AMA, 51 Other Medical Organizations, oppose Gun Violence, Duh.

Doctors endorse single-payer | Philadelphia Inquirer | 12/04/2007

Doctors endorse single-payer Philadelphia Inquirer 12/04/2007:
“Because much of the growth in expense in the current system is in procedures performed by specialists or in increased use of technology like MRIs, doctors who work in those areas have the most to fear from a single-payer system, Getzen said. Internists, who serve as primary-care doctors for many people, have less to fear.

The ACP also called for better payments for primary-care doctors to help avert a shortage and for the creation of a uniform billing system and greater use of electronic health records to reduce administrative costs.

Dale said that some U.S. doctors and hospitals were better than their counterparts in other nations, but that this country’s health system compares poorly. ‘Part of our call is, ‘Look around, guys, and see how other people are doing,’ ‘ he said, ‘and they’re doing better than us.’ “

Nicely done summary of where most of the tension in advocating for single payer lays.

The ACP position paper is here, and I believe free to anyone.

Cheers,

Draft Proposal for a Single Payer, Comparative Healthcare Wiki

Comparative Healthcare: Economic, Policy, Provider and Public Perspectives

Nation: General description/overview of system
Economics
Macroeconomic view
Per capita, GDP spending
Financing system
Cost to taxpayers
Cost to employers/employees
Efficiency
Microeconomic view
Business evaluation of efficiency
Citizen evaluation of efficiency
Provider evaluation of efficiency
Hospitals
Other facilities (SNF, surgery centers, testing/imaging)
Providers
Physicians
Nurses
Others: extenders/PT/OT/RT/ Pharmacists

Policy Considerations
Socialized/Single Payer/Hybrid
Private insurers/providers
Federal Perspectives
Perceived shortcomings
Percieved efficiencies
Things to include
Things to avoid
Political pitfalls
Funding
Administration

State/Province/Other Perspectives
Local Administration
Local Governanace

Provider Perspectives
Hospitals
Adminstrators
Nurses and allied healthcare
Physicans
Physicians
Perspectives of Physicians
Timeliness
Effectiveness
Practice Variation
Quality data
Fairness
Access
Research
“High Tech” health care
End-of-Life Care
Reimbursemnet
Bureacracy
Autonomy of decision making
Access to data (quality)
Access to data (EHR)
Mental Health/substance abuse care

Nurses
Physician Extenders
Utilization
Role
Income
Other Allied healthworkers
Pharmacists
Dentists
Optometrists
Psychologists

Public Perspectives
Timeliness
Effectiveness
Access
Out-of-Pocket Costs
Rationing
Spending/Cost to nation
Value

Although U.S. Spends Twice as Much…- Kaisernetwork.org

Coverage & Access Although U.S. Spends Twice as Much as Other Industrialized Nations on Health Care, More in This Country Have Access Problems, Survey Finds – Kaisernetwork.org:

“The article notes that the U.S. spent $6,697 per capita, or about 16% gross domestic product, on health care in 2005. Other nations in 2005 spent less than half that amount per person on health care. The survey found that respondents in Canada and the U.S. often visit emergency departments for routine care and that those in the U.S. ‘were most likely to have gone without care because of cost and to have high out-of-pocket costs.’

In addition, the survey found that 37% of all respondents in the U.S. and 42% of those with chronic diseases ‘had skipped medications, not seen a doctor when sick, or forgone recommended care in the past year because of costs — rates well above all other countries.’ In contrast, respondents in Britain, Canada and the Netherlands ‘rarely report having to forgo needed medical care because of costs,’ according to the survey. Respondents in New Zealand and Britain had the least confidence in the quality of care that they received, and those in Germany and the U.S. had the most access to elective surgeries, the survey found.

Commonwealth Fund President Karen Davis said, ‘The survey shows that in the U.S., we pay the price for having a fragmented health care system,’ adding, ‘The thing that struck me in this survey is the trouble that Americans have in getting to see their own doctors'”

More on US Health Care and Health Insurance cost

Two new bits in the Inbox today regarding US spending on health care and consumers spending on insurance:

From Health Affairs:
Health Spending In OECD Countries In 2004: An UpdateGerard F. Anderson, Bianca K. Frogner and Uwe E. Reinhardt
In 2004, U.S. health care spending per capita was 2.5 times greater than health spending in the median Organization for Economic Cooperation and Development (OECD) country and much higher than health spending in any other OECD country. The United States had fewer physicians, nurses, hospital beds, doctor visits, and hospital days per capita than the median OECD country. Health care prices and higher per capita incomes continued to be the major reasons for the higher U.S. health spending. One possible explanation is higher prevalence of obesity-related chronic disease in the United States relative to other OECD countries.

From The Kaiser Family Foundation:
Premiums for employer-sponsored health insurance rose an average of 6.1 percent in 2007, less than the 7.7 percent increase reported last year but still higher than the increase in workers’ wages (3.7 percent) or the overall inflation rate (2.6 percent), according to the 2007 Employer Health Benefits Survey released today by the Kaiser Family Foundation and Health Research and Educational Trust. Key findings from the survey were also published today in the journal Health Affairs.The 6.1 percent average increase this year was the slowest rate of premium growth since 1999, when premiums rose 5.3 percent. Since 2001, premiums for family coverage have increased 78 percent, while wages have gone up 19 percent and inflation has gone up 17 percent.

