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Sooner or later

10 Jan

Sooner or later this topic was going to come up, might as well be now. Healthcare, something needs to be done, its broken. We need to stop pretending that everything is fine and that we somehow have the best healthcare system in the world, we don’t. Our system is expensive and wasteful, and the only ones suffering because of it are the consumers, us. Furthermore, enough with the half-assed, weak knead reforms our government has been passing, they’re not working. They have done nothing to keep the outrageous costs under control and nothing to actually help the uninsured. We’re constantly being told by shifty politicians and the manipulative media that our healthcare system is the best in the world, they just don’t get it. We can’t keep going on like this ladies and gentlemen, a major overhaul is in order. What needs to be done, can anything be done? But before we can begin towards the road to recovery we must admit that we have a problem. So what’s the problem?

What’s so bad about our current healthcare system?
We spend, by the most recent calculations, over 15% of our GDP on healthcare. Have a look at this graph that compares the percent of GDP spent by various industrialized nations on healthcare. Notice how all of them have a slowly increasing staircase ending with Switzerland. But just as you get to the US, BAM, we jump nearly 5 points from Switzerland. One of the biggest reasons for this discrepancy is money, politicians love them some monies. Why do you think healthcare reform, that was supposed help save us money, got chopped down to a few pathetic regulations that do nothing of the sort? Politicians, too numerous to mention, have been receiving campaign contributions from many different healthcare service providers, don’t want to bite the hand that feeds you.

This is my next Audi payment

Doctors are Expensive
A 2007 study found that doctors in America are among the highest paid in the world. Now, before you crap your pants and say, “What? Are you saying they don’t deserve it,” let me finish. Here’s two of the most common arguments I hear, malpractice insurance and student loans. That same study also found that nearly $58 billion of excess physician income remained after having deducted the costs associated with malpractice insurance and administrative costs. And the student loan thing, yeah, the study addresses that as well, finding that among other professional fields that require similarly advanced degrees, physicians still come out better than their peers. Now, do physicians deserve to be paid well, definitely, do they deserve to be paid as much as six times the amount of their patients salary, probably not. Not when you compare it to the average amongst the rest of the world of no more than four times. However, maybe there are some reasons for the difference, perhaps some things the study didn’t take into account:

  • Some physicians have a tendency to recommend unnecessary procedures and medications. Why would they do that? More procedures, more money, in fact, some physicians invest in clinics and labs that perform special procedures.
  • Insurance companies negotiate the pricing for various procedures with the physicians themselves. Oftentimes, when a physician seeks to accept a certain type of insurance, a rate may have already been determined for that area. On occasion these rates are so fantastically low that the physician begins to lose money just to operating expenses. Lately I’ve seen many doctors and physicians groups being gobbled up by hospitals, this is mainly due to hospitals having more weight with the insurance companies and resources to support the physician. Something needs to be done about this as well. This brings me to the next problem.

Hospitals are Expensive
The average cost per-day to stay in a hospital is $1,666, 2.6 times the industrialized world average. The hospital’s most common justification is caring for the uninsured. However, according to the McKinsey & Company study referenced earlier, the cost associated with uninsured care is minimal. While it is true that many hospitals manage to only break even there are some that manage to rake in enormous profits on a regular basis. In 2008, Parkview Health, reported a $45 million (after expenses) operating margin. Anyone in the area has seen what they are doing with this money, building a huge multi-story hospital facility and buying up multiple family doctor groups in Fort Wayne and surrounding areas. Obviously, as a not-for-profit health network, the only thing they can do with that money is reinvest it back into their facilities (a good thing) and expand their reach (not necessarily as good). But they could have just as easily budgeted for some smaller, less expensive, improvements and charged all of the patients, or the respective insurance providers, less. How about the for-profit hospitals, they can do whatever they want with their profits. Lutheran Hospital, for instance, in their Report to the Community, tried to tout the local taxes they pay as “supporting the community,” uh, that’s because you have to pay taxes. How incredibly arrogant! Regardless of the profitability of a particular hospital, the fact still remains that they are expensive, perhaps there’s a reason for that to:

  • According to the study, higher administration costs than other industrialized .
  • Many hospitals also own and operate diagnostic imaging centers, these DICs will often have duplicate equipment that their parent hospital already has. This equipment costs the same and requires the same number of people to use and maintain it, but will get used much less.

