Sunday, September 20, 2009

The phone rang. It was my daughter, calling me from Arizona to let me know that she and her husband have arrived safely. They flew up from Australia. Her youngest son lives in Tucson Arizona. That was their first stop. After traveling over 24 hours on a plane, they will spend the next day visiting the Grand Canyon and then, Tombstone Arizona. If I flew 24 hours on a plane, I would want my first day to be a day of rest with my feet up, drink in hand.

I could tell that she was excited to see her youngest son and his wife...and probably glad to get off that plane. She will call me every night to tell me of the day's adventures and I probably will write about them here.

The allotment is only four days to tour around Arizona, then in a car for a long drive to the northeast to see more family.


Sunday, September 06, 2009

E mail from J. H.: I'm not certain that this recessionary period is the best time to introduce an expensive revamping of the health system in this country, but there is little doubt that a simgle-payer government-run system is the way to go. The article below (from today's LA Times) is a good and I think fair comparison of the Canadian system with our own. I only wish that more citizens of our country were able to open their eyes and see what's really going on in the health care world and be less tied down by their ideologies.


The caricature of 'socialized medicine' is used by corporate interests to confuse Americans and maintain their bottom lines instead of patients' health.

by Michael M. Rachlis August 3, 2009

Universal health insurance is on the American policy agenda for the fifth time since World War 11. In the 1960s, the U.S. chose public coverage for only the elderly and the very poor, while Canada opted for a universal program for hospitals and physician's' services. As a policy analyst, I know there are lessons to be learned from studying the effect of different approaches in similar jurisdictions. But, as a Canadian with lots of American friends and relatives, I am saddened that Americans seem incapable of learning them.

Our countries are joined at the hip. We peacefully share a continent, a British heritage of representative government and now ownership of GM. And, until 50 years ago, we had similar health systems, healthcare costs and vital statistics.

The U.S. and Canada's different health insurance decisions make up the world's largest health policy experiment. And the results?

On coverage, all Canadians have insurance for hospital and physician services. There are no deductibles or co-pays. Most provinces also provide coverage for programs for home care, long-term care, pharmaceuticals and durable medical equipment, although there are co-pays.

On the U.S. side, 46 million people have no insurance, millions are under insured and healthcare bills bankrupt more than 1 million Americans every year.

Lesson No. 1: A single-payer system would eliminate most U.S. coverage problems.

On costs, Canada spends 10% of its economy on healthcare: the U.S. spends 16%. The extra 6% of GDP amounts to more than $800 billion per year. The spending gap between the two nations is almost entirely because of higher overhead. Canadians don't need thousands of actuaries to set premiums or thousands of lawyers to deny care. Even the U.S. Medicare program has 80% to 90% lower administrative costs than private Medicare Advantage policies. And providers and suppliers can't charge as much when they have to deal with a single payer.

Lessons No. 2 and 3: Single-payer systems reduce duplicative administrative costs and can negotiate lower prices.

Because most of the difference in spending is for non-patient care, Canadians actually get more of most services. We see the doctor more often and take more drugs. We even have more lung transplant surgery. We do get less heart surgery, but not so much less that we are any more likely to die of heart attacks. And we now live nearly three years longer, and our infant mortality is 20% lower.

Lesson No.4: A single-payer plans can deliver the goods because their funding goes to services, not overhead.

The Canadian system does have its problems, and these also provide important lessons. Notwithstanding a few well-publicized and misleading cases, Canadians needing urgent care get immediate treatment. But we do wait too long for much elective care, including appointments with family doctors and specialists and selected surgical procedures. We also do a poor job managing chronic disease.

However, according to the New York-based Commonwealth Fund, both the American and the Canadian systems fare badly in these areas. In fact,an April U.S. Government Accountability Office report noted that U.S. emergency room wait times have increased, and patients who should be seen immediately are now waiting an average of 28 minutes. The GAO has also raised concerns about two to four-month waiting times for mammograms.

On closer examination, most of these problems have little to do with public insurance or even overall resources. Despite the delays, the GAO said there is enough mammogram capacity.

These problems are largely caused by our shared politico-cultural barriers to quality of care. In 19th century North America, doctors waged a campaign against quacks and snake-oil salesmen and attained a legislative monopoly on medical practice. In return, they promised to set and enforce standards of practice. By and large, it didn't happen. And perverse incentives like fee-for-service make things even worse.

Using techniques like those championed by the Boston-based institute for Healthcare Improvement, providers can eliminate most delays. In Hamilton, Ontario, 17 psychiatrists have linked up with 100 family doctors and 80 social workers to offer some of the world's best access to mental health services. And in Toronto, simple process improvements mean you can now get your hip assessed in one week and get a new one, if you need it, within a month.

Lesson No. 5: Canadian healthcare delivery problems have nothing to do with our single-payer system and can be fixed by re-engineering for quality.

U.S. health policy would be miles ahead if policymakers could learn these lessons. But they seem less interested in Canada's, or any other nation's experience than ever. Why?

American democracy runs on money. Pharmaceutical and insurance companies have the fuel. Analysts see hundreds of billions of premiums wasted on overhead that could fund care for the uninsured. But industry executives and shareholders see bonuses and dividends.

Compounding the confusion is traditional American ignorance of what happens north of the border, which makes it easy to mislead people. Boilerplate anti-government rhetoric does the same. The U.S. media, legislators and even presidents have claimed that our "socialized" system doesn't let us choose our own doctors. In fact, Canadians have free choice of physicians. It's Americans these days who are restricted to "in-plan" doctors.

