Sentient Times Aug/Sept 2007

Nothing happens in a political vacuum. Nothing. The toe bone is connected to the head bone. Healthcare’s place in a country agenda is but a microcosm of where a nation ranks its social consciousness. It reveals the quality of our purpose, our economy, our priorities and where they are placed on the chain of command. Along with education, healthcare tells all about a government and its people. Without a healthy and literate people, a society cannot succeed. World history has proven that over and over again. Where then does America stand on the ladder of accomplishments when stacked up against the rest of the nations of the world? Sadly we fall behind most other industrialized nations in just about every area of social need. In fact, America sits weakly at number twenty-nine of the thirty-five nations included in the latest UN Human Development Report released in 2005, which lists average life expectancy. It is notable that not only have more countries moved ahead of the US, but also the gap between us and the healthiest country, Japan, with its average life expectancy of eighty-two years, continues to widen.

What is the state of healthcare in the US today? With over 45 million Americans having no healthcare coverage at all, it is easily estimated that over 40 million more have healthcare that can only be described as inadequate. The US spends over 50 percent more than say, Switzerland, on healthcare per capita, and on average, we spend 150 percent over other industrialized nations. The latest data from the Organization for Economic Cooperation and Development (OECD) has now confirmed that although the United States spends more, we do not receive the services we pay for.

Healthcare layout accounts for about 15 percent of the US GDP at a time when only two other countries, Switzerland and Germany, put out more than 10 percent. Averaging over the first years of the new millennium, the United States spends circa $5,200 per person on healthcare. Canada $2,900; Germany $2,800; Switzerland $2,600; Britain $2,200. Yet, each of them boasts of a longer life expectancy, lower infant mortality. All have a national healthcare service that covers all their people. No one is shut out.

The OECD conclusion was not a surprise. We just do not get enough for our buck. But that is not true for everyone in the country. There is an employee/insurance deal in the US that includes unlimited doctor office visits of your choosing; covers all accidents, routine exams, physical therapy, labs and X-rays; and the like; unlimited hospital visits and stays; certain chronic care and rehab; full prescription coverage; and unlimited specialty consultations. For the employee and the entire family. There are no deductibles, no co-pays, and only a $35 monthly fee taken from an annual salary of $158 though. Thirty-five dollars!

The group awarded this insurance looks forward to a full pension and continued coverage until their deaths. Who gets this coverage? It would be nice if it were the underprivileged or the chronically ill and debilitated or our veterans. But no. For starters, the 535 members of the US Congress, and add to that the few hundred in the upper executive and judicial branches of government. They are also the very same group who keeps such credible healthcare proposals and bills like John Conyers’ HR676 and Barbara Lee’s HR3000 holed up in committee, year after year, denying them access to a public hearing and floor vote. In 2005, when they voted to slash $10 billion over the next decade from Medicaid, their own medical benefits stayed intact. Using those same governmental accounting sources, the billions spent on the Iraqi campaign yearly would have given similar healthcare benefits to four out of every five Americans for a year.

A study of US bankruptcies tells a part of this scandalous story. Harvard Medical School’s Steffie J. Woolhandler addressed a meeting of the Society of General Internal Medicine and said, “Among all debtors filing for bankruptcy, 55 percent ... cited one or more medical causes ... This is an incredibly profound indictment of healthcare financing in the United States.”

Spending by the general population on its healthcare increases every year, similar to the growing governmental allocations per person for health that we mentioned earlier, now up to over $6,000 an individual. Healthcare expenses are now the third largest overall outlay in the US, surpassed only by the government and the retail industry. They are measured in the trillions and account for almost 15 percent of the total economy.

As getting sick is expensive for the individual in our society, so, too, is it costly to the taxpayers, the system, and the facilities. Sickness affects us all. Prevention would be a lot cheaper for everyone. And add to that the loss of a productive person’s skills and labor to our diminishing “quality of life.”

We remain without a healthcare program that covers all our citizens. In presenting the data for this book to various publishing outlets I was told by more than one that healthcare and its need does not seem to be that important to people. I guess I should have answered by reminding them that they should think that over when they don’t feel so well.

There is nothing more devastating than having poor health, but worse still is having a health deficiency that is undiagnosed, frightening, painful, and goes untreated for one reason or another. Nothing equals that feeling of powerlessness and frustration. Imagine, then, having such a feeling but with the added burden of never having hope or an avenue of relief of any kind, much less a cure.

