fayfreethinkers.com

DAR
Another fantastic article debunking myths about single payer and Canada's health care system.

LINK.

O Canada,
Health Care Myths
from the Great White North

A talk by Karen S. Palmer MPH, MS, California Physicians Alliance (CaPA), San Francisco, January 13, 1999

(Karen Palmer has lived with one foot on either side of the Canada/US border since 1984. She spends part of every year in the U.S. and part in Canada, and she participates in the health care systems of each country as both a patient and a policy analyst. She holds graduate degrees in international health and health policy, and is a passionate advocate for universal health care. She is also on the board of Physicians for a National Health Program. When in Canada, she lives in Alberta, and in the US she has lived in California, Hawaii, and currently in Utah)

KAREN PALMER
I have been asked to talk to you about how health care works in Canada. Some might ask why I bother telling people about how health care systems work in other countries. If I knew, for a fact, that the majority of Americans were happy with the way health care works in the US, I would probably keep my big mouth shut about the way it works in other countries. But polls show that the majority of Americans are not happy with the state of health care here. A 1999 Harris Poll showed that 82% of the public and physicians support fundamental change in the health care system. A 1999 Kellogg Foundation survey found that 85% think that the expense of health care in this country is created by insurance bureaucracy and 79% think health care should be a right.
In fact, we know that the US is the only industrialized country in the world that doesn't guarantee at least some form of health care to all of its citizens or legal residents. So, it seems that people are at least curious about how we might improve the health care system in the US, and that ís where I come in.
In a sense, the entire debate comes down to whether you think health care is a right or a privilege. If you think that it is a privilege, and that it should be rationed on the basis of ability to pay, then you are presumably happy with the way things are and this talk will only irritate you. But if you, like most Americans, think health care is a right and that everyone deserves care irrespective of ability to pay, then you might be interested in what I have to say.

I am not here to tell you that we should copy Canada's system in its entirety, or that Canada is better than the US. I am here to tell you that Canada's system works, with some recent exceptions, for all Canadians and that there are things about it that could work in the US. Bashing Canada's health care system seems to be a favorite pastime, but uncritical analysis of anecdotes serves no real purpose. I encourage you to use the same critical thinking skills with which you would analyze the diagnosis and care of a patient, that is, look at peer reviewed literature, and ignore anecdotes when real data tell you otherwise.
I will first spend a little time talking about how health care works in the US, then I'll describe the architecture of the Canadian health care system along with some of the amazing-but-untrue myths about Canada's system, and finally we'll open it up to your questions.

Excerpt:

“The total costs to administer claims for Canada's public system eats up about 1% of all health care expenditures. In the US, Medicare claims administration costs take about 2-2.5% (US pays on a per hospital stay basis rather than lump sum budgeting as in Canada.) Total administrative costs in Canada including hospital administration and physician's office costs is about 14% of total spending, as compared to about 25% in the US. Some US insurance costs can devour nearly 1/3 of the dollars spend on health care. Because less money is spend on administration in Canada, Canadians actually get more physician and hospital services than Americans.”

“When I was in graduate school in Hawaii, Governor Michael Dukakis taught a health policy course. We didn't agree on things like employer mandates, but we had fun arguing about it. At the end of the course, he decided that he wanted to visit Canada, and so we went to Vancouver to talk with Robert Evans (a brilliant health economist) and others. We visited a large metropolitan hospital and the governor asked to see the "billing wing". We took him to a small room about the size of my kitchen and pointed to the small staff who made up this "billing wing". The Governor was amused."

The Rest.

DAR
Long but worth a skim if you're interested in this subject.

President Obama calls on American’s to rally in favor of health care reform today to weaken the position of lobbyist and bring about real change. Unless our congress pass health care reform the billing wing in our private insurance company's and hospitals will keep expanding. Who’s in?

