From my blog "One Little Victory"

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Today's Topic: Health care in the United States of America

WARNING: THIS IS GOING TO BE A LONG POST

This is probably the most vexing issue in the U.S. today, though special interests and conservative paranoids have made this issue far more complicated than it really is. As you can probably surmise, I went to see Michael Moore's "Sicko" the other night and, love him or hate him, the man made some good points. But as opposed to having this post be a debate over Michael Moore's views, we're instead going to look at why I have reached the conclusion that I have.

Two assumptions I am utilizing for the purpose of this article:

1) How we treat our least fortunate in the United States says a great deal about our values as a society.

2) Neither capitalism nor socialism is good nor evil left unto itself. Rather, it is how the concepts are applied. It is my sincere view that we as a nation have taken capitalism to a very unhealthy place, allowing the most successful capitalists to become more successful at the cost of others. This, to me, is where the line must be drawn, and where socialist concepts must be applied.

Politics have supported the status quo and reduced the quality of health care in the United States. Our infant mortality rate has risen fairly dramatically since 32nd ranked infant mortality in the developed world (second worst). Our life span has fallen off compared to the rest of the industrialized world, as has our average height.

We are the most "powerful" nation on earth, and we are happy with one of the worst health care systems in the industrialized world?

Let's take a look at some of Moore's claims from "Sicko" and juxtapose them to the fact-checking done by CNN. For the purpose of this article, I will take CNN's word over that over the self-appointed MTV health expert Kurt Loder. Loder is one of the science-denying idiots still trying to run around "debunking" Al Gore's An Inconvenient Truth. Let's just say that if you get your news from Loder, you could be doing a tad bit better. Frankly, who gives a rat's ass what that pinhead thinks?

So back to Moore's claims:

1) Out of 50 million uninsured people in the U.S., roughly 18,000 will die each year due to being uninsured.

CNN Response:

For the most part, that's true. The latest numbers from the Centers for Disease Control and Prevention say 43.6 million, or about 15 percent of Americans, were uninsured in 2006. For the past five years, the overall count has fluctuated between 41 million and 44 million people. According to the Institute of Medicine, 18,000 people do die each year mainly because they are less likely to receive screening and preventive care for chronic diseases.

2) The United States spends more of its gross domestic product on health care than any other nation.

CNN Response:

Again, that's true. The United States spends more than 15 percent of its GDP on health care -- no other nation even comes close to that number. France spends about 11 percent, and Canadians spend 10 percent.

Like Moore, we also found that more money does not equal better care. Both the French and Canadian systems rank in the Top 10 of the world's best health-care systems, according to the World Health Organization. The United States comes in at No. 37. The rankings are based on general health of the population, access, patient satisfaction and how the care's paid for.

So, if Americans are paying so much and they're not getting as good or as much care, where is all the money going? "Overhead for most private health insurance plans range between 10 percent to 30 percent," says Deloitte health-care analyst Paul Keckley. Overhead includes profit and administrative costs.

"Compare that to Medicare, which only has an overhead rate of 1 percent. Medicare is an extremely efficient health-care delivery system," says Mark Meaney, a health-care ethicist for the National Institute for Patient Rights.

3) Moore shows patients in Canada, Great Britain, France and Cuba all waiting patiently for health care that they easy and free access to.

CNN Response:

Not as simple as it looks in the movie.

In most other countries, there are quotas and planned waiting times. Everyone does have access to basic levels of care. That care plan is formulated by teams of government physicians and officials who determine what's to be included in the universal basic coverage and how a specific condition is treated. If you want treatment outside of that standard plan, then you have to pay for it yourself.

"In most developed health systems in the world, 15 percent to 20 percent of the population buys medical services outside of the system of care run by the government. They do it through supplemental insurance, or they buy services out of pocket," Keckley says.

The people who pay more tend to be in the upper income or have special, more complicated conditions.

In the movie, Moore focused exclusively on people who did have health insurance, shining light on the dirty tactics that insurance companies. While Loder is quick to dismiss those as dreadful exceptions, upon whose word are we to believe that these are exceptions? Even people in the industry were more than willing to talk to Moore about the unethical and immoral behavior taking place.
So while most people agree that our system needs to change, there is sharp disagreement over whether this should be done privately or through the government.

In order to present the discussion in a more (relatively) neutral spotlight, I found this article from About.com.

What is Universal Health Care?
From Bobbie Sage,
Your Guide to Personal Insurance.

