From A National, Centrally Planned Health System To A System Based On The Market: Lessons From China

By Jin Ma, Mingshan Lu and Hude Quan
Health Affairs
July/August 2008

No other country has undergone health care reforms as dramatic as China’s. Starting in 1978, China reformed its health system from a governmental, centrally planned, and universal system to a heavily market-based one. Now, three decades later, the Chinese government openly acknowledges that the reforms failed and seeks new directions. This paper adds to the literature by examining China’s health care from a system perspective, describing its health services delivery, access, outcomes, and population health in the post-reform era. It also identifies the main issues in the current system and highlights the key lessons learned from China’s reform process.

http://content.healthaffairs.org/cgi/content/abstract/27/4/937

When Incentives And Professionalism Collide

By William C. Hsiao

As Jin Ma and colleagues observe, an unfettered market approach in China has reduced access to care, increased patients’ financial burden, and reduced emphasis on prevention and may have caused declines in quality and outcomes. A major driving force was that perverse incentives altered physicians’ behavior toward self-interest at the expense of patients, even where professional ethics dictated otherwise. Other nations, including India, are grappling with the profit motive and its consequences. Chinese leaders are attempting to deal with these problems by expanding public investment and reducing perverse incentives. However, profit motives remain a powerful, potentially offsetting feature of a reformed system.

http://content.healthaffairs.org/cgi/content/abstract/27/4/949

Fundamental human ethics and mores are the same the world around.

There are those of us who believe that the people of the United States possess some sort of a superior intellect that allows us to use the sterile tools of market economics to provide a better life for all of us, at least for those of us who are willing to put in a greater effort, without any compromise whatsoever in our ethical and moral principles.

Some of the intellectuals in China had decided that using market dynamics was just the solution that they needed to help modernize the Chinese health care system. Sterile, amoral business decisions allow the leeway to bring out the best in us… and the worst. China got the best for a few, and the worst for the many.

Our health care system represents both the best and the worst, but now is so expensive that we have reached a point that we must realign incentives to promote the best for everyone, and discourage the worst that is draining our resources while benefiting primarily those who are capitalizing on the market.

China’s great experiment with free market health care demonstrates, once again, that mankind’s mores and ethics are best supported by social solidarity, rather than by the market, when establishing policies designed to benefit us all. It is a lesson that most other nations have learned, but one with which we are still struggling.

What this seems to be:

$40 miilion dollars is being spent by K-Street professionals to tell the American people that the disaster of the U.S. health care system is due to the for-profit private insurance companies. That is a good thing, right? Heck, when I first saw the print Ad I thought it WAS a single payer group. It is single payer language about the failure and evil of the for profit private insurance companies. But then they chicken out on their remedy. David and Don’s critique below are completely correct as a matter of policy. But since HCAN is not really making a call to action, policy is not what this is about.

What it really is:

Where is the money coming from and why is it going to this campaign that does not actually have a specific call to action? The official message from on high is that HCAN is grassroots. Yup $40 million bucks, top down pre-determined pre-compromised message by K-Steet establishment. Nicely done professional Ads. Paid staffers sent out on-message from central office. But we are told its grassroots. So says Ezra Klein. So says David Sirota (who really should know better). Well HCAN is many things. It is a lot of money beng spent with our message that the for-profit private insurance companies are the problem. But grassroots it obviously is not! Sheesh. These are grassroots!

What it really is, is about building mailing lists and fundraising and get-out-the vote for November. It is a $40 million investment in party organizing. Think of it as the Democratic messaging counterpart to the National Rifle Association. In addition, the campaign is going to take advantage of MoveOn.org’s massive data files to reach out to like-minded supporters and officials promised to work in Democratic and Republican districts alike. “We’ll have an organizer in the district of every Blue Dog Democrat,” said HCAN campaign manager Richard Kirsch of the conservative Democrats. I guess that is all good. But it would be nice if for $40 million dollars they supported something without pre-compromising.

What it could have been:

What is weird, is that they seem to truly believe that the message that will resonate with the American people is our single-payer message that the insurance companies are the problem. That is the out front message to pull people in. Co-opting our message. To get people’s contact info and donations. Brilliant. Glad we could help. You are welcome. 