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.........................TEN QUESTIONS ABOUT HEALTH CARE


BUZZFLASH GUEST COMMENTARY

Forwarded by Dave Lindorff (based on an idea from one of his readers)

Questions Should You Find Yourself at a microphone at a 'Town Meeting':

1. If Canada's single-payer system is so god-awful, why have repeated Conservative governments at the provincial and national level in Canada never touched it? Canada is a democracy. If Canadians don't like their health care system, why haven't they gotten rid of it in 35 years? Since the system there is run by the separate provinces, many of which are very politically conservative, why has not one province ever tried to get rid of single-payer?

2. Why is rationing by income, as we do it here, better than rationing by need, as they do it in Canada?

3. Wouldn't single-payer mean that companies could no longer threaten working people with the loss of their health insurance? Why is this a bad idea?

4. The bigger the insurance pool, the better. So doesn't having a national pool, as with single-payer, make the most sense?

5. Why should we be allowing politicians who are taking money from the medical industry to write the new health care legislation?

6. How can the Congress be developing a health system reform scheme and not even invite experts from Canada down to explain their successful system?

7. If Medicare--a single-payer system here in America--is so popular with the elderly, how come it's no good for the rest of us?

8. Isn't it true that Medicare currently finances the most costly patient group--the elderly and infirm--so that extending it to the rest of the population--most of whom are young and healthy--would be much cheaper, per person?

9. The AMA, the Pharmaceutical Industry, and the Insurance Industry all bitterly opposed Medicare in 1964-5 when it was being debated in Congress and passed into law, with the right, led by Ronald Reagan, calling it creeping socialism. It became a life-saver for the elderly and didn't turn the US into a soviet republic. Why should we give a tinker's damn what those same three industry groups and the Republican right think of expanding single-payer now?

10. The executives of Canadian subsidiaries of US companies all support Canada's single-payer system, and even lobby collectively to have it expanded and better funded. Why does Congress listen to the executives of the parent companies here at home, and not invite those Canadian execs down to explain why they like single-payer?

BUZZFLASH GUEST COMMENTARY

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The new england journal of medicine

Costs of Health Care Administration
in the United States and Canada
Steffie Woolhandler, M.D., M.P.H., Terry Campbell, M.H.A.,
and David U. Himmelstein, M.D.

background
A decade ago, the administrative costs of health care in the United States greatly exceeded
those in Canada. We investigated whether the ascendancy of computerization, managed
care, and the adoption of more businesslike approaches to health care have decreased
administrative costs.

methods
For the United States and Canada, we calculated the administrative costs of health insurers,
employers’ health benefit programs, hospitals, practitioners’ offices, nursing
homes, and home care agencies in 1999. We analyzed published data, surveys of physicians,
employment data, and detailed cost reports filed by hospitals, nursing homes,
and home care agencies. In calculating the administrative share of health care spending,
we excluded retail pharmacy sales and a few other categories for which data on administrative
costs were unavailable. We used census surveys to explore trends over time in
administrative employment in health care settings. Costs are reported in U.S. dollars.

results
In 1999, health administration costs totaled at least $294.3 billion in the United States,
or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration
accounted for 31.0 percent of health care expenditures in the United States
and 16.7 percent of health care expenditures in Canada. Canada’s national health insurance
program had overhead of 1.3 percent; the overhead among Canada’s private insurers
was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers’
administrative costs were far lower in Canada.
Between 1969 and 1999, the share of the U.S. health care labor force accounted for
by administrative workers grew from 18.2 percent to 27.3 percent. In Canada, it grew
from 16.0 percent in 1971 to 19.1 percent in 1996. (Both nations’ figures exclude insurance-
industry personnel.)

conclusions
The gap between U.S. and Canadian spending on health care administration has grown
to $752 per capita. A large sum might be saved in the United States if administrative costs
could be trimmed by implementing a Canadian-style health care system.

abstract here

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The brutal truth about America’s healthcare

An extraordinary report from Guy Adams in Los Angeles at the music arena that has been turned into a makeshift medical centre

The Independent, 15 Aug, 2009

They came in their thousands, queuing through the night to secure one of the coveted wristbands offering entry into a strange parallel universe where medical care is a free and basic right and not an expensive luxury. Some of these Americans had walked miles simply to have their blood pressure checked, some had slept in their cars in the hope of getting an eye-test or a mammogram, others had brought their children for immunisations that could end up saving their life.

