U.S. women face higher health care costs

Posted by on Monday, Jul 16, 2012

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Oceans Apart: The Higher Health Costs of Women in the U.S. Compared to Other Nations, and How Reform Is Helping

By Ruth Robertson, David Squires, Tracy Garber, Sara R. Collins, and Michelle M. Doty
The Commonwealth Fund, July 2012

Abstract

An estimated 18.7 million U.S. women ages 19 to 64 were uninsured in 2010, up from 12.8 million in 2000. An additional 16.7 million women had health insurance but had such high out-of-pocket costs relative to their income that they were effectively underinsured in 2010. This issue brief examines the implications of poor coverage for women in the United States by comparing their experiences to those of women in 10 other industrialized nations, all of which have universal health insurance systems. The analysis finds that women in the United States — both with and without health insurance — are more likely to go without needed health care because of cost and have greater difficulty paying their medical bills than women in the 10 other countries. In 2014, the Affordable Care Act will substantially reduce health care cost exposure for all U.S. women by significantly expanding and improving health insurance coverage.

From the Conclusion

When fully implemented, the Affordable Care Act will correct much of the inequity in the U.S. system. A substantial expansion of affordable health insurance options is expected to reduce the percentage of uninsured working-age women from 20 percent to 8 percent.

http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Jul/1606_Robertson_oceans_apart_reform_brief.pdf

Over 35 million working-age women in the United States potentially face financial hardship should they need health care either because they are uninsured or because their insurance exposes them to excessive out-of-pocket expenses. That’s not acceptable.

The authors of this Commonwealth Fund report note how the Affordable Care Act “will correct much of the inequity in the U.S. system.” But not enough. Not only will underinsurance remain a problem, 8 percent of working-age women will have no insurance at all. That’s not acceptable either, especially since we already know how to fix our system and can afford to do so. We simply have to do it.

WP’s Richard Cohen on Obama and single payer

Posted by on Friday, Jul 13, 2012

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Terror among the rich

By Richard Cohen
The Washington Post, July 9, 2012

I wrote last year that Obama had lost the Hamptons. Nothing has changed. He is roundly denounced for not doing a Heimlich on the economy, for his allegedly socialist ways, for Obamacare, for low employment, for high unemployment, for not returning phone calls, for not asking advice — for being cold, distant and, increasingly, just for being president of the United States. The man, it seems, has to go.

I share some of these sentiments. The economy remains in the doldrums, the occasional good month followed by two or three bad ones. Obama is something of a cold fish, which may be something he cannot help, but he is also a lazy politician, unwilling — not unable — to do the telephoning and backslapping that his job requires.

As for Obamacare, it is both a legal and programmatic mess not because it is even modestly socialist but because it is not socialist enough. A government-run health-care system such as the ones used in virtually all the industrialized world — the so-called single-payer system — would have been the way to go. Instead, we have a system in which private insurance companies will abuse doctors and patients alike in the cause of profit. This, alas, truly is the American Way.

http://www.washingtonpost.com/opinions/richard-cohen-obama-the-ineffable/2012/07/09/gJQA3mcCZW_story.html

Obviously, this quote is being distributed because of the strong endorsement of single payer, a vastly superior model of financing health care when compared to the current “American Way” of using private insurance companies.

Although, in this opinion article, Richard Cohen blasts President Obama for his, shall we say, inaction, he doesn’t include here the difficulties Obama faced from the obstructionism by the opposition party, nor from the inaction of the electorate which suffers from a combination of being uninformed and misinformed, thus unable to advocate effectively for policies that would benefit us all. Of course, the candidate of the opposition party spent the weekend in the Hamptons hauling in millions in campaign donations from the “terrified rich,” thus offering little hope that the November elections would bring us any relief from our political quagmire.

Political leaders do not lead; they follow. We will have to lead by promoting education, coalitions, and grassroots efforts. It will be not be easy, but there is no substitute for massive citizen activism.

Myths about ED use by Medicaid patients

Posted by on Thursday, Jul 12, 2012

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Dispelling Myths About Emergency Department Use: Majority of Medicaid Visits Are for Urgent or More Serious Symptoms

By Anna Sommers, Ellyn R. Boukus, Emily Carrier
Center for Studying Health System Change, July 2012

Contrary to conventional wisdom that Medicaid patients often use hospital emergency departments (EDs) for routine care, the majority of ED visits by nonelderly Medicaid patients are for symptoms suggesting urgent or more serious medical problems, according to a new national study by the Center for Studying Health System Change (HSC). About 10 percent of nonelderly Medicaid patient ED visits are for nonurgent symptoms, compared with about 7 percent for privately insured nonelderly people.

