Moore: We deserve better than Obamacare

Never let it be said that Michael Moore is a Democratic hack. He speaks his mind.

Of course, for some conservatives, Moore's call for single-payer feeds right into their conspiracy theory that Obamacare was always meant to fail, thereby somehow (I still don't get the how) opening the door for single-payer medical insurance for all Americans who want it.

The Obamacare We Deserve

By Michael Moore

December 31, 2013 | New York Times

Today marks the beginning of health care coverage under the Affordable Care Act’s new insurance exchanges, for which two million Americans have signed up. Now that the individual mandate is officially here, let me begin with an admission: Obamacare is awful.

That is the dirty little secret many liberals have avoided saying out loud for fear of aiding the president’s enemies, at a time when the ideal of universal health care needed all the support it could get. Unfortunately, this meant that instead of blaming companies like Novartis, which charges leukemia patients $90,000 annually for the drug Gleevec, or health insurance chief executives like Stephen Hemsley of UnitedHealth Group, who made nearly $102 million in 2009, for the sky-high price of American health care, the president’s Democratic supporters bought into the myth that it was all those people going to get free colonoscopies and chemotherapy for the fun of it.

I believe Obamacare’s rocky start — clueless planning, a lousy website, insurance companies raising rates, and the president’s telling people they could keep their coverage when, in fact, not all could — is a result of one fatal flaw: The Affordable Care Act is a pro-insurance-industry plan implemented by a president who knew in his heart that a single-payer, Medicare-for-all model was the true way to go. When right-wing critics “expose” the fact that President Obama endorsed a single-payer system before 2004, they’re actually telling the truth.

What we now call Obamacare was conceived at the Heritage Foundation, a conservative think tank, and birthed in Massachusetts by Mitt Romney, then the governor. The president took Romneycare, a program designed to keep the private insurance industry intact, and just improved some of its provisions. In effect, the president was simply trying to put lipstick on the dog in the carrier on top of Mitt Romney’s car. And we knew it.

By 2017, we will be funneling over $100 billion annually to private insurance companies. You can be sure they’ll use some of that to try to privatize Medicare.

For many people, the “affordable” part of the Affordable Care Act risks being a cruel joke. The cheapest plan available to a 60-year-old couple making $65,000 a year in Hartford, Conn., will cost $11,800 in annual premiums. And their deductible will be $12,600. If both become seriously ill, they might have to pay almost $25,000 in a single year. (Pre-Obamacare, they could have bought insurance that was cheaper but much worse, potentially with unlimited out-of-pocket costs.)

And yet — I would be remiss if I didn’t say this — Obamacare is a godsend. My friend Donna Smith, who was forced to move into her daughter’s spare room at age 52 because health problems bankrupted her and her husband, Larry, now has cancer again. As she undergoes treatment, at least she won’t be in terror of losing coverage and becoming uninsurable. Under Obamacare, her premium has been cut in half, to $456 per month.

Let’s not take a victory lap yet, but build on what there is to get what we deserve: universal quality health care.

Those who live in red states need the benefit of Medicaid expansion. It may have seemed like smart politics in the short term for Republican governors to grab the opportunity offered by the Supreme Court rulings that made Medicaid expansion optional for states, but it was long-term stupid: If those 20 states hold out, they will eventually lose an estimated total of $20 billion in federal funds per year — money that would be going to hospitals and treatment.

In blue states, let’s lobby for a public option on the insurance exchange — a health plan run by the state government, rather than a private insurer. In Massachusetts, State Senator James B. Eldridge is trying to pass a law that would set one up. Some counties in California are also trying it. Montana came up with another creative solution. Gov. Brian Schweitzer, a Democrat who just completed two terms, set up several health clinics to treat state workers, with no co-pays and no deductibles. The doctors there are salaried employees of the state of Montana; their only goal is their patients’ health. (If this sounds too much like big government to you, you might like to know that Google, Cisco and Pepsi do exactly the same.)

