By RONI CARYN RABIN
The New York Times,  June 14, 2010

Uninsured Americans often have difficulty getting care and paying for medications. But what happens once they are admitted to a hospital with a life-threatening illness?

A new study finds that even after they have heart attacks or strokes and are admitted to hospitals, the uninsured are more likely to die than those who carry private insurance.

A gap persisted even after the researchers adjusted for disparities in the patients’ underlying health, socioeconomic status and other factors.

Researchers analyzed more than 150,000 discharges of working-age Americans, ages 18 to 64, who were hospitalized for heart attack, stroke or pneumonia. The data was drawn from the 2005 Nationwide Inpatient Sample.

The study found that uninsured patients who had heart attacks were 52 percent more likely to die in the hospital than the privately insured, and those who had a stroke were 49 percent more likely to die in the hospital.

“We thought there would be some disparity and a little bit of a difference, but we were surprised there were such significant differences,” said Dr. Omar Hasan, a hospitalist at Brigham and Women’s Hospital in Boston who was the lead author of the study, in the Journal of Hospital Medicine.

One reason, Dr. Hasan suggested, may be that patients who have trouble getting care may have more advanced disease.

“We know for a fact that people who are uninsured delay seeking care,” he said.

http://www.nytimes.com/2010/06/15/health/research/15disp.html

By Steven Reinberg, HealthDay Reporter
Business Week, June 23, 2010

WEDNESDAY, June 23 (HealthDay News) — Compared with six other industrialized nations, the United States ranks last when it comes to many measures of quality health care, a new report concludes.

Despite having the costliest health care system in the world, the United States is last or next-to-last in quality, efficiency, access to care, equity and the ability of its citizens to lead long, healthy, productive lives, according to a new report from the Commonwealth Fund, a Washington, D.C.-based private foundation focused on improving health care.

“On many measures of health system performance, the U.S. has a long way to go to perform as well as other countries that spend far less than we do on healthcare, yet cover everyone,” the Commonwealth Fund’s president, Karen Davis, said during a Tuesday morning teleconference.

“It is disappointing, but not surprising, that despite our significant investment in health care, the U.S. continues to lag behind other countries,” she added.

However, Davis believes new health care reform legislation — when fully enacted in 2014 — will go a long way to improving the current system. “Our hope and expectation is that when the law is fully enacted, we will match and even exceed the performance of other countries,” she said.

The report compares the performance of the American health care system with those of Australia, Canada, Germany, the Netherlands, New Zealand and the United Kingdom.

According to 2007 data included in the report, the U.S. spends the most on health care, at $7,290 per capita per year. That’s almost twice the amount spent in Canada and nearly three times the rate of New Zealand, which spends the least.

The Netherlands, which has the highest-ranked health care system on the Commonwealth Fund list, spends only $3,837 per capita.

Despite higher spending, the U.S. ranks last or next to last in all categories, Davis said, and scored “particularly poorly on measures of access, efficiency, equity and long, healthy and productive lives.”

The U.S. ranks in the middle of the pack in measures of effective and patient-centered care, she added.

Overall, the Netherlands came in first on the list, followed by the United Kingdom and Australia. Canada and the United States ranked sixth and seventh, Davis noted.

Speaking at the teleconference, Cathy Schoen, senior vice president at the Commonwealth Fund, pointed out that in 2008, 14 percent of U.S. patients with chronic conditions had been given the wrong medication or the wrong dose. That’s twice the error rate observed in Germany and the Netherlands, she noted.

“Adults in the United States [also] reported delays in being notified about abnormal test results or given the wrong results at relatively high rates,” Schoen said. “Indeed, the rates were three times higher than in Germany and the Netherlands.”

“As a result we rank last in safety and do poorly on several dimensions of quality,” Schoen said.

In addition, many Americans are still going without medical care because of cost, she said. “We also do surprisingly poorly on access to primary care and access to after hours care given our overall resources and spending,” Schoen said.

In fact, 54 percent of people with chronic conditions reported going without needed care in 2008, compared with 13 percent in Great Britain and 7 percent in the Netherlands, she said.

The United States also ranked last in efficiency, Schoen said. There are too many duplicate tests, too much paperwork, high administrative costs and too many patients using emergency rooms as doctor’s offices. In addition, poverty appears to be a big factor in whether Americans have access to care, the report found.