I proffer three solutions to relieve this healthcare morass in the United States of America that demands our attention and action:

The health of a people must be reclassified and defined. Healthcare is not a privilege. It is a right. A right of all living souls in this world. No exceptions. Deny them healthcare and you deny them that right. (Right: Something that is morally, ethically, and legally proper; that which is just and good; endowed by nature. Merriam-Webster’s Collegiate Dictionary) They are disavowed the very fabric of life. The United States has never adopted a social policy that has included healthcare in that context.

We flirted with it in the first of FDR’s New Deal administrations and settled. The Great Society of LBJ then and since led to our most memorable breakthrough, with an advancement—Medicare—that has been among the greatest accomplishments in our history. But that is still far from enough. Throughout the whole discussion of the controversy, healthcare has always been looked upon as a privilege, something that the government was going to offer as a gift. A handout. Never as a right that cannot be denied to the people.

The United States of America, in order to protect that right forever, must use the inherent machinery for such a guarantee by enacting and passing a twenty-eighth amendment to the US Constitution that would define healthcare as a right for all.

The Constitution, with all its brilliance, is a flawed document. Indeed, the first ten amendments (the Bill of Rights) and over the next 200 years the subsequent amendments secured the rights to religion of one’s choice; freedom of speech and the press; the right to assemble; the right to form a militia; the principle of habeas corpus; a trial by jury of one’s peers; the abolition of slavery; the vote for all without restriction from race, color, previous condition of servitude, and, eventually, sex; the collection of income taxes; the prohibition of alcoholic beverages, and then its repeal; the lowering of voting rights to age eighteen.

The good news is that there is a modus operandi for more amendments. But it will take a commitment that declares healthcare as that right instead of a privilege. It all starts there. A twenty-eighth amendment is the one way to assure us all of that declaration.

There is also the sure way to declare the denial of healthcare to the American people is a national problem requiring a national solution, for only the US Constitution sets a national standard. When the Supreme Court, charged with interpreting the Constitution, hands down a decision, it automatically covers all fifty states. That is the way it was intended. Why? National problems require national solutions.

Once healthcare is declared a right and a Constitutional amendment is eventually passed that assures that right be protected forever, the federal government must act to live up to that responsibility as an entitlement, never discretionary. There are five qualities that are necessary for our nation and its governmental apparatus to assume.

1) Health care coverage must be comprehensive.

2) Health care coverage must be universal in every way. No one residing in the United States of America can be denied, regardless of race, color, creed, previous condition of servitude, sex, or age. With healthcare a right, no one can be dismissed from the system. No one.

3) Health care must be transferable to all fifty states.

4) Such coverage must be available and accessible across the board. No registered, accredited, and licensed healthcare professional or institution of any sort, by statute, can opt out of the system. Their legal permit to practice their trade is automatically national in scope and demands they be available to care for all who seek to be their patients.

5) So people can be provided healthcare by skilled practitioners and healthcare professionals and institutions, a National Health Service must be inaugurated which is a publicly supported, tax-sustained entitlement, single-payer, fully administered agency of the federal government with cabinet rank, prestige, and empowerment.

Healthcare is just too important to be left in the hands of profit driven and motivated private business interests. It is just that simple. This is not pie-in-the-sky thinking. Grass roots protests and activism have turned the government around before. There was the Boston Tea Party, the Martin Luther King, Jr., Washington Mall march, the uproar over Vietnam, and the clamor that brought down the World Trade Organization (WTO) in Seattle. What then follows is the grass roots activism that would be the machinery for change. Anthropologist Margaret Mead put it this way. “Never doubt,” she said, “that a small group of thoughtful committed citizens can change the world. Indeed, it is the only thing that ever has.”

A medical doctor with nearly four decades in private practice, Don Sloan has published more than 85 peer-reviewed journal articles on medical practice and the politics of his profession. Sloan is active in New York healthcare reform organizations and national legislative forums. Excerpted with permission from Practicing Medicine Without a License! The Corporate Takeover of Healthcare in America (Caveat Press, 2005) Reprinted with permission of White Cloud Press, PO Box 3400, Ashland, OR 97520, www.caveatpress.com, (800) 380-8286. ©2005, Don Sloan, all rights reserved.

