Friday, March 15, 2013

The Evils of Socialized Medicine... would be seen as an improvement in the US

Aaron Carroll over at The Incidental Economist takes a look at the data on the British National Health Care system and notices the story the media is missing (Burying the lede when talking about the NHS):
So the UK enjoys a great health service but not great health, a puzzle that the conference participants never fully tackled. One who tried was Liam Donaldson, the former chief medical officer. “I think it strains credibility to say we have a world class service,” he said in response to Osborn’s presentation. “I don’t think it is.”
When I first read that, I thought that the NHS must be making tradeoffs. The system is dirt cheap. They’re kicking butt in access. It’s not surprising that quality might suffer. But then I got to thinking. They’re “second worst” now in terms of amenable mortality? Who’s the worst?
NHS story
This kind of stuff drives me a little crazy. I have no idea if anyone in the US will cover this story. If they do, however, I bet it will be along the lines of the title. Sure, the UK does well in terms of access, but their outcomes are terrible. Do you want that to happen here? 
What will be missed is the fact that the outcomes are, perhaps, terrible, but they are worse here. So “would I want that to happen here”? If you mean that we could spend less than half of what we do on health care, see access improve massively, and see our outcomes go from worst to second worst? I could live with that.
For the record, using 2010 data, the UK would have moved up a spot. The US would still be last.
The US health care system is in shambles.  It is probably the most inefficient health system in the industrialized world.  But the challenge is there are massive amounts of excess profits being made at your expense.   Its called rent seeking and the majority of professionals within the the US health care system are guilty of it in some form or fashion.

Who has been spending the most money lobbying politicians to capture as much profit through bending the rules to their wishes?  Why the health care industry!  Pharma/Healthcare/HMO, the total lobby dollars spent between 1998 and 2012 was $5.3 billion

For those who like to fixate on the deficit health care costs is the culprit and a major role in why costs are so high is that there is so much excess profits going to 1%'ers within the health care industry.

The solution to long term fiscal issues the US faces are solely about health care costs.

The Center for Economic and Policy Research has a really cool Health Care Budget Deficit Calculator so you can see what would happen to our long term fiscal outlook if our health care costs were in line with other industrialized nations who have found ways to provide higher quality care much cheaper cost.

Sadly the media is covering Health Care "reform" plans such as Paul Ryan's as ways to save money when in fact that are ineficitent ways to increase the cost of Government provided health care via forcing people into less efficient private health care providers; not to mention throwing large numbers of those currently able to tap in to medicaid out in the cold..  Remember my point above about rent seeking?  Yeah, the Ayn Rand acolyte Paul Ryan is a huge champion of wasting tax payer dollars with the single goal of handing it to private sector businessmen for profits.  Dean Baker and David Rosnick talk about this in a paper they wrote last year (Representative Ryan’s Trillion Medicare Waste Tax)
“The Ryan plan does nothing to control private-sector waste in health care costs,” said David Rosnick, an author of the report.  “As a result of the waste in the private system, beneficiaries will end up paying substantially more for Medicare, in effect paying a hefty new tax on their health care.” 
The report, “Representative Ryan’s $30 Trillion Medicare Waste Tax,” documents the potential effects of replacing Medicare with a system of vouchers or premium supports and raising the age of eligibility from 65 to 67 as suggested in the Ryan plan
Keep in mind the conservative efforts to defund ObamaCare and not pass expansion of Mediciad in Republican controlled states is quite litterally a death warrent on Americans.

