Tuesday, August 24, 2010

Sick of Health

Steve D Russell

Forgive the pun, but I'm sick of watching and listening to the ideological bigotry being used by both sides in the current debate over healthcare reform. Even the fallacy that the debate could possibly be encapsulated by "two sides" makes me angry. The very idea that being able to shout louder than someone else or that a few words written on a placard contributes anything to a debate on such an important issue is asinine in the extreme. Such behavior, including mindless chanting of simplistic slogans, effectively halts all objective discussion and obscures the real issues.

So, stop mouthing off, stop quoting extreme anecdotal examples and stop using prefabricated, emotive labels designed to perpetuate already polarized thinking.

This maybe a revolutionary idea, but why don't we start looking at factual evidence backed up by legitimate research. Yes I know this a new concept, but just bear with me for a while, you never know, we might then draw some reasoned and sensible conclusions.

Here is an initial, outrageous idea to open up your thinking:

Starting in 2011, schooling for our children will no longer be funded or provided by either state or federal government. All parents and children will be expected to pay in full for their academic education which will be provided by private institutions. Emergency treatment for difficult math problems and long words will be available at certain schools but waiting times might be quite long.

This policy will be introduced on the overall premise that nobody ever died as a direct result of not being educated. However, people do die as a direct result of health issues. In view of this, all funding currently provided by every level of government to education will be reallocated to healthcare. Silly idea because that's not the way we do things - and imagine the increased incidence of illiteracy...Oh, wait a second...

Now that you are smiling broadly and are instantly ready take on new and radical ideas, here are some facts:
• The United States of America does not have the best health system in the world
• The United States of America does not have the worst health system in the world
• The United States of America has some of most advanced healthcare expertise in the world
• The United States of America's delivery of overall healthcare and its health outcomes do not compare well to most other industrialized countries
• The United States of America has the capability to offer expert treatment to patients of all ages
• The United States of America has an illogically high incidence of infant mortality, short longevity and avoidable death rates

Okay, that smile has lessened somewhat, so here are some factual statements and observations:

• I don't know which country does have the best health system in the world - but neither does anyone else reading this
• The United States of America spends more (per capita) on administering the bureaucracy of its healthcare than any other country in the world. Sometimes by a factor of three or four over countries with effective universal systems.
• There is no particular reason why employers should continue to be responsible for providing healthcare. It is an invidious practice that can be extremely detrimental to both employee and employer interests. The practice has its origins in the pay freezes of World War II, yet now seems entrenched in the American working life. Why should your employer decide what health cover you get? Your family physician doesn't tell you where you should work!
• There is no reason why a national, universal health plan should increase individual or government healthcare costs. Individual tax costs will increase but, if a scheme is implemented effectively, there will be no health insurance premiums to pay. Employers should no longer have to pay their portion to the insurers and there should be no co-pay. In case you missed that - NO CO-PAY! Your employer may even pass his or her savings on to you as a wage increase.
• Effective preventative healthcare makes an enormous contribution to the quality of life and the longevity of that life. In the current situation prevailing in the United States of America, there is little incentive for health insurers to finance preventative care. The premise is that, as people change jobs and healthcare insurers, the financial benefits of preventative medicine might be enjoyed by organizations other than those that originally funded it.
• Viewed from afar, the citizens of the United States of America are hypochondriacs obsessed by illness. This hypochondria is fueled by a constant barrage of television commercials for prescription drugs containing information that should only really be evaluated by competent medical professionals. Trendy acronyms only exacerbate the obsession - why not become obsessed by health and wellness instead?
• Market forces and human nature are generally inappropriate in healthcare. Physicians are encouraged to treat where treatment is perhaps unnecessary. Pharmaceutical companies need a steady stream of new illnesses, gullible or mercenary physicians and new drugs to keep them in business. Health insurers need to be able to promise nurturing care from cradle to grave and yet be able to deny treatment on all possible occasions.

Now that the smile has been replace by a scowl and you're thinking about shouting or painting a placard, here are some comparisons that will restore your faith in man's inhumanity to man.

