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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?


To: TimF who wrote (1690)5/22/2007 3:11:10 PM
From: Road Walker  Read Replies (1) | Respond to of 42652
 
re: Your "pointing out" something that isn't true.

OK, they have to wait 'til they are 65 YO.



To: TimF who wrote (1690)5/22/2007 3:20:41 PM
From: Road Walker  Respond to of 42652
 
A Short American Life
By NICHOLAS D. KRISTOF
How’s this for a glimpse into America’s HEALTH care mess:

The student winner I’ve chosen to accompany me on a reporting trip to Africa next month is a superb medical school student named Leana Wen. She receives her M.D. this month, and will research HEALTH care access this summer at a Washington think tank.

I asked Leana about her HEALTH insurance coverage, just in case she catches leprosy on the Africa trip.

“Actually, I was going to become one of the 45 million uninsured for the summer,” she said. “The think tank does not provide insurance for ‘temporary’ employees, and my school did not allow extension of HEALTH insurance post-graduation. I still haven’t found a reasonably priced insurance plan for this period.”

Aaaaargh! When a newly minted doctor investigating Americans’ access to medical care has no insurance — then you know that our HEALTH care system is truly bankrupt.

Let’s hope that the presidential campaign helps lead us toward a new HEALTH care system. John Edwards has set the standard by proposing a serious and detailed plan for national HEALTH care reform, and other candidates should follow.

The medical and insurance lobbies have been busy blocking national HEALTH care programs since they were first seriously proposed back in the 1920’s — and the result has been millions of premature deaths in this country because of people falling through the cracks. Doctors fighting universal coverage have been saving lives in their day jobs while costing lives with their lobbying.

Over all, a person without insurance is less likely to have diseases diagnosed early, less likely to get routine preventive care — and faces a 25 percent greater chance of dying early.

Americans with good jobs and complex needs receive superb medical care. But a child in Costa Rica born today is expected to live longer than an American child born today.

The U.S. now spends far more on medical care (more than $7,000 per person) than other nations, yet our infant mortality rate, maternal mortality rate and longevity are among the worst in the industrialized world. If we had as good a child mortality rate as France, Germany and Italy, we would save 12,000 children a year.

It is disgraceful that an American mother has almost three times the risk of losing a child as a mother in the Czech Republic. According to a new report from Save the Children, a woman in the U.S. has a 1-in-71 chance of losing a child before his or her fifth birthday.

Some speculate that America’s high infant mortality rate is partly a result of greater honesty about neonatal deaths or of more in vitro fertilizations. But even if those are factors, they don’t explain why a woman is 50 percent more likely to die in childbirth in the U.S. than in Europe.

The existing medical financing system also creates perverse incentives for expensive procedures; that may be why Americans are far more likely than Europeans to get C-sections. Meanwhile, the burden of paying for these second-rate statistical outcomes is crippling American business. By next year, the average Fortune 500 company will spend more on HEALTH care than it earns in net income, according to Steve Burd, the head of Safeway. Mr. Burd and other executives have formed the Coalition to Advance HEALTHcare Reform, creating a corporate constituency for national HEALTH reforms.

There’s evidence that the most efficient financing system would be a single-payer structure, such as that found in most Western countries. Some 31 percent of U.S. HEALTH spending goes to administration, more than twice the rate in Canada.

So bravo to Physicians for a National HEALTH Program, a group of 14,000 doctors and other HEALTH professionals that favors a single-payer system.

But universal coverage is only part of the answer. We also need far greater attention to public HEALTH programs focusing on prevention. Two of the most important life-saving HEALTH interventions in recent decades weren’t medical at all: the cigarette tax and laws mandating air bags and seat belt use. A national public HEALTH campaign on obesity (similar to the one Gov. Mike Huckabee started in Arkansas) should be an essential component of HEALTH care reform.

Even if a single-payer system isn’t politically possible right now, universal coverage is feasible through other mechanisms — as Massachusetts has shown. We need to hold the presidential candidates accountable, for universal coverage is an idea whose time came in the 1920s. We should insist we get it before the 2020s.

