Thursday, January 19, 2006

A US Free Market Based Health Care System- Time to Admit This Cruel US Experiment has Abysmally Failed

My 4th cause for our moribund health care system (see once more my January 3 Blog on the etiology of the crisis) was the US’ peculiar obsession with only free markets as the basis for our health care system. In retrospect I was sorry that I used the word “peculiar”- rather I should have used the word “cruel”.

Instead of expounding exhaustively on this topic I believe that what my blog partner and co-editor, Cervantes, posted on this blog on Jan 12 entitled Lost in Space pretty much summarizes my own view. Cervantes wrote this essay a while back with a physician colleague Anthony Schlaff. The basic summary of this essay was that 1) there is no truly free market in health care nor should there be 2) A free market approach to health care blatantly ignores the reality that universal health care coverage serves the public good over the few who are wealthy. (“we don’t trade in human flesh”) 3) The current proposals put forth by the White House and the majority Republican party leaders in Congress are like Health Savings Accounts (HSAs) and free market “competition” approaches to Medicare Benefit expansions (like the new Drug benefit) are real-time failing now or doomed to fail.

There are many fine values-based experts who have written on this topic. Among my favorites is Noam Chomsky perhaps the US’ greatest living intellectual. In a recent interview posted on January 14th of this year on Chomsky in simple language says this “…..say for example health care. Probably the major domestic problem for people. A large majority of the population is in favor of a national health care system of some kind. And that's been true for a long time. But whenever that comes up -- it's occasionally mentioned in the press -- it's called politically impossible, or "lacking political support," which is a way of saying that the insurance industry doesn't want it, the pharmaceutical corporations don't want it, and so on. Okay, so a large majority of the population wants it, but who cares about them? Well, Democrats are the same. Clinton came up with some cockamamie scheme which was so complicated you couldn't figure it out, and it collapsed.” (I, Blake, would add perhaps not as complicated as the recently implemented new Drug benefit under Medicare)
Chomsky goes on to say “Kerry in the last election, the last debate in the election, October 28 I think it was, the debate was supposed to be on domestic issues. And the New York Times had a good report of it the next day. They pointed out, correctly, that Kerry never brought up any possible government involvement in the health system because it "lacks political support." It's their way of saying, and Kerry's way of understanding, that political support means support from the wealthy and the powerful. Well, that doesn't have to be what the Democrats are. You can imagine an opposition party that's based on popular interests and concerns”

Let me recommend another extremely important piece written by Malcolm Gladwell of the New Yorker Magazine on August 29th of this year entitled “The Moral-Hazard Myth- The bad idea behind our failed health-care system”. In this piece, Gladwell explains the concept of moral hazard (an Insurance Industry term) and how this pervasive concept is intellectually and itself morally bankrupt. Critical Care readers –you need to understand this counter-intuitive concept of moral-hazard in order to understand how the Republicans are trying, once more, to redistribute health and wealth to the rich. Gladwell tells us that six-times in the past century, beginning during the First World War, efforts have been made to introduce some kind of universal health insurance and six times we as a nation have failed. Gladwell calls this one of the greatest mysteries of political life in the United States? I attribute it to the immaturity of a 230 year old country which took the good concept of free enterprise in business and made a huge and cruel error of applying it to Health Care which, as Cervantes says, ignores the public good of a healthy US citizenry. We all must act now to stop the very life threatening hemorrhaging of our fatally wounded US Health Care system lest we are forced to administer last rites.

PS- BREAKING NEWS- Upcoming Presidential State of the Union Address will primarily deal with Health Care-

Readers and fellow Americans
- Watch your wallet!
- Watch your souls!


Blogger Cervantes said...

Hey Blake, this is indeed timely with the SOTU focusing on Bush's plans to further trash our health care system. Here's an excellent report by our friends Alan Sager and Deborah Socolar at BU, which explains exactly why the Republican health care agenda is heading in exactly the wrong direction.

8:31 AM  
Blogger Blake said...

great partner!- How do we get this excellent report you linked us to on the eyeballs of congress, their staffers or better yet "we the people" Be Well :)

10:18 AM  
Anonymous Shel Samuels said...

