Still More Healthcare Perspectives

I saw this on the NBC Nightly News:

And saw an interesting take on it from Real Time with Bill Maher (ep 164), where Dana Gould compares the angry white people (who likely have health insurance) to the calm and hopeful people (some who have health insurance, but their insurance doesn’t cover vision or dental services) receiving free healthcare. This is the status quo. This is what people living in denial don’t want to see; that providing healthcare to everybody makes sense, that it’s the right thing to do and that the rich need to pay for it.

Here’s a British take on the same scene:
The brutal truth about America’s healthcare
UPDATE: For an extra dose of conservative denial and psychosis, read the comments on the forelinked Independent piece. Horrifying.
(Via @mulegirl on Twitter.)

Of note:

“In the first two days, more than 1,500 men, women and children received free treatments worth $503,000 (£304,000). Thirty dentists pulled 471 teeth; 320 people were given standard issue spectacles; 80 had mammograms; dozens more had acupuncture, or saw kidney specialists. By the time the makeshift medical centre leaves town on Tuesday, staff expect to have dispensed $2m worth of treatments to 10,000 patients.”

“The gritty district of Inglewood lies just a few miles from the palm-lined streets of Beverly Hills and the bright lights of Hollywood, but is a world away. And the residents who had flocked for the free medical care, courtesy of mobile charity Remote Area Medical, bore testament to the human cost of the healthcare mess that President Obama is attempting to fix.”

“Christine Smith arrived at 3am in the hope of seeing a dentist for the first time since she turned 18. That was almost eight years ago. Her need is obvious and pressing: 17 of her teeth are rotten; some have large visible holes in them. She is living in constant pain and has been unable to eat solid food for several years.”

“‘I had a gastric bypass in 2002, but it went wrong, and stomach acid began rotting my teeth. I’ve had several jobs since, but none with medical insurance, so I’ve not been able to see a dentist to get it fixed,’ she told The Independent. ‘I’ve not been able to chew food for as long as I can remember. I’ve been living on soup, and noodles, and blending meals in a food mixer. I’m in constant pain. Normally, it would cost $5,000 to fix it. So if I have to wait a week to get treated for free, I’ll do it. This will change my life.’”

There are other stories of inspiration and desperation as well.

The best part is at the end where it shows how much better the average UK citizen is under NHS than the more expensive U.S. “free market”. I’ll let you enjoy those numbers. They are similar to numbers I’ve shared via links in the past (click here for the post; it’s required reading).

Democrats: align and get your shit together. It’s time. Republicans, you are missing history’s boat. We can do this. It’s time.

  • DaveK

    ” . . . it’s the right thing to do and that the rich need to pay for it.”

    I’m a little surprise that you would say that second part. It’s a little inflammatory, and isn’t going to help “the cause”. I totally agree that it’s the right thing to do, but it something that should be shared by all taxpayers (although perhaps not equally). By many perspectives I am “rich”, I make much better than minimum wage, as I suspect you and Heather also do, and as people who HAVE health insurance we are already bearing the cost burden of health care.

    People who don’t have health insurance, whether rich or poor, shift the burden to the (declining) so called middle class.

    But that still isn’t really the problem, but it does have very much to do with the rich and why I fear the problem isn’t going to be fixed anytime soon. The problem is that health care is a PROFITABLE BUSINESS.

    We do not need a National Health Insurance system, we need National Health CARE.

    • http://blurbomat.com/wordpress blurb

      Obama said as much yesterday (as he’s said all along) that the wealthiest would see a tax increase. I don’t disagree with this in the least. We’ve lost our way as a country. If I make enough money to qualify as one whose taxes go up, I’ll gladly pay into the system so that those less fortunate get healthcare.

      I agree with what you are saying about healthcare being a profitable business.

      You’ll need to clarify your last sentence/paragraph. I’m not sure those two are mutually exclusive, unless I’m misunderstanding your point.