Universal Health Care Gains Popularity

Universal health care gained popularity with former President Bill Clinton. Although President Clinton's proposal is looked at as a large failure, it did start the universal health care ball rolling and got many in America thinking about a united health care plan. Ever since President Clinton's proposal, the debate on a united and universal health care system for the U.S.A. has continued to be weaved into election topics as a proposed cure to the United States health care crisis, which estimates have said leaves 41-50 million people in America without health insurance.

What is it?

Universal health care or also commonly known as a singe-payer system, united health care system, or national health care, would be similar to the current U.S. Medicaid health care program for low-income peoples but would apply to all citizens of the U.S. regardless of ability to pay.

Who else does this?

Many countries have a united or national health care system, and all industrialized countries except for the U.S., have some sort of single-payer universal health care system. Most notably Canada and the UK have coverage under this type of united health care.

Sounds great! How come we don't have a national health care system in the U.S.?

There is no right formula for a united universal or national health care system. All countries have different ways of accomplishing the task of insuring every citizen in their country. How to accomplish a national health care single-payer system in America and if it would be better and more cost-effective than our current system are the main debate areas for universal or national health care in the U.S. There are many advantages and disadvantages to a single-payer health care system in the U.S.

Advantages:

Every citizen would be covered under a national united health care system and administrative costs could be drastically reduced. According to the article Make Healthcare a Right. It's Cheaper! by By John R. Battista, M.D. and Justine A. McCabe, Ph.D., studies have shown that with a publicly administered system health care costs would have been reduced in Connecticut by two billion dollars in 1999 by the reduction of administrative costs along with other different medical buying techniques such as buying medications in bulk.

Disadvantages:

Income taxes would increase and private insurance companies may be put out of the health care administrative business. Not to mention many Americans are worried it is just another route to socialism so therefore taking away private health care is un-American.

Most would not argue that basic health care should be an available human right to all Americans and most would also agree that our current system is not working and we should all get united on health care in the U.S. The universal national health care debate will be with our society for an inevitable amount of time, or at least until healthcare is available to more Americans, so expect this to be a topic for politicians in many future elections.

So let's look at some of the points from this article.

1) Every citizen would be covered and administrative overhead would be dramatically reduced.

Response: And I can hear the conservatives saying, "why should I have to pay for someone else's health care"? Answer: Because that's what society does for the worse off. We take care of each other, knowing that we will be taken care of if and when the time comes. Pure capitalism lacks compassion - compassion must exist in society for that society not to become evil. And for all we have grumbled over the years about the Soviet Union and China, and more recently Iraq and Iran, we are the ones looking pretty evil around the globe, and for good reason.

2) Income taxes would increase.

Response: Yep, and I don't mind paying my taxes when I know that they are being used responsibly. During the Clinton administration, my taxes not only funded domestic, foreign and military budgets, but also helped get rid of the deficit. Under the Bush administration, I am pretty sure most of my taxes are sitting in the Middle East - and they don't belong there. And remember, while taxes would go up, out of pocket expenses would be nearly eliminated.

3) Private insurance companies may be put out of the health care administrative business.

Response: Boo hoo. The goal of private insurance companies is to make money - that is at odds with providing quality health care to all people that need it. It is a question of values - are we worried about our people or about the insurance companies? There is a reason that insurance companies have expanded into the financial services industry - providing insurance to society is an untenable means of doing business. Twenty to thirty years from now I can see this entire industry being either regulated or government controlled, particularly after debacles such as Katrina. There is a role for private insurance, but that role should be limited and tightly regulated.

4) Universal health care is a path to socialism.

Response: Yep, just like in France, Great Britain, and all of western Europe. I don't see "Commies" taking over the world, as I am pretty sure the collapse of the Soviet Union proved the fallacies of communism. But our society is now failing as well - it's a question of whether you choose to remain in denial about this and whether or not you are able to keep an open mind about what is best for everyone. Try thinking outside of yourself.

There are two other items from the movie worthy of some attention. First, a highly interesting interview with a former British government official, who succinctly distinguished between American and European societies. European governments, he pointed out, are afraid of their people and thus do what is in the best interest of the people. In America however, the people are afraid of the government, thus leaving the government free to do what is in the best interest of the government. On many levels, we have become the Redcoats that we rebelled against.

The most disturbing and revealing scene of Moore's movie served as support to this point. There is a tape of Nixon speaking (on February 17, 1971) with aide John Ehrlichman. The conversation was as follows:

John D. Ehrlichman: “On the … on the health business …”

President Nixon: “Yeah.”

