Archive for the ‘Health’ Category

Setting the Record Straight: More from our Canadian Cousins

Written by Robert Justin Lipkin on August 28th, 2009

Listen to some more. Finally, Canadians are fighting the slanderous characterizations of the Canadian health care system by U.S. insurance companies and other ideologues. As stated, medical care is a human right, not an economic product to be evaluated simply in terms of the bottom line.  We, Americans, would do well to heed the advice of out northern cousins.  But we also need more help from Canada in setting the record straight about its own system and pointing out the systematic attempt on the part of those Americans opposing health insurance reform to distort, obscure, and simply lie about the Canadian system.  Click here for more.

Health Care: Canada v. the United States

Written by Robert Justin Lipkin on August 28th, 2009

From the Canadian Medical Association Journal

August 24, 2009

America, embrace health care reform

If power, wealth and talent alone determined how a nation serves the needs of its people, the United States would be second to none in health care. Yet America’s health care system clearly ranks behind those of Canada and most other developed countries. The precious opportunity that US President Barack Obama’s health care reform proposals offer to Americans is currently threatened by partisan disunity, which could once again deny Americans the quality and accessibility of health care that they should receive.

Canada’s “socialist” health system is the favourite whipping boy of antireform lobbyists, who employ fear-mongering and myths about rationing, waiting lists and lack of choice to persuade the American public to accept their status quo as better. As Canadians, we agree that Canada’s health system is not perfect. We have said so many times in CMAJ. Nevertheless, it takes only a few comparisons to show how much better Canada’s health system is than that of the United States — and how much Americans could hope to gain from embracing reform.

Consider the following statistics, taken from the Organisation for Economic Co-operation and Development’s health data for 2006.1 We start with the most basic outcomes any health care system is supposed to optimize: life and death. The life expectancy of an average American is nearly three years shorter than that of an average Canadian (78.1 vs. 80.7 years). That survival gap starts from the moment of birth: infant mortality is higher in the US than in Canada (6.7 vs. 5.0 deaths per thousand live births). Yet the US economy spends — or increasingly, borrows — more than half again as much for health care as does Canada’s (16% vs. 10.1% of the economy). And despite spending so much more, Americans get to see their doctors a third less often than Canadians (3.8 vs. 5.8 doctor visits a year).

While these differences result from many factors, the inescapable truth is that, compared to Canada, America is achieving poor value for money from its health care system, and that is killing Americans. The potency of that truth is the reason why antireform lobbyists are now turning to attack Canada’s system.

As Republican strategist Dr. Frank Luntz puts it, the opposition’s strategy rests on “health care denial horror stories from Canada.”2 Yet the attacks are so absurd and full of fantasy that they would be laughable — if not for the fact that many Americans believe them. Canadians do not, in fact, conduct euthanasia on our elderly; If we did, then Canadian life expectancy would hardly be longer than American.  There is no such thing as a “death panel,” neither in Canada’s health care system, nor President Obama’s reform proposal.  Nor is it true that in Canada, the system imposes a government bureaucrat between a patient and their doctor to decide what care to provide.  On the contrary, that is a routine feature in America’s system, where doctors and patients struggle endlessly with insurance company “bureaucrats” for payment.

The only accusation that has even a shred of evidence, albeit heavily misrepresented, is that Canadians face waiting lists for health care.  But that does not mean Canadians routinely die waiting for tests and operations, because the lists are for elective procedures, such as joint replacement surgery, and not for emergency or life-saving care.  Prioritizing actually helps ensure the serious cases are seen first.

We cannot condemn strongly enough the intellectual dishonesty of the lobbyists and politicians whose distortions of Canada’s health system camouflage their appalling rejection of reform for uninsured and underinsured Americans. All 32 million Canadians are insured. To be sure, some are unhappy to wait and some are denied treatments it would be better they had; no system is perfect or pleases everyone.  But even the least fortunate Canadian is better off than the 47 million uninsured Americans, for whom no treatments are covered and for whom the wait is forever, unless they can afford to pay the health care bills.

If America wants to improve its citizens’ health — as it must — then some negative attitudes need to be turned around.  Here are some.

First, the US$1 trillion that the Obama administration says it will cost to cover America’s uninsured over 10 years is not a burden; per capita, it is a screaming bargain. Canada spends about US$156 billion each year to cover fewer people than America’s uninsured. For Congress to hesitate at the outlay is penny-wise and pound foolish, when economic studies suggest that the cost of not investing could be greater still, owing to lost productivity and lost jobs, provided that expanded coverage goes hand-in-hand with cost-containment measures.3,4 Still, when Congress last year dropped US$700 billion at a sitting to bail out Wall Street, it is hard to understand why a lesser amount for public health insurance provokes so much anxiety.