All eyes are on Vermont’s plan for a single-payer system, starting in 2017. If it flies, it will change everything, with many states sure to follow suit by setting up their own versions. That’s why corporate money will soon flood into Vermont to crush it. The legislators who’ll go to the mat for this will need all the support they can get: If you live east of the Mississippi, look up the bus schedule to Montpelier.

So let’s get started. Obamacare can’t be fixed by its namesake. It’s up to us to make it happen.

Bloomberg: U.S. heath system least efficient in the world

Speaker John Boehner and Majority Leader Mitch McConnell both called the U.S. health care system the best in the world.

What were they thinking?!  The U.S. has the most expensive (in absolute terms) and the least efficient health care system (in relative terms) in the world! Check it out.

The Most Efficient Health Care Systems In The World

By Kavitha A. Davidson

August 29, 2013 | Huffington Post

As supporters and opponents of the Affordable Care Act debate the best way to overhaul a clearly broken health care system, it's perhaps helpful to put American medicine in a global perspective.

The infographic below is based on a recent Bloomberg ranking of the most efficient countries for health care, and highlights enormous gap between the soaring cost of treatment in the U.S. and its quality and effectiveness. To paraphrase Ricky Ricardo, the American health care system has a lot of 'splainin' to do.

It's remarkable how low America places in health care efficiency: among the 48 countries included in the Bloomberg study, the U.S. ranks 46th, outpacing just Serbia and Brazil. Once that sinks in, try this one on for size: the U.S. ranks worse than China, Algeria, and Iran.

But the sheer numbers are really what's humbling about this list: the U.S. ranks second in health care cost per capita ($8,608), only to be outspent by Switzerland ($9,121) -- which, for the record, boasts a top-10 health care system in terms of efficiency. Furthermore, the U.S. is tops in terms of health care cost relative to GDP, with 17.2 percent of the country's wealth spent on medical care for every American.

In other words, the world's richest country spends more of its money on health care while getting less than almost every other nation in return.

It's important to note that this data doesn't necessarily reflect the best health care in the world; it is simply a measure of overall quality as a function of cost. Bloomberg explains its methodology as such:

Each country was ranked on three criteria: life expectancy (weighted 60%), relative per capita cost of health care (30%); and absolute per capita cost of health care (10%). Countries were scored on each criterion and the scores were weighted and summed to obtain their efficiency scores. Relative cost is health cost per capita as a percentage of GDP per capita. Absolute cost is total health expenditure, which covers preventive and curative health services, family planning, nutrition activities and emergency aid. Included were countries with populations of at least five million, GDP per capita of at least $5,000 and life expectancy of at least 70 years.

So what can the U.S. learn from the many countries that get more bang for their health care buck? Unsurprisingly, there is no one formula for success when it comes to efficient medical care. The systems that rank highly on Bloomberg's list are as diverse as the nations to which they belong. The unifying factor seems to be tight government control over a universal system, which may take many shapes and forms -- a fact evident in the top-three most efficient health care systems in the world: Hong Kong, Singapore, and Japan.

Ranking third on Bloomberg's list, the Japanese system involves universal health care with mandatory participation funded by payroll taxes paid by both employer and employee, or income-based premiums by the self-employed. Long-term care insurance is also required for those older than 40. As Dr. John W. Traphagan notes in The Diplomat, Japan controls costs by setting flat rates for everything from medications to procedures, thus eliminating competition among insurance providers. While most of the country's hospitals are privately owned and operated, the government implements smart regulations to ensure that the system remains universal and egalitarian.

Meanwhile, Singapore's health care system is largely funded by individual contributions, and is often hailed by conservatives as a beacon of personal responsibility. But as conservative David Frum notes, the system is actually fueled by the invisible hand of the public sector: individuals are required to contribute a percentage of their monthly salary based on age to a personal fund to pay for treatments and hospital expenditures. In addition, the government provides a safety net to cover expenses for which these personal savings are inadequate. Private health care still plays a role in Singapore's system, but takes a backseat to public offerings, which boast the majority of doctors, nurses, and procedures performed.

Despite being considered by some as having the freest economy in the world, Hong Kong's universal health care system involves heavy government participation; its own health secretary calls public medicine the "cornerstone" of the system. Public hospitals account for 90 percent of in-patient procedures, while the numerous private options are mostly used by the wealthy.