But… gee… all that money, and no real call to specific action, except to compromise and take single payer off thetable without even a fight. Now, imagine if they did everything the same, but also included in their $40 million blitz an option ask Americans to on call their Congresspeople to sign onto HR-676.

Imagine. Yes we can.

Health Care for America Now (HCAN) is pushing a superficially attractive health reform model that has a long record of failure – akin to prescribing a placebo for a serious illness when effective treatment is available. They would offer Americans a new public insurance plan and a menu of private ones, with subsidies for coverage for low income families.

This approach reprises the format of Medicare’s ongoing privatization. Despite promises of strict regulation and a level playing field that would allow the public plan to flourish, private insurers would (as they have done in Medicare) predictably overwhelm regulatory efforts through crafty schemes to selectively recruit profitable, lower-cost patients, and avoid the expensively ill. Like the Medicare Advantage program, originally touted as a market-based strategy to improve Medicare’s efficiency, the HCAN plan would evolve into a multibillion dollar subsidy for private insurers whose massive financial power (amassed largely at government expense) would prove a political roadblock to terminating the failed experiment.

Unfortunately, proposals like HCAN’s that cede a central role to private insurers can only add coverage by adding costs. They promise savings from computerization and chronic disease care management. Yet the Congressional Budget Office has warned that there is little or no evidence for such savings.

The HCAN proposal forgoes most of the $350 billion annually in administrative savings possible under single payer national health insurance (NHI). Administrative waste is a natural byproduct of the private insurance firms that would retain a central role under HCAN’s plan. Private plans’ overhead is 12-fold higher than under NHI; the excess is squandered on marketing, underwriting, utilization reviewers and profits, and for the billions paid to executives. And the multiplicity of insurers envisioned in the plan precludes paying hospitals a global, lump sum budget; such budgets would save additional billions by obviating the need for most hospital billing and much of the internal accounting needed to attribute hospital costs to individual patients and payers.

HCAN’s proposal duplicates key elements of health reforms that have passed (and then failed) in multiple states: Massachusetts in 1988; Oregon in 1989; Tennessee, Minnesota and Vermont in 1992; Washington State in 1993; and Maine in 2003. In each case, rising costs scuttled the reform effort; none had a durable impact on the number of uninsured. The 2006 Massachusetts law, which incorporates many of the features of HCAN’s plan, is already threatened by rising costs, despite offering skimpy coverage and leaving many uninsured. And Massachusetts, with its low rate of uninsurance to begin with, and a large fund devoted to care of the uninsured, offered the optimal conditions for trying such a plan.

HCAN’s proposal tries to avoid a head-on collision with private insurers, but the result is a plan that cannot achieve universal coverage or make care affordable. For physicians, offering a placebo in place of effective treatment is a serious ethical violation. Hence, while we salute the good intentions of the members of the HCAN coalition, we must warn against their proposal.

HEALTH CARE FOR AMERICA NOW!

Campaign launch – July 8, 2008

For coalition members see:
http://healthcareforamericanow.org/site/content/who_we_are/

Campaign ad:

Mother with son, consulting Magic Eight Ball: Will they pay for his inhaler?

Magic Eight Ball: Not likely

Gentleman, in workshop of his garage: Is my surgery covered?

Magic Eight Ball: Don’t think so

Pregnant mother-to-be: Can I chose my child’s doctor?

Magic Eight Ball: Better not tell you

Concerned woman, too young to die: Will they cover the chemo?

Magic Eight Ball: Doubtful

Off-screen voice: Will health insurance companies ever put your health before their profits?

Magic Eight Ball: Not a chance

Off-screen voice: We can’t trust insurance companies to fix the health care mess.

http://www.youtube.com/watch?v=tirU5qpmFK4

Statement of common purpose:

Our government’s responsibility is to guarantee quality affordable health care for everyone in America and it must play a central role in regulating, financing, and providing health coverage by establishing:

A choice of a private insurance plan, including keeping the insurance you have if you like it, or a public insurance plan without a private insurer middleman that guarantees affordable coverage.

(… and nine other requirements for a regulated private insurance industry.)

http://healthcareforamericanow.org/site/content/statement_of_common_purpose

The members of the Health Care for America Now! (HCAN) coalition are very dedicated, altruistic individuals and organizations who share with us the goal of affordable, comprehensive, high quality care for everyone. They agree with us that the private insurance industry has failed miserably in fulfilling its responsibility to bring to all of us the affordable health care that we need.

