortality, lower life expectancy, more price inflation and an actual uninsured population, a phenomenon virtually unknown in the rest of the developed world, where universal healthcare is, well, universal.

These are unsustainable trends. The U.S. healthcare system cannot, in its current form, go on forever, or even for very much longer — employers can't afford it, individuals can't handle it and the country's conscience won't countenance it.

And change may come sooner than most think. Across the country there are unmistakable signs that the gridlock and confusion sustaining our sadly outdated system are coming to an end and that real reform may finally emerge, possibly even starting in California, where Gov. Arnold Schwarzenegger is promising to spend his upcoming State of the State speech explaining how he will push the Golden State closer to universal healthcare in the coming year.

So what changed in two years? It's simple, there are more powerful people losing money under the current system than are making money. I never for one moment thought that health care in the US would change because it was the right thing to do but that it would come when it became an economic necessity. Businesses large and small can't compete on the national stage because of the burden of our inefficient health system. Even the insurance companies are beginning to have difficulty showing a profit are more and more individuals and businesses are priced out of the game.

Klein explains that changes are on the way on several fronts.

But there is evidence, finally, that their castle is being stormed. Massachusetts has passed the nation's first near-universal healthcare plan, creating a structure that should cover 95%-plus of its citizens by making healthcare as mandatory as car insurance. Nationally, the Democratic resurgence has returned universal healthcare to the agenda and its advocates to power. In the House, Rep. Pete Stark (D-Fremont), a staunch Medicare-for-all advocate, is expected to be chairman of the health subcommittee.

Surrounded by an unlikely array of union leaders and corporate chief executives, Sen. Ron Wyden (D-Ore.) has unveiled an inventive, comprehensive reform plan that would end the employer system forever. What businesses pay in employee premiums would be redirected to employee raises; insurers would offer their plans through state associations that would no longer allow price discrimination for reasons of health or job status; and everyone would have to buy in. Universal coverage would be achieved in under two years.

The most compelling evidence that resistance to reform is futile, however, is coming from the insurers themselves. Cognizant that Congress and the nation are tiring of the current dystopia, the insurance industry recently released its own plan for universal healthcare.

It's a bad plan, to be sure. Its purpose is more to preserve the insurance industry's profits than improve healthcare in this country. But the endorsement of universality as a moral imperative, and the attempt to get in front of the coming efforts at reform, mark the emergence of a distinct rear-guard mentality within the insurance industry. Their game is up, and they're turning some of their attention to shaping their future rather than betting that they can continue protecting their present.

So change is coming and we must convince the legislators to ignore the special interests of the Medical Industrial Complex and come up with a good plan the first time.

Update
More on Senator Ron Wyden's plan above.

Sphere: Related Content

View blog reactions