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How Can We Reform Health Care?

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The United States is the only one of all industrialized nations that does not have some kind of system providing health care to all of its citizens. How can we ignore upwards of 45 million people and growing who do not have access to affordable health care. There are many things on our collective plate that need attention and if ignored will result in grave consequences. We have been discussing this dilemma for many years. Other issues of war and the economy have cast a shadow over the political campaign and now over tackling the challenges ahead. There are few things more fundamental than health, food, shelter and education. We can no longer set aside these issues and ignore their importance or urgency.

Different nations have found a variety of ways to provide universal healthcare to their citizens. Nonetheless they all ended up with similar results. If we are to rebuild America it cannot be done without providing for the health security of our citizens. All health care systems are imperfect but all came from the necessity of circumstances. The health care needs of wartime Great Britain drove them to the obvious and desirable solution of the National Health Service. Although one of the most socialized in the world, health care in United Kingdom has enjoyed a large measure of success and satisfaction over the last 50 years while continuing to thrive. France evolved a similar system starting from a different basic healthcare structure. The end result was access to quality health care of for the entire population in a system which considered by some to be the best in the world. Although the United States may be a leader in medical innovations, we rank 37th in overall services among other countries.

In a recent article in the New Yorker magazine by a practicing physician Dr Atul Gawande, he described the successes of universal health coverage in Massachusetts since its adoption in 2007. The majority of people who had satisfactory coverage in place remain largely unaffected while a sliding scale fee program was established making health care coverage available to all who are uninsured. Choices still have to be made regarding cost containment and most necessary services. However any system has to have oversight and requires difficult decisions be made to continue providing quality and needed services. Overall the Massachusetts plan has been a satisfactory if not entirely perfect success insuring over 97% of its citizens with a very high rate of satisfaction.

We can learn from all of these examples that a change in our health care policy is not only needed but inevitable. History has taught us that issues such as this are path dependent. The most recent Nobel Prize in Economics was given to Paul Krugman for demonstrating how this very phenomenon drives trade patterns and geographic location. It all harkens back to the idea that necessity is the mother of invention. Circumstances and initial steps in our history literally drive the subsequent direction of the outcome. Even if you are ignorant of history you cannot escape its viral influence. The path during this journey has become narrow. We too have reached a point in our history where change must come. The choices are more diminished but are not without merit. They must be bold. But like others before us, we can build on what we have now that works. We can repair what does not work and add choices where there are none. The cost will be an investment that will reap dividends for all of us who share this third rock from the sun.

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About Bruce Kaler M.D.

  • http://www.fontcraft.com/rod/ Dave Nalle

    Bruce, I think I could take your impassioned plea for national healthcare a lot more seriously if there was any indication that you knew what the hell you were talking about. I’m sure you have your reasons for supporting national healthcare, but they clearly don’t involve any awareness of what those systems are actually like for the people subjected to them.

    The healthcare system in England is in shambles, producing measurable declines in life expectancy and quality of life. The same is true in Germany. And the latest figures from Massachusetts show exactly why we need to think long and hard about national healthcare, as that attempt has gone hundreds of millions of dollars over budget, resulted in year-long waits just to get a physical, and left some of the most critical patients and cases uncovered. Gov. Deval Patrick is now looking at shutting the system down as his state faces a multi-billion dollar deficit because of a system which everyone is describing as a ‘disaster’.

    So if that’s what you’re holding up as an example – I think I’ll pass.

    Dave

  • bliffle

    Our health system consumes 16% of the GDP, twice any other nation, yet fails to cover everyone. In fact, it leaves more people uncovered every year.

    It’s not hard to see why more people are uncovered all the time, it is in the interests of every insurance company to do that. There is no countervailing force, not even a Free Market option, that can resist it.

    So coverage will get worse and worse.

    Meanwhile, premiums will go up.

    Because they can.

    Regulation can’t do anything because the McCarran Fergusson act of 1945 exempts insurance companies from Federal regulation, leaving just weak state regulation.

    The only solution is UHC. The insurance companies, if they survive at all, have to be reduced to mere record keepers. They cannot be allowed discretion to set policy.

    Just think of all the better uses we could have for the excess 8% of GDP that the current system costs.

  • http://www.fontcraft.com/rod/ Dave Nalle

    You’ve convinced me, bliffle. The system is so expensive and inefficient now that if we put it in the hands of government bureaucrats who will make it even more inefficient and expensive we’ll be utterly doomed. Another good argument against socialized medicine.

    Dave

  • http://drdreadful.blogspot.com Dr Dreadful

    That’s it, Dave, talk it up.

  • http://drdreadful.blogspot.com Dr Dreadful

    Dave’s right in that the National Health Service in Britain isn’t all Dr Kaler cracks it up to be. Neither, though, is it a total shambles.

    It’s an excellent system if you’re reasonably healthy and all you ever need is an annual physical, a ten-yearly tetanus booster and the occasional patch-up job at the ER. The system is simple, there’s minimal red tape, no copays (except for prescriptions) and you don’t need a master’s degree in accounting and another in archives management just to keep track of your coverage. The care you get is for the most part competent although somewhat workmanlike – which really shouldn’t matter to you if you only avail yourself of it infrequently.

    Where it falls down is in caring for people who are not healthy. Britain has some of the finest major surgery facilities in the world (the Papworth Hospital near Cambridge, for example, is a pioneering heart transplant center) but they’re few in number and hugely overextended. People die every day waiting for transplants or life-saving surgeries. It’s got to the point where those who can afford it will travel to France for vital surgeries because they can be treated right away and receive care that’s just as good if not better than back home.

    As far as the US is concerned, I’ve found the quality of healthcare by and large to be excellent. (This perception may, I admit, have a good deal to do with my economic status.) What I hate is the endless bureaucratic nonsense, the niggling little bills that keep on coming just when you think you’ve paid everything up to date, and the potential for costs to snowball you into bankruptcy even if you have good insurance.

    On balance, I’d rather have the National Health Service – but keep my current doctor, who is superb.

  • STM

    And here’s a telling factor despite all the failings of the NHS … even those who have private insurance in the UK are happy to get whizzed off to the public Emergency Departments of some of the world’s most famous hospitals for life-saving treatment of trauma, or heart attack etc.

    The ambulance service is fantastic, as is the actual hospital treatment itself.

    It costs zilch, too.

    It’s only when you start needing appendicitis surgery and the like that it gets a bit wonky in terms of waiting lists and the like.

    Would I be happy to be treated in a British hospital, and would I believe I was getting the best of care?

    All things considered, yes …

    Would I prefer to be treated in the US? Probably, but only if it was worth the impost on my wallet or the head miles people end up doing about the costs.

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    Bliffle,

    What about eliminating the middle man – i.e., the insurance companies – altogether. Some argue that’s an integral part of the equation.

    RN

  • Doug Hunter

    It used to burn me up that in order for me and my wife to have children we had to pony up roughly $8000 in extra premiums and deductibles while people who don’t work have loads of kids at no charge and actally get paid extra benefits for each one they do have.

    We already have a sort of de facto universal healthcare where everyone gets treated in an emergency a many hospitals will treat those unable to pay. In it’s proper form universal healthcare would simply add more preventative care, eliminate the threat of bankrupting hardworking people who have health issues, and ensure that everyone pays in.

    There’s lots of healthy 20 and 30 somethings that believe it’s worth the risk not to pay, yet when they crash they’re motorbike they get the same treatment you would. Let’s make sure they’re paying for that priviledge, not gaming the system to get something for nothing.

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    Plus, because so many uninsured use (because they cannot be denied) emergency services, the hospitals jack up the prices to the insured by tenfold or more – from aspirin to God knows what.
    The obvious result being that the insurance premiums keep on skyrocketing. They are the real winners, because of all the suckers who pay.
    A perfect model of efficiency in a free and unihibited market system.
    But that’s only how it should be: charge as much as the market can bear, and the consumer will pay.

    Great system!

  • Arch Conservative

    A good starting point to approaching the issue would be to admit that the 45 million number includes many who are not actually legal citizens of this nation.

  • M(ark E)den

    When we criticize the profit motive it behooves us to present an alternative — equally simple and ‘efficient’. Everything short of that is pissing in the wind.

    ark E

  • http://www.indyboomer46.blogspot.com Baritone

    Generally the people who rise up against national or universal health care are those who have good health insurance, and/or who are financially stable enough to absorb any added costs. That millions of people are left dangling in the wind with no insurance is of little concern to them.

    The fact is that no health care system is perfect. They are all created by us imperfect humans. There will always be failures. There will always be those who choose to cheat the system. Opportunists abound.

    It goes without saying that Dave and others who are able to get and maintain adequate health insurance have no desire to change the system. For them it is a machine that’s not broken.

    As many as 40 million others can’t even hitch a ride.

    B

  • http://www.EurocriticsMagazine.com Christopher Rose

    I would have thought a better starting point is how is the USA to deal with the 20 to 25 thousand people who die in the USA each year due to lack of access to medical services.

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    Arch,

    I’m not certain what the breakdown is; and of course the proponents of National Health Care would want to jack the overall figure up. But even in early nineties, when Clinton took office and was so rah-rah about trying to fix the problem, the figure was about 20-30 million. And we did’t have as many illegals in the U.S. then, I should think.

