Tag Archives: health care

Lack of Insurance Causes 45,000 Annual US Deaths

Here is a link to a new study which estimates that 44,789 Americans die each year because they lack health insurance. This is the study that Rep. Alan Grayson referenced when he faux-apologized for mocking the Republicans’ lack of a health plan.

This is a purely statistical study, and I am totally unqualified to assess its methodology. However, it is being published in a peer-reviewed academic journal, and was written by fancy-pants researchers at Harvard Medical School, so it’s probably a pretty decent piece of work.

Health Care is a Moral Issue

T.R. Reid, author of “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Healthcare,” recently wrote an article for Newsweek comparing the American health care system to the systems in other developed countries. The subtitle of the article is “To judge the content of a nation’s character, look no further than its health-care system,” and you can imagine where it goes from there. Reid notes that the U.S. is the only developed country that does not provide universal health care, and he quotes the facts that result: 22,000 Americans die per year because they can’t afford a doctor, and 700,000 Americans go bankrupt each year due to medical bills.

Reid compares this to Europe, where they approach health care with an emphasis on equality, on providing service to everyone. Here are some key quotes from Europeans regarding their view on health care:

  • A French physician: “But when we get sick – then, yes: everybody is equal.”
  • A former president of Switzerland: “Because it is a profound need for people to be sure, if they are struck by the stroke of destiny, they can have a good health system.”
  • A Swedish health minister: “The formula is so simple: health care for everybody, paid for by everybody.”
  • The Czech constitution: “health care for all.”

Reid sums it up: “The principle seems so obvious to people in Europe, Canada and the East Asian democracies that health officials asked me over and over to explain why it isn’t obvious to Americans as well.”

In America, on the other hand, we approach health care with an emphasis on freedom of choice, particularly during this summer of health care debates. But it’s not true freedom, since those without insurance are, in fact, denied any choice at all.

Reid again: “In the U.S., in contrast, some people have access to just about everything doctors and hospitals can provide. But others can’t even get in the door (until they are sick enough to need emergency care). That amounts to rationing care by wealth. This seems natural to Americans; to the rest of the developed world, it looks immoral.”

Republicans this summer tried to frame the issue as industrious workers supporting the lazy unemployed and uninsured, but that’s a canard. This frame ignores reality. To look at reality, take two factory workers: one is employed by GM, and has thus insurance, and the other is employed by a small local factory which doesn’t provide insurance. They are equally industrious, equally hard working, but the one without insurance is more likely to skip his doctors visits and – statistically speaking – more likely to die. Or take Nikki White, who was industrious and employed, until she became too sick with lupus to work, thus lost her insurance, was unable to afford the care she needed, and soon died.

The issue is not one of who works hard. The issue is whether we, as a society, want to let the people who randomly get sick (or randomly don’t have insurance) go bankrupt or die, simply because of their random bad luck. As Reid notes, this is a moral issue, and I don’t believe that American morals have decayed this far. We are better than this. We live in America, the greatest and richest country in the world. This country was founded on the premise that “all men are created equal,” remember? Not “all healthy men” or “all wealthy men.” Do we really want to live in a country that allows people to die purely because of their financial situation? I don’t think we do.

FYI, here is a New Republic article on the moral dimension of health care.

Follow Up to Markets & Health Care

Just a quick link to this article by a pediatric cardiologist giving both data and anecdotes on what bad consumers we all are when it comes to health care. Something to keep in mind as we look at more market-driven approaches to our health care system.

A Market Approach to Health Care

As regular readers know, I am focused on health care reform and am frustrated by the general dysfunctionality of the American health care system. My few posts have approached the problem from the perspective of working within the system we have, in particular by pushing doctors to emphasize patient care instead of revenue generation.

However, the latest issue of The Atlantic magazine has a fascinating article that takes the entire system to task and suggests a radical new approach. The author, David Goldhill, is a businessman rather than a policy guy, but he was driven to explore the health care system after his father died from a hospital-acquired infection. (Disclosure: I know David and am friendly with him) This article has been praised from the right and the left, and even has its own Facebook page.

Goldhill starts from the specifics and moves outward. He notes the 100,000 deaths per year in the US from hospital-acquired infections, and how hard it is to convince doctors to adopt a checklist that has been proven to dramatically reduce infection. “But many physicians rejected the checklist as an unnecessary and belittling bureaucratic intrusion, and many hospital executives were reluctant to push it on them.” He wonders how a society that shuts down restaurants for a single case of food poisoning tolerates this.

As a businessperson, Goldhill assumes there must be a reason for these terrible facts. Since people respond to economic incentives, the incentives in health care must be deeply flawed for our system to work as poorly as it does. Goldhill’s diagnosis: rather than following a market system, where consumers drive providers to lower costs and improve service, our health care system is a patchwork of information-obscuring insurance and lobbying-influenced regulations. In a market system, DVD players get better and cheaper, while in the health care system, nothing ever gets cheaper.

Goldhill’s treatment plan is to make health care more like a standard consumer product. Everyone will have catastrophic insurance, but in his system, those plans will have a deductible of $50,000 rather than the usual $2,000-$4,000. The government will provide subsidies to make this insurance affordable. But for most medical expenses, consumers will pay for them out of income and savings. Where will they get the money for this? Under Goldhill’s plan, since employers will no longer need to provide insurance ($12,000 per year for the average family), workers will be paid more, and thus have money to spend on medical expenses. If consumers are paying for most things themselves, the entire system will be subject to market forces, which improve quality and decrease cost.