Second, all health care systems ration care — including the US system. The only cruelty in rationing health care comes in doing it the wrong way. When America’s private insurers routinely refuse to cover persons having pre-existing health conditions, that is the worst kind of rationing, aimed mercilessly at those who need medical care most. In Canada, nobody is denied coverage for pre-existing conditions, and there is no cut-off age. Instead, Canada aims to ration medically futile treatments. Where we occasionally make mistakes is in rationing new treatments that in hindsight prove to be useful, not futile. In Canada’s deferential culture, we correct such mistakes slowly by pressuring the public insurer. In America’s litigious culture, suing the public insurer is likely to correct such mistakes more rapidly. That difference, we believe, is likely to make rationing fairer in American than Canadian hands.

Third, certain members of Congress need to get over the bogeyman of “socialist” medicine. Thinking about the military may help. All of America’s closest NATO allies, including those, like Canada, who fight alongside the US in Afghanistan, receive “socialist” medicine back home. Furthermore, when Americans join the military, they qualify for public, government-run health insurance that provides access to care at Veterans Administration hospitals. When Texas Republican Congressman Louie Gohmert described Canadian health care as “a bureaucratic, socialistic piece of crap,”5 was he also implying that America’s soldiers are getting bureaucratic, crappy care?

Fourth, freedom-loving Americans who value making their own medical and economic choices ought to be outraged at how the status quo restricts their choice and freedoms. Because private insurance plans are usually provided through one’s employer, changing jobs often means losing existing coverage and having to re-qualify for new coverage (if one can) under a new plan — a risky move.  Private insurance has become the freedom-destroying leash that ties Americans and their families to jobs with less pay or satisfaction than other opportunities that might exist. Canadians, in contrast, can change jobs in our universal, portable public system and stay insured throughout.

Fifth, and perhaps most importantly, America has reached an economic tipping point where the “public option” is inevitable, if only because households (read: voters) find the current system’s costs unsustainable. Canada’s first meaningful foray into public insurance happened in 1940s Saskatchewan, when public anger boiled over as health bills forced families — including many in the middle class — into bankruptcy. That same tragedy is replaying in America, where more than half of personal bankruptcies are medically related.6 This number will only worsen as health costs rise in America, as the population ages and as the US dollar loses ground as a reserve currency. Even if Congress and President Obama fail to achieve a public insurance option this year, in the long term the smart money is against any political party whose name becomes attached to these personal medical bankruptcies.

If Americans find the courage to embrace change, they could enjoy health care that is second to none. Canada’s example has many positive lessons — and a few negative ones — to teach reformers. Lamentably, in the current partisan circus playing out on Capitol Hill, analysis is short and sophistry of the Louie Gohmert variety is long. America must move beyond this if it ever hopes to be able to provide the best care for all its people.

Amir Attaran LLB DPhil
Associate Editor, Editorials

Matthew B. Stanbrook MD PhD
Deputy Editor, Scientific

Paul Hébert MD MHSc
With the Editorial-Writing Team (Ken Flegel MDCM MSc, Noni MacDonald MD MSc and Laura Eggertson BA)

Cite as CMAJ 2009. DOI:10.1503/cmaj.09-1511


The Cause of His Life

Written by Rebecca Zietlow on August 27th, 2009

Ted Kennedy is gone.  Now is the time for Congress to enact meaningful health care reform, including a public option, as a tribute totmpphpN2Ylkc[1] the “Lion of the Senate.”  Last year, Senator Kennedy referred to health care reform as “the cause of my life.”  This was no exaggeration.  Kennedy ran on the issue of affordable health care in 1962, in his first run for the Senate.  Kennedy was instrumental in the passage of Medicare and Medicaid programs, both controversial programs that faced considerable Republican opposition at the time which have now become highly popular.  In 1980, in his famous “the dream will never die” speech at the Democratic National Convention, Kennedy announced that he would “continue to stand for national health insurance” because “the state of a family’s health should never depend on a family’s wealth.”  There would be no better tribute to a man who gave over 45 years of his life to championing the cause of the poor, the middle class and the disenfranchised, than for Congress to enact health care reform in Ted Kennedy’s name.

There is precedent for enacting major human rights legislation to honor a fallen senatorial comrade.  In 1875, Kennedy’s Bay State predecessor, the great anti-slavery advocate Senator Charles Sumner, lay on his death bed as he pleaded with his Senate colleagues to “enact my civil rights bill.”  Sumner’s colleagues in Congress responded by enacting the 1875 Civil Rights Act as a tribute to his lifelong battle against slavery and on behalf of civil rights.  The 1875 Act prohibited race discrimination in privately owned places of public accommodation.  (Historical note: The Supreme Court struck the 1875 Act down, necessitating the 1964 Civil Rights Act (which also passed with Ted Kennedy’s support)).

