Guest Blogger: Mimi Merrill
Items From Crabby Old Lady's Blog Notebook

Universal Healthcare and the 2008 Election

category_bug_journal2.gif Here is an example of how one area of soaring healthcare costs can be contained: The Veterans’ Administration, which is the only government agency allowed to negotiate drug prices with pharmaceutical companies, pays 50 percent less than Medicare for the top-20 brand-name drugs sold to elders.

It’s not just brand-name drugs that can price non-VA patients out of treatment. A study from the Kaiser Family Foundation reports that while inflation rose 21 percent from 2000 to 2007, patient payments for generic drugs rose 38 percent in the same time period.

Medicare, by a provision of Part D, the prescription drug plan, is prevented from negotiating drug prices. How could one part of the government be disallowed from saving money while another part is allowed to do so? You might want to ask your Congressional representatives along with presidential candidates who all take big campaign bucks from the pharma lobbies of which there are more than 600 - 600-plus for one industry! - in Washington.

But it’s not just the pharmaceutical companies that are raking in profits on the backs of sick people and a sick economy. It’s every sector of the healthcare industry:

…”we must confront the fact that we pay more for virtually every pill, every artificial knee, and every screw than any other developed nation in the world - for absolutely no reason except that lobbyists have paid Congressmen to believe that if we don’t overpay, medical research will grind to a halt. The truth is that pharmaceutical companies spend much more on advertising than they do on research, and in recent years drug-makers and device-makers have been racking up double-digit profits - at the expense of the rest of the U.S. economy. Employers in Detroit simply cannot afford to keep the drug and device industry in the style to which it has become accustomed.”
- TPM Café, 11 April 2008

Another practice that inflates healthcare costs is the mostly standard fee-for-service system in which providers, physicians and institutions are paid for each procedure, test and evaluation whether the patient needs it or not. At the Mayo Clinic and a few others, however, doctors are on salary, which keeps down costs.

All the Social Security scare stories are mostly hogwash; the system can be secured for decades to come with a few tweaks that won’t cause undue financial harm to anyone. Healthcare, including Medicare, on the other hand, is in deep financial trouble as is anyone trying to buy either coverage or treatment.

The only solution anyone in the world has invented that gives everyone access to healthcare is universal coverage, sometimes called a single-payer system, national healthcare, etc. (Anyone reading this who wants to shout, “But that’s – horrors! - socialized medicine”, please do it elsewhere. You are probably still weeping at Joe McCarthy’s grave.)

To succeed, a universal healthcare plan must be truly universal – that is, everyone participates. In that way, premiums are spread equally among the healthy and the sick. It is the essence of the idea of any kind of insurance: we pay because we’re betting that we may get sick one day with astronomical costs we could not otherwise afford. Some people pay without using much of the system. Others use much more than they pay. It is fair because every one of us is only a four-leaf clover away from needing the care.

In this volatile election year when something like 75 percent of the country is angry with the general status quo and only the wealthy are unconcerned with healthcare costs, we have an opportunity to change the healthcare system for the good of everyone by whom we vote for, and here’s what you need to know about that:

The minutiae of the two Democratic presidential candidates’ healthcare proposals are unimportant. Presidents don’t create legislation, although they can advise, consult and veto. That’s one of the reasons Hillary Clinton’s healthcare plan failed in the early 1990s. In operating out of the White House in secrecy, she ignored Congress, which does create legislation. (The senator may or may not have learned from that experience; it's hard to know.)

So what you want to look for as you choose your candidates for Congress, as well as president, is their commitment to true universal healthcare in general, and soon. By the time a plan works its way through Congress, the details will be chewed over, mangled, written and rewritten, and who knows? in the process, someone may come up with better ideas than Senator Clinton’s “mandates” and Senator Obama’s “children only” which still don't cover everyone and if implemented, would need to be redone in the near future with repeat cost to taxpayers in consultants, research and experts.

The bigger obstacles to a universal plan are those 600-plus pharma lobbies along with the insurance and healthcare provider lobbies.

Public momentum is with universal healthcare right now. And 59 percent of physicians nationwide support it. Medicare is a decent model; its administrative costs are about two percent compared to private coverage’s 15 to 20 percent. When I’ve written about universal coverage in the past, invariably several commenters wring their hands over all those poor employees of private insurers who will be out of work. Yes, and they’ll be immediately hired into the new system. Experience will be needed to run it.

