Two thoughts on health care

First, where do people get the notion that America has the best health care system?  I suspect that they really mean it's the best one they know.  And they should know better:

The United States ranks 31st in life expectancy (tied with Kuwait and Chile), according to the latest World Health Organization figures. We rank 37th in infant mortality (partly because of many premature births) and 34th in maternal mortality. A child in the United States is two-and-a-half times as likely to die by age 5 as in Singapore or Sweden, and an American woman is 11 times as likely to die in childbirth as a woman in Ireland.

As my friend RL notes, we have to be careful of cherry-picking our rankings.  But whether or not we're the best in a select group of industrial nations, we are definitely not number 1.

Then there's the hyperbole of health care opponents.  A selection:

Critics storm that health care reform is “a cruel hoax and a delusion.” Ads in 100 newspapers thunder that reform would mean “the beginning of socialized medicine.”

The Wall Street Journal’s editorial page predicts that the legislation will lead to “deteriorating service.” Business groups warn that Washington bureaucrats will invade “the privacy of the examination room,” that we are on the road to rationed care and that patients will lose the “freedom to choose their own doctor.”

Oops, wrong debate.  As the Times' Kristof points out, these are statements from the Medicare debate in the 1960s.  They were wrong about Medicare and they're wrong about the current health care bill. 

Of course, they do illustrate a third point: hyperbole is not a new tactic in politics.  Something we should all keep in mind.

Sen. Franken nails the problem of medical bankruptcy

This is brilliant commentary from Minnesota's junior senator:

Two on health care

From FiveThirtyEight, how to poll properly on the public option:

This is the Quinnipiac poll, which asks:

Do you support or oppose giving people the option of being covered by a government health insurance plan that would compete with private plans?

This is a perfect question.

From Minnpost, health insurers reaping a bonanza:

The half-dozen leading overhaul proposals circulating in Congress would require all citizens to have health insurance, which would guarantee insurers tens of millions of new customers -- many of whom would get government subsidies to help pay the companies' premiums. "It's a bonanza," said Robert Laszewski, a health insurance executive for 20 years who now tracks reform legislation as president of the consulting firm Health Policy and Strategy Associates Inc.

Things Republicans have taught me in discussing health care

1. Consistency is unimportant, but stridency is.
2. Knowing the definition of words you use does not matter.
3. Lying about who provides your health care does not matter, particularly when people like their government provider more than their private one. (yes, in America).
   
4. It's great fun to tell outright lies about health care legislation...
5. ...especially when the "death panels" were actually proposed by a Republican to help families make tough end-of-life decisions...
6. ...And (referring back to #1) let's not forget that Republicans have no problem with government interfering with end-of-life decisions.

A public option is crucial for health care reform

The debate isn't really a debate, except in Congress, as nearly three-quarters of Americans support a government-provided option for health insurance, to help negotiate lower prices and keep private insurers honest.

So why is Congress, controlled by supposedly liberal Democrats, stalling on the key component to universal, affordable health care? From FiveThirtyEight:

"Can we actually see -- statistically -- the impact of lobbying by the insurance industry on the prospects for health care reform? I believe that the answer is yes."

Check out the link. It's a stunning indictment of the role of money in the health care legislation, with a strong statistical correlation between insurance PAC donations and lower support for the public health option.

Health Canada would be a great thing for the U.S.

Nicholas Kristof:

The swift boating of Obama's health care plan has begun, with comparisons to the scary Canadian system (note: the ads always seem to leave out the buses of seniors going to Canada to get affordable prescriptions).

How bad is the Canadian system? The Kristof article has this anecdote from an American who had a stroke while working in Canada:

There were two patients to a room, and conditions weren’t as opulent as at some American hospitals. “The food was horrible,” she said...

[But] “They never spoke to me about money,” she said. “Not when I checked in, and not when I left...” [emphasis mine]

She now pays the equivalent of just $49 a month for health care

She had a relapse while visiting in the United States, and the story was different:

Ms. Tucker fainted while on a visit to San Francisco, and an ambulance rushed her to the nearest hospital. But this was in the United States, so the person meeting her at the emergency room door wasn’t a doctor.

“The first person I saw was a lady with a computer,” she said, “asking me how I intended to pay the bill...”

Nothing was seriously wrong, and the hospital discharged her after five hours. The bill came to $8,789.29. [emphasis mine]

I think it's time we ask for a better health care system.

Diet pop will save you calories and dollars

A nice piece by Nicholas Kristof on the brilliance of New York Governor Patterson's plan to make ends meet by taxing sugared soda. 

An 18 percent sales tax on soft drinks and other nondiet sugary beverages 

Why is this so great?  Because taxing unhealthy behavior is one way that we can make money by improving health.

Let’s break for a quiz: What was the biggest health care breakthrough in the last 40 years in the United States? Heart bypasses? CAT scans and M.R.I.’s? New cancer treatments?

No, it was the cigarette tax. Every 10 percent price increase on cigarettes reduced sales by about 3 percent over all, and 7 percent among teenagers, according to the 2005 book “Prescription for a Healthy Nation.” Just the 1983 increase in the federal tax on cigarettes saved 40,000 lives per year.

And why are sugared drinks in particular so bad?

Evidence is accumulating that sugary drinks are a major contributor to obesity because of the evolutionary heritage I mentioned at the outset: Except for soups, liquid calories don’t register with the body, according to Professor Popkin and other specialists. [emphasis mine]

Tax the hell out of them.  