The United States also performed worst in terms of the number of people who die early, in levels of infant mortality, and for healthy life expectancy among older adults, Schoen said.

Dr. David Katz, director of the Prevention Research Center at Yale University School of Medicine, commented that “as a physician and public health practitioner, I have routinely spoken out in favor of health care reform in the U.S. The responses evoked have not always been kind. Prominent among the counterarguments has been: ‘You should see what health care is like in other countries.'”

“This report utterly belies the notion that the former status quo for health care delivery in the U.S. was as good as it gets. Others have been doing better and we can, and should, too,” he said.

However, at least one expert doesn’t believe that health care reform, as it now stands, will solve these problems.

Dr. Steffie Woolhandler, a professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program, said that “the U.S. has the worst health care system among the seven countries studied, and arguably the worst in the developed world.”

“Unfortunately, the U.S. will almost certainly continue in last place, since the recently passed health reform will leave 23 million Americans without coverage while enlarging the role of the private insurance industry, which obstructs care and drives up costs,” she said.

By Maggie Fox, Health and Science Editor
Reuters, June 23, 2010

Americans spend twice as much as residents of other developed countries on healthcare, but get lower quality, less efficiency and have the least equitable system, according to a report released on Wednesday.

The United States ranked last when compared to six other countries — Britain, Canada, Germany, Netherlands, Australia and New Zealand, the Commonwealth Fund report found.

“As an American it just bothers me that with all of our know-how, all of our wealth, that we are not assuring that people who need healthcare can get it,” Commonwealth Fund president Karen Davis told reporters in a telephone briefing.

Previous reports by the nonprofit fund, which conducts research into healthcare performance and promotes changes in the U.S. system, have been heavily used by policymakers and politicians pressing for healthcare reform.

Davis said she hoped health reform legislation passed in March would lead to improvements.

The current report uses data from nationally representative patient and physician surveys in seven countries in 2007, 2008, and 2009. It is available at http://bit.ly/9wLgQH.

In 2007, health spending was $7,290 per person in the United States, more than double that of any other country in the survey.

Australians spent $3,357, Canadians $3,895, Germans $3,588, the Netherlands $3,837 and Britons spent $2,992 per capita on health in 2007. New Zealand spent the least at $2,454.

This is a big rise from the Fund’s last similar survey, in 2007, which found Americans spent $6,697 per capita on healthcare in 2005, or 16 percent of gross domestic product.

“We rank last on safety and do poorly on several dimensions of quality,” Schoen told reporters. “We do particularly poorly on going without care because of cost. And we also do surprisingly poorly on access to primary care and after-hours care.”

NETHERLANDS RANKED FIRST OVERALL

The report looks at five measures of healthcare — quality, efficiency, access to care, equity and the ability to lead long, healthy, productive lives.

Britain, whose nationalized healthcare system was widely derided by opponents of U.S. healthcare reform, ranks first in quality while the Netherlands ranked first overall on all scores, the Commonwealth team found.

U.S. patients with chronic conditions were the most likely to say they gotten the wrong drug or had to wait to learn of abnormal test results.

“The findings demonstrate the need to quickly implement provisions in the new health reform law,” the report reads.

Critics of reports that show Europeans or Australians are healthier than Americans point to the U.S. lifestyle as a bigger factor than healthcare. Americans have higher rates of obesity than other developed countries, for instance.

“On the other hand, the other countries have higher rates of smoking,” Davis countered. And Germany, for instance, has a much older population more prone to chronic disease.

Every other system covers all its citizens, the report noted and said the U.S. system, which leaves 46 million Americans or 15 percent of the population without health insurance, is the most unfair.

“The lower the performance score for equity, the lower the performance on other measures. This suggests that, when a country fails to meet the needs of the most vulnerable, it also fails to meet the needs of the average citizen,” the report reads.

(Editing by Sandra Maler and Cynthia Osterman)

By Dean Baker
Co-Director of the Center for Economic and Policy Research
The Huffington Post, June 21, 2010

Next weekend will feature another milestone in the drive to cut Social Security and Medicare. The organization America Speaks will be hosting a series of 20 meetings in cities across the country. They will ask the people at these meetings, a cross section of the nation, to come up with proposals for dealing with the country’s projected long-term budget deficit.

The way the problem is outlined for these meetings virtually guarantees that most of the participants will opt for big cuts to Social Security and Medicare. The results of this song-and-dance exercise will then be presented to President Obama’s fiscal responsibility commission on June 30th, which will use it as further ammunition for plans by its co-chairs to gut these programs.

