Swampland - TIME

Swampland - TIME:

"Our Gross National Product, now, is over $800 billion a year, but the GNP--if we should judge America by that--counts air pollution and cigarette advertising, and ambulances to clear our highways of carnage. It counts special locks for our doors and jails for those who break them. It counts the destruction of our redwoods and the loss of our natural wonder in chaotic sprawl. It counts napalm and the cost of a nuclear warhead...and the television programs which glorify violence in order to sell toys to our children.
Yet the gross national product does not allow for the health of our children, the quality of their education, or the joy of their play. It does not include the beauty of our poetry or the strength of our marriages; the intelligence of our public debate or the integrity of our public officials. It measures neither our wit nor our courage...it measures everything, in short, except that which makes life worthwhile. And it can tell us everything about America except why we are proud to be Americans.--Robert F. Kennedy
March 18, 1968"

Thanks to Joe Klein!

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Crooks and Liars » Nataline Sarkisyan passes away. Shame on Cigna!

Crooks and Liars » Nataline Sarkisyan passes away. Shame on Cigna!: "We [Crooks & Liars] posted this story yesterday with an update to the heartbreaking result. While battling CIGNA for a new liver, her family and friends fought and protested until CIGNA finally gave in, but it was too late—the seventeen-year-old Nataline Sarkisyan died."

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Democrats get infusion of campaign money from health care | Dallas Morning News | News for Dallas, Texas | National Politics

Democrats get infusion of campaign money from health care Dallas Morning News News for Dallas, Texas National Politics:

"Depending on who is elected, the role of government and employers could swing dramatically, from Democrat John Edwards' call to require all employers with five or more workers to provide coverage or contribute 6 percent of payroll toward a public program on one end of the spectrum, to Republican Fred Thompson's call to 'divorce [the] complete dependence people have on employment for their insurance.'

In Texas, health care executives have donated almost twice as much to presidential candidates in this campaign as they did in the last election. Doctors and hospitals have a vested interest in increasing the number of people who have insurance, since that ups their chances of getting paid. Meanwhile, insurers want to ensure that people and companies keep purchasing plans from private insurance companies, as opposed to switching to a government-run system.

So, perhaps it should not be surprising that, through September, Texans in areas ranging from surgery to medical supplies donated $934,000, up 75 percent from the $531,000 poured in during the same period of the 2004 campaign.

This time around, about as much of that money went to Democrats as Republicans. Democratic candidates raked in a total of $459,650, versus $474,234 for Republican presidential candidates.
On the national level, the Democrats actually beat the Republicans. Through September, Democratic candidates collected $6.5 million from the health care industry, compared with $4.8 million for Republican candidates, according to the Center for Responsive Politics, a Washington, D.C.-based campaign finance research group.

Mrs. Clinton, the Democratic front-runner, has been the biggest beneficiary from Texas health industry donations, with $237,000 through September; Republican front-runner Rudy Giuliani came in second, with $223,000.

Next in line for Democratic contributions was Illinois Sen. Barack Obama, with $110,000 from Texas health care donors. Mr. Obama also collected the state's single-largest such donation, with $24,000 from the Dallas-based medical technology company T-System Inc., according to a study prepared for The Dallas Morning News by the Center for Responsive Politics. "

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Doctors endorse single-payer | Philadelphia Inquirer | 12/04/2007

Doctors endorse single-payer Philadelphia Inquirer 12/04/2007:
"Because much of the growth in expense in the current system is in procedures performed by specialists or in increased use of technology like MRIs, doctors who work in those areas have the most to fear from a single-payer system, Getzen said. Internists, who serve as primary-care doctors for many people, have less to fear.

The ACP also called for better payments for primary-care doctors to help avert a shortage and for the creation of a uniform billing system and greater use of electronic health records to reduce administrative costs.

Dale said that some U.S. doctors and hospitals were better than their counterparts in other nations, but that this country's health system compares poorly. 'Part of our call is, 'Look around, guys, and see how other people are doing,' ' he said, 'and they're doing better than us.' "

Nicely done summary of where most of the tension in advocating for single payer lays.

The ACP position paper is here, and I believe free to anyone.

Cheers,

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Draft Proposal for a Single Payer, Comparative Healthcare Wiki

Comparative Healthcare: Economic, Policy, Provider and Public Perspectives

Nation: General description/overview of system
Economics
Macroeconomic view
Per capita, GDP spending
Financing system
Cost to taxpayers
Cost to employers/employees
Efficiency
Microeconomic view
Business evaluation of efficiency
Citizen evaluation of efficiency
Provider evaluation of efficiency
Hospitals
Other facilities (SNF, surgery centers, testing/imaging)
Providers
Physicians
Nurses
Others: extenders/PT/OT/RT/ Pharmacists

Policy Considerations
Socialized/Single Payer/Hybrid
Private insurers/providers
Federal Perspectives
Perceived shortcomings
Percieved efficiencies
Things to include
Things to avoid
Political pitfalls
Funding
Administration

State/Province/Other Perspectives
Local Administration
Local Governanace

Provider Perspectives
Hospitals
Adminstrators
Nurses and allied healthcare
Physicans
Physicians
Perspectives of Physicians
Timeliness
Effectiveness
Practice Variation
Quality data
Fairness
Access
Research
“High Tech” health care
End-of-Life Care
Reimbursemnet
Bureacracy
Autonomy of decision making
Access to data (quality)
Access to data (EHR)
Mental Health/substance abuse care

Nurses
Physician Extenders
Utilization
Role
Income
Other Allied healthworkers
Pharmacists
Dentists
Optometrists
Psychologists

Public Perspectives
Timeliness
Effectiveness
Access
Out-of-Pocket Costs
Rationing
Spending/Cost to nation
Value

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Although U.S. Spends Twice as Much...- Kaisernetwork.org

Coverage & Access Although U.S. Spends Twice as Much as Other Industrialized Nations on Health Care, More in This Country Have Access Problems, Survey Finds - Kaisernetwork.org:

"The article notes that the U.S. spent $6,697 per capita, or about 16% gross domestic product, on health care in 2005. Other nations in 2005 spent less than half that amount per person on health care. The survey found that respondents in Canada and the U.S. often visit emergency departments for routine care and that those in the U.S. 'were most likely to have gone without care because of cost and to have high out-of-pocket costs.'

In addition, the survey found that 37% of all respondents in the U.S. and 42% of those with chronic diseases 'had skipped medications, not seen a doctor when sick, or forgone recommended care in the past year because of costs -- rates well above all other countries.' In contrast, respondents in Britain, Canada and the Netherlands 'rarely report having to forgo needed medical care because of costs,' according to the survey. Respondents in New Zealand and Britain had the least confidence in the quality of care that they received, and those in Germany and the U.S. had the most access to elective surgeries, the survey found.

Commonwealth Fund President Karen Davis said, 'The survey shows that in the U.S., we pay the price for having a fragmented health care system,' adding, 'The thing that struck me in this survey is the trouble that Americans have in getting to see their own doctors'"

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Exhausted

From a note on my patient's chart today:

Dr. _______
Mrs. ________ has exhausted her SNF [Skilled Nursing Facility] coverage. She has used her full 100 days and does not qualify for Medical Assistance [Medicaid]. She would have to privately pay for an SNF and she cannot afford this.

Doctor's Reply: What can I do about this?

Response: The patient and family are aware and husband says he will hire help but cannot afford private pay at SNF.

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Joint Canada/United States Survey of Health: Findings and public-use microdata file: Analytical report

Joint Canada/United States Survey of Health: Findings and public-use microdata file: Analytical report:

"Overall, most Canadians (88%) and Americans (85%) reported being in good, very good or excellent health. However, the range of health status was more polarized in the United States. More Americans reported being at either end of the health status spectrum – in excellent health (26%) and in fair and poor health (15%) – compared with Canadians (24% and 12% respectively)."

I saw a post arguing that this data proved the US system is better, and I just wanted to post the summary report for reference. Follow the link for the rest of it. It's worth remembering how much more we spend here than there as you review the numbers, and it's worth restating that we want to build an American system that is the best in the world in its totality, not just in niches of high tech and procedural related care.

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James C. Capretta on Medicare on National Review Online

James C. Capretta on Medicare on National Review Online:

It is a useful exercise for me to go through these now and again to make sure my arguments are on the up-and-up.

Clinton has now embraced and updated the idea — enrollment would be voluntary, not mandatory as it was in the 1990’s version — but the effect would be the same: more bureaucratic control of health-care arrangements, with lower quality, less innovation, more inefficiency, and still rapidly rising costs. Indeed, the irony of Medicare is that the program’s complex and burdensome payment regulations, aimed at controlling costs, actually drive up costs for the program — and everyone else who pays for health care too.

It is truly amazing that people outside of healthcare have this idea that Medicare is the insurance plan that has the stultifying bureaucracy and that the government (you know, with the NIH, NCI, IOM, CDC, and millions of grant dollars every year) are responsible for reducing quality and innovation.

Government-run Medicare is 1960’s-style fee-for-service insurance. No attempt is made to manage the use of services with a network of affiliated providers or other mechanisms. The only way to controls costs in this kind of insurance is to require enrollees to pay for some of the costs when they get health care, thus discouraging unnecessary use, or to cut the payment rates per service. Predictably, politicians have preferred to cut payments rates rather than impose cost-sharing on beneficiaries. Today, most Medicare fee-for-service enrollees pay little or nothing at the point of service.

The result? An explosion in demand. The Medicare Payment Advisory Commission (MedPAC) reports that the average Medicare beneficiary used 30 percent more physician services in 2005 than they did just five years earlier. Spending for physician-administered tests went up 46 percent during this period, while use of CT scans and MRIs went up 61 percent.

