A few weeks ago, an article by Noam Levey of the Los Angeles Times caught my eye. It was titled “Global Push to Guarantee Health Coverage Leaves U.S. Behind” and it described how “even as Americans debate whether to scrap President Obama’s health care law and its promise of guaranteed health coverage, many far less affluent nations are moving in the opposite direction — to provide medical insurance to all citizens.”
Among those other countries are China, Thailand, Mexico, Rwanda and Ghana. The article went on to explain that, “Two decades ago, many former communist countries in Eastern Europe and elsewhere dismantled their universal health care systems amid a drive to set up free-market economies. But popular demand for insurance protection has fueled an effort in nearly all of these countries to rebuild their systems. Similar pressure is coming from the citizens of fast-growing nations in Asia and Latin America, where rising living standards have raised expectations for better services.”
Many other countries are moving full speed ahead to guarantee health care for all their citizens, not only because it is morally and ethically right but because it is a powerful economic development tool that will ensure these countries have healthy populations and an efficient and effective health care system.
Meanwhile, the U.S. seems stuck in a state of political paralysis and may soon move full speed astern. What explains this striking and unfortunate example of American exceptionalism?
I attribute it to motivators often used to explain the behavior of Wall Street: fear and greed.
I would also add a third: ignorance. There are those who still believe (or claim to), despite all the evidence to the contrary, that the U.S. has the best health care system in the world. This belief is demonstrably contradicted, both by the facts and everyday experience. We have the most expensive health care system in the world and some of the fanciest technology, but our arrangement for getting health services to our people ranks far down the scale, behind about 40 other countries.
Fear is a major factor in the political stalemate we are now witnessing surrounding health care reform. About 50 million people in the U.S. are uninsured and increasing numbers are badly underinsured. Bankruptcies and other financial hardships due to medical costs are becoming more and more common.
Despite this, we are treated almost daily to distracting arguments, many unfounded and ridiculous, about “death panels,” “government tyranny,” “rationing” and other largely mythical or irrelevant threats to our well-being. Some of the critics responsible for these fear tactics are simply misinformed, but others are dissembling to pursue obstructionist political agendas.
Much of the fear-mongering around the health care reform debate is induced by the second motivator: greed. Health care in the U.S. is almost a $3 trillion industry. It is credibly estimated that about a third of our spending does not contribute to the health of our people in any meaningful way. The proof is that other wealthy nations provide health care to their people for about half of what we spend yet get better results.
Elimination (or more accurately redirection) of some of that money would mean moving funds away from a few people and toward the rest of us, thereby reducing the income of influential industries such as large pharmaceutical and medical supply companies and corporate providers of health care services. Many of these companies are enjoying windfall profits thanks to American public policy. Greed and the political muscle that goes with money are a major source of resistance to changes that would benefit the vast majority of Americans.
Our market-driven health care system is disintegrating. Many are being harmed in the process. How can people of good conscience allow this to continue? We need to change the ways we finance, pay for and deliver health care.
Our for-profit insurance and delivery systems must be transformed (not just reformed) into nonprofit ones, like most other countries. Coverage must be expanded to include everybody. Firm, fair and effective cost controls need to be put in place. In order for widespread support for such a system to be sustained, everyone must be in the same system.
In other words, we must replace our existing system sustained by fear, greed and ignorance with one that is fair, inclusive, efficient, effective and mission-driven. Such transformation has occurred elsewhere. Given the political will, we in the U.S., including Maine, could do it too. We’d all be much better off.
Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com.
…….moving full speed ahead to guarantee health care for all their citizens, not only because it is morally and ethically right but because it is a powerful economic development tool that will ensure these countries have healthy populations…….
I’m good with the “morally and ethically right” reasoning.
I do not understand why the obfuscaters won’t accept the “powerful economic development tool” reasoning. Actually, I do understand–in a word–graft.
