Tuesday, April 18, 2006

Health care: Feelin' alright? I'm not feelin' too good myself

Ed isn't doing well. After having clear scans at Christmas time, he now has nodules, and is currently back in the hospital. This is not the first time in the hospital for Ed.

Ed's son Chuck, my brother-in-law Dave's brother, died of cancer in 2000. Much too young.

Our dear friend Lizzie died 4 years ago last month. Her cancer could have been caught earlier, but a callous and uninformed docter told her the lumps in her breasts couldn't be cancerous, because at 27, she was too young. She was 31 when she died.

My beautiful younger sister Kristin, about whom I have written many times, also died 4 years ago last month, from uterine cancer. She had a hysterectomy due to a benign uterine tumor a couple of years earlier, but no one mentioned that follow-up scans should be done.

And now we learned tonight that Pam's cousin Laurel, who Pam called Lollipop, died last night due to as yet unknown reasons. One thing we do know is that Laurel couldn't find a job. The last job she applied for, for $8.00/hr, had hundreds of applicants. She had been out of work for 2 years.

I'm not trying to be melancholy, but I want to try and make the point that here in America, we have pretty crappy health care compared to the rest of the industrialized world. And having said that, I don't know that anything would have been, or will be different for the people I mention above.

From Ezra Klein, who is rapidly becoming on of the left's leading lights on thoughtful health care issues, we have this:
Interesting study out from Health Affairs comparing the care experiences of patients in six countries. The lucky lab rats are Australia, America, Canada, Germany, England, and New Zealand. The results, for Americans, are not comforting. I'll quote you the interesting parts:

"Concerns about transition care extended to medications. Patients in all countries were often given a new medication when discharged, with U.S. patients the most likely to report new medications. Yet in all but Germany, at least one in four patients said that nobody had reviewed the medications they were taking before their hospitalization.[...]

. . .

Our findings also indicate that insurance and delivery systems affect patients’ experiences beyond basic access and waiting times. Symptoms of inadequate insurance coverage and more fragmented care in the United States emerged throughout the survey. The United States outspends the other countries, spending 14.6 percent of national income compared with Germany’s 10.9 percent, Canada’s 9.6 percent, Australia’s 9.1 percent, New Zealand’s 8.5 percent, and the United Kingdom’s 7.7 percent.25 Yet the United States often ranks last or tied for last for safety, efficiency, and access. With one-third of U.S. patients reporting medical, medication, or lab errors and a similar share citing duplicate tests or medical record delays, our findings indicate widespread performance deficiencies that put patients at risk and undermine care. Moreover, a recent study finds that the United States is not systematically a leader in clinical outcomes.26
And this piece:
Canada's system is too biased against the private sector; some degree of private, supplementary insurance should be allowed. We do not live in an equal society and we've never had a problem with allowing the richest to benefit from their funds. But if Canada's problem is that they have a ceiling, our problem is that we don't have a floor. Liberals shouldn't construct a system that stops Americans from getting ever-better health care, but we need one that guarantees a certain level of care. In essence, we want a floor without a ceiling.

France and Britain are more interesting, Britain for their enormous cost control and France for the fact that their health care is really very good. But Britain's frugalness has a price -- care simply isn't as good, surgeries are underused, medicines under-prescribed, and so forth. While they still have better outcomes than we do, it's only because so many of our citizens are totally without access to health care. If you had to decide where to be treated, you definitely want it to be here.

France is more my speed. Government provided, ceiling without floor, etc. The lack of a gatekeeper leads to overuse (i.e, the French go to the doctor's too often), but that's changing their, and it could easily be side-stepped here. What a shame, then, that France is so off-limits in political dialogue. But whether or not we can invoke the French, they're the closest thing to a model structure out there, and we should study them for ideas.

Kevin Drum has this to say:
In the Wall Street Journal today, Dr. Benjamin Brewer writes that he's finally come around to the idea that America would be better off with a single-payer national healthcare system:
Doctors in private practice fear a loss of autonomy with a single-payer system. After being in the private practice of family medicine for 8 1/2 years, I see that autonomy is largely an illusion. Through Medicare and Medicaid, the government is already writing its own rules for 45% of the patients I see.

My virtual son Jim was visiting his fiance in France over Christmas, and while working in a vineyard, his eye was hurt. He went to a hospital, saw a doctor, was given a prescription, and all ended well. He wasn't denied care because he was a foreigner. On the contrary, he was treated, but because he wasn't a citizen, the fee was 20 Euros instead of the 5 Euro co-pay.

My point is that we really need to do something to fix the system. The insurance lobby claims, falsely, that malpractice claims are increasing. Industry claims that insurance premiums are wiping them out, yet Exxon's CEO:
Raymond received a compensation package worth about $140 million last year, including cash, stock, options and a pension plan. He is still entitled to stock, options and long-term compensation worth at least another $258 million, according to a proxy statement filed by Exxon with the Securities and Exchange Commission on Wednesday.
The total sum for Raymond's golden years comes to at least $398 million, among the richest compensation packages ever. The record was the payout of $550 million to Michael Eisner, the former head of Walt Disney, in 1997.
Exxon's board also agreed to pick up Raymond's country club fees, allow him to use the company aircraft and pay him another $1 million to stay on as a consultant for another year. Raymond agreed to reimburse Exxon partly when he uses the company jet for personal travel.
And record profits:
Exxon Mobil Corp. posted record profits for any U.S. company on Monday -- $10.71 billion for the fourth quarter and $36.13 billion for the year -- as the world's biggest publicly traded oil company benefited from high oil and natural-gas prices and solid demand for refined products.
Lest anyone think I'm mixing metaphors, or comparing apples and oranges, I'm really not. It's a matter of priorities.

Many "Conservatarians" as I call them howl loudly about socialism when we discuss universal health care, for reasons, that, while wrong, are understandable. No one wants to surrender control over their health care to a mindless bureaucracy. But there is a different issue to consider. Rather than submit to faceless authority, we instead submit to profit.

I argued with a conservatarian many years ago that the auto insurance industry should be nationalised. No organisation that I am obliged by law to make payments to should earn a profit. It should be regulated, fairly simply, and left to earn subsistance based on actuarial projections. And at the end of the fiscal year, all excess funds returned in the form of a rebate.

I really see no difference. I don't want my health care provider, my primary care doctor, my surgeon, my physical therapist to make medical decisions based on profit motivations.

And I don't want pharmaceutical companies to promise 4 hour erections on TV.

The point is that government has the necessary infrastructure to efficiently provide health care to all Americans, in the same way that it can provide for the common defense. Remember that phrase?

Forced into choosing between Uncle Sam & Wall St. for medical care, I go with Uncle any day. After all, if America can't do it right, who can?

May God/Allah/YHWH/Mother Earth bless Ed, Chuck, Lizzie, Kristin, Laurel, and all who suffer. And may we all contribute to caring for each other.