I don't think this is an either-or proposition, but I'll play: Either you want rationing or not. If you want rationing, call it rationing, don't call it "managing services" or "discouraging unnecessary use". If your preferred method of rationing is bureaucracy and co-pays and economic rationing based on which plan you can afford, well, we already have that. It's called private insurance.

To combat the costs of rising service use, Medicare administrators have tried just about every trick in the price control playbook. Indeed, the care and feeding of the payment systems for hospitals, physicians, physical therapists, nursing homes, labs, home health agencies and many others is now an all-consuming, all-year enterprise for the Medicare bureaucracy. Not surprisingly, doctors, hospitals, and other service providers have engaged their own small army of advocates to watch the bureaucracy’s every move and respond as necessary to protect their financial interests.

More often than not, it’s the health-care service providers who come out ahead in this struggle. Politicians and program officials do not want to be accused of disrupting how or where seniors get care. So, naturally, service providers use exactly that threat — closed facilities and reduced access — to extract payment rate concessions. And so, despite the issuance of mountains of payment rules by the bureaucracy, Medicare’s costs continue to rise as rapidly as ever, with no end in sight.

OK, so Mr. Capretta, I presume, want to wants to ration by his method, economically, in which you get only what you can afford, rather than based upon need. I prefer a societal discussion on how we allocate resources and services.

Medicare’s price controls not only don’t work to control costs, they also undermine the incentive for true, cost-reducing innovation. New types of organizations (like integrated hospital-physician efforts), pricing approaches (like a single bundled payment for a full episode of care), and ways of taking care of a patient (like over the internet and phone) are simply not accommodated by the program’s inflexible payment rules. Doctors and hospitals are thus understandably reluctant to invest in new, consumer-friendly and cost-effective approaches to providing care which will only pay off in the unlikely event Medicare officials will accommodate the change within a reasonable time frame. The result is that today’s costly system for delivering services is virtually frozen in place — for all users of U.S. health care, not just Medicare beneficiaries.

Well, if you want to take an example, the VA helathcare system, the socialized US model in which the government owns and runs the whole thing, is making great strides in electronic health records and medical infomatics. It is much easier for them because they have a single insurance/payment system to interact with, all providers get the same system within whcih to work, and there are not dozens of different insurers trying to deny services in hundreds of different way each and every minute of the day.

If Clinton succeeded in creating a new Medicare-like insurance option for working-age households, there is no reason to believe the results would differ from the four-decade experience of current Medicare. Many workers would enroll in the new government-run insurance because the price control system and other rules would shield them from high cost-sharing. With prices artificially low, demand for services would be high, and the government would respond with flawed and clumsy attempts to keep a lid on costs with tighter payment rates and more regulation. All the while, service providers would become resigned to working the payment regulator for higher fees instead of searching for better and less expensive ways of providing care.

Same deal, he wants economic rationing, I want a societal agreement.

What’s needed is a Medicare reform which deregulates consumption and fosters competition and cost-cutting innovation while ensuring reliable insurance for enrollees.

Reformers should look to the design of the new drug benefit for how to get started. For drug coverage, the government relies on price competition, not price controls, to keep overall costs in check. The Medicare program pays 65 percent of the weighted-average of the bids submitted by the competing insurance plans. The beneficiary then pays all of the difference between the Medicare payment and the actual premium charged by the insurance plan they have chosen.

The competition for drug benefit enrollees is not distorted by the presence of government-run insurance with regulated pricing. Drug plan sponsors are all private insurers competing on exactly the same terms: their ability, using only private-sector tools and innovation, to put together an attractive combination of covered drugs, price per prescription, and beneficiary cost-sharing — at the lowest possible premium.

The results have been promising — and unheard of in health care. Beneficiary premiums fell from 2006 to 2007, and Medicare officials announced in August that the average monthly premium for 2008 will be just $2 higher than it was in 2006 — and 40-percent below original projections.

I do not claim to be a real economist, I am willing to listen, but did this have anything to do with the mountain of cash infused into the system for the Part D benefit?


Non-italics from: James C. Capretta is a fellow at the Ethics and Public Policy Center. He is also a health-policy and research consultant.

Cheers,

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Doctor X takes on flawed (Irish) system

Doctor X takes on flawed system:

"He told ‘Morning Ireland’ that the two biggest problems in Ireland were lack of accountability in the Health Service Executive, and the two-tiered system of private and public health. “Consultants hold all the power in the Irish system, and that is one of the main problems,” he said. The Bitter Pill devotes a chapter to his criticisms of the two-tier system. “In order that a private health service can justify its existence, it is necessary that it offers a better service than the public health service. It follows, then, that the public service is below-par and therefore unable to deliver best practice,” he writes. Among the many flaws he describes is the fact that consultants are often not in a hospital when one of their patients is ready for discharge, because they are at their private clinics. This can mean that a patient who is ready to leave must stay in hospital, sometimes over a weekend, with all the attendant costs on the system and the ‘blocking of the bed’ for the next sick person."

His book is The Bitter Pill: An Insider’s Shocking Expose of the Irish Health System.

There is another book, Emergency Irish Hospitals In Chaos - Author Marie O Connor , and I'm trying to find out more about it. Here's something.

In any case, just trying to gather information about what we want in a healthcare system and what we want to avoid.

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The McGill Daily - Hyde Park: When universal healthcare isn’t

The McGill Daily:

"But as any medical professional will tell you, this vaunted Canadian universalism is gradually being attenuated. As I recently discovered, universal in Ontario does not always translate to universal in Quebec. Specialized doctors are increasingly compelling their out-of-province patients – a group that includes many university students – to pay out-of-pocket for medical services.

"Specialists are adopting this practice because it relieves them of the cost of processing out-of-province claims and protects them from the occasional loss should a patient turn out to lack provincial health coverage. While out-of-province patients are still entitled to reimbursement from their home provinces, they must seek recovery on their own, a process that can take many weeks. If an out-of-province patient fails to pay, however, the specialist may refuse treatment, a course of action that carries no disciplinary consequences. "

Another caveat. Makes state by state action less appealing. Medicare-for-all looks better as Medicare causes no trouble when traveling to say, Florida for part of the year.

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Curing Canada's chronic ills - features

Curing Canada's chronic ills - features:

"Advocates of the public system, such as McBane, insist that universal health care is one of the strongest manifestations of Canadian values and identity. 'We don't think we can survive with rugged individualism alone. We believe that we need community, especially to take care of sickness. The sick shouldn't be alone to take care of themselves,' he says. 'That's how we've organized a lot of social policy. Around collective approaches to problems, not survival of the fittest-which is very American.'

"Day, however, insists that even adament supporters of private care do not aspire to everntually 'adopt an American-style health system.'

"Despite prevailing anti-American sentiments, Professor Soderstrom maintains that the best way to analyze the likely effects of a private provision on the performance of health care in Canada is to look at the American experience for guidance.

" 'There is a large amount of literature out there that looks at the likely effects of private provision on the performance of the health care services. If you look at the preponderance of evidence, it suggests that the full profit provision does not improve quality of care, does not improve productivity and it's not at all clear that it improves access,' he says. 'There is even literature that looks at private clinics and says if you look at the quality of care, the private clinics have it much worse than public clinics. Unfortunately, [Canada] is not yet marked by this debate.'"

Clearly there are caveats in this piece for America as we adopt a single payer system.

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2008 Presidential Candidates Healthcare Proposals Side by Side Comparison

Analysis - health08.org:

"This side-by-side comparison of the candidates positions on health care was prepared by the Kaiser Family Foundation with the assistance of Health Policy Alternatives, Inc. and is based on information appearing on the candidates websites as supplemented by information from candidate speeches, the campaign debates and news reports. The sources of information are identified for each candidates summary (with links to the Internet). The comparison highlights information on the candidates' positions related to access to health care coverage, cost containment, improving the quality of care and financing. Information will be updated regularly as the campaign unfolds."

This is an interesting exercise. I suggest you click on Kucinich and anyone else and view them side by side.

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Survey Confirms Growing Demand for Primary Care Physicians -- AAFP News Now -- American Academy of Family Physicians

Survey Confirms Growing Demand for Primary Care Physicians -- AAFP News Now -- American Academy of Family Physicians:

"The average salary or income-guarantee offers made to family physicians increased from $145,000 in 2005-06 to $161,000 in 2006-07, a gain of 11 percent; however, average offers made to FPs who also practice obstetrics remained relatively flat, increasing from $158,000 in 2005-06 to only $159,000 in 2006-07. "

It's good to see some move towards better compemsation for PCP's. If reimbursement weren't so heavily skewed towards procedures, we'd get more appropriate distrubution among specialties.

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House Republicans plan their own health plan - The Crypt's Blog - Politico.com

House Republicans plan their own health plan - The Crypt's Blog - Politico.com:

"Under fierce attack by Democrats over the children’s health insurance plan, House Minority Leader John A. Boehner said Sunday Republicans will unveil their own health care plan over the next few months. “Republicans are working on a plan that will provide access to all Americans to high quality health insurance, make sure that we increase the quality of insurance that we have in American, and we want to foster a sprit of innovation,” said Boehner on “Fox News Sunday.” “This is a plan we’ll see over the next coming months where we put the patients in charge of their health care.”"

Wow. Another step to the tipping point?

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The Doc's In, but It'll Be a While (Business Week)

The Doc's In, but It'll Be a While:

"The Doc's In, but It'll Be a While Despite spending lots more per capita on health care, the U.S. is often as bad or worse than other industrialized nations in wait times "

h/t to Marc Brown

It is from June '07, but it was new to me...