Defeat is Victory - health care measure pulled

In Ohio, petitioners just gave in to pressure and withdrew their ballot measure mandating paid sick leave for all Ohio workers. The Ohio House speaker (a Republican) responded with this:

“This is a victory for all Ohioans. This proposal would have hurt Ohio businesses and driven jobs out of our state. It was poorly crafted, confused voters and would have placed Ohio at a significant disadvantage to compete with other states, much less in the global economy,”

No guarantee of staying home for a day without losing pay, whether you have a cold or cancer.  Some victory.

To the libertarian on health care: you're assumptions are wrong

Paul Krugman has a nice post about the challenge that libertarians have in accepting the evidence on health care - that their fundamental assumptions about the efficiency of markets just don't hold up.

The basic facts on health care are clear: government-run insurance is more efficient than private insurance; more generally, the United States, with the most privatized health care in the advanced world, has a wildly inefficient system that costs far more than anyone else’s, yet delivers no better and arguably worse medical care than European systems.

 See more of Krugman's post here. 

Science and drug companies: follow the money

A new cholesterol drug, Zetia, was being studied in the past two years. It got FDA approval for lowering LDL (bad cholesterol) more than statins alone, but was being studied for its efficacy at reducing arterial plaque (the actual goal of a cholesterol drug).

The findings weren't what the company hoped for - despite hitting lower LDL targets, it turns out that it was no more effective than existing drugs.

So what was the big deal in the recent announcement?

1. The lag time - the study was completed two years ago (April 2006), but the company only released preliminary data in fall 2007 under intense public pressure.
2. The money factor - Merck/Schering-Plough made $5.2 billion off the drug last year. Why tell people it was no more effective than other drugs?
3. The science issue - how can we trust the efficacy of our medicine when so many studies are funded by those with a financial interest in the outcome?
4. The regulatory issue - the FDA approved the drug because it lowered LDL, but it turns out that's not sufficient to improve health. It's like approving teeth whitening toothpaste because it makes teeth look better, not because it makes teeth stronger or healthier. Should this practice continue?

In the end, no one's health was harmed by this company's action, though no doubt a lot of folks paid more for medicine that was no better than the alternative. Science was stymied by the company's financial interest, and the FDA gets egg on its face for fast-tracking approval of a drug that doesn't do much.

Sounds like free market health care is working great.

Obama: you better stick to universal health care

The time is ripe for universal health care, so as much as I want Obama to win, he better be planning to go for gold. This news about the company he keeps is not impressive. In other words, get on the stick, Obama!

Obama's health care plan (and rhetoric) needs a tweak

Paul Krugman has taken Obama to task several times in recent weeks for holes in his health care plan. For some of the campaign rhetoric from the Obama camp, check out Factcheck.org's recent post on an Obama health care mailer.

Krugman's criticism is tough love, since it addresses a couple shortcomings in the Obama plan: the issue of free riding and enforcement. Basically, if healthy people opt to not have insurance until they get sick, they get a "free ride." To make health care more economical, you make them sign up. Which takes enforcement. Obama's been criticizing Hillary for having an enforcement provision, but you really can't go universal without it.

Unless...you go with my idea. Which is that people are automatically signed up for health insurance on the government employee's plan unless they opt out. And you can only opt out if you have other health care coverage. You can opt for a monthly premium payment or just pay it from your taxes. In other words, leave the enforcement to people who already do it (the IRS) and the health care to an existing health care group (government employees).

And Obama, get your wonks and rhetoric around free riders and enforcement. Because we can't solve the health care problem without addressing both.

Disclosure: I'm supporting Obama on Super Tuesday.

U.S. Health Care: It's not the private part that makes us innovative

A tip of the hat to Paul Krugman for this piece that debunks the idea that universal health care will undermine the U.S. lead in medical innovation.

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)...

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. (emphasis mine)

The most well-known example of this is Nexium, which AstraZeneca introduced several years ago as the successor to Prilosec...AstraZeneca promoted Nexium heavily through advertising--you may remember the ads for the new "purple pill"--and, as a result, millions of patients went to their doctors asking for it. Trouble was, the evidence suggested that Nexium's results were not much better than Prilosec's--if, indeed, they were better at all. And, since Prilosec was going off patent, competition from generic-brand copies was about to make it a much cheaper alternative. (The fact that Prilosec's price was about to plummet, needless to say, is precisely why AstraZeneca was so eager to roll out a new, patented drug for which it could charge a great deal more money.)

There's your private sector health care innovation - it's in the marketing department.

GOP likes higher cost, less coverage health care

The U.S. House will consider a bill on children's health insurance soon, but the politics are getting far ahead of the actual debate. With new rules requiring offsets for new spending, the children's health care proposal asks for higher tobacco taxes and less money for Medicare patients in the private health care plans. The latter is actually a cost savings, since the government-run Medicare health plans are cheaper than the private ones.

That doesn't stop Republican opponents from political posturing:

“Dragging people out of private health insurance to put them into a government-run program is ‘Hillary care’ come back,” [House Republican leader] Mr. Boehner said.

If "Hillary care" means less expensive but more expansive medical care for Americans, let me know where to sign up.

Note: This post was titled in the spirit of the Republican opponents to children's health insurance. It's inflammatory and misleading and I approved this message.

A few points on health care

Rising health care costs come from a lot of places, one of which is simply the fact that we want to live healthier, longer. But this guy looks at some of the most significant ways to address the not-so-necessary costs of doing health care business.