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    Mark,

    I responded to your comment on my own thread. Look at it, please, and give me your feedback when you get a chance.

    Roger

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    Christ,

    I hate to sound cynical here, but I’m certain that there are many who don’t regard this as a problem. It’s just nature restoring its ecological balance – no different than war, pestilence, etc.

  • Arch Conservative

    There are many good starting points Christopher but when numbers of uninsured are being thrown around by the proponents of national healthcare the numbers usually don’t tell the whole story and they’re thrown out they’re to elicit some type of emotional response intended to make one recoil at the ghastliness of American insensitivity.

    First of all many without insurance are actually here illegally and therefore do not have the right to insurance.

    Second…many who do not have insurance do not have it because they choose not to have it.

    But another good starting point would be discussing the fact that our American lifestyle of fast and unhealthy food, jobs which don’t require us to leave our desks for eight hours and our limited physical activity actually leads to the detriment of our health. People actively choose to engage in unhealthy behaviors which lead to health issues which lead to increased healthcare costs which lead to bitching and moaning about how bad the system is. I am in no way saying that the system is perfect. Far from it…there are many areas that could be vastly improved by intense scrutiny followed by dramatic change. It’s just that when the problem is discussed hardly anyone ever discusses this aspect of it. Why examine your own poor dietary and exercise choices when you can just sue McDonalds for making you obese..right? As with all problems the answer we get from the American left………
    “blame someone else”

  • Brunelleschi (c)

    So far no one has even gotten close to the problem.

    Dave’s view is full-on GOP junkfood. Dave sounds like the one kid in high school that wears a tie and tries to imitate the grownups he sees on Faux news, while the rest of the class laughs at him!!

    The medical care disaster in the US goes far deeper than tired private vs public arguing.

    Medical care in the US does not need reform. It needs a full-on revolution.

    This is a very significant problem. It will not be easy and it will take the political will, but our private-is-better dogma is holding us back.

    A medical care system has to put caring for the most people with the least waste first.

    Right now, we have a lot of people making money doing things that have little to do with quality care. We have a lot of people with no care, so they go to a hospital, get the bill, and throw it away.

    How can you reform THAT? It’s a complete failure.

    Lawyers are getting rich suing drs for any little thing. Insurance companies get rich selling liability insurance to drs, and health programs that work poorly. HMOs are charging employers for expensive, poor care. Big pharmacuticals are making a lot of money pushing pills, and even advertise to the public to “ask your dr about…”

    Drs have been scared away from being drs, and prefer to rush people in and out with a quick diagnosis and a pill from a huge pharmacutical. They get paid the fee for the visit and rush you down the hall to the pharmacy, and hope for the best.

    Let’s slow down and think about sick people for once.

    This mess is important to me because I lived through hell in this system for over 10 years. I speak from experience. I saw the money wasted, got the “take this pill and see you later” treatment, and finally I just found a good dr and paid him myself, and turned the situation around.

    In my previous life, I had a lot of readers in Europe. When I wrote up my experience, the next few times I went to Europe a lot of those readers approached me and said pretty much the same thing. “That shit doesn’t happen here, what the heck are you people doing? Your system is a joke.”

    I also know some Euros that live in the US, and when the need a dr, they fly back to Europe-not to save money-but to actually get care, not a rushed visit and a trip down the hall for a pill.

    Just one example (I could write about this all day because I lived it)- Say I am one of the “lucky” Americans with a job that has an HMO as a benefit. Say I have a chemical problem I don’t understand, and its causing all kinds of problems. I’m covered, so I make an appointment at the HMO.

    My HMO sent me from place to place, just to address each symptom one at a time.

    My weight was expanding out of control, even though I carefully followed the diet their nutritionalist gave me. It was a waste of time and money. “WHAT are you EATING?” they would say. Maybe you should consider a gastric bypass. No thanks I said, “I want to know what is wrong, can you help?” They didn’t know.

    Then came skin problems, another appointment. “What is causing this?” I would say, “Why all these problems at once?” My HMO said “rub cream on it.” I wonder what the total cost was for that stroke of brilliance?

    Next came chronic fatigue and sleep apnea, a by product of the weight. I got a sleep study and a cpap, about a $1,200 machine, but no answers.

    I could go on and on.

    Skipping to the end, 2 different HMOs wasted huge amounts of money and actually made me worse. One of the pills they had me on for years actually did the opposite of what they intended, and they just blamed it on me! They didn’t know what else to do.

    Neither did I, until I was whining about it on line, and someone read it and sent me a tip about a place to see about it. I just paid for it myself because most insurance won’t pay for this drs approach. He doesn’t use pills from big pharmacutical except as a last resort. They found the problem and explained it.

    The weight is gone. The problems went away. I feel 15 years younger and I’m healthy at last, no thanks to our defective and wasteful approach!

  • Woorker Bee (MD)

    The articles ” facts” are so uninformed that it makes me think you are not an MD. Talking to Md’s from these other countries should have erased the thoughts expresed in your article. I do admit that you write well. The other “fact” to keep in mind is that the stats you quote are ” madeup” by those wishing for their system i.e. goverment handouts to continue. Goverment workers…All you have to do to see this is try to apply a standard of ” live birth and infant mortality” through out the world. These numbers are propaganda.

  • Brunelleschi

    Care to re-write that in coherent English?

    :)

  • http://drdreadful.blogspot.com Dr Dreadful

    In my previous life, I had a lot of readers in Europe. When I wrote up my experience, the next few times I went to Europe a lot of those readers approached me and said pretty much the same thing. “That shit doesn’t happen here, what the heck are you people doing? Your system is a joke.”

    Presumably these folks weren’t from Britain, because that shit does happen there.

    You gets what you pays for, unfortunately. When I first moved to the US I had an HMO, and the quality of care (and of doctors) wasn’t appreciably better than what I was used to back home. Because I was healthy, that was fine – except for the bureaucracy, which is one thing you thankfully don’t have to mess with too much as an NHS patient.

    I’m starting to feel the effects of aging, so being able to afford a PPO now and select my own doctors gives me the peace of mind I used to get back home from not having to worry about healthcare at all.

    But your friends in Europe were right about one thing – the American system is a joke. Unfortunately it’s one of those where the joke-teller won’t tell you the punchline.

  • http://www.fontcraft.com/rod/ Dave Nalle

    I think the argument could be made that the problem with the US system is that our healthcare is TOO good. On reading up on what differentiates care in the US from care in other countries, what stands out is the availability in the US of operations and services which could be considered non-essential or even luxury services, covered under normal health insurance, especially when it comes to gerontology and improving the quality and length of life for the very old.

    We have double the number of procedures like hip and knee replacements of European countries. Where they would take these older folks with worn-out joints and put them in wheelchairs, we spend huge amounts of money to patch them up and keep them active. We also spend enormously more on marginally necessary cosmetic procedures and do things with orthotics and limb replacement which countries with socialized medicine don’t even consider attempting.

    Our medical system is unique in placing a premium quality of life as well as preservation of life. We would certainly lose that if we switched to socialized medicine, but I think it could be argued that we’d ultimately benefit from such sacrifice, givne how much we pay right now as a nation.

    Dave

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    Dave,

    “our healthcare is TOO good.”

    For those who can afford it. No question about the quality of the doctors and medical expertise.

    Roger

  • Clavos

    No question about the quality of the doctors and medical expertise.

    Actually, Dave and Roger, I do question the quality of the healthcare, and I do so from a particularly knowledgeable standpoint.

    For the past nearly four years, as many of you know, my wife has been very seriously ill. Because she is totally disabled, she has Medicare, backed up by a very high end PPO, the premiums for which cost me just over $900 a month; we have unlimited access to any medical care available in this country, and take full advantage of that. Her medical bills over the past four years have averaged $400K a year, with our out-of-pocket expenses, including the above premiums, averaging $25K a year.

    Desoite this small fortune (mostly paid by the taxpayers) being spent on her, my wife is not appreciably better now than she was four years ago, when she first became ill. Why? Because, IMO, even when you have access to the best, the “best” is none too good.

    Case in point: Over the past year, she has had to have a mid-level (very routine-thousands are done every day, on a national basis) surgical procedure repeated three times, because of what I consider to be incompetence on the part of medical staff.

    When she has been hospitalised (more than six months during 2008), we have encountered literally dozens of nurses who are incompetent to an appalling degree. In fact, as her primary care giver over this time, I have come to realize that, I as a layman, have become more proficient at caring for (and diagnosing) her than any of her nurses, and even than some of her physicians.

    That’s appalling when one considers that we have access to the best medical care available.

    In truth, the best is none too good when you’re seriously sick.

  • STM

    Doc: “I’m starting to feel the effects of aging”

    Must be tough hitting 35 is it Doc??

  • STM

    Thank God for Dr Pacific, whom I visit regularly.

    Doesn’t cost a cent, either.

  • http://drdreadful.blogspot.com Dr Dreadful

    I’m a bit older than that, mate!

  • http://drdreadful.blogspot.com Dr Dreadful

    Clav,

    Your observation regarding nurses brings up another discussion point.

