From Bloombery News, this is something that’s been screamingly obvious, and widely known. It has, however, been barred from any examination of American health care reforms. Because Denial isn’t just a streetcar, it is a national state of mind.
Americans are dying sooner and living with more illnesses than residents of Slovenia and other less prosperous countries . . . the U.S. is getting a poor return on money it spends on health care.
. . . lose more years of life to heart disease, lung cancer, preterm birth complications, diabetes and more . . . than most of 34 other developed countries from 1990 to 2010..
The study comes from the famously socialist Journal of the American Medical Association.
The U.S. failed to keep up with other nations in improvements in health care despite spending most per capita . . . U.S. death rate fell to 27th place in 2010 from 18th place in 1990.
Anything here you didn’t already know about?
You can have wealth concentrated in the hands of a few, or democracy. But you cannot have both.
Whatever Works 
We like it that way, because just like Ebenezer Scrooge, we want to “decrease the surplus population.”
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Two points:
It can’t work in the US until people change how they view health & healthcare as a whole.
Sad as it sounds, if we eliminated enough of the Blacks from the studies to bring our demographics down to match those others nations, we place quite well in the chart. I know; I ran the numbers once.
Sucks, don’t it…and blaming politicians and “evil insurance companies” isn’t going to do any good because the problem is the people themselves and how they think of health, life, and dying.
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You are exactly right, John, that the problem of universal healthcare is how people think of it, that is, as socialism. It’s a powerful meme, buttressed by a full half-century of Cold War thinking and a strong association with communism. It’s too bad the body politic can’t bring itself to realize that socialism has already been a great success for this country in the form of Social Security, Medicare and Medicaid. Those programs are immensely popular and they don’t make us all communists, but rather a self-supporting society that sets minimum standards of economic decency for all its citizens. And yes, it sure improves the stats if you eliminate “Blacks”, who disproportionally represent the poor, along with many Hispanics and others who pick the fruit, lay the bricks, clean the floors and empty the bedpans. Who needs ’em?
Our present outrageously expensive healthcare system, which presumably is science-based, has serious flaws. It is powered not by concerns over long-term patient welfare but through-put, i.e., money. Rather than a sensible systems approach with patterns, rules, limits and check-lists, it relies on individuals with medical degrees to make individual decisions, decisions that are sometimes arbitrary and ego-driven. Here’s an example. About a month ago, after over-exerting myself with yard work on a hot day I suffered what I thought was a TIA. I couldn’t think straight, couldn’t read print, couldn’t even talk sensibly for about a half hour. In addition, I noticed a numbness in three fingers on my left hand and left side of my mouth. Scared the hell out of me.
After blood tests, three MRI’s, one MRA and a probably unnecessary electromyography test a neurologist decided I had probably only suffered from heat stroke. Nevertheless he prescribed an indefinite course of monthly B12 shots, the expensive blood-thinner Plavix, an increase of daily aspirin from 81mg to a full aspirin, and the muscle relaxer Flexeril. I found from the NIH web site (another socialist appendage) that Flexeril should be prescribed only for 3 weeks in most cases and is contra-indicated for elderly patients (my category). Based on my own research and with my family doctor’s concurrence I am ignoring all but the B12 shots which actually seem to be diminishing the numbness. (Turns out, my B12 levels are low.)
As long as we embrace a system designed for profit, and indulgent of ego instead of wellness, we are doomed to suffer the consequences. This Frankenstein system will reel and stagger onward for many years until, I suppose, it fails of its own inefficiency or bankrupts the country.
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No, Jim. You misunderstand.
The problem of universal healthcare isn’t that it’s socialist, though it is. The problem is that it can’t work in America unless we dramatically change how we approach our own health and desire for medical treatment, as your example of heat stroke points out.
And it’s not, necessarily that that Blacks are poor. There are other biological factors involved as well. But, as we have a higher percentage of Blacks than any other of the industrialized nations, they have a negative effective upon comparison studies.
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Jim, did you read Stephen Brills epic 36-page story in Time mag called “Bitter Pill”? It parallels so much of your own experience. Stunning article.
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I read every word of Brill’s essay. Even did a post on it. Isn’t it amazing that such a clear analysis of the problem can be expressed so clearly and have so little impact on our distracted and self-involved nation?
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After I read it, I fully expected it to change the national conversation. I mean how can such an important story appear in one of the most read publlications in the country and still not change anything? I was naïve for sure. But I’m still stunned at how it just disappeared. (Sure didn’t see him on the Sunday shows or TV News, did we . . . )
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What would be the point of ‘eliminating the Blacks’ from the studies? I’m talking about Americans.
