April 30, 2008

The Joke Post

Filed under: Bush Administration, Iraq War, Health Care, Republican Party — maha @ 10:18 am

Here’s a joke for you. Doug Feith has published a book called War and Decision: Inside the Pentagon at the Dawn of the War on Terrorism . Must be a laugh riot.

Here’s another joke: John McCain’s health care plan. As near as I can make out, he wants to “lure” people away from employer-based health plans by eliminating tax incentives to employers to offer those plans. Instead, people will get a $5,000 “family tax credit” that will enable them to purchase private insurance, he says, even though the actual average cost of health insurance for a family is way more than double $5,000. And he has little idea what to do about people with a pre-existing condition who cannot purchase health insurance at any price.

Hilzoy takes the plan apart so I don’t have to.

Steve Benen says the plan “probably won’t receive much in the way of scrutiny.” From the press it won’t, no, but that’s why the Dems need to purchase lots of advertising time to scrutinize it. I think if the public were to hear the details, that by itself would be enough to sink McCain’s chances to win in November.

Lorita Doan, who made herself a punch line by pressuring General Services Administration employees to “help” Republican candidates, and who threatened to sanction anyone who cooperated with an investigation of her, has stepped down from her position as chief of GSA. She blames political pressure and bad grammar.

And last but not least, Tom Friedman explains why the Clinton-McCain gas tax plan is a joke.

Spotlight

April 6, 2008

Why Wingnuts Are Idiots

Filed under: Health Care, conservatism — maha @ 6:48 am

Yesterday I wrote a post about the way our health care system is no longer capable of providing basic, primary care and emergency services to everyone who needs it. There are several causes for this, but the primary cause is that the “system” has been skewed away from preventive and emergency care services (in which there is no profit) and toward the creation of treatments and health care products that do make a profit.

Yesterday’s post focused on a New York Times story about Massachusett, which initiated a “universal” health care program that currently is insuring 340,000 people who had no health insurance before. And now there are not enough primary care physicians to go around. One physician has a 13-month waiting list for basic physicals.

A few wingnuts commented on this same New York Times story. Their take? “See? Socialized medicine doesn’t work!”

Don Surber:

Question: Why isn’t universal health insurance working in Massachusetts?

Answer: Good intentions also lead to shortages in everything. What the New York Times calls “unintended consequences,” I call predictable.

If we didn’t have all these wimpy good intentions, there wouldn’t be a problem. Clearly, that millions of Americans have been cut off from basic health care services is not a problem.

Another rightie, Soccer Dad, concludes that the primary care physician shortage proves Mitt Romney (credited with the Massachusetts health care program) is incompetent. Romney may be incompetent, but the fact is whenever and however the U.S. finds a way to provide decent health care services to those currently uninsured, whether by public or private means, what’s happening in Massachusetts is going to be a nationwide phenomenon.

Put another way, the only reason the insured don’t have massive waiting lines for health care services (in most parts of the country) is that so many Americans have been kicked out of the line.

In other Right Wing news — Yes, Hugh, there were arm bands and book bags in 1968. I was there. Wearing arm bands in protest of the Vietnam War was pretty common, actually.

And why can’t we have civilized debates about important issues? Read this and be amazed — at the psychological projection.

Idiots.

Update: Another idiot speaks –

Why, it must be some kind of doctor shortage! … Could it be, oh I don’t know, lack of incentive?

No, brainless one, there is plenty of incentive. However, all the incentive tilts in the direction of what parts of medical practice that are very profitale (i.e., new technologies and drugs) and away from those parts that are much less profitable (i.e., preventive care) or tend to lose money (i.e., emergency rooms). Your market-driven health care system at work.

And, as Kevin Heyden says, Massachusetts has better health care resources than most other states. So “what will it be like in the Southern states that are mostly rural, or the vast wide open states that grow bigger, the wester you go?”

For years I’ve been hearing health-care experts saying that the nation’s ability to delivery basic medical services to its citizens has been deteriorating, even as we continue to excel at the development of new technologies and drugs for extremely serious illness.

The lack of basic services, however, is one of the factors that is driving up the cost of health care for everyone. It would be far more cost-effective if people got regular checkups and went to doctors at the first sign of illness. However, the millions of Americans who are uninsured or underinsured tend to wait until symptoms are more severe and the illness more difficult (and expensive) to treat.

Here’s just one example — the United States on the whole has world-class hospital neonatal care for infants born prematurely or unhealthy. However, we fall far behind most other industrialized nations in providing basic prenatal care for all pregnant women. Thus, a higher percentage of American babies are born prematurely or unhealthy and need intensive, and expensive, hospital care to survive.

This is what’s called “stupid.” Naturally, wingnuts are for it.

Someone asked in the comments if we have to choose between “unevenly distributed access to health care, and evenly distributed inaccess to health care?” No, we don’t have to choose that at all. Wingnut mythology aside, most industrialized nations provide access to perfectly good health care with no waiting lines to all its citizens. Some do a better job than others, but it can be done, and at a lower cost per capita than we’re paying now. But the longer we pretend that somehow “market forces” are going to solve our health care crisis the worse the inequality will grow, because “market forces” are causing the inequality.

When we do ever switch to universal health care, it will probably take several years to build the medical infrastructure needed to deliver good basic care.

Spotlight

April 5, 2008

Marketing Health Care

Filed under: Health Care — maha @ 10:32 am

Massachusetts instituted what’s called a universal health care program — about 340,000 of Massachusetts’ estimated 600,000 uninsured have gained coverage, — and now supply is no longer adequate to meet demand. Kevin Sack writes in today’s New York Times –

Once they discover that she is Dr. Kate, the supplicants line up to approach at dinner parties and ballet recitals. Surely, they suggest to Dr. Katherine J. Atkinson, a family physician here, she might find a way to move them up her lengthy waiting list for new patients.

Those fortunate enough to make it soon learn they face another long wait: Dr. Atkinson’s next opening for a physical is not until early May — of 2009.

A 13-month line for a physical? But the wingnuts tell us only Canadians have to wait in line!

In pockets of the United States, rural and urban, a confluence of market and medical forces has been widening the gap between the supply of primary care physicians and the demand for their services. Modest pay, medical school debt, an aging population and the prevalence of chronic disease have each played a role.

This is something I’ve written about before. The fact is that “market forces” have skewed the way health care is delivered in this country away from basic services like preventive care and emergency rooms. That’s because the real money is in providing boutique medical care products and services for those with means to pay for it. About a year ago, I wrote,

Basically, our health care system is good at delivering difficult and expensive stuff but blows at simple, ordinary stuff, like preventive care, compared to other nations. This means we save some lives that might have been lost in Europe, but we also lose lives that would have been saved in Europe.

How did this come to pass? Certainly we Americans value creation and innovation. But it’s also the fact that our private, profit-based health care system is very good at creating new health care products that will make a lot of money. But where there’s no chance of profit, forget it.

