By Arthur Richter
August 4, 2005

The recent “my view” charging that adopting universal health care will bankrupt America (July 6) cannot go unanswered. Our existing privatized health care delivery system is experiencing continued escalation of premiums and cost shifting by providers and employers. We expend twice as much per capita as other industrialized countries, with poorer health outcomes, such as life expectancies and infant mortality.

Health premiums are escalating at a faster rate than health- care costs, therein benefiting the insurance industry to the extent that it is able through its lobbying and campaign contributions, to expend, at a national and state level, hundreds of millions of dollars in buying or renting some of our legislators. And its largesse is not limited to any one political party. The recently enacted Medicare Modernization Act is a blatant example of the power of the insurance and pharmaceutical lobbies in their effort to privatize our Medicare system.

In the past, Medicare was able to deliver its services with a less than 3 percent overhead, as compared to our “free market” for profit system with its overhead of 15 to 30 percent. In passing the legislation in a most dubious fashion and claiming at the time of passage that it would cost less than $400 billion over 10 years, its now estimated to cost over $800 billion and now with the intention of passing the cost of this “benefit” to the states.

Any federal legislator who voted for this legislation clearly does not deserve reelection. A simple search of the campaign contributions made to these legislators will explain their votes.

Comparing the Canadian system to ours is valid, and that their system has some shortcomings is acknowledged. These shortcomings are addressed in the Romanov report, issued in 2003, with the recommendation to increase its health care expenditures to mitigate the wait times that some of its residents have experienced. However, even with some of their systemic warts, Canadian citizens experience life spans 2½ years longer than U.S. residents and they expend half as much per capita.

Our systemic shortfalls are gigantic and, compared to their “warts,” we may well call our system “cancerous.” We have 45 million uninsured and an equally large number underinsured. We have family and friends who are the users and beneficiaries of the Canadian system, and they are well aware of our system and they turn thumbs down on what we have here.

We would do well to implement a “Medicare for all” system and curb the parasitic insurance and drug industries and their corrupting influence and rid ourselves of those “compliant” legislators. We have the technology and the resources, but our health delivery system is exploited, distorted, unfair and very inefficient. Let’s wise up.

Arthur Richter is co-chairman of Citizens for Universal Healthcare, in Kingston.

By Paul Krugman
July 29, 2005

Americans tend to believe that we do everything better than anyone else. That belief makes it hard for us to learn from others. For example, I’ve found that many people refuse to believe that Europe has anything to teach us about health care policy. After all, they say, how can Europeans be good at health care when their economies are such failures?

Now, there’s no reason a country can’t have both an excellent health care system and a troubled economy (or vice versa). But are European economies really doing that badly?

The answer is no. Americans are doing a lot of strutting these days, but a head-to-head comparison between the economies of the United States and Europe – France, in particular – shows that the big difference is in priorities, not performance. We’re talking about two highly productive societies that have made a different tradeoff between work and family time. And there’s a lot to be said for the French choice.

First things first: given all the bad-mouthing the French receive, you may be surprised that I describe their society as “productive.” Yet according to the Organization for Economic Cooperation and Development, productivity in France – G.D.P. per hour worked – is actually a bit higher than in the United States.

It’s true that France’s G.D.P. per person is well below that of the United States. But that’s because French workers spend more time with their families.

O.K., I’m oversimplifying a bit. There are several reasons why the French put in fewer hours of work per capita than we do. One is that some of the French would like to work, but can’t: France’s unemployment rate, which tends to run about four percentage points higher than the U.S. rate, is a real problem. Another is that many French citizens retire early. But the main story is that full-time French workers work shorter weeks and take more vacations than full-time American workers.

The point is that to the extent that the French have less income than we do, it’s mainly a matter of choice. And to see the consequences of that choice, let’s ask how the situation of a typical middle-class family in France compares with that of its American counterpart.

The French family, without question, has lower disposable income. This translates into lower personal consumption: a smaller car, a smaller house, less eating out.

But there are compensations for this lower level of consumption. Because French schools are good across the country, the French family doesn’t have to worry as much about getting its children into a good school district. Nor does the French family, with guaranteed access to excellent health care, have to worry about losing health insurance or being driven into bankruptcy by medical bills.

Perhaps even more important, however, the members of that French family are compensated for their lower income with much more time together. Fully employed French workers average about seven weeks of paid vacation a year. In America, that figure is less than four.

So which society has made the better choice?

I’ve been looking at a new study of international differences in working hours by Alberto Alesina and Edward Glaeser, at Harvard, and Bruce Sacerdote, at Dartmouth. The study’s main point is that differences in government regulations, rather than culture (or taxes), explain why Europeans work less than Americans.

But the study also suggests that in this case, government regulations actually allow people to make a desirable tradeoff – to modestly lower income in return for more time with friends and family – the kind of deal an individual would find hard to negotiate. The authors write: “It is hard to obtain more vacation for yourself from your employer and even harder, if you do, to coordinate with all your friends to get the same deal and go on vacation together.”

And they even offer some statistical evidence that working fewer hours makes Europeans happier, despite the loss of potential income.

It’s not a definitive result, and as they note, the whole subject is “politically charged.” But let me make an observation: some of that political charge seems to have the wrong sign.

