Browsing the blog archivesfor the day Sunday, February 26th, 2006.


Obliviousness

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Canada, conservatism, Health Care

This is a follow up to “Touching Innocence,” below. A blogger named Russell Roberts writes,

Proponents of single-payer health care reform in the United States have long pointed toward Canada as a model for the US to emulate.

The New York Times reports that the Canadian system is imploding. …

You already know where this is going … the Times report discusses problems with the Canadian system, and says some private health care is rushing in to pick up the slack. Whereupon blogger Russell gloats a bit about how superior the U.S. health care system is, and how fortunate Canadians will be when their public system breaks down entirely and they can have a health care system just like ours.

Russell goes off track with the first sentence — “Proponents of single-payer health care reform in the United States have long pointed toward Canada as a model for the US to emulate.” Although I’ve met such people, in fact the Canadian Model is a bugaboo of the Right. Try to discuss national health care with a rightie, and the first sentence out of his mouth will be, “You mean like in Canada?” Then he will go off on a tirade about the problems with the Canadian system. (Unless you remind them of the underfunded British system, which is the other good “bad” example of a system with problems.)

And, I’m sorry to say, I also run into uninformed lefties who seem to think our only choices are a Canadian-style single-payer or the overblown mess that is the U.S. “system.”

As I wrote earlier today, just about every nation on earth affluent enough for most citizens to own a microwave has some kind of national health care system, with the exception of the United States. And every nation has worked out its own system; it is not true, as the uninformed would have it, that there is only the Canadian Model or ours. People who have looked at the myriad systems on the planet say that Canada’s is not necessarily the model we should be emulating. Other countries (notably France, whose system is ranked #1 in overall performance by the World Health Organization) have mixed public and private systems, with public “universal coverage” supplemented by private insurers and hospitals for those who want to pay for them. This may be where Canada is heading now.

Ezra Klein wrote a series of posts on the health care systems of various other countries. France’s system, he says, is not only more cost-effective than ours, it also provides better care for most people.

France’s health care system bodyslams us on most every metric. Beyond the beds per 1,000 stat mentioned above, France has more doctors per 1,000 people (3.3 vs. 2.4), spends way less, has 3.2 more physician visits per capita (6 in France vs. 2.8 in America, which probably accounts for the better preventive care in France), has a much higher hospital admission rate, and beats us handily on the most important measure: potential years of life lost. American women lose 3,836 years per 100,000, while American men give up 6,648 in the same sample size (yes, we get screwed). In France, the comparable numbers are 2,588 years for the women and 5,610 for the men. Still not great, but quite a bit better.

So France spends less, gets more, and does so through a public-private hybrid that’s heavily, heavily public.

Also,

The hospitals offer about 8.4 beds per 1,000 people (America, btw, offers 3.6. Ouch.) The public sector provides 65% of the beds, private hospitals — which operate on a fee-for-service basis — make up the rest, and primarily concentrate on surgeries. French citizens choose which one to go to and get the same reimbursement at either. How’s that for choice? Not good enough? The French also get to choose their physicians, their physicians get to choose where they practice, and there’s patient-client confidentiality.

Everyone I’ve ever met who’s lived in France even a short time sings the praises of the French health-care system. This is not to say that Americans with lots of money or top-notch insurance don’t get as good, or better, care. But, I’m told, if you don’t have lots of money or insurance, try to arrange to have your health problems in France.

The Canadian health care system is slowly breaking down, The New York Times says. The U.S. system, by contrast, is not slowly breaking down. Parts of it are already broken, and what’s left of it is hurtling toward disaster at breakneck speed.

Once again, Jane Bryant Quinn:

America’s health-care “system” looks more like a lottery every year. The winners: the healthy and well insured, with good corporate coverage or Medicare. When they’re ill, they get—as the cliche goes—”the best health care in the world.” The losers: those who rely on shrinking public insurance, such as Medicaid (nearly 45 million of us), or go uninsured (46 million and rising).

To slip from the winners’ circle into the losers’ ranks is a cultural, emotional and financial shock. You discover a world of patchy, minimal health care that feels almost Third World. The uninsured get less primary or preventive care, find it hard to see cardiologists, surgeons and other specialists (waiting times can run up to a year), receive treatment in emergencies, but are more apt to die from chronic or other illnesses than people who pay. That’s your lot if you lose your corporate job and can’t afford a health policy of your own.


Here
Sebastian Mallaby explains why Bush’s health savings accounts will make our system even worse. In another column, Mallaby concludes,

Beyond the imperative of restraining prices, the biggest challenges in health care are to get insurance to everyone and to create incentives for preventive treatment — even though prevention may pay off 30 years later, by which time the patient will have gone through multiple switches in health plans. The most plausible subsidizer of universal insurance is government, and the only entity with a stake in lifelong wellness is the government. Is the administration ready to see that?

