Essay by Martha Quillen
Health Care – October 2007 – Colorado Central Magazine
SEVERAL MONTHS AGO, Colorado State Representative Tom Massey hosted a community meeting at the Salida Senior Citizens Center to get input on what local citizens want and need in a health care system. And to my surprise, it turned out that everybody attending was amenable to some sort of universal, comprehensive, government-run system that cuts out the big insurance companies.
That, of course, didn’t mean much, since the only people who showed up were reporters, local medical professionals, and people already active in health care reform.
But even Massey, a Republican, seemed open to some sort of government plan.
One of the attendees asked Massey why. “Aren’t Republicans supposed to support privatization and have faith that the market will fix things?” he asked.
“Yes,” Massey agreed, and quickly reaffirmed his belief in private enterprise and avoiding government intervention. “But in this case it’s not working.”
And that seems to be what most Americans have concluded. Despite decades of assurances that HMOs and insurance companies would bring expenses in line, medical costs and insurance rates are sky-rocketing.
Thus, health care has become a central plank in candidate platforms this season, and it’s gotten there because the stats are bleak. The U.S. now spends more money on its health care system than any other country in the world. According to the World Health Organization’s 2006 report, the U.S. spent 15.2% of its GDP (gross domestic product) on health care, which amounts to $5,711 per capita.
Whereas Germany spent 11.1% of its GDP on health care and $3,204 per capita; France spent 10.1% of its GDP and $2,981 per capita; and Spain spent 7.7% of its GDP and $1,514 per capita.
And U.S. results are not exemplary. Despite our superior spending, France, Germany, and Spain all have lower infant mortality rates and higher life expectancy rates than the United States (as do Australia, Austria, Belgium, Canada, Greece, Iceland, Israel, Italy, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and many, many other nations).
The discrepancy between what we get and what we spend is not the worst of it, though. The real horror is that Americans enjoy less equality in health care availability and accessibility than do citizens in most first-world nations — and the percentage of uninsured and underinsured in the U.S. is increasing.
A recent cover story in the New York Times featured an interview with a cancer patient whose bill (at that point) had come to hundreds of thousands of dollars. She said her husband’s insurance was excellent and had covered almost all of the costs, but she admitted that some of the treatments her doctors were considering might not be covered. The woman wasn’t worried about the potential expense, though. She said she’d just have to borrow the money from relatives if her insurance company refused to pay.
MOST AMERICANS, however, don’t have relatives with half of a million dollars to spare. And many don’t have insurance, either. In the U.S., fifteen percent of whites, 19.6% of blacks, and 31.7% of Hispanics don’t have health insurance. In Colorado, it’s estimated that about 16.9% of citizens are uninsured (which amounts to more that 770,000 people).
That percentage is a trifle higher in Colorado than in most states, but it probably isn’t worth fretting over — because the uninsured are just a small part of America’s health care problem.
We also have the uninsurable, the under-insured, and the maxed out.
And some people simultaneously loose their jobs, their insurance, and their health.
According to an article in the October 2007 Good Housekeeping magazine, the U.S. Census Bureau reports that more than 45 million Americans are uninsured; the Institute of Medicine estimates that 18,000 Americans die every year because they don’t have insurance. And according to Harvard University, in 2001 medical costs drove two million Americans into personal bankruptcy, even though 75% of them had medical insurance at the onset of their illnesses.
And to make matters worse, there’s a considerable industry developing to sell spurious insurance and collect for fraudulent charities.
Likewise, soaring costs have inspired questionable medical practices. Insurers and HMOs have instilled our health care system with marketplace values which somehow make it seem logical to limit surgical procedures, and establish treatment standards, reduce hospital stays, and shorten appointment times for financial rather than medical reasons.
And even though the U.S. has some of the best doctors and facilities in the world, our best care is not for everybody — or even for most people
In his best-selling book, How Doctors Think, Jerome Groopman inadvertently illuminates that problem. Groopman asserts that patients need to be savvy, well-educated consumers, who learn as much as possible about their conditions; seek second, third and even fourth opinions; pay attention to their qualms, and weigh their options carefully.
To illustrate his point, Groopman shares his shopping spree for hand surgery, in which he consults numerous doctors, and even jets in and out of different cities to visit several of the leading experts in the field. Those doctors, in turn, advance wholly different diagnoses and surgical procedures, which Groopman and his friend (both of them highly experienced doctors) carefully evaluate before making a decision.
Groopman contends that such careful study and evaluation can make the difference between success and failure — and even life and death — when it’s applied to medical treatment and surgery. But let’s hope he’s wrong, because the vast majority of us aren’t doctors and many of us can barely afford a first opinion. (And you can be sure that HMOs and insurance companies won’t be eager to pay for quadruple opinions plus additional consultations to evaluate those opinions).
So what are poor, medically ignorant patients supposed to do?
I HAVEN’T SEEN Michael Moore’s Sicko yet, but I’m sure it’s great — because Moore’s movies are not only controversial, they’re entertaining. Moore is a brilliant filmmaker, and he supports the sort of universal health care system I think we should look into.