In the week that Britain's National Health Service was held aloft by Republicans as an "evil and Orwellian" example of everything that is wrong with free healthcare, these extraordinary scenes in Inglewood, California yesterday provided a sobering reminder of exactly why President Barack Obama is trying to reform the US system.

Entire story here.

"I've been very conservative in my outlook for the whole of my life. I've been described as being about 90,000 miles to the right of Attila the Hun. But I think one reaches the reality that something doesn't work... In this country something has to be done. And as a proud member of the US community but a loyal British subject to the core, I would say that if Britain could fix it in 1944, surely we could fix it here in America.

Healthcare compared

Health spending as a share of GDP

US 16%

UK 8.4%

Public spending on healthcare (% of total spending on healthcare)

US 45%

UK 82%

Health spending per head

US $7,290

UK $2,992

Practising physicians (per 1,000 people)

US 2.4

UK 2.5

Nurses (per 1,000 people)

US 10.6

UK 10.0

Acute care hospital beds (per 1,000 people)

US 2.7

UK 2.6

Life expectancy:

US 78

UK 80

Infant mortality (per 1,000 live births)

US 6.7

UK 4.8

Source: WHO/OECD Health Data 2009

Quite a story here too:

How American Health Care Killed My Father

Excerpts:

***
"As a nation, we now spend almost 18 percent of our GDP on health care. In 1966, Medicare and Medicaid made up 1 percent of total government spending; now that figure is 20 percent, and quickly rising. Already, the federal government spends eight times as much on health care as it does on education, 12 times what it spends on food aid to children and families, 30 times what it spends on law enforcement, 78 times what it spends on land management and conservation, 87 times the spending on water supply, and 830 times the spending on energy conservation. Education, public safety, environment, infrastructure—all other public priorities are being slowly devoured by the health-care beast."

...Well, for every two doctors in the U.S., there is now one health-insurance employee—more than 470,000 in total. In 2006, it cost almost $500 per person just to administer health insurance."

--http://www.theatlantic.com/doc/200909/health-care/2

"...hospitals, drug companies, health insurers, and medical-device manufacturers now spend roughly $6 billion a year on advertising.

Medicare spends almost twice as much per patient in Dallas, where there are more doctors and care facilities per resident, as it does in Salem, Oregon, where supply is tighter. Why? Because doctors (particularly specialists) in surplus areas order more tests and treatments per capita, and keep their practices busy. Many studies have shown that the patients in areas like Dallas do not benefit in any measurable way from all this extra care.

"For fun, let’s imagine confiscating all the profits of all the famously greedy health-insurance companies. That would pay for four days of health care for all Americans. Let’s add in the profits of the 10 biggest rapacious U.S. drug companies. Another 7 days. Indeed, confiscating all the profits of all American companies, in every industry, wouldn’t cover even five months of our health-care expenses.

Somebody else always seems to be paying for at least part of our health care. But that’s just an illusion. At $2.4 trillion and growing, our nation’s health-care bill is too big to be paid by anyone other than all of us.

In 2007, employer-based health insurance cost, on average, more than $12,000 per family, up 78 percent since 2001. I’ve run several companies and company divisions of various sizes over the course of my career, so I can confidently tell you that raises (and even entry-level hiring) are tightly limited by rising health-care costs. You may think your employer is paying for your health care, but in fact your company’s share of the insurance premium comes out of your potential wage increase. Where else could it come from?

Let’s say you’re a 22-year-old single employee at my company today, starting out at a $30,000 annual salary. Let’s assume you’ll get married in six years, support two children for 20 years, retire at 65, and die at 80. Now let’s make a crazy assumption: insurance premiums, Medicare taxes and premiums, and out-of-pocket costs will grow no faster than your earnings—say, 3 percent a year. By the end of your working days, your annual salary will be up to $107,000. And over your lifetime, you and your employer together will have paid $1.77 million for your family’s health care. $1.77 million! And that’s only after assuming the taming of costs! In recent years, health-care costs have actually grown 2 to 3 percent faster than the economy. If that continues, your 22-year-old self is looking at an additional $2 million or so in expenses over your lifetime—roughly $4 million in total.