• Universal schemes can only provide the greatest good for the greatest number and will spend any and all amounts of money provided
• Private schemes will drop you if it looks as though you might get a long-term illness
• Universal schemes will always treat acute cases first and will generally do these well. less urgent cases may well wait some time for treatment
• Private schemes will treat your acute or less urgent conditions entirely in respect of financial considerations, but will have you back in your car about the same time the anesthesia wears off, often causing you to come back again (with another co-pay) in a couple of days
• Universal schemes often provide unintentional long-term accommodation for the homeless
• Private schemes always use the latest and most expensive treatments irrespective of whether they are superior to proven treatments.
• Universal schemes are often unwilling to adopt new procedures until cost and/or patient benefits have been established

Here is a dirty word:


Actually it's two words, but you get the drift. Most universal or national health schemes operate this policy. Supporters of the status quo in United States health policies consider it blasphemy. It is a prime example of the emotive labeling so apparent in current healthcare discussions.

Single-payer simply means that payment for medicines and treatment comes from a single source. That single source is the organization that operates the health service - almost invariably the government. Pharmaceutical companies and medical practitioners abhor this policy because they are unable to play numerous payers (with differing priorities) off against each other. Instead they have to deal with a single body that has the single objective of balancing cost and patient benefit - more simply known as value for money. The VA health system bureaucracy "sorta-kinda" operates in a similar way to single-payer.
This does mean that many medical practitioners will get less for the work that they do. Pharmaceutical companies will undoubtedly claim that they will be unable to research new treatments. Personally, I can live with this because the physicians that earn substantially less will only be those who have been financially focused in their practices. Pharmaceutical companies will continue to research and develop because that is what they have to do to exist. Maybe these new pressures will force them to be more focused on effective remedies? Am I the only person who wonders whether drug companies develop new products and then look for an illness to treat with it? The objective of a healthcare system is to look after the receivers of that healthcare - not to make a few professionals obscenely wealthy.

The bottom line is that the current healthcare systems (in terms of delivery and outcomes) in the United States of America are ineffectual and probably irreparable in their current form. Federal and state politicians are scared to death of the pharmaceutical lobby and failure to be re-elected (but then I repeat myself). The AMA represents the interests solely of the medical profession and has stood four-square in the way of any proposed initiatives that benefit patients at the expense of their members. I don't think insurance companies care one way or the other because they think they will still get a large slice of the cake whatever happens. When it dawns on them that single-payer may become a reality, they will get the rest of the politicians that the pharmaceutical companies missed.

It should not (and cannot) be beyond the wit of the US Government to take the time to investigate the healthcare schemes that are the most successfully operated in other industrialized countries. Surely, somewhere in this nation, we have officials with the ability to judge and evaluate the best of those and surely we have the expertise to implement such a scheme here.

According to the Organization for Economic Co-operation and Development (OEDC), in 2003/2004, per capita health expenditure in the United States of America was $6,120 (15.3% of GDP), life expectancy was 77.5 years and infant deaths, per thousand, were 6.9. During the same period in Japan, per capita health expenditure was $2,249 (8% of GDP), life expectancy was 81.8 years and infant deaths, per thousand, were 2.8.

Here are some final kickers. How can the country that considers itself the most advanced economy in the world, allow its citizens to be denied preventative healthcare because of corporate avarice? How can it allow around 700,000 families each year to bankrupt themselves seeking healthcare? How can it let people die for lack of healthcare?

For those that say government cannot afford universal healthcare, consider this: in 2003 (according to the World Health Organization) the United States government spent more, per capita, on healthcare than each of the governments of the United Kingdom and Sweden. Two countries that each have universal healthcare, the citizens of these countries did not have co-pays and both countries achieve generally better health results than the United States of America can boast.

Personal net expenditure on healthcare would drop significantly under a properly implemented universal scheme and a single payer scheme would have the potential to cut billions of wasted dollars out of administrative costs.

Finally, President Obama's scheme will not work because it does not address the fundamental underlying problems. The supporters of the status quo will gladly watch the percentage of GDP spent on healthcare rise to 20% in the unreasoned belief that the marketplace will deliver effective healthcare and that we already have (of course) the best healthcare in the world. Basically we're screwed!

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