The private insurance industry, as it functions today, clearly must be replaced with a system that works. So what is the solution proposed by the HCAN coalition? Let’s replace the private insurance industry with… the private insurance industry. Only let’s regulate it by requiring the insurers to provide us with the comprehensive coverage that we need “through the largest possible pools” – thus ensuring that their products will have premiums that only the very wealthiest of us can afford.
The HCAN coalition also would enact a public program in competition with the private plans to be sure that the private plans would sell us the comprehensive products that we need – a not-so-difficult challenge considering that the public program would be outrageously expensive due to adverse selection. So then we would have a choice of highly-regulated, unaffordable private plans, or an even less affordable public program option.

Why did the coalition insist on including private plans when the industry’s track record is so miserable? It was a political decision based not on which policies would actually work, but rather based on rhetorical framing that would resonate with a public that remains relatively uninformed on the make-or-break nuances of health policy. Focus groups and polls showed that “choice of private plans” resonated well, so they decided to abandon policy and go with messaging.

The members of Physicians for a National Health Program would take a more “doctorly” approach toward reform. While the HCAN coalition is recommending placebo therapy, we would point out that effective treatment is available: a single payer national health program.

Women readers, get ready to fight. As reported in the Los Angeles Times, Blue Cross Blue Shield of California has decided to charge women more for health care insurance than men. A California woman, Tova Hack, works part-time, and has to buy her own individual health care policy because her employer doesn’t provide health insurance for her. She found out that the cost of her high- deductible, bare-bones individual policy was going up 20 percent. The increase couldn’t be due to the possibility of pregnancy, because her policy didn’t cover pregnancy-related expenses. Blue Cross Blue Shield simply discovered that women are more expensive to insure than men and decided to stick them with the costs.

Blue Cross Blue Shield’s reasoning was straightforward. Insurance companies encourage preventive services. However, their actuarial studies show that, unlike seniors who don’t use insurance company rebates to sign up to join a gym and save the company money, women actually use preventive services, like mammograms and pap smears that cost the insurance company money.

And if, unlike Tova’s policy, their insurance policies do cover prenatal and obstetric services, women understandably seek that care when they are pregnant. Blue Cross Blue Shield of California concluded that women should pay more for their insurance policies than men, since women contribute more to the insurance company’s “medical losses.” (”Medical loss” is insurance-speak for money the company has to pay out for medical care. The ideal scenario for an insurance company is for no one to use the money paid in premiums for actual health care). Insurance companies carve out risk pools to reduce the likelihood that the people they insure will use health care services. Women, it seems, are just too risky.

Meanwhile health insurance company CEOs are receiving benefits that defy belief. For example, Larry Glasscock of Wellpoint left the company in 2007 with a farewell package of $23.9 million. And health insurance company stocks continue to provide revenue for their shareholders, even as primary care doctors, who actually provide medical care, earn less and less.

The Kaiser Foundation health tracking poll recently found that 25 percent of people reported having problems paying for health care and health insurance, and 59 percent said, “We need to get everyone into the same insurance pool so we can spread the costs of sick and healthy people over the whole population.”

If we eliminate the multiple, for-profit insurance companies and have a single-payer health care system, funded and administered by the government, everyone would be in the same risk pool. Women would not have to pay more for health insurance because they take good care of themselves by getting pap smears, mammograms and prenatal care. Women would not be discriminated against because they are the ones who get pregnant, have babies, and use obstetrical services. Women would not be punished just for being women.

If the multiple private health insurance companies were eliminated, $350 billion in administrative funds would be saved. These funds could be used to cover everyone with a universal, comprehensive, single-payer health insurance that would provide not only medical care and prescription drugs, but would also pay for long term care for our seniors.

Recently, at the national convention of the League of Women Voters, women voted unanimously to make advocacy for, and education about, health care reform a top priority. Women have fought long and hard for their rights in the past decades. It is time for them to take on the insurance companies, and fight for their right to affordable and accessible health care.

Originally published in the Berkshire Eagle

Although we pay more and more each year for health insurance (average premium for a family of four now over $12,000), we get less and less for it. Insurers continue to take high profits first, leaving enrollees more vulnerable to high out-of-pocket costs for health care.