If the superficiality of Chomsky makes him great, then there are a lot of 'greats' walking around. And you docs are too close to the blood and gore to be able to see the forest [and your leaders too deaf to hear the trees falling.] The key political - and most substantive issue - has never been whether or not we should have a "national health care system", WE ALREADY HAVE SEVERAL ALL TAX SUBSIDIZED DIRECTLY OR INDIRECTLY, but how to dismantle the existing structures and replace them with new or within existing efficient comprehensive systems. This is the key logistic problem on which the original Clinton effort failed, and which the new drug program falls apart.
From about 1940 to 1980 we had the skeleton of a fair system in the National Blue Cross network. That fell apart when major local blues refused to endorse effective national administrative/governance standards. Since then, many have tried to either merge with the commercials or go commercial themselves. The original system [in Texas!] was controlled by local docs, local hospitals, local employers, and the unions [who founded them!] The self-perpetuating, insulated nature of their corporate boards allowed deterioration in governance from which no blue has recovered. [I am a witness, since I was a member of the first and last National Blue Cross Advisory Board]. That's part of the logistical issue.
There are other parts, such as getting ALL private and public employers and unions out of the insurance business, and to negotiate a uniform delivery plan much like that of the Swedish or German systems [which work well], where everyone is covered [no cherry picking], everyone pays premiums deducted like income tax, incorporates workers comp healthcare, Medicare/Medicaid, eliminates the co doc system, with tripartite independent governance [labor, management and government] industry-by-industry and region-by-region functioning through community-owned hospitals and clinics that incorporate group and specialty practices competing for patient choice. Practice standards should be set by the IOM & administrative/governance standards by the existing hospital accreditation system. Would eliminate about 1/3 the cost of health care just through litigation reduction, paper work and drug choice savings [Have you ever tracked the multiple billing for a 15 minute consultation by multiple personnel & organizations and insurers?]
And let's stop yakking about the [poorly defined] uninsured. In a state like Maryland, for example, uninsured = not enrolled in an insurance plan and paying premiums. Not just the poor and indigent. The deadbeats, too! Not the same in Tennessee or Florida. Here hospitals are all nonprofit community owned and treat everyone, albeit sometimes ineffectively. In my county, the uninsured see my doctor who the hospital requires to help man the 'emergency' room. He's top notch! And the hospital is top notch and associated with a regional network for specialized care and treatment. Thus everyone insured by our community and the state, as well as by private insurance or union pension plans.
We need to mandate the merger and restructuring of the boards of BC/BS and the union-owned companies. Channel ALL local, state and federal employees into that system and automatically enroll everyone else in a phased buildup.
The primary obstacle to reform has historically centered around people with conflicts of interest like the Frists operating primarily through the US Chamber of Commerce. And that really boils down to the commercial insurance companies and their local agents and employees. They [about 750, 000] would lose their jobs. It would be cost effective to put them all on pension at full pay, rather than to perpetuate the current stupidity!
Shel Samuels

4:01 PM  
Blogger stoney13 said...

How very true! But what can we expect when King George's "Uncle Dan's family happens to own a vast amount5 of stock in one of the country's leading drug manufacturer's!

The medical marijauna case is more proof that the drug makers are the real force behind health care in the United States! GWB has tried every dirty trick in the book to do away with the very notion! Fortunatly, he's failed in four out of five attempts. I watched my mother die of bone cancer. I don't have to tell you what it was like, you're a doctor and you already know!

I sent a letter off to my state Senator Jesse Helms at the time, asking for support for medical marijauna and a bill that would let doctors perscribe pain medication in doses high enough to offset the pain of cancer. What I got back was a form letter explaining how my mother (83 years of age at the time, lifetime tetotaler, Methodist, and Republican), was suffering because she made "reckless lifestyle choices which led to her condition" I haven't been able to look at a Republican since without having disturbing thoughts concerning high-caliber firearms!

6:47 PM  
Blogger Blake said...

Hey Stoney13- Thanks for joining us on Critical Condition. Sorry about your Mom. But my guess is that she would be proud of your activism. Yep- Big Pharma is surely a power to be reckoned with-a formally good industry gone "completely sour"(or worse evil) But so is Big Insurance Industry in cahoots with the devil-Be Well- :)

7:11 AM  

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