France’s model healthcare system – The Boston Globe

France’s model healthcare system – The Boston Globe:

“National health insurance in France stands upon two grand historical bargains — the first with doctors and a second with insurers. Doctors only agreed to participate in compulsory health insurance if the law protected a patient’s choice of practitioner and guaranteed physicians’ control over medical decision-making. Given their current frustrations, America’s doctors might finally be convinced to throw their support behind universal health insurance if it protected their professional judgment and created a sane system of billing and reimbursement. French legislators also overcame insurance industry resistance by permitting the nation’s already existing insurers to administer its new healthcare funds. Private health insurers are also central to the system as supplemental insurers who cover patient expenses that are not paid for by Sécurité Sociale. Indeed, nearly 90 percent of the French population possesses such coverage, making France home to a booming private health insurance market.”

I think that, except for the hard core ideologues, physicians would by and large accept this bargain.

Lebanon Daily News – When it’s free, health care really costs

Dismembering a typical philistine, pig-ignorant op-ed (apologies to John Cleese)

When it’s free, health care really costs

Editor:
Lebanon Daily News

The presidential candidates, the media and some local misguided souls have been turning up the rhetoric supporting universal or single-payer health care while cautiously avoiding the truth that such systems are simply socialized medicine.

Part I: Invoke socialism bogey-man. Betrays common ignorance of all right-wingers in not understanding the difference between ‘socialized medicine’ and single-payer systems. Also fails to understand that in the context of health-care, we all wish to have basic healthcare for ourselves, our families, and, I hope, if one claims some basic humanistic/Christian/Islamic/Jewish/Hindi/Buddhist/whatever qualities, for the ‘least among us.’ That means poor and lower income and those with previously diagnosed health conditions (for the empathy impaired).

Socialized medicine does not work anywhere.

Part II: Ignore all evidence to contrary of your opinion. Ignore OECD, Commonwealth fund, essentially all scientific literature on the topic.

It never has, and by it’s very structure, it never will. When I use the word “work,” I mean it in the context of providing what we have in the U.S. — the finest health care in the world.

Part II, again. Ignore all overwhelming evidence to the contrary. I’ll try to link back to evidence soon.

Hundreds of thousands of people come to our country for their health care every year because what they need is not available where they live.

I don’t think some Saudi and UAE princes count as hundreds of thousand. And they come for what is right about American medicine: the high tech, cutting edge care that cannot be BOUGHT elsewhere. That is, they can’t jump the line elsewhere, like they can here.

Certainly we have problems in our current system, but the problems are fixable if all the parties in the system will step up to their part of the problem. Some uninformed people cite the insurance companies as the single problem in our health-care system. While insurers certainly are a part of the problem, they are no more of a problem than are the providers themselves. The cost of repairing botched surgeries, medical errors, hospital-based infections, allowing medical providers who have lost their license in another state to be licensed in Pennsylvania, overutilization, underutilization and a general unwillingness to purge their ranks of known, bad providers, contributes as much or more to the cost of health care as does the “greedy” insurance industry, and every honest medical provider knows it. It’s time to stop the blame game and get on with solutions.

I’m an honest medical provider, and the writer is wrong. The litany he lists all need fixed, but will be much easier to fix in a properly funded single payer system. And, sorry, the for-profit system, the same unrestrained, repugnant greed-based system that led to Enron, Tyco, and a two billion dollar surplus for Highmark alone, is by far the biggest problem.

To cite the one-sided propaganda film “SiCKO”as beneficial because it stirs debate on health care is like endorsing communism because it will make our citizens more patriotic. It’s sicko logic.

SICKO showed some of the serious flaws in our system and showed some of the serious benefits to others. That really is the bottom line. I’ve been following the media coverage closeely, interviews with various experts, MM himself in interviews, etc. There are lots of complaints about what he “left out.” Well, it’s only a two hour movie and I think it is not his job nor his role to be the healthcare czar and review every nuance of healthcare here and abroad. He had a lot of points to make and he made them very well, very humorously and sometimes heart-breakingly poignantly. If you see it, you’ll know that he didn’t tell the downsides of universal access in other countries, but, frankly, as we healthcare providers know better than the average viewer, neither did he scratch the surface of the problems so widespread in our “system.” But he always says in interviews that of course other systems have problems. Our goal should be to take the best parts of each of those systems and craft an American system better than all the others. But, he makes no bones that this needs to be a single payer system at its core. He seems to have no bone to pick with physicians – he believes the focus of reform should be getting rid of private health insurance as we know it.

I urge everyone to see it. It engenders debate, not just about healthcare, but about who we are as a people. Are we, as Americans, about “me” or “we”? That really is the central question he asks.

For the truth about how socialized medicine does not work, go to http://www.fraserinstitute.ca/ and click on “health.” Several interesting reports are available online, but the report entitled “Paying More, Getting Less” is particularly revealing. The Fraser Institute is an independent Canadian research organization and is the only source of accurate statistics on wait times and the status of their failing system of health care.