Richard Kirsch wrote a good post a few days ago over at the Next New Deal about the thousands of Americans Paul Ryan and his Republican friends are proposing be killed Paul Ryan’s Budget Would Kill Health Insurance Programs – and Thousands of Americans:
I have trouble with putting policy glosses on proposals that would deny health care coverage to millions of people and make care much more expensive to millions more. Because when more people lack health coverage, more people die. And when health costs prevent people from getting the care they need, they get more seriously ill.
How many people are we talking about? Estimates of the number of people who will die because they are uninsured vary, from about 500 to 1,000 for every one million who lack coverage. Repealing Obamacare would block promised coverage for 32 million people, so that would mean somewhere from 16,000 to 32,000 each year who will die prematurely. Of course, since some Republican governors and legislatures are not implementing the expansion of Medicaid coverage in their states, some of those deaths are already on their hands.
Which leads us to the Ryan plan for slashing Medicaid. He replaces a program that now entitles low-income people to health coverage with a block grant to states to spend however they want on health care for the poor. The federal government would save money by decreasing what it pays to state governments and states would get to do the dirty work of cutting people’s health care. That will mean fewer people on the program, higher out-of-pocket costs, or a reduction in coverage of medically necessary care. And more people dying who would have lived if they had kept their previous health coverage.
In cutting Medicaid, Ryan is fulfilling the biggest concern that Republican governors say they have when they consider expanding Medicaid under Obamacare. A typical remark came from Arizona Governor Jan Brewer: “As I weighed this decision, I was troubled by the possibility that a future President and Congress may take steps to reduce federal matching rates, leaving states with a greater and greater share of health costs over time.”
Everyone is familiar by now with Ryan’s proposal to replace Medicare with vouchers to buy private insurance. The Ryan voucher plan is not about controlling health care costs; instead, it is intended to shift costs from the federal government to the seniors and the disabled who are covered by Medicare. When people can’t afford the care they need – and the CBO reported that the first Ryan voucher plan would have doubled the already high cost of health care to seniors – they will get sicker.
The parts of Obamacare that Ryan doesn’t repeal underscore his cynicism. Ryan would keep the $716 billion in Medicare spending reductions over a decade, which he railed against when he was running for vice president. In his debate with Joe Biden, Ryan called the Medicare changes a “piggybank” for Obamacare, which would cause hospitals and nursing homes to close and lead to seniors losing benefits. None of this is true, as Biden pointed out. So now Ryan is using that $716 billion in savings to help him reach his goal of balancing the federal budget instead of what those savings were intended for: increasing Medicare benefits under Obamacare and expanding coverage to millions of Americans.
Remarkably, Ryan also keeps the other tax increases in Obamacare, some $1 trillion raised mostly from upper income taxpayers and various medical providers and insurers. Ryan is using money raised to provide life-saving health coverage to millions of people, taxes he and other Republicans railed against, to meet his fantasy target of balancing the budget in 10 years.
I’ve grown tired of providing a veneer of respectability to people in power – people with good health insurance, coverage that provides them with access to the best medical care, and pays most of their bills – who deny their constituents a basic human right. Governors and state legislatures who won’t expand Medicaid even though the federal government will pay virtually all of the cost. Members of Congress whose health coverage is largely paid for by their constituents who still make political hay by demagoging against Obamacare.
Fortunately for those whose lives are at risk, the Ryan budget is dead on arrival. But the debate about how to make the promise of Obamacare real is only just the beginning. States will continue to debate whether to expand Medicaid. And when Obamacare’s major provisions kick-in next January, there will be a new round of debates about whether families can afford the new coverage and whether employers and government should do more or less to assure that people get covered. What will not end is the real consequences in each of those decisions for people’s lives. 
Its sad that conservatives have taken to trying to de-fund and destroy the health reform ideas that conservatives came up, rallied behind, and tried to implement for a number of years.  It wasn't until that radically sane neoliberal conservative Barrack Obama got his hands on their plan and actually got it passed that they decided killing Americans  was far more important than any intellectual integrity they might have for their old pet projects (RIP RomneyCare).

By the by if you are looking to learn more about the nuts and bolts of the Affordable Care Act and the history behind its origins you should check out Inside National Health Reform (California/Milbank Books on Health and the Public) which sits, well used, and quite close to my desk, in the study upstairs.

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