A 2007 study of small-group and individual insurance markets in California, published by Health Affairs, shines a bright light on this problem. “Actuarial value” was defined as “the proportion of claims expenses for covered services paid by the insurance plan for a large standardized population.” Between 2003 and 2006, the actuarial value in the small-group market held at 0.83 (83 percent of bills paid), but fell precipitously in the individual market from 75 to 55 percent. The investigators concluded that, without reform of the marketplace, people of average means will be faced with catastrophic health care bills.

As we saw in an earlier post, insurers try to avoid coverage of people at higher risk of illness and cherry pick the market for healthier enrollees. They pursue a goal to keep their medical-loss ratios (MLRs) below 80 percent if at all possible (ie., retain 20 percent or more for overhead and profits).

As the market for employer-sponsored health insurance continues to shrink, insurers are now targeting healthier people in the individual market, especially in the 20 to 30s and 50 to 64 age groups. These examples reveal how little coverage these new policies actually provide.

• Wellpoint and Aetna (the largest and third largest insurer in the country, respectively)  are marketing individual insurance packages for young adults, the fastest growing population of uninsured Americans. They offer these policies in states where looser regulations  don’t get in the way of cherry picking enrollees. Wellpoint offers three Tonik plans with different deductibles (Thrill Seeker, with a $5,000 deductible; Part-time Daredevil, $3,000; and Calculated Risk Taker, $1,500).  None of these plans cover maternity benefits, a leading expense during childbearing years, with average costs for normal pregnancy and delivery now $8,000 to $12,000.  The MLR for these policies is about 70 percent.
• Aetna’s new Affordable Health Choice plan caps hospital benefits at $2,000 and accident/ER benefits at $1,000.
• Limited benefit policies being sold to such large employers as Wall Mart and McDonalds often have annual caps as low as $1,000 to $2,000.
• Some early retirees are opting for high-deductible plans with deductibles as high as $7,500; a 50-year-old male nonsmoker living in Colorado could expect to pay $1,000 for such a policy.

These examples make a mockery of AHIP’s stated goals to “expand access to
high quality, cost-effective health care”, but they do succeed in meeting another of their goals –“product flexibility and innovation”. But at a high cost, much higher than public and not-for-profit programs. Investor-owned Blue Cross plans operate with overhead and profits exceeding 26 percent, in sharp contrast to traditional Medicare, which spends more than 97 percent of its budget on direct medical care, and Kaiser Permanente, which spent 96 percent of premium revenue on patient care in 2000.

Why do we put up with such an expensive industry that provides so little protection against the cost of necessary health care?  Part of the answer is that we are constantly bombarded with the claimed advantages of “choice”. We will look at just how much choice we really have in the next post.

Adapted from Do Not Resuscitate: Why the Health Insurance Industry is Dying, and How We Must Replace It, forthcoming, August 2008 by John Geyman. With permission of the publisher, Common Courage Press.

Purchase book from Common Courage Press: http://www.commoncouragepress.com/index.cfm?action=book&bookid=396

Failing Grades: State Consumer Protections in the Individual Health Insurance Market

Families USA
June 2008

Key Findings

• Only five states prohibit all insurance companies from cherry-picking the healthiest consumers and excluding everyone else.
• In 35 states and the District of Columbia, there are no limits on how much insurers can vary premiums based on health status. An additional six states have limits that still allow dramatic variations in premiums.
• In 21 states and the District of Columbia, insurers can exclude coverage for pre-existing conditions for more than one year. In eight of those states and the District of Columbia, insurers can exclude coverage for pre-existing conditions for the duration of an individual’s policy.
• In 20 states and the District of Columbia, insurers can set and raise premiums without adequate oversight.
• In 45 states and the District of Columbia, insurers can spend less than 75 cents of every premium dollar on medical services.
• Insurers in 29 states and the District of Columbia are allowed to look at a policyholder’s medical history and perform medical underwriting months, or even years, after they issued the policy.
• In 44 states and the District of Columbia, insurers can revoke an individual’s health insurance policy without advance review by the state.

http://www.familiesusa.org/assets/pdfs/failing-grades.pdf

Most of the politicians are telling us that national health insurance is not politically feasible. They tell us that we should not abandon what is already working well for us: the private insurance industry. They tell us that they would improve the private insurance market so that health plans would become affordable for all of us while still providing us with the protection that we need.