Would you have guessed these numbers were so large? If not, you have good cause: only a quarter would be paid by you directly (and much of that after retirement). The rest would be spent by others on your behalf, deducted from your earnings before you received your paycheck. And that’s a big reason why our health-care system is so expensive."

http://www.theatlantic.com/doc/200909/health-care/3

The states that have been most skeptical of President Barack Obama's agenda for health care reform also have some of the highest levels of uninsured people in the nation.

A new study by Gallup shows that large swaths of populations in the South and West -- anywhere from one-in-five to one-in-four individuals -- are currently lacking health insurance coverage.

These same regions also have the largest percentage of populations who believe widely perpetuated mistruths about the Obama agenda, including allegations that the president will set up "death panels" and wants a complete government takeover of the health care system.

According to Gallup, of the 25 states with the greatest percentage of the uninsured, all but three are based in the South or the Midwest.

LIST OF STATES WITH MOST UNINSURED

Texas - 27 percent of the population is uninsured New Mexico --- 25.6 percent Mississippi - 24 percent Louisiana - 22.4 percent Nevada - 22.2 percent Oklahoma - 22.2 percent (considered a Midwest state) California - 21 percent Wyoming - 20.7 percent Florida - 20.7 percent Georgia - 20.7 percent South Carolina - 20.4 percent Montana - 20.3 percent Alaska -- 20.2 percent Arkansas - 20.1 percent Colorado - 20 percent Oregon - 19.4 percent West Virginia - 19.3 percent (considered a Northeast state) North Carolina - 19.3 percent Idaho - 18.8 percent Utah - 18.1 percent Kentucky - 17.9 percent Tennessee - 17.8 percent Nebraska - 17.7 percent Alabama - 17.2 percent Missouri - 17.1 percent (considered a Midwest state)
STATES IN SOUTH AND WEST ARE AS FOLLOWS

South: FL, NC, SC, AL, MS, GA, VA, TN, KY, LA, AR, TX
West: NM, CA, OR, WA, AK, HI, MT, ID, UT, NV, AZ, WY, CO


Compare these findings to those pulled from a recent Daily Kos/Research 2000 poll, which showed that more people in the South and Midwest are prone to believe myths about Obama's health care plan than in other regions of the country.

See here.

For those who like to bash the VA:

***
Does the government actually run the BEST healthcare?

August 10, 11:24 AMSF Health News Examiner
Jefferson Adams

Excerpt:

But is there really a good argument to be made against government run healthcare plans in general? Certainly, the healthcare enjoyed by members of congress is government-run, as is that offered to our armed servicemen and women. How do they measure up to privately run medical programs?

A team of researchers recently set out to compare the quality of VHA care with that of care in a national sample by using a comprehensive quality-of-care measure.

The research team was made up of Steven M. Asch, MD, MPH; Elizabeth A. McGlynn, PhD; Mary M. Hogan, PhD; Rodney A. Hayward, MD; Paul Shekelle, MD, MPH; Lisa Rubenstein, MD; Joan Keesey, BA; John Adams, PhD; and Eve A. Kerr, MD, MPH.

The Veterans Health Administration (VHA) has introduced an integrated electronic medical record, performance measurement, and other system changes directed at improving care. Recent comparisons with other delivery systems have been limited to a small set of indicators.

The researchers made a cross-sectional comparison of 12 VHA health care systems and 12 communities. They looked at 596 VHA patients and 992 patients identified through random-digit dialing. All patients were male and over 35 years of age.

Using a chart-based quality instrument consisting of 348 indicators targeting 26 conditions, the team measured looked at the period between 1997 and 2000. They adjusted results for clustering, age, number of visits, and medical conditions.

VA scores highest in quality of care
The research team found that patients from the VHA scored 16 percentage points higher for adjusted overall quality (67% vs. 51%; difference [95% CI, 14 to 18 percentage points]),

For chronic disease care, the VA finished 13 percentage points higher (72% vs. 59%; difference [CI, 10 to 17 percentage points]).