    As you may remember, my wife works in a hospital: she’s a speech therapist in a rehab unit. The nurses in the unit are by all accounts exceptionally well-paid but next to useless. The auxiliary staff – therapists, PCAs, aides etc – do most of the actual work of physically caring for patients: the nurses seem to consider such to be beneath them or not part of their job description, which I find absolutely incredible. They spend most of their time pushing paper around, and routinely ignore patient call buttons.

    So should auxiliary medical staff be expected to do all of the legwork? What is the rationale behind employing auxiliaries to do the work nurses used to do? And what, then, is the point of nurses if they are not actually doing any nursing?

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    Clavos,

    Some of it deteriorates as our physicians and health workers (e.g., the Indians) move into U.S. to practice. Plus, there are always differences in the health care you get from hospital to hospital. My sister and brother-in-law both are physicians, by the way, he a surgeon; and even there, there are significant differences between individual abilities and dedication to their profession. My point only was that theoretically we should have way better than average quality of medical care, because of the money: but even that is being diluted because of Medicare requirements which force many doctors to relax their standard of practice in the interest of seeing as many patients as possible and make up thus for the loss of income.

    Roger

  • STM

    Dave: “Our medical system is unique in placing a premium quality of life as well as preservation of life.”

    Well, hardly unique Dave … perhaps it would be if you compared it, say, with the system in Egypt.

    All the stuff you’ve written about in that post doesn’t look too different to what goes on here, and ours is a dual socialised/private system that ends up costing you zippo up front either way.

    You are right in a sense though … as health is run purely as a business in the US, there is a lot more options compared to a great many other places.

    That doesn’t make it better overall, though … since there are other factors that detract – especially if you can’t afford the insurance cover or if continuing treatment is going to send you bankrupt.

    What happens if you suddenly lose your job and the company’s been paying your premiums?

    You’re out of work with no money to pay for cover AND your premiums are no longer being paid, which means if you get sick with a long illness, for instance, you are totally rooted.

  • STM

    DD: “I’m a bit older than that, mate!”

    OK, 35 and a half then.

  • http://drdreadful.blogspot.com Dr Dreadful

    Well, Stan, I was born in 1966, so unless it’s still 2002…

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    Shoot! At that age, what in the hell are you doing spending so much time online?

  • bliffle

    Dave says:

    “…The system is so expensive and inefficient now that if we put it in the hands of government bureaucrats who will make it even more inefficient and expensive…”

    Not a given.

    There is no magic in privatization just as there is no develtry in public management. The thing that makes the difference is competition. If there is successful competition and monopolization is prevented, then private management may be better. But it is not a given.

    Privatization of the Iraq war has failed because of no-bid contracts that obviated competition.

    Privatization of health insurance is failing because of lack of regulation, pursuant to the McCarran Ferguson act of 1945 which prohibited federal regulation. There is no competition.

    Moving beyond the lack of competition and the ascendancy of de facto monopolization, there are further problems with the private insurance system.

    One of those is the cost of profits, but a bigger problem is the proper monetarization of a persons health. What is good health worth? Even if we decide that question we have no way to incorporate it into our market models, except rationing.

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    Could you spell this out some more:

    “a bigger problem is the proper monetarization of a persons health. What is good health worth? Even if we decide that question we have no way to incorporate it into our market models, except rationing.”

  • http://drdreadful.blogspot.com Dr Dreadful

    No kids, Roger…

    :-)

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    Well, maybe the problem IS Fresno. I passed through it only once or twice, but that was enough. Decrepit downtown (unless they’re rebuilding) and quite spread out. You’ve got to move closer to the Bay Area. It’s beaming with people and action.

  • Clavos

    but even that is being diluted because of Medicare requirements which force many doctors to relax their standard of practice in the interest of seeing as many patients as possible and make up thus for the loss of income.

    What you say is true of private medical insurance, but decidedly not true for Medicare–they pay my wife’s physicians (I handle the accounting as well) at least as well as our private insurance does, usually more.

    Medicare also grossly overpays for durable medical equipment. I’ve made this point on these threads before, so I’ll give the short version now: when Medicare paid for my wife’s wheelchair (manual, not electric), they paid $5K.. When I found this out, I logged on to the manufacturer’s web site and priced the identical chair out–for $2400. I pointed this out to the Medicare office that services this part of Florida; their response? “Doesn’t matter, we have to buy from Medicare-approved providers” (i.e. middlemen).

    I could go on for pages with tales of Medicare waste, but won’t bore you with them now.

    BTW, I have physicians in my family as well. They confirm that my experiences with Medicare are not unique; not even unusual.

  • Brunelleschi

    “Our system is TOO good.”

    As a victim of this shitty system, that made me spit out my cappuccino.

    Dr D-

    You are exactly right! The people that read about my situation and said “that shit won’t happen here” were from Italy, France and Belgium. My UK friends said what you said, care sux there too. In fact, my UK friend flies to the US to see the same dr I found.

    I stand behind what I said still. The Euro athletes that I know here won’t let US drs touch them. When they get injured, they get on a plane.

  • http://drdreadful.blogspot.com Dr Dreadful

    Roger, your passing assessments of Fresno weren’t far off the mark. The city is basically one huge chunk of suburban sprawl in the middle of nowhere. Downtown is decrepit – it’s OK during the day (I work there) but dead at night. There’ve been many grand plans put forward for revitalizing it – our celebrity ex-mayor Alan Autry spent most of his eight-year tenure trying to get something done, but apart from the building of a new baseball stadium very little has changed.

    It should be possible to achieve a new, vibrant downtown – San Jose and Sacramento managed it – but no-one seems to know quite how; and perhaps it’s not even the way to go. I recently attended a very interesting and exciting presentation by the city’s planning chief involving some ambitious proposals for the city’s future. They don’t fixate on downtown but are more neighborhood-based, which considering the nature of Fresno is probably a lot more realistic and doable.

    I love San Francisco, which is one of my five favorite cities in the world, but I’m not all that keen on the Bay Area as a whole. Cost of living’s a bitch, as I mentioned above. Nevertheless, we are considering moving out of Fresno and it is one of the three possibilities. The other two are San Diego (same problem) and Portland, OR.

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    Well, I was stuck in Fresno for about 4 days; were distributing Milens Jewelers’ piece (I think for the Mother’s Day) throughout the whole town; even seen “the Mongol” part of town, the projects. Plus shootings, drug dealings and cheap whores along the main drag, forgot the name.

    I wouldn’t live in the City now; too drug infested and depressing; but I lived in Alameda (just across the Bay Bridge from SF) for the past 7-8 years until a bad streak of luck brought me to KY. It’s expensive, but you can’t replicate the experience. People of all sizes, shapes and colors. I never realized that I would miss it so much. There’s no place like California (even though I’m originally from Europe and lived in NYC for seventeen years. It’s God’s country. No wonder people are coming in droves.

  • http://drdreadful.blogspot.com Dr Dreadful

    Hmm. Fresno’s so decentralized now that there isn’t even a ‘main drag’ worthy of the name. Apart from the freeways, there are four main arteries, any one of which would qualify as the ‘main drag’ depending on where you live (there would be a fifth, but the airport’s in the way). The one you remember is probably Blackstone, which is the most iconically American street in the city: broad, six lanes, seedy, and power lines, lighted advertising signs and billboards everywhere. It’s also the only one of the four which connects the north and south of Fresno, which is the way the city roughly divides on economic lines.

    My wife’s best friend used to live in Alameda and I’ve spent quite a bit of time there. It’s a pretty place. I like its small-town feel despite it being so close to the inner-city parts of Oakland.

    There are two things I don’t like about San Francisco: you’ve got to be insane to try and drive in the city, and the bums are the most aggressive I’ve seen anywhere, even in South America.

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    Right, it was Blackstone. And Alameda, though its provincial, has its charm. Not quite a bedroom community, though. Just enough vibes not to be dull.

  • Brunelleschi (c)

    Fresno was my college town. Don’t be talkin smack about Fresno!

    We used to cruise up and down Blackstone in the middle of the night when the temp was nice, because it’s too hot during the day. The good ‘ol days,

    The hookers were on G Street (not that I would know) hehe.

    Back to the topic-

    Ditto on bad nursing. Don’t get me started. After a couple of hospital experiences, I have learned to look after myself and not trust nurses. I ask them everything they are doing, what’s in that IV? How long should it last? Will there be more? etc etc

    You literally have to learn to watch out for yourself, because they don’t.

    My last hospital experience went like this- (last may)

    I have no large intestine. Instead there is a short pouch inside made from small intestine. It’s been getting me by for over 15 years, but twice it flared up and put me in the hospital. I know what to do.

    I walk into an emergency room in California in great pain. It’s swollen and I am bad off. I tell the checkin people what it is. I need to see it is a UTI, or this pouch flared up? They don’t listen.

    I sit in emergency in great pain for hours, and they said they are doing an MRI. OK fine. I explain carefully there are not going to see what they expect. When they get the scans, they are shocked. They have never seen anything like it. A small crowd gathered around to view the scans and they were like “holy shit, what is that?” A few feet away I am trying to explain why it’s different. They mistakenly think what they see is a huge abscess, but its the pouch that replaced the intestine.