The rigged deck approach should come as no surprise. America Speaks is largely funded by Peter G. Peterson, the investment banker billionaire who has been on a decades long crusade to gut these programs. In recent years, Peterson has redoubled his efforts, committing more than a billion dollars to a wide variety of groups in addition to America Speaks. To advance his agenda Peterson has even set up a fake news service, the Fiscal Times. To fill the staff, Peterson’s son hired a number of reputable reporters who were displaced by the collapse of the newspaper industry.

Federal Budget 101, the guidebook for the discussion, follows a predictably shoddy path. The book discusses the budget in almost complete isolation from any larger discussion of the economy. There is virtually no discussion of the ways in which the budget fosters growth, for example by funding education, research and infrastructure; nor the way in which the pattern of growth affects the budget.

For example, the booklet never discusses the extent to which the economic mismanagement that allowed the unchecked growth of an $8 trillion housing bubble contributed to the debt that is its central concern. The downturn caused by the resulting economic collapse will eventually add more than $3 trillion to the country’s debt, according to the Congressional Budget Office’s projections.

The booklet also neglects to point out the extent to which the long-term budget disaster story is driven by our broken health care system. If per person health care costs in the United States were the same as in any other wealthy country, we would be looking at enormous budget surpluses in the long-term, not deficits.

Incredibly, the booklet does not even point out the fact that income is projected to grow over time. The average hourly wage is projected to buy 20 percent more in 2025 (the year for which participants are supposed to design a budget) than it does today.

This knowledge might affect how people view things like tax increases. For example, if we know that people will be on average 20 percent richer, we might be less concerned if their tax rate were to rise by 1-2 percentage points.

The booklet also never mentions the plunge in wealth that older workers have suffered as a result of the collapse of the housing bubble and plunge in the stock market. This has left the bulk of near retirees (those in their late 40s and 50s) facing retirement with almost nothing other than their Social Security and Medicare.

The booklet even gets its basic economics wrong, warning participants at the very beginning that rising deficits can lead to a weaker dollar. In the real econ 101, students learn just the opposite — that budget deficits can jack up interest rates leading to a stronger dollar. This is how a budget deficit can be tied to a trade deficit — by raising the value of the dollar. A higher dollar makes U.S. exports more expensive to foreigners and imports cheaper for people living in the United States.

People who want to see our trade deficit fall want a lower dollar. Getting the value of the dollar down (not up) is an argument that more serious people would give for a smaller budget deficit. Peterson should have been able to get a better product for his millions.

Finally, it is striking that not a single person connected with this project was among those who warned of the housing bubble before its collapse wrecked the economy. Ostensibly, America Speaks tried to include a diverse range of economists and policy analysts. Yet, in the category of people who recognized the biggest economic disaster of the last 80 years, America Speaks came up completely empty.

To put this in perspective, suppose Peter Peterson had funded this exercise back in 2004, when the housing bubble was already huge, but still at a point where it could have been deflated without devastating the economy. This group would have given us a great discussion of the 2020 deficit, but said nothing about the tsunami that was about to wreck the economy (and send the deficit skyrocketing).

Unfortunately, there is no reason to assume that the America Speaks crew’s understanding of the economy is any better today than it was in 2004. We need more serious analysis than this propaganda exercise as a basis for deciding the fate of essential programs like Social Security and Medicare.

http://www.huffingtonpost.com/dean-baker/america-speaks-back-derai_b_619465.html

By William Greider
The Nation, May 20, 2010

In setting up his National Commission on Fiscal Responsibility and Reform, Barack Obama is again playing coy in public, but his intentions are widely understood among Washington insiders. The president intends to offer Social Security as a sacrificial lamb to entice conservative deficit hawks into a grand bipartisan compromise in which Democrats agree to cut Social Security benefits for future retirees while Republicans accede to significant tax increases to reduce government red ink.

Obama’s commission is the vehicle created to achieve this deal. He ducks questions about his preferences, saying only that “everything has to be on the table.” But White House lieutenants are privately talking up a bargain along those lines. They are telling anxious liberals to trust the president to make only moderate cuts. Better to have Democrats cut Social Security, Obama advisers say, than leave the task to bloodthirsty Republicans.