For preventive care, the VA finished 20 points higher (64% vs. 44%; difference [CI, 12 to 28 percentage points]). The comparison the VA did not win was for acute care.

The VHA held the strongest advantage in processes targeted by VHA performance measurement, where the VA finished 23 percentage points ahead of the competition (66% vs. 43%; difference [CI, 21 to 26 percentage points]).

The weakest advantage was in areas unrelated to VHA performance measurement, where they finished 0 to 10 percentage points ahead of their nearest competitor (55% vs. 50%; difference, 5 percentage points [CI, 0 to 10 percentage points]).

The study results were somewhat limited by unmeasured residual differences in patient characteristics, a lower response rate in the national sample, and differences in documentation practices could have contributed to some of the observed differences.

From the study, the research team concludes that patients receiving socialized, government-run medicine from the VHA received higher-quality care according to a broad measure. Differences were greatest in areas where the VHA has established performance measures and actively monitors performance.

What this study really says is that the more accurately we measure, the more we begin to see that socialized, government-run medical programs like the VA provide extremely high quality medical care.

This study seriously undermines a common refrain of those opposed to healthcare reform, and a strong public healthcare option, that government-run healthcare means poor quality. This recent study of the government-run VA medical system shows that contrary to those doubters, government-run healthcare leads in nearly every measurable category.

So, next time you hear the canard that government-run healthcare will be poor quality, cite the recent VA study that shows just the opposite: Government-run medical care actually leads in nearly every meaningful measure of quality."

LINK

***
Bonus:

"The fact is that the government-run U.S. Veterans healthcare system is now considered signficantly more efficient than private-sector healthcare according to:

The New England Journal of Medicine ("Effect of the Transformation of the Veterans Affaris Health Care System on the Quality of Care, May 29, 2003)

The Annals of Internal Medicine ("Diabetes Care Quality in the Veterans Affairs Health Care System and Commercial Managed Care: The TRIAD Study," August 17, 2004)

U.S. News & World Report (America's Best Hospitals, Military Might, July 18 2005);

The American Journal of Managed Care ("The Veterans Health Administration: Quality, Value, Accountability, and Information as Transforming Strategies for Patient-Centered Care," 2004,10; part2);

Washington Monthly ("The Best Care Anywhere," January/February 2005)

The Washington Post ("Revamped Veterans Health CAre Now a Model," August 22, 2005).

The Healthcare blog

Quite enjoyable to hear the old accent again.

Canadians talking about their health care. They look to the south and try to understand, but it is difficult for them. They dealt with this problem in 1966, the year I was born.

Just a nine minutes:

http://www.youtube.com/watch?v=VQFX32Ed7ZQ

Blurb:

"In the spirit of truth, my friend Matte Black (@Shoq on Twitter) and his brother took their video camera to Canada on vacation to interview Canadians about their health care system. When we talked about it, I asked him to try to get negative views with specifics for balance. Here is the result. It has been edited for brevity, but the negative views were not removed, because there were none. He could not find one Canadian who thought they should kill the system."

Link.

"In December 2007, the 124,000-member American College of Physicians endorsed for the first time a single-payer national health insurance program. And a March 2008 study by Indiana University -- the largest survey ever of doctors' opinions on financing health-care reform -- concluded that 59 percent of doctors support national health insurance."
--George McGovern, Washington Post

"[Obama] walked into the White House and inherited a $1 trillion-plus deficit from the Republican administration because they had fought a war in Iraq they didn't pay for, the gave tax breaks to the wealthy they didn't pay for and they had a prescription drug program under Medicare they didn't pay for. This president said that's over, and members of Congress should take that seriously... The fact is, under Medicare now we are providing multibillion-dollar subsidies to health insurance companies for something called Medicare Advantage. The health insurance companies said to us, let us run Medicare. We can show you how the government's not doing it efficiently, we can do it at a lower cost. Guess what, it's not at a lower cost. We are subsidizing private health insurance companies to provide the Medicare benefits that we can provide at a lower cost. That has to change. That subsidy has to end. That is the kind of savings that can come back into the system to help small businesses provide health insurance and help those with lower incomes pay their premiums in America." --Sen. Dick Durban, Sunday Sep 13, 2009 LINK

The number of physicians who support a public option has increased.