Ever spend time talking to a person that comes from a country with universal health care, and get their opinion about it? I happen to have spoken to numerous people from England, France, Spain, Germany, Belgium, Netherlands, Greece, and Canada, all over the last 24 years of my aviation career that allows me to travel and meet a lot of people (working class). They all have one thing to say, they don’t like it, and it’s very expensive which has caused these countries to insure high VAT taxes and fuel taxes which is a burden on their overall economies. It’s mercifully slow, you get few if any choices, most decisions aren’t made by the patient, and the system is woefully inadequate. Also there is little research and development . ( Thats all done here). The only positive things they say is it’s useful for emergency care.
Our system sure needs fixing, but going in the direction every other modern country has gone is not the answer unless you are looking for substandard care and even more economic woes. You are wrong about it being an economic development tool. Ever hear the saying “you can’t buff a turd”? Well, universal health care is your basic turd.
Yes, I have spent time talking with people from Canada and they do like their health care system. They pay more in taxes but they also do not have incredibly high premiums taken out of their check every pay day. As for the burden on their economy, Canada has not been affected by the economic slow down as much as we have been. People keep calling universal health care socialism. If you believe this to be true, then how many of you are willing to give up your medicare and social security when you retire? After all, these are programs that everyone pays into with their taxes – just like a universal health care system.
This is just boilerplate unless the “elsewhere” is named, and isn’t one of those places that’s currently melting down under the burden of its social services costs.
The US economy is “melting down” due to the cost of many years of fighting wars while DECREASING revenues by giving tax breaks to billionaires. This was started on purpose by Bush and his colleagues specifically in order to build a phony case for dismantling social services in the US. Their propaganda has been masterful. Day after day I see comments by people who are likely paying huge premiums (much of which goes to CEOs’ inflated salaries) and are at risk of medical bankruptcy–who are arguing vehemently against universal health care reform.
Are you aware that many of the for-profit health insurance corporations’ CEOs have salaries so huge that their DAILY income is more than most Americans make in a full year?
So, Greece, Spain, etc. are in financial crisis because of their adventures in Afghanistan? And some CEOs have an income of more than fourteen million dollars per year? (Do the math.)
I’m perfectly comfortable – from things I’ve seen myself – with the idea that American medicine is in the hands of greedy exploiters and that ‘something needs to be done’, but your ‘arguments’ are laughable. And a national medical system, whatever its details, will be prone to being captured by exactly those exploiters, or subject to the sort of governmental spending shifts that result in the politicians assuring us that the roads aren’t really mostly potholes.
Don’t assume that because a situation is bad, it can’t be made worse.
2007 figures for the for-profit health insurance corporation CEO salaries:
Aetna Ronald A. Williams: $23,045,834
Cigna H. Edward Hanway: $25,839,777
Coventry Dale B. Wolf : $14,869,823
Health Net Jay M. Gellert: $3,686,230
Humana Michael McCallister: $10,312,557
U.Health Grp Stephen J. Hemsley: $13,164,529
WellPoint Angela Braly (2007): $9,094,271
L. Glasscock (2006): $23,886,169
I don’t know about you, but I kind of feel sorry for HealthNet’s CEO, making a piddling 3.6 million per year. On the bright side, Cigna’s CEO earned a “healthy” sixty-eight thousand ($68,000) dollars per DAY.
http://www.healthreformwatch.com/2009/05/20/health-insurance-ceos-total-compensation-in-2008/
I stand corrected as to executive over-compensation in the insurance business: not that the over-compensation was ever in doubt, but the amounts are startling.
I don’t have figures offhand, but a large proportion of our health insurance premiums are spent–not for our care–but for anti-reform propaganda, including lobbyists and the funding of political campaigns and supposedly grass-roots anti-reform groups. The insurance execs have plenty of motivation to fight against health insurance reform, since it would affect their salaries.