Very odd idea.
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But America’s residents aren’t all the same, Moe.
Blacks have generally worse health outcomes than Whites for a variety of reasons and America has a much, much higher percentage of Blacks in the population than most other developed countries, Moe.
This ends up skewing any comparative study of health or life-spans between the US and other nations. If you want a fair one, you have to normalize the demographics.
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Skewing? Nonsense. We are who we are. Vermont, Hawaii, Iowa, Minnesota, Maine and New Hampshire ranked 1 to 5 in 38 indicators; Mississippi, along with Oklahoma, Louisiana, Arkansas, Nevada and Texas were at the bottom.
That’s not race, that’s politics..
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Stealing this for my FB page.
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Go right ahead lady. . . .
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Nobody thinks twice about protecting persons and property using police and fire personnel, and nobody thinks we, as a nation, can’t afford these services. Healthcare protects persons just as surely as the police, and with the same necessity.
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One, the cost outlays are a lot different. Two, you might want to do some research on police and fire coverage as you might be shocked at how wrong you are about “nobody thinking twice” about its needfulness vs. its costs.
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One: irrelevant. Two: I’m well aware of past and present schemes for privatizing these services; however, I’m not talking about the ravings of psychotics.
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I was talking more of lack of any coverage than privatization, but that works too as an example.
Funny how any anti-government or reduced government sentiment is “the ravings of psychotics” though. Planning on having us all committed to “nice” tax-funded asylums?
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Of course not; I’m saying such wacky plans will never be implemented in this country. But right now some wealthy people are building oceangoing platforms where they can bask in their free market utopia–you’re free to join them.
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I remember watching a 60min episode on the health care system in the states. They interviewed and 85yr old woman with cancer who was referred to a psychiatrist because she was not feeling very well. He diagnosed her with depression. After she found out it cost $5000 for that session she was visibly upset. Her words. “No shit Im depressed, Im dying”. I think I spewed my beer on that one. 🙂
That pretty much sums up the problems with capitalism and the health care system.
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Your “depression” anecdote is a good one, T4T. The U.S. healthcare “system” of course is no system at all and your comment reminds me of an analogy. Suppose the commercial air travel industry were like the healthcare system. If it were, then it would be up to each individual plane captain on how to do everything, including how often to change the landing tires and overhaul the engines, vary load and fuel limits, adjust air spacing with other planes, risk marginal weather conditions, fly when tired and sample the alcoholic beverages. I have no doubt what would then happen to the air safety statistics. They would look like those of the healthcare system.
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I think it’s a perfect analogy Jim.
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It also perfectly sums up what will happen under “socialized” medicine because that’s exactly what always happens under it. Once the government runs the medicine and controls access to it, they get to decide who gets treatment…and an elderly woman is not going to get treatment for cancer beyond painkillers, a shrink visit or two, and directions to the nearest govt. suicide station (And yes, that will happen).
Additionally, it points out what I was saying. Only in America would an elderly woman actually expect extensive medical treatment and our desire to just keep living and get treatment for anything and everything is the attitude that I described and why the sort of medical access system that the Left wants can’t work in America.
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Except jonolan, that is NOT how it works in other countries. A single payer is not a provider. Providers are not usually gov’t employees. Regulations would apply, just as they do now.
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Moe, the payer is in essence the provider because the payer, when it’s the government, chooses exactly how much they’ll pay and under what circumstances. That’s true in the UK’s NHs, and if France’s system,…and in Medicare (Doc Fix anyone?).
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And it’s true with private insurance as well. They say TO YOU how much they’ll pay. They don’t set prices for procedures like Meidcare does, but for the patient they set the limits. Medicare sets limits but I guess it’s okay cuz the private hospitals around here are advertising for patients, and hospital chains are tripping over each other to buy out local hospitals. Most hospital patients are, as you know, on Medicare.
Medicare is also highly efficiently run with something like 2% overhead.. Private insurance is inefficient.
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One, with private insurers providers have a choice. There’s more than one fish in the sea and there’s a LOT of negotiation going on. With a Single Payer there’s just a monopoly.
two, the efficiency of Medicare is a huge lie. It’s overhead is HUGE but is hidden through political maneuvering, Doc Fix being one of the biggest as it’s NOT counted towards their budget. Their facilities costs are also not part of their official budget either.
