How the American Healthcare System Is Broken

The healthcare system in the U.S. is broken in dozens of fundamental ways. Over dinner last night, a friend said: “We have the best healthcare in the world with the worst delivery system in the world.” More accurate words could hardly be spoken.

Another way in which the system is fundamentally broken is the way defensive medicine adds billions of dollars to the cost everyone pays in increased insurance premiums and tax dollars.

I thought I’d share a personal story on this subject that happened to me not too long ago.

I have what is called Cystic Acne. I’ve had it since my early 20s. I don’t get many pimples, but every few years I get a Sebaceous Cyst. These are large, unsightly and usually painful boil-like pimples that will harden into a large nodule.

Two things can be done about these. One is antibiotics, which sometimes helps. But in my personal experience, I’ve never had success. The other way to treat these is to lance them and drain them, and on occasion, cut out the infected tissue.

Now treating a cyst like this is something that until relatively recently was done by your general practitioner. The process is quite straightforward and technically speaking, is well within the capabilities of any first-year resident, much less someone who’s completed residency.  I’ve had these removed by a GP before and it’s about a 15 minute process.

I hadn’t had one of these in almost 20 years, so I was amazed when I went to my excellent GP and was told yes, it was a cyst, but no, she couldn’t treat it. Apparently the medical board and her malpractice insurance insist that anything more complicated than a fever be treated by a specialist. That office visit was $50.

My next stop was at the dermatologist, who looked, remarked that it was a cyst and a rather large one at that, but then shook his head and said he couldn’t treat it either, because it was someplace he thought yet another specialist was better qualified for, due to the regulations and malpractice insurance requirements. That visit was billed at $200.

My next stop was the “specialist.” Yet again I was told that my observation was 100% correct. HE could treat the thing. the consultation was $350, the fee to do the 15-minute procedure was $900.

So the end result was that I completely wasted my time, and wasted the time of two specialists who could have been treating people with far more complicated and serious medical conditions, and paid $1500 for a procedure that my GP could have performed effortlessly for perhaps $200 at most.

Fortunately, I have rather good insurance and the out-of-pocket expense was minimal. But I didn’t get away without paying for the entirety of that procedure, and if you have Blue Cross, neither did you.  I didn’t pay it all up front, and you won’t either. What will happen is that this situation will be played out thousands and thousands of times and for each one of those, the cost of insurance premiums will rise. Since 1999 employer-based plans have had their premiums rise by 120%, compared to an average 44% cumulative rate of inflation.

Medical costs aren’t magically “absorbed.” Whether it’s my $1500 cyst or the $800 emergency room visit by an uninsured person with the flu complications, someone has to pay, and that someone is you and me.

So there is my story. And I personally want to thank each and every one of my friends opposed to serious reform of the system for paying their share of the $1,500 cyst removal that should have cost $200.  Get used to it, it won’t change unless the system itself gets an enema.

Healthcare Hysteria Part Deux

My friend Jay G and I have got into a rather heated discussion on the comments section of his blog over healthcare, and in particular, about his assertion that the left in general and the Democrats in particular are inciting violence at town hall meetings being held by congresspersons this month on healthcare reform. His case rests upon this article, in which Whitehouse staffers Jim Messina and David Axelrod told Democrat Senators and their staff members: “If you get hit, we will punch back twice as hard.”

Of course this single quote leaves out the context of the quote:

Senior White House adviser David Axelrod and deputy chief of staff Jim Messina told senators to focus on the insured and how they would benefit from “consumer protections” in the overhaul, such as ending the practice of denying insurance based on preexisting conditions and ensuring the continuity of coverage between jobs.

They showed video clips of the confrontational town halls that have dominated the media coverage, and told senators to do more prep work than usual for their public meetings by making sure their own supporters turn out, senators and aides said.

And they screened TV ads and reviewed the various campaigns by critics of the Democratic plan.

“If you get hit, we will punch back twice as hard,” Messina said, according to an official who attended the meeting.

First, I just think Jay is flat wrong in his interpretation of the article in question. It seems crystal clear to me, that White House Deputy Chief of Staff Jim Messina, who was speaking to Democrat Senators about strategy, was referring to political tactics, not violence. That is, unless you think he was suggesting that U.S. senators punch out protestors at their town hall meetings, an assertion that’s frankly silly in my opinion.