But Moore’s critics have blasted him for egregiously exaggerating the caliber of the Cuban health care system. And I figure they’re right. Moore tends toward iconic, over-the-top statements and images — just like President Bush does. It’s hard to forget President Bush standing on the deck of a ship under a “Mission Accomplished” banner announcing that “Major combat operations in Iraq have ended.” And Moore is almost as memorable, baiting poor, old Charlton Heston. Or visiting a gleaming Cuban hospital and declaring that we asked for the same level of care that Cuban citizens get, and “that’s what we got.”
Who is Moore kidding? You’d have to be an idiot to think that being famous and taking a camera crew to the hospital with you wouldn’t change your treatment anywhere in this world. (I am not, however, recommending this course in lieu of insurance — unless you’re making a major motion picture, in which case it might work).
Moore isn’t an idiot, though. Nor are his foremost critics, those arch conservatives who frequently insist that everyone in the world envies and admires everything American — including our health care system. Nor are the rest of us.
But we sure do let ourselves get worked up — to the point where we seem to entirely forget the issue at hand.
Theatrics have been a part of American politics since the beginning, and they’re necessary: Candidates have got to do something to get people to the polls. But all too often theatrics eclipse conscientious analysis. And now, Michael Moore and John Stossel are squaring off for another melodramatic production. Soon, they’ll be taking their health care debate to television — to launch another furious face-off between liberal and conservative ideology.
According to Stossel, American health care has problems because “Government mandates, overregulation and a tax code that pushes employer-aid health insurance prevent the free market from performing its efficient miracles.”
SO HERE WE GO AGAIN — treated to yet another hackneyed old economics debate about public vs. private enterprises. At this point, how many of them have we heard?
And why do people keep rising up to defend free enterprise when it clearly isn’t threatened?
The whole histrionic, overstated, “good vs. evil” nature of these arguments is a crock — because everybody knows that big business and big government are equally capable of malfeasance. Yet some staunch conservatives reflexively clamor for privatization and deregulation in everything. They say they believe in smaller government and less government intervention.
But who doesn’t? Nobody wants to spend all of their money on government, or let congress decide their business. On the contrary, the major difference between liberals and conservatives is not in how much government they want; it’s in what they want to cut.
Should it be the military? CIA? DEA? Homeland Security? Bureau of Prisons? And NASA?
Or the FDA? EPA? OSHA? Forest Service? Park Service? National Endowment for the Arts? And Peace Corps?
And what exactly does deregulation mean in the health care field? Lower standards? Or less enforcement? Or no interference with industry whatsoever?
For several decades now, there’s been a concerted — and somewhat successful — effort to gut government agencies. And after Katrina, it’s pretty clear that we’ve done a fair job of destroying at least one of them.
But do conservatives really want to eliminate public service agencies like the FDA, CDC, and FEMA?
And if so, then who will we call after the next disaster? Halliburton? Oprah? France?
I suspect most Americans stand somewhere in the middle of this two-sided struggle that dominates our public discourse. But our national conversation seldom touches the middle ground. In fact, we don’t even seem to be able to focus our conversations on the problem at hand (which in this case is health care). Instead, we keep butting heads over socialism vs. capitalism, liberalism vs. conservatism, and other complex philosophical concepts that can’t be integrated or resolved.
FOR MANY AMERICANS, U.S. health care woes are more than just a political debate. And insurance isn’t our only problem.
Today, the World Health Organization warns that we’re increasingly threatened by foodborne illness due to the globalization of our food supply, which not only lets contaminated products in, but also pathogens. Likewise, travellers, refugees and immigrants are frequently exposed to unfamiliar foodborne pathogens while abroad, and then bring them home.
There are also changes in the microorganisms, themselves — with new pathogens, more virulent strains of old pathogens, and antibiotic-resistant strains developing.
WHO says foodborne diseases are a growing problem world-wide and estimates they’re up 30% in industrialized nations. And the U.S. Center for Disease Control (CDC) estimates that there are 76 million cases of foodborne illness in the U.S. resulting in 325,000 hospitalizations and 5,000 deaths a year.
And that isn’t the sum of our medical challenges. U.S. government agencies are also charged with looking for deliberate sabotage — terrorists, anthrax, dirty bombs, etc.
September was National Food Safety Education Month, and one of the things most of us could celebrate in its honor is that we made it through August without noticing all of the FDA’s recalls and safety alerts.
For August 2007, the FDA website issued warnings about Gilchrist and Soames, Dentapro, and Bright Max toothpastes (which were made in China and contained diethylene glycol); and raw oysters; numerous pet foods; packaged sandwiches; many mislabeled drugs; smoked mackerel and salmon; a frozen fish dish; pies; a contact lens solution; spinach; carrots; beverage containers made with lead; and canned herring, green beans, chili, hash and other products.
The only amusing FDA listing for August (albeit probably not particularly amusing to potential victims) was an allergy alert issued after Death by Chocolate Cookies forgot to put walnuts on an ingredient list.
But despite the FDA’s extensive warnings, in recent months toys have beaten food
in the bad news department. Currently Mattel and Fisher Price are recalling numerous products that contain lead paint. But that’s just a small part of the story.