Ehrlichman: “… we have now narrowed down the vice president’s problems on this thing to one issue and that is whether we should include these health maintenance organizations like Edgar Kaiser’s Permanente thing. The vice president just cannot see it. We tried 15 ways from Friday to explain it to him and then help him to understand it. He finally says, ‘Well, I don’t think they’ll work, but if the President thinks it’s a good idea, I’ll support him a hundred percent.’”

President Nixon: “Well, what’s … what’s the judgment?”

Ehrlichman: “Well, everybody else’s judgment very strongly is that we go with it.”

President Nixon: “All right.”

Ehrlichman: “And, uh, uh, he’s the one holdout that we have in the whole office.”

President Nixon: “Say that I … I … I’d tell him I have doubts about it, but I think that it’s, uh, now let me ask you, now you give me your judgment. You know I’m not to keen on any of these damn medical programs.”

Ehrlichman: “This, uh, let me, let me tell you how I am …”

President Nixon:

Ehrlichman: “This … this is a …”

President Nixon: “I don’t …”

Ehrlichman: “… private enterprise one.”

President Nixon: “Well, that appeals to me.”

Ehrlichman: “Edgar Kaiser is running his Permanente deal for profit. And the reason that he can … the reason he can do it … I had Edgar Kaiser come in … talk to me about this and I went into it in some depth. All the incentives are toward less medical care, because …”

President Nixon:

Ehrlichman: “… the less care they give them, the more money they make.”

President Nixon: “Fine.”

Ehrlichman: “… and the incentives run the right way.”

President Nixon: “Not bad.”

Trust me when I say that the "not bad" by Nixon was damn near gleeful.

The next day, Nixon publicly announced he would be pushing legislation that would provide Americans "the finest health care in the world."

Finally, I have had friends raise the issue of cost, and what such a program would do to our nation. Let's put some context on this.

Let's take Hillary Clinton's health care proposal, estimated to cost between $90 and $120 billion dollars annually. Just for giggles, let's assume that the cost will be on the high side, let's say $150 billion per year.

Let's put $150 billion into context:

* The cost of war in Iraq is estimated at around $2 trillion so far, or about $500 billion per year.

* We give Israel between $6 and $10 billion in foreign aid each year.

* We give annual subsidies exceeding $1.5 billion to big oil companies, and fail to collect billions more in taxes each year.

* The Bush tax cuts for the rich will total $477 billion between 2001 and 2010.

Sounds like we have the money. We simply lack the political will and the moral character to make it happen.

Michael Moore has a simple and effective plan for resolving the health care crisis in America:

1. Every resident of the United States must have free, universal health care for life.

2. All health insurance companies must be abolished.

3. Pharmaceutical companies must be strictly regulated like a public utility.

Sounds too simple, but it works. I would amend #2 to provide for supplemental insurance for those exceeding the benefits of the system, but this would need to be tightly regulated.

By the way, this movie opens with one of my favorite "Bushisms":

GEORGE BUSH: We got an issue in America. Too many good docs are getting out of business. Too many ob-gyns aren't able to practice their love with women all over this country.

Well Dubya, the docs in Britain are making the equivalent of $200 K a year. Not enough for people like Dubya perhaps, but enough to "get by".

See the movie.

------A couple of additional thoughts since I wrote this a few hours ago:

Addendum #1:

The scare tactic of the Republicans is that universal health care will mean that a bureaucrat will be responsible for determining what care you will receive. Well, surprise! That is already happening with private health insurance. As a matter of fact, the movie demonstrated well the incentives given to doctors and administrators for advocating less or even no care. One such person testified that she knew she had signed one man's death warrant, but knew that the cost savings would be rewarded by her employer. Conversely, doctors in Great Britain are given pay incentives for how healthy their patients become, how much weight they lose, whether or not they quit smoking, etc. THIS IS A SCARE TACTIC OF THE CONSERVATIVES AND NOTHING MORE!

Addendum #2:

The good "Dr." Loder was incensed that one French patient was allowed to vacation on taxpayer dollars in order to recuperate. Now I initially thought this was (at least) a bit unusual, but then I thought.... the French work less than we do (35 hours a week) and get more vacation time, yet are also more productive workers than Americans. They are also healthier. This leads me to a simple conclusion; treat workers like crap and they perform like crap and won't feel good about themselves doing it. Treat people well and they will perform well... they will also be able to keep work in perspective, not let it dominate them and thus be more productive while they are working. That's a pretty easy choice to me.