The president has stacked the deck to encourage this strategy. The eighteen-member commission is top-heavy with fiscal conservatives and hostile right-wingers who yearn to dismantle the retirement program. The Republican co-chair, former Senator Alan Simpson, is especially nasty; he likes to get laughs by ridiculing wheezy old folks. Democratic co-chair Erskine Bowles and staff director Bruce Reed secretly negotiated a partial privatization of Social Security with Newt Gingrich back when they served in the Clinton White House, but the deal blew up with Clinton’s sex scandal. Monica Lewinsky saved the system.

Any recommendations require fourteen votes, and Obama has at least five loyalists who will protect him—Senators Dick Durbin and Max Baucus, Representatives Jan Schakowsky and Xavier Becerra, and former SEIU president Andy Stern. On the other hand, if Obama really wants to make a deal, these commissioners will very likely support him.

The people, once again, are kept in the dark. The Obama commission will not report its recommendations until after this fall’s elections—too late for voters to express objections. Both parties assume they can evade blame by holding hands and jumping together.

What’s extraordinary about this assault on Social Security is that a Democratic president is leading it. Obama is arm in arm with GOP conservatives like Wall Street billionaire Pete Peterson, who for decades has demonized Social Security as a grave threat to the Republic and has spread some $12 million among economists, think tanks, foundations and assorted front groups to sell his case. If Obama pulls the deal off, this will be his version of “Nixon goes to China”—a leader proving his manhood by going against his party’s convictions. Even if he fails, the president will get some protective cover on the deficit issue. After all, he is targeting Big Government’s most beloved and trusted program—the New Deal’s most prominent pillar.

Obama’s initiative rests on two falsehoods spread by Peterson’s propaganda—the notion that Social Security somehow contributes to the swollen federal deficits and that cutting benefits will address this problem. Obama and his advisers do not say this in so many words, but their rhetoric implies that Social Security is a big source of the deficit problem. Major media promote the same falsehoods. Here is what the media don’t tell you: Social Security has accumulated a massive surplus—$2.5 trillion now, rising to $4.3 trillion by 2023. This vast wealth was collected over many years from workers under the Federal Insurance Contributions Act (FICA) to pay in advance for baby boom retirements. The money will cover all benefits until the 2040s—unless Congress double-crosses workers by changing the rules. This nest egg does not belong to the government; it belongs to the people who paid for it. FICA is not a tax but involuntary savings.

As a candidate, Obama assured voters that any shortfall was in the distant future and could be easily resolved with minor adjustments. As president, he has abandoned this accurate analysis and turned rightward without explaining why. He faces an awkward problem, however. Despite conservative propaganda, cutting Social Security will have no impact on the deficit problem that so stirs public anxiety. The White House knows this, and some advisers admit as much. So why is the president targeting Social Security?

Paul Volcker, former Federal Reserve chair and adviser to the president, declares, “In my view, we can deal with the Social Security problem fairly promptly.” Cutting benefits, Volcker adds, “is not going to deal with the deficit problem in the short run, but it’s confidence building.” John Podesta of the Center for American Progress, another adviser, agrees but says, “Reforms could starkly demonstrate to skeptical debt markets that the United States is willing to take on a politically difficult fiscal issue.”

In other words, targeting Social Security is a smokescreen designed to reassure foreign creditors and avoid confronting the true sources of US indebtedness. The politicians might instead address the cost of fighting two wars on borrowed money or the tax cuts for the rich and corporations or the deregulation that led to the recent financial catastrophe and destroyed vast wealth. But those and other sources of deficits involve very powerful interests. Instead of taking them on, the thinking in Washington goes, let’s whack the old folks while they’re not watching.

This issue is a seminal fight with the potential to scramble party politics. If Democrats can no longer be trusted to defend Social Security, who can be? The people from left to right overwhelmingly support the program (88 percent), and a majority (66 percent) believe benefits should be increased now to cope with the loss of jobs and savings in the Great Recession.

Citizens can win this fight if they mobilize smartly. We can do this by arousing public alarm right now, while members of Congress face a treacherous election and before Obama can work out his deal. Some liberal groups are discussing a “take the pledge” campaign that demands senators and representatives sign commitments to keep Hands Off Social Security Benefits. If politicians refuse to sign, put them on the target list for November. Barack Obama is standing on the third rail of politics—let’s give him a warning jolt.

http://www.thenation.com/article/whacking-old-folks