Don Sloan, MD

SICKO … The Human Tragedy

By Robert Weissman

The health insurance industry and its allies have worked hard to respond to Michael Moore’s new documentary SiCKO by promulgating a series of deceptions. It’s awfully hard to defend the current US system, so their emphasis is on criticizing other countries’ healthcare systems. They have a lot of practice at this stuff. Get on a call with people like Sarah Berk of Health Care America and Sally Pipes and John Graham of the Pacific Research Institute, and they will compellingly recite three key misleading arguments: People in other countries have to suffer through long waiting periods before seeing a doctor or getting treatment; National health plans ration care; “Government-controlled healthcare” or “government monopoly healthcare” is inherently of inferior quality.

When you don’t feel well, or need treatment, you want to see a doctor right away. So, the image of waiting lists to get treatment has some resonance. But exactly how easy is it to see a doctor in the United States? It turns out that the answer is the same as in other countries: It depends. It depends in large part on what you need to see a doctor for.

Live in the United States and have a bad rash and need to see a dermatologist? Well, try not to scratch too much.

My colleague Sam Bollier called 20 dermatologists in the Washington, DC area, included under Care First/Blue Cross-Blue Shield or Cigna insurance plans. The average wait to get in the door is 36 days. He called OB/GYNs and asked how long the wait would be for a woman who found a lump on her breast. The answer on average: 16 excruciating days. In fact, wait times to see a doctor in the United States are worse than other industrialized countries—all of which have national health insurance—except for Canada, where the system has been starved of funding (but overall performance is still better than the United States on most key measures).

In 2005, the Commonwealth Fund commissioned phone surveys of sicker adults in New Zealand, Germany, Britain, Australia, Canada and the United States. In the United States, 47 percent of those surveyed said that, the last time they were sick, they were able to get a doctor’s appointment the same day or the next day. This was worse than every other country except Canada. In New Zealand, 81 percent reported being able to see a doctor by the next day.

Asked what happened the last time they needed care in the evening or on a weekend or holiday, and whether they could get care without going to the emergency room, a full third in the United States said it was “very difficult” and half said it was at least “somewhat” difficult. This was worse than every other surveyed country. In Germany, only 14 percent said it was very or somewhat difficult.

What about rationing? It’s awfully hard to take this argument seriously, though there’s no question it resonates. All insurance plans, if they have some budgetary constraint, must ration to some extent. The relevant questions are: who’s doing the rationing, on what grounds, and how is the rationing allocated.

In the private insurance system in the United States, rationing is done by the health insurance industry, which rations with an eye both to health needs and the insurers’ profitability. And, of course, the worst rationing is imposed on the 45 million people in the United States without insurance.

Rationing is far worse in the United States than in other countries. In the Commonwealth Fund survey of sicker adults, 40 percent of people in the United States said there has been a time when they did not fill a prescription because of cost—twice the level of the next worst performing country. Far higher numbers in the United States said that, because of cost, they did not visit a doctor when they had a specific medical problem, or that, again because of cost, they skipped a medical test, treatment or follow-up recommended by a doctor.

And then there is the matter of quality of care. There’s no doubt that the United States often offers top-line care to those able to pay—including “boutique” service for the super-rich at leading hospitals. But in the aggregate, US healthcare indicators are terrible, for worse than other industrialized countries—all of which have national health plans.

With SiCKO heating up the debate, Business Week profiled the French health system, which is treated favorably in SiCKO. “To grasp how the French system works, think about Medicare for the elderly in the US, then expand that to encompass the entire population.” But, notes Business Week: “the French system is more generous to its entire population than the US is to its seniors.”

Business Week lined up a comparison between the United States and France: No one is uninsured in France. Out-of-pocket spending in France is barely a quarter of what people in the United States pay. There are almost a third more doctors per capita in France. French life expectancy is two years longer for men, four for women. Infant mortality is 43 percent lower in France. On top of which, French health expenditures amount to 10.7 percent of the national economy. In the United States, it is 16.5 percent.

It turns out that national health insurance is not just more humane, it is far, far more efficient.

Robert Weissman is editor of the Washington, D.C.-based Multinational Monitor, www.multinationalmonitor.org and director of Essential Action www.essentialaction.org. Excerpted from an article posted at: http://lists.essential.org/pipermail/corp-focus/2007/000264.html.

Universal Health Care

Over 46 million Americans do not have any health insurance. Tens of millions more have inadequate or incomplete coverage. As the richest country in the world, this is simply unacceptable. Four out of five of the uninsured are in working families. Forty-six percent of all bankruptcies are tied to medical bills piling up due to an illness in the family. Three-quarters of those bankrupted by illness were insured when they first got sick.