As to Medicare and other countries' national healthcare horror stories, there are just as many, if not more, involving private coverage. No system is perfect, mistakes will be made, but you must ask yourself how well the current system is working when one-sixth of population has no coverage at all.

As we contemplate our votes this year, the Iraq war is important, the economy and housing are important along with corruption in high places, assaults on the Constitution and – well, you know the litany. But healthcare is equally, if not more, important.

When I was a kid, old people constantly repeated the phrase, “As long as you’ve got your health…” meaning that everything else is secondary. Even if your worst health problem has been only a bad flu, you know they are right. Nearly 50 million people can’t afford any kind of health coverage and have not seen a doctor in years. Due to recent increases in some co-pays from private insurers, some people are facing $4,000 and more for a month’s supply of needed drugs. No ordinary person can do that. Is the alternative to die even though a drug could save them?

The United States needs universal coverage. Keep that in mind as you choose your candidates this year and know where they stand on it before you vote.

[At The Elder Storytelling Place today, Norm Jenson penetrates an electronics problem we have all faced in The Beep.]


Comments

"75 percent of the country is angry"

How about 'bitter.'

After seeing the cost of my thyroid meds rise 10 bucks in one month from 12 to 21 dollars, I know that every word of this s true! I guess gouging granny is their favorite sport. No wonder there is a higher percentage of elder women living in poverty.

After spending the last 18 months living in Denmark, it's clearer to me than ever how insane it is that we don't have universal health care in the states. I read on-line last week that now more than 50% of American doctors favor it, and say that the complaint that the quality of US health care will decline is an absurd lie perpetuated by those who have everything to gain financially by keeping 50 million people uninsured, and by keeping the cost of drugs high and unaffordable for those on a fixed income.

You've certainly made the case here for the need for a health care system that provides services to everyone. I think it's morally unacceptable that people are without health care in this country, or that some could become bankrupt due to health care costs.

This week "Frontline" on PBS TV aired a program focused on healthcare systems in various countries around the world. Anyone unfamiliar with other countries healthcare would find this program informative. Clearly there are possibilities and ideas that could be adopted or adapted here.

I agree it is ridiculous that pharmaceutical companies are not expected to provide uniform lowest drug costs to all of us.

I think we really need to pressure our congress to legislate for the voters -- that's us -- that's why we hired them. We're their employers!

I saw the FRONTLINE show that joared mentioned and I wish everyone in the U.S. could watch it. In every country that had universal health care people loved their system. In some, no appointments were necessary; you just show up at the doctor's office. No referrals were necessary so just think how much paper work would be saved by this one factor alone. The administrative costs were so low that it almost amounted to a 20% saving in health care costs. People think we couldn't switch from our complicated system overnight, but Switzerland did it and it works. One of the secrets was to eliminate the profit for the insurance and pharmaceutical companies. The fear was that they would no longer be able or interested in serving the public. That fear was unfounded as they still compete for the insured because they can then sell them other forms of insurance.

We could study all of these many successful plans (as Taiwan did) and avoid the pitfalls and improve the pluses and come up with a wonderful universal coverage plan. It can be done; we just need to convince our legislators to do it.


Do you think it is possible to have a Universal Health care system that is not full of monetary abuse?

I am on Medicare and it works just fine. Really! Except that I am ,Thank God, fairly healthy and still I have to follow my Doctor's orders and have what I consider to be unnecessary tests. Medicare pays for me to have an MRI for a slight pain in my shoulder (Dr's Orders).My husband is constantly being sent for tests so the doctor can defend himself in court in case something happens.

We have to stop being so litigious and take some responsibility for our own actions. Somebody smokes for 50 years then blames the doctor when they get lung cancer.If we would stop suing the doctors for everything that is wrong with us, perhaps they wouldn't order all those unnecessary tests.


In Florida, because of abuse of expensive testing equipment,such as MRI machines, a doctor is not allowed to tell his patient to have any test that is on equipment that he has a personal stake in. So, they just refer their patients around to each other.