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Sadly, No! » Malkin vs. Malkin

Sadly, No! » Malkin vs. Malkin

Too funny! (Or is it too sad?)

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Capitol Feud: A 12-Year-Old Is the Fodder - New York Times

Capitol Feud: A 12-Year-Old Is the Fodder - New York Times:

"An aide to Senator Mitch McConnell of Kentucky, the Republican leader, expressed relief that his office had not issued a press release criticizing the Frosts.

But Michelle Malkin, one of the bloggers who have strongly criticized the Frosts, insisted Republicans should hold their ground and not pull punches.

“The bottom line here is that this family has considerable assets,” Ms. Malkin wrote in an e-mail message."

I realize this is somewhat off-topic for a single-payer blog, but here goes anyway.

Since when does Michele Malkin think that having considerable assets means one should not try to take the government for all one can, be that corporate welfare, no-bid contracts, capital gains tax cuts, killing the estate tax for the mega-wealthy, etc.?

I expect I won't be the first one to say, without embarrasment, that it really frosts me how they are treating the Frosts. My God, if we went after every person St. Ronald of Reagan threw at us to "put a human face" on a situation, we'd still be at it 20 years later! Not to mention the Snowflake babies and their families ("any abortionists in the family, ma'am? anybody with Parkinsons?")!

But I would like to know when someone is going to have the Edward R. Murrow moment or the Joseph Welch moment.

"Have you left no sense of decency?" When George W. Bush said after 9/11 that you were either with us or against us, I had presumed he meant with America and the liberal democracies in the world or not. No, as it turned out, he meant that you were either with the far right wing of the American Republican Party, the neocons, the fundamentalists, the constitutional "originalists," the unitary executive-ists, the authoritarians, the xenophobes, the selfish, the unilateralists, the imperialists, and the military industrial complex. If you were not one of that "us," you were unpatriotic, anti-american, ungodly. You deserved to be labeled with Newt Gingrich's dirty words from his infamous GOPAC memo.

Cheers (or, Good night and good luck)

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Medicare Audits Show Problems in Private Plans - New York Times

Medicare Audits Show Problems in Private Plans - New York Times:

"The audits document widespread violations of patients’ rights and consumer protection standards. Some violations could directly affect the health of patients — for example, by delaying access to urgently needed medications. "

"I'm shocked, shocked," says Captain Renault...

Update: I've trackbacked (or is it trackedback?) to firedoglake post on this, so that if you need lots more examples of why we need single payer, you can click on the various topics I have set up on the right to get data when you are in a fracas...

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Harold Meyerson - Return of the Goldwater GOP - washingtonpost.com

Harold Meyerson - Return of the Goldwater GOP - washingtonpost.com:

"Today's Republicans seem determined to re-create that magical Goldwater self-marginalization. Opposing the provision of health care to children because it conflicts with one's faith in an economic future (capitalism insures everyone) that capitalism itself does not really share (or it would insure everyone) is the same kind of theological nuttiness that led to the Goldwater debacle. In the name of attacking socialism, what Republicans are really doing is affronting the empiricism and the pragmatism, not to mention the decency, of the American people. At, one need hardly add, their own risk. "

A nice piece that covers nicely the ideology leading to opposition to SCHIP, let alone Medicare-for-All.

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Politics | What Sicko doesn't tell you ...

Politics What Sicko doesn't tell you ...

Local people from Portsmouth to Scarborough have been protesting against ISTCs draining scarce NHS funds, which has led to service closures and staff redundancies to balance the books. There is not an area of the country where services are not being cut and closed. Protests against the closures of accident and emergency departments and hospital services are happening in Surrey, East and West Sussex, Kent, Worcester, Manchester, Leeds, Durham and Huddersfield; and against the 150 community hospitals in places such as Norfolk, Cambridge, Leicester, Devon, Marlborough and Bromley. The NHS, the government says, has had unprecedented levels of funding - so where has all the money gone if it isn't into services? Is it really all down to bad managers and greedy doctors and nurses?

All markets need systems for pricing, billing and invoicing. Labour has introduced those: the electronic patient record, part of the £1bn IT disaster. The NHS too is being transformed from within. Foundation trusts such as University College London Hospitals Trust have been given new powers to enter joint ventures with commercial companies such as the Hospital Corporation of America and to spend millions of pounds on advertising campaigns, PR agents, mega-departments of finance and accounting, press officers, management consultants and profits. As in the US, billions of pounds, probably approaching 20% of annual NHS funds - estimated to be £20bn in England in a year - are being squandered on what are called the transaction costs of the market.

Earlier this year the US chief executive officer of UnitedHealth, Bill McGuire, was sacked along with other board members for repricing share options. His annual $126m package was not enough for him. Meanwhile more than 50 million Americans, including 10 million children, go without care - in the richest country in the world. Is this what we want?

· Allyson Pollock is author of NHS plc: The Privatisation of Our Healthcare and professor and head of the centre for international public health policy at the University of Edinburgh.

Interesting piece about how greed and capitalism are not turning out to be the cure for the NHS. And, on the other hand, how the NHS needs some serious work, making the case for Medicare for all all the stronger.

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With health deal, UAW's clout, influence grow

With health deal, UAW's clout, influence grow:

"'The size and visibility of this trust fund puts the UAW at the epicenter of the health care debate,' said Harley Shaiken, a labor expert at the University of California, Berkeley and a longtime adviser to the union. 'It expands the UAW's visibility, influence and clout in a major way.'

The UAW has long been an outspoken advocate for nationalized health care. Union leaders already are making it clear that they intend to use their new clout to push for a national solution to rising health care costs. '(This) strengthens our commitment to national health care reform,' said Alan Reuther, the UAW's chief lobbyist in Washington. 'This is an issue that has to be addressed by Congress.'

The timing could not be better. 'National health care could be on the agenda as early as 2009,' said Mike Whitty, a labor expert at the University of Detroit-Mercy. 'It will allow the union to take the lead in pushing for a single-payer national health policy.'"

Another push towards the tipping point?

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REP. TODD TIAHRT: SCHIP IS POLITICAL TUG-OF-WAR

Kansas.com 09/26/2007

"Ensuring the welfare of America's children should be top priority among congressional members. That's why I supported SCHIP when it was created by the Republican Congress in 1997. I would continue to offer my support this year; however, Democrats have politicized this program and used it as a platform to take one giant step toward a national socialized health care system."

It's always disappointing when a member of Congress argues against the straw man of "socialized medicine" when nobody is advocating for a socialized system in which the government owns all parts of the health system. It can work: look at the VA, and imagine the VA if it weren't underfunded and forced to outsource parts of its responsibilities to those wonderful "privateers" (remember the Walter Reed debacle - outsourcing).

But virtually nobody wants socialized medicine. Virtually everyone whom I've ever heard advocate for universal coverage advocates for a single payer system where we, the taxpayers, pay for our health insurance via taxes, and it is administered through a system like Medicare is right now. Medicare contracts with private companies that operate under Medicare rules (our rules, by the way, Congress sets the rules) and pay hospitals, doctors, etc. No socialized medicine, thank you; Medicare for all, please.

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Kolodner says U.S. docs weak on IT adoption, stresses interstate collaboration

Kolodner says U.S. docs weak on IT adoption, stresses interstate collaboration:

"Most patients in the United States receive care in physician practices with one or two providers, yet only four percent of these practices have electronic health records, said Robert Kolodner, MD, here Monday. "

"We’re not getting value for our healthcare dollar in this country,” Kolodner said. “We’re paying more, but we’re ranked much lower than most other developed nations in health outcomes. Health IT is the right thing for our families and communities, but it’s also the right business case.”

In other nations, healthcare IT adoption is subsidized or incentivized more appropriately. Also, there is more uniformity with a single payer or universal system that reduces much uncertainty about purchases and implementation. A practice or hospital does not have to deal with a fragmented sytem on the outside with a myriad of insurers, hospital systems, etc, each with its own unique IT structure (or lack thereof).

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Our Health-Care System Needs Intensive Care - WSJ.com

Our Health-Care System Needs Intensive Care - WSJ.com

Some responses to John Stossel's typically inane piece in the WSJ...

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Girl power has seized the day at university and college campuses

Girl power has seized the day at university and college campuses:

Vive la Différence!

Interesting piece on how women are changing the scientific world. This includes, healthcare, of course.

"'Women are not crazy, and they insist on a more balanced life. But there are social implications.' Indeed, flip through a scientific journal, policy paper or professional magazine, and it doesn't take long to find an article on the changing of the gender guard and the repercussions on salaries, staffing levels and job benefits when women seize the reins in medicine, law and the sciences. For now, on campuses at least, there's little evidence of strain or backlash. "

I think a more European approach to life might have some of the healthcare benefits that allow them to out live us...

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NEJM -- Health Care for All?

NEJM -- Health Care for All?
by M. Gregg Bloche, M.D., J.D.

Just some commments. Dr. Bloche describes the origins of state benefits such as heath care and notes that post war treatment of those who scraficed was an impetus:

In exchange for widespread sacrifice, citizens began looking to the state
to secure their welfare.

I always am taken aback when people view democratic governments as 'the other'. As Pogo said, "We have met the enemy, and he is us." I understand with the ridiculously low level of civil participation these days in the us, it seems like us v. them. And especially with the current administration, I definitely feel like I'm a "them" these days. But, "the state" is still us. Our government, our social contract.