These problems, at least to me, seem like they could easily be remedied.

Pharmaceuticals are Expensive
Prescription drugs are expensive, I’m sure there aren’t a whole lot of you that would disagree with me on that. While we consume less of them than the rest of the world we still manage to spend more, $57 billion more. Why is that?

  • U.S. consumers get access to the latest and greatest prescription drugs almost 18 months before the other countries, that’s gotta be worth something.
  • Due to a lack of regulation, drug companies are able to charge roughly 70% more for their products here than in other countries.

The excuse the companies use is that the associated costs with R&D, testing, and obtaining FDA approval aren’t cheap. Well, scratch the approval part, you’ll need to get that regardless of the country your selling your products in. And the rest, well, let’s take a look at Pfizer, one of the top US-based pharmaceutical companies. Pfizer’s total revenue, in 2008, was over $48 billion. Now take their R&D costs of 2006 (latest value available in 2008) of about $7 billion along with their administrative costs subtracted from their revenue and you get a 2006 net income of roughly $11 billion (not million, billion). In 2009 they decided to acquire Wyeth, a competing pharmaceutical and OTC manufacturer, which cost a pretty penny ($68 billion). When Pfizer completes their acquisition of Wyeth they will have eliminated 20,000 jobs from Pfizer and Wyeth’s workforce, to “reduce costs” they claim. So you’ll layoff an ass-ton of regular Joes that need to pay bills and feed their families just so you can become more powerful and rich, awesome. Pharmaceutical company CEOs are extremely well paid, here’s the top 17, Pfizer’s former CEO, Jeff Kindler, is in that list at $12.6 million. Not the highest paid, but certainly not the lowest, and this isn’t accounting for their “golden parachutes” should they ever leave or be fired. How about instead of laying off those employees and adding them to the unemployed ranks you stop advertising your drugs to consumers, cut CEO pay and bonuses, and stop paying doctors for prescribe/promote your drugs.

The Unemployed
In this day and age, with our roughly 10% unemployment rate there’s one huge glaring problem, health insurance for the unemployed. It’s bad enough that these people are out of work and, in some cases, unable to find new jobs. On top of those worries they have to worry about what they’re going to do if their spouse or children get injured or sick.

Paid Sick Leave
60 million American workers have no access to paid sick leave which is a huge problem. Many people when faced with the choice of staying home to get better or still being paid will choose to go to work sick. We’ve all experience this, that person hacking up a lung in the cubicle next to you while you cover your mouth hoping not to catch it, you still will. Just for a fun comparison, out of the 196 countries in the world, 160 ensure that all of their working citizens receive paid sick leave.

The Conclusion
A lot of the problems we’re having with our current system revolve around money and how much can be made, it’s all about profits. But this a free market and we’ll be damned if we hypocritically regulate one industry and not the others. That would be Socialist, right? At the cost of our own health and well-being, even if we all go bankrupt because of it, we must not interfere with the free market. The hospitals and pharmaceutical companies don’t care about our health, they just want our money, and they’ll do whatever it takes to get it. Insurance providers can’t take all the blame, they’re expensive because of these problems, and they want their slice of the pie.

Please stop listening to the lies and realize that this system is not sustainable! We’ve got people filing for bankruptcy from medical bills, people dying because they can’t afford insurance or to go to the doctor. And for what!?! Have we become so selfish that we can’t be bothered to think about the health of our neighbors, rich or poor? Perhaps. I’d like to think that we’re more humane than that, but I’ve heard the way some people talk and it sounds like they just don’t care about anyone besides themselves. Or maybe it boils down to the fact that some of us really think that we’ll morph into a completely socialist country if we begin regulating this one market. Meanwhile the government sits on their hands, too busy counting their “donations” from the healthcare industry and refusing to do something because they share that same, narrow-minded thinking that regulating the healthcare industry will turn us into socialists. There’s one other argument that I hear all the time, “Why should I have to pay for everybody else?” Don’t you get it, we already are!

I think this guy said it first.