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By facilities costs do you mean office space etc? They’re not a Department,, they’re part of Health and Human Services and facilities would appear in that budget I expect.
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Yep. I meant buildings. It’s not HHS though. All those buildings are payed for under a separate budget item, which is not a problem. It’s just part of why you can’t believe or use the official overhead figures for when comparing them to the private sector.
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It is HHS – I just checked.
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Only in America would an elderly woman actually expect extensive medical treatment and our desire to just keep living and get treatment for anything and everything is the attitude that I described and why the sort of medical access system that the Left wants can’t work in America.(Jonolan)
Not just in America, we have the same issues here in Canada. I agree also, there needs to be a point when the health care system is not going to be there for every person regardless of age and health. There is only so much to go around. Isnt there a point where life insurers wont insure someone because of there age and health?
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T4T – I know it’s sacrilege for me to say this, but I agree that there has to be a line. The problem is that there’s a huge ethical dilemma around where that line is and who makes that decision.
My father died at 98. He was healthy all of his life until the last weekend. He was hospitalized, had six hours of surgery (he wanted it, the docs were not urging him to have it, in fact were gently telling him they weren’t recommending it and would ‘make him comfortable’) and then went to ICU where he suffered for 36 hours before dying.
Those last 60 or so hours of his life cost almost $100,000.
There is so much wrong with that scenario one hardly knows where to begin.
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Yep, and how would be OK under any sane Single Payer system? The answer is that wouldn’t be and the follow-up is that American’s in general won’t tolerate any system for long that mandated that wasn’t OK.
That’s the perfect summation of my point of why it won’t work here. It’s not wrong; it’s just not right for us because of how we feel.
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Moe-I understand that scenario as I have seen it play out several times. I think one of the issues I see is the fact that culturally, we as a whole, don’t prepare ourselves well for our impending deaths. I believe when a culture becomes more revolved around the “I” or “Me” instead of the “We” you see many people trying to hang on regardless of the emotional and financial impact it will have. When you look around the world you can see other cultures that would gather round their father at that stage and bless his life and help him welcome the transition. Here in the West, not so much. I acknowledge and smile at the fact you had your father for a very long time, I hope it was a sweet ride. Mine passed at 37.
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Oh T4T, so sorry to hear that you lost him so young. That must have been hard.
You’re right that we have very different attitudes about death here. Just look at the move away from the word “died” to ‘passed on’, ‘departed’, whatever. I remember during the Terri Schiavo fiasco years ago hearing GOP congress critters recoil on the floor of the House at the mere mention of making a decision to ‘pull the plug’, as though that were akin to murder.
Differences in people too . . . my mother (I’m not gloating, please don’t think that) lived to 96. Her mother to about the same age. And both of them spoke acceptingly in their last years of knowing their days were shortening, and being okay with that. Dad, on the other hand, would never even talk about it so when it came he was in denial.
Much better to be ready to go and, if you’re able, to just slip away..
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Well, T4T, when it comes to bad thinking and materialism, Canada is sort of America-Lite. 😆
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Medicare, by law, analyzes all the costs of providing medical services, including overhead, equipment and salaries, then pay the hospitals a fair price for those services. On average, Medicare pays one tenth the amount printed on the patient’s bill–and the hospitals still make money. Healthcare in America is the biggest scam going.
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Healthcare in America is the biggest scam going.(Ojmo)
Well, the thing with really good scams is how they affect your emotions. When it comes to health and wellness that is pretty damn easy.
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No, ojmo, not a fair price; just the price they’re willing to pay which is often far less than most medical professional think is fair. That’s why, even with the ever-ongoing Doc Fix, it’s hard – FL mostly excepted – to find doctors who will accept Medicare patients.
But, if one doesn’t believe that doctors and nurses should be making that money in the first place, it’s easy to decide that the lower payments are fair I guess.
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So who decides what’s fair jonolan? Do we put limits on this or can my GP decide with impunity a blood test is worth $800? And don’t say I can go to another doctor; if one does it, they’ll all do it. Will the private insurers go along or will they just tell me they’ll cover up too $100 and after that . . .
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I can’t see anyway to come close to determining a fair price for services rendered other than the providers making that choice and the consumers deciding whether or not they can bear it, Moe. Anything else will end up being unfair in the long run and likely drive medical professionals out of the business.
Of course it’s not completely up to the providers right now. They negotiate fee structures with the insurance companies they work with. Hell! Those negotiations are a $billion+ per year industry in and of themselves.