  • @wz@m

    I heard this on NPR the other day (maybe it was local WBGH) but it was completely fascinating. I just cannot believe the size of some people’s hearts sometimes….and that will occasionally make me have hope for the human race.

  • deepthought86

    The really brutal truth is that the average doctor’s salary in the US needs to be halved. The article shows that the UK have around the same number of docs per capita, but they spend half as much as the US.

    For some reason this is rarely brought up in the debate. When was the last time you heard of a poor doctor? It’s time for them to forget about their cushy lifestyle that rests on the backs of the rest of society.

    If the government gives loans to med students to complete their studies they should stipulate that they have to serve 7 years in the public health system, and pay them fixed salaries like the rest of the world.

    Rocket scientists get paid salaries, why are these greedy doctors paid per procedure in the first place?

  • Cortner

    What is the average doctor’s salary in the US, specifically a primary care doctor? I invite anyone to spend 8 years in higher education including 4 years of medical school then spend a minimum of 3 years in residency training and then accept working for half that figure as salary for a minimum of 60 hours a week while paying back $150,000 in loans, supporting a family and planning for retirement. In the meantime, they will pay an office staff, pay for board examination, state liscensing and in some places a professional tax. When you choose to demonize a profession, know what you are talking about or at least step up to fill the void. Who were the people providing the free medical services at this event? If not doctors and dentists then who?

    President Obama made a statement about surgeons making $30,000 to cut off a diabetic foot. The AMA released a statement saying that a surgeon’s reimbursement is about $500-700. So which one is misleading us. Many graduating physicians do not even want to enter primary care now because reimbursement is so poor. Reimbursement from medicare favors procedures and specialists. Reimbursement, even from private payers, is based on the RBRVS system set up by medicare. The system is pretty much already socialized. Medicare pretty much distorted the free market long ago. I would argue that America’s high health care costs are not a free market failure. The free market disappeared long ago.

    It’s also not a question of putting up more money. It’s also a factor of time. Most of you might be willing to wait 6-8 weeks to have an arteriogram to work up your chest pain. Not me. I’m not arguing against reform. I like Tom Coburn’s plan. When he talks about health care, he at least gets his facts straight. I will never support a government option that leads to a single payer system. I will always have to pay for my healthcare as well as those who can’t afford it. I will work to retain any bit of liberty I have left. The idea that taxes will go up on the rich only is just a bogus way of using class envy to sell this thing. If you raise taxes on the “rich,” you’ve just increased their overhead. Small adjustments in the prices of goods and services will place that burden directly back on the middle class where the tax burden always rests the heaviest. With a single payer system, the middle class will find themselves with the same crappy government insurance provided to the poor while the wealthy continue to pay privately for the timely healthcare that they need. It will further highlight class division.

  • HDC

    There’s more on the Remote Area Medical free clinic in L.A. here.
    http://www.latimes.com/news/local/la-me-lopez16-2009aug16,0,3959652.column

    For the record, not that it’s worth much, I am squarely middle class and would happily take a tax increase to help insure we stop sliding into third world status. Seriously, what would it take? An extra $1000 a year? I’d pay it happily along side what I already pay for my private insurance. The selfishness is truly criminal in this country. What’s wrong with us?

