STOP ALL THE B.S. AND GIVE AMERICANS HEALTH CARE

I have been listening to politicians extol the virtues of providing affordable health care for everyone for at least the last 30 years and we still are no closer to getting it passed today even with a democratic majority in the house and the senate AND with a democratic president TOO BOOT!! why is it?

-is it because the republicans are in control?--NO

- is it because most major businesses are against it?--NO, ask most any CEO what their fastest rising cost of doing business is and most assuredly it will be health care related

- is it because most Americans oppose some type of universal health coverage?-NO, most polls point to the overwhelming majority of Americans supporting universal coverage

-is it because all such attempts by other countries have proven that universal health care is impossible and not practical?--NO, just a few of the examples: Australia, Belgium, Canada, Brazil, Cuba, China, Costa Rica, Denmark, Finland, France Germany Greece, Iceland, Ireland, Israel, Italy, Japan United Kingdom Saudi Arabia, Spain, Sweden, South Korea, to name a few

-is it because most people in universal health care systems do not like the care, the wait times, the lack of choice, the lack of good quality care? NO- NO- NO- NO--THE REASON, THE ONLY REASON THAT WE STILL CANNOT PASS HEALTH CARE FOR ALL- IS THAT WE HAVE WEAK KNEED, SPINELESS, GUTLESS, AND SELF SERVING FAT ASSED, WELL FED, SUPERBLY INSURED POLITICIANS THAT CARE MORE ABOUT BEING RE ELECTED.

for a fantastic write up that gets down to the nitty-gritty of all the BS, please visit this site and be prepared to be pissed that others around the world are enjoying full coverage and enjoying it without having to sell the kids and mortgage the farm:

Are Patients in Universal Healthcare Countries Less Satisfied?

Let's start with the Health Affairs article Toward Higher-Performance Health Systems: Adults' Health Care Experiences In Seven Countries, 2007[1], a survey on healthcare experiences in the US, versus the universal healthcare systems in the UK, the Netherlands, Germany, Australia, New Zealand and Canada. These systems are highly varied, and I hope to write about their benefits and drawbacks in the next few days. But briefly,

1. the US is a non-universal patchwork of public and private spending, drugs and procedures may be subsidized by insurance

2. the UK is completely single-payer with private care as an option, all drugs and procedures are paid for

3. Canada is single-payer with provinces deciding how health care is spent and strict limits on private care, prescription drugs are heavily subsidized,

4. Australia has a public baseline access to physicians with subsidization of private insurance and option of private care, prescription drugs are heavily subsidized,

5. New Zealand has universal public health care, primary care and prescription drugs are subsidized with some cost sharing, and private care is an option

6. the Netherlands has a system of obligatory private health insurance (like a nationwide Massachusetts system), premiums have a flat rate for all citizens, with subsidies for poorer people who can't afford insurance premiums. Individuals pay for about half, and employers pay for about half, with government making up the difference.

7. Germany has a system of mandatory insurance with purchase of access to one of several hundred "sickness funds" paid for by employers, there is a private option for those who afford it, and those who cannot or are unemployed are subsidized by government.

Each of these systems is very complex, most are a mixture of public and private hospitals, and public and private insurance. Universal health insurance, it should be clear does not mean we have to have a single-payer system like Canada, or like Britain as the anti-reform ads would suggest.

In their first figure, this table is a comparison of the per-capita costs of the different healthcare systems.

Note the United States spends more per capita than any other system and not by a small amount. We spend almost twice as much as the next nearest spender, Canada, and this without covering all of our citizens. We also spend more of our GDP than any other country, almost twice as much as any other country. Note, most other countries have a high percentage of patients enrolled with electronic medical records, a system that makes sharing of information between facilities (currently a major cause of redundancy in expenses) more efficient. Note also that universal doesn't require primary care providers be the gatekeepers. Other systems exist that allow self-referral to specialists.

The Commonwealth Fund, which sponsored this study, has a figure in one of their online chartbooks of health data that summarizes how we spend nicely.

The entire presentation is fascinating and worth a look if you have time. Almost universally we pay more for less. We pay more per capita for fewer hospital beds, we pay more per capita for fewer ICU beds, and pay more for ICU stays despite patients staying for fewer days, we have far fewer long term stay facilities, we spend more on fewer practicing physicians per capita, and for all that we perform worse in indices of mortality, and control of chronic disease.

But are people happy with these systems? Not surprisingly, no one is ever really happy with their healthcare:

Almost all systems have a high number of citizens who think it needs significant changes, although only the US system has a 34% rate of people desiring it to be completely rebuilt, almost twice that of any other country. For the most part, the belief that their medical systems will provide high-quality, expert care, is similar across these countries. This table addresses another critic complaint though. What about wait times? Some countries do have a clear problem with elective wait times for surgery. Canada and the UK are the worst in this regard, but several universal systems have wait times that appear to rival or surpass those in the US. Worse, US citizens complain more of access problems than any other country, with 37% of respondents forgoing care, not seeing the doctor or filling prescription because of issues of cost

Now, on the issue of access, despite claims to the contrary, in most of these systems access to a doctor is rapid, with appointments available in the same day:

In fact, aside from Canada, we were least likely to be able to get an appointment on the same day, and most places could provide access to a doctor in an ER faster than in the US. So is access really worse in universal systems? It would appear that in most universal systems, doctors in clinics and the ER are more available than in the US.

The remainder of the data compares perceived quality of care, and coordination of care between primary care and specialists, and for the most part, the systems are equivalent according to the subjective experience of those surveyed. In the US, there were more complaints about expense of prescription medications, and poor coordination of care - I suspect due to poor penetrance of the electronic medical record.

So, after seeing some data on more than the few horror stories from health systems around the world, are you convinced that universal systems will mean longer wait times? Poorer care? More expensive care? I believe the data suggests more people around the world in these systems experience less of these problems than those of us in the US. We spend more, almost twice as much as any other country. Despite that, our wait times for physicians are worse, we pay far more out of pocket for prescriptions and copays than any other system, we spend more on administration of health care than any other country, we have more people who avoid seeing the doctor for fear of costs, and we are more likely to say we want our system scrapped. In anupdate to this analysis [2] the Commonwealth fund found that in deaths which were amenable to health care interventions the US performed worse than the other 18 industrialized countries to which it was compared. If we performed as well as one of the top three countries, we would eliminate about 100,000 excess deaths a year. Which is the real horror story?

The plural of anecdote is anecdotes, not data, so don't believe the horror stories, look at the total experience in these systems to find a better approximation of the truth.

SOOOOO, LETS REVIEW. We're not happy with what we have, we can't afford what we have-either as individuals or as a nation, something like 46 million are not covered at all and several million of us are barely covered for the bare minimum, we spend countless hours waiting in waiting rooms, can't afford our medications, can't stand our ppo's, hmo's, etc, are told that this or that procedure is not covered, for many uninsured the only access for health care is the emergency rooms which for a simple cut finger(happened to someone i know) cost him a cool $2,300-of which he did not pay as he had no money and on and on and on. AND YET WE ACCEPT EVERYTHING WE ARE TOLD BY THE RIGHT AND PASSIVELY SHUFFLE OFF TO OUR NEXT APPOINTMENT.