Looking at this Families USA report card of private plans in the individual market, it is clear that the private insurance utopia that they envision does not exist. Because of the lax regulatory requirements in far too many states, the insurers have been able to dodge their responsibility to cover everyone regardless of their health care needs.

So what kind of improvement in the insurance market are the politicians proposing?

Sen. McCain would further relax the regulatory oversight which would result in some insurance products with lower premiums, but at the cost of reducing even further the inadequate consumer protections we have. Being able to afford health insurance is of almost no value if it makes health care itself even less affordable.

Sen. Obama would close many of the insurance loopholes noted in this report by increasing the regulatory oversight of this industry. What would happen to insurance premiums if you required the plans to include everyone regardless of needs, and required them to provide benefits comprehensive enough to prevent financial hardship? Sen. Obama certainly knows, and this is why he says that we cannot require each individual to purchase insurance until he has made the plans affordable. Merely wishing that you could make comprehensive private plans affordable will never make it happen.

Numerous simulations and the experience of other nations have proven that using private health plans to provide reasonably comprehensive coverage for everyone is by far the most expensive method of financing health care. Looking at the Families USA report card, you can imagine how expensive it would be to bring our coverage up to a passing grade level. A single payer national health program would be less expensive and much more efficient. Why would a more expensive model that isn’t working for us be considered to be more feasible than a less expensive model that would?

There are many proposals for “reform” of the U.S. health care system out there.  For the newcomer it can be very confusing. Here are the four simple questions to ask of any health care proposal.

1. Is it Universal? Does it cover all people? This would seem to be pretty basic, insofar as all other developed countries do it.  But just being, or claiming to have, universal coverage is not enough.  It is a common error to claim universality and then let it go at that. When thinking about a so-called health care reform proposal you must also explore how the proposal deals with items 2, 3 & 4:
2. Is it Comprehensive?  Does it cover all needed conditions, prevention, treatment? What care is included under the proposal? What care is not covered? And given the way the for-profit private insurance companies actually operate in the real world, one has to ask what is REALLY covered: does the health proposal allow insurance companies to deny medical treatment, diagnosis, referrals recommended by a patient’s physician because of cost? Does it stop insurance companies from refusing to cover patients with pre-existing conditions or rescinding policies for people when they get sick?
3. How much is it going to Cost Individuals? Is it affordable year-in and year-out.  How much does it cost you and your family if you are not sick?  Can you afford to get sick.  What is the total cost of the system to you and your family including taxes, premiums, deductibles, copays, uncovered conditions/expenses, denial of care/coverage refusals/claim rejections.  What is your total out of pocket costs?  If you get sick are you going to go bankrupt?
4. How much is it going to Cost Overall? What is the cost to the system, to the country, for example as a percent of GNP?  How does it control costs. How is it paid for, and who is paying, all the pieces, direct and indirect?

Too many folks fall for the trap of hearing “reform” or even “universal” and don’t realize that it is not really Universal Coverage, IF that Coverage is really “coverage” because it leaves you with too much legitimate care not actually covered, leaves you and your family with bankruptingly high out of pocket expenses when somebody does get sick, and the total system costs keeps rising as percent of GNP. 

Any real reform has to do all 4.

Conservatives in government, free market stakeholders, and their lobbyists won a big one last week.  Even after the House gave overwhelming bipartisan support to the Medicare Improvements for Patients and Providers Act (HR. 6331) by a vote of 355-59 (including 129 Republican votes), the Senate fell two votes short of the 60 votes needed to overcome a presidential veto.  Presidential candidate Obama voted in favor of the bill; McCain was a no-show.  The bill would have cancelled a physician pay cut of 10.6 percent, reduced overpayments to private Medicare plans, improved coverage of mental health and preventive services under Medicare, and added consumer protections for enrollees in private plans.  President Bush planned to veto the legislation because of payment reductions to private plans and the improved benefits, claiming that they would “reduce access, benefits and choices for many of the 2.25 million enrollees in Private Fee for Service (PFFS) plans.   Robert Hayes, President of the Medicare Rights Center, called this “a craven submission to the insurance industry”.