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I think our system is so bad, so dangerous to our future that we must get hold of it. If we keep talking about ‘choice’ . . . there is just no such thing in our system other than to choose not to seek health care. You seem to start with the idea that health care is a commodity, which I think is false.
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If you’re not willing to have slave doctors like the Romans did, it’s a commodity. It’s a commodity even in Europe; just the profits are shifted around even further away from the actual medical personnel themselves.
Face it, Moe; do you REALLY want medical firms and Pharma firms being huge government contractors? Haliburtion MED anyone?
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Got a better solution jonolan?
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There’s no solution at all that isn’t predicated upon Americans “getting right” with: their health; their responsibility for the health; and their deaths. If that doesn’t happen, no healthcare / healthcare access system is going to work well for us.
And, Moe…If I knew how to make that society change happen, there’d be temples in my name across the land.
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jonolan – re people taking “responsiblity’ for their health. That’s a laudable goal and in fact we’re starting to see some action there as insurers are cracking down on smokers, some of the obese, etc. Life insurance has always done that. So it’s relevant, but only for some people.
Children don’t have much say about their early life choices that affect their health, newborns born without any prenatal care, the diseased, the crippled, the mentally unable, the senile elderly, the chronically poor . . . are they expected to adjust their thinking about death? And ergo about health care? Are we to hold them responsible if they have poor health?
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‘scuse me for cutting in here, jonolan, but you are making a serious error to assume that a universal or single-payer system has to suffer the same kinds of excess as in the War on Terror, a la Halliburton. Medicare is proof of it. I get EOB’s from Medicare regularly and they show that the government has negotiated wildly smaller charges for every procedure than what is charged cash customers. Yes, I know private insurers negotiate also, but they lack the clout of the government. The Brill report confirms this.
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Well, the government doesn’t really negotiate does it? It sort of just mandates what they’ll pay and on what terms, so you’re pretty close to right. That’s why many doctors won’t accept Medicare patients. I don’t see that working on a larger, choiceless scale because we’ll lose too many doctors, both from them quitting and from attrition.
If we went Single Payer, there’d have to be the Big Medicine and the lobbyists or it’d fail even quicker and more spectacularly. Of course, with them it fail due to bloat.
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Of course the gov’t negotiates jonolan, many steps along the way – before they finally set a price they’ll pay.
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And jonolan,, while you’re focused on ‘single payer’ (which I favor of course), that’s not the only way to get out of where we are now. In Switzerland for instance, it’s pretty much all private insurance – with subsidies of course – but in order to offer health insurance, companies must form separate, non profit divisions for that. If they’re not willing, they can’t sell health insurance. Works well, Keeps the costs WAAAAYYYY down.
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The Medicare price is the fair price, a fairer price than the price-gouging hospitals charge. Patients who have private health insurance also get discounts, because the insurance companies can leverage their size to negotiate lower prices. But patients having no insurance or whose insurance has exceeded the coverage limits are billed full price, about ten times the Medicare price. So the patients least able to pay are forced to pay the highest rates.
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So fair equates to the poorest being able to afford it irrespective of any other concerns. OK, there’s no point in my continuing this discussion with you as you’re beyond reason and have some very serious issues that can’t be addressed with words.
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What’s unfair is hospitals charging different prices for the same procedure, and charging the uninsured the most.
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Right, ojmo. The prices hospitals and doctors charge are not based on market forces. Nobody “shops” for a hospital or doctor when they’re sick, they simply commit themselves to them. Chargemasters, the hospital price lists, are arbitrary and based mainly on greed.
Last May my wife was having joint pain in her hip. She saw an orthopedist who had two x-rays taken. I’m looking at the EOB (explanation of benefits) right now: The hospital billed $5,162.00 for the two x-rays. Medicare paid them $485.32.
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Yes! The essential point is that for the reasons you state, market forces have little to do with determining healthcare prices.
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Reblogged this on Thoughts From The Well.
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I have reblogged your excellent piece and can’t thank you enough. I’ve nearly run out of patience and/or diplomatic approaches to pointing out the benefits of a universal system to individuals and communities (therefore the entire nation). I’ve decided ‘inability to imagine’ based on lack of experience is a major problem. When I list key immediate reliefs in conversation – that I experienced during 40 years in Canada – (no deductibles, no co-pays, no bankruptcies), facial expressions show shock and disbelief before the owners of said faces nod their heads. And even then many quickly shift to default “America’s approach surely must be good or we’d not have it.” I seem to have to repeat over a period of time for the possibility and benefits of ‘everybody in, nobody out’ to sink in.