The new compact is likely to start with an enhanced sense of individual obligation — to eat sensibly, exercise regularly, avoid smoking, and otherwise care for ourselves. It may include an obligation to buy insurance. Government, in exchange, can offer some protection against the threat of economic and social change that will disrupt people's coverage by destabilizing employment and family relationships. Not only can the state provide subsidies to enable poorer citizens to buy insurance; it can, at low cost, combine people's purchasing power and clear away obstacles to competition, empowering markets to extend coverage to tens of millions who now go without it. Government can also fashion incentives to foster evidence-based practice, health promotion, the elimination of racial disparities in care, and the reduction of medical errors.

I absolutely hate this "personal responsibility" and "individual obligtion" crap. The people who are largely harmed by issues typically cited (obese, smokers) usually either a) don't start draining the system until they are in Medicare or b) save us money by dying young (we get all of their Medicare and Social Security money). The other personal responsibility issues, such as seeing your physician and buying your meds are at least as much economic issues as responsibility issues.

And again with the subsidiesand incentives! Many are so poor that this doesn't help. And most don't know how to put their risk into perspective. Why is this so incomprehensible?

^{What is possible is a new reciprocity of personal and public commitment, tailored to American self-reliance and the uncertainties of a global economy. This arrangement stands a decent chance of delivering near-universal coverage. Success could cement a new understanding of government's role — not as a guarantor of easy living irrespective of striving but as an insurer of basic decency when self-reliance fails.}

^{Ugh. Reaarange those deck chairs. Again.}

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First world results on a third world budget | Special reports | Guardian Unlimited

First world results on a third world budget Special reports Guardian Unlimited:

A nice, evenhanded piece on the Cuban system, with some comparison with the UK's NHS at the end. Clearly not the be-all-and-end-all of healthcare, but, really, can't we do better than Cuba?

"But how good, exactly? And how does Cuba do it given such limited
means? Neither question is easy to answer. The communist government is not
transparent, some statistics are questionable and citizens have reason to muffle
complaints lest they be jailed as political dissidents. According to the World
Health Organisation a Cuban man can expect to live to 75 and a woman to 79. The
probability of a child dying aged under five is five per 1,000 live births. That
is better than the US and on a par with the UK.

Yet these world-class results are delivered by a shoestring annual per capita health expenditure of $260 (£130) - less than a 10th of Britain's $3,065 and a fraction of America's $6,543. There is no mystery about Cuba's core strategy: prevention. From promoting exercise, hygiene and regular check-ups, the system is geared towards averting illnesses and treating them before they become advanced and
costly."

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More on US Health Care and Health Insurance cost

Two new bits in the Inbox today regarding US spending on health care and consumers spending on insurance:

From Health Affairs:
Health Spending In OECD Countries In 2004: An UpdateGerard F. Anderson, Bianca K. Frogner and Uwe E. Reinhardt
In 2004, U.S. health care spending per capita was 2.5 times greater than health spending in the median Organization for Economic Cooperation and Development (OECD) country and much higher than health spending in any other OECD country. The United States had fewer physicians, nurses, hospital beds, doctor visits, and hospital days per capita than the median OECD country. Health care prices and higher per capita incomes continued to be the major reasons for the higher U.S. health spending. One possible explanation is higher prevalence of obesity-related chronic disease in the United States relative to other OECD countries.

From The Kaiser Family Foundation:
Premiums for employer-sponsored health insurance rose an average of 6.1 percent in 2007, less than the 7.7 percent increase reported last year but still higher than the increase in workers’ wages (3.7 percent) or the overall inflation rate (2.6 percent), according to the 2007 Employer Health Benefits Survey released today by the Kaiser Family Foundation and Health Research and Educational Trust. Key findings from the survey were also published today in the journal Health Affairs.The 6.1 percent average increase this year was the slowest rate of premium growth since 1999, when premiums rose 5.3 percent. Since 2001, premiums for family coverage have increased 78 percent, while wages have gone up 19 percent and inflation has gone up 17 percent.

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David Brooks: European system won't fix U.S. health care woes

"Some liberals, believing that government should step in as employers withdraw,
support a European-style, single-payer health care system. That would be fine if
we were Europeans. But Americans, who are more individualistic and pluralistic,
will not likely embrace a system that forces them to defer to the central
government when it comes to making fundamental health care choices."

Yeah, the elderly are practically rioting in the streets to get rid of Medicare, aren't they? What a self-serving load of hogwash. It's easy enough to just say you are ideologically against any kind of reform involving a single payer type solution. It's another thing to blame it on the "American Character", as if this is some unchanging monolith, or ever was.

"We shouldn't disrupt the lives of those who are happy with the insurance they
have."

Mr. Brooks apparently doesn't realize what a vanishingly small number of people this is these days.In the end, Brooks advocates yet another half-baked idea that tinkers aroun the edges and fails to provide real healthcare security for all Americans.

read more digg story

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Public Citizen | Publications - Report: Equal Pay for Equal Work? Not for Medicaid Doctors (HRG Publication #1822)

Public Citizen Publications - Report: Equal Pay for Equal Work? Not for Medicaid Doctors (HRG Publication #1822):

The states that had the lowest ratios and therefore had the highest
disparities in Medicaid and Medicare payments in 2003 now have the following
Medicaid-to-Medicare ratios:
Medicaid-to-Medicare Fee Ratios for Selected Primary Care Procedures,
Low-Parity States, 2007


New York .29
New Jersey .31
Rhode Island .40
Pennsylvania .42
District of Columbia .48


Read the full report to get the idea, but what we in healthcare have known all along is that Medicaid is de facto rationing. It is a severe economic disincentive to serve this population. And it is worth noting that, depending upon where you practice, Medicare is likely your lowest payer to begin with, so these numbers become even more tragic.

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NEJM -- Efficacy and Safety of Epoetin Alfa in Critically Ill Patients

NEJM -- Efficacy and Safety of Epoetin Alfa in Critically Ill Patients

Results: As compared with the use of placebo, epoetin alfa therapy did not result in a decrease in either the number of patients who received a red-cell transfusion or the mean number of red-cell units transfused.

Conclusions: The use of epoetin alfa does not reduce the incidence of red-cell transfusion among critically ill patients, but it may reduce mortality in patients with trauma. Treatment with epoetin alfa is associated with an increase in the incidence of thrombotic events

Then, in the discussion:

In contrast, [to trauma patients] no significant reduction in mortality was seen among surgical and medical patients receiving epoetin alfa.

and

The use of epoetin alfa is not supported for patients admitted to the ICU with a nontraumatic surgical or medical diagnosis, unless they have an approved indication for epoetin alfa.

^{The only reason I post this is because of the extraordinary amount of money I saw spent on promoting the use of this very expensive drug in the critically ill patient population over the past five or ten years. And, mea culpa, I fell for it, too. It will now, hopefully, dry up as yet another revenue source for these companies as word (slowly) filters out to the critical care community. I'm betting there won't be a full court press to get the word out about this particular article.}

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Robert E. Litan - Forbes.com

How to fix healthcare...Mr. Litan describes how private health insurance is stifling American business and the lays out his remedy: adjusting the tax treatment of private health insurance.

I am sure this would help literally thousands of already well-insured people, so, "Hear, hear!". Snark.

It reminded me of an old Monty Python sketch called "How To Do It!", in which the presenters breathlessly make their pitch:

Alan: Well, last week we showed you how to become a gynaecologist. And this week on 'How to do it' we're going to show you how to play the flute, how to split an atom, how to construct a box girder bridge, how to irrigate the Sahara Desert and make vast new areas of land cultivatable, but first, here's Jackie to tell you all how to rid the world of all known diseases.
Jackie: Hello, Alan.
Alan: Hello, Jackie.
Jackie: Well, first of all become a doctor and discover a marvellous cure
for something, and then, when the medical profession really starts to take
notice of you, you can jolly well tell them what to do and make sure they get
everything right so there'll never be any diseases ever again.
Alan: Thanks,
Jackie. Great idea. How to play the flute. (picking up a flute) Well here we
are. You blow there and you move your fingers up and down here.

It is so tiresome to keep hearing these inane ideas about tinkering at the edges of such a profoundly dysfunctional system.

Cheers,

read more digg story

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Firedoglake - Firedoglake weblog » Welcome To My World

Firedoglake - Firedoglake weblog » Welcome To My World

Jane Hamsher posts one of her surgeon's bills. As Sicko pointed out, even getting sick with insurance is tough financially on top of the usual travails.

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We are all uninsured now - The Boston Globe

We are all uninsured now - The Boston Globe

Starts out OK, but I don't agree with tinkering around the edges that he come around to later in the piece. Is he afraid that this is somehow socialism writ large, or is he just worried about the epithets?

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Rocky Mountain News - Denver and Colorado's reliable source for breaking news, sports and entertainment: Health Care

Rocky Mountain News - Denver and Colorado's reliable source for breaking news, sports and entertainment: Health Care

Just 1 quick snippets to illustrate the point about income discrepancy in medicine.

Median salaries

2005 2006 Change

Family practice $160,729 $164,021 + 2 percent (without OB)

Psychiatry $189,409 $192,609 + 1.7 percent

Cardiology: invasive $463,801 $457,563 - 1.3 percent

Orthopedic surgery $428,119 $446,517 + 4.3 percent

Internal medicine $167,178 $174,209 + 4.2 percent

Source: Medical Group Management Association

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Response to: Commentary: What's Wacko about Sicko

Commentary: What's Wacko about Sicko
From Dr. Donald P. Condit, orthopaedic surgeon specializing in hand surgery in Grand Rapids, Mich. He also holds an MBA degree from the Seidman School of Business at Grand Valley State University. [My comments are in italics.]