All this government care isn't taking much of a bite out of the state's bustling economy: According to Bloomberg, Hong Kong spends just 3.8 percent of GDP on health care per capita, tied for the third-lowest among nations surveyed and good for the most efficient health care system in the world.

Krugman: 5 litmus tests for true conservatives?

Krugman is totally right about one's values determining one's view on the welfare state. (I would say it's more a question of aesthetics.)  It's not something you can really debate. Believe me, I've tried.

There really are people who believe in the "work or starve" / "let the devil take the hindmost" philosophy of social Darwinism, and they make up about 20 percent of the U.S. population and the core of the Tea Parties and Republican Party.

When it comes to the general welfare, they are not interested in outcomes, but rather in ideology, in establishing ideal, Randian rules of the game that don't impede the unlimited accumulation of wealth with no responsibility to give anything back.  For them that belief is ironclad; it's beyond argument.

Krugman offers 5 issues, on the other hand, that do hinge on results, on empirical evidence.  One side is definitely right or wrong.  For these issues it's not a question of values or what's "right," but rather what's provably correct.  Krugman observes that while liberals can and do disagree on these 5 issues, and still call themselves liberal without suffering ideological exile, conservatives must answer a certain way on all 5 or else be confined to an ideological reservation for "RINOs."

The Closing of the Conservative Mind

By Paul Krugman

May 25, 2013 | New York Times

URL: http://mobile.nytimes.com/blogs/krugman/2013/05/25/the-closing-of-the-conservative-mind/

Obama reveals hospitals' real prices. Now what??

There goes that socialist Obama Administration again!:

The database released on Wednesday by the federal Centers for Medicare and Medicaid Services lays out for the first time and in voluminous detail how much the vast majority of American hospitals charge for the 100 most common inpatient procedures billed to Medicare. The database -- which covers claims filed within fiscal year 2011 -- spans 163,065 individual charges recorded at 3,337 hospitals located in 306 metropolitan areas.

This time Obama had the gall to publicly release information about the real prices that hospitals and doctors charge for medical procedures.  So that people, can, like, you know, compare prices and stuff.

If that sounds like something out the free market, you're right. But that doesn't matter, because it was OBAMA who publicized the information!  He always has a diabolical ulterior motive!  We just don't know what it is yet....

Seriously though, I know from personal experience that the prices hospitals charge are totally wacko. Recently my young child spent five days in the hospital while our registration for new health insurance, retroactive to Jan. 1, was still in process.  She's perfectly fine now, thank Allah, but we subsequently received a hospital bill for $31,000.  Bill collectors immediately started to call the house several times a day, every day, and all we could tell them was the same thing the insurance company told us: the paperwork is still in process; later the hospital could re-submit the claim.  

After our health insurance finally kicked in and the claim was processed, the hospital told us over the phone that our share would be about $3,000, but a few months have passed and still no bill for $3,000.  Meanwhile the hospital's billing office asked us to submit an application for a discount, which we did.  I suspect that $3,000 remaining charge will simply disappear, but if not.... Thankfully, I can afford to pay it, but for most poor families an unexpected medical emergency like that would ruin them.  

Indeed, medical bills are the #1 cause of personal bankruptcy in the U.S.

This case illustrates why health care can never be a free market.  First, the patient has no clue what he needs to buy.  If you're in critical condition and the doctor says, "We're going to stick this tube down your throat," you're not going to second-guess him... and meanwhile bargain or threaten to "take your business elsewhere."  No, you just do whatever he says, immediately. (This is assuming you're conscious at the time; otherwise the doctor just does it.)  

As a medical "consumer," you rarely have an actual choice.  Without information/knowledge, prices and choice there cannot be a competitive free market.  

The most that such information provided by Obama can do is help a patient after the fact who asks his provider, "Why did you charge me so much, when Hospital X down the road charges one-tenth as much for the same thing?"  But a patient is in a pretty weak bargaining position ex post facto.