    They don’t listen. Instead they email the scans to an expert, and he is shocked too. I get some morphine and put in a room for the first of 5 nights.

    The incorrect reading of the MRI goes on my chart. I tell the night nurse that is wrong, and the morphine is going to make it worse. I need and anti-inflammatory, not morphine that slows the system down and makes it hurt more.

    She says I am wrong, the dr said….

    The MRI was $5,000. They didn’t even read it right or listen to me trying to explain what they saw!

    Total bill $20,000.

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    Brune,

    I never said I despised seedy places, especially when they come with seedy hookers. I think it does wonders to the intellect to wallow now and then in a pigsty. Then you realize you’re a human after all.

  • Bliffle

    Archie says:

    “A good starting point to approaching the issue would be to admit that the 45 million number includes many who are not actually legal citizens of this nation.”

    OK. How many?

    It’s an issue you brought up, so get us the data.

    How many?

  • Clavos

    The government says there are upwards of 12M illegal wetbacks in this country. That sounds about right.

  • STM

    Geez, that’s two million more than half the population of this entire country.

    Thinking about it that way makes it seem like a lot. Is that fair dinkum, that figure, or do some illegals just come over to work and go home regularly, say on the weekends to see family?

  • bliffle

    So, how do those 12million illegals get counted into the 45 million uninsured?

    Even if ALL those illegals were counted in, that still leaves 33 million uninsured who are citizens. Not profoundly different frm the full figure.

  • Clavos

    About 25% different…

    And Stan, they do go home, but not on a casual weekend basis, because of the risks trying to come back. Since the recession started, a lot of them HAVE gone home (no work here), and this is becoming a serious financial problem for Mexico; the money those workers send home during the good times is Mexico’s third largest source of foreign income; after oil (also down now) and tourism (REALLY down).

  • STM

    Same everywhere mate. We’ve weathered it OK up to now, but now some of the bigger companies like BHP are starting to lay off workers.

    That’s really bad news, as we depend on our mining exports to China, which is obviously also feeling the pinch, and elsewhere.

    The government has propped up the banks with guarantees and has been handing out wads of money left, right and centre and dropping our variable mortgage interest rates to try to stimulate the economy, but all that happened was the Christmas retail figures were up a bit on last year.

    They’ve now fallen again.

    We live in interesting times … but we’ve been there before, as have you.

    Availability of credit seems to be the big problem as far as many businesses go. It doesn’t matter for the average punter, but if business can’t turn over its money, it’s a drama.

    We’ll see over the next 12 months.

  • Lisa Solod Warren

    Dave, your assessment of health care in this country is absurd. It’s broken, clear and simple. Like Clavos, I have a seriously ill, disabled sister who is now seeking alternative, out of the box treatments that she is paying for herself because insurance won’t. Until now, it has been meds, meds, meds. None of which have helped at all. Our drs are in thrall to the pharmaceutical companies, drugs are the answer to any symptonm no one tries to find the cause, the insurance companies drown us in paper, if we lose coverage for any reason it is nearly impossible to get it again (trust me, I know). “Pre-existing conditions” can mean anything the insurance companies want it to mean, and so on and so on. Do we have good doctors and hospitals? Sure we do. Are we doing good research? Yeah. Is it possible to get this all back on track? Yup.

    But not without a complete overhaul.

    You are living in a dream world. Medical care is expensive, drug driven, inefficient, complicated, and doctors are fleeing the profession in droves. People who should be getting well care are getting medicated. It’s a mess all around.
    Don’t keep kidding yourself.

  • http://ex-conservative.blogspot.com Glenn Contrarian

    Dave –

    The healthcare system in England is in shambles, producing measurable declines in life expectancy and quality of life. The same is true in Germany.

    I think I’ve been over this ground before with you.

    England and Germany – who, according to you, have such terrible health care, both have a longer national life expectancy than America.

    In fact, as the doctor mentioned (funny how you think you know more than a doctor), America is the ONLY MODERN INDUSTRIALIZED DEMOCRACY THAT DOESN’T HAVE UNIVERSAL HEALTH CARE…and almost every one of them have LONGER national life expectancies in America, and in terms of percentage of GDP, NONE of their governments pay much more than HALF of what the American government’s ALREADY paying! If England’s and Germany’s are SO bad…then why are the end results – national life expectancy and tax dollars spent – so much BETTER than ours?

    Okay? NO EXCUSE, Dave.

    Not the illegal immigrants – because several countries in Europe have worse IA problems than we do.,

    Not the “you can’t choose which doctor” GOP excuse – because as Europe and Canada has ALREADY shown, they CAN. We, on the other hand have to go where the HMO says to go!

    Not the “you have to wait for years for lifesaving treatment excuse” – because in Europe and Canada, lives in danger go to the HEAD of the line…and if you want elective surgery right away instead of waiting, you pay for it. Unlike here in America, if you want lifesaving surgery OR elective surgery, you just PAY for it.

    Not the “America’s too corrupt” excuse – because Italy’s FAR more corrupt…but they have Universal Health Care, a serious illegal alien problem, and a longer national life expectancy.

    Not the “America’s eating habits are that bad” – have you been to England lately?

    NO EXCUSE, Dave.

    And what’s wrong with Medicare for all? This is from an op-ed in the LA Times:

    “By almost every measure, Medicare is cheaper and more effective than private plans, according to government and academic research. Medicare spends 2% on overhead; private insurers typically spend 25% to 27% for overhead and profit.

    A UC Berkeley study last month found that a public option like Medicare could result in $1 trillion in national savings over 10 years by driving down costs, improving efficiencies and fostering innovation.

    Critics contend that Medicare pays doctors so little that most physicians won’t accept the coverage, and that it is too bureaucratic and financially unstable. Medicare does use its size to drive down what doctors and hospitals are paid. However, the Medicare Payment Advisory Commission reports that 97% of physicians accept new Medicare patients, with 80% taking all or most patients, which is comparable to HMO acceptance rates.

    Finally, the president’s pledge to give the Medicare program the authority to buy prescription drugs in bulk for the program’s 44 million recipients would be another cost-saver. This should drive down prices for recipients by about 60%.”

    I know your patriotism, Dave – so I issue you a challenge: If you cannot come up with a reason that Universal Health Care in America cannot work just as well as it does in Canada and Europe – where the governments pay LESS than ours already does and their populations have a LONGER life expectancy, then why can you not change your mind and SUPPORT Universal Health Care?

    In the final analysis, the effectiveness must be judged by a country’s national life expectancy and tax dollars spent – and Canada and Western Europe AND JAPAN all have UHC, and all closely meet or surpass us in life expectancy…and all spend a FAR lower percentage of their GDP than our government already does.

    If you can’t prove it it’s not a better idea – like the rest of the free world has already found – then why not support it? Which is more patriotic, Dave? To stick to the rhetoric of the GOP, the HMO’s, and Big Pharma? Or to join with the DOCTORS, the nurses, the majority of the American public…and the statistics which prove you wrong on EVERY level?

    Be a patriot, Dave!

  • Lisa Solod Warren

    Good job, Glenn!!!!!!!!!!!!!!!!!

  • zingzing

    damn… that was a giant smack down. like a ram jam.

  • Brian aka Guppusmaximus

    I have to agree with Glen,Lisa & Zing… and I would also include Dental care. Replacing a tooth with an implant is not covered by insurance?! WTF, is that all about? Last time I checked,teeth are an important part of the digestion process.
    One more thing, The way these Nursing homes are run in MA. is atrocious. The RNs & Directors don’t give a flying f*ck about how the CNAs(mostly Haitian) handle the elderly.

  • STM

    Out of interest, I just looked up the life expectancy (according to the UN) in Australia: 79 years (men), 84 years (women) … and yes, we do have universal health care (although if Dave’s to be believed, we’re all walking around with gammy hips and dicky knees :)

    The US figure is just under 74.5 for men and 80.5 for women.

    The UK is 77 for men and 82 for women, off the top of my head because I can’t be bothered looking at the stats again.

    While the figures certainly shoot down Dave’s initial argument about US health care being TOO good, and about the value placed on quality of life, there might be a couple of other factors at play here (I initially thought Australia would have a lower expectancy than the US because it has the world’s highest rate of skin cancers, but that’s obviously not a factor).

    One factor might be lifestyle … being outdoors a lot and having a very high level of sports participation … and the British too are big sports participants (rather than watchers) per capita even through to middle-age, despite the weather.

    I’d venture that food is fresher too. I know food is of quality generally in the US but because of the problem of feeding so many people, it gets held up and stored for periods in warehouses in the, whereas in Oz we benefit from a small population and it pretty much goes from farm to market to shelf to table. The Europeans are pretty strict on food freshness and quality too.

    However, fast food is popular in all the countries mentioned – perhaps a key is the quantity eaten (and I don’t mean at an individual sitting :)

    The main reason, though, for the discrepancy, is likely to be that there is a much bigger gap between rich and poor in the US than in the other countries that have already been mentioned.

    With a population of 300 million, that means there are a lot more people not living well, eating poorly (or if caught up in a cycle of poverty also abusing alcohol and drugs) simply because they can’t afford to.

