This explosive BBC documentary, unlike anything you’ll see on American MSM, shows how bad the healthcare situation is in America. You’ll see a charity originally set up to deliver healthcare to third world countries, drawing hundreds of clients in Kentucky. The clip effectively shows the enormous chasm between rich and poor in America. You’ll see rich Republicans who think our system is the greatest in the world, and who are fighting to keep the status quo. The political situation is spelled out as well. The last segment interviews a woman who is getting chemotherapy while living in a tent – she had to choose between rent or medicine.

Several thoughts (feel free to add your own):

We used to have a functioning media in this country that would take risks and report on this kind of thing. Now it distracts, silences, and shapes public opinion, instead of being challenging or revealing. While never perfect, who the media is supposed to serve has changed over time.

The victims in this documentary – the ones too poor for health insurance – come from states that usually vote for those whose policies overwhelmingly ensure the perpetuation of their victimhood. How these people were bamboozled into voting against their own best interests is explained in Thomas Frank’s What’s the Matter With Kansas?

Maha wrote earlier about the delusions of the very wealthy. The healthcare situation in this country is a symptom of the same. At some point, all of us choose to shut out the plight of others from our awareness, and we come up with rationalizations for this act – liberals to a lesser extent, conservatives to a greater extent. So much of the political battle is consumed by efforts to cut through defenses of this sort. Keeping explosive documentaries such as this out of the public eye is hugely strategic, because an angry public won’t put up with excuses. Documentaries like this, that have the potential to foment public anger, torpedo all the defenses.

There is a spiritual dimension to this that all contemporary writers and documentaries show or talk around, but which can never seem to directly discuss. It’s as though we don’t have the language for it, or we’re not permitted to directly speak about it – which by itself silently screams obscenities against our culture. We simply feel the moral outrage that some deep spiritual laws are being violated. But without a common language to articulate and address this outrage, this energy is stymied from changing anything. It’s the result of conservative efforts to trivialize and confine spirituality to personal matters, such as who you’re having sex with, blastocytes, and so on, and to keep spirituality away from anything that would seriously challenge the conservative worldview.

Part 2 is here.
Part 3 is here. You’ll want to watch all three.

Link to the original BBC program is here, but viewers outside the UK can’t see it.

h/t to nyceve

The Los Angeles Times is beginning a three-part series on the health insurance mess. Part one, “An eroding model for health insurance,” discusses people who were dumped by their insurers for minor, treatable illnesses.

This is, of course, a problem that righties say does not exist. Maybe the LA Times is just making stuff up.

Update on my physical therapy issues — my physical therapy doctor says he will tell Empire Blue Cross that my leg came off, so I need a few more physical therapy sessions. We go through this dance all the time, he said. Of course, Empire Blue Cross will argue, “she can hop.”

Recently I was diagnosed as having sciatica, a.k.a. a “slipped disc” in the spine, a common ailment that (they tell me) ought to be fixable. The orthopedic guy who diagnosed me prescribed physical therapy, three times a week for a month. Yesterday I got a letter from Empire Blue Cross saying they were overruling the doctor. I need only two weeks of physical therapy, they said.

I’ve had one week of therapy already, and I am doubtful just one more week is going to fix me, but I guess I can continue to do most of the exercises by myself. As medical aggravations go, this is hardly a tragedy. But this is the way life is for most of us. If you aren’t wealthy, the medical treatment you receive is what your insurance provider, not your doctor, decides you should have.

And that’s if you are lucky enough to have insurance. At least I could go to a doctor and get a diagnosis, and now I have some idea of what I need to do to take care of myself.

One of the most persistent myths on the Right is that health care is too expensive because we are indulging ourselves with too much of it. The persistently stupid Jeff Jacoby writes in today’s Boston Globe,

With health benefits tax-free if they were employer-supplied, tens of millions of Americans were soon signing up for medical insurance through work. As tax rates rose, so did the incentive to keep expanding health benefits. No longer was medical insurance reserved for major expenditures like surgery or hospitalization. Americans who would never think of using auto insurance to cover tune-ups and oil changes grew accustomed to having their medical insurer pay for yearly physicals, prescriptions, and other routine expenses.

We thus ended up with a healthcare system in which the vast majority of bills are covered by a third party. With someone else picking up the tab, Americans got used to consuming medical care without regard to price or value. After all, if it was covered by insurance, why not go to the emergency room for a simple sore throat? Why not get the name-brand drug instead of a generic?

I think righties must be blessed with unusually good health, since clearly they’ve never had to deal with health insurance.

First off, although it may be different in Massachusetts, many years ago insurance companies stopped paying for emergency room visits if they decide after the diagnosis that the medical problem wasn’t an emergency. Although exactly why anyone with insurance would choose to an emergency room for a non-emergency eludes me.

But what happens if you think it’s really an emergency? Is the sudden chest pain a heart attack, or heartburn? If you pick A and go to the emergency room, it turns out to be B, you just ran up a several thousand dollar medical bill that the insurer won’t pay. If you pick B and it turns out to be A, you could die. Coin flip?

Same thing with generic versus name-brand drugs. Most insurers simply will not pay for the name brand if a generic is available. The consumer has no choice.

Also, in New York a “routine” office visit is somewhere in the $100-200 range, and even “generic” prescriptions can cost over $100 a month. Lots of people on limited and fixed incomes will not spend that kind of money just because. They’ll wait until they are really sick. But a lack of preventive care is one of the factors driving up health care costs.

When patients think someone else is paying most of their healthcare costs, they feel little pressure to learn what those costs actually are – and providers feel little pressure to compete on price.