This case also illustrates why everybody needs to be insured.  You cannot plan for the unplanned that costs who-knows-how-much.  And you're in no condition to bargain when you're critically ill.  That's why people buy insurance.  But for any kind of insurance scheme to work, the insurance pool has to be large enough to spread out risk and expense over many customers/insured.

Usually it's the 49 million poorer Americans who have no health insurance. The sick irony is that those people who are least able to pay are the ones asked to pay the full, "real" price of medical treatment.  Of course they often cannot pay.  So the hospital's actual cost for that treatment, whatever it really is, gets passed onto those who can pay, i.e. to health insurance companies.  It's a terribly messed-up "system."

Again, let me remind you that Obamacare opts to work primarily through this existing labyrinth of private health insurance.  This is the same system that Republicans think is not broken so we don't need to fix it.  Obamacare's most unpopular aspect -- the individual mandate -- requires people to participate in this "free-market" system.  It sets up new healthcare exchanges where people can buy private health insurance.  This is all as the Heritage Foundation, Newt Gingrich and Mitt Romney said it should be, before Obama took their suggestion and they decided they hated it.  

Whereas many liberals like myself want us to have a single-payer system, aka Medicare for all, to keep down costs and ensure universal coverage. But our compromiser-in-chief didn't opt for that route, he never even tried.  

Hospital Bill Shocker: U.S. Releases Thousands Of Records Showing Huge, Wildly Differing Prices

By Jeffrey Young and Chris Kirkham

May 8, 2013 | Huffington Post

URL: http://huff.to/16W4BIC

Lancet: How to achieve universal health coverage

Warning: this study in the prestigious medical journal The Lancet is not for followers of faith-based science, or supporters of CATO, Heritage Foundation or the Family Research Council. This is for Americans who, living in the richest country on Earth, believe that universal health coverage (forget about the means for a moment) is both our common goal and moral obligation.

Here's the Summary:

Countries have reached universal health coverage by different paths and with varying health systems. Nonetheless, the trajectory toward universal health coverage regularly has three common features. The first is a political process driven by a variety of social forces to create public programmes or regulations that expand access to care, improve equity, and pool financial risks. The second is a growth in incomes and a concomitant rise in health spending, which buys more health services for more people. The third is an increase in the share of health spending that is pooled rather than paid out-of-pocket by households. This pooled share is sometimes mobilised as taxes and channelled through governments that provide or subsidise care—in other cases it is mobilised in the form of contributions to mandatory insurance schemes. The predominance of pooled spending is a necessary condition (but not sufficient) for achieving universal health coverage. This paper describes common patterns in countries that have successfully provided universal access to health care and considers how economic growth, demographics, technology, politics, and health spending have intersected to bring about this major development in public health.

Note that America meets the second criterion already, and Obamacare meets the other two. 

And here's the key take-away: 

Countries that want to achieve universal health coverage need to adopt public policies that reduce reliance on out-of-pocket spending and improve the institutions that manage pooled funding to address the equity, efficiency, and sustainability of health expenditures.

Finally, let's recognize that although government must always play a strong role, constant tinkering with the system is a hallmark of universal health coverage. Countries with universal coverage don't declare victory and call it a day:

A large government role is always an essential element in the expansion of access to care and provision of financial protection. However, the process of negotiation and compromise over health reforms leads governments to assume different roles and leads health systems institutions to take on different forms. Even in countries that have effectively universalised access to most health care, the process of debate and contestation does not end. Instead, debates continue in response to changes in economics, politics, and medical technology, as well as inequities in access that persist even in the most effective systems.

Thus, when right-wing media cite public "discontent" with universal coverage systems in countries like Britain and Canada, we must note that their public is never in favor of scrapping their system in favor of "free-market medicine," but rather reforming their existing system.  Indeed, as cited byThe Wall Street Journal, in a survey of the 10 major economies in 2008, Americans reported the lowest level of satisfaction with their health coverage.  

Political and economic aspects of the transition to universal health coverage

By Dr. William D Savedoff, et al

September 8, 2012 | The Lancet

URL: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61083-6/fulltext