    I wonder, too, whether stress is a factor … without laws that protect people’s jobs and working conditions in the US, and less government help for aged retirees, could uncertainty play a role here as well, especially approaching retirement?

    Throw second-rate public health care into the mix in the US and you might be getting close to an answer.

    I’d bet, though, that for Americans with good health insurance earning above a certain amount of money (nothing flash at the lower end: just from the middle-income earners and above, and then of course right to the top of the scale), the figures will be as good, if not better, than they are for the other places mentioned in these posts.

    It would be telling if we could have a breakdown of those figures.

    Surely what you should be aiming for is top-level care for everyone, regardless of income. That would change the figures – I’d guarantee it.

    Discuss, maggots :)

  • Cindy D

    RE #53,

    Great post Glenn.

    But Glenn, it’s sort of mean. Do you want Dave’s head to explode? Just entertaining such an idea could be fatal to Dave.

  • zingzing

    stm: “dicky knees”

    oh my god. first “hot cock” and now “dicky knees?” you guys are murdering the language in perversely creative ways. if i ever form a punk rock group, dicky knees will be my pseudonym.

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    Glenn,

    Re #53. And addendum:

    There’s also a moral issue at stake. I can’t remember now who had said or the exact words, but we’ll be remembered and will be judged by how we care for THE LEAST among us, not the best-off.
    And this goes beyond the limited notions of patriotism or plain partisanship but touches upon the judgment of posterity.

    A good rule of thumb: pragmatic considerations (costs, inconvenience, etc.) should be of little or no account and should never trump moral issues.

    I find an interesting disconnect here when it comes to the conservative mind. They’ll be the first to invoke the moral question when it suits their purposes (the right to life, for example); they’ll also be the first to deny its relevance when it does not. Kind of disingenuous, wouldn’t you think?

    You can’t have it both ways, guys.

  • Clavos

    England and Germany – who, according to you, have such terrible health care, both have a longer national life expectancy than America.

    That is mostly due to the fact that the usa has one of the highest infant mortality rates in the world (I read somewhere that the city of Memphis, TN has the highest in the usa, ironic when you consider that Memphis is home to the Shriners Children’s Hospital). According to the Centers for Disease Control, our infant mortality rates are due to the high number of pre-term single parent births by relatively uneducated mothers who have received little or no prenatal care and training.

  • Clavos

    Replacing a tooth with an implant is not covered by insurance?! WTF, is that all about? Last time I checked,teeth are an important part of the digestion process.

    …And they can be replaced by bridges and/or plates; both of which cost far less than implants.

  • Cindy D

    I think bone loss results unless you eiether have a tooth or an implant. Something in the bone itself.

    If we don’t use the best choice that preserves teeth/bone, would there be a need for any dental care? Go straight to dentures after they fall out?

  • Brian aka Guppusmaximus

    And they can be replaced by bridges and/or plates; both of which cost far less than implants.

    Both of which are not covered by insurance. The problem with bridges is that bacteria can get caught up and cause the other teeth, that hold the bridge, to decay. It’s not a great solution.

    As for the bone, I’m all for surgery to replace it with synthetics.

    BUT, my point was that

  • http://ex-conservative.blogspot.com Glenn Contrarian

    Clavos –

    Again, NO EXCUSE.

    1. If we had Universal Health Care, we’d have FAR better prenatal health care for women who are presently having to choose between paying for food/shelter or for health care.

    2. When comparing infant mortality rates, Clavos, you do not look at the stats for ONE city, but for the entire country.

    America is 30th for overall national life expectancy. (the top twenty-seven all have Universal Health Care)

    America is 42nd (out of 220) for overall infant mortality rate…and almost all of those top twenty-seven in #1 have a better infant mortality rate.

    The fact remains, Clavos, that there is NO EXCUSE for America doing what the rest of the free world has found to be FAR better for their people and particularly for their respective economies.

    Clavos – I give you the SAME challenge I gave Dave: since ALL – repeat ALL – the statistics support UHC, which is more patriotic? To keep spouting “It’s socialist!”? Or to accept that maybe, just maybe the GOP, the HMO’s, and Big Pharma are wrong and that the doctors, the nurses, the majority of the American people are right?

    By the experience of the rest of the free world, Clavos, UHC is better for the general population and for the economy. So which is more patriotic? To do what’s best for the GOP and the neo-cons? Or to do what’s best for America as a whole?

  • Richard A. Damon, MD

    I read myriads of personal testimony and cited imperfections in the health care system, all of which are true in some degree. I do not read any sound reform policy suggestions that have substance, and fulfill the goals of making quality, affordable, accessable care for all. Several points to be made:

    1)Machiavelli’s Law of Reform is applicable and in essence states that reformers intending to change the order of things will be opposed by those who have profited from the status quo.(Drug makers, insurers, highly paid medical specialists, makers of costly medical devises and equipment,employers who employ only young healthy workers, and uninformed employees who feel their health insurance coverage is free, and others.) These opposers of reform are special interest forces which will always exist.

    2)Only after unanimity of all the health care players is reached, will there be a single approach to reform, identifying the most essential aspects of reform:

    a)beginning with how the nation should deal with the socio-economic disparities obstructing health,

    b)what changes are necessary to bring medical education up to 21st century standards,and produce primary care givers (much needed) instead of increasing specialists (less needed)

    c)how we incorporate a universal medical information network for every provider of care,

    d) recognize that the entire system must perform within the parameters of economic principles of DEMAND for care being balanced with SUPPLIERS of care

    e)that there should be a transfer of costs from end of life efforts that are unrewarding to preventive health efforts beginning at the start of life,

    e)that education in general has a determining impact on outcome of illnesses and health

    f)that every quasi-successful health care system in other industrialized nations, although not perfect, place income caps on insurers, drug manufacturers, physicians, and hospitals, and rewards time spent, face to face, primary care contacts by efforts to keep people healthy.

    g)there is an absolute necessity to restructure taxation as a means of funding any national system with consideration to a “consumptive tax system” based on sales tax of nonessential or excessive items of purchase. This tax could be augmented by a low flat tax for every person unrelated to income and an additional incremental tax for incomes in excess of $250,000 per year. The cost savings of such a simple system would be astronomical, would close loops holes, and off set other government expenses.

    In the face of our current drastic economic decline, some would say the nation cannot afford to make such great changes. I would say it is imparitive that we proceed to help the economic condition.

    I do not understand why there has not been an effort to put money back into the hands of those middle class people caught with small business bankruptcy, foreclosures, and job loss. If people could stay in their homes by the government taking over the foreclosures with new long term low interest mortgage loans, people would be able to continue purchasing, industries could continue manufacturing and banks could start loaning again. The banks have not played their responsible and ethical role for the nation in using bail out billions to bolster their own coffers.

    RAD-1

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    Bruce,

    “I do not understand why there has not been an effort to put money back into the hands of those middle class people caught with small business bankruptcy, foreclosures, and job loss. If people could stay in their homes by the government taking over the foreclosures with new long term low interest mortgage loans, people would be able to continue purchasing, industries could continue manufacturing and banks could start loaning again. The banks have not played their responsible and ethical role for the nation in using bail out billions to bolster their own coffers.”

    Because it’s not in the interest of the powers that be. Without the middle man – the banks, real estate companies, the brokers, HUD – there’d be no money to be made. This may be simplistic, but that’s how I see it.

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    Errata: #67 should be addressed to Richard.

  • http://www.fontcraft.com/rod/ Dave Nalle

    I give you the SAME challenge I gave Dave: since ALL – repeat ALL – the statistics support UHC, which is more patriotic?

    But Glenn, all the statistics do not support universal healthcare. What the statistics support is that our current system is not working well. That doesn’t mean that UHC is the answer, and there are plenty of statistics out there to suggest that in some of the countries most similar to the US it isn’t working either.

    When your car breaks down you don’t go out and buy another car which doesn’t run to replace it. You either fix it or look for a new car which is more reliable.

    What we need in this debate is a clearly defined set of objectives and then some rational analysis on how we can meet them, and I bet we can come up with solutions which don’t involve a massive single-payer system like the ones which are failing in Europe and Canada.

    Dave

  • bliffle

    R A Damon: I give you one word: Corruption.

    “do not understand why there has not been an effort to put money back into the hands of those middle class people caught with small business bankruptcy, foreclosures, and job loss.”

  • bliffle

    But Dave, all the statistics DO support UHC. Whether cost, or life expectancy, UHC wins.

    All that the anti-UHC folks have is anecdotal cases and wild unsubstantiated assertions. Such as claiming that the NHS is a ‘shambles’, which has never been shown.

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    So Bliffle, you essentially agree with my response to R.A. Damon in #67. There’d be nothing to gain from a clear-sighted solution.

  • http://ex-conservative.blogspot.com Glenn Contrarian

    Dave –

    WHAT statistics don’t support Universal Health Care?
    And how, exactly, would those supplant the FACTS that the top twenty-seven countries in terms of life expectancy ALL have UHC…and NONE of them spend much more than HALF what the U.S. is ALREADY spending in taxpayer dollars?

    WHAT statistics in WHAT countries ‘similar to the U.S.?