Michael Moore wants socialized medicine in the United States.

Actually, he wants single payer or a Medicare for all system, not a socialized system such as Britain's.

It would, as his film Sicko suggests, give us a system that better delivers health care to those who need it. Although Moore effectively documents some deficiencies in American health care, his message is undermined by misinformation, inconsistent rhetoric, and a disingenuous agenda.


I argue that it is not his job to do a 12 hour mini-series. He had two hours to make his case, and he did. See this post for more details: http://cmhmd.blogspot.com/2007/07/sicko-heavily-doctored-by-kurt-loder.html

Moore's plan would result in worse, not better, health outcomes for Americans -- including the poor and underserved.

Please supply some evidence of this. Here is a bit showing you are wrong:
http://cmhmd.blogspot.com/search/label/US%2FWorld%20Health%20Care%20Comparisons
http://cmhmd.blogspot.com/search/label/Canada


As a hand surgeon who treats many traumatic injuries, Moore's portrayal of a patient who amputated his middle fingertip captured my interest. He depicted this uninsured man as required to pay $23,000 to have his finger "saved." Moore lost considerable credibility here. Most hand surgeons would never consider micro-surgically replanting this table saw injury at the finger nail base. Rather, this unfortunate injury would have been comfortably and safely treated -- without reattachment of the severed bit of finger -- in an office procedure room for $1,000 or less.

Doing a Dr. Frist, here, aren't we? Diagnosing and managing via a film clip? I am encoursged that you think this kind of thing wouldn't happen where you are.

In Sicko, Moore consistently equated lack of insurance with inability to obtain care.

See here: http://www.washingtonpost.com/wp-dyn/content/article/2007/02/27/AR2007022702116.html
and here: http://www.newyorker.com/printables/fact/050829fa_fact
and here: http://cmhmd.blogspot.com/search/label/Rationing%20Health%20Care

I'd say the problem is grossly inadequate ability to obtain care.


In Grand Rapids, Mich., where I practice, a sign on the front door of Blodgett hospital, in English and Spanish, indicates patients will not be turned away for lack of ability to pay. This is policy across the United States.

As John McEnroe might say, "You cannot be serious!" Does anybody really believe that having to show up in an emergency room, knowing that if you can't pay you'll be hounded for years to pay whatever you can, is equivalent to open access to primary care as is done essentially everywhere else in the industrialized world? No disincentive to comply with treatment there, is there?


We hear a lot about the nearly 50 million Americans without health insurance. However, approximately half of them are insured six months later with new jobs, suggesting more of a problem with our employer based health care system than with affordability.

And another 50 take their place. This happened to my brother, an engineer, while between jobs. His wife took ill and he nearly filed for bankruptcy. He had a last minute generous help from his employer. Most are not so "lucky."

Moore harshly criticizes the U.S. government. Yet he is arguing for a centrally controlled allocation of health care resources. Who does he want to run health care in this country?

Easy answer, here: NOT private health insurers! Not even "not for profit" ones!

Medical resources are not unlimited. The combination of aging demographics, technological advances and unconstrained consumption within our third party payment system has led to an unsustainable trajectory of ever increasing spending.

Unconstrained consumption? Really? How about delayed appropriate consumption resulting in later excessive costs due to inadequate treatment of manageble acute and chronic illnesses? How about the burden imposed on providers by private insurers? How about administrative costs? The lack of a national medical informatics infrastructure? The only place where I really do worry about consumption is in the last months of life. We do a lousy job of dealing with end-of-life care and our patients pay dearly for it with their suffering and angst, and society suffers under the burden of using resources inappropriately.

It is already clear that price controls have created strong disincentives to debt-burdened students considering careers in primary care.

That, and the ridiculously skewed compensation to procedure related specialties. Compared to the rest of the world, our PCP's income is comparable. It's in the procedure-intensive specialties where the big diference lies. Spread that money out more evenly and those price controls don't hurt PCP's so much.

Yet Sicko gives market oriented solutions no consideration.

What about the last fifty years makes you even a teensy optimistic?

Three individuals with ailments after admirably serving in New York rescue and recovery efforts after September 11, 2001, were transparently used in Sicko to promote Moore's agenda. This manipulation was as revolting as the stories of individuals egregiously denied care by insurance companies. Transported to Cuba, the three 9-11 patients were shown to Cuban doctors who (while cameras were rolling) appeared more than happy to provide care and subsidized prescriptions.

I think they were willing participants and understood what they were doing. I think it funny that people get exorcised that he "held up Cuba" as a fine example. I think his point was that EVEN Cuba, a communist dictatorship, pretended it had some universal healthcare. And still managed to only come in a couple slots lower than us in the infamous 37/39 slide.

This contrasted with a California hospital denying care to a child with a severe infection and a sick, elderly woman dropped off by a taxi in front of a rescue mission while still in her hospital gown. The latter two tragic situations were portrayed as illustrative examples of our domestic medical system.

You're a surgeon. I bet given 15 minutes you can come up with a half dozen anecdotes about the stupidity and callousness of our 'system,' can't you?

There is no question we need major improvement in U.S. health care. To use a few outrageous anecdotes to argue for a socialized solution, however, is a non-sequitur.

Agreed. And besides, in a contest of anecdotes, we'd lose. Badly.

Despite ostensibly compassionate intentions on the part of its backers, greater harm would result from centrally planned and controlled health care. Canada and the United Kingdom provide contemporary models: rationing occurs by decree and delay.

Rationing comes by under funding the system. That will be a serious danger here, too, when we move to Medicare-for-All. It is up to us to make sure it doesn't.

And of course, our rationing is economic. I find this indefensible and reprehensible.

Even the Canadian Supreme Court, when ruling against Canada's single-payer law prohibiting private payment for health care in 2006, stated, "access to a waiting list is not access to health care … in some cases patients die as a result of waiting lists for public health care ... and many patients on non-urgent waiting lists are in pain and cannot fully enjoy any real quality of life."

The Supreme Court decision was bad for a number of reasons, and since has been near universally derided in the Canadian press. Follow this link:http://www.pnhp.org/single_payer_resources/Canadian%20Supreme%20Court%20Ruling.pdf (Thanks to Nick Skal, of PNHP for this bit.)

Please click on the topic Waiting Lists on the right side of my blog for more info.

Pope Benedict XVI wrote in his recent encyclical Deus Caritas Est, "We do not need a State which regulates and controls everything, but a State which, in accordance with the principles of subsidiarity, generously acknowledges and supports initiatives arising from the different social forces and combines spontaneity with closeness to those in need."

I do not know the context of these remarks, but considering very other industrialized nation in the world has some form of universal healthcare, I expect he was specifically not talking about helathcare. But that's just a guess based upon my Catholic upbringing. And this, from Cardinal Bernadine, "Health care is an essential safeguard of human life and dignity and there is an obligation for society to ensure that every person be able to realize this right."


Moore and his allies would do well to take this exhortation to heart. We now have unsustainable consumption of medical resources, with third party responsibility for health care expenses. A socialized system would increase state dependency and diminish motivation for charity. Greater government bureaucracy would increase inefficiency and waste compared to doctor-patient "two-party" interaction. Socialized medicine violates the social justice principle of subsidiarity by interfering with the family, churches, charitable clinics, and other intermediate organizations

Violates social justice? You've got to be kidding, or, more likely, just defending a weary ideology not suited for this issue and rationalizing.

Cheers,

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Census Shows a Modest Rise in U.S. Income [BUT]- New York Times

Census Shows a Modest Rise in U.S. Income - New York Times:
"Census officials attributed the rise in the uninsured — to 47 million from 44.8 million in 2005 — mostly to people losing employer-provided or privately purchased health insurance. The percentage of people who received health benefits through an employer declined to 59.7 percent in 2006, from 60.2 percent in 2005."

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delawareonline ¦ The News Journal, Wilmington, Del. ¦ Patient increase, limited medical school slots make seeing doctor tougher to do

delawareonline ¦ The News Journal, Wilmington, Del. ¦ Patient increase, limited medical school slots make seeing doctor tougher to do:

"Some doctors say the problem lies not with a doctor shortage, but with an uneven distribution of MDs. New doctors gravitate toward more lucrative specialties, such as sports medicine. Specialties that require surgery, such as ophthalmology, also attract doctors because Medicare and insurers reimburse surgical procedures at a far higher rate than evaluations. Cooper said young doctors are turning to these profitable specialties at the expense of Medicare patients, who largely suffer from diabetes and arthritis and are in need of endocrinologists and rheumatologists. Medical school students also may be dissuaded from primary care. Dr. David Krasner, who works at Family Practice Associates in Wilmington, said the existing reimbursement system pays too little for cognitive evaluations by primary care physicians. 'For physicians to go into primary care in this day and age, it's akin to committing financial suicide,' he said. 'The shortage in my opinion won't get better until Medicare changes the way it reimburses.'"

Please click on some of the tags below: physician income, in particular to learn more about this topic...

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Insurance provider lowers physician reimbursements while earnings grow 08/19/07 - LubbockOnline.com

LubbockOnline.com - Insurance provider lowers physician reimbursements while earnings grow 08/19/07:

"Although it is a not-for-profit company, Health Care Service's bottom line continues to rise at a rapid rate. According to Laura B. Benko of Modern Healthcare, in 2005 Health Care Service Corp recorded its fourth consecutive year of earnings growth, 'posting net income of $1.15 billion on $11.7 billion in revenue. Its total surplus was $4.3 billion, up 47 percent from 2004 and 227 percent from 2000.' Ms. Benko points out the company's president and chief executive officer, Raymond McCaskey, received $6 million in salary, bonuses and other compensation in 2005. I believe some of the millions of dollars the residents of this area pay in premiums to Blue Cross would be put to better use by the healthcare professionals in our community."