American conservatives despise European welfare states like France. Yet many of them stress the importance of “family values.” And whatever else you may say about French economic policies, they seem extremely supportive of the family as an institution. Senator Rick Santorum, are you reading this?

E-mail: krugman@nytimes.com

Copyright 2005 The New York Times Company

Letters Editor
Calgary Herald

Re: “Opening access to health care choices is a moral duty,” Ralph Klein, Opinion, July 30

Premier Klein states that “all the money in the world” is not going to eliminate waiting lists, unless the source of the funds is private instead of public. What nonsense. An MRI machine or surgical bed is no different whether paid for by private or public dollars.

Excessive queues are eliminated by making minor, selective adjustments in the capacity of the system. Compared to the global costs of establishing and maintaining a health care system, the costs of these adjustments are negligible.

Responsible stewards of any health care system, whether public or private, will make these appropriate adjustments. The difference is that the public system would be adapted to accommodate everyone, whereas private systems accommodate only those with the ability to pay.

By failing to tweak the capacity of the system, Premier Klein has confirmed that he is an irresponsible steward of Alberta’s public system. He should consider resigning so that he could accept a position as a health care executive in the United States. Our grand experiment with his preferred private system has demonstrated that we are capable of spending almost $2 trillion without allowing the 45 million uninsured to have any position in the queue.

All systems ration care. Excessive rationing due to limited capacity is very easily remedied. Rationing by ability to pay, in contrast, results in suffering and death. We know which model of rationing Premier Klein prefers, but which model do Albertans really prefer?

Don R. McCanne, M.D.
Senior Health Policy Fellow
Physicians for a National Health Program

Tuesday, July 26, 2005
By Alana Semuels
Pittsburgh Post-Gazette

Although her husband is employed, 30-year-old Pamela Ramirez still pays her health bills the same way many immigrants do — out of her savings account.

Ramirez, of the South Side, moved here from Argentina more than four years ago. She’s typical in that she costs less to the health care system than do native-born residents, according to a study published yesterday in the American Journal of Public Health.

The study found that immigrants use 55 percent less health care than non-immigrants, and that both insured and non-insured immigrants use less services than the native born.

Immigrants actually subsidize care for the rest of the population, according to the study, because they pay Medicare payroll taxes and health insurance premiums, but do not reap all the benefits of these services.

“This ought to explode the myth that health care costs are due to immigrants,” said Dr. Steffie Woolhandler, an associate professor of medicine at Harvard Medical School and one of the authors of the study.

In dollar terms, per capita health expenditures were around $1,139 per immigrant, versus $2,564 for non-immigrants.

This is the first national study of immigrants’ health care expenditures. It looked at data from 21,241 people in the Agency for Healthcare Research and Quality’s 1998 Medical Expenditure Panel Survey, counting anyone born outside the country as an immigrant. The data is the most recent available, Woolhandler said, and the problems it highlights — such as immigrants’ fear of seeking treatment — have probably been exacerbated in the post-9/11 world.

Woolhandler argues that it highlights the need for a national health insurance program, which is the goal of the organization she co-founded, Physicians for a National Health Program.

But a think tank that supports tighter controls on immigration said that the study shows only that immigrants are poorer than non-immigrants, and are thus less able to afford health care.

“To the extent there’s an immigration policy conclusion, it would be that we’re taking in too many poor immigrants,” said Mark Krikorian, executive director of the Center for Immigration Studies in Washington, D.C.

One of the most striking pieces of the study found that immigrant children receive very low levels of care. They got 71 percent less care in doctors’ offices, and 72 percent fewer prescription medications than native-born children. The cost of their emergency room visits was the only expenditure that was higher — three times greater than those of native-born children — implying that parents wait until their children are very ill before seeking care.

“There’s widespread agreement that young children need to see a doctor on a regular basis,” said Woolhandler. “There’s very strong evidence that there was under-use of services in immigrant children.”

Although many of Pittsburgh’s immigrants are better-educated than those in other cities, children and elderly immigrants who don’t qualify for services are particularly vulnerable, said Dr. Vish Nimgaonkar, a professor of psychiatry at the University of Pittsburgh School of Medicine and a member of Woolhandler’s nonprofit group.

Local doctors have tried to help immigrant children obtain health care by running a bilingual clinic every week at Children’s Hospital and a monthly clinic on the South Side for uninsured children.

Lack of insurance, language barriers, and cultural differences are three of the main reasons preventing immigrants in Pittsburgh from seeking care, said Dr. Diego Chaves-Gnecco, a pediatric resident at Pitt who founded the local clinics. Many Latinos he treats would rather use traditional remedies than try to navigate a health care system that doesn’t speak their language.

Latino immigrants were found to utilize half as much health care as U.S.-born Latinos, and 70 percent less than U.S.-born whites, according to the study.

“We’re overcoming those barriers,” he said. The clinics have now had more than 1,000 visits — a significant number for a city with a small Latino population.

Ramirez takes her Pittsburgh-born daughter to Chaves-Gnecco’s clinic. But she and her husband don’t have a similar outlet to seek care for themselves.

“The ideal situation is when you don’t have to overcome all the barriers we have mentioned,” she said. “Immigration status shouldn’t affect health care.”

Alana Semuels can be reached at asemuels@post-gazette.com or 412-263-1928.