    And you apparently agree that our present health care system could be a LOT better…but you’re refusing to even consider what the REST OF THE FREE WORLD is doing that DOES work much better than what we have.

    Dave, I think the ‘lipstick on a pig’ metaphor fits quite well here. Our present system’s a big ugly hog, and all the lipstick you wanna use to make it ‘better’ ain’t gonna change the fact that it’s a hog!

    So WHAT ‘solutions’ are the conservatives offering? Oooooohhh! TAX CUTS! Yep! That’ll do what it always does. NOTHING.

  • http://drdreadful.blogspot.com Dr Dreadful

    WHAT statistics don’t support Universal Health Care?

    Well, strictly speaking, all of them. Correlation does not equal causation. All they show is that most of the countries with longer life expectancies and lower infant mortality rates than the US happen to have some form of UHC.

    Glenn, understand that I’m not siding with Dave here, because he doesn’t seem to have the slightest clue as to what would work. I do agree with him that UHC is not necessarily the only solution.

    But if not, then whatever it is will need to be a damn sight more imaginative than anything anyone’s come up with to date.

  • http://ex-conservative.blogspot.com Glenn Contrarian

    Doc –

    If the TOP twenty-seven countries on the life-expectancy list ALL have Universal Health Care, then that’s a pretty good doggone clue as to what works best.

    After all, if you were managing a sports team and you were doing something radically different from what the top ten or fifteen teams were ALL doing, that’s a clue that either you need to LEARN from the other guys…or the owner needs to fire you and get someone who IS willing to learn from the other guys so your team can be competitive with the other teams.

    ALL TWENTY-SEVEN, Doc. We’re number 30. And who’s #28 and #29? Jordan and Bosnia, respectively.

    So WHO should we emulate? England? Japan? Italy? Spain? South Korea? Australia? Canada?

    Or Jordan and Bosnia?

    C’mon, Doc – how much more obvious does it have to be…especially when NONE of those top twenty-seven are spending much more than HALF of what America’s already spending?

    How much more obvious does it have to be? There are NO COUNTRIES that do NOT have national health care who are in the top twenty-seven…yet you want to make it seem like that emulating those who ARE doing it…isn’t a solution?

    How much more obvious does it have to be?

    Patriotism is doing what’s best for America and the American people – and sometimes that means going AGAINST one’s own political beliefs.

  • http://blogcritics.org/writer/dan_miller Dan(Miller)

    Glen, you ask, So WHAT ‘solutions’ are the conservatives offering? Oooooohhh! TAX CUTS! Yep! That’ll do what it always does. NOTHING. You might want to read an article on the subject which I wrote back in May of last year. It is here, and suggests some ideas (not including tax cuts) for “universal health care.” Not all of the suggestions are likely to apply directly to the U.S., but some might.

    Dan(Miller)

  • Clavos

    Glenn #65:

    First, I WAS talking about the entire usa in regard to the infant mortality rate. I only mentioned Memphis because of the quirk of its having the highest infant mortality rate among cities in this country, while also being the home of one of (if not THE) most advanced childrens hospitals in the country.

    If we had Universal Health Care, we’d have FAR better prenatal health care for women who are presently having to choose between paying for food/shelter or for health care.

    That’s not necessarily true. The contention is that the lack of prenatal care is due more to a lack of sophistication and education on the part of the women who most are contributing to the infant mortality rates, than it is to a lack of availability.

    Your argument as to which health system is more “patriotic” falls on deaf ears in my case, Glenn. I’m not a patriot (of either of the countries whose passports I carry), nor do I look at these kinds of issues in that light. I look at them only as a taxpayer; as one of the people who will pay for whatever we come up with.

    What I do see, after four years of direct, personal experience with the “best” government health system currently operating in this country, Medicare, is enormous cost overruns, rampant fraud (Medicare’s fraud bill is $7m a day, 365 days/year), and rationing of care in the name of cost savings.

    I am not against everyone being covered by health insurance. I AM against the government’s involvement in such a plan beyond being the bill payer; if bureaucrats who aren’t accountable and can’t be fired are put in charge of a national health insurance plan, as they are now with Medicare, we will spend ourselves broke on it within a decade or two. In fact, Medicare is already one of the (if not THE) most expensive social program in this country. And BTW, the old shibboleth about Medicare’s “overhead” being so much lower, vis-a-vis those of private insurers is specious; it doesn’t among other things, take into account the millions in fraud, most of which Medicare administrators are unaware.

    Let the government pay for it, but keep them away from administering it; set up an independent oversight organization, comprised of medical professionals, qualified administrators and financial experts to operate it, not bureaucrats.

  • Brunelleschi

    No one has mentioned Cuba yet. Cuba is not rich and is pretty much socialist, but they have managed to put together a health care system that just about all of Latin America can’t match.

    Why?

  • http://blogcritics.org/writer/dan_miller Dan(Miller)

    Glen, getting back to my earlier comment (#76), I suspect, but do not know, that there are substantial obstacles to “Universal Health Care” in the U.S., including the existence of many powerful groups willing and even anxious to spend lots of money to ensure that their own perceived interests are protected. For the most powerful groups, ideology is unlikely the dominant factor and money probably is. Many physicians probably want to maintain and improve an affluent life style. Many trial lawyers ditto. Many insurance companies probably want to continue to make as much money as possible. Many pharmaceutical companies ditto. These and others have associations which retain very well connected, very expensive and highly effective lobbyists. Although it might be pleasant to fantasize about putting these monsters in their proper place out in the trash dump, the Democrats seem little more likely to try effectively to do so than do the Republicans.

    Any “Universal Health Care” system with even a chance of adoption in the U.S. must, unfortunately, take firmly into consideration these and other groups and their respective (and often conflicting) financial interests. I suggest that small steps be taken, and built upon, rather than trying to fashion a wholly new system grounded in the belief that it is the proper thing, ideologically, to do.

    There is a need for better and less expensive health care, but I do not think that ideologically driven arguments are likely to do more than create hostilities and sound bites for the media to prey upon.

    Dan(Miller)

  • STM

    Let’s not fall for the Cuban government’s line on its health care.

    Health care in Cuba is a disgrace, just like everything else. Do your homework properly Brun,

  • Brunelleschi

    Everything is relative. What source you you have that they are doing a bad job?

    It’s common knowledge that Cuba does a better job than just about all of Latin America, and they do it with less.

  • Brunelleschi

    This is typical, and widely known to be factual…

    “…Cubans say they offer health care to the world’s poor because they have big hearts. But what do they get in return?
    They live longer than almost anyone in Latin America. Far fewer babies die. Almost everyone has been vaccinated, and such scourges of the poor as parasites, TB, malaria, even HIV/AIDS are rare or non-existent. Anyone can see a doctor, at low cost, right in the neighborhood.

    The Cuban health care system is producing a population that is as healthy as those of the world’s wealthiest countries at a fraction of the cost. And now Cuba has begun exporting its system to under-served communities around the world–including the United States.

    The story of Cuba’s health care ambitions is largely hidden from the people of the United States, where politics left over from the Cold War maintain an embargo on information and understanding. But it is increasingly well-known in the poorest communities of Latin America, the Caribbean, and parts of Africa where Cuban and Cuban-trained doctors are practicing…”

  • Clavos

    Stan,

    Your comment (which is dead on) about Cuba’s sorry health care looks like it didn’t publish completely; I hope you’ll finish it.

    I’ve met and talked to several Cuban doctors, both here and in Cuba, and to a man (and woman) they say same thing: while Cuba’s medical training is indeed quite good, the distribution of medical care to the citizens is very poor. It is rationed (except to government insiders), and they have serious deficiencies in equipment, medicines, and supplies.

    Those who are friendly to the Castro regime blame the US embargo for these shortages, but that’s not true; the embargo doesn’t apply to medicines, and in any case ample medical supplies and medicines are available on world markets; the Cuban government is just too impoverished because of misguided policies and generalized mismanagement of their economy for the last fifty years to be able to afford adequate supplies.

  • Brunelleschi

    Bullshit.

    You guys need to pick your battles. This one makes you look too biased and ignorant.

