Tuesday, April 22, 2008

Health Care Systems around the world

If you missed last Tuesday's episode of Frontline entitled Sick Around the World you missed one of the most informative documentaries on the cost and value of health care that has ever been made. I'll just summarize for you some of the more important points it made. But I encourage you to go to the website link above and scroll to the bottom of the page where you can view the whole thing online.
In our country we spend 15.3% of our GNP on health care. But our outcomes and quality of life and death are much lower than in other countries. We have a higher infant mortality rate and a lower life expectancy than the the five other countries examined. The other countries included Great Britain, Taiwan, Japan, Switzerland and Germany. Some of them charge premiums, some don't. What they do in common is lower percentages of GNP spent than us and arguably, better care. I always thought that the over use of MRI's and CT scanners was the driving factor for our expensive system but Japan has many times over the number of scanners we have. They are all also SINGLE PAYER systems, the dreaded "government run" health care. The republicans harping about how terrible the Medicare bureaucracy is simply meant to distract us while their cronies rob us blind. Medicare is a very efficient system. Medicare "reform" has been an expensive boondoggle of the American people. Bush and his wealthy friends in the hospital, drug company and insurance industry sat down and divided Medicare into fat slices of cash pie split three ways. Medicare was supposed to be reformed by forming Medicare HMOs. What they didn't tell us was their real plan.
Start off by supplementing the health insurance companies, drug companies and hospitals to fool people with relatively low rates for their policies. They could do this because Bush pays these companies 12% MORE than he pays Medicare. So they rope all the elderly and disabled into the Medicare HMOs and get them used to their policies because they have perks like crappy dental and vision coverage. It seems like a no brainer for the users now but there is more to their plan. They will continue to raise their rates every year. They will continue to cut coverage and raise co-pays. But by the time the average person understands what they are doing it will be too late to go back to plain old Medicare coverage because it will be gone. That is where our system is headed now, a profit-making system where giant corporations grow cash by providing us with expensive and ever shrinking coverage. When money is the measure, the unnecessary elements, like listening to the patient or examining them are bypassed in order to shovel them through the meat grinder of modern practice. It is not really that different from the way we treat cattle, except we don't get slaughtered, usually. Did I say how important it is that we get a Democrat elected?

Monday, April 14, 2008

The Multiple Costs of Permanent War as a Policy

The military-big oil complex continues to drain our treasury everyday we are in Iraq. Meanwhile our educational system, social welfare and physical infrastructure suffers. As Bush's lackeys have plowed through every protective regulation put in place to protect American consumers from fraud and abuse our economy has lain fallow. And we the hapless public are going to pay through the nose for the next decade for their reign over the various regulatory agencies they rested control of. Add to that the neglect of our social services and physical infrastructure and you have all the makings of a worsening of the recession we are in. This situation is not accidental. Bush and his right wing nut job buddies set out to de-fund and cripple the agencies that protect us from lead in toys, bad drugs, corporate corruption, wildly speculative investment banks, mortgage fraud, pollution, overcrowded highways and plundering of our resources. No wonder the average American feels stressed and overworked. It usually takes both parents working at least one job each to make ends meet. The middle class squeeze is real and directly related to the unprovoked, lie filled, grossly mismanaged war we are trapped in. Bush’s buddies in the military-industrial-oil company-financial and insurance industry-drug company’s complex have prospered at our expense. Big business is God to these people, as you can tell from the pay packages that even incompetent CEO’s get on a regular basis. As our wealth as a nation has been channeled to these greedy and short-sighted thieves our standard of living has deteriorated, our debt has risen and our spirits have been drained. As Bob Herbert of the New York Times states:

The U.S., once the greatest can-do country on the planet, now can’t seem to do anything right. The great middle class has maxed out its credit cards and drained dangerous amounts of equity from family homes. No one can seem to figure out how to generate the growth in good-paying jobs that is the only legitimate way of putting strapped families back on their feet.

The nation’s infrastructure is aging and in many places decrepit. Rebuilding it would be an important source of job creation, but nothing on the scale that is needed is in sight. To get a sense of how important an issue this is, consider New Orleans.

The historian Douglas Brinkley, who lives in New Orleans, has written: “What people didn’t yet fully comprehend was that the overall disaster, the sinking of New Orleans, was a man-made debacle, resulting from poorly designed levees and floodwalls.”