It’s a right, not a privilege…
The fact of the matter is, a person’s health, is a right, not a privilege. We all like to pretend that the current system is somehow capable of caring for everyone including the uninsured, it’s not, there are almost 50 million uninsured people in the United States. These numbers have grown sharply in recent years due to the significant rise in insurance costs and the resulting dropping of coverage by employers and individuals. Some of these uninsured, to prevent being a burden to everyone else, refuse to go to an emergency room for simple things (since that’s what many suggest is how we “take care” of the uninsured), these simple things turn into serious things and they either die or are taken to the ER by others. That doesn’t sound like being taken care of to me. Healthcare is NOT to be a luxury reserved only for those with enough money. During the healthcare reform debates someone got it in their head that the government was considering death panels to determine whether someone would receive life saving treatments or not based on their age. Well, we already have a death panel, it’s us, by choosing to do nothing or by our failure to convince our government to do something, we have become a death panel that decides who will live and die based not on their age, but by how much money they make. Free/community clinics exist, definitely, but due to the current economic situation these clinics are being overwhelmed with an influx of newly uninsured patients, they can’t keep up. Nearly 18,000 die every year due to a lack of insurance, some studies show as much as 100,000 after including the under-insured. Doesn’t matter which number is more accurate, if even one person dies because they couldn’t obtain insurance, that’s one too many. On whom does the blame fall for this inhumanity? All of us, that’s who.

What Can Be Done?
Is a public healthcare option the right solution? Maybe, maybe not, at the moment there are too numerous arguments for and against. A public system strong enough to support America would take time and careful planning to get right, however, we’re at an advantage. Being one of the last industrialized nations to implement a public option would put us ahead of the others, we can learn from the other countries’ mistakes. Unfortunately the media has done an excellent job of confusing viewers about the true benefits and risks of a public system. Many would have you believe that implementing one would signal a catastrophic collapse of healthcare in our nation. Would it really?

So what’s wrong with a public option?
Let’s look at the arguments against a public healthcare option and find out if they hold up against raw facts. To make this easy on us all I’ll be comparing these arguments mostly against Canada’s system, which by the way, they’ve had since 1961 (earlier for some of the provinces) and don’t appear to be on the brink of some sort of healthcare collapse.

“Patients will be denied services because a bureaucrat didn’t think they needed it.”
Experimental treatments, perhaps, but with the exception of some extremely rare cases, this has not been a trend in any of the nations with public options. Our private insurance, on the other hand, has a record of denying services they don’t think are necessary. In the nations with public healthcare, the choice of treatments is up to the patient and their doctor. There would be no difference between these systems when it comes to the handling of experimental procedures.

“Treatment will require appointments months in advance, hospital lines will be hours long”
This problem isn’t so much a failure of a public healthcare system, but instead of under served areas. You’ll find examples of this occurring in the US as well. Public systems handle patients based on severity, just like ours. Obviously someone run over by a car is going to get in ahead of the person with a broken arm, so in some cases you may wait longer if something really bad has happened. Having said that, there may be cases of a hospital/clinic/doctor attempting to support too many people and being overwhelmed. This is an issue that needs to be addressed regardless of the type of system. Let’s look at some data:

  • Canada reported 36% of patients having to wait six days or more for an appointment.
  • The United States came in second with 23%
  • New Zealand, Australia, Germany, and the U.K. were the lowest.

So Canada may have the longest wait for appointments with non-emergencies but we don’t have the best, hardly a knock against public healthcare. How about getting non-emergency care on nights, weekends, and holidays without a trip to the ER.

  • The United States reported 61% of patients found it very or somewhat difficult.
  • Canada was next in line at 54%
  • Germany was the best at 22%

In this case we’re the worst, still nothing solid against public healthcare. How about specialty care.

  • The U.K. reported 60% of patients having to wait four weeks or more to see a specialist physician.
  • Canada followed with 57%
  • The United States did the best in this category with only 23%

Hey, there we go, good job USA!

As you can see from these numbers, one couldn’t base an entire argument on how horrible public healthcare is as we’re not the best all the time either.