Like Sumner, Ted Kennedy worried about his life’s cause while on his death bed. From home, he continued to advocate for health care reform with his staff and colleagues. The week before he died, Kennedy repeated his request to the Massachusetts legislature to authorize the governor to appoint his successor instead of waiting until a special election filled his spot. Ted Kennedy knew that every vote would count in the Senate battle for health care reform.

So, members of Congress, it is up to you to realize Senator Ted Kennedy’s lifelong dream.  He deserves it, and so do we.

President Obama’s Mysterious Strategy

Written by Robert Justin Lipkin on August 21st, 2009

Try, as I may, it’s difficult figuring out President Obama’s approach to the health care battle. He continues to praise Senator Grassley’s attTelevangelists Financesempt at “bipartisanship” when the “good” Senator keeps making outrageous remarks suggesting otherwise.  The latest in a round of comments is his suggestion (requirement?) that health care reform should receive at least 80 votes in the Senate.  Thank about it. That’s 20 Republicans. Name one certain Republican vote. What’s going on? Does the President watch television? Has he heard Grassley’s “death panel” remarks? Is there a secret agreement between the President and the Senator that Grassley will make negative comments designed to assure his reelection, but vote for the bill anyway? That’s not a likely strategy for his reelection or the bill. So just what is going go? Supporters of the public option need to know. Please Mr. President talk to us. The point is President Obama introduced the idea of a public option to many of us, explained its importance in significantly reducing costs, and arguing for its effectiveness in offering Americans a choice. He, above anyone else, cannot be the one to waver or capitulate. Mr. President you must come out forcefully for the public option now. Your transformative, defining moment as a president is at your door step.  Take the step boldly.

Hank Chambers’ “President Obama and Health Care in Four Acts” for the Pulitizer Prize in Political Drama

Written by Robert Justin Lipkin on August 20th, 2009

I am hoping, beyond hope perhaps, that my co-blogger, Hank Chambers, is right about how President Obama’s health care plan will play out. Among other important elements, President Obama must keep his original promise to include a public option which, among other things, is necessary to contain costs. Bravo, Hank. Author!

Is it Too Late for Obama to Come to His Senses?

Written by Robert Justin Lipkin on August 18th, 2009

A health care plan without a public option will cover more people–as any plan should–but will do nothing to control the costs of health.  PretmpphpzYSHJ4[1]sident Obama warned against the exploding health care costs and promised to include a public option in any plan he signed, but now seems ready to break that promise also. I continue to admire the new president. But admiration won’t suffice any longer. Broken promises about matter as critical, critical in general, but more importantly, critical according to the President, are unacceptable. I don’t understand his strategy and expect and encourage a progressive rebellion. It’s just unfathomable why when controlling the government, even with the problem of conservative Democrats, the President should not insist on the public option, the only effective means of controlling costs, costs that will continue to cripple the economy. Who is advising the President and what are the reasons for capitulating to the Republicans and the so-called “Blue Dog Democrats”? I implore the President to rethink this issue and be prepared to fight for a public option in September. The alternative is too ill-defined with no obvious reason to believe in its efficacy. Please Mr. President heed the wise advice of Senators Rockefeller and Feingold and fight for the public option.

Please Mr. President: Keep your Word this Time!

Written by Robert Justin Lipkin on August 17th, 2009

I have never been as enthusiastic in supporting a president ever before in my life. I admire President Obama as tmpphpHLJ4VN[1]a man and as a president.  He is intelligent, knowledgeable, affable, and possesses a magnetic personality. If he lacks anything, it’s fortitude. The president has promised the American people “that creating a nonprofit, government-sponsored insurance plan — competing alongside private insurers — would provide a lower-cost alternative for consumers and keep the industry ‘”honest.'” I believed this promise and independently believe the public option, though it does have defaults, is essential to significant health insurance reform. Please, Mr. Present, do not renege on this promise. Fortunately or not, wisely or not, you must fear President George H. W. Bush’s “read my lips.” Reconsider and fight for the public option.

The Fight for Obama Care (is lost?)

Written by Robert Justin Lipkin on August 17th, 2009

My favorite president needs to better execute two strategies if his health care plan is to avoid crashing and burning: (1) He must take time to explain and defend the health care solutions in his “plan” AmtmpphpOLJntC[1]ericans care most about and explain the misinformation about them simply and crisply.  For example, (a) President Obama needs to explain why Americans will be able to choose their physicians. He says we will, but his critics deny it.  Who’s right?  President Obama needs to explain, or (b) How will they be able to keep their current health insurance. He says, we will, but his critics deny it. Who’s right?  President Obama needs to explain. (2) Mr. nice guy must also take a crash course in arm twisting Democrats, especially the so-called “Blue Dog” democrats like Senator Conrad. He must explain that reaping the advantages of being part of the majority party has certain responsibilities, one of which must be backing the leader of the Party’s most pressing domestic program. The gloves must come off now. Word has it that President Obama once said he’s ready to accept that passing adequate health reform might cost him a second term.  That’s admirable and a profile in courage that he and his supporters should be prepared to accept. Finally, the public option stands between a real health care plan and the semblance of one. The clock is ticking and Mr. Obama must awake from his natural, polite slumbers and be ready to engage in honest battle to achieve the most important goal of his presidency.