This is what the “magic of the marketplace” has given us. You know how markets work; where there’s a demand, someone will hustle to provide a supply, and competition encourages the creation of better products at lower cost. Our system is very good at creating new drugs and new technologies and then marketing them to hospitals, physicians, and even potential patients. And I’m not saying this is a scam; many of us have benefited from the drugs and gizmos. The problem is that some parts of the health care process just don’t make any money. And where it isn’t profitable, our system is falling apart. …

… Here’s what the “free market” people never seem to wrap their heads around: Unprofitable demands do not generate supply, even when those demands are desperately needed.

Put another way, not everything that’s worth having can generate enough profit to pay for itself. …

… By now “market forces” have so skewed our health care delivery system that, even if we began to allocate our health care dollars according to need rather than profit, it would take years before the neglected parts of our system were built back up to where they should be.

Every now and then there will be a news story about our shameful infant mortality rates or our less-than-stellar life expectancy rates or that emergency rooms are closing or the number of hospital beds per capita is shrinking, and you can count on some wingnut to come out of the woodwork and declare that we are number one at delivering new drugs to colorectal cancer patients that increase their life expectancy by a whole 4.3 months, so take that.

One occasionally finds the claim that the U.S. has too many doctors, rather than a shortage of doctors. The problem is that the “oversupply” seems to fall short in primary care. Kevin Sack of the New York Times explains,

While fewer American-trained doctors are pursuing primary care, they are being replaced in droves by foreign medical school graduates and osteopathic doctors. There also has been rapid growth in the ranks of physician assistants and nurse practitioners.

A. Bruce Steinwald, the accountability office’s director of health care, concluded there was not a current nationwide shortage. But Mr. Steinwald urged the overhaul of a fee-for-service reimbursement system that he said undervalued primary care while rewarding expensive procedure-based medicine. His report noted that the Medicare reimbursement for a half-hour primary care visit in Boston is $103.42; for a colonoscopy requiring roughly the same time, a gastroenterologist would receive $449.44.

My understanding is that there are adequate numbers of medical students who graduate as general practice doctors, but since they carry an average of $120,000 debt for student loans they can’t afford to go into primary care.

This is unfortunate, because comprehensive health care reform requires better primary care so that health problems are prevented or treated at earlier stages. But in the U.S. “market forces” are better at creating and marketing expensive drugs and gizmos to hospitals to treat seriously ill patents. Ain’t no money to be made in preventive care. Money to be saved, yes, but not to be made. So emergency rooms rot, and people in Massachusetts wait 13 bleeping months for a bleeping checkup.

The situation may worsen as large numbers of general practitioners retire over the next decade. The incoming pool of doctors is predominantly female, and many are balancing child-rearing with part-time work. The supply is further stretched by the emergence of hospitalists — primary care physicians who practice solely in hospitals, where they can earn more and work regular hours. President Bush has proposed eliminating $48 million in federal support for primary care training programs. [emphasis added]

Of course he has. You can count on Bush to do exactly the wrong thing.

Anyway, just because real-world experience proves beyond a shadow of a doubt that “market forces” will not provide anything approaching halfway decent health care for all Americans doesn’t mean the wingnuts will lose faith in market forces. There’s no point even arguing with them. And because wingnuts dominate media, few Americans hear all sides of this argument. All they ever hear about are waiting lines in Canada.

Of course, the only reason we haven’t had worse waiting lines here is that so many people have been kicked out of the health care system altogether.

Be sure to read Paul Krugman’s most recent column, “Voodoo Health Economics.” GOP presidential candidate John McCain’s health care plan is, essentially, to allow the “magic of the marketplace” to provide inexpensive health care for everyone. Krugman explains in no uncertain terms why this is nonsense. The Boston Globe has more about McCain’s not-even-half-assed heath care proposals.

I’m not enthusiastic about either Hillary Clinton’s or Barack Obama’s health care proposals. They both fall under the heading of “better than nothing” in my book, McCain’s proposals being “nothing.”

The two Dems may not be beyond hope on health care, however. From an editorial in today’s Toledo Blade:

At one time or another, both Senator Clinton and Senator Obama have said they could support a single-payer national health insurance system, a kind of “Medicare for all,” as a solution to the health care crisis, but they have apparently calculated that it is not politically feasible to advocate it today.

The new survey of the nation’s doctors suggests otherwise.

These findings dovetail with those of an AP/Yahoo public opinion poll last December showing 65 percent of Americans favor a similar approach.

National health insurance is not only necessary, but increasingly popular.

Winston Churchill is remembered to have said of Americans that we always do the right thing, after we have exhausted all the other possibilities.

It is time for our political leaders to stand up for the health of the American people and implement a nonprofit, single-payer national health insurance system.

In part I blame news media for not presenting anything approaching a balanced, fact-based debate on health care. We get only the Right’s POV and more of the Right’s POV. I think if the American people understood the facts, we’d have national health care already.

Spotlight

December 27, 2007

Soylent Green Is People

Filed under: Bush Administration, Health Care — maha @ 9:24 am

In another sign of how the country is going to hell in a handbasket, Robert Pear writes in today’s New York Times:

The Equal Employment Opportunity Commission said Wednesday that employers could reduce or eliminate health benefits for retirees when they turn 65 and become eligible for Medicare.

The policy, set forth in a new regulation, allows employers to establish two classes of retirees, with more comprehensive benefits for those under 65 and more limited benefits — or none at all — for those older.

More than 10 million retirees rely on employer-sponsored health plans as a primary source of coverage or as a supplement to Medicare, and Naomi C. Earp, the commission’s chairwoman, said, “This rule will help employers continue to voluntarily provide and maintain these critically important health benefits.”

Let us pause and reflect upon Ms. Naomi C. Earp’s words. In fact, I was so taken with what Ms. Naomi C. Earp said that I went to the EEOC web site for more. And lo, there’s a press release with the head:

EEOC MOVES TO PROTECT RETIREE HEALTH BENEFITS
Implementation of Final Rule Ensures Age Bias Law is No Barrier to Employer Insurance

And in the body of this press release I read:

The U.S. Equal Employment Opportunity Commission (EEOC) today announced the publication of a final rule allowing employers that provide retiree health benefits to continue the longstanding practice of coordinating those benefits with Medicare (or comparable state health benefits) without violating the Age Discrimination in Employment Act (ADEA). The regulation, which safeguards retiree health benefits, was published in today’s Federal Register and is available on the EEOC’s web site at www.eeoc.gov.

“Implementation of this rule is welcome news for America’s retirees, whether young or old,” said Commission Chair Naomi C. Earp. “By this action, the EEOC seeks to preserve and protect employer-provided retiree health benefits which are increasingly less available and less generous. Millions of retirees rely on their former employer to provide health benefits, and this rule will help employers continue to voluntarily provide and maintain these critically important benefits in accordance with the law.”