See also “Single-Payer Health Would Increase US Competitiveness” by Hale Stewart at BOP News.

This is a huge topic, and this evening I don’t have the time to go into the detail the topic requires. But whenever I see a rightie snicker about the problems of other health care systems, I wonder what it’s going to take to get them to see that our system is a disaster in progress. Corpses in the streets? Oh, wait, we’ve been there already. I’m afraid it’s what Quinn says — the shock of being dumped out of the “winners” rank. Until then, it’ll take major surgery to get their heads out of their butts.

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Screen Capture o’ the Month!

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big picture stuff, entertainment and popular culture, News Media, science

Anna Nicole Smith illustrates the “ecological role of mammals” on a web site called South Coast Today.

(To be fair, there is some news about Ms. Smith further down the page. But this, um, made me laugh.)

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Touching Innocence

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abortion, big picture stuff, conservatism, Health Care, Social Issues

This is a sorta kinda followup to the last post, which discussed matters of life and death, space and time, religion, law, morality, and what it is to be human. Which was a tad ambitious now that I think about it. But I request that people not add comments disagreeing with this post until you’ve read that one. This will save us both a lot of time.

Anyway, I see that some righties are upset about a British court ruling that will allow physicians to impose a “do not resuscitate” order for Baby Charlotte, a desperately ill two-year-old, against the wishes of her parents.

The rightie blogger of Stop the ACLU asks,

Is this the direction America is headed? Is this where the ACLU, and the “right to die” folks will take us?

Kim Priestap of Wizbang blames socialized medicine:

Baby Charlotte’s health is fragile normally, so she will go through health scares like this again. This will cost Britain a lot of money. Since Britain has a nationalized healthcare system, funded by taxpayer money, it’s in the state’s best interest to let her die.

What’s going on here? As a mother myself I’m very uncomfortable when government interferes with family decisions like this. I tend to think that when the family is agreed the patient should be resuscitated, the doctors should respect the decision and not involve courts. I don’t know enough about Baby Charlotte to be able to judge whether there is a compelling reason to make an exception in her case. I infer from news stories that the doctors consider her case to be hopeless and that keeping her alive is just making her suffer. And her parents see things very differently.

I argued in the last post that humans need to struggle with hard choices. When governments or other institutions swoop into our lives and make our choices for us, it makes us less human. And this is true even when we make “bad” choices (within the law, of course). Our decisions may be less important than the process we go through to make them. So in that respect I’m sympathetic to the rightie point of view.

However … the title of this post doesn’t refer to Baby Charlotte. It refers to the righties who are oh, so innocent of the facts of life and death these days.

Nearly a year ago us “culture of death” liberals took up the cause of Sun Hudson, a Texas baby whose life support was terminated against family wishes. Although their diagnoses may differ, the legal situations of Baby Sun and Baby Charlotte seem to me to be nearly identical. If anything, Sun’s case was more extreme than Charlotte’s. His mother (father unknown) wanted aggressive medical care to continue, but the law sided with physicians who decided enough had been enough. Baby Sun’s breathing tube was removed on March 15, 2005, and he died of asphyxiation within minutes.

My understanding is that Sun Hudson’s prognosis really was hopeless. But then, so was Terri Schiavo’s.

Sun Hudson died three days before Terri Schiavo’s feeding tube was removed for the last time. Some of you might recall that righties got a tad excited about the Schiavo case. However, they were mostly silent about Sun Hudson — slipped their attention, I guess. Were it not for liberal blogs I wouldn’t have heard about Sun Hudson either.

Why were righties so oblivious to the Sun Hudson case? One explanation is that the law that allowed his life to be terminated had been signed by then-Governor George W. Bush.

The federal law that President Bush signed early yesterday in an effort to prolong Terri Schiavo’s life appears to contradict a right-to-die law that he signed as Texas governor, prompting cries of hypocrisy from congressional Democrats and some bioethicists.

In 1999, then-Gov. Bush signed the Advance Directives Act, which lets a patient’s surrogate make life-ending decisions on his or her behalf. The measure also allows Texas hospitals to disconnect patients from life-sustaining systems if a physician, in consultation with a hospital bioethics committee, concludes that the patient’s condition is hopeless.

Bioethicists familiar with the Texas law said yesterday that if the Schiavo case had occurred in Texas, her husband would be the legal decision-maker and, because he and her doctors agreed that she had no hope of recovery, her feeding tube would be disconnected. [Knight Ridder]

The Sun Hudson story came out just as the VRWC media echo chamber was working overtime to promote George W. Bush as a champion of life. Faux News’s Bill O’Reilly first commented on the Sun Hudson story before he discovered the Bush angle, forcing him to flip-flop harder than a trout on a hot pier. While Terri Schiavo’s parents were depicted as noble and pure of heart, Sun Hudson’s mother became a deranged black woman who couldn’t face reality. Never fear; O’Reilly had flip-flopped back by April when he attacked the ACLU for (perhaps) being behind “infanticide for impaired babies.”