I said later that in my opinion, the protestors are, by and large, being manipulated and organized by very well paid lobbyists and front groups for the GOP and people with vested financial interests in the outcome of the debate over healthcare reform. Jay asked for verification of this and I’m happy to provide a couple of examples:

First, lets start with an organization called FreedomWorks.  This organization’s Board of Directors is a veritable who’s who of GOP insiders including Dick Armey, Jack Kemp and C. Boyden Gray, Legal Counsel to GHW Bush from 1981 to 1993.

In addition to being a fairly thinly veiled front organization for the GOP, Armey went from congress and his position as HUD director directly to one of the most high-powered law firms in the world called DLA Piper, which has a “strategic alliance” with the lobbying firm, The Cohen Group.The Cohen Group is a giant lobbying firm.

FreedomWorks boasts that: “This past week, FreedomWorks helped to organize “Taxpayer Tea Party” protests around the country, in the wake of Rick Santelli’s (CNBC) call for a “Chicago Tea Party” to protest the ridiculous economic policies of President Barack Obama. These protests were a huge success around the country! Thousands of Americans showed up and made their voices heard.”

To call FreedomWorks a legitimate bottom up grassroots organization is simply a joke. It’s a paid subsidiary of the GOP.

Another organization is called Conservatives for Patients Rights. This organization, which calls for people to go to town hall meetings and has a convenient list of all the scheduled town hall meetings, acts as though it’s another grassroots organization. It is anything but.

What the website doesn’t tell you is that the head of this organization is none other than Rick Scott, owner and co-founder of Solantic, a Florida based large chain of walk-in urgent care facilities. Scott also has the dubious distinction of:

Scott founded the Columbia Hospital Corporation in 1987 and later merged Columbia/HCA along with the brother of Senator Bill FristThomas J. Frist in 1989, but was ousted by the company’s board of directors in 1997 in the midst of the nation’s biggest health care fraud scandal in which the company ultimately plead guilty to the nation’s then largest Medicaid and Medicare fraud and paid a record fine of $1.7 Billion dollars.

Nope, no vested interest in the topic here at all. And of course it’s purely coincidental that Scott is joined by disgraced former Bush administration Administrator of Medicare, Thomas Scully, who left office under a cloud after he was found by a Bush Administration internal investigation of threatening to fire a Medicare auditor who was about to go to congress with the actual cost of the Bushie’s medicare prescription drug plan. A plan that was so botched on the part of the GOP and their willing Democrat co-conspirators that it amounts to a welfare program for pharmaceutical companies.  Scully is now on the board of directors of Solantic.  If that’s who you want to ally yourself with, fine. But know who you’re sleeping with.

I don’t doubt that many Americans are unhappy with the Obama administration. After all, forty some-odd percent of the people voted for McCain. I also don’t doubt that in a time of serious economic uncertainty, that people are afraid.  Fear is easy to manipulate. And right-wing big business has been doing an excellent job of this stuff for decades. It happened in 1993, helped in large measure by a hapless effort on the part of the Clintons at heealthcare reform.

I also don’t doubt that the Democrats plans are flawed. They aren’t even discussing serious malpractice reform, which is an absolute requirement for reducing the ruinous inflation of healthcare costs in this country.

But there is no way in Hell that a loud, disruptive appreaance at town hall meetings, shouting down your representatives and screaming insanity is a good way to approach it. That’s exactly what the lobbyists and the healthcare industry wants you to do. They want to scare the living bejeesus out the American public so they can continue to make a killing without any sort of regulation.  They don’t have anyone’s interests at heart except their own.

I’ve said repeatedly that I would dearly love to see the GOP take part in a serious debate on this issue. But they haven’t and they aren’t now. Only yesterday I was able to see the first signs of anything serious in the way of policy proposals from the right, which was an article in the Washington Post by conservative columnist Charles Krauthammer, where he advocated for the elimination of civil malpractice.  Good for him, let’s see more serious proposals.

But the teabagger movement and the folks showing up at town halls hysterical over commie programs and forced euthanasia are nothing more than useful idiots for moneyed interests who are very adept at manipulting people’s fears.  You’re being lied to folks, by the same people who’ve been selling you snake oil for 20 years.  The Democrats truly suck as a party. But what’s coming out of the GOP and their corporate sponsors is pure baloney. And worst of all, it’s baloney paid for with corrupt money.

Healthcare Hysteria

Unless you’ve been living in a cave these last few weeks, you cannot have failed to hear about the hysteria from many on the right about the proposed healthcare reform bills circulating around congress.