The EEOC proposed the rule in response to a controversial decision in 2000 by the U.S. Court of Appeals for the Third Circuit in Erie County Retirees Association v. County of Erie. The court held that the ADEA requires that the health insurance benefits received by Medicare-eligible retirees be the same, or cost the employer the same, as the health insurance benefits received by younger retirees. After the Erie County decision, labor unions and employers alike informed the EEOC that complying with the decision would force companies to reduce or eliminate the retiree health benefits they currently provided – leaving millions of retirees aged 55 and over with less health insurance, or no health insurance at all.

Ah, I see. The Bushies are protecting retired people from discrimination by allowing their former employers to cut off their health benefits. Robert Pear continues,

Premiums for employer-sponsored health insurance rose an average of 6.1 percent this year and have increased 78 percent since 2001, according to surveys by the Kaiser Family Foundation. Because of the rising cost of health care and the increased life expectancy of workers, the commission said, many employers refuse to provide retiree health benefits or even to negotiate on the issue.

In general, the commission observed, employers are not required by federal law to provide health benefits to either active or retired workers.

Because health care costs are ballooning, the burden of providing health insurance for retirees is too much for many businesses to bear — no doubt this is true — so the EEOC says it’s OK for the companies to cut the retirees loose and let them fall back on Medicare. But because Bushies are Bushies, they can’t just come out and say it that way. Instead, they crank out some Orwellian doublespeak pretending this is all for the retirees’ own good.

And, of course, wingnuts want to eliminate Medicare also. As Rich Lowry so well explained, spending on big government programs like Medicare siphons off money that could be better put to use maintaining a big military to spread American hegemony around the planet and allow all people to enjoy our superior way of life. Until, of course, they are too old to be productively making money for Halliburton. I believe the plan at that point is to set the old folks adrift on ice floes, although given global warming I’m not sure how that’s going to work, either.

Robert Pear continues:

AARP and other advocates for older Americans attacked the rule. “This rule gives employers free rein to use age as a basis for reducing or eliminating health care benefits for retirees 65 and older,” said Christopher G. Mackaronis, a lawyer for AARP, which represents millions of people age 50 or above and which had sued in an effort to block issuance of the final regulation. “Ten million people could be affected — adversely affected — by the rule.”

The new policy creates an explicit exemption from age-discrimination laws for employers that scale back benefits of retirees 65 and over. Mr. Mackaronis asserted that the exemption was “in direct conflict” with the Age Discrimination in Employment Act of 1967.

Seems that way to me. Weirdly, the AFL-CIO supports the Bushies’ plan. I say they have some ’splainin’ to do.

Just yesterday I stumbled on a group discussion on single payer health care. Righties wittily asked if the government would also provide them with free lunches and congratulated themselves on having the prescience to get jobs with health benefits. Spoken like people who have no experience whatsoever dealing with the health care system. And the wingnuts have no clue what the current “system” is doing to our economy. Ultimately a single payer system would be better for employers and entrepreneurship generally. Righties can’t see anything beyond their own limited experiences and needs, which is what makes them righties.

Speaking of the AARP and Medicare, I found this press release on the AARP site –

“The American people deserve better. It is a shame that our elected officials will go home for the holidays without helping low-income beneficiaries get the care they need by strengthening programs directly targeted at the most vulnerable older Americans.

“It also is discouraging to millions of older Americans that the administration was unwilling to consider any reductions in the billions of dollars in excess payments to Medicare Advantage plans—particularly to private fee-for-service plans, which do not have to coordinate care and have been the subject of widespread marketing abuses—in order to help improve Medicare.

Bushies don’t see old folks as citizens; they see them as an exploitable resource. But I guess as long as they’re an exploitable resource they won’t be marched off to the Soylent Green factory.

Spotlight

November 17, 2007

Just Wrong

Filed under: Health Care, Immigration — maha @ 7:37 am

Immigration authorities separate nursing mother and baby.

Even more heartbreaking, today Bob Herbert writes about a mother battling her health insurance provider while her daughter battled cancer.

One night, after coming home from school, Brittney suddenly found that she couldn’t walk. The cancer had attacked her spinal cord. As the doctors geared up to treat this new disaster, Ms. Hightower received word that her insurance policy had maxed out. The company would not pay for any further treatment.

Ms. Hightower was aghast: “I said, ‘What do you mean? It was supposed to be a $3 million policy.’ ”

She hadn’t understood that there was an annual limit of $75,000 on benefits. “It was just devastating when they told me that,” she said. …

…Sandra Hightower became almost frantic with the combined tasks of caring for her daughter and trying to figure out how to pay for the increasingly expensive treatments.

“Her back surgery, with the reconstruction and all that, was over three hundred and some thousand dollars,” she said. “I had to start doing fund-raisers, bake sales. And the community kicked in, my community here in Nacogdoches. Definitely the high school. And people donated to a benefit fund at the bank.”

After several months, Brittney was declared eligible for federal disability benefits, which enabled her to qualify for Medicaid. “But we still owed for everything before that,” said Ms. Hightower.

Brittney fought like crazy to survive, her mother said. But in the end, she didn’t make it. She died, at age 16, on June 5.

“I see her everywhere,” said Ms. Hightower, who still owes thousands of dollars in medical bills. “When I go to the grocery store, I see her favorite food. I go shopping, and I see the perfect little outfit that she would love.

“I’m so lost right now. And I feel like I failed my baby because I couldn’t bring in all the help she needed.”

I’m sure the wingnuts can dismiss Ms. Hightower by saying she should have chosen a job with better benefits.

Update: Satire? Pathology? You be the judge. A blogger writes,

What would life in the United States be like under a President who is obsesssed with personal power, does not respect the rule of law and has no tolerance for criticism?

Who has to wonder? But here’s the punch line — the blogger was writing about Hillary Clinton. Sort of snarks itself, huh?

Spotlight

November 13, 2007

Free Markets, Health Care, and Innovation

Filed under: Health Care — maha @ 8:58 am

I waded into Jonathan Cohn’s “Creative Destruction: The Best Case Against Universal Health Care” with misgivings. But to my delight Cohn presents the “best case” and then demolishes it.

The “best case” is the argument that a free market health care system encourages innovation that leads to new treatments and cures. Yes, we devote 16 percent of our gross domestic product to health care, but our health care spending is driving innovation for the entire world. If the profit motive were removed from health care, say the “free market” advocates, innovative medical research would be squelched. And that’s a compelling argument.

However, there’s theory, and then there’s the real world. As Cohn says,

But it’s one thing to say that universal coverage could lead to less innovation or reduce the availability of high-tech care. It is quite another to say that it will do those things, which is the claim that opponents frequently make. That argument requires several leaps of logic, many of them highly suspect. The forces that produce innovation in medicine turn out to be a great deal more complicated than critics of universal coverage seem to grasp.

It turns out that in the real world the real innovations, the breakthroughs that take medical research into whole new directions, are generally not made by the private sector health care industry.