Here’s a hint of their spending to just one group–“Insurance companies gave the U.S. Chamber of Commerce more than $100 million to fight Democrats’ healthcare reform effort, according to a report in National Journal. America’s Health Insurance Plans (AHIP), the insurance industry’s leading trade group, did not directly launch an offensive against healthcare reform during the year-long legislative debate over healthcare. But AHIP quietly diverted millions of dollars to the Chamber, which aggressively attacked the healthcare bill and Democrats who supported it. The transfers do not have to be disclosed as lobbying or political contributions and are discernible only from a close review of tax records.” [http://thehill.com/blogs/healthwatch/politics-elections/232573-report-insurers-gave-us-chamber-100-million-to-fight-healthcare-reform]
Tell me Dr Caper where does one go to get an MRI in Rwanda? Zimbabwe, maybe? Does the government pay the cost for everyone that needs one? Is that level of care available there?
Will people from rural areas have to return to their native villages in order to get health care if they illegally move to the cities in order to get work like they do in China?
My point is, Dear Doctor, that you have not set up an Apples to Apples comparison.
Comparing the US to Rwanda is hardly an apples-to-apples comparison. Try comparing America to Canada, Europe, and Scandanavia.
“No doubt you’ve heard that the United States is the only developed nation without a universal health care system that provides care for all. The result is that 47 million people in the United States lack health coverage. It’s one reason the U.S. ranks 29th in the world in terms of life expectancy and at or near the bottom of most international health care comparisons. What you might not know is that many of the universal health care systems in Europe provide high-quality health care to all residents, at a much lower cost than what people in the United States spend on health care. Waiting times for care aren’t all that different from the United States, and Europeans use the same high-tech medicine, only more sparingly.” [http://www.npr.org/templates/story/story.php?storyId=92136549]
“In 2000, health care experts for the World Health Organization tried to do a statistical ranking of the world’s health care systems. They studied 191 countries and ranked them on things like the number of years people lived in good health and whether everyone had access to good health care. France came in first. The United States ranked 37th. Some researchers, however, said that study was flawed, arguing that there might be things other than a country’s health care system that determined factors like longevity. So this year, two researchers at the London School of Hygiene and Tropical Medicine measured something called the “amenable mortality.” Basically, it’s a measure of deaths that could have been prevented with good health care. The researchers looked at health care in 19 industrialized nations. Again, France came in first. The United States was last.” [http://www.npr.org/templates/story/story.php?storyId=92419273]
Rwanda wasn’t my comparison. It was Dr Caper’s.
My point was there are unique problems common to the US (or to other countries) that make his comparisons invalid.
I can see two major differences between us and Europe for example that make us using the European model for comparison difficult.
First WW2. …. Yes, 70 years after the end of that war it still has an effect. Europe was absolutely crushed. There were barely two bricks stuck together. This means the entire continent, including its social structure had to be rebuilt from the ground up. It’s economy, its medical services, everything. That means because there is nothing to start with you can build from the beginning without any residual infrastructure to concern yourself with. It makes it much easier. Had the US been equally devastated and we had a large benevolent benefactor to provide for our defense from nearby enemies like Europe did, we might have been able to do the same thing.
Secondly, Europe does not have a large population of non-contributing unhealthy citizens that we do. ( obese). Neither does Canada for that matter.
Healthy Scandinavians and our large population of couch dwellers is not a good comparison either.
Complaining that Americans–millions of whom have no health insurance–are “unhealthy” is pretty roundabout logic.
The extreme generalizations of “non-contributing” and “unhealthy” and couch-dweller” Americans are simply blanket statements seem designed to cast aspersions on people to make it seem like they’re not worthy of healthcare.
Look, these are people for the most part on Mainecare/medicaid. Presumably they are already getting healthcare. They cost per obese person on medicaid is an additional $1,000 per person annually in healthcare costs.
So, not even do you get everyone’s point, and I suspect you haven’t really understood what the issue is here; here’s a hint, the issue isn’t necessarily always about money it’s about healthy people.
