Monday, March 22, 2010

The Burden on Society, Part 1

The healthcare system in the US sucks.

To understand why, let us review excerpts from The paradox of US healthcare by Andrew Kennis, found in Al Jazeera from November 9, 2009, interspersed with my comments.

For nearly two decades, Wendell Potter led a very comfortable life as a public relations health insurance executive.

However, while flying on a corporate jet and being served lunch on gold-rimmed china with gold-plated cutlery, Potter had an epiphany of sorts.

He realised that the reason why millions of Americans were without health insurance or under-insured was because: "Our Wall Street-driven healthcare system has created one of the most inequitable healthcare systems on the planet."

This June, Potter left his well-paid and secure job at CIGMA, one of the US's largest health insurance companies, and has spoken out in favour of healthcare reform.

'Killing thousands'

With almost 50 million people living without any health insurance and another 25 million people under-insured during a recession, the debate about how to reform the US healthcare system has been underway for many months in Washington and is expected to continue through to the end of the year.

Since leaving CIGMA Potter become a whistleblower and is now speaking out against industry abuses on national television news shows.

He does not mince words when telling Al Jazeera that if a strong "public option" is not passed by Congress, healthcare executives would be effectively allowed to continue policies that "literally kill thousands of Americans every year, through denied coverage, as a result of relentless pressure coming from Wall Street".

Americans are not dying from lack of healthcare insurance.

Americans are dying from lack of adequate medical care (among other things).

There is a difference between paying an insurance company, and getting adequate medical care when needed. However, Americans seem to have forgotten this.

It used to be that Americans had more buying power, which came from higher-paying jobs, for example, in manufacturing. These jobs have been globalized, and sent overseas. Why pay an American worker dollars an hour, when you can pay de facto slave laborers in a foreign country cents an hour? Also, as the tax system has become more and more oppressive, Americans keep less and less of the fruits of their labor.

Oh, some people might say that they actually get back everything from the IRS, or that they don't pay taxes, but this misses the point. There would be more jobs, and the jobs there are would pay more, if the government weren't sucking the life blood out of the business sector. People who don't have a job and who get a government check for not working pay the ultimate income tax, as they are denied the self-esteem (not to mention the chance to build a better tomorrow) by being locked into a government program which will never allow them to get ahead. So, they take the narcotic of a government check, and wait for their next fix.

Back in the day, if, in a family, there were two jobs being worked, it was so the family could get ahead -- maybe buy a vacation home, or send a kid to college. Now, it is not uncommon for both a husband and a wife to be working, just to keep the family's collective head above water. A situation where the two people work three jobs between them is hardly rare. And, difficult indeed is the situation for a family with only one adult working -- say, a working mom supporting a child.

When people had more money, they paid doctors, nurses and some receptionists/administrators directly -- low overhead. Now, though, there are big buildings full of insurance company bureaucrats and administrators, all of whom need a cubicle to sit at, a computer to work on -- oh, and health care insurance! -- which gets paid for by our healthcare dollars. On top of that, the government has other such buildings, and dollars that could go to pay for medical care has to pay for all these guys, too.

That is why Americans are...

Paying more, getting less

About 50 million Americans are without health insurance. In the meantime, the US continues to be the country with the highest proportion of uninsured people in the developed world. It also has the distinction of spending a greater portion of its total economic output on healthcare than any other developed country - just over 17 per cent of its gross domestic product (GDP) last year.

On average, the US spends twice as much as other developed countries on healthcare.

But even though US citizens pay more for healthcare, they get less of it, resulting in a lowly 37th place ranking among healthcare systems in the world, according to a study by the World Health Organization based on quality and fairness.

What the socialists in Washington are giving us is more of the problem: more bureaucrats, more administrators, more insurance... most emphatically not more doctors and nurses.

The Al Jazeera article goes on to extol the benefits of socialized medicine.

The fact of the matter is that this is everything that was wrong with the Soviet Union, this is everything that is still wrong with Cuba....

Wait until the problem gets worse, and they begin to....

But wait, wait! I cannot divulge what the future holds.

Let us instead consider the past:

The NHS cannot, and never has been able to, offer every treatment to everyone who needs it.

The NHS is funded from taxes, and it spends more than £42bn every year - £779 for every person in the UK. But it is not a bottomless pit of funds and some treatments have to be restricted.

Raising taxes to pay for every possible need is politically unthinkable, as it would require a massive increase in income tax to raise enough revenue to make a significant difference to spending.

This means some treatments have to be restricted, or rationed.

Rationed healthcare?

But of course!

The healthcare climate in the United Kingdom is insular. It lives in a storm zone of its own creation: the National Health Service. Everything revolves around the myth of the NHS. In politics, openly expressed doubts about its absolute and eternal validity will cast a politician into outer darkness. Even the Thatcher government—the most radical in the UK since the Attlee government of 1945-50 which set up the NHS—had to struggle desperately to prove to an incredulous electorate in the 1980s that 'The NHS is safe in our hands'. Belief in a myth will permit the faithful to discount reality. That is not being flippant. The rationing climate in the UK is tied to the myth of the NHS, its inviolability, and its ultimate sanctity in the eyes of the people and of health experts alike. The myth dictates that rationing is worth enduring if it will help to keep the NHS virginally 'intact'. Of course, everybody knows that the NHS is underfunded and that rationing is therefore inevitable. All that is required of the experts is that they should tell us how to ration health care fairly and effectively.

Rationing healthcare fairly and effectively means deciding who lives, and who dies.

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