The great breakthroughs in the history of medicine, from the development of the polio vaccine to the identification of cancer-killing agents, did not take place because a for-profit company saw an opportunity and invested heavily in research. They happened because of scientists toiling in academic settings. “The nice thing about people like me in universities is that the great majority are not motivated by profit,” says Cynthia Kenyon, a renowned cancer researcher at the University of California at San Francisco. “If we were, we wouldn’t be here.” And, while the United States may be the world leader in this sort of research, that’s probably not–as critics of universal coverage frequently claim–because of our private insurance system. If anything, it’s because of the federal government.

The single biggest source of medical research funding, not just in the United States but in the entire world, is the National Institutes of Health (NIH): Last year, it spent more than $28 billion on research, accounting for about one-third of the total dollars spent on medical research and development in this country (and half the money spent at universities). The majority of that money pays for the kind of basic research that might someday unlock cures for killer diseases like Alzheimer’s, aids, and cancer. No other country has an institution that matches the NIH in scale. And that is probably the primary explanation for why so many of the intellectual breakthroughs in medical science happen here.

There is absolutely no reason why moving to a universal health care system would require cutting back on NIH research. In fact, since 2003 President Bush and his congressional allies have allowed NIH funding to stagnate. They needed room in the budget for other priorities, like tax cuts. “In this sense, the greatest threat to future medical breakthroughs may not be universal health care but the people who are trying so hard to fight it,” Cohn writes.

In fact, in the real world there are indications that the profit motive might be stifling innovation. Most of the private health care industry is focused on developing and marketing as many new, patented products as they can. As a result, much product and development research is focused on incremental improvements on those products that have made money in the past. Research that does not hold a promise of new product development, even if it might lead to cures, is shoved aside. For example, in this article in Genetic Engineering and Biotechnology News, the authors argue that cancer research needs to get away from tweaking products and move into areas that have clinical impact. Cohn writes,

As books like Marcia Angell’s The Truth About the Drug Companies and Merrill Goozner’s The $800 Million Pill point out, a lot of the alleged innovation we get from private industry just isn’t all that innovative. Rather than concentrating on developing true blockbusters, for the last decade or so the pharmaceutical industry has poured the lion’s share of its efforts into a parade of “me-too” drugs–close replicas of existing treatments that offer little in the way of new therapeutic advantages but generate enormous profits because they are patented and because companies have become exceedingly good at promoting their sales directly to consumers.

In some cases private industry has gone from creating products to cure diseases to tweaking diseases to sell more products. For example, the criteria for clinical depression have been so watered down that just about anyone having a bad hair day might fit the diagnosis. It seems obvious that Big Pharma is behind this — the better to sell large quantities of Zoloft and Paxil, my dears. This phenomenon, in turn, leads to misuse of drugs, more unfortunate side effects, clinical trials that show drugs have little effect on “depression” (because the trial subjects were not actually depressed), and the persistent notion that clinical depression isn’t a real disease and people who think they have it are just whiners. Those of us who really are clinically depressed may appreciate our Big Pharma meds, but we have major issues with the Big Pharma marketing departments.

Cohn writes of CT scanners, which are wonderful devices. However,

It’s the potential to sell many more such devices, at a very high cost, that has enticed companies like GE to invest so much money in them. In fact, compared to the rest of the developed world, the United States has a relatively high number of CT machines (although Japan has more). But experts have been warning for years of CT overuse, with physicians ordering up scans when old-fashioned examinations would do just fine. (Some experts even worry that over-reliance on scans may be leading to atrophied general exam skills among physicians.) Studies have shown that the mere presence of more CT scanners in a community tends to encourage more use of them–in part because the machine owners need to justify the cost of having invested in them. The more CT devices we buy, the less money we have for other kinds of medical care–including ones that would offer a lot more bang for the buck

And on and on. It’s an excellent article that I urge you to read and bookmark.

So far I’ve seen one reaction from a “free market” blogger, who simply ignores all of Cohn’s well-documented arguments and repeats the mantra:

The advantage of markets is that they foster innovation. They reward successful innovation. Moreover, they eliminate obsolete institutions and organizations.

Government is much more likely to protect incumbents. Regardless of whether it stifles innovative treatments, government will certainly stifle innovative ways to organize and deliver health care. Indeed, it already does so, with its restrictions on medical licensing and practice. A complete government takeover could only make things worse.

Wingnuts simply cannot process empirical evidence that their glorious theories don’t apply to the real world.

In other health care news, today Eugene Robinson discusses “socialized medicine” snake oil and a major study conducted this year by the Commonwealth Fund:

Respondents in the United States were less likely than those in the other countries to say their health-care system “works well” — and much more likely to see a need for “fundamental” change or a total overhaul. With 47 million Americans lacking health insurance, I suppose that shouldn’t be much of a surprise.

What did surprise me was the wealth of data refuting the general criticism that single-payer health-care systems are cold, impersonal and, well, uncaring. According to the survey, 80 percent of Americans have a regular doctor whom they usually see. That sounds pretty good, until you learn that 84 percent of Canadians, 88 percent of Australians, 89 percent of New Zealanders and Britons, 92 percent of Germans, and 100 percent of Dutch respondents surveyed said they had regular doctors. Marcus Welby, M.D., seems to have emigrated.

Okay, but what about the long waits for treatment under single-payer systems? The survey found that 49 percent of Americans said they could get a same-day or next-day doctor’s appointment when they were sick — as opposed to 75 percent of respondents in New Zealand, 65 percent in Germany, 58 percent in Britain and so on. Only in Canada was it more difficult to see a doctor within 48 hours.

It’s true that in the United States, the wait for elective surgery is likely to be shorter than in the other countries (except Germany, which has the shortest wait of all). But onerous delays of six months or more were significantly more common only in Australia, Canada and Britain.

And then there’s this:

The United States spends $6,697 per capita annually on health care, according to the survey — more than twice as much as any of the other countries surveyed. Americans were much more likely than any other national group to have spent at least $1,000 out of pocket on medical expenses over the past year. And, of course, 16 percent of Americans reported being uninsured, as opposed to essentially none in the other countries.

It makes sense, then, that far more Americans than respondents in the other countries reported that in the past year, they had failed to fill a prescription or skipped doses, experienced a medical problem but decided not to go to the doctor, or skipped a prescribed test, treatment or follow-up.

We may have a mess of a health care system, but I bet we beat the world at cooking up half-baked theories and clinging to them through thick and thin. Alas, disease and death are not theories.

Update: Andy Sullivan misses the point.

Spotlight

November 11, 2007

Food v. Medical Care

Filed under: Health Care — maha @ 1:41 pm

According to the McKinsey Global Institute, the United States now spends more on health care than it does on food. Is that self-evidently screwy, or what?

I looked up McKinsey Global Institute because Paul Krugman mentioned it in his Friday column, “Health Care Excuses.”

Excuse No. 2: It’s the cheeseburgers.

Americans don’t have a bad health system, say the apologists, they just have bad habits. Overeating and teenage sex, not the huge overhead of America’s private health insurance companies — the United States spends almost six times as much on health care administration as other advanced countries — are the source of our problems.