So what I gather you have said that those individuals who pay for their own healthcare, are not typically obese because they do exactly…..what? differently? But someone who receives Mainecare (also a health insurance, which is what those paying a premium have) are obese because, of what?..
The issue is trying to cover everybody with health insurance. Rich, the working poor, lower and middle middle class…..everybody. Of these 4, how many get health insurance
and how do you determine which ones are obese and which ones arent? You compare Rwanda’s ability with an MRI……..you don’t have to use Rwanda, of these above 4, which one could afford an MRI in THIS country?
My point is that because we have a large obese population it costs more and creates some unique problem that other countries don’t have to deal with. Comparing us to Scandinavian countries and their healthcare systems for that reason is a non-starter.
Furthermore, if we don’t consider all the monetary factors it just plain isn’t going to happen.
If we don’t consider the costs of not paying attention to health care, then the monetary factors aren’t going to happen either. NO one gets paid, if more than half of the countries population cannot afford health care. What it does do, is increase the costs to those who can afford it.
My entire point was that when Dr Caper compares our medical system to foreign efforts it is a false one.
These are the folks I suspect you are referring to with the word “non-contributing.” I keep seeing this kind of connection being made in Comments sections. It seems like an oversimplification.
Many people on MaineCare have complex personal, medical, and psychiatric histories. A history of severe trauma (sexual abuse, physical and emotional abuse) can result in anxiety and depression that people self-medicate with food.
Many people on MaineCare with medical or psychiatric illnesses take medications–many of which can lead to obesity. As I’ve mentioned here now and then, one of my adult daughters is disabled from a genetic condition. One of her medications caused a 70-pound weight gain in about a year. We’ve tried other medications (they don’t address her symptoms as well), tried diet plans, gotten her husband’s support in getting more exercise, gone to weight-loss classes with her, paid for gym memberships, tried everything you can think of, yet that medication causes her to fixate on food night and day.
Many people on MaineCare (I would not guess at the percentage) very likely have IQ scores that are well below average. Indeed, many adults who have mental retardation have MaineCare for their health insurance. These folks lack the executive functions and general cognitive skills that it takes to balance food yearnings with restraint and exercise.
I suppose some might regard disabled people, or people who are unemployed and impoverished as “con-contributing,” and thus perhaps not worthy of concern or assistance. But my daughter0–for one example–contributes to the world simply by being a human being who is living in it day by day. There is more to “contributing” than the amount of money a person earns or the level of vocational skills they have… or whether or not they are obese.
I don’t recall Canada having been devastated by WWII and having to rebuild from the ground up. Yet somehow they developed an excellent universal health insurance system…
Like I said all countries have their unique differences. Canada is not a model for the US for obvious reasons that they do not have the same demographic model we do. Obese poor people.
My only point is using another country as a model for our healthcare system ignores the facts that we have unique problems that they do not.
All HC prices are posted for patients in France – ummm!
Physician Philip Caper:
Will forced sterilization be part of China’s universal health care program?
This article was written by Canadians–
“If power, wealth and talent alone determined how a nation serves the needs of its people, the United States would be second to none in health care. Yet America’s health care system clearly ranks behind those of Canada and most other developed countries..
“Canada’s “socialist” health system is the favourite whipping boy of antireform lobbyists, who employ fear-mongering and myths about rationing, waiting lists and lack of choice to persuade the American public to accept their stat us quo as better…
“The life expectancy of an average American is nearly three years shorter than that of an average Canadian (78.1 v. 80.7 years). That survival gap starts from the moment of birth: infant mortality is higher in the US than in Canada (6.7 v. 5.0 deaths per thousand live births). Yet the US economy spends — or increasingly, borrows — more than half again as much for health care as does Canada’s (16% v. 10.1% of the economy)…
“As Republican strategist Dr. Frank Luntz puts it, the opposition’s strategy rests on “health care denial horror stories from Canada.” Yet the attacks are so absurd and full of fantasy that they would be laughable — if not for the fact that many Americans believe them…
“We cannot condemn strongly enough the intellectual dishonesty of the lobbyists and politicians whose distortions of Canada’s health system camouflage their appalling rejection of reform for uninsured and underinsured Americans.”