“Our government is already in a deficit, a public option will just make it worse.”
A public system of our own would require careful planning to prevent a financial burden similar to Medicare. Seeing as we spend about six thousand dollars per person annually on healthcare, almost double what Canadians spend, I’m sure we could trim some waste and get our costs down. Putting the costs aside, where do you think the money for free/community clinics is coming from, your tax dollars,  $2.19 billion a year (plus $11 billion from the Health Center Trust Fund). Who do you think is paying for the uninsured patients that are going to the emergency rooms with colds, you are, with higher medical bills and taxes. The government foots 85% of the uncompensated care with $35 billion (your tax dollars). The remainder is passed onto us directly via our medical bills. One of my favorite arguments from those that are against a public option is, “Who’s gonna pay for all this?” We already are! But with a little organization and some restructuring we could all be paying less and insuring every man, woman and child. A study found that, without any administrative and organizational changes of our current health system, placing the uninsured under some form of medical insurance would only increase the share of the GDP going to healthcare by .4%. That’s not four percent, that’s point four percent.

“A public option will drive private insurance companies out of business leaving us without choices.”
Just remember, the USPS ships packages while FedEx and UPS seem to be doing alright. Here’s your free market at work, folks, provide a better product at a better value, and customers will be knocking down your doors. Don’t, and you’ll be boarding up your doors. A public option, while intended for those that can’t afford the private solution, would eventually draw much of everyone else because of lower prices. At that point the private carriers have two options, provide a better product at a better value, or close up shop. The days of multi-million dollar CEO bonuses are over, its time they start trimming the unnecessary BS and become competitive. People like to argue that the great thing about our free market is that consumers have choices and that if you don’t like the way one company is treating you, just switch to one of their competitors. This would work if all the insurance providers didn’t behave in the exact same way, with their eyes on profits and not your wellbeing. Perhaps if they were faced with the risk of shuttering their doors they might start thinking about becoming more efficient and truly competitive.

“The doctors and hospitals will work for the government.”
Not really, while some countries with public insurance may do it this way, Canada’s public system is not this way, doctors and hospitals are all private sector while receiving payment for services from the government. Many doctors are self-employed and hospitals are run by private boards or regional health networks. Think of our current healthcare system and replace the insurance company with the government, doctors would still be considered a 3rd party.

Quality like this

“The quality of care will drop.”
Do you know what the infant mortality rate is in the U.S.? 6.14 to every 1,000 births. Okay, now what’s the infant mortality rate in Canada? 4.99 per 1,000 births. Cuba: 5.72, UK: 4.69, Australia 4.67. Here’s more if you want to see them. Public healthcare must be really bad if…wait a second…ours is worse than all of them. Not by much, but enough to say that the care quality isn’t “drastically reduced” by becoming public. Look at the World Health Organizations tables on Numbers and rates of registered deaths for the US and Canada and you’ll see that Canada’s total ratio of deaths is lower than the US.

Ask anyone that’s against a public option and they’ll undoubtedly share a story about someone who received poor care in the hands of a public system, as if that instance completely justifies their feelings towards public healthcare. Ask enough people in the U.S. and you’ll undoubtedly begin to hear very similar examples of poor healthcare. In fact, I’ve got a few examples of my own, but I’ll spare you because it doesn’t prove or disprove anything. Not that these stories aren’t sad, they really are, but saying some other country’s healthcare system is worse than ours because of a few stories you heard hardly proves anything. For example, a 2009 poll of Canadians found that 86.2% supported or strongly supported their public solutions. Compare that to the satisfaction of the American healthcare system, where a third of us believe a complete rebuild is in order and another 16% think at least minor changes are needed (there’s almost 50% who don’t think our system is the best in the world).

At the end of the day you know what these “poor quality healthcare” issues boil down to? Mistakes. I’m sure you all remember the saying, “Only human.” We all make mistakes, even Doctors and Nurses make them, but they didn’t make them because they have a public healthcare system or a private one. They made them because they are…human.

“Our taxes will increased.”
Will they rise? Probably, but the difference between what you were paying for health insurance and the tax increase (if the system were correctly planned) should save you money. 38.4% of Canada’s GDP is tax while the US is 28.2%. Before you start spitting on your keyboard because of a 10 point difference, bear this in mind, the US has a deficit hovering around 4%, Canada has consistently held a 1% surplus. Wow, not only are they providing healthcare for everyone but they’ve balanced their budget as well, how nice would that be.

“Doctors won’t be paid enough to offset schooling and malpractice insurance, thus a shortage of doctors.”
Doctors in Canada make about $161,000 a year at the low-end. Currently US doctors make upwards of $230,000 a year. While I’m certainly not suggesting that our doctors be forced to cut their pay in half to match Canada’s, I’m sure a fair compromise could be reached. If we’re still griping about the schooling thing, perhaps we should look at what some other countries are doing and offer higher education at reduced rates, something we could all enjoy.