There’s a grain of truth to this claim: Bad habits may partially explain America’s low life expectancy. But the big question isn’t why we have lower life expectancy than Britain, Canada or France, it’s why we spend far more on health care without getting better results. And lifestyle isn’t the explanation: the most definitive estimates, such as those of the McKinsey Global Institute, say that diseases that are associated with obesity and other lifestyle-related problems play, at most, a minor role in high U.S. health care costs.

In truth, American fast food circles the globe. And native cuisines of other nations are not necessarily health food. Have you ever been subjected to a full English breakfast? There’s probably less cholesterol in cheeseburgers.

The other excuses, btw, are (1) people without insurance get health care, anyway; (3) we get better medical care now than we did 50 years ago, so the money is well spent; and (4) socialized medicine! Krugman explains why these excuses are bogus.

On the same day this column was published, the Heritage Foundation released its own assessment of America’s health care:

The debate over government-run health care has roiled for decades. Today, we’re at the tipping point.

Incremental growth in public health programs has brought us to the brink. Today, almost half of America’s children — 45 percent — have their health care paid for by taxpayers. The children’s health bill (SCHIP) now before Congress would boost this to 55 percent. And that’s the tipping point.

Once most children are covered by taxpayers, the remaining children will shortly follow. Then their parents. Then those with no children at home. Eventually, the whole country would be under Washington-run health care, using tax dollars to pay the bills.

Even without a megabillion-dollar SCHIP expansion, taxpayers already pick up the tab for almost half the health care in America, via Medicare, Medicaid and the Veterans Administration. The SCHIP expansion could tip that, too, so the majority of all health care — not just kids’ care — is government-paid and therefore government-controlled.

If Congress overrides President Bush’s SCHIP expansion veto, the full and final federal government takeover of medicine in America becomes inevitable. With that would come lower quality health care, long waits and explicit government rationing of care. That’s the story wherever countries have nationalized their health systems.

That last part is a lie. It’s true the national health care systems of some countries, notably Britain and Canada, have hit some bumps. But most countries with national health care do not have “lower quality health care, long waits and explicit government rationing of care.” The fact is that, in measure after measure, the U.S. health care system is actually below average. It’s true that we still manage to lead the world in some aspects of health care, such as cancer survival rates. But I explained here why our glorious cancer survival rates are not really all that glorious.

And I bet no Brit or Canadian has to line up to get health care in old animal pens.

Heritage continues,

SCHIP expansion also distracts from efforts to make health care more affordable. That would require a reversal of the Washington-dictated bureaucracy that is pandemic in American medicine and drives up costs — as illustrated by 135,000 pages of federal regulations that hog-tie doctors and hospitals. Reduce the bloated bureaucracy, and you reduce the costs.

[Update: Turns out the 135,000 pages is a myth, and an old myth, at that. From the comments of Rep. Pete Stark, House Ways and Means Committee, hearing on Medicare Reform, March 15, 2001.

Mr. STARK. Don’t mention that to the good folks in the 13th District of California, please.

There is no business operation–and that is what HCFA is–that can’t stand improvement and doesn’t need constant revision to see that we are using current technology. In fact, we are offering you a buck off, I think, if you will file electronically. Maybe we should charge you a buck–you being your group and other participating doctors–if you don’t file electronically to urge you to get out and buy that laptop and help us be more efficient.

There are a lot of ways we can cooperate, but the MERFA may very well completely eliminate any ability to enforce our laws and regulations. It is not the way to go. And I would urge you to–which is unlike previously, 10 years ago with the AMA–continue to be in the tent with us as we write any improved legislation, and I think we can go a long way together.

But, please, you know, for a lot of the guys who work hard, this argument 135,000 pages of regulations is baloney. We have counted them. There are about 35,000, which is maybe too many, but it isn’t 135,000. That number came from Mayo, who have refused to send us any documentation of where it came from. But, believe me, I want to stay out of the Mayo Clinic if they can’t tell the difference between 135,000 and 35,000, or when they read my cholesterol level, I am going to have a real problem.

So thank you for your organization’s support to stop smoking, to get kids insured, to reform managed care. But remember that one of the complaints you have that are fixed in the Patients’ Bill of Rights is that you get paid by the private insurers on time. At least we do that. We may come back after you later, and maybe we have to change that. But be careful what you wish for. It could come to pass. And I look forward to working with you.

I take it the 135,000 pages is a kind of urban legend that’s been around for a while.]

I googled around for some concrete examples of how federal regulations “hog-tie doctors and hospitals” and run up costs. There are probably other examples, but all I found was this: The EPA has issued some regulations regarding disposal of “infectious waste,” defined as “microbiologic (stocks, cultures); blood products; pathology waste (tissue and organs); sharps, including needles and blades; animal carcasses, body parts, and bedding from infected animals; and bedding and waste from patients placed in health-related isolation.” Some of these regulations came about after health care residue such as bloody gauze and used hypodermics washed up on some beaches. But if you don’t mind the beaches, I suppose it would save a little money to let hospitals dump this stuff any way they want.

But I don’t see how relaxing pathology waste regulations is going to change the fact that the United States spends almost six times as much on health care administration as other advanced countries. I bet most of those other countries have regulations, too, since they’re all have socialized medicine.

I still say that if “market forces” could have found a way to solve the health care crisis, it would have done it by now.

But here’s something else alarming, picked up from Paul Krugman’s blog.

Two important articles co-authored by Peter Orszag, the director of the Congressional Budget Office.

The first emphasizes a point I’ve also tried to get at:

    The long-term fiscal condition of the United States has been largely misdiagnosed. Despite all the attention paid to demographic challenges, such as the coming retirement of the baby-boom generation, our country’s financial health will in fact be determined primarily by the growth rate of per capita health care costs.

In other words, Social Security is not the big problem (and it’s not in “crisis,” Sen. Obama); it’s Medicare and Medicaid, and their problems are wrapped up in a general health-care crisis.

In other words, if we don’t retire the bleeping “free market” health care system, we’re doomed.

The second has a lot to say about controlling costs, and also explains succinctly, albeit in slightly obscure terms, why “consumer-directed” care, which is at the core of all the Republican plans, won’t work:

    On the consumer side, higher deductibles would encourage patients to be more prudent in their use of services, but they also raise concerns about the financial burden on persons with major health problems. Furthermore, the concentration of health care spending among a relatively small percentage of the population with very high costs limits the effect on total spending of increased cost sharing for initial charges.

In short, making people pay more for things like doctors’ visits is going where the money isn’t. The big bucks go for big expenses like cardiac surgery — and either these things are paid for by insurance, or not at all.

Cutting-edge medical science of a mere century ago was nearly medieval compared to what we have now. My father used to claim that, in his youth, tonsillectomies were performed on a kitchen table, and the chief surgical instrument was a hot spoon. My dad used to embellish a tad, but the fact remains that most of the really expensive procedures and equipment didn’t exist until the 1940s or later. Before then, there was no open-heart surgery, no MRIs, no chemotherapy, no dialysis. Mass production of the first antibiotic, penicillin, didn’t begin until 1943.