Physicians will now see their already low reimbursement fall by an additional 10.6 percent, many may stop seeing new Medicare patients, patients recovering from strokes and other injuries will face an arbitrary cap on rehabilitative therapy, and 1.5 million seniors and people with disabilities living on less than $1,171 a month ($1,576 for a couple) will be dropped from programs that help them pay for physician services and prescription drugs.  Meanwhile, of course, large overpayments to private Medicare plans continue uninterrupted, and Medicare enrollees will likely be faced with less access at higher costs.

Conservatives have long had an agenda to “save” Medicare by killing it (ie., privatize it, and shrink the public program to a much smaller welfare program).  As part of the Contract with America in 1994, Newt Gingrich, as Speaker of the House, predicted that this kind of “reform” might solve “the Medicare problem” and cause it “to wither on the vine”.  All this fits into a larger goal to shrink government.

Conservatives continue to claim that private Medicare plans are more efficient and save money.  It is astounding (but hardly surprising) how big the disconnect has become between their rhetoric and reality.

Consider these facts:

• Traditional Medicare operates with an administrative overhead of about 3 percent (vs. private plans at least five times higher)
• Medicare plus Choice plans received 13 percent overpayments compared to  traditional FFS Medicare between 1998 and 2000, yet many left the market due to insufficient profits, forcing 2.4 million seniors to find other coverage and often change doctors.
• The Medicare Prescription Drug, Improvement and Modernization Act of 2003 further privatized Medicare by establishing Medicare Advantage as the sequel to Medicare plus Choice, creating the new “more flexible” Private Fee for Service (PFFS) option (even more expensive than other Medicare Advantage plans), and forbidding the government from negotiating lower drug prices with manufacturers, as the VA does so well with 45 percent discounts.
• PFFS plans receive 19 percent overpayments from the government, but often restrict choice and are not available in many areas; in 2005 they overstated their projected payments for medical care and instead  took in an additional $ 1.4 billion in profits, according to a recent study by the GAO.

We need to ask where the outrage is with all this.  In 1988, Congress passed the Medicare Catastrophic Coverage Act, which required Medicare beneficiaries to pay more than 80 percent of the new benefits themselves.  A firestorm of protest erupted.  As Chairman of the House Ways and Means Committee, Dan Rostenkowski (D-Ill) had led the way in passing this legislation.  When he returned to Chicago, his chauffeured  car was surrounded by 50 angry seniors who pounded on  the car windows and beat on it with signs protesting the bill.  This incident received wide press coverage, forcing Congress to repeal it the next year.

This year’s elections give us an opportunity to express outrage again over this latest attack on the Medicare program.  As a 43 year old program assuring comprehensive coverage with full choice of physician and hospital for more than 42 million Americans, it has served as a reliable bulwark for guaranteed access for seniors and the disabled.  While it needs some reform (especially by eliminating its overpriced and exploitive private  plans without offsetting increased value), it can serve as a model upon which to build a single-payer public financing system to cover all Americans while preserving the strengths of our private delivery system.

Adapted from Shredding the Social Contract: The Privatization of Medicare, Common Courage Press, 2006, and Do Not Resuscitate: Why the Health Insurance Industry is Dying, and How We Must Replace It, forthcoming, August 2008. Both books by by John Geyman. With permission of the publisher, Common Courage Press, Monroe, ME.

Buy This Book: http://commoncouragepress.com/index.cfm?action=book&bookid=396

Adapted from Shredding the Social Contract: The Privatization of Medicare, Common Courage Press, 2006, and Do Not Resuscitate: Why the Health Insurance Industry is Dying, and How We Must Replace It, forthcoming, August 2008. Both books by by John Geyman. With permission of the publisher, Common Courage Press, Monroe, ME.

Britain Weighs the Social Cost of High-Priced Drugs

By Joanne Silberner
NPR
July 3, 2008

Funding ‘Wonder’ Drugs

The government agency that decides what drugs the NHS will provide is the National Institute for Health and Clinical Excellence (NICE). Sir Michael Rawlins, chairman of NICE, says he knows his agency’s rulings can cause much disappointment.

Paying huge amounts of money for every new drug with the faintest hope of extending life by even a small amount would make it impossible for the NHS to provide universal care.

And Rawlins is sure that someday Americans will have to deal more directly with these same thorny questions of rationing and hope.