“The government can’t even run a successful post office, what makes you think they can run healthcare.”
For starters, the Post Office, while a government agency, is independent and does not receive federal support via taxpayer dollars. Yes, they are borrowing money from the treasury due to the recent financial crisis, keyword “borrow.” Next, keep in mind the reason they’re doing so poorly, more and more people use Email almost exclusively, rarely sending letters anymore. That, coupled with the recent economic standing of our country and housing market, caused a dramatic reduction in mail volume leading to the overall poor shape that the USPS is in. The USPS obviously needs to make some changes to stay relevant and not collapse, but saying that the government can’t run an agency based solely on this example is a weak argument. The government isn’t perfect, but we’ve got them screwing up healthcare before they’ve even started, I don’t count the recent reforms as actually starting because they didn’t really do anything to spectacular.

“The government is going to try to tell me what I can and cannot eat or do.”
Nobody likes to be treated like children and one of the many fears that opponents of a public solution have is this. With a public system the government would have a vested interest in our health, they then might have a desire to restrict or tax certain foods and activities that were considered to be “hazardous” to one’s health. It’s possible that this might happen, to some extent we’ve already begun seeing it with the recent healthcare reform with the tax on artificial tanning. At one point the government was toying with the idea of placing an excess tax on pizza and high calorie beverages. This is no different from our private insurance companies that charge higher premiums because of someone’s weight or smoking habits. If you fit into these categories you become a higher risk and a larger (no pun intended) burden to the system, and that needs to be accounted for. I’m on the fence with this one as I can also see some good coming out of this. For instance, in the past few years Canada has successfully and significantly limited the use Trans Fat throughout their entire nation, that is one really good outcome. When the government is involved with the health and wellbeing of its citizens so closely it’s within their best interest to make sure what the citizens put into their bodies is at least somewhat healthy. The government of a public healthcare nation could use their position as a way to persuade citizens to make healthy life choices, in return for lowered taxes, many employers already do something like this. On the other hand, placing a tax on pizza just because of its calorie content doesn’t help anyone and punishes the family that buys a single pizza to share.

What could a well thought out, public system be like?
While a public system may not be the best solution for us, I want you to imagine for a second what it could be like. Put aside the arguments and worries about how it would be paid for. Focus on the good that it could bring. Imagine you’ve been injured or have become extremely ill, you go to the doctor or emergency room (depending on the severity) and all you have to do is show them your ID and from that moment forward you do nothing but focus on getting better. No more worrying about the deductible or copays, how much your prescriptions will cost, keeping track of paperwork, just getting healthy. As someone that’s been through a hospital I can attest to the mountains of paperwork and stress that I faced and how much better I would’ve felt knowing that it was all taken care of.

So your point is?
My goal has been to show that our current system isn’t working, hasn’t been working, and is never going to work, not without some serious changes. The information I’ve provided hardly scratches the surface. I wanted to approach the common arguments against public systems and investigate their validity. Some arguments are valid and would need to be addressed before a change like this could be made. Other arguments are based on misinformation and assumptions brought on by fear mongering politicians and news media. I know we’re proud of our free-market and that we don’t want to tarnish it, but our health and lives are at stake and are worth much more than the service and value we’ve been receiving. Our wellbeing is depending on us to make or demand serious change. Change is hard, but just because we’re the only industrialized nation that hasn’t seriously changed our healthcare system doesn’t mean we’re the only ones doing it right. I don’t have all the answers, I never claimed to, but I can see the problems, just as anyone else can that is willing to open their eyes. No country’s system is perfect including our own, however, we are at the point where we have the opportunity to be the first ones to create a healthcare system that could make other country’s jealous. One where the homeless man living on the street get’s the same attentive medical attention as the millionaire CEO. I look forward to that day, that will be the day where the rest of the world can look upon us and say, “Wow, look what they did, they really are the best country in the world.” This thinking isn’t Socialist, Communist, Democratic, or Republican, it’s none of these, its nothing more than a desire to see all men, women and children living a healthy life regardless of their position in society.

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Posted by on January 10, 2011 in General, Political Crap

 

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