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I agree entirely Maggie – and yet there it is. The opposition to universal care is strong, vocal and entirely delusional – most of the opposition has nothing to do with efficiency, cost or best practices in health care. It is based on an ideology that says ‘small’ government, whatever that is in the 21st Century, equates with freedom.
We already have an enormously efficient system in Medicare . . . making IT the universal system would solve everything, but . . . well, you know.
Anyway, welcome Maggie!
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I think in addition to small government ideology, American culture also has an a historically rooted ‘Calvinist’ slant. Maybe the two are related. Calvinism often preoccupies itself with whether or not an unfortunate individual ‘deserves’ or ‘has earned’ more than miser-level assistance. (Fortunate individuals, of course, do ‘deserve’ what benefits come their way because otherwise they’d not have the benefits!) Aye yi yi!
Canada I’m told had the same kinds of anti-universal arguments, and began to recognize value when Saskatchewan led the way. Thankfully several US states are on the ball with their own systems. Yes, Medicare – all set up and ready to go … but, yes, I know…!
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Oh yes, that Calvinist thing. It’s deep in our psyche. Lots of ‘blame the victim’ there.
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The problem is not “blaming the victim.” The problem is fools declaring the unsuccessful as inherently victims in the first place, Moe.
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Since we’re talking about healthcare for eveyrone including children, the elederly, the disabled, and the poor, perhaps you’d define unsuccessful for me? And as a follow up, I suppose anyone who doesn’t need a hand is to be labeled successful? Like Trump’s kids or Rush’s wives?
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Yes, More; there are those worthy of charity. That doesn’t change the fact that most needing the supposed benefits of Obamacare aren’t such types.
And yes, Moe. In the only terms that American now seem to accept, those that don’t need handouts are the successful.
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Ultimately jonolan, the ones needing the ‘benefits of Obamacare’ are the taxpayers, present and future, in the United States of America. Health care costs are killing us no matter who’s paying – private or public.
All the media focus seems to be on who is eligible, but what’s important I think is that Obamacare has built in incentives for cost effectiveness and looks like the best shot at present to help rein in the costs. It’s only a step, a very imperfect one so far, but it is definitely in the right direction.
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Well, Moe, in a 1 or 2 thousand page omnibus bill, much of it vague and to realized / codified by the unelected bureaucrats, there’s bound to be some potential good in it, such as those points you just brought up.
It won’t, however, rein in costs unless they full on rationing and “death panels,” which I think they’ll eventually do if it actually continues for any length of time.
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And let’s not forget that almost all legislation is crafted by ‘unelected bureaucrats’.
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@ jonolan,
John, after following this thread between you and Moe on ObamaCare and healthcare costs I am struck by how stubbornly you cling to the notion that the present system is preferable to one in which the government controls costs. Now your position would make sense if:
1. Capitalism and the marketplace governed what people pay. It doesn’t. Nobody shops for major healthcare by price.
2. Hospital and doctor charges had any rational cost basis. They don’t.
3. Fewer people diedof medical errors in hospitals than in vehicle accidents. They don’t, more die of goofs in the hospital.
4. Your and my capitalist government hadn’t mandated by EMTALA that the system provide top-quality medical care to anybody regardless of their ability to pay for it, thus transferring massive obligation to all taxpayers while letting young people skate.
Conclusion: You and other conservatives are misplacing the blame for the problem on ObamaCare which is actually trying to address these problems. You are outraged about the wrong things. IMO.
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jonolan – who knows if rationing or ‘death panels’ will come to the US (although we could certainly say they exist now for the uninsured who geet inferior care or no care and dye of undiagnosed or untreated diseases or in childbirth). If that happens you can be sure private insurers will do it as well.
But if we’re predicting possible futures, let’s acknowledge it could go the other way as well and improve on what we now have. We can’t just turn our criticism toward Obamacare – it has to be evaluated in the context of the entire system, since it was designed to work within that system.
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I cannot see where the other, positive way is possible exactly because Obamacare is was designed to work within the current system and the current system grew in our society with it’s ridiculous ideas of- and feelings towards medical care.
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I agree that we have some stupid ideas about medical care, although I think we are evolving somewhat on that. But what’s different about Obamacare from what we have is the outcome based cost incentives instead of the idiotic fee-for-service model we now use. That’s entirely new.
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