http://www.cmaj.ca/content/181/8/E128.full?etoc
Well said, very well said. My many relatives in Canada are VERY pleased to have the Canadian healthcare system and rail against the BS spouted by the GOP here in the States about how their system does not work. There would be a revolution in Canada if the government tried to impose an American style healthcare system.
Congratulations on having many healthy relatives in Canada. During a length of time as a patient of Cancer Care of Maine I encountered a number of our Canadian neighbors who were sent here for radiation therapy. I asked one gentleman why he came here and his response was that he did not want to wait more than 90 days to begin his treatments. During one visit I asked out loud how many folks were here from Canada and got four folks raising their hands out of about 10 people present. Probably a day when Fox news and the GOP were channeling patients to Cancer Care of Maine.
Actually I have 3 elder relatives in Canada each recently diagnosed with a different kind of cancer, prostate, bowel, and breast cancer. Absolutely NONE of them have had to wait 90 days for treatment. It was more like 1 week. Now one of them did have to travel from New Brunswick to Nova Scotia. That’s about like going from here to Boston. I’m not saying you were lied to by those you queried however it just doesn’t jive with the reality my family has experienced in Canada. Not even close.
Three out of thousands of people is not a very significant number. Why would they lie about where they were from? It may have gotten to a point that paying for treatment, meals, mileage and rooms in the Riverside Inn got too expensive. That experience left me wondering if there insurance program was all that good. At one time there was a big push for something like that just here in Maine. I figured I could probably go to NH or MA to get treatments.
Well regardless of our divergent opinions here, I wish you the very best while you fight your own battle with cancer. It is a horrible and frightening disease. Best of luck Sir.
spammer bot
Universal health coverage will improve overall average outcome measures, but will not provide benefits that are as good as high-end private insurance. That’s the nature of socialized anything: regression to the mean.
The question is whether there will be enough people willing to supplement national health insurance to support high end services for those willing/able to pay. I hope so…
Congratulations to you on being able to afford “high-end” private insurance.
Yes, I’m thankful I can. I also chose my job because of the coverage and pay through the nose for it, but I value good health care more than other luxuries.
My comments simply reflect reality. I’m actually in favor of a single payer system because I can’t conceive of a better way to cover all. However, this just means I’ll pay more in taxes for that system and then have to pay for supplemental insurance. I only hope enough people are willing to supplement so there is the same access to excellent care. No matter how you slice it, we’ll always have a two tier system.
In 1979 while taking some college cources I wrote a paper on health care financing. Basically, put everyone in a high deductable plan with a Health Savings Account (I called it a Health Bank). Fund the HSA’s on a prorated basis. Have hospitals and physicians post their prices. Do away with Medicaid and Medicare. Let patients choose what they value and forgive what they find impossible to pay. Health care inflation was a problem then, as it is now. This is similar to the Swiss Health Care system now where thay spend about 60% of what we do and they are all covered. All decisions are made between the patient and their doctor – no interference from federal, state goverments, or insurance companies.
At the time I had 13 years working in emergency rooms and hospitals and had several problems involving health insurance. Health care inflation has been around 7% since then and is predicted to continue forever at around 6.8% regardless of reform. At this rate it will take 25%, then 30%, then 40% of your pay. Is this what you want?
There are NO CONTROLS on how much of YOUR money I can spend on MY health care. NONE! I can literally call an ambulance every day to take me to an emergency room for some perceived illness.
People spending their own money will provide the necessary controls as they seek cost effective, needed care.
Single payer government health care will take the profit motive out of health care and stifle innovation and progress toward new cures and better care.