Before the 1940s, “consumer-directed” medical care probably was as economically efficient as any other consumer service. But for the past few decades medical care has become so expensive that only the extremely wealthy can pay for it. So consumers were cut out of the system a long time ago. Now we have an insurance company-directed health care system, and the health care sector is eating all our other economic sectors.

Heritage claims “taxpayers already pick up the tab for almost half the health care in America.” Heritage is not famous for its factual accuracy, but let’s assume for a moment that’s true. What we’ve basically done over the years is patch together some government programs to take over some parts of the population the private insurance companies weren’t serving — to pick up the droppings from the private health insurance table, so to speak. Put another way, we’ve created a mess of government programs to help maintain the fiction that our “free market” health insurance system works just fine. As they say in Britain, brilliant.

Spotlight

November 3, 2007

Surviving

Filed under: Health Care — maha @ 9:43 am

Yesterday I wrote about claims and counter-claims being made about cancer treatment. A number of statistics say that the United States leads the world in successful treatment of cancer, and those stats have become beloved of righties who argue that our crippled, hemorrhaging behemoth of a health care system is still The Best Health Care System in the World.

I suspect part of this success comes from an initiative signed into law by Richard Nixon in 1971, the National Cancer Act, also known as the “war on cancer” act. Nixon dedicated a considerable chunk of taxpayer money to cancer research and treatment. Among other initiatives, a military biological warfare facility was converted into an internationally admired cancer treatment center, and the National Cancer Institute was given unique autonomy and special budgetary authority within the National Institute of Health. Although many specific drugs and treatments are manufactured by private industry, much of the basic research that made those drugs and treatments possible was underwritten by taxpayer dollars.

Gotta love those big gubmint programs, huh?

So today, U.S. citizens with cancer enjoy superior diagnosis and treatment … as long as they have insurance. Otherwise, tough luck, buddy.

Bob Herbert writes in his column today about Lonnie Lynam, a self-employed carpenter in Pipe Creek, Texas, whose cancer went untreated because he didn’t have insurance. Lynam put off seeing a doctor for his headaches, so the tumors in his brain went undiagnosed until the pain was unbearable. Even after the cancer was discovered, he received spotty, hit-and-miss treatment because he had no insurance.

Betty Lynam flew to Texas as often as she could to be with her son. She said he needed chemotherapy and radiation treatment, but since he couldn’t afford it, he couldn’t always get it.

“He was trying to pay a little bit at a time for the doctors and for the different treatments,” she said. “But he didn’t have a savings account or any collateral, except for his tools.

“I’d ask how he was feeling, and he’d tell me, ‘Well, I didn’t get the treatment today.’ And I’d say, ‘Why?’ And he’d say, ‘Well, I got in there and they found out I didn’t have any insurance and the woman told me I’d have to come back another time because she’d have to check with the doctor or somebody.’

“He suffered a great deal. Yes, he did.”

Lynam died in March, at the age of 45.

Cancer is no longer the all-but-automatic death sentence that it once was. Extraordinary progress has been made in fighting the myriad forms of the disease.

But, as the American Cancer Society has recently been stressing, the health coverage crisis in the U.S. is a major drag on this fight.

“A woman without health insurance who gets a breast cancer diagnosis is at least 40 percent more likely to die,” said John Seffrin, the cancer society’s chief executive.

According to the cancer society: “Uninsured patients and those on Medicaid are much more likely than those with private health insurance to be diagnosed with cancer in its later stages, when it is more often fatal.”

The uninsured (and underinsured) are also much less likely to get the most effective treatment after the diagnosis is made.

There are 47 million Americans without health insurance and another 17 million with coverage that will not pay for the treatments necessary to fight cancer and other very serious diseases.

The bottom line, said Mr. Seffrin, is that “the number of people who are suffering needlessly from cancer because they don’t have access to quality health care is very large and increasing as I speak.”

In fact, the American Cancer Society is so alarmed by our failure to treat the uninsured that it recently launched an initiative to call attention to the problem. From the ACS web site:

The new initiative aims to draw attention to plight of the 47 million Americans who have no health insurance at all, and the millions more whose coverage isn’t adequate to meet their health care needs. If cancer strikes, these people may have to do without necessary treatment because it’s too expensive, or put themselves into deep financial debt to pay for care.

That’s what happened to Raina, one of the patients highlighted in the new campaign. Her insurance didn’t cover all the costs of her thyroid cancer treatment, and her family couldn’t afford the payments.

“Basically, on every medical bill that I have, they’ve turned it over to a collection agency,” says Raina, who will join Seffrin and other ACS officials at Monday’s conference.

“No one should have to choose between taking care of their health and paying their bills,” says Richard C. Wender, MD, national volunteer president of ACS and another conference speaker.

The consequences of being uninsured or underinsured can be dire. Recent American Cancer Society studies found that people with no health insurance and those with only Medicaid coverage were more likely to be diagnosed with advanced cancer than people who had private health insurance. The more advanced cancer is when it’s found, the harder it is to treat — and the more expensive, in both personal and financial costs.

It’s an article of faith among righties that the uninsured are, somehow, getting medical care, somewhere. They can always go to emergency rooms, right? Going to the ER is OK if you’ve got a broken leg, but for catastrophic or chronic illnesses it’s not working. By law, emergency rooms are required only to stabilize everyone who comes in the door. They aren’t set up to provide free chemotherapy.

Last May, righties were linking proudly to a report that said American cancer patients survive at higher rates than anywhere else because our patients get advanced drugs not available elsewhere. Captain Ed wrote,

A new study by the Karolinska Institute in Sweden shows that the American health care system outperforms the socialized systems in Europe in getting new medicines to cancer patients. The difference saves lives, and the existing Western European systems force people to die at higher rates from the same cancers, although the Telegraph buries that lede (via QandO).

As Dr. Luba helpfully pointed out yesterday, the “survivor” rate Captain Ed is so proud of is not a measure of people who are cured, but of how many people with a given cancer survive 5 years. When the Center for Disease Control gives a survival rate of 97% and a mortality rate of 26.5 for prostate cancer patients, it’s telling you that a chunk of the “survivors” will die of their cancer eventually.

The hype from May was that U.S. cancer patients lived longer because they had better access to new oncology drugs. The Telegraph reported:

The researchers, whose report is published in the journal Annals of Oncology, found that Austria, France, Switzerland and the US were leaders in using new cancer drugs.

The greatest differences in the uptake of drugs were noted for the new colorectal and lung cancer drugs.

The proportion of colorectal cancer patients with access to the drug Avastin was 10 times higher in the US than it was in Europe, with the UK having a lower uptake than the European average.

Score one for the private pharmaceutical industry, say the righties. But this article from Genetic Engineering and Biotechnology News says these results are less glorious than they might appear.