  • Cortner

    I understand your desire to do your fair share HDC but I don’t think more money is the answer. We already spend more than other countries but don’t necessarily get a good value for it. Part of the problem is the emphasis in reimbursement on prodecures and specialists. You could say it’s the evil greedy doctors that just do procedures for the sake of supporting their “lush” lifestyles, but the reimbursement system as it stands creates a market force that favors procedures. Canada tends to have the opposite problem for specialists, they have a shortage of them. Hospitals in general are poorly reimbursed for medical patients and may actually show a net loss if those patients are heavily medicare. This leads to hospitals building up profitable procedure oriented programs to offset that cost and maybe show a profit. A lot of people tout this as a failure of the free market, but as I stated before, the fee schedule is established by medicare. Medicare rations care poorly. Care will be rationed to contain costs either by the government, a third party payer or consumers. There is no unlimited amount of resources with which to provide an unlimited amount of care.
    Another part of the problem is that we as consumers rely primarily on a third party payer to pay medical expenses and therefore tend to be less educated about our healthcare purchases than other goods and services. If people paid directly for their healthcare and procedures, they would be more concerned about the value for their money. People want no expense spared and want any diagnostic test or procedure that can be provided. As long as they have a low deductable and don’t have to worry about the cost, they don’t care. There are also a lot of treatments and interventions that frankly don’t in the long run alter disease mortality. I don’t know much about whether so called defensive medicine contributes to this or if that can even be quantified.
    The President acts like he’s vaguely aware of these things but does not present a plan that really aims at saving costs. It doesn’t really matter if it’s the government or insurance that’s paying. Ultimately it’s you, and you are not getting good value for what you spend now in our socialized system. I am for reform but I don’t want anything that leads to a single payer system. I think if people have more control over their health care dollars then you would see people spending those dollars in more reasonable, rational ways. I don’t think POTUS is being honest about the single payer system topic. It’s obvious that is what his supporters want. I think calling it an option is just a means to an end. It’s a complex problem with a lot of hands in the pie and a commodity that means a lot to each of us. Demonizing doctors, hospitals, or third party payers may be politically advantageous but it does not fix the system. I’m willing to try most anything except single party payer and creating a new entitlement system beyond the medicare and medicaid systems we already have. I think you’re spending plenty already HDC. If you had to spend more, I’d rather you be able to decide where to spend it.
    http://www.stateofworkingamerica.org/tabfig/08/SWA06_Fig8J.jpg

  • DaveK

    @ Blurb: I’m talking about seperating the profit and additional administrative costs that come with the commercial insurance system.

  • Cortner

    …because a government run single payer system would have no administration costs. I seriously doubt any government run program will run more cost efficient than a comparable private sector one. How about they fix medicare first and then maybe I’ll trust them to efficiently run my healthcare. I have no problem with using profit to motivate efficiency. As it is, reimbursements are all figured based on the RBRVS system set up by medicare. So prices are already fixed based on what the government decides it will pay. The system is ALREADY socialized though most people don’t know it. A little inside joke within the VA administration: “How do you get rid of a government employee (or VA employee)? You promote them.” Obama’s arguement about cost savings through prevention is also a fallacy. Prevention costs money through education and screening tests which themselves can be prohibitively expensive,. Any cost savings, if there is any, would be years later. Prevention is good when it saves lives and prevents morbidity. It’s not a cost savings scheme. Any third party payer system including the government will have to decide whether it can afford that particular screening test. If they decide it’s not warranted, like routine chest x-rays for smokers, I want the option of paying for it on my own. Like I said, he can start by fixing medicare, but he won’t because it would be political suicide. It’s pointless to argue the specifics of the current House bill though. I have a feeling the final bill will look nothing like it.

  • HDC

    Cortner, I agree 100% that cost management and curtailment is a big, big part of the reform needs. However, I get sick of the threat of middle class tax hikes as a scare tactic to derail the whole issue of reform, especially after seeing what the Remote Area Medical folks keep showing us. Moreover, I’d still happily pay in if it meant we could create a truly enviable system that the rest of the world would want emulate.

    Also, on your claim that Obama’s argument about preventative care as a cost saver being a fallacy, I think you may be misinterpreting what he’s said. From his speeches, I have taken his meaning to be not preventative care but rather pre-cataclysmic care. He’s repeatedly brought up diabetic issues, as have others, in making his point on that. Things like getting diabetics early treatment to problems before they have the chance to spiral out to crises that require hospitalization and subsequent expensive treatment. Further, I think that the Administration would agree with you that preventative care is not necessarily a substantial cost saver as I’m fairly certain they have been reading the same numbers the medical community has been publishing on that issue. But I think they must toe the line on that language carefully as many in the listening audience might bristle at the thought that the proposed reforms do not encourage personal responsibility, i.e. preventative care.