The United States will one day have to take cost effectiveness into account, he says. “There is no doubt about it all. You cannot keep on increasing your health care costs at the rate you are for so poor return. You are 29th in the world in life expectancy. You pay twice as much for health care as anyone else on God’s Earth.”

Social Solidarity

And then of course, he points to the millions of Americans with no access to health care because they can’t afford it.

“We have in Britain, as in most of Europe actually, a health care system based on social solidarity,” he says. “We look after each other when we’re sick. And that’s very precious to us in Britain. And I think that’s what we find so difficult about your health care system; you don’t have that.”

Cancer patient Donald Sutherland is happy with the British system, even with its limits.

“I think we’re quite patient people, albeit if we want something, we’ll make sure that we get it,” he says. “In my experience, I can only say that whenever I’ve needed the National Health Service, it’s always been there, and I’ve always had first-class treatment.”

Sutherland’s big interest is in more funding for the search for an effective treatment for lung cancer. And he doesn’t expect his fellow taxpayers to pay for a drug until there’s solid proof that there’s a benefit.

http://www.npr.org/templates/story/story.php?storyId=91996282

And…

Weighing the Costs of a CT Scan’s Look Inside the Heart

By Alex Berenson and Reed Abelson
The New York Times
June 29, 2008

(CT angiograms) were given to more than 150,000 people in this country last year at a cost exceeding $100 million. Their use is expected to soar through the next decade. But there is scant evidence that the scans benefit most patients.

And they expose patients to large doses of radiation, equivalent to at least several hundred X-rays, creating a small but real cancer risk.

Mr. (Robert) Franks has a family history of cardiac disease, and his father and two uncles died of heart attacks. But Mr. Franks… is in excellent shape.

(Mr. Franks) decided to have a nuclear stress test. When that test showed no problem, the cardiologist who conducted it said he did not need more testing.

After doing research on the Internet, (Mr. Franks) found Dr. (Harvey) Hecht, who recommended a CT angiogram. Dr. Hecht acknowledged that Mr. Franks probably did not have severe heart disease. But he said the scan would be valuable anyway because it might reassure him. And his insurance would cover the cost.

http://www.nytimes.com/2008/06/29/business/29scan.html?hp=&pagewanted=all

One of the more important reasons that the U.S. health care system is so much more expensive than those of other nations is our well documented excess use of expensive high-tech services and products. As much as 30 percent of spending is for services of little or no benefit, and often leads to adverse consequences as a direct result of the intervention or indirectly due to other interventions that this overuse may lead to.

$100,000 drugs that have a 100 percent incidence of poisoning, but have only a negligible impact on the malignancy targeted, are not the breakthrough technology that those profiting from them imply. An expensive imaging procedure that has not been demonstrated to be of benefit, but has radiation doses known to cause cancer, is another breakthrough that favorably impacts profits to the detriment of patients.

We can learn much from the National Institute for Health and Clinical Excellence (NICE), an independent organization that provides Britain’s National Health Service with “national guidance on promoting good health and preventing and treating ill health.” Sadly, much of the publicity in the U.S. on NICE has come from the opponents of a government role in health care, claiming that NICE is depriving British citizens of life-saving cures. In fact, NICE is reducing the waste of taxpayer funds by providing better guidance on how those funds should be spent.

Compare that to the United States. Mr. Franks (NY Times article above) received an expensive test that was not medically indicated, but that perhaps could provide him with reassurance, and it would add to Dr. Hecht’s income, possibly at the cost of giving Mr. Franks cancer. But it was okay because his insurance would pay for it. What?

Whether health care is paid for by a public program or a private insurance plan, we all pay for it. Excess public spending wastes our taxes, but excess private insurer spending wastes our premium dollars and further adds a surcharge in outrageous administrative costs that are tacked on to our health care bill.

A NICE-like program combined with public financing in the United States would dramatically increase the value received for health care spending for all of us, and isn’t that what social solidarity is all about?

You should go to the NICE website to familiarize yourself with this program. Not only will you be able to answer the ideologues who try to demonize this program, but, much more importantly, you will be in a position to advocate with greater confidence for an even better health care system that is more affordable for all of us.

National Institute for Health and Clinical Excellence (NICE):
http://www.nice.org.uk/