We could have saved the victims of the Hurricane Katrina catastrophe, but we didn’t. And now, more than 2 ½ years after the tragedy, we are still unable to lift the stricken city off its knees.

Other nations can provide health care for everyone. The United States cannot. In an era in which a college degree is becoming a prerequisite for a middle-class quality of life, we are having big trouble getting our kids through high school. And despite being the wealthiest of all nations, nearly 10 percent of Americans are resorting to food stamps to maintain an adequate diet, and 4 in every 10 American children are growing up in families that are poor or near-poor.

The U.S. seems almost paralyzed, mesmerized by Iraq and unable to generate the energy or the will to handle the myriad problems festering at home. The war will eventually cost a staggering $3 trillion or more, according to the Nobel Prize-winning economist Joseph Stiglitz. When he was asked on “Democracy Now!” about who is profiting from the war, he said the two big gainers were the oil companies and the defense contractors.

This is the pathetic state of affairs in the U.S. as we approach the end of the first decade of the 21st century. Whatever happened to the dynamic country that flexed its muscles after World War II and gave us the G.I. Bill, the Marshall Plan, the United Nations (in a quest for peace, not war), the interstate highway system, the civil rights movement, the women’s movement, the finest higher education system the world has known, and a standard of living that was the envy of all?

So, how could this slide into paralysis as a nation with a deteriorating quality of life and a wasted economy be reversed? The congress in all its wisdom wants to bribe us with a small tax rebate to “stimulate the economy”. Forgetting that this plan has already been called basically dead on arrival, how logical is it? Reading Jim Hightower’s column in the March 21st issue of The Texas Observer puts the rebate in another light, especially in regard to our deteriorating infrastructure.


Washington is about to mail $600 checks to you, me, and nearly everyone else (unless you’re poor—then you only get half that). The checks are to prompt us to “go shopping,” as George W. so eloquently sums up our chief duty as citizens. This is Washington’s bipartisan plan to stimulate the American economy and avoid a recession.

Well, they’re a bit late for most Americans, since the working-class majority sank deeply into recession long ago. There’s also a basic flaw in Washington’s stimulus strategy: Most of the stuff we’ll buy with our government checks is made in China or other low-wage nations. So our so-called leaders are shipping $168 billion from our public treasury for a “stimulus” program that will effectively stimulate foreign economies. Smart, huh?

Meanwhile, back at Ranchito U.S.A., there’s lots of stimulating that could be done, returning huge benefits to our people and our nation for every dollar spent. Even as Bush and Congress were telling us to go shopping for foreign stuff, a federal commission issued a startling report calculating that we need to be spending $225 billion a year—for the next 50 years—to maintain and upgrade America’s infrastructure of roads, bridges, and other transportation systems. That cost doesn’t cover our decaying water systems, sewage plants, dams, and schools, nor the exciting potential of building a new, green energy infrastructure.

You want stimulation? Let’s invest our public dollars—and leverage trillions of private dollars—in a grassroots recovery program that will put millions of skilled laborers, entrepreneurs, inventors, small businesspeople, and others to work rebuilding America’s future. A good job at good wages doing good work beats a $600 check any day.

Jim’s proposal sounds like The New Deal put forth by Franklin Delano Roosevelt following the Great Depression. Part of that legislative agenda included creating the Federal Deposit Insurance Corporation (FDIC), the Federal Housing Administration (FHA), and the Tennessee Valley Authority (TVA). The largest programs still in existence today are the Social Security System and Securities and Exchange Commission—the primary regulator of publicly traded U.S. firms. It is no coincidence this administrations focus on destroying these programs is putting us back into a recession we have yet to see the bottom of.