The clinical reality for metastatic colorectal cancer is that the FDA-approved combination regimen of IFL (irinotecan, bolus fluorouracil, and leucovorin) plus Avastin increases median overall survival by 4.7 months. This small increase comes with a host of side effects, which impinge upon quality of life, as well as placing a burden on the patient and the healthcare system.

While this small increase is hailed by the FDA as being impressive, the clinical reality is that there is no cure for metastatic colorectal cancer. The much-vaunted blockbuster drug Avastin is simply an antibody supplement incorporated into an already complex chemotherapeutic drug regimen that may slow down the cancer process depending on the genetic constitution of that individual. The cost of drugs for metastatic colorectal cancer alone would exceed $1.5 billion per year if all the patients in the U.S. received treatment.

The clinical reality for metastatic breast cancer is similar. The latest treatment with Herceptin followed by lapatinib and capecitabine only increased the median time to progression from 4.4 to 8.4 months. Furthermore, 70% of patients do not respond to Herceptin, and resistance develops in virtually all patients.

Of these two big killers, both remain incurable, and this sobering fact contrasts with the glowing reports on Avastin and Herceptin emanating from the financial and tabloid media.

Headlines in the popular press and blogs said that new cancer drugs like Avastin are “saving lives.” But I think most of us would agree that a median overall increase of survival by 4.7 months, while nothing to sneeze at, is not “saving lives.” This is especially true when the for-profit system that generated the 4.7 months for some patients is kicking other patients to the curb. (See also “Unhealthy Care“)

After one of my recent health care rants a rightie commenter wrote, “Life expecvtancy has little to do with health care. Cancer survival rates do. Post them.” Here you are, dude. Enjoy.

Spotlight

November 2, 2007

Lies, Damn Lies, and …

Filed under: Health Care, Republican Party, conservatism — maha @ 12:23 pm

Rudy Giuliani is running a radio ad that is generating much comment and derision. Paul Krugman explains:

“My chance of surviving prostate cancer — and thank God I was cured of it — in the United States? Eighty-two percent,” says Rudy Giuliani in a new radio ad attacking Democratic plans for universal health care. “My chances of surviving prostate cancer in England? Only 44 percent, under socialized medicine.”

Really?

You see, the actual survival rate in Britain is 74.4 percent. That still looks a bit lower than the U.S. rate, but the difference turns out to be mainly a statistical illusion. The details are technical, but the bottom line is that a man’s chance of dying from prostate cancer is about the same in Britain as it is in America.

Defending Rudy, rightie blogger Don Surber spoke up:

The head of the National Health Service, Alan Johnson, took offense when Rudy Giuliani pointed out that the 5-year survival rate of prostate cancer is superior in the United States to places like England that offer “free” health care.

Rudy is a prostate cancer survivor. Rudy said in the U.S. the survival rate is 82%, 44% in socialized medicine countries.

Johnson waded into this and piped up that he has a 74% survival rate.

So what? It is 99.3% here.

Rudy was not misleading anyone. He was only using old data. New data shows that the billions Americans spend on cancer research is paying off.

Lancet Oncology magazine ran the numbers last month, according to Medscape.

I looked at the Medscape article Surber linked. The numbers he provides are from an analysis “headed by Arduino Verdecchia, PhD, from the National Center for Epidemiology, Health Surveillance, and Promotion, in Rome, Italy, was based on the most recent data available. It involved about 6.7 million patients from 21 countries, who were diagnosed with cancer between 2000 and 2002.” So it’s about five years old.

Medscape also says, “The United Kingdom in particular comes out badly in the tables, showing cancer survival rates that are among the worst in Europe.” So comparisons with the UK are not necessarily indicative of “socialized medicine countries.”

But what about the 99.3 percent survival rate? I spent way too much time this morning cruising around for information, and I am way confused. For example, the Center for Disease Control gives a survival rate of 97% and a mortality rate of 26.5, which to number-challenged me makes no sense. I’m sure one of you will attempt to patiently explain it to me, though.

This is from the American Cancer Society:

The 5-year relative survival rate is the percentage of patients who do not die from prostate cancer within 5 years after the cancer is found. (Men with prostate cancer who die of other causes are not counted.) Of course, patients might live more than 5 years after diagnosis. These 5-year survival rates are based on men with prostate cancer first treated more than 5 years ago.

Overall, 99% of men diagnosed with prostate cancer survive at least 5 years. Ninety one percent of all prostate cancers are found while they are still within the prostate or only in nearby areas. The 5-year relative survival rate for these men is nearly 100%. For the men whose cancer has already spread to distant parts of the body when it is found, about 32% will survive at least 5 years.

There are relative survival rates and age-adjusted survival rates and all kinds of other rates, plus mortality rates that make it seem people are surviving and dying at the same time, and the numbers are all over the map. I hypothesize that all these different sources are basing their numbers on diverse criteria, and comparing one set of stats with another is likely comparing apples to oranges. And I have a headache.

Eugene Robinson:

As several truth-squading journalists — notably, The Post’s Michael Dobbs– have pointed out, mortality rates from prostate cancer in Britain and the United States are roughly the same: About 25 men out of 100,000 die of prostate cancer each year in both countries. (That’s the standard way of reporting mortality rates, deaths per 100,000 individuals.)

From there I finally got to Michael Dobbs’s explanation, and it’s very clear and good, and there is a line graph to help those of us who need visuals. The line graph reveals that African American men are way more likely to die from prostate cancer than either white Americans or Brits, which ought to be a concern.

The other point Dobbs explains is that prostate cancer tends to develop very slowly. I gather that nearly everyone survives at least five years from the onset of the disease, with or without treatment. So, because patients in the U.S. are diagnosed much sooner, our diagnosis-to-death stats are much better than Britain’s, even though the actual outcomes aren’t much different from Britain’s.

Back to Krugman:

So Mr. Giuliani’s supposed killer statistic about the defects of “socialized medicine” is entirely false. In fact, there’s very little evidence that Americans get better health care than the British, which is amazing given the fact that Britain spends only 41 percent as much on health care per person as we do.

The 41 percent is a step up; it was a lot less than that in the 1990s.

The figure shows spending for health care per capita in various nations, in 1998. I added “USA” and “UK.” In 1998, the U.S. was spending $4,178 per capita and the UK was spending $1,461 per capita. (From the University of Maine’s “The U.S. Health Care System: The Best in the World, or Just the Most Expensive?” [PDF]). There’s no question that the British NHS has problems, but my understanding is that most of those problem stem from gross underfunding rather than the nature of the system itself.

Krugman, again:

Anyway, comparisons with Britain have absolutely nothing to do with what the Democrats are proposing. In Britain, doctors are government employees; despite what Mr. Giuliani is suggesting, none of the Democratic candidates have proposed to make American doctors work for the government.

To righties, all universal health care proposals are the same. They’re all “socialized medicine” or “Hillarycare.” Since what Senator Clinton proposes now bears little resemblance to what she proposed as First Lady in 1993, it can be argued that even Hillary isn’t pushing “Hillarycare.” But what this shows us is that righties aren’t even looking at the arguments or proposals. Their reactions are pure knee-jerk groupthink, and their opinions are based more on irrational fears and emotions than on facts.