Wishful thinking. Sunday night, the New York Times reported that the White House is ready to drop the public option. For many of us that means at best a cosmetic bill.  Even with a public option, the bill was milk toast, but Mr. Obama doesn’t have the fortitude to fight for even that. This choice means the American people lose, but it also means Mr. Obama loses any chance of becoming a “transformative” president. He will be, at best, just another politician.  The disappointment in this betrayal is incalculable.

Thomas Jefferson Got the Health Care Crisis Right

Written by Robert Justin Lipkin on August 14th, 2009

Ultimately, Wall Street is at the bottom of our health care reform problems. Insurance companies are corporations that must nurture the bottom line at any cost to American citizens who as patients must rely of the good will of insurantmpphpmz0YNh[1]ce companies.  These companies have little, if any, of that particular commodity. Since the bottom line is shareholder profits, not patient care, insurance companies must deny a variety of claims in order to secure the appropriate–the sky’s the limit of appropriateness–level of profits.  Some insurance practices, regarding individual policies, for example, will surreptitiously renew policies every six months in order to maximize the chances that they will be in a position to deny a claim due to “pre-existing conditions.” Other practices include refusing to insure patients, fine print qualification that can be deadly, caps on lifetime support for patients, discriminating on the basis of gender, and a host of other devices that benefit corporations not patients.  Thomas Jefferson predicted as much.  Consider his words: “I hope we shall crush in its birth the aristocracy of our moneyed corporations [including health care insurance companies I hope] which dare already to challenge our government to a trial of strength and bid defiance the laws our country.”   –Thomas Jefferson, November 12, 1816. Prescient, as if our third president were writing today. What will we do it about this most egegious injustice?

The New Thuggery in the Health Care Debate

Written by Robert Justin Lipkin on August 13th, 2009

Word has it that orchestrated groups of Americans fill Town halls not to discuss, not even passionately to discuss, the Obama health care bill, but to prevent discussing it. Is it wrong to oppose health care in a democratic society? Obviously not! Is it wrong to oppose discussing health care reform? No! But it is wrong to engage in conduct that prevents others from civilly discussing such reform.  Opposition to civil discussion in a democratic society is anti-democratic pure and simple.  Who is to blame? The culprits are those who are orchestrating the specific goal of engaging in obstructionist tactics that prevents these town hall meetings from being an exchange of views on health care and those who feed them distortions and lies about the health care bills. Who are these undemocratic folks? I don’t know for sure, but whoever stands aside and fails to condemn such barbarism are equally as undemocratic as those who engage in the orchestration in the first place.

Two culprits can be identified: Newt Gingrich and Charles Grassley. While acknowledging that none of the five congressional btmpphpUhE7OF[1]ills contains an end of life “death panel” requirement, former speaker Newt Gingrich warned that “[c]ommunal standards historically is [sic] a very dangerous concept.” Presumably, he means that though the death panel language is not in the bill, its application through communal standards could in the future construct such a provision.  After all, “You are asking us to trust turning power over to the government, when there are clearly people in American who believe in establishing euthanasia, including selective standards.” Well, I suppose so, but something similar is true of every single provision in every law ever passed in the United States. Those same people can introduce euthanasia into our present Medicare system.  To reject legislation because it must be applied through communal standards is simply to reject democracy outright.  If the community makes such an egregious mistake, then we’ll all band together legislatively to fix it by explicitly rejecting such applications. If we cannot do so because the majority embraces such communal standards, then we’re stuck just as we are in every case where the majority has abuse a piece of legislation. Fear of abuse cannot be reason for endorsing what otherwise is a perfectly respectable piece of legislation without abandoning democracy entirely.  And even in this case, our job as democrats, small “d,” is through politics to become a new majority and eliminate the heinous provision. Gingrich should know better.  Either he does, but is duplicitous, or he doesn’t and needs to rethink his quite unsupportable position. Chuck Grassley’s misconduct is much simpler. He simply lied about whether such a provision is in the bill, and should apologize to his constituents for doing so. Indeed, The Senate should censure Senator Grassley and my favorite president should retract the favorable remarks he made earlier this week about this duplicitous “deather.”