Non-profit for whom?

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NEJM -- Healing Our Sicko Health Care System

NEJM -- Healing Our Sicko Health Care System:

"To get around this catch-22, we will need populist anger but also
political foresight. Moore heads abroad to show us that a single public insurer
is the only hope. But one need not travel to Canada, the United Kingdom, or
France (much less Cuba — Moore's most dubious destination) to see the virtues of
combining universality with public cost control. Medicare, our country's most
popular and successful public insurance plan, covers everyone older than 65 and
people with disabilities — groups with great need for coverage and little
ability to obtain it privately. Yet it has controlled expenses better than the
private sector, spends little on administration, and allows patients to seek
care from nearly every doctor and hospital. For some reason, Moore ignores
Medicare. He talks about the post office, the fire department, public education
— but not the one public program that most resembles the 'free universal health
care' he extols.

"That's too bad, because the Medicare model is the not-so-secret
weapon in the campaign for affordable health care for all. Today, many advocates
of national health insurance have wisely started calling for 'Medicare for All'
rather than their old rallying cry, 'Single Payer.' But moving to a national
insurance plan overnight, whatever the label, means threatening the private
coverage on which so many Americans rely and requiring our cash-strapped
government to raise the highly visible taxes necessary to fund a system now
financed largely by the hidden drain on workers' paychecks. We may be moving
toward the day when we are ready to clear these hurdles in one leap, but we are
not there yet. "

A fairly reasoned discussion in all, but we need leadership of the RFK variety:

"There are those that look at things the way they are, and ask why? I dream of things that never were, and ask why not? "

(Okay, wikiquote says he lifted that from GB Shaw, but, same spirit.)

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An unhealthy health care plan

I only link to mock...An unhealthy health care plan -- The Washington Times, America's Newspaper By Robert Goldberg (vice president of the Center for Medicine in the Public Interest)
Pablo Picasso observed, "To copy others is necessary, but to copy oneself is pathetic." Is anyone more pathetic than Arnold Relman, the former editor of the New England Journal of Medicine, who continually writes about why America should adopt the Canadian health care system? There is. It's Arnold Relman himself, writing in Canada about why Canadians shouldn't abandon the Canadian health care system. In this case, it's Mr. Relman in the Toronto Globe and Mail opposing the Canadian Medical Association (CMA) proposal to "allow physicians to bill patients (or private insurance plans) for services that are covered by Medicare, and allowing Medicare to purchase covered services from for-profit private facilities." The goal of the CMA plan is to allow people a chance to get medical care when they need, not when the government sees fit to provide it. Canada has pumped billions of dollars into its system to reduce waiting times for specialty services, cancer care, first-time health visits and emergency rooms.

Here's the link to the article by Relman. Dr. Relman's piece speaks for itself.

But according to Health Canada and the independent Frasier Institute the waiting times and shortages have gotten worse.

Please see this previous post to read why you should discount anything from Fraser, and yet recognize that Fraser is a pernicious force to be watched and refuted at every opportunity.

In a recent incident, a child with a brain tumor headed to the states to get a MRI because he would have had to wait four months in Canada. His family paid cash because Health Canada refused to cover the cost. Mr. Relman's response? He urges Canadians to "avoid exploitation by those who would like to make profits from publicly funded health care. Canadians should not follow Americans down the path to greater privatization." The kid should die for the greater glory of socialized medicine rather than pay cash and line the pockets of profit hungry docs in America. Groucho Marx once observed, "Who do you believe? Me or your eyes?" Our eyes tell us that here and abroad government run and financed health care stinks.

Welcome to another episode of "Anecdote-Off", the great justifier of all things wrong in the US sytem if you believe people like this. As I've said many times before, if you want to debate this by anecdote, the US loses. Badly.
For waiting times, go here.

Price controls cause shortages of doctors in the UK that in turn are filled by waiving immigration regulations that allow neurologists with bomb-making skills into the National Health Service (NHS).

Good thing we don't allow ferners to practice medicine here.

In the United States, restrictive formularies and cookbook approaches to care have undermined mental health treatment for soldiers returning from Iraq.

Got that backwards.

Medicaid reimbursement levels have increased waiting times and caused millions of children to seek care in emergency rooms.

Because we underfund Medicaid and the economics of reimbursement of course cause providors to scurry for the hills. How is this an argument against single-payer?

Meanwhile SCHIP — 10 years after its enactment — has failed to enroll 3-out-of-5 Medicaid eligible children in private health care plans and access to care has barely increased.

Again, how does this support an argument against universal healthcare? It's an argument against the stupid patch-work non-system we have here in the US, I agree.

Incredibly, Mr. Relman claims that's just a sign free market health care does not work and does not care about people. Enlighten us Arnie, how are the two connected?

Because the patch-work "free market" mess we have here does not work. Clearly Mr. Goldberg has never actually seen patients or been responsible for providing healthcare in this disaster we work in. When funded properly and overseen appropriately and by giving doctors the ability to provide care as they see fit (as opposed to insurers or underfunded goverment programs), a single payer system can not possibly be worse that what we have now. Unless someone puts the Republicans in charge of it. Then, watch out, Brownie will be in charge!

"Physicians in our commercialized, profit-driven system tend to gravitate toward the highly paid specialties, so we now face a major shortage of primary-care doctors." Well, we know how flush the NHS is with well-trained terrorists — I mean family doctors. What about Canada? It turns out the College of Family Physicians of Canada found that 17 percent of Canadians didn't have a family doctor because of a primary care physician shortage. Two million of the Canadians that Mr. Relman wishes to deny free choice of care to have attempted to find a family physician in the past year, but have failed. In the U.S., we have a market-based response to the problem.

OMG! 17% don't have a PCP. I've got an idea, let's take insurance away from 1/6 of Candians and underinsure another 1/6 so they can't afford a PCP visit, and see what happens to that shortage. The free-market will get rid of those whiners!

A rapid expansion of retail health clinics in the United States is taking place in what the Department of Health and Human Services has designated as medically underserved areas. Take MinuteClinics, a division of the drugstore chain CVS, which offers walk-in health care centers for common medical problems such as strep throat, sunburn, mono, flu, ear infections and sinus infections, and offer vaccinations, checkups, etc. People can pay cash or use their regular insurance.

"People can pay cash or use their regular insurance." Hahahahahahah!

And will Mr. Goldman and his family use this service? Of course not, because they have good insurance.

Most visits are 15 minutes or less with no appointment needed. In many cases, MinuteClinics are often affiliated with local hospital or physician practices, and will refer customers to a primary care doctor if they don't have one. Additionally, the center generates an electronic medical record that customers and doctors can access through the phone, fax or Internet. There are 200 MinuteClinics across America. Most are in federally designed medically underserved areas providing immediate care, referrals and electronic medical records for about $50 per person. Other private companies are involved in this trend as well and have been joined by the American Academy of Family Physicians in an effort to improve access to health care for millions Americans.

Well, let's take it a step further and have us (by us, I mean the U.S., our government) fund such a system. And that way, when the patient is referred to a PCP, the patient will be able to actually go to the PCP without choosing between healthcare and something else.

Meanwhile, as the marketplace makes medical care more accessible in America ...

...still can't get that idea that it should be universal rather than just "more accesible"...

Mr. Relman is telling Canadians, "One thing is certain. If medical care and health insurance are allowed to become private businesses... patients with little or no resources do not get the care they need."

And Mr. Goldberg doesn't care about those people. Why not just come out and say it?

What did Santayana say about fanaticism? It consists of redoubling your efforts when you have forgotten your aim.

Pot, meet kettle... And as John Kenneth Galbraith said, "The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness."

Fighting against medical choices that are available elsewhere in the world is a sure sign that ideological zeal has transcended compassion or the Hippocratic oath.

Uh, he's fighting for medical choice, not against it. He's advocating for compassion, not against it. And if Mr. Goldberg thinks physicians anywhere in the world compromise the spirit of Hippocrates (put the well-being of the patient above all else) more than we do in America, he is as out of touch as the rest of his piece confirms.

Mr. Relman, once a great scholar, should be pitied, not scorned.

It's Dr. Relman, and he doesn't need Goldberg's pity.
read more digg story

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Costly 'affordable' health care -- The Washington Times, America's Newspaper

Costly 'affordable' health care -- The Washington Times, America's Newspaper:

"John Stossel is right."

When an editorial starts out like this, and it's from the Rev. Moon's Times, you know it's going to be dead on true, don't you?

Healthcare policy by anecdote- isn't that what Michael Moore is accused of all of the time?

UPDATE: I contacted an ICU director in Brussels regarding this article. His response:

This is simply wrong - and worrisome if published in the Washington Times
(hopefully not the Washington Post)!

As stated, we have here one of the best health care systems in the world.
Much better than socialistic systems like in the UK or in Scandinavia or even
the Netherlands.

Maybe his grandfather became deaf because of an aminoside administration, but
the antibiotic choice was not restricted by costs !

Maybe it is a case of malpractice - I do not know, these can happen anywhere
- but it is not related to a limitation in health care costs.

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Best Care Anywhere | The New America Foundation

Best Care Anywhere The New America Foundation:

This is a link to a two hour panel discussion on the VA Healthcare system, our own home-grown single-payer carve out, and it is very informative. It is lead by the author, Phillip Longman of "Best Care Anywhere: Why VA Health Care is Better Than Yours "

Below is a link to an audio only, MP3 version that you can download as well.