Misconceptions

Policy makers and providers frequently point to Medicaid patients’ heavy reliance on hospital emergency departments as a problem that contributes to crowded emergency departments, long wait times and high costs, as well as poor management of chronic conditions. Recent research has dispelled misconceptions linking ED use to crowding, finding that most crowding results from emergency patients admitted to the hospital but waiting for an inpatient bed—so-called ED boarding—not a high volume of nonurgent ED visits. Other research has dispelled the mistaken belief that most ED users have Medicaid coverage, are uninsured or do not have a usual source of care. In fact, people with private insurance account for most ED use, and people with higher incomes and a private physician as their usual source of care are driving ED visit increases over time.

Other misconceptions about Medicaid patients’ ED use continue to drive policy. In response to state budget crises, some Medicaid programs have sought to cut ED use by denying payment for emergency care viewed as unnecessary, increasing patient cost sharing to discourage visits and penalizing patients for too many ED visits—all based on the assumption that Medicaid patients commonly use EDs to evaluate symptoms that could wait for a primary care clinician to treat. Media coverage of so-called frequent flyers—a small number of people with hundreds of ED visits—may have contributed to commonly held views that Medicaid and uninsured patients often use emergency departments inappropriately.

http://www.hschange.com/CONTENT/1302/

In an effort to control health care spending we are seeing efforts to punish Medicaid patients for their excessive use of our Emergency Departments (EDs). This reports adds to the policy literature that confirms that this premise is flat out wrong. Just like privately insured patients, most Medicaid patients use EDs for urgent and emergency conditions.

Rather than penalizing patients for attempting to receive urgent care that they should have, we should direct our efforts to incorporating health system design changes that would improve access to urgent care services, both through EDs and through other community resources such as extended-hour practices and urgent care centers. As an example, EDs could use community physicians during peak hours to provide care for less intensive problems that have been sorted out by triage.

With a single payer system we could adjust incentives to encourage more effective and efficient use of our health care delivery system. Under our current fragmented financing system, dominated by private health plans and perpetuated by the Affordable Care Act, rational coordination of care for urgent conditions is not possible because of conflicting interests, financial and otherwise.

We can do a much better job of getting our priorities straight through a single payer national health program.

Dr. Pippa Abston

A few months ago, I got an email from Jeremy Helton asking if I was interested helping him get the word out about a project from the Recollective, telling real stories about patients abandoned by our profit-driven insurance system.  The stories are intensely moving.  Each vignette shows a still picture with voice-over—Jeremy spent hours with these folks to get the stories down to their essential meaning, and I think he did a marvelous job.

When I talked to some friends in Physicians for a National Health Program(PNHP) about the project, one concern was that the project focuses on patients at a faith-based clinic providing charity care.  I’m sure you’ve heard conservatives say we can care for the uninsured easily with personal charity—we know that’s wrong because we’ve had thousands of years to try it without success.  It would be a terrible injustice to suggest the solution is simply to establish practices like Jericho Road all across the country, mission accomplished.

What’s so wonderful to me about these stories is the honesty that we MUST have systemic reform to create true access to care.  There is no suggestion that charity is fine without reliable insurance.  At the same time, this practice is not waiting for our government to do the needed reforms.  They are doing the best they can for their patients while advocating for change.  They are setting an example for us of how to treat our fellow humans.

We are facing a similar problem in Alabama with Medicaid.  If Alabama doesn’t do the expansion, we will abandon those most in need of relief.  We are even in danger of defunding care for our currently covered children, disabled, and elderly in nursing homes if we don’t solve our 2013 budget trouble.  I heard a PNHP member say recently that “liberals” support Medicaid expansion but “progressives” are in favor of single payer, because Medicaid perpetuates injustice and unequal access to care.  Yes, but.  I do not think we have the right, those of us not on Medicaid or hoping for it, to say this.  The families I talk to who can’t get any kind of care unless they are in immediate danger of death do not agree.  Of course they want full access to healthcare.  Until that time, they would be grateful for temporary though imperfect relief, as long as we are also continuing to push for a truly just system.