Unfortunately, many Americans won't get to hear the straight goods because vested interests are promoting a caricature of the Canadian experience.

(Michael M. Rachlis is a physician, Health policy analyst and author in Toronto.)


Wednesday, September 02, 2009

email from Melanie: As you know, I don't really like to get into political debates. I figure - vote with your conscience and it's no one else's business, but, as you know, health care availability and affordability for all is an especially important issue to me, especially since I have seen my sons suffer without it.

Someone posted this essay in Facebook, and it says a lot of what I think when people start shouting "socialism" in the USA. They use the word "socialism" or "socialist" like it's a dirty word. I really think that those people don't understand what it really means. But this guy does (for the most part.):

Here is a post passed on from Carl Wlodarczyk (Denver, CO), who wrote:

This morning I was awoken by my alarm clock powered by electricity generated by the public power monopoly regulated by the US Department of Energy. I then took a shower in the clean water provided by the municipal water utility. After that, I turned on the TV to one of the FCC regulated channels to see what the national weather service of the National Oceanographic and Atmospheric Administration determined the weather was going to be like using satellites designed, built, and launched by the National Aeronautics and Space Administration. I watched this while eating my breakfast of US Department of Agriculture inspected food and taking the drugs which have been determined as safe by the Food and Drug Administration.

At the appropriate time as regulated by the US congress and kept accurate by the National Institute of Standards and Technology and the US Naval Observatory, I get into my national Highway Traffic Safety Administration approved automobile and set out to work on the roads build by the local, state, and federal departments of transportation, possibly stopping to purchase additional fuel of a quality level determined by the Environmental Protection Agency, using legal tender issued by the Federal Reserve Bank. On the way out the door I deposit any mail I have to be sent out via the US Postal Service and drop the kids off at the public school.

After spending another day not being maimed or killed at work thanks to the workplace regulations imposed by the Department of Labor and the Occupational Safety and Health Administration, enjoying another two meals which again do not kill me because of the USDA, I drive my NHTSA car back home on the DOT roads, to my house which has not burned down in my absence because of the state and local building codes and fire marshal's inspection, and which has not been plundered of all its valuable thanks to the local police department.

I then log on to the internet which was developed by the Defense Advanced Research Projects Administration and post on and Fox news forums about how SOCIALISM in medicine is BAD because the government can't do anything right.


With the exception of the Federal Reserve Bank, which is a private banking consortium, I have to agree. It's too bad people are so controlled by scaremongering.


Tuesday, September 01, 2009

The following is a reprint from the Opinions page of the Connecticut Post from September 1, 2009. The author is Hans Wilhelm
I am trying to understand why we Americans think we live so much better than the rest of the world. In many ways I can compare myself with my brother who lives in Bremen, Germany, in a house that is very comparable to ours with regard to size, value and location. He pays only a bit more than $1,000 a year on taxes. This allows him not only to live in his house till the end of his life but also pass it on to his children. As a matter of fact, his estate has been in our family for more than 150 years and will continue staying in the hands of his children.
Our taxes for our American house are close to $20,000 a year and I doubt whether we will be able to afford the ever increasing taxes in 15 or 20 years, and may be forced to sell the house instead of passing it on to our children. For for millions of other is simply not possible to live out our lives in the house we are calling home.
The children of my brother can visit the best universities for virtually free. When they are finished they will not be burdened down by enormous student loans, and neither does my brother have to mortgage his home to pay for their education. Compare that with costs for college education for the average American family. Too many American kids cannot afford to work in a profession they really want because it may offer lower pay. Instead, they have to take any well-paying job....just to pay off their loan. So much for "following your dream."
My brother does not have to worry about any excessive health care costs, for himself or his children. His son actually had a complicated heart surgery...with no extra costs to my brother. A third of all personal bankruptcies in the U.S. are a result of unpaid health care costs. We throw our children to the wolves and give them no safety net whatsoever when it comes to illness. What king of parents are we?
Germany is a highly industrial nation with a higher productivity per worker than America. And yet the average fully paid holiday for Germans and other Europeans is four to six weeks! Compare that to an average of 8.2 days of paid vacation in America. Maybe we would enjoy our work more if we had also more time to refresh our mind, body and spirit.
Like most Europeans, my brother can expect a pension that will not make him rich...but will keep him in his own House and far away from the poorhouse. Compare that with the latest statistics that say 80 percent of all baby boomers in America are underfunded for their retirement and will run out of money before they die.
Our favorite argument is that we pay less tax than the Europeans. Well, I wonder, just add our outrageous property taxes, our steep private health insurance premiums and actual health care costs that we have to pay out of pocket, and add our costs for colleges and you will see that we probably pay very much the same.
It is also interesting to note that the European Union is made up of many very different countries, nationalities, languages, histories and traditions...and yet, there is one common thing that all 500 million Europeans have firmly agreed on: They all have voted for governments that have socialism as their base and provide each citizen with health care, pension and free education. As a matter of fact, even our close neighbor Canada has voted for similar values.
I am not saying that everything is perfect and better in Europe. It is not. They also have their problems with their big programs just like we have. But why are we so afraid of a little bit of "socialism" when we could have so much more in our lives and the lives of our children? In all statistics about living standards and quality of life, America trails well behind the European countries.
Why are we satisfied with so little? Why can't we live like the rest of the civilized world? (end of article.)
My opinion about socialism was changed when I saw Michael Moore's movie, "Sicko". In the movie I am reminded that we use our parks, libraries, police and fire departments without paying directly. Our mail is delivered without paying the mail carrier. That is socialism. I don't think that is a bad thing.