    Just a snip from wiki…

    “In 2006, BBC flagship news programme Newsnight featured Cuba’s Healthcare system as part of a series identifying “the world’s best public services”. The report noted that “Thanks chiefly to the American economic blockade, but partly also to the web of strange rules and regulations that constrict Cuban life, the economy is in a terrible mess: national income per head is minuscule, and resources are amazingly tight. Healthcare, however, is a top national priority” The report stated that life expectancy and infant mortality rates are pretty much the same as the USA’s. Its doctor-to-patient ratios stand comparison to any country in Western Europe. Its annual total health spend per head, however, comes in at $251; just over a tenth of the UK’s. The report concluded that the population’s admirable health is one of the key reasons why Castro is still in power.[60] In fact, a recent poll carried out by the Gallup Organization’s Costa Rican affiliate — Consultoría Interdisciplinaria en Desarrollo (CID) — found that about three-quarters of Cuban citizens are positive about their country’s education and healthcare systems.[61]
    In 2000, Secretary General of the United Nations Kofi Annan stated that “Cuba should be the envy of many other nations” adding that achievements in social development are impressive given the size of its gross domestic product per capita. “Cuba demonstrates how much nations can do with the resources they have if they focus on the right priorities – health, education, and literacy.”[62] The Kaiser Family Foundation, a non-governmental organization that evaluated Cuba’s healthcare system in 2000-1 described Cuba as “a shining example of the power of public health to transform the health of an entire country by a commitment to prevention and by careful management of its medical resources”[63] President of the World Bank James Wolfensohn also praised Cuba’s healthcare system in 2001, saying that “Cuba has done a great job on education and health”, at the annual meeting of the Bank and the International Monetary Fund. Wayne Smith, former head of the US Interests Section in Havana identified “the incredible dedication” of Cubans to healthcare, adding that “Doctors in Cuba can make more driving cabs and working in hotels, but they don’t. They’re just very dedicated”.[64] Dr. Robert N. Butler, president of the International Longevity Center in New York and a Pulitzer Prize-winning author on aging, has traveled to Cuba to see firsthand how doctors are trained. He said a principal reason that some health standards in Cuba approach the high American level is that the Cuban system emphasizes early intervention. Clinic visits are free, and the focus is on preventing disease rather than treating it. [65] Furthermore, London’s The Guardian newspaper lauded Cuba’s public healthcare system for what it viewed as its high quality in a Sept. 12, 2007 article. [66]..”

  • Clavos

    Brune,

    In a choice between information gleaned from physicians who have actually worked in the Cuban medical system and a Wiki entry written anonymously by an obvious apologist for the Castro regime, quoting such stellar authorities as Kofi (oil for food ripoff artist) Annan and presenting data which compares Cuba’s life expectancy and infant mortality rates [as being] pretty much the same as the USA’s…, in the same thread that pretty much shows USA’s life expectancy and infant mortality rates are among the worst in the world, I’ll take the Docs’ account, thank you.

    And the remark by Wayne Smith, “Doctors in Cuba can make more driving cabs and working in hotels, but they don’t. They’re just very dedicated,” pretty much supports the point that Cuba is severely lacking in resources for their medical system; to the point they can’t even pay their physicians a living wage. Mr. Smith, who is highly regarded by the Cuban exile community here in Miami, was obviously (but diplomatically) pointing out the inadequacy of Cuban health care with his comment.

    You’re the one who looks ignorant on this one, Brune…

    I suggest you go to Cuba (as I have, on several occasions) and see for yourself, rather than quoting such dubious sources as Wikipedia.

  • bliffle

    Clavos, #77 says:

    “…millions in fraud, most of which Medicare administrators are unaware.”

    Actually, they are quite aware, and people go to jail every day for fraud or attempted fraud of the system. That includes both “providers” and “recipients”. Every state that has medicare is required to use Fraud Detection software, by federal law, and that software is quite good. I worked for several years in the Fraud detection business, and our salesperson could use live data to catch actual current attempted frauds while making a sales pitch! We even caught the State Medicare Administrator participating in one fraud.

    “Let the government pay for it, but keep them away from administering it; set up an independent oversight organization, comprised of medical professionals, qualified administrators and financial experts to operate it, not bureaucrats.”

    The worst bureaucrats and administrators in the USA are in private industry! Just look at their failures in the financial industry, in automobiles, etc. they’re all in line for government handouts.

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    I really appreciate the work you’re doing, Bliffle.

    You ARE a watchdog, making sure none of us will get away with disinformation or less than veritable facts.

    Keep at it, please!

  • Clavos

    Actually, they are quite aware, and people go to jail every day for fraud or attempted fraud of the system. That includes both “providers” and “recipients”.

    They are aware of some, but by no means all, obviously, or the level of fraud would not be as high as $7 Million Dollars per day, every day. According to The Miami Herald, the government spends

    less than two-tenths of a cent of every dollar in its $456 billion annual budget on waste, abuse and fraud problems.

    In contrast, health maintenance organizations spend considerably more — an average of six cents of every premium dollar, according to a 2006 report by America’s Health Insurance Plans, which represents 1,300 members providing health coverage to more than 200 million people. That allocation includes anti-fraud, waste and claims compliance costs.

    Some experts believe that Medicare — armed with sophisticated computer weaponry like that of a credit-card company — could catch much of the fraud that costs the program tens of billions of dollars a year.

    Besides outright fraud, Medicare spends much more for durable medical equipment than private insurers, and MUCH more than patients do. Case in point: my wife’s wheelchair cost Medicare $5K; at the time, I could have bought it for $2,400, direct from the manufacturer. No fraud, just another instance of government bureaucrats buying $600 hammers…

  • http://www.fontcraft.com/rod/ Dave Nalle

    WHAT statistics don’t support Universal Health Care?

    Statistics specifically showing the longer wait times and rates of death from specific types of conditions, especially heart disease and cancer which aren’t handled well under many of the universal care systems. I had articles on BC with links to all these stats, but google’s search no longer has our archives in them and it’s too slow to go through all my articles, but I’ll try to find them later.

    And how, exactly, would those supplant the FACTS that the top twenty-seven countries in terms of life expectancy ALL have UHC…and NONE of them spend much more than HALF what the U.S. is ALREADY spending in taxpayer dollars?

    They spend considerably more than we spend in tax dollars, just less than what we spend including every other kind of spending. And I believe that in the better ones the total spending is well above half of what we spend, plus their growth rate is generally higher. Take a look at the OECD figures.

    And you apparently agree that our present health care system could be a LOT better…but you’re refusing to even consider what the REST OF THE FREE WORLD is doing that DOES work much better than what we have.

    I think we can do better than the rest of the free world. Why trade one failed system for another. There are myriad systems out there, some of which do a superior job at a better price. Just jumping into a single-payer system without thinking it through and considering the alternatives is incredibly foolish.

    So WHAT ‘solutions’ are the conservatives offering? Oooooohhh! TAX CUTS! Yep! That’ll do what it always does. NOTHING.

    Now there’s a non-sequiter. Tax cuts aren’t going to solve our healthcare problems and I know of no conservatives who have suggested that they will.

    Dave

  • STM

    Brun on Cuba’s healthcare: “It’s common knowledge that Cuba does a better job than just about all of Latin America, and they do it with less.”

    Well, that’s hardly any kind of recommendation now, is it?

    It’s well known – any expat will tell you – that health care in Cuba is absolutely atrocious for the average Joe or Joanne. It’s all well and good getting in quickly to see a doctor, but if they can’t offer a proper diagnosis or the correct treatment (because of drug and equipment shortages), what’s the point.

    Besides which, do you think it would be beyond the Cuban dictatorship to divvy up the figures in their favour on a whole range of issues to make themselves look way better than they are?

    Cuba’s a basket case, and its people still live in fear and living conditions that make a mockery of any claim to social justice.

    And I’m a leftie, too, but in the face of truth, how could anyone support that regime?

    Seriously, get real mate.

  • STM

    Quoting the BBC and The Guardian on Cuba, both elitist, chardonnat-quaffing left-leaning organisations, is hardly any recommendation either.

    I reckon Clav might trump you on this one. He’s been there more than once or twice.

    The Cubans modelled their health system on the soviet system, and I’ve been there when it was as red as your face should be … and I can tell you it was a shocker, unless you were a high-ranking party member, in which case often the answer was to seek medical treatment outside the Soviet Union – particularly for conditions that went beyond the common cold or a broken bone

  • http://drdreadful.blogspot.com Dr Dreadful

    Stan, what’s a chardonnat?

    Some beast of a grape that somehow got interbred with a kangaroo in the depths of the Hunter Valley and which the Aussies are now trying to pass off as quality hooch to anyone who’ll drink it?

  • STM

    Ho ho Doc …

    A chardonnat is actually a literary mutation … more commonly known as a typo. Look closely at your keyboard, good doctor, and note that the T and the Y are next to each other.

    BTW, speaking of ho ho, did you get the full set of Patrick O’Brian’s Aubrey/Maturin novels in hardcover in your Chrissy stocking??

    If not, insist for your birthday dear boy!

  • http://drdreadful.blogspot.com Dr Dreadful

    Alas, no – drew a blank on the O’Brian.

    And your hastily invented story about the typo would have been more convincing if you’d explained it as a liyerart muyayion.

  • Clavos

    Doc,

    You should cut back on the Chardonnat…

  • http://drdreadful.blogspot.com Dr Dreadful

    I prefer a nice Caberney…

  • STM

    What kind, a sauvignob?

  • Brunelleschi

    Backing up a few posts..

    What I wrote about Cuba’s health care doing a far better job than it’s peers (other latin american nations) did not come from a quick google search. I have known this myself for 20 years and its common knowledge.

    They are not rich and have to live with a US embargo that tries to kill them. But they still managed to figure out a way to do a better job with less money spent.

    Of course you can find people that complain. You can find the same here in the US.

    The problems each side has are very different.

    The US government has no interest in having a system that works. The US system has tons of money, technology, etc, but care sucks ass (I know myself, having wasted over 10 years living sick and struggling to find ONE dr that would actually help me find my problem, instead I got shoved from one useless place to the next, each making a lot of money and accomplishing nothing!).