And don't get me started on the doctors who fought Medicare tooth and nail in the 60's and now buy yachts and cars with all the money they are making.

Just go to visit someone in the hospital. Here is what you will see. A whole floor filled with people who are over 65 and are on Medicare. They keep them in the hospital and convalescent homes as long as their medicare coverage is in force.

But, go to the First floor and you will see the younger women having "Drive thru" Mastectomies because their "Civilian" insurance will only pay so much for that procedure.

One doctor put my Dad in the hospital when he was 84 years old and dying. He came to see him one day and found him down in spirits. So, he called his friend from Med School, The psychiatrist, and had him look in on Dad. My Dad asked him if he were 84 years old and dying would he be a little down in the dumps? For the visit to Dad the doctor charged Medicare $200.00...

It could be a good thing if all those insurance people had to go to work for the Government. Maybe with all their "Civilian" insurance training they could bring some of the practices that make insurance companies so successful to Universal Health Coverage.

We all want health insurance for EVERYONE but don't want it to be subject to the kind of monetary abuse than medicare suffers under.

What makes people think that our government is going to be able to administer something as massive as universal health care coverage?

Do I think every citizen should have universal coverage? You betcha, I do. If I thought for a heartbeat that it would work, I'd be all in favor of it.

But let me predict what will happen: The current for-profit insurance companies will turn themselves magically into 'non-profit' insurance companies. Our government will 'oversee' them. Just like they oversee not-for-profit hospitals. Not-for-profit hospitals rake in massive amounts of money each year - but they pay no taxes on this profit, nor on their property - nor on their investment property. But what do they do with these profits? Help the 'poor'? That is what you would think, right? But no, they invest this money in high dollar bonds, and take out 'tax free' loans at piddling interest rates. (Don't believe me? Go look here: wherethemoneygoes dot com.) Oh yes, and build new hospitals in 'wealthy' areas, shutting down those pesky units that lose money. Our Government allows this.)

The only exception that I know of is the Shriner's hospitals. Shriners, through their activities and large donations keep the doors open in even the most poverty ridden areas, distributing money from the more profitable hospitals to the less so. Isn't that the way it is SUPPOSED to work?

There will be this big change. Older people will find out what rationed health care means. Hey, you gotta save those BABIES, right? They're the future's cash cow. They can justify any amount of testing, procedures, heroic (and mostly pointless) measures when it comes to babies - and the insurance companies will pay up too. But you there, with the leaky heart valve. Yeah, you, the one who has been a contributer to society for all these years... you think that you are going to get the same attention? Dream on...

You can watch the Frontline program online at www.pbs.org, including Q & A with T.R. Reid, who is writing a book on the same subject.

If you're in the New York City area and want to put more effort into pushing for single-payer, there is an all-day training session at PNHP, Physicians for a National Health Program, on Sunday, April 27. It's free and open to anyone.

Nancy & anyone else who laments unnecessary testing "ordered" by doctors. A physician cannot "order" one to take a test--only recommend. We need to take responsibility for saying "no" to testing--a practice that I've been using, if a little imperfectly, since 1983. Just say "No!"

I'm afraid that some of the naysayers just made my point. They lament the waste in Medicare and it's true. Universal Health Coverage would more closely follow the Veteran's program and it is a successful government program with less fraud (if any) and waste. The abuses mentioned are there now so what do we have to lose? If the profit motive is taken out of the equation most of those abuses would vanish.
As for rationed health care - under the Universal Plans it can't happen. I suggest the naysayer's watch the Frontline program and educated themselves on what really happens with Universal care. Thank you, Naomi, for the link.

For those willing to really do something about moving the country toward a single payer plan, I recommend checking to see whether or not there is a group working toward this end that you can get in touch with. For example, if you live in Ohio, there is Single-Payer Action Network Ohio, or spanohio.org. If you live in another state, Google "single payer health plan" and name of state. That should be a start.

Did you see the Bunk study stating 2/3 of doctors in America want National Health Care. The doctors who did this study also conducted one in 2002 and found that the majority of doctors did not want national health care, the problem with this is that the 2 question surveys drastically differ in there 2nd question. I found this article, 60% of Physicians Surveyed Oppose Switching to a National Health Care Plan, It's worth a read

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