Let’s go back to the Texas Advance Directives Act of 1999, which is the law under which Sun Hudson’s life was terminated. Put very simply, the law allows a health care facility to discontinue life support against the wishes of the patient’s family. The law requires the facility to jump through a number of hoops before it can do this, which ensures there is an overwhelming medical consensus that the patient’s condition is hopeless before the plug is pulled. The family has the option of finding another medical facility willing to continue life support. But other medical facilities are unlikely to take such a patient, especially if the patient will be a drain on the budget.

In other words, if the family is wealthy enough to pay the costs of Grandma’s care and make a generous contribution to the hospital building fund, Grandma lives. If the family’s insurance is capped and they’ve already spent the second mortgage to pay her medical bills, she dies. To paraphrase (well, OK, mock) Kim Priestap of Wizbang (see above), Grandma’s care will cost hospitals a lot of money, so it’s in their best interest to let her die.

There are two issues to be addressed here, both involving rightie inability to face reality. The first is regarding health care and how it is paid for. Just about every nation on earth affluent enough for most citizens to own a microwave has some kind of national health care system. The exception is the United States. In a recent Newsweek column, Jane Bryant Quinn (hardly a socialist) said that America’s health-care system is turning into a lottery.

The winners: the healthy and well insured, with good corporate coverage or Medicare. When they’re ill, they get—as the cliche goes—”the best health care in the world.” The losers: those who rely on shrinking public insurance, such as Medicaid (nearly 45 million of us), or go uninsured (46 million and rising).

To slip from the winners’ circle into the losers’ ranks is a cultural, emotional and financial shock. You discover a world of patchy, minimal health care that feels almost Third World. The uninsured get less primary or preventive care, find it hard to see cardiologists, surgeons and other specialists (waiting times can run up to a year), receive treatment in emergencies, but are more apt to die from chronic or other illnesses than people who pay. That’s your lot if you lose your corporate job and can’t afford a health policy of your own.

Years ago there was a joke in circulation that said a conservative is a liberal who got mugged. The new joke is that a liberal is a conservative who’s lost his health insurance.

The point is that all the evil, inhumane things going on in Other Countries That Have Socialized Medicine are happening here, too. Righties just refuse to acknowledge them. Among those Other Countries, Britain is a good “bad example” because they’ve underfunded their system for years. Meanwhile, we in the U.S. spend far more per capita than other nations (see this report in PDF format; note especially Figure 1 on page 3) but we’re getting worse results (see Table 1, page 4). By some measures we’re getting even worse results than those cheapskate Brits.

And the moral is, people whose health care system is a broken down mess shouldn’t be pointing fingers at other peoples’ health care systems.

The other issue I see here is the touching innocence of righties regarding hopelessly terminal patients. Physicians have made decisions not to aggressively treat hopeless patients, especially suffering hopeless patients, since Hippocrates. Generally they’ve done it quietly and without drawing attention to themselves, but they’ve done it. For example, since the 19th century physicians have prescribed larger and larger doses of opiates to ease the pain of dying patients, knowing that eventually the dosage will be fatal. And as far as the family ever knew, it was the cancer that killed Grandpa, not that last dose of morphine.

Just about any health care professional will confirm this. I’m sure such decisions are being made all over America even as you read this.

The reason we’re hearing about such cases these days is, IMO, multifold. First, in the past medicine wasn’t all that effective. It was easy for doctors to make a show of “doing all we can” because in truth there wasn’t a whole hell of a lot they could do. But now we can do so much more. We have medical technology that will retain life in a body even when the person that body once sustained has long since dissipated, as in Terri Schiavo’s case. The line between life and death itself has blurred.

Second, because of the technology, more and more families refuse to accept a hopeless prognosis. I understand even anencephalic babies are sometimes put on life support these days, even though those babies have no hope of survival. In earlier times, the only choice offered parents would have been whether they wanted to hold the baby while it died, or not.

And third, mass media and our “reality TV” culture make sure the more controversial decisions get global publicity. In earlier times, these matters wouldn’t have been been discussed outside the family. Today, people with less than a half-assed idea of the facts can plaster their uninformed opinions all over the Web.

As individuals, as a nation, as a society, as a species, we’ve got hard choices to make. These choices involve ourselves and our loved ones. We need to make some mature, non-politicized judgments about how to pay for health care. We must think rationally about how much of our health-care resources should be spent on futile care. We need non-hysterical discussion about if, or when, governments should intervene in family decisions. These are all complex issues. Reasonable people will disagree on many points. But we’re going to get nowhere until we’re able to face some hard realities.

Which means we’re going to get nowhere as long as righties dominate the discussion.

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