Listen to this segment by Dr. Glick.  He gets it.  We need Medicare for All AND we need to see each other more compassionately.  Confronting ourselves with faces and voices will keep us from thinking these uninsured persons are numbers, maybe numbers we can parse down until they don’t seem like much. The longer I watch our country struggle over healthcare reform, the more I believe we will never get what we need until we have a change of heart.  A law alone won’t fix things.  We must become the kind of people who will not compromise in healthcare justice, who believe it is not possible to serve our own self-interest and ignore the needs of our wider community, and who will do whatever it takes to make a national insurance system excellent instead of constantly trying to sabotage or repeal it.

Kudos to Dr. Glick, his staff and patients, and the Recollective team for bringing these stories to light!  Please visit the site frequently as they post new stories, share them on your Facebook page, and help get the word out.

Originally posted on Dr. Abston’s blog.

Administration expands use of exemption from mandate penalty

Posted by on Wednesday, Jul 11, 2012

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Letter
July 10, 2012
From: Kathleen Sebelius, Secretary of Health and Human Services
To: State Governors

Excerpt:

As you know, beginning in 2014, the Affordable Care Act provides for the expansion of Medicaid eligibility to those adults under age 65 with incomes up to 133 percent of the federal poverty level who were not previously eligible for Medicaid. The Supreme Court held that, if a state chooses not to participate in this expansion of Medicaid eligibility for low-income adults, the state may not, as a consequence, lose federal funding for its existing Medicaid program. The Court’s decision did not affect other provisions of the law. For example, the decision did not change the fact that the federal government will completely pay for coverage under the eligibility expansion in 2014-2016, and for at least 90 percent of such costs thereafter, or that states have flexibility to design the benefit package for the individuals covered.

Ultimately, I am hopeful that state leaders will take advantage of the opportunity provided to insure their poorest working families with unusually generous federal resources while dramatically reducing the burden of uncompensated care on their hospitals and other health care providers. If any state were to choose not to do so, the Affordable Care Act exempts individuals who Congress determined cannot afford coverage from the individual responsibility provision. As to the very small number of affected individuals who would not quality for the statutory exemption, Congress provided additional authority, which we intend to exercise as appropriate, to establish any hardship exemption that may be needed.

http://capsules.kaiserhealthnews.org/wp-content/uploads/2012/07/Secretary-Sebelius-Letter-to-the-Governors-071012.pdf

It is outrageous that some governors are refusing to provide coverage to low-income adults, even though the Affordable Care Act authorizes the federal government to pay most of the costs of this expansion in the Medicaid program. So what is the Obama administration doing to be sure that these individuals become insured?

Many of these low-income adults who are not yet included in the state Medicaid programs are so poor that they will qualify, under ACA, for an exemption from the “individual responsibility provision” – the penalty or “tax” that must be paid for not being insured. Thus they have the explicit right to remain uninsured without being penalized for being so.

Others are still poor, but fall above the threshold for the exemption from the individual responsibility provision. It is for this sector that the administration is taking action. They are making the generous offer to exercise their authority to provide exemptions for these additional individuals from the penalty or tax that would otherwise be assessed for not being covered by an extension of a Medicaid program that the governors refuse to authorize, or for not purchasing a plan in an insurance exchange that they can’t possibly pay for even with the subsides provided (not to mention that most of these very low-income adults were presumed under ACA to be covered by Medicaid, thus the law seems to lack provisions for them to be allowed to receive subsidies for purchase of plans in the exchanges).

Wow. The most needy population is being left out and all the administration can do is to relieve them of the financial penalties they would owe for being uninsured?

To be fair, this is not simply a response of an uncaring president and his administration. They have an irreparably flawed health care financing system with which to work. But the administration should be lambasted for not just cooperating with but also for leading with the planning and implementation of such an unmerciful system.

This system is beyond repair. We need to replace it with a humane, equitable and efficient single payer national health program that would take care of the health care needs of all of us.

Uninsured seasonal firefighters

Posted by on Tuesday, Jul 10, 2012

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Seasonal firefighters face many dangers without health insurance; union seeks federal coverage

By Associated Press
The Washington Post, July 9, 2012

They work the front lines of the nation’s most explosive wildfires, navigating treacherous terrain, dense walls of smoke and tall curtains of flame. Yet thousands of the nation’s seasonal firefighters have no health insurance for themselves or their families.

The National Interagency Fire Center in Boise, Idaho, which coordinates firefighting efforts nationwide, says 15,000 wildland firefighters are on the federal payroll this year. Of that number, some 8,000 are classified as temporary seasonal employees, who work on a season-to-season basis with no guarantee of a job the following year and no access to federal benefits.

