Back in April, I observed:
Seeing Michael Moore's film, 'Sicko', has a few surprises and is good back grounding. Much easier to access are the PBS FRONTLINE documentaries, Sick Around the World and Sick in America. These are readily available online (just right click on the titles to open the relevant Websites). The first reviews health insurance and health care in five capitalist countries (The United Kingdom, Japan, France, Taiwan, and Germany) and gives some idea of the variations that are possible based on the model invented by Bismark in Germany in late 19th Century.
Of the five countries mentioned, Japan is touted as being the most healthy. Interestingly, in Japan, health care was built into the constitution of Japan by the American, General Douglas MacArthur. This made the health of the people of Japan the responsibility of the Japanese government. Taiwan is unique in that, when seeking a new approach to health care, it investigated systematically health systems in other democratic nations.
There is a lot of concern about the overall cost of health care here in the US. About 17% of Gross National Product goes to providing health care and may rise to 22% over the next few years. This is roughly twice as much as in peer countries and with inferior health outcomes in several areas such as life expectancy and infant mortality. Some put this down to the fee-for-service basis of health care in the United States. However, most other countries retain this approach, such as Australia, France, Canada, and Japan while keeping health care costs lower. The report I alluded to in my September post (Accounting The Cost of Health Care in the United States, published in January 2007, by the McKinsey Global Institute) showed that costs related to diagnostic procedures, inpatient care, drugs, and multiple administrative structures contribute most to the overall cost of care. To see this report, you will have to register on their Website.
According to some polls, Americans appear to be loosing interest in health care as an issue. There is a some chance that the Republican Party may be able to rally sufficient support to defeat the final bill. If we are loosing interest, it may be because of rising disillusionment with the political process. In my April posting, I suggested you look to the lobbying around health. In September a CNN report (Health care lobbying: Political power machine) indicated some $400 million had already been spent and I have read that as much again has been spent since. The spending "leaders" are drug manufacturers, hospitals, and nursing homes. The legislators most active in opposing the present legislation seem to be those who have benefited most in campaign contributions and lobbyist support over the last year.
What could have possessed Gen. Douglas MacArthur to make health for everyone the responsibility of the Japanese legislature? However could he have conceived such a radical approach? Perhaps because, as a military leader, he knew how critical health is to the functioning of an army. Despite the many 'horror' stories we hear and read about the personal tragedies (see 'Sick in America' above) resulting from the failure of the so-called 'health system' in the US, politicians appear to be insensitive to the importance of good health services for all citizens. Unlike the President, they perhaps have been insulated from the consequences of our dysfunctional 'system' of care.
The cynic in me wants to leap to the forefront. In this year, the House of Representatives faces re-election as does one third of the Senate. Additionally, many governors face re-election. Due to the central role of TV advertising, the costs of political campaigning continue astronomical despite the ncreasing importance of the Internet in gleaning election funding. Meanwhile contributions, or the promise of contributions, from corporations can be critical to the degree when viewed as a safe source of support for those aspiring to election or re-election.
In the struggle over health reform, could we be experiencing the slow death of democracy where the 'rights' of vested interests supervene over those of ordinary citizens? If the price of peace is eternal vigilance, what then is the price of democracy?
As The Bard remarked, There is many a slip twixt the cup and the lip.
About 40 American voters read this post. If you have a concern about health reform, pass on the need for vigilance and action to some of your friends. I recommend you review the sources I have listed.
And, a Happy and Healthy New Year!
2 comments:
Robert,
I occasionally get a chance to read your blog and I find it most interesting and entertaining (good reminders of why we got along so well when working together).
I particularly liked your Christmas reminiscence but also your most recent analysis of the health care reform debate here in the US.
I have been teaching health policy in a new MBA program at OHSU for the past year. In that class and the other arenas (med students and psychiatry residents) in which I teach, I have been using TR Reid's work (Sick Around the World and his book, The Healing of America), which provides an excellent overview of other national health systems and how we could reform ours. I have also been working on the health reform initiative that Oregon is now developing (http://www.oregon.gov/OHA/index.shtml). Much could be learned from how our little state proceeds with its approach (a variation on the Bismarck model).
I have also penned an essay on how behavioral health can and should fit into the overall health reform process, which I would be glad to share with you if I could figure out how to attach a Word file to this blog.
Have a great New Year and come by and visit if you're back this way.
Thank you, David and always good to have you on this page. Reid is a great reporter and good writer. Besides, as a presenter, he is much more entertaining than another hero of mine, Michael Pollan. To even the score, Pollan is the more accomplished writer. They come out about equal, I guess, and both have been prepared to plunge into the experience of which they later write.
Reid puts his finger on the central conundrum of health reform in the US (as he remarks, we have all the models already here in the US), which is the role of profit-making insurance companies. This results in a significantly large slice of what the insured pay going off to high administration costs and shareholders returns; it also results in a considerable squeeze on health service providers. Limiting insurance to cover purchased by employers has several difficulties that impede good health provision the chief of which is insurers have little interest in the ongoing health care of individuals as they change jobs and pass beyond the insurer's ken. Reid has done a great job of pointing this out.
The value of the 'status quo' is such that vested interests have contrived a true 'gordian knot' of influences to keep this particular oxcart well and truly tethered; I doubt there is another Alexander to so swiftly and easily cut it through!
Adequate health care as the right of every citizen, and therefore the responsibility of politicians, is missing from planning in the US. How this can be achieved cost-effectively is a proper task for government. Perhaps the 'knot' can be untied through a careful examination of the causes of high cost and low efficiency and not in one 'fell swoop', 'fell' meaning here something ill-contrived or even disastrous, and 'swoop' meaning a sudden attack, a blow struck quickly, as by a plummeting bird of prey. As Macduff cried out, on hearing of the murder of his family: "All my pretty ones?
Did you say all? O hell-kite! All?
What, all my pretty chickens and their dam
At one fell swoop?"
It would be good to see what a bunch of bright MBA-ers might come up with along these lines. Good luck on the course.
Maybe the states will eventually get the job done if the Federal government will allow it.
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