MP3 Audio Recording of this Event15.9 MB"

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NEJM -- A Decade of Direct-to-Consumer Advertising of Prescription Drugs

NEJM -- A Decade of Direct-to-Consumer Advertising of Prescription Drugs:

"Results Total spending on pharmaceutical promotion grew from $11.4 billion in 1996 to $29.9 billion in 2005. Although during that time spending on direct-to-consumer advertising increased by 330%, it made up only 14% of total promotional expenditures in 2005. Direct-to-consumer campaigns generally begin within a year after the approval of a product by the FDA. In the context of regulatory changes requiring legal review before issuing letters, the number of letters sent by the FDA to pharmaceutical manufacturers regarding violations of drug-advertising regulations fell from 142 in 1997 to only 21 in 2006. "

From the discussion:

"Our study has some key limitations. We obtained data on industry sales from PhRMA, which includes in its annual reports sales data only for its members. Ideally, we would include sales of all branded drugs sold by prescription, including pharmaceutical and biologic agents, and exclude sales of generic drugs (because generic drugs typically are not promoted). PhRMA sales data may include some generic sales (if a member reports both branded and generic sales) and typically exclude sales of biologic agents, which are manufactured by companies that belong to another trade group (Biotechnology Industry Organization). As a result, the sales figures may underestimate total dollar sales for the industry. We provide data on spending on free samples valued at their approximate retail price, which is how they typically are valued in industry promotional audits. Thus, the value of free samples we present probably overstates the opportunity cost to manufacturers, which would lie somewhere between the marginal cost of production and the retail value."

A billion here, a billion there, pretty soon you're talking serious money...

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The Reality-Based Community: Rationing health care

The Reality-Based Community: Rationing health care:
Rationing health care
Posted by Mark Kleiman

"All this, let's recall, with the Chancellor breathing down the neck of the boss of the medical area on behalf of a full professor at the university that owns the hospital. So my experience with the system was probably about as good as it gets except for corporate executives using places like the Mayo Clinic or family members of people on the boards of directors of hospitals. (Apparently it's generally understood that if you stump up enough in the way of contributions to get on the board of the hospital, you're entitled to priority care; that's how not-for-profit hospitals raise capital.) It was only later that I discovered why the insurance company was stalling; I had an option, which I didn't know I had, to avoid all the approvals by going to 'Tier II,' which would have meant higher co-payments. The process is designed to get very sick or prosperous patients to pay to jump the queue. I don't know how many people my insurance company waited to death that year, but I'm certain the number wasn't zero. "

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The Doctor Will See You—In Three Months

The Doctor Will See You—In Three Months: "It's not just broken for breast exams. If you find a suspicious-looking mole and want to see a dermatologist, you can expect an average wait of 38 days in the U.S., and up to 73 days if you live in Boston, according to researchers at the University of California at San Francisco who studied the matter. Got a knee injury? A 2004 survey by medical recruitment firm Merritt, Hawkins & Associates found the average time needed to see an orthopedic surgeon ranges from 8 days in Atlanta to 43 days in Los Angeles. Nationwide, the average is 17 days. 'Waiting is definitely a problem in the U.S., especially for basic care,' says Karen Davis, president of the nonprofit Commonwealth Fund, which studies health-care policy. All this time spent 'queuing,' as other nations call it, stems from too much demand and too little supply. Only one-third of U.S. doctors are general practitioners, compared with half in most European countries. On top of that, only 40% of U.S. doctors have arrangements for after-hours care, vs. 75% in the rest of the industrialized world. Consequently, some 26% of U.S. adults in one survey went to an emergency room in the past two years because they couldn't get in to see their regular doctor, a significantly higher rate than in other countries."

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Waiting Times for Care? Try Looking at the U.S. - Nurses, Doctors Say It's Time to Debunk the Myths

Waiting Times for Care? Try Looking at the U.S. - Nurses, Doctors Say It's Time to Debunk the Myths: "'There’s been a lot of clamor lately about delays in care in some other countries. But if you want to see some really unsightly waiting times, look at U.S. medical facilities,' said Deborah Burger, RN, president of the 75,000-member CNA/NNOC. While the problem has been largely overlooked by the major media, it was quietly exposed by the chief medical officer of Aetna, Inc. late in Aetna’s Investor Conference 2007 in March. In his talk, Troy Brennan conceded that 'the (U.S.) healthcare system is not timely.' He cited 'recent statistics from the Institution of Healthcare Improvement… that people are waiting an average of about 70 days to try to see a provider. And in many circumstances people initially diagnosed with cancer are waiting over a month, which is intolerable,' Brennan said. Brennan also recalled that he had formerly spent much of his time as an administrator and head of a physicians' organization trying 'to find appointments for people with doctors.' While Brennan's "

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Angry Bear on OECD Waiting Times Study

Angry Bear:

"The data shows that many countries with 'nationalized' health care systems have little or no waits for elective medical procedures. A 2003 OECD working paper entitled 'Explaining Waiting Times Variations for Elective Surgery across OECD Countries' by Luigi Siciliani and Jeremy Hurst provides some survey evidence of actual waiting times in various OECD countries. The results of that survey are presented below."

Two nice tables here explain a lot...

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The waiting is the hardest part...

Thanks to Todd Kunkler at MD Net Guide for his excellent post with links to information about waiting times!

I'll repeat the links here in individual posts for easier access. If you go to his original post, they are obviously all there for the investigating.

Cheers,

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US Slipping in Life Expectancy Rankings - washingtonpost.com

US Slipping in Life Expectancy Rankings - washingtonpost.com: "Murray, from the University of Washington, said improved access to health insurance could increase life expectancy. But, he predicted, the U.S. won't move up in the world rankings as long as the health care debate is limited to insurance. Policymakers also should focus on ways to reduce cancer, heart disease and lung disease, said Murray. He advocates stepped-up efforts to reduce tobacco use, control blood pressure, reduce cholesterol and regulate blood sugar. 'Even if we focused only on those four things, we would go along way toward improving health care in the United States,' Murray said. 'The starting point is the recognition that the U.S. does not have the best health care system. There are still an awful lot of people who think it does.'"

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Cost Control for Dummies - WSJ

Summary from National Center for Policy Analysis (as I don't get the WSJ)
COST CONTROL FOR DUMMIES
[Source: Merrill Matthews, "Cost Control for Dummies," Wall Street Journal, August 15, 2007.]
http://online.wsj.com/article/SB118714325206398102.html

Whenever the government controls prices, it arbitrarily determines who it will
pay, how much, and for what, explains Matthews.

Someone explain to me why this is seen as "arbitrary"? Are they tossing coins? As long as we can maintain an open debate about healthcare spending priorities, decisions will not be "arbitrary." Though, I think , the definition of arbitrary for many, is that it didn't go their way.

Cheers,

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France's model healthcare system - The Boston Globe

France's model healthcare system - The Boston Globe:

"National health insurance in France stands upon two grand historical bargains -- the first with doctors and a second with insurers. Doctors only agreed to participate in compulsory health insurance if the law protected a patient's choice of practitioner and guaranteed physicians' control over medical decision-making. Given their current frustrations, America's doctors might finally be convinced to throw their support behind universal health insurance if it protected their professional judgment and created a sane system of billing and reimbursement. French legislators also overcame insurance industry resistance by permitting the nation's already existing insurers to administer its new healthcare funds. Private health insurers are also central to the system as supplemental insurers who cover patient expenses that are not paid for by Sécurité Sociale. Indeed, nearly 90 percent of the French population possesses such coverage, making France home to a booming private health insurance market."

I think that, except for the hard core ideologues, physicians would by and large accept this bargain.

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Aggressive Treatments at End of Life Linked to Worse Quality of Death

Aggressive Treatments at End of Life Linked to Worse Quality of Death:

"'The more time patients spent under hospice care, the greater their quality of death,' Mr. Silverman said. 'For example, patients who received at least 5 weeks of hospice care were in less physical distress in their last week of life than those who lived less than a week with hospice, and those who received no hospice at all were in the most physical distress at the end of their lives. These results suggest that when patients are actively dying, the use of aggressive treatments should be considered with caution and only pursued with the full understanding of patients or their surrogate decision makers.' "

Another pet topic of mine, poor end-of-life care. This is especially tragic, as it represents people being egged on to continue aggressive treatments with full knowledge that there will be no substantial benefit. The resources wasted by this are secondary to the human suffering, but they are massive.

Cheers.

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Medicare Fraud Settlement Causes Oncologists to Lose Income

Medicare Fraud Settlement Causes Oncologists to Lose Income:

"The cases centered around a major sales promotion effort by two pharmaceutical companies, AstraZeneca and TAP Pharmaceuticals, that encouraged oncologists who received free drug samples to provide the samples to their Medicare-insured prostate cancer patients and bill Medicare the $1,200 charge for the product. Many oncologists earned an extra $100,000 annually in income with this program, and some of the busier ones earned more than $1 "

Sorry this is old news, but I'm tring to dig up information on "rebates' and the like to physicians from drug and equipment companies. Let me make it clear that this is unique to certain specialties and is not in any way routine practice for the vast majority of physicians.

Cheers.