You are invited to comment on this column at Mr. Kristof’s blog, www.nytimes.com/ontheground.



To: TimF who wrote (1690)5/23/2007 12:39:16 PM
From: Road Walker  Respond to of 42652
 
Health care crisis squeezes working families By Lisa Baertlein
Wed May 23, 9:20 AM ET


Volunteer firefighter Cindy Holland has no medical insurance, and her husband's health benefits as a full-time paramedic do not extend to family members, so she and their three children go without.

The hard-working Northern California family makes too much money to qualify for public health insurance but too little to afford a private policy, caught in a Catch 22 that puts many U.S. workers at risk of financial ruin.

While many industrialized countries provide care for all, the United States covers only the elderly and the poor. Some 45 million, or 15 percent, of people in the world's richest nation lacked health insurance in 2005, up 3 percent on the previous year.

That number is widely believed to be higher today as healthcare costs skyrocket, employers slash worker benefits and insurers gut coverage and cherry-pick the healthiest customers.

President George W. Bush and governors of states like California have taken on the task of finding ways to provide health coverage, but it's not soon enough for families like the Hollands.

'ROLLING THE DICE'

John Holland, like most Americans, gets his health insurance through his job as a paramedic with a private ambulance company, which pays half the expense.

When Cindy, 36, shopped for coverage for herself and their children, she found it would cost about $1,000 a month, excluding dental insurance.

"It would kill us financially to do the insurance -- if we want to keep a roof over our head and food in my kids. You end up rolling the dice," said Cindy, a California native who works a pair of part-time jobs on top of firefighting.

As a two-parent family, the Hollands could earn just over $60,000 and still be eligible for Healthy Families, a children's health insurance program financed by state and federal funds.

But that would require John to stop working overtime, which he does in order to pay old medical bills and other expenses.

Meanwhile, Cindy wrestles with the idea of applying for public benefits.

"I wasn't raised to do that," she said. "It's almost embarrassing that you're not covered. There is this stereotype that you're an illegal alien sitting on your butt and not working."

These days, the family heads to one of the many Wal-Mart in-store health clinics springing up around the country, where doctor visits cost $39.

"We went from one extreme to the other," said Cindy, who when she was pregnant with triplets had good insurance through John's prior job. Surgery and follow-up care to save the lives of two of them -- one died in the womb -- cost just $200.

THE BIG SQUEEZE

More and more, America's uninsured -- and increasingly its insured population -- can't win. And the prospects are grim as U.S. healthcare spending is projected to double to $4 trillion by 2015.

Mexico-born Maria Morales, 53, is a single mom and legal U.S. resident who is a full-time caregiver to her severely disabled son. They are both covered under public programs.

Lately, though, she worries about her 16-year-old, a U.S. citizen who suffers from fainting and dizzy spells and was mistakenly cut from public coverage.

It took her nine months and help from Los Angeles' Venice Family Clinic, the nation's largest free clinic, to get him reinstated. Meanwhile, a recommended trip to the neurologist had to be delayed.

"I find myself with a big surprise that life is so hard in the United States. I'm a resident, just imagine how difficult it is for people who are undocumented," she said.

Jeremy Smola, 33, already knows the devastating toll an illness can take on people living in what many immigrants see as a "Land of Opportunity."

Five years ago, he had no insurance and was diagnosed with a goiter. He finally had it removed three years later, when he had a job with health benefits.

Even with insurance coverage, Smola had $15,000 in uncovered medical bills. He declared bankruptcy, and, like about half of the people who do, cited medical expenses as a key reason.

After years of pursuing a music career, Smola plans to join the "real work force" and find a job with benefits.

"I'm at an age where if I start a family, you have to have it. You can lose everything if you break a leg and can't work for six months," said Smola, who performed with the unsightly goiter on his neck as he searched for a job with benefits.

Jonathan Cohn, author of the new book "Sick" about the broken U.S. healthcare system, said America's wasteful and inadequate safety net is eroding at a rapid pace, but thinks improvement is possible.