Now, more than ever, it is clear that our current health care system does not work.

It is not because we do not pay enough. Rather, we’re not getting what we’re paying for. American taxpayers alone pay almost twice as much per capita in health care costs as taxpayers in countries that provide universal health care. In short, we are already paying for a universal standard of care, we are just not getting it.

Congressman Dennis Kucinich and Congressman John Conyers have co-authored legislation HR 676, Medicare for All, endorsed by more than 14,000 physicians from Physicians for a National Health Program, to provide full health care coverage for every American. It would expand Medicare’s benefits and grant Medicare’s coverage to everyone in our country. This legislation would cover all medically necessary procedures, with no premiums, no co-payments and no deductibles..

Economists have estimated that a Medicare for All system could be paid for simply by reallocating money that is currently in the system. It would eliminate waste and capture dollars from current inefficiencies. In short, patients would get better care and pay less for it.

The National Academy of Science’s Institute of Medicine estimates that 18,000 Americans die each year because they have no health insurance. Considering the following facts from Tom Daschle’s article for the Center for American Progress, Paying More but Getting Less: Myths and the Global Case for US Health Reform:

Myth: Americans are the healthiest people in the world. Fact: Citizens of 34 nations live longer than Americans.

Myth: The US is the best place to get sick. Fact: The World Health Organization ranked the US 37th in the world for health system performance. Countries like Australia and the United Kingdom rank above the US. Americans have lower odds of surviving colorectal cancer and childhood leukemia than Canadians who do have national health care. Americans also experience greater problems in coordination of care than the previously mentioned countries and New Zealand.

Myth: Covering all Americans will lead to rationing. Fact: Same-day access to primary-care physicians in the US (33%) is far less available than in the United Kingdom (41%), Australia (54%) and New Zealand (60%). Per capita spending for health care averaged $2,696 in countries without waiting lists and $5,267 in the US.

Myth: Global competitiveness is hampered in a comprehensive system. Fact: “Health care costs are not just a burden and barrier to care for individuals; they are taking a heavy toll on American businesses.” The strain on employers in 2005 was staggering. “The average total premiums for an employer-based family plan was $9,979 in 2005 ...” Most of our competitors in the world markets finance their systems outside corporate taxes and employer mandates. Without Medicare for everyone, the US will continue to hemorrhage jobs.

Myth: We cannot afford to cover all Americans. FACT: We already spend enough to have universal health care. “The truth is, we cannot afford to not reform the health system.” We spend about 50% more than the next most expensive nation and nearly twice per person what the Canadians do. On May 1, 2006 Paul Krugman explained in “Death by Insurance” how incredibly wasteful the current system is. The doctor he referenced has two full-time staff members for billing, and two secretaries spend half their time collecting insurance information on the 301 different private plans they deal with. This type of waste is easily 20%. Also consider that 98% of Medicare funds are spent on medical care.

The inaccurate mantra of Republicans when universal health care is introduced is to blame trial lawyers and malpractice cases for our lack of national health care. In fact, 0.46% of our total health spending is spent on awards, legal costs, and underwriting costs—about the same as Canada and the United Kingdom and about the same amount we spend on dog and cat food each year. While “defensive medicine” may drive up the price, it hardly accounts for our stunning health care costs. The belief that citizens should give up their right to fair legal redress for legally proven medical mistakes in exchange for lower health care costs rings as true as the promise that if we must give up our civil rights to be safe from terrorists. Even those with coverage too often pay exorbitant rates. The current profit-driven system, dominated by private insurance firms and their bureaucracies, has failed.

We must establish streamlined national health insurance, “Enhanced Medicare for Everyone.” It would be publicly financed health care, privately delivered, and will put patients and doctors back in control of the system. Coverage will be more complete than private insurance plans; encourage prevention; and include prescription drugs, dental care, mental health care, and alternative and complementary medicine.

Even Ph. D. economist and columnist for the New York Times Paul Krugman now agrees that “covering everyone under Medicare would actually be significantly cheaper than our current system.” We already spend enough to provide national health care to all but lack the political courage to make the tough decisions that doctors, nurses and medical professionals must run our health care system—not “for profit” insurance companies, who make money by denying health care.

It is time to recognize that all the civilized countries have a solution that we must adapt to this country. American businesses can no longer be competitive shouldering the entire cost of health care. Health care is a right that all Americans deserve.

From Congressman Dennis Kucinich’s web site, www.kucinich.house.gov, where you can find more on HR 676, Medicare for All.