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ACP Online - ObserverWeekly - 14 August 2007

ACP Online - ObserverWeekly - 14 August 2007: "Study: Expanding preventive services would save 100,000-plus lives Beefing up preventive care measures such as flu shots and cancer screenings would save more than 100,000 U.S. lives each year, a new study found. The Partnership for Prevention study found 45,000 fewer people would die each year if 90% of adults took aspirin daily to prevent heart disease, instead of the 50% taking it currently. Likewise, if 90% of smokers were given cessation advice, medicine and support by a health professional, 42,000 fewer people would die each year, the study found. Other measures that would save lives, if 90% of the target population received them, include: Colorectal cancer screenings for adults age 50 and over would save 14,000 lives. Fewer than 50% of these adults are screened now; Annual flu shots for adults age 50 and over would save 12,000 lives. Fewer than 37% get the shots now; Breast cancer screening every two years for women age 40 and over would save 3,700 lives. About 67% are screened now; and Chlamydia screenings for sexually active young women would prevent 30,000 cases of pelvic inflammatory disease annually. About 40% are screened now. The study also found African Americans, Hispanic Americans and Asian Americans were less likely to use preventive care than whites. That’s partly because many minorities lack continuity of health care or an ongoing relationship with a health professional who can help ensure preventive measures are taken, an expert said. The study was funded by the CDC, the Robert Wood Johnson Foundation and WellPoint Foundation. The Partnership for Prevention report is online here in pdf. "

Another data point for (inadequate) access to treatment and preventative services. In Sally Pipes piece, she comments about 10% of Canadians looking for a PCP. Ha!

Cheers,

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Court Rules Out Terminally Ill for Tests - washingtonpost.com

Court Rules Out Terminally Ill for Tests - washingtonpost.com:

"Terminally ill patients do not have a constitutional right to be treated with experimental drugs, even if they likely will be dead before the medicine is approved, a federal appeals court said Tuesday. The ruling by the U.S. Court of Appeals for the District of Columbia Circuit overturned last year's decision by a smaller panel of the same court, which held that terminally ill patients may not be denied access to potentially lifesaving drugs."

Just thought I'd start gathering data points about access to treatment, as that seems to be brought up quite a lot in these discussions. My position is that these access issues will need to be carefully thought out and thoughtfully debated as we move to a single payer system.

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Most Canadians scoff at portrayal of their country as a health-care paradis

"When the government pays for healthcare, saving money is more important than saving lives. So bureaucrats have an incentive to delay - or deny - the introduction of new, costly drugs."

The people who write this stuff are a.) not involved in healthcare (at least, not seeing actual patients in any meaningful way) and b.)must have the best G-D insurance in the world. The idea that the US would come out on top in an "anecdote-off" is laughable to all of us actually in healthcare. Our US bureaucrats in our wonderful private insurance industry would make most Soviet era bureaucrats blush.

But the key is this: when the government pays for healthcare, if they don't cover what we demand, then that is a problem with the citizenry, not the bureaucrats, for not taking command of the situation. When we get to a single payer system, it will be up to us to be vigilant and oversee what is being done by our government. I know that is an odd concept to the Bushies, but that is how government needs to work. And, yet, I can guarantee that the Sally Pipes' of this world will howl the loudest when money is being spent on Rituxan for someone other than her family member because it would then be "wasteful government spending"!

Cheers,

read more digg story

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10 Questions: About Health Care - Couric & Co.

10 Questions: About Health Care - Couric & Co.

>>Expanding government control over the financing and delivery of medical services will guarantee even bigger bureaucracy,<< Not necessarily bigger, just different. Ask any healthcare provider or patient which bureaucracy they'd rather deal with, Medicare or a private insurer, and you'll have your answer as to why this a bad argument for conservatives to make. We, the people, have control over our governement bureaucrats, we have none over the privateeers.

>> higher taxes,<< I know this is supposed to scare us (like invoking Castro), but the trade off is no health care premiums and higher salaries (as no more healthcare expenditures out of our total compensation). So, certainly, if this is done in a progressive manner, the top 5% may lose a little, but everyone else will be far better off.

>> and increasingly detailed regulations governing the delivery of care.<< I refer you back to my first comment.

>> Conservative candidates generally emphasize the need to re-energize the market<<
I'd say that the performance of the healthcare sector, particularly insurers and Pharma, suggest no lack of "energy."

>> and make individuals and families the key decision-makers in the system.<< Amen to that, but the author must really live in an alternate universe if he thinks that will EVER happen with private insurers!

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Postbulletin.com: If you want great care, don't put government in charge - Wed, Aug 8, 2007

Postbulletin.com: If you want great care, don't put government in charge - Wed, Aug 8, 2007


An op-ed from Grace-Marie Turner, president of the Galen Institute, which is funded in part by the pharmaceutical industry and medical industry, http://www.galen.org/.


Let's take this apart line-by-line:

ALEXANDRIA, Va. -- No one denies that America's health sector faces problems. Costs continue to rise, and 45 million people lack insurance. Even worse, many politicians think they've discovered the cure in a single-payer system.
But that remedy would be worse than the disease. The government-dominated health systems of Europe and Canada are struggling with serious cost pressures, inefficient bureaucracies and unmet demands for more advanced medical care.


And of course, we have none of that here. I beleive her first sentence is about cost-pressures and unmet demands for care here in the US. She forgets by the time she got to the end of her thought, I guess. Perhaps she was trying to parse "advanced" medical care. If you want basic medical care and can't afford it, that's not our problem. And if she would like to get into a contest regarding inefficient bureaucracies and hold up private health insurance as the better system, she is truly clueless. The ignorance boggles the mind.

For the privilege of their supposedly "free" care, other countries pay much higher taxes. In 2005, taxes consumed 41 percent of GDP in Canada, 42 percent in Britain, and 51 percent in France, compared to 32 percent in the United States.


Yes, the $10-15K or so it costs to insure a family is sooo much better than higher taxes. Why do these people always ignore the cost of health insurance to employers, employees, the self-employed, the un-insured, the under-insured, etc.? Do they realize that cost to individuals becomes subsumed into taxes or some other finance mechanism? I pay less for insurance (or my employer can pay me more salary), and I pay some higher tax rate. I can live with this. And, depending upon your income, 10-20% higher taxes is a great bargain compared to $10K or more for insurance.

Single-payer systems invariably involve rationing. What good is free care if the government denies access to it?


Yes, clearly much better to have private insurers or economic circumstances ration it.
What good is the most advanced high tech medical care in the world if you can't get it?


About 1 million people in the U.K. are on waiting lists for hospital care, including surgeries. And 200,000 more are waiting just to get on the waiting list.
Cancer patients in Britain have resorted to waging public relations campaigns because their government won't pay for new medications for breast and kidney cancer.


Our waiting lists are nicely trimmed by leaving 1/6 of the population out of eligibility to even get into the queue. And if there were alarming statistics indicating a significant differnce in mortality in our favor in more than a few tiny niches, this might actually matter!! And if you can't afford any medication at all beyond the $4 Wal-mart list, tough break, loser!

In Canada, the situation is no better. Long waiting lines lead to restricted access to care. There were 45 inpatient surgical procedures per 1,000 Canadians in 2003, compared to 88 in the United States. Canadians received only one-third as many MRI exams and half as many CT scans.


Again, if we could point to better outcomes, and if we didn't ration so heavily by economics, this might be important. It is a minor concern, and if we were somehow limited in our choice of single-payer to either the Canadian system or nothing, it would only be slightly greater than a minor concern.

Meanwhile, patients in Sweden have been sent to veterinarians for diagnostic tests so the government could reduce waiting lists.


Same.


Proponents of a single-payer system argue that the United States would be different -- that we could get all the money we need to finance universal health insurance by eliminating profit in the private health sector.
But that's like trying to cure a disease with arsenic. Socializing our health-care system would mean that one-sixth of our economy would operate under different economic rules, with the government setting prices, allocating resources and deciding what medical care would be available to whom and when.


Seems to work everywhere else, apart from some issues that we should address as we move forward. But, as with all these pieces, invoking the socialism bogeyman is de rigeur. Because we all know how awful Medicare turned out. Those poor elderly bastards!

There is a better way.
We should embrace competition, not stifle it. We should reward innovators, risk-takers and entrepreneurs for providing faster, better, more affordable health care. And we should recognize that progress depends upon innovation and profit. The U.S. market already is pointing the way by responding to consumer demands for more convenient, more affordable health services.



Yes, this has worked out so well, hasn't it?


Health plans increasingly are offering programs to help patients better manage chronic diseases like diabetes and heart problems that account for roughly 75 percent to 80 percent of our medical payments. The result: dramatic gains in lowering costs and improving healthy outcomes.
Small clinics are springing up in retail stores around the country, providing customers with easy access to nurses who treat common ailments like ear infections and poison ivy. These clinics cost less than a visit to the doctor or emergency room.


And yet, we still lag behind those poor suckers in almost every other country in the western world. They just don't appreciate the sublime beauty of our system.

Competition is leading to more affordable prescription drugs.

And the new Medicare drug benefit shows how competition can lower costs and provide better benefits.
When the Part D program started in 2003, Congress estimated the drug benefit would cost beneficiaries an average of $37 a month. But because private drug plans compete to deliver the Medicare benefit, prices have been far lower than predicted. The average monthly cost of the standard benefit is just $22.


Hahahahahahahahahahahahahaha!

Coming in below cost is unprecedented for a government program -


and for non-government programs as well [DUH!]


- and it shows the government can lower prices by encouraging competition. It's virtually the opposite of a single-payer system, in which governments shut out the private sector.
Rather than regressing to the failing systems of Europe -


Uh, they're only "failing" directly depending upon the degree of underfunding. And, oh, yeah, they're not failing: they're doing bette than we are!!!


- with waiting lines and rationing -- we must develop our own unique solution. Ultimately, that means embracing the truly American qualities of innovation and competition.

How embarrassing for her. But I'm sure she's paid well for it.

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