Tuesday, April 8, 2008

Speaking of Healthcare

Both Hillary and Barrack are strong advocates, as I am, of reimbursing preventive services as part of health care reform in the United States. Unfortunately, the economic realities of such a policy are not positive. It is easy to assert, as each of them does that preventive services saves money because we all like to hear that message. But in a today in a closer examination of that issue a Washington Post story reveals how preventive services mostly drive up costs, even though thsy save laws. It is all about the statistics of prevention whereby a fairly large number of people have to be screened with preventive tests to prevent one person from actually getting the disease. Not that prevention is always more costly than the disease. Quitting smoking, for instance, does prevent significant disease and early death in a cost effective way. But other measures can be more costly not less in the long run. I think this article is helpful because it describes how complicated the health care debate is in just one fairly straightforward area, prevention. There are no simple answers in the debate on health care in our country. If you think universal health care coverage is the answer ask someone from Canada or England. We Americans are spoiled by the degree of access most of us have to high priced technologies like CT scans , MRI's and sophisticated lab tests. The ultimate future of health care in our country is going to involve ever increasing costs which still continue to grow at rate many times that of inflation. It is true that insurance companies are greedy and that most doctors are too. On the other hand people continue to demand antibiotics for colds that are expensive and do nothing for them. As an example of such behavior multiple randomized controlled trials have shown that sinusitis cannot be diagnosed by symptoms or a physical exam alone. No matter how much ugly stuff is coming out of the nose it does not mean you necessarily have sinusitis. Only a CT scan of the sinuses can tell for sure. Only then are antibiotics truly indicated though they may not shorten how long you have your symptoms at all. I know, I know, your symptoms are much worse, you're different except not really. Medicine is now a science and the most well trained doctors practice it that way. The rest would rather write you the Rx you don't really need than to have to fight with you. Then when you get the expensive medicines that you are prescribed how many of you take them until they are all gone? Imagine the billions of dollars that could be saved by not wasting that medication. So you see, we are all part of the problem of substandard heath care in our country. The answer is to make every player in the game more accountable. In other words, yes the drug companies and insurance companies are evil but on the other hand most of us are lazy and avoid doing the simple things we can do to prevent our own illnesses. I think this simply points out what experience tells us, from the outside of every issue the answers look easy but from the inside where the details reside every issue is more complicated. The best most of us can do is to get educated, talk to people who are knowledgeable and try to make informed responsible decisions. Rhetoric is easy, taking real actions on our own behaves is hard.

Monday, April 7, 2008

Iraq, Iran, McCain and Dem Superdelegates

Monday April 7th 2008
The Los Angeles Times reported on several aspects of the Iraq war. In an article entitled Officials foresee no ebb in Iraq violence reporters describe the continuing hopeless intractability of The Bush-Cheney-Rumsfeld war. In another article in the same edition an American consultant describes a frustrating year in Baghdad trying to set up a development center. In the New York Times talks about the ways in which the recent confrontation with Sadr's militia has only added to the instability in Iraq. The Information Clearing House reports that the testimony of Gen. Patraeus and Iraqi Ambassador Crocker will be focused on indicting Iran as responsible for the instability in Iraq as a probable prelude to war with Iran. From all indications Bush, Cheney and their neocon followers will simply not give up on their plans to invade Iran. With the continuing failure of this war on the front pages of every major paper in the United States you would think that the Democratic candidates stand on extracting us from Iraq would be welcome news. Instead the mainstream media plasters John McCain's latest insinuation that leaving Iraq to settle it's own conflicts is somehow unpatriotic all over the front page. Thankfully Frank Rich in the Sunday NYTimes details the many ways that McCain's vision of Iraq is some kind of weird misinformed militaristic fantasy.
Also in the LA Times they talk about the what's in it for me aspect of the choices the Superdelegates have to make between Barack and Hillary. By the way the people who are Superdelegates are those who used to be called the Party Bosses who made decisions behind closed doors in smoke filled rooms. If you would like to see how the vote count of the Texas Super's are totally up take a look at Burnt Orange were so far Hillary Clinton has a very strong advantage. At Capital Annex Vince Liebowitz reviews the horrible state of health care in Texas as documented in the 2007 National Health Care Quality Report released by the Agency for Health Care Research and Quality. In Rockwall County we can effect these disappointing statistics in two ways: 1) by supporting the charity work of the fine folks at Helping Hands who have a charity health care center and 2) by getting our own check ups and screening tests like Pap smears, mammograms, Prostate exams, colorectal screening etc. It is a shame that so many of us put these life saving tests off for years sometimes. The earlier any disease is detected the better the chance of a cure. A good example is colonoscopy where a polyp which is pre-malignant can be easily removed and prevent cancer from developing. Stop behaving like you were still children afraid of a shot at the doctor's office. Yes, like most adult responsibilities, it is always inconvenient and occasionally uncomfortable but keep in mind that we are talking about your life, not jury duty. And yes, I will get off my doctor soap box for now.
Glenda Denton, the Rockwall County Elections Administrator told me today that the turnout for the run off in the Railroad Commissioner's race in early voting was dismal. As disappointing as that is I can understand why; there just wasn't much of a way to distinguish between the two candidates, given their meager budgets and lack of media coverage.