I’m not doing justice to Goldhill’s solution. When read in full, it makes a lot of sense. Goldhill notes at the beginning of his piece that he is a Democrat who believes that everyone should be covered, and his system would do that. Ignoring the fact that Goldhill’s system will never happen (the insurance and hospital lobbies are way too strong), I have only one general critique, which has that Goldhill has, I think, too much faith in the market, which we have seen over the past two years is not always efficient, and is sometimes capricious and cruel. It’s bad enough when the market screws up your mortgage, but if it ruins your health care….

Here are two specific examples where I think Goldhill overestimates the wisdom of the market:

  1. Goldhill says that if companies did not have to provide insurance, all the money saved would go to the workers as increased salary, so they could afford their own health care. But we all know that the majority of the savings would actually go to executives and stockholders, and workers would be left uninsured and unable to pay for visits to the doctor.
  2. I certainly agree that we want people to be better informed consumers in the health care market, but as the mortgage debacle has shown us, many people are simply incapable of making intelligent decisions in a complicated environment. If somebody is unable to figure out if they can afford an adjustable rate mortgage, can we really expect them to intelligently perform the cost-benefit analysis between possible treatment plans for their cancer?

Medical Doctors: Stop Being Greedy

Check out this article about the panel that decides how Medicare reimburses every procedure, doctor visit or call in the medical world. The panel is completely run by the AMA, and dominated by specialists. So, big surprise, specialist visits and procedures are continually going up in value, while simple visits to your GP stay static. And the government does nothing to stop this; instead, the AMA — an organization of doctors — gets to decide how much doctors should get paid. Paid by taxpayers.

This is why simple tests cost $3,000, or why my GP tried to charge me $250 to spend 90 seconds freezing off a wart (I refused to pay). I have commented before on how greedy doctors are no better than subprime mortgage traders on Wall Street, and this article adds evidence to my viewpoint. A system where people get to decide on their own compensation is a bad system, and a world where jerk off dermatologists (yes, I’m talking about you, Dr. K) think they deserve $500k per year is a world with misplaced priorities.

So, AMA, organization of money-grubbing doctors that has fought health care reform for the past 60 years, I say to you: stop being greedy and screwing over your patients.

Living The Health Care Debate

There are plenty of policy papers out there on both sides of the health care reform issue, as well as plenty of nutjobs talking about death panels. But here is an anecdote from the front lines: I recently had a test done at California Pacific Medical Center, which is purportedly a non-profit hospital affiliated with Sutter Health, a collection of non-profit hospitals. CPMC is the only hospital in the northern half of San Francisco, and essentially has a monopoly on health care for a big chunk of the city. What do they do with their monopoly power? My breath test, which was run not by a doctor but by a young technician, and which took 90 minutes, was billed at $3,000. That’s right: $2,000 per hour was what they charged for their technician’s time and use of the machine. To compare, a top partner at a major corporate law firm I have used billed me at $650 per hour. This is why the current system is unsustainable. Insured individuals never see these bills, because their insurance pays it, so hospitals keep charging obscene rates. But for those of us who have to pay our own medical bills, we have no choice but to protest and fight back. Reforming the system is part of our fight.

“Death Panels” Are Another GOP Lie

Check out this NY Times article which shows in detail how the ridiculous rumor about “death panels” in the current health care reform effort came from the same sources whose lies helped kill Clinton’s health care reform. Why do Republicans so hate health care reform? Do they really think it’s OK for poor people to get worse health care than wealthy ones?

Don’t Screw Up Healthcare to Make Political Points

The health care reform effort in Congress is hitting some snags, and reports are discussing how the republicans see this as a make or break moment for the Obama administration. The republicans want to stop reform to make Obama look bad and weaken his chances to implement other parts of his agenda. Jim DeMint (R-SC) called it a “Waterloo moment” for the president.

This is why people hate politicians. Because instead of focusing on policy and helping their country and their constituents, they play douche bag political games like this is some sort of high school mock senate instead of the real thing.

If politicians don’t like the health care reform bills being presented, that’s fine. They are challenging bills, and concerns about their cost or about growing government bureaucracy or any number of other issues are legitimate. Hell, if you think that the free market should rule and people should be on their own for health care, that’s a legitimate, although heartless, view.

Virtually everyone – including republicans – agrees that health care reform is needed. The disastrous state of the American health care system is well known. So to fight health care reform bill – not fight to improve it, but fight against it passing at all – just to score political points, well that sucks. As happens so often here at Thoughtbasket, I must ask our representatives to stop dicking around and do the right thing.

Is Healthcare Rationing Inevitable?

Yesterday’s NY Times magazine preview had a thought-provoking article by Peter Singer on health care rationing. Singer clearly comes at this from an extreme position (this is a guy whose fame is due to weighing hypothetical lives against each other), but he raises some excellent points. I’m not sure where I come down on rationing, and how it might work, but it’s clear that spending $50,000 on new drugs that only extend life by a few months is not a sustainable system. As congress gets ready to debate the health care bills coming out of committee, we should all start thinking about how America pays for health care, and reading Singer’s article is a good place to start. You only really need to read the first half. In the second half he goes into his usual shtick about disabled people vs. fully abled and goes off point.