In two years, the Affordable Care Act, the new federal health care law, will allow seasonal firefighters the same opportunity to buy health insurance as other uninsured Americans.

http://www.washingtonpost.com/national/health-science/seasonal-firefighters-face-many-dangers-without-health-insurance-union-seeks-federal-coverage/2012/07/09/gJQAUMWHZW_story.html

Very few would disagree with the principle that firefighters and their families should be covered with health insurance, even if only seasonally employed. The question then is, should that coverage be provided by the government as the employer?

The issue of health insurance coverage faces all seasonal employees. If coverage is provided, would it be only during the period of employment? Would off-season employment in other occupations be the source of intermittent and therefore fragmented coverage? Would being unemployed off-season qualify the family for Medicaid, again with fragmentation of coverage?

Does the ability to purchase coverage through state exchanges, to be established under the Affordable Care Act, provide adequate opportunities for coverage in these populations with fluctuating incomes, with varying eligibilities for coverage or for subsidies? Are the rules that allow exemptions, based on income, from the mandate to purchase coverage an adequate solution, since it means that the family would remain uninsured?

With variations in the type of coverage and especially in the composition of provider networks between various employer-sponsored plans when there may be more than one employer during the year, or with intermittent coverage under Medicaid, or with individual plans purchased through the exchanges, or with dependency on charity or safety-net institutions during periods while uninsured, is this disruption and fragmentation an acceptable standard for coverage for these families? No.

It would be less expensive and more efficient to provide one single coverage throughout life – coverage that provides choice of health care professionals and institutions. Employment status should no longer be a factor in determining health benefits, choices in health care, and even whether or not one is covered at all. An improved Medicare that covered everyone would finally bring an end to our irrational current and ACA-pending methods of financing health care.

Private insurers have more administrative services to sell us

Posted by on Monday, Jul 9, 2012

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

How to split the health care dollar (America’s Health Insurance Plans meeting)

By Emily Berry
American Medical News, July 9, 2012

Payers are well aware that physicians and hospitals need the kind of business expertise that insurers have held almost exclusively until now: how to track claims, coordinate care, administer case management and deploy a new records system.

Health insurers are offering physicians and health systems access to that expertise — for a price. UnitedHealth Group’s enormously profitable Optum subsidiary is one example of that business angle. Indeed, Dr. Safavi said, some hospitals and doctors may be in a position of paying Optum for consulting and information technology expertise so they can be prepared for the demands that United and other insurers will make under new payment models. They will have to pay United before they can get paid by United.

http://www.ama-assn.org/amednews/2012/07/09/bisa0709.htm

What did you expect? As long as private insurers are left in charge, as they are under the Affordable Care Act, they will always figure out a way to work the system to benefit themselves. We really do need to replace them with a single payer system.

Employers considering defined contribution for health care

Posted by on Friday, Jul 6, 2012

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

With health care law upheld, employers weigh shift to defined contribution insurance plan

By Peter Frost
Chicago Tribune, July 3, 2012

Many Chicago-area employers have remained on the sidelines with their employee health plans, waiting for the U.S. Supreme Court to determine whether the 2010 health care overhaul passed constitutional muster.

But with the court’s decision last week to uphold most of the law, companies may pursue a historic change.

Many employers are quietly considering a move away from traditional defined benefit plans and toward defined contribution plans, which set aside a fixed amount of money each year for employees to use toward health care costs.

Under the structure of defined contribution plans, companies hand an employee a set amount — say $9,000 — and employees use that money to buy or help pay for a health insurance plan they choose themselves.

At the heart of the shift is a desire of companies to reduce their exposure to health care costs by shifting the risk of unpredictable expenses to their workers.

Few employers, particularly large companies, are eager to discuss their internal deliberations on the issue because they don’t want to raise concerns among employees before final decisions are made, said Paul Keckley, executive director of the Deloitte Center for Health Solutions, the health care research arm of consulting firm Deloitte LLP.

“The only thing that’s certain right now is (companies are) doing everything that’s legal to shift cost to employees,” Keckley said.

Employees of companies that pursue the defined contribution route may be funneled into so-called corporate health care exchanges, which function in much the same way as state-run exchanges.

The private exchange market “is really emerging and growing, largely because of all the interest in the state exchanges,” said Michael Thompson, a principal in PricewaterhouseCoopers LLC’s global human resources practice.

Inside the exchanges, employees will be offered more choices on what types of coverage they desire — and how much they’re willing to pay.

“If you value broad access and you’re willing to pay for it, that’s fine,” Thompson said. “If you’re willing to live with a narrower network (of providers) and possibly a higher deductible, you would have the ability to save significant money on your premiums.”