Now normally I’m all for confronting your elected officials about policies with which you’re unhappy .  I still think that’s a good thing. But confrontation and mob hysteria are two entirely different things, especially when the hysteria has been fed by highly paid political operatives from the GOP and slick campaigns of blatant lies by people with a vested financial interest in the status quo.

Rachel Maddow has done an excellent job recently exposing this fraud.  Whatever you may think of her politics, she has the facts straight. Before you head out to your congressperson’s next town hall meeting with a pocket full of outrage, be sure to watch this segment. It’s a microcosm of the fraud being perpetrated by vested interests to stop any and all progress on healthcare reform.

I’d love to see the right get actively involved in a real debate on the issues with some concrete ideas that would seriously address the issues of why we pay 175% of what Canada pays for healthcare, have a life expectancy that’s 3.8% less than Canada’s, have a death rate that’s 8.4% higher than Canada’s and a system of health insurance and malpractice that’s literally putting American companies out of business.

What’s been proposed by the GOP has been so close to nothing as to be meaningless. It’s been at best a rehash of the McCain campaign’s proposals, which, in case you missed it, didn’t win the election. One reason for that is that the proposals he put forth, including taxing health benefits paid to employees, are non-starters.

I’ve recently been hearing Obama’s plans to reform healthcare compared to the Soviet Union.  It’s funny, but the friends I have in Canda, Australia, Holland and other places with some form of government assisted or administered healthcare don’t seem to think they live in the Evil Empire.  In fact, most of them are pretty pleased with the quality of their healthcare. Which is certainly more than I can say for most people I know in this country.

The Democrats really need serious input from people with alternative views. But mob hysteria and “NO” is not serious input. It’s plain old obstruction.

Don’t cut taxes, fix healthcare

I’ve written before that Reaganomics didn’t work in the 1980s, as demonstrated by the tripling of the national debt during Reagan’s administration and the serious recession which resulted.

The one economic policy Reagan got right was to lower confiscatory tax rates. But that was well over 20 years ago. Americans at or near the top have not been over-taxed in nearly a generation. In fact the only group which is over-taxed in this country are those in the middle. That is, people making under $200,000 a year or so.

This group gets socked with federal income tax, state income tax, property tax, gas tax, sales tax, excise tax etc. It has received little in tax relief under Republican administrations which seem to be married to the concept of “trickle-down” economics. Or as George Bush the Elder put it: “Voodoo Economics.”

Trickle down works (to an extent) when tax rates at the top are confiscatory, as they were in 1980, when the top marginal rate hovered around 70%. (I must add that no rich person ever paid anything like this rate because of massive tax loopholes and shelters which existed at the time).

But the Bush tax cuts have done nothing whatever to “stimulate” the economy. Nor have the two bribes in the form of stimulus checks, beyond the very short term.

If nothing else results from this latest economic crisis, I hope that the lasting lesson is that tax cuts are not a magic formula for economic growth. You cannot reduce revenue while increasing spending. If you really want to stimulate the economy, you make sure tax rates are not so high that they ACTUALLY discourage investment, while making sure your spending matches revenue and addresses actual needs of the people, not miscellaneous subsidies to the Defense Department, agri-business, giant corporations and the like.

An idea for actually stimulating the economy? Fix healthcare.

Ask any small business owner: They cannot afford ever-increasing insurance premiums. Either implement something like Mitt Romney’s Massachusetts plan or something akin to Canada’s. (Canada pays about 1/2 of what we do and provides vastly better care for the majority of it’s people. Anyone saying otherwise is either ignorant or a liar).

Free up small business’ money; not with tax cuts but with business expense cuts in the form of health insurance premiums for their employees. In the end, it’s a lot more money into the pockets of everyone, because it allows small business, which employs 85% of Americans, to expand and grow.

We’re already paying double what the Canadians pay. So the idea that this would mean massive tax increases is frankly a fraud. It’s a matter of making what are now voluntary payments into mandatory ones, and distributing those costs evenly across the spectrum. We could provide substantially better care than we provide now, at less cost, and cover everyone. This isn’t rocket science, it’s healthcare company lobbying and ideology bereft of intellectual honesty that’s kept it form happening to date.

Americans must learn to think beyond the ends of their noses. Growth and prosperity don’t come from above. They come from below. And short-term growth for some at the expense of long term economic health for the many is a bad trade-off.

American large business and the wealthy are not over-taxed. Quite the opposite. Trickle down wish-thinking and tax cuts for the sake of tax cuts was a lousy policy in the 1980s and it’s a lousy policy now.