Ezra Klein writes,

Giuliani’s cancer was treated by way of a therapy called Bradychardia, which involves implanting small, rice-sized radioactive capsules into the prostate gland. The technique was developed [PDF] by a researcher from Copenhagen, Denmark. Denmark, you’ll recall, is both in Europe and has a universal healthcare system. It’s a wonder Giuliani didn’t stalk out of his hospital on principle.

Moreover, Giuliani was unlucky enough to get prostate cancer at a fairly young age. But his experience was not typical. The average age at the time of diagnosis is 70 - which means that the domestic care Giuliani is lauding is being provided under the auspices of Medicare - a federally-run, single-payer insurance system.

Ah-HAH! Take THAT, Don Surber.

Since Mr. Surber cited the Lancet Oncology journal as a source, I poked around on the Lancet site looking for more information. Most of their articles are behind a pricey subscription firewall. But I did come across one that’s available for public view, from the October 2007 issue: “Increasing inequalities in US healthcare need taming.”

Although clinics in the USA offer some of the best anticancer services in the world, the proportion of Americans who cannot access these services is shocking. According to the US Census Bureau, in 2005 46·6 million Americans (including 8·3 million children) were without health insurance, with certain subgroups of the population faring especially poorly. For example, a quarter of people whose household income was less than $25 000 were uninsured—this is not surprising, however, given that the average cost of a single adult insurance policy is $2268. Texas had the highest percentage of uninsured people with 30% of adults aged under 65 years without insurance. From an oncology perspective, uninsured people are less likely to have access to screening or early-detection facilities; are more likely to be diagnosed late with more advanced tumours; are less likely to receive appropriate treatment; and are more likely to die from their cancer. Clearly, to make progress in the war on cancer, access to healthcare is a fundamental requirement that precedes any concerns about specific treatments.

Even for those with insurance, coverage is often less than optimum. A 2006 survey by USA Today, the Kaiser Family Foundation, and Harvard School of Public Health, of 930 adults who had cancer or who had a family member in their household with cancer, showed that insurance plans for nearly a quarter of patients paid less than actually needed; one in ten patients reached the limit of what their insurance would pay for cancer treatment; one in 12 were unable to get a specific type of treatment because of insurance limitations; and one in 14 were unable to pay for basic necessities such as food, heating, or housing because of financial burdens encountered in paying for their treatments. Furthermore, 6% of patients lost their health insurance as a result of having cancer. More than 17 million US adults are underinsured, yet current legislation to ensure appropriate provision is inadequate. For example, although many US states recently mandated that insurers cover screening for cancers of the breast, cervix, prostate, and colon, several states have since passed exceptions to these mandates, thereby allowing health insurance companies a licence to underinsure. …

… Currently, about 2·5 million people are diagnosed with cancer in the USA each year, of which about one in six have no health insurance and will receive inadequate care. Given the wealth of the USA, these figures are frankly unacceptable. In the run up to the 2008 US presidential elections, the time is right to highlight these issues to make them a high political priority, and to finally eliminate this appalling inequality of care.

See also Joe Conason [Update] and The Carpetbagger.

Spotlight

October 24, 2007

Been There

Filed under: Health Care, Congress — maha @ 9:51 am

Today BlogHer is promoting a virtual rally for the Mother’s Act, which would ensure that new mothers are screened for postpartum depression and provided with education and treatment. It would also provide for increased research on postpartum depression at the National Institute of Health.

Screening for postpartum depression amounts to asking the patient some questions. No expensive high-tech gizmos are required.

Postpartum depression is a serious, sometimes life-shattering condition that deserves more respect. I’m all in favor of screening, because people in the grip of serious depression are challenged to cope with everyday life situations, like getting out of bed and knowing what time it is. And I’m not exaggerating. It’s unrealistic to expect severely depressed individuals to take the initiative to get medical help for themselves. Screening could lead to earlier diagnosis and treatment and prevent what should be a challenging but happy time from turning into a nightmare.

Researchers are still groping about in the darkness to understand why new mothers are particularly susceptible to depression. The more we know about causes, the better we can treat and possibly even prevent postpartum depression.

Although I can be militant about respecting depression as a disease with a physiological basis, I share this writer’s concerns:

[Psychiatrist James] Potash summarizes the state of postpartum science, and it’s largely focused on attempts to find the genetic and molecular underpinnings of postpartum depression — underpinnings that could, in turn, be treated with drugs. Non-medicating approaches, such as cognitive behavior therapy and psychotherapy, are an afterthought.

I don’t want to imply that scientists ought to ignore the biology of this condition. But neither should it dominate their research. The bill next goes to the Senate; maybe they can slip in a little language about earmarking some of the money for talk therapy.

I think they should slip in a little more money to see if lack of physical support for new mothers is a factor. In our society new mothers can be terribly isolated. Their husbands and their friends work during the day. Extended family members — the new mother’s parents or siblings — may live some distance away or also work full time. Until I had children myself I didn’t appreciate how unnatural this is. It may be that to prevent the usual “baby blues” from turning into something worse, some new mothers just need more rest and another adult around to talk to.

In most human societies since Cro-Magnon Man new mothers lived in the midst of an extended family or tribe that provided physical and emotional support. Today, although we don’t expect women to give birth in the cornfield and go back to picking corn, neither do we respect the physical challenges of the postpartum period. Women are expected to snap back into their pre-pregnancy state and activities almost as soon as they leave the hospital, which is unrealistic. Women should be able to take the time they need to recover without feeling socially substandard.

And although generally I’m all in favor of people taking meds instead of “toughing it out,” nursing babies are exposed to whatever drugs the mother is taking. Non-pharmaceutical means of helping the mother need to be thoroughly explored.

Katstone writes,

The bill is currently with the Health, Education, Labor & Pensions (HELP) Committee of the Senate. If the majority of the HELP Committee members endorse the MOTHERS Act, the bill will move forward for consideration by the Senate. Without Senate sponsors, the bill could languish in committee and await reintroduction at a future date. The moms of America can’t wait for that.

Please contact these senators:

Committee members:

Democrats by Rank

Edward Kennedy (MA)
Christopher Dodd (CT)
Tom Harkin (IA)
Barbara A. Mikulski (MD)
Jeff Bingaman (NM)
Patty Murray (WA)
Jack Reed (RI)
Hillary Rodham Clinton(NY)
Barack Obama (IL)
Bernard Sanders (I) (VT)
Sherrod Brown (OH)

Republicans by Rank

Michael B. Enzi (WY)
Judd Gregg (NH)
Lamar Alexander (TN)
Richard Burr (NC)
Johnny Isakson (GA)
Lisa Murkowski (AK)
Orrin G. Hatch (UT)
Pat Roberts (KS)
Wayne Allard (CO)
Tom Coburn, M.D. (OK)

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