The Fraser Institute is as reliable as the Cato Institute, the American Enterprise Institute and every other right-wing “think-tank” From Nick Scala, of Physicians for a National Health Plan ( pnhp.org)

“…data supplied by the Fraser Institute, an ultraconservative PR firm that masquerades as a legitimate research institution. Dr. Robert McMurtry, the Canadian orthopedic surgeon who is a former dean of a Canadian medical school and served on the national waiting times commission tells me that not even the right wing Canadians take them seriously. Their “scientific” method of determining wait times consists of bulk-mailing a list of pro-privatization physicians and asking them how long they think their patients will have to wait to see them. If they return the mailing they are entered in a drawing to win a $2,000 cash prize. It’s pathetic. Unsurprisingly, Fraser comes up with outrageous waiting time estimates (17.8 weeks last year, as I recall), and is quite adept at publicizing them in the American media. Wait times are scientifically measured every year by Statistics Canada (the counterpart to the U.S. Census Bureau). I’m sure most Americans would be surprised at the results of scientific measurement: In 2005, median wait times were 4 weeks for elective surgery, 4 weeks for specialist care, and 3 weeks for diagnostic tests.

http://www.statcan.ca/Daily/English/060131/d060131b.htm

Also, the Canadian Health Services Research Foundation has done a short, scholarly critique of Fraser’s methods and compared them with real studies. (In fact, I think they’re far too kind to Fraser).” (Thanks, Nick!)

If you think health care is expensive now, wait until you see what it costs when it’s free.

Final bit, trot out a really stupid, non-sensical cliche. We spend nearly twice as much per capita as every other western country, and we’re supposed to worry about “what it costs when it’s free?”

Stan Alekna, Cornwall

Sorry, Stan, but that is a really lame rehashing of right-wing garbage that does not stand up to even mild critical analysis.

Christopher M. Hughes, MD

Aussie, Aussie, Aussie

Aussie, Aussie, Aussie: by Ian Morrison (author, consultant and futurist based in Menlo Park, Calif.)

“Somebody must be doing it right, we start to think. Well, actually, every system around the world is an ugly compromise among cost, quality, access and security of benefits, and almost all systems are in crisis according to the local news media. We in the United States have a bad bargain, maybe the worst: high costs, uneven quality, poor access and no security of benefits except for those over age 65.”

Nice overview of a system we rarely hear about in discussions of universal healthcare, Australia.
Now, let me conclude this post with a prayer: Australia, Australia, Australia, We Love You. Amen. Crack the tubes!

NPR : Diagnosing U.S. Health Care — and ‘Sicko,’ Too

Terrific interview with a very knowledgeable healthcare policy expert.

NPR : Diagnosing U.S. Health Care — and ‘Sicko,’ Too: “Interviews
Diagnosing U.S. Health Care — and ‘Sicko,’ Too

Fresh Air from WHYY, July 9, 2007 · Jonathan Oberlander, a political scientist with an expertise in health-care politics and policy, discusses problems with the U.S. health-care system and considers how other countries handle health care. He’ll also give us a critique of Michael Moore’s documentary Sicko. Oberlander is an associate professor at the University of North Carolina at Chapel Hill.”

Amy Ridenour’s National Center Blog: Universal Health Care: Universally Bad

I think trying to bring the most horror stories to the table is not a fruitful way to move the debate on single-payer vs. the status quo forward. Besides, the horror stories attributed to other nation’s systems are trivial compared to the stories about our own. On top of this, once you add the population based problems with our system, there really is no comparison.

I say this as a physician who has always looked favorably on single-payer after a medical school experience in England. Yes, that system had lots of problems, but nowhere near as pervasive nor unfair as our own. As the years have gone by, I have seen so many heart breaking (and infuriating!) situations with our own system, my view has gone from simply favorable to my current view: it is really not acceptable to maintain the status quo.

I am not alone. I am involved in organized medicine on the state level. When I started in 2002 in this capacity, I think the current was then 10-1 (or 2) against single payer. i think that is now perhaps 10 to 3 or 4. Now, mind you, these are leading physicians in my state. These are those who used to be very reliably against anything that smacked of single payer.

I think there are many currents that are drawing physicians along. The injustice of the system that we see every day wears us down. The waste in a system managed by not-for-profit-in-name-only insurers and the true for-profit health plans, pharmaceutical and equipment companies and on and on is unconscionable. The loss of control over the patient-physician relationship could not possibly be worse under the most draconian socialized system, let alone a simple single-payer system. The pay differential among specialists is causing strain. The cost of the system is clearly becoming unsustainable.

There are more, but you get the idea.

Cheers,

The truth about European health care. A TNR debate, Day 4

The truth about European health care. A TNR debate, Day 4: “A TNR Online Debate
Universal Health Scare
by Jonathan Cohn & David Gratzer
Only at TNR Online Post date 04.19.07 “

Part 4 of The New Republic’s Healthcare debate. Don’t forget to read the discussions!