Saturday, April 30, 2011

President Lyndon B. Johnson's Remarks With President Truman at the Signing in Independence of the Medicare Bill July 30, 1965

President Lyndon B. Johnson's Remarks With President Truman at the Signing in Independence of the Medicare Bill July 30, 1965:

"This is an important hour for the Nation, for those of our citizens who have completed their tour of duty and have moved to the sidelines. These are the days that we are trying to celebrate for them. These people are our prideful responsibility and they are entitled, among other benefits, to the best medical protection available.

"Not one of these, our citizens, should ever be abandoned to the indignity of charity. Charity is indignity when you have to have it. But we don't want these people to have anything to do with charity and we don't want them to have any idea of hopeless despair."
"Many men can make many proposals. Many men can draft many laws. But few have the piercing and humane eye which can see beyond the words to the people that they touch. Few can see past the speeches and the political battles to the doctor over there that is tending the infirm, and to the hospital that is receiving those in anguish, or feel in their heart painful wrath at the injustice which denies the miracle of healing to the old and to the poor. And fewer still have the courage to stake reputation, and position, and the effort of a lifetime upon such a cause when there are so few that share it.

"But it is just such men who illuminate the life and the history of a nation. And so, President Harry Truman, it is in tribute not to you, but to the America that you represent, that we have come here to pay our love and our respects to you today. For a country can be known by the quality of the men it honors. By praising you, and by carrying forward your dreams, we really reaffirm the greatness of America.

"It was a generation ago that Harry Truman said, and I quote him: "Millions of our citizens do not now have a full measure of opportunity to achieve and to enjoy good health. Millions do not now have protection or security against the economic effects of sickness. And the time has now arrived for action to help them attain that opportunity and to help them get that protection."

"Well, today, Mr. President, and my fellow Americans, we are taking such action--20 years later."
"And through this new law, Mr. President, every citizen will be able, in his productive years when he is earning, to insure himself against the ravages of illness in his old age."
"I said to Senator Smathers, the whip of the Democrats in the Senate, who worked with us in the Finance Committee on this legislation--I said, the highest traditions of the medical profession are really directed to the ends that we are trying to serve. And it was only yesterday, at the request of some of my friends, I met with the leaders of the American Medical Association to seek their assistance in advancing the cause of one of the greatest professions of all--the medical profession--in helping us to maintain and to improve the health of all Americans.

"And this is not just our tradition--or the tradition of the Democratic Party--or even the tradition of the Nation. It is as old as the day it was first commanded: "Thou shalt open thine hand wide unto thy brother, to thy poor, to thy needy, in thy land."

"And just think, Mr. President, because of this document--and the long years of struggle which so many have put into creating it--in this town, and a thousand other towns like it, there are men and women in pain who will now find ease. There are those, alone in suffering who will now hear the sound of some approaching footsteps coming to help. There are those fearing the terrible darkness of despairing poverty--despite their long years of labor and expectation--who will now look up to see the light of hope and realization.

"There just can be no satisfaction, nor any act of leadership, that gives greater satisfaction than this."

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Friday, April 29, 2011

It's the Inequality, Stupid | Mother Jones

It's the Inequality, Stupid | Mother Jones:

Illustrations by Jason Schneider

Eleven charts that explain everything that's wrong with America.

It is amazing we haven't had a revolt yet.

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Sunday, April 24, 2011

The Waiting Times Myth

The Incidental Economist Blog started talking about wait times this past week, and has several interesting posts on the topic here, here, and here. I won't reiterate them, they speak (well) for themselves. The bottom line is that we aren't really any great shakes with our wait times and access to care, we spend way too much time and money and use too much of our work force doing expensive procedures when we should be concentrating on primary care and reducing the need for all of those heroics. The US supply of physicians vs. specialists is inverted from high performing health systems where most doctors provide primary care.

Given this background, here's my take.

When I discuss health care reform with friends, families, colleagues, or in public, the two most pervasive myths about health care outside the US are that in every other country, care is inferior and rationing is accomplished by intolerable waiting times. As I endeavor to dispel these myths, I am invariably told an anecdote about a person who died in Canada or England awaiting some procedure or other.

Dispelling these myths is two-fold: first, pointing out the rationing that occurs in America either by private health insurers or by lack of wherewithal to afford services, and second, by pointing out that there are more health care systems than “ours” and “theirs.”

Given that an estimated 45,000 Americans are estimated to die every year due to lack of access to health care services , rationing in America is particularly troublesome, and oddly overlooked. There are many reasons for this, but mostly it is the lack of drama and, paradoxically, the pervasiveness of this experience, especially to those of us in health care. Anecdotes are powerful things, and so I have to always tell a few of my own to counter the horror stories they’ve heard about other countries. So, a few cases of my own: a man who puts off seeing a doctor (for what he knows is diabetes), ends up in the ICU critically ill, because he is trying to get on a health insurance plan and hopes he won’t be found out; a down-sized engineer with a year long persistent cough and weeks of coughing up blood, who waits until he is near death to come to the hospital because he can’t afford to see a doctor; and finally a young man with a seizure disorder admitted twice to the ICU for unremitting seizures in just a few months because his neurologist won’t see him because he’s been underemployed and couldn’t pay his last bill. Multiply my stories by nearly a million physicians in America and you see the magnitude and pervasiveness of the problem.

Beyond anecdotes, there is actual data, such as the Commonwealth Fund study showing that "U.S. patients reported relatively longer waiting times for doctor appointments when they were sick, but relatively shorter waiting times to be seen at the ER, see a specialist, and have elective surgery.” Additionally, Americans are less likely to have a regular doctor, less likely to get prescriptions filled, less likely to get follow-up care, less likely to keep a doctor long-term, and have a harder time getting taken care of nights and weekends. In another report, the Commonwealth Fund has shown the US ranks 19th out of 19 countries evaluated on preventing deaths that are amenable to adequate health care, an excellent measure of the overall performance of a country’s health care system.

That there is more than one country outside the US with a unique health system, might surprise some whose rhetoric suggests a vast wasteland of a series of Soviet style medical gulags. OECD data shows (Siciliani, 2003) that waiting times are a problem in some countries, but only about half of those in the OECD. The others are like the United States in lack of significant waiting times, but unlike us they manage to do this with their entire population covered, and at significantly lower costs.

Now, let's do a little thought experiment. Say you are in a country that has relatively high waiting times for elective procedures, say Canada (but not England so much any more!). Take one sixth of your population and deny them access to care because, oh, they don't deserve it. What do your waiting times look like now? Take another sixth or so, and tell them they have to choose among school, dental care, glasses, food OR preventive health care. Or even life saving health care. OK, now how are your queues?

Americans ration, all right. It is unbecoming, to say the least. It is leaving people to slowly die, to be more blunt. It is under the radar for most, but not for us, not for the millions of care givers and social workers and nurses and parents and children who have to bear witness.

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Some more on Ayn Rand

DownWithTyranny!: The Inspiration For Paul Ryan's Profoundly And Explicitly Anti-Christian Budget

An overview of Ayn Rand and the un-Christian worldview she and her followers, like the hard core conservatives in Congress, represent.

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