On private exchange GoHealth.com, consumers can shop and ask for advice. Michael Mahoney, GoHealth’s vice president of marketing, said the company has explored a corporate health care exchange for its employees, but it will continue offering its “traditional and robust” health insurance plan for the time being.

His reason? “If you give control to the employees, they could choose to save money and possibly choose something where they’re not completely covered, so they end up in a pinch. Right now, we’re going to overspend on our employees and give them more than they want so they’re always covered.”

http://articles.chicagotribune.com/2012-07-03/business/ct-biz-0703-corp-exchanges–20120703_1_health-care-health-insurance-deloitte-center

Just as they did with employee pension plans, employers are now gearing up to convert employee health benefit programs from defined benefit to defined contribution. What does that mean?

Over the past few decades, employers passed on the risks of their pension plans to their employees by switching from a defined benefit (a guaranteed dollar amount that employees would receive monthly in retirement) to a defined contribution such as 401(k) plans (a set dollar amount contributed to the pension account, but with no guarantee of the amount received in retirement – the employee thus bearing the full risk of the uncertain investment returns on the pension funds).

Now many employers plan to do the same with their health benefit programs. They intend to pay a set dollar amount for the premiums, whereas the employees will have to bear the the costs of health care inflation plus the costs of any benefits in excess of the basic program to be offered  by the employer.

This will be disastrous. Employees are already being stuck with higher deductibles in order to slow the rate of premium increases for the employer. With defined contribution, premiums can be contained further by limiting the benefits covered, by further increasing the out-of-pocket cost sharing of deductibles, copayments and coinsurance, by tiering cost sharing of different levels of products and services, and by further restricting the panels of approved health professionals and institutions.

When the employee uses the defined dollar amount to purchase plans from the choices offered, but must pay the full balance of the premium, most will choose lower cost plans that place them at very high risk for out-of-pocket expenses should they or their family members need health care. This is the disaster that is pending. Employees will not be able to afford the care that they or their families need, in spite of being nominally insured by their employers.

From a policy perspective, we can understand why employers would want to control their overhead expenses, in this case by protecting themselves from health care inflation, but we can’t understand why policymakers would want to keep employers in charge of health care financing for the majority of Americans, and then add further insult by perpetuating regressive tax policies that favor wealthier employees over those with lower incomes.

With this defined contribution threat looming, we should once and for all remove the employer from the equation. Let’s replace our health care financing system with a much more sensible and equitable single payer national health program, which would remove from employers the burden of having the responsibility of supervising health benefit programs.

Can we learn from Rawanda?

Posted by on Thursday, Jul 5, 2012

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

In Rwanda, Health Care Coverage That Eludes the U.S.

By Tina Rosenberg
The New York Times, July 3, 2012

Last week’s Supreme Court decision upholding of the constitutionality of President Obama’s health care law moves the United States closer to the goal of health coverage for all. All other developed countries have it. But so do some developing nations — Brazil, Thailand, Chile. These countries are mostly middle income. But one country on the list is among the poorest of the poor: Rwanda.

The point is not that Americans should envy Rwanda’s health system — far from it. But Rwanda’s experience illustrates the value of universal health insurance.  “Its health gains in the last decade are among the most dramatic the world has seen in the last 50 years,” said Peter Drobac, the director in Rwanda for the Boston-based Partners in Health, which works extensively with the Rwandan health system.

It couldn’t have happened without health insurance.

Rwanda is known, of course, for the 1994 genocide that killed 800,000 Tutsi and moderate Hutu. Since 1994, the country has been ruled by Paul Kagame, at first as de facto leader and, since 2000, as president.  Kagame runs a repressive regime that equates criticism with treason; opposition journalists or politicians in Rwanda have disappeared or died mysteriously.

But Kagame is also widely admired as the most effective leader in Africa. A country in ashes 18 years ago is now safe and clean. It is one of the least corrupt countries in Africa. Per capita income has tripled — although the fact that it is now only $550 a year tells you how destitute Rwanda was.

Its most impressive gains, however, have been in health. AIDS has been cutting life expectancies in Africa and is widespread in Rwanda. Yet life expectancy at birth in Rwanda has increased from 48 to 58 — in the last 10 years. Deaths of children under 5 have dropped by half in five years; malaria deaths have dropped by roughly two-thirds. “Of all countries in Africa Rwanda is probably getting the closest to having health for all, health access for all,” said Josh Ruxin, a longtime resident of Rwanda who is the founder of the Access Project, a Rwandan-run health program.