==============================
More than 80% of the America's largest doctors' union-- the Union of American Physicians & Dentists-- consider some form of public insurance to be essential.

**** Press Release *********
OAKLAND, CA -- At its Triennial Convention in San Francisco on Friday, October 2, the Union of American Physicians & Dentists (UAPD), an affiliate of the American Federation of State, County & Municipal Employees (AFSCME) and the AFL-CIO, will announce the results of an internal survey that shows that union doctors overwhelming support offering a public option as part of health care reform.

More than 80% of UAPD doctors consider some form of public health insurance to be the best plan for American health care.

Read more here.

All,

Last night at dinner I started to think about how health care reform would affect Workmen's Compensation. If employers are required to carry health insurance on all of their employees in case they get hurt on the job wouldn't that be redundant if everyone had health care?

Has anyone heard how that might affect Worker's Comp? I would think if everyone had health coverage then there would be no need for Workmen's Compensation. I could see employers would either have to be bonded or insured to cover wages of someone hurt on the job and they would still be required to have a safe work environment. The employers would still have to comply with all of the health and safety rules such as OSHA. But has anyone considered getting more bang for your buck if you have to purchase Workmen's Comp insurance but instead you apply those cost national health care.

JamesH wrote:...wouldn't that be redundant if everyone had health care?

DAR
Yep. If the US could get it's ridiculous health care costs under control (start by stop feeding the insurance beast), the savings would cascade throughout the workforce and economy. It costs $3 to $4 more per worker, per hour, to run a business in the US than in Canada due to the difference in health care costs. These higher costs are not insignificant and get passed along to everyone and really hamper US competitiveness.

Speaking of healthcare rationing:

***
WASHINGTON - Twenty percent of Americans say they have delayed or postponed medical care, mostly doctor visits, and many said cost was the main reason, according to a survey by Thomson Reuters released on Monday.

That figure is up since 2006, the last time the question was asked on the survey, when 15.9 percent of people said they had postponed or canceled medical care in the past year.

"The results of this survey have serious implications for public health officials, hospital administrators, and healthcare consumers," Gary Pickens of the Healthcare division of Thomson Reuters, who led the study, said in a statement. "We are seeing a positive correlation between Americans losing their access to employer-sponsored health insurance and deferral of healthcare."

http://www.msnbc.msn.com/id/30306780/

AND:

Studies Confirm Americans Are Self-Rationing Health Care

"a new Consumers Union survey revealed that due to skyrocketing costs and reductions in coverage, Americans are forced to deny themselves needed medical treatment. Among the findings of CU's poll of a 1,002 respondents:

In the new poll 59 percent said that the cost of their health care had increased more than their other expenses over the past two years. Fifty-one percent said they had faced difficult health care choices in the past year. The most common responses were putting off a doctor visit because of cost (28 percent), not being unable to afford medical bills or medication (25 percent), and putting off a medical procedure because of cost (22 percent).

Twenty-eight percent said they had lost or experienced cutbacks in their health care coverage in the past year. The greatest concerns about health care expressed by respondents were a major financial loss or setback from medical cost due to an illness or accident (73 percent), not being able to afford health care in the future (73 percent), necessary care being denied or rationed by health insurance companies (73 percent), and the prospect of rising costs forcing them to choose between health care and other necessities (64 percent)."

LINK

Another ranking of countries (16 of them) by health care. Canadian I guess:

Canada Outshines U.S. in Health Performance, But Lags Well Behind the Top Countries

Pic is Former Canadian Prime Minister, John Chretien.

A new AP poll finds that Americans who think the law should have done more outnumber those who think the government should stay out of health care by 2-to-1.

...The poll found that about four in 10 adults think the new law did not go far enough to change the health care system, regardless of whether they support the law, oppose it or remain neutral. On the other side, about one in five say they oppose the law because they think the federal government should not be involved in health care at all.

See here.