    The US system is a model of inequality, unequal access, waste, greed, and shortsightedness. HMOs, insurance companies, and drs get rich, but 45 M people are “on their own” and one sickness or accident away from bankruptcy. Every day you can find appeals for fundraising on line for one sad story after the other. Even people with insurance can end up bankrupt if their problem requires an extended stay.

    Cuba’s situation is opposite. They are not getting rich providing care, but they figured out how to include everyone, and focus on keeping people healthy in other ways.

    I would not expect anyone to pick a poor system over a rich one if they get sick, assuming they don’t go bankrupt using the rich system. But, if I had a choice between getting care in Cuba, or one other Latin American nation chosen at random, it would be foolish to not pick Cuba.

    The have PROVEN that a socialized system can and does work, even if resources are limited. The real difference is the political will to take care of people, which is absent in the US.

  • http://www.fontcraft.com/rod/ Dave Nalle

    If Cuba is such a healthcare paradise, why is their life expectancy lower than the life expectancy in the US, despite a healthier overall diet and universal healthcare?

    The truth is that Cuba does have an excellent medical education system and great hospitals. They are reserved almost entirely for the political elite and foreign medical tourists who bring in dollars and euros they desperately need for international trade. The average Cuban sees little of this healthcare, living under what experts call a “medical apartheid” where they receive less healthcare spending per capita than anyone else in the western hemisphere.

    And since Cuba’s healthcare is so great and ours is so awful, let’s compare some healthcare stats with Cuba vs. the US using data from the PanAmerican Health Organization.

    Cuba USA
    Infant Mortality at Birth 7.2 7.2
    Under 5 Mortality 11.2 8.4
    Deaths in Child Birth 34.1 7.1
    Death Rate from Communicable Diseases 51.8 46.1
    Health Spending as a % of GDP 6.7%13.1%
    Population with access to drinking water 92.9%100%

    So this wonderful medical system has a higher overall death rate, a higher rate of death among kids, a higher rate of death among adults from disease, less health spending, people who can’t even get drinkable water and FIVE TIMES the number of deaths of mothers in child birth.

    Wow, that’s fantastic. I know the people of the US will be jumping for joy when we have a 5 times increase of mothers dying in childbirth after implementing cuban style healthcare.

    Dave

  • http://theugliestamerican.blogspot.com Andy Marsh

    I didn’t take the time to read all the comments, but I think it’s kind of ironic that a doctor, one of the primary causes of rising health care costs, along with the pharmcos, is the one calling for a national health care system in the article.

    Maybe, just maybe, if Dr. fees weren’t so freaking high, the 16% of GDP that the country spends on health care would be enough to cover the 45 mil that aren’t covered!

    Just out of curiousity, how many of those 45 mil are here legally? Or doesn’t that matter? How many of them don’t have health care coverage because they just don’t think they need it? You know, I don’t want to have the deduction taken out of my pay check kinda thing? And lastly, how many of them have EVER been denied service at an American emergency room?

  • bliffle

    OK, Andy: how many?

    Or are you just dragging red herrings across the trail?

  • Brunelleschi

    Dave-

    Apples and Oranges. Rich nation vs poor under decades of embargo.

    Compare Cuba to Jamaica or Honduras, or one of those places ad get back with us.

    At least Cuba has its priorities in the right place, where the US clearly does not.

    America’s mistake, and yours, is the false assumption that the market will magically produce the best health care system.

    Andy-
    Too much money goes in the US simply feeds greed, and leads to a lot of shitty care. “Take a pill and pay your bill” is not a system.

    Look around the world. Open your eyes!

  • http://drdreadful.blogspot.com Dr Dreadful

    Hmm… Jamaican healthcare system.

    Don’t know anything about it, but I do remember a stand-up routine by the black British comic Lenny Henry in which he makes some observations on the laid-backness of all aspects of Jamaican life and contrasts them to the urgency of a typical TV hospital show.

    His depiction of what a Jamaican TV medical drama would be like went something like:

    “[toke] Mmm, we operate in a second… You mus’ not stress because… dese tings take time…”

  • http://www.fontcraft.com/rod/ Dave Nalle

    Compare Cuba to Jamaica or Honduras, or one of those places ad get back with us.

    Honduras, now THERE’s a standard to measure up to. The country which has the highest murder rate in the world, 16 times the rate of violent death of the US and about 30 times the rest of the world, not to mention having no infrastructure and an ongoing near civil war 24/7. A country where any foreigner can expect to get kidnapped and held for ransom within 24 hours of arrival. Woohoo, Cuba has better healthcare than hell on earth. What an accomplishment.

    Dave

  • http://theugliestamerican.blogspot.com Andy Marsh

    So bliffle – legitimate questions are red herrings?

    I still think it’s ironic that this article was written by a doctor…I didn’t notice him mentioning his willingness to take a pay cut to help with the cost of health care coverage?!??!

    But I do understand why he wants it. Everyone knows that the gov’t pays way to much for EVERYTHING it pays for, so, in all honesty, he’s really looking for a pay raise!

  • Brunelleschi

    Dave-

    You don’t even get the irony, do you?

    My point was that Cuba has done a better job than places like that, which pisses you off for some reason.

    Cuba has done a better job under US embargo than Honduras (and the rest) have under the thumb of US control.

    THINK for once.

    Read “Inevitable Revolutions” by LaFeber.

    Educate yourself. You have a LONG way to go.

  • http://theugliestamerican.blogspot.com Andy Marsh

    Honduras is under US control? I had no idea! When did that happen?

  • Clavos

    Don’t believe everything you read, Bru, especially if written by a lefty.

    Have you been to Cuba? I have — numerous times; During the 1990s and early 2000s, I operated (with permits from both governments) B727 charter flights from Miami to various Cuban cities for more than ten years.

    The only good aspect of the Cuban medical system is that they do a very good job training the docs. But once they’re sent out into the field, they have old, antiquated equipment (or none at all), and very few medicines to work with. Most have been reduced to relying on the old “folk medicine” cures, supplemented by whatever they can scrape together. Shortages force rationing.

    The government does operate a handful of well equipped, well stocked top notch hospitals, but these are restricted to top party members and medical tourists (primarily Canadians) who pay in hard currency.

    The effects of the embargo have been greatly exaggerated, especially by apologists for the Castro regime, to excuse the massive failures of Fidel’s revolution. In that sense, the embargo was a very bad strategic move for the US. With no embargo, there would be no excuses for the utter disaster that is the Castro government, and the world would see it for the inept, totalitarian disaster that it is.

    The real problem Cuba faces in terms of the importation of medicines (or food and manufactured goods) is a lack of funding. Ever since the demise of the late, unlamented Soviet Union, Cuba has been plunged into abject poverty in every sector of its economy. Unable, under the Communist economy installed in Cuba by Fidel, to produce exportable goods (or even to feed and provide adequately for their own population), Cuba was totally dependent on the largess of the Soviets, in the form of over $2 billion a year in subsidies, for decades. Since the collapse of the Soviet Union, Hugo Chávez of Venezuela has stepped into the breech, but with only half as much ($1B annually) charity; and even he has pulled back as the price of oil has dropped, leaving him short of cash.

  • Brunelleschi

    Andy-

    Absolutely. Do your research. I have referenced Inevitable Revolutions enough times already. If you want to keep a closed mind, that is your choice.

  • Brunelleschi

    Clavos-

    blah blah blah

    The fact remains that they have their health priorities in order better than the US.

    Shortages are due to politics, we can all agree on that.

  • Clavos

    Bru,

    The fact remains that they have their health priorities in order better than the US.

    blah blah blah

    There’s a wide gulf between setting priorities and achieving them; it’s particularly wide in Cuba.

  • Brunelleschi

    I would not disagree with that!

    Would you chose any other Latin American government, chosen at random, or Cuba?

    The fact remains that Cuba get high praise, and it can’t be attributed to propaganda.

    Cuban drs are held in high regard in most countries, but not here. Wonder why?

  • Brunelleschi

    I just listened to a lecture about Jeremy Bentham and John Stuart Mill and thought about this thread.

    Bentham was the guy we get “greatest good for the greatest number of people” (utilitarianism) from.

    What would Bentham or Mill think about this one?

    :)

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    Here you go, Brune. Waiting for a philosopher to assess our present conditions and come up with a remedy.

  • Brunelleschi

    Not exactly.
    Philosophers are very useful in helping us think outside of the box.
    They don’t make roadmaps to the answer, they just give directions.

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    I don’t disagree and you know I wasn’t being facetious. It’s just that there’s so of the ideological going back and forth, it’s extremely difficult for a person to stay aloof and start thinking clearly. The major exponents of the Left, like Zinn or Chomsky, are not doing their job. They’re as much into the fray as anyone else, even more so. It’s not from them that we can expect clear-headed solutions.

  • Brunelleschi

    Agree. Zinn and Chomsky are important critics, but so are we, right?

    :)

  • Cindy D

    LOL Zinn and Chomsky are not doing their job.

  • http://takeitorleaveit.typepad.com/ Roger Nowosielski

    I think you’re right, Brune. This whole issue has got to be re-conceptualized in terms of new ideas, not just facts. Interesting you thought of Bentham and Mill, the chief antagonists of their time. You might have something there by way of a general argument. Later.