"Most people have a sense that an enlightened society does not do this to its citizens," Cohn said. "We've solved this for the elderly (with Medicare). Every other country in the developed world has solved this."



To: TimF who wrote (1690)5/26/2007 9:30:25 AM
From: Road Walker  Respond to of 42652
 
A Katrina Health Care System
By ATUL GAWANDE
This is my fourth week as a guest columnist. Let’s take a look at the health care news that’s transpired in that time.

First, DaimlerChrylser sold off 80 percent of its Chrysler division for three pebbles and a piece of string. O.K., the cash payment was actually $1.35 billion. But for an 82-year-old company that built more than two million cars and trucks last year, took in $47 billion in revenue, and owns 64 million square feet of factory real estate in North America alone, that’s almost nothing. Yet analysts say that it was a great deal for Daimler. Why? Because the buyer, Cerberus Capital Management, agreed to absorb Chrysler’s $18 billion in health and pension liability costs.

Stop and think about this for a minute. The deal meant that the costs of our job-based health insurance system — costs adding $1,500 to each car Chrysler builds here, but almost nothing to those built in Canada or Europe — have so broken the automaker’s ability to compete that giving it away became the smartest thing Daimler could do. Chrysler’s mistake was to hang around long enough to collect retirees and an older-than-average work force. As a result, it now has less market value than Men’s Wearhouse, Hasbro, the Cheesecake Factory, NutriSystem, Foot Locker and Pottery Barn. Oprah is worth more than Chrysler. This is not good.

Meanwhile, officials at West Jefferson Medical Center outside New Orleans reported that the number of indigent patients admitted there has tripled since Hurricane Katrina. The uninsured are now 30 percent of their emergency room patients. Officials in Houston hospitals are reporting similar numbers. Conditions seem worse rather than better. Katrina caused a vicious spiral. Large numbers of people lost their jobs and, with them, their health coverage. Charity Hospital, the one state-funded hospital in New Orleans, closed. The few open hospital emergency rooms in the area have had to handle the load, but it’s put the hospitals in financial crisis. Four hundred physicians filed a lawsuit against the state seeking payment for uncompensated care, and massive numbers of doctors and nurses have left the area.

In Washington, a conference held by the American College of Emergency Physicians revealed that New Orleans may have it worst, but emergency rooms everywhere are drowning in patients. Mandated to care for the uninsured, they are increasingly unprofitable. So although the influx of patients has grown, 500 emergency rooms have closed in the last decade. The result: 91 percent report overcrowding — meaning wait times for the acutely ill of more than an hour or waiting rooms filled more than six hours per day. Almost half report this occurring daily.

A few days later, the Commonwealth Fund released one of the most detailed studies ever done comparing care in the United States, Australia, Canada, Germany, New Zealand and Britain. We’ve known for awhile that health care here is more expensive than anywhere and that our life expectancy is somehow shorter. But the particulars were the surprise.

On the good side, the study found that once we get into a doctor’s office, American patients are as likely as patients anywhere to get the right care, especially for prevention. Only Germans have a shorter wait for surgery when it’s needed. And 85 percent of Americans are happy with the care they get.

But we also proved to be the least likely to have a regular doctor — and starkly less likely to have had the same doctor for five years. We have the hardest time finding care on nights or weekends outside of an E.R. And we are the most likely (after Canadians) to wait six days or more for an appointment when we need medical attention. Half of Americans also reported forgoing medical care because of cost in the last two years, twice the proportion elsewhere.

None of this news, however, did more than lift a few eyebrows. So this is the picture of American health care you get after watching for a few weeks: it’s full of holes, it’s slowly bankrupting us and we’re kind of used to it.

That leaves two possibilities: (1) We’ve given up on the country; or (2) we’re just waiting for someone else to be in charge.

I’m pulling for No. 2.

Atul Gawande, a surgeon at Brigham and Women’s Hospital in Boston and a New Yorker staff writer, is the author of the new book “Better.” He is a guest columnist this month.
Copyright 2007 The New York Times Company