One key reason that Rwandans are so much healthier today is the spread of health insurance.  In 1999, Rwanda’s health facilities sat unused, as the vast majority of people couldn’t afford them.   In response, the Health Ministry began a pilot project of health insurance in three districts.   In 2004, the program began to spread across the nation.   Now health insurance — called Mutuelle de Santé — is nearly universal. Andrew Makaka, who manages the health financing unit at the Ministry of Health, said that only 4 percent of Rwandans are uninsured.

In most poor countries — and in the United States — health disasters are a leading cause of a family’s decline into poverty, but not for Rwandans. “It gives relief to people knowing that if you get sick, you don’t need to have a lot of money,” said Dr. Agnes Binagwaho, Rwanda’s health minister. “It gives you psychological stability so you can concentrate on something else. The money can be used for other things — this is very important in trying to stimulate economic development.”

“You can bring on all the diagnostic services, new technologies and specialties,” said Drobac. “But if those things can’t reach people in need, what’s the point?”

We could ask the same thing in the United States.  Rwanda, starting from nothing, decided to build a health system that includes everyone.  And it found economic value, alongside human value, in doing so.  Now we can get started.

http://opinionator.blogs.nytimes.com/2012/07/03/rwandas-health-care-miracle/

Rawanda, one of the poorest nations in the world, has seen a dramatic improvement in the health of their people since the establishment of their near-universal health insurance program, Mutuelle de Santé, covering all but 4 percent of their population.

After the Affordable Care Act is fully implemented in the United States, over 8 percent of our population will still be uninsured – over twice the percentage of Rawanda’s uninsured. Shouldn’t we be ashamed? We know how to do better than that; we just have to do it.

OECD 2012 Economic Survey of the United States

Posted by on Tuesday, Jul 3, 2012

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

The United States needs to foster education and innovation to keep its cutting edge

OECD Economic Surveys: United States 2012
OECD, June 26, 2012

Particularly worrying is the performance in education, which is essential to provide workers with the skills necessary to become more productive and to adapt to technological change. Attainment in tertiary education stagnated over the past three decades while it grew significantly in almost every other OECD country. Today, 22 out of 30 OECD countries surveyed have more graduates in science and engineering among the 25 to 34 year old workers than the United States.

To prevent long-term unemployment from becoming chronic, the Survey suggests a greater focus on “active” labor market programs that help to facilitate job search and guide individuals towards training and education. These measures have proven to be effective even during periods of high unemployment and should complement existing “passive” benefit programs. The United States spends very little on activation policies relative to other OECD countries.

The Survey also highlights rising income inequality in the United States. The trend owes mainly to rising skill premiums and disproportionate income growth for top earners over the past two decades. High income inequality is also associated with low intergenerational social mobility. Children born to low-income parents in the U.S. find it more difficult to move up the social ladder than in most European OECD countries.

Providing equal access to high-quality elementary and secondary education is essential to addressing this challenge. The Survey also notes that the U.S. tax and benefits system is much less effective in reducing relative poverty than that of other OECD countries. This is largely the result of the limited and poorly targeted financial transfers to low-income households.

http://www.oecd.org/document/59/0,3746,en_21571361_44315115_50653435_1_1_1_1,00.html

OECD Economic Surveys: United States 2012 (122 pages)
http://www.keepeek.com/Digital-Asset-Management/oecd/economics/oecd-economic-surveys-united-states-2012_eco_surveys-usa-2012-en

So what does an economic survey of the United States have to do with health care? Simply that we cannot expect to have a superior health care system that serves everyone well if we don’t fulfill our citizen obligation to demand greater government oversight and intervention in education, employment, and especially in the intolerable rise in income inequality. Current trends in the United States are not encouraging.

Trying to fix health care alone without addressing our other serious economic deficiencies offers little hope of bringing to all of us a truly high performance  health care system. The Affordable Care Act, by establishing a standard of low actuarial value plans with excessive financial barriers to care will not enable the masses to have the same access to high quality care that the more affluent members of our society experience.

Why are we focusing on austerity when our potential is so great? We should reject political leaders who would foster yet more austerity. We need leaders who understand the importance of education, employment, and more equitable income distribution. That’s not only good for our economy, it’s good for our health as well.

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Physicians for a National Health Program's blog serves to facilitate communication among physicians and the public. The views presented on this blog are those of the individual authors and do not necessarily represent the views of PNHP.

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