The U.S. Consumer Product Safety Commission (CPSC) website lists hundreds of toys made by scores of different manufacturers, which have been recalled for presenting a possible choking hazard, fire hazard, laceration hazard, entanglement hazard, entrapment hazard, collapse hazard, or aspiration hazard, or possible impalement injury, head injury, explosion, or strangulation, or because they contain strong magnets (which can cause intestinal injuries if swallowed).
After a popular toy containing “aspirin-sized” rare-earth magnets caused a toddler’s death in 2005, headlines attacked that hazard. But what about all of those other recalled products? Does anyone actually read most of these recall and alert lists?
It seems unlikely. Yet some of the hazards disclosed by recent listings are appalling: Botulism. Listeria. Exploding aerosol cans. Fans, microwave ovens and coffee makers that overheat and ignite. Tools that blow up. And if the EPA really wanted to make a difference, they’d forget old mining towns and start delving into toy boxes.
I wanted to send a baby present to a new grand-niece this summer and decided on a toy because I had little notion of the kid’s size. I also decided to avoid Chinese products due to recently publicized lead problems. But I finally gave up. After looking in numerous downtown shops, then Safeway and Wal-Mart, I found that every stuffed animal I fancied was made in China, regardless of the brand (although pricier brands were hand-made in China).
And since then I’ve noticed that many food items have also started reporting that they contain ingredients from China. Although Americans got mad at pet food companies for putting dubious Chinese ingredients in their products, at this point I’d bet that a lot of homemade goodies made right here in Salida contain Chinese ingredients supplied by unidentified Chinese factories.
SO WHAT SHOULD WE DO about a health care system that neglects some Americans, bankrupts others, annoys most of us, costs all of us plenty, and yet somehow has to meet the new challenges introduced by changing technology, terrorists, and pathogens?
Conservatives urge us to trust in the marketplace. But common sense tells me that market values aren’t going to work here.
Why? Because the private sector can’t possibly reform health care — as long as its primary responsibility is to make profits. The two objectives conflict. Look at the insurance companies. They sell policies to the healthiest and wealthiest, and leave the sick and elderly for the government to deal with — because actually selling policies to people who need them most would not be good for business.
And health care isn’t like other products. Wall Street wisdom contends that if someone can’t afford something, he should do without. But if too many people do without health care, we’re all in trouble, because microbes are notorious gate crashers, sneaking into some of the most exclusive of places.
And health care doesn’t work like mousetraps. Build a better mousetrap and the world may beat a path to your door. But if you’ve got appendicitis, you’ll doubtlessly beat a path to the door of the closest guy on call.
And furthermore, it’s silly to call it “privatization” when you encourage private businesses to profiteer off of tax-supported hospitals, emergency services, research institutes, medical schools, and government assistance programs.
With hundreds of health care insurers, providers, and suppliers, America’s medical standards, facilities, costs and procedures are constantly changing and melding.
And more and more players keep joining in: HMOs, insurance companies, private clinics, consultants, and more — until it seems like we’ve made a mess of our whole system.
BUT WHAT’S BECOMING increasingly clear is that there really isn’t an American health care system. What we call our health care system is a big, amorphous mass of public and private entities that are independent, uncoordinated, and unmanaged.
So right now, we’re paying for medical research, hospitals, emergency services, government agencies, and medical assistance programs with our tax dollars. And we’re paying for private labs, physicians, insurance, pharmaceuticals, and medical equipment and services with our own dollars. And thus, not too surprisingly, Americans spend more than twice as much on health care as the Japanese.
Currently, our health care system is expensive, expansive, and overburdened. We need to make it more efficient, more affordable, more accessible, and more user-friendly. We need to find ways to keep defective products from ever making it into stores.
And we need to focus more on preventive care — on diet, exercise and lifestyle.
But in Colorado we’re already doing that, by establishing recreation programs, bike paths, walking trails, and river parks. Colorado has the thinnest population in the country, and one of the reasons may be GOCO, which provides funds for recreation facilities.
And while national news personalities natter on about nonsense, Colorado is seriously looking at four proposed health care plans, which range from a low-cost insurance program, which would more fully assist people eligible for federal programs, to a comprehensive single-state plan with full coverage for all (and a $15 fee for hospital stays) financed by a 7.5% increase in income tax and a 6% increase in payroll tax.
Until the rest of the country joins suit, however, health care costs will probably continue to spiral up, and public health improvements will be hard to get past Congress.
When I left the Senior Citizens Center, I was relieved to have met so many people who leaned toward establishing a government-run comprehensive health care plan. At this point, I don’t actually know whether a national single-payer plan, a Colorado insurance plan, or some kind of a public/private cooperative will prove to be more realistic or adoptable.
But I do know that it is way past time for us to put our differences aside and seriously discuss health care. We need to put some plans on the table — state plans, partial plans, Canadian, Japanese, and Swedish plans. We need to look at how they work. We need to study our current costs, and look at their costs. We need to try to figure out exactly why and where our costs are soaring, and how other nations fund and implement their health care systems.
But most of all, we need to scrap our stalemate, ditch our assumptions, and really look at our options — then convince Congress that we are serious about health care, and demand that they get serious in turn.