Jacoby has no clue how the system works. Health providers aren’t pressured by consumers to compete on price. They are pressured by the insurance companies to compete on price. Then insurance companies compete with each other to provide the lowest costs to employers. So the company that puts together a network of cheap doctors can offer a better price to the employer, but in my experience the employer doesn’t give a bleep whether the doctors know a spine from a sock. Quality is optional.

De-linking medical insurance from employment is the key to reforming healthcare in the United States. McCain proposes to accomplish that by taking the tax deduction away from employers and giving it to employees. With a $5,000 refundable healthcare tax credit, Americans would have a strong inducement to buy their own, more affordable, insurance, rather than relying on their employer’s plan.

Unfortunately, since the actual cost of a year’s worth of health insurance is a hell of a lot more than $5,000, only very well-paid employees will be able to use the credit. And, of course, if you have a pre-existing condition, in most states you can kiss off buying insurance at any price.

BTW, after the elections I may be asking for donations so I can pay for accupuncture. I figure it’s worth a try. I’d like to be able to take walks again.

Update: Jacoby’s email address (published in the Boston Globe) is [email protected].

Paul Krugman assesses the chances that maybe, someday, the United States will join the rest of the First World and provide universal health care for its citizens.

What’s easy about guaranteed health care for all? For one thing, we know that it’s economically feasible: every wealthy country except the United States already has some form of guaranteed health care. The hazards Americans treat as facts of life — the risk of losing your insurance, the risk that you won’t be able to afford necessary care, the chance that you’ll be financially ruined by medical costs — would be considered unthinkable in any other advanced nation.

Most Americans don’t know that these risks would be considered unthinkable in any other advanced nation. As soon as one says “guaranteed health care” in the U.S., someone will say, oh, you mean like in Canada? As if that were the only other nation on earth that provides for health care for its citizens. Occasionally someone will bring up the British system, which has serious problems because for many years the British government has underfunded it.

But in the American public consciousness, the national health care systems of 30 other industrialized nations — most of which provide excellent care, without waiting lists for procedures, at a lower per-capita cost that in the U.S. — do not exist.

I agree with Krugman that if we could get a true national health care system in place that would provide care for all citizens and eliminate the risk of financial ruin, Americans would love it. It would, like Social Security and Medicare, be beyond the reach of the Right to take it apart no matter how hard they try.

That, of course, is what the Right fears.

Krugman points to three hurdles to getting any kind of program in place.

1. Democrats, who have made health care reform the center of the 2008 platform, have to control the White House and Congress.
2. Reformers would have to overcome the public’s fear of change.
3. Once in control of the White House and Congress, the Dems would have to keep their focus and not be distracted by the many other issues screaming for their attention after 8 years of grotesque mismanagement of the government.

Prairie Weather has another one: “Smugness, greed, and ignorance will pull together, forming an army which will fight viciously to keep things just as they are. ”

Ironically, given the “fear of change” issue, McCain’s “health care plan” would change the current system more than Obama’s. This is according to Jonathan Oberlander, a professor of health politics and policy at the University of North Carolina at Chapel Hill. Julie Rovner reports for NPR:

Of the two candidates, McCain is arguably the one whose plan would change the health system the most. Right now, if you get insurance from your employer, you don’t pay taxes on the value of that benefit.

[As alert reader k pointed out, this is not true. My understanding is that the McCain plan would eliminate tax incentives that employers get for offering health benefits to employees. Meaning that most of ’em would drop health benefits. The ideal, in McCainLand, is to shove everyone into one big private market system, which would leave even more people uninsured than there are now. — maha]

But if you have to buy your own insurance and you’re not self-employed, you don’t get any tax help. McCain would change that: He’d make employer-provided insurance taxable, but then give everyone a tax credit.

“Our proposal is to give every family in America a $5,000 refundable tax credit, and they take that tax credit and that money — a refundable tax credit — to go across state lines, to go any place in America, and go online, and pick out the insurance policy they want,” McCain said.

There are lots of questions about McCain’s plan. How hard will it be for people who are already sick to buy insurance? Will people really be able to find policies they can afford when the average family policy now costs more than $13,000? And does the public really want to move away from a system in which employers provide most people’s health insurance to one where most people buy their own?

I still don’t think the “crossing state lines” thing is going to work. There are differences in cost of policies from one state to another, but those costs vary in part according to cost of running a medical practice — more expensive in some states than in others, if only because overall cost of living varies — and how easy or difficult it is in that state for insurance companies to dump “customers” who actually get sick.

McCain’s plan no doubt would cause many employers to dump health benefits for their employees. I think this is something people need to be told. They also need to understand that McCain is making no provision for people with pre-existing conditions or health risk factors to be able to purchase private insurance. I believe his plan would cause millions more Americans to become uninsured and cut off from all but third-world level health care.

My problem with Obama’s plan is that it doesn’t go far enough, and could end up being not much more than a tweak of the current system. If he’s elected, I hope Congress pushes him to go further than what he’s proposed so far.

A big reason right-wingers are better at getting elected than they are at governing once they get elected is that they can’t get facts straight. This is from the Wall Street Journal:

New Jersey is about the last place one might think to look for free-market policy reform. But this week Jay Webber, a Republican Assemblyman in Trenton, will introduce legislation to let Garden State residents buy low-cost health insurance from any registered policy in any of the 50 states.

I have major questions about how this would actually work if put into practice, especially for HMO policies that only pay for in-network care. But I’ll put that aside for now.

The average national cost for a family health plan is $5,799, according to America’s Health Insurance Plans, but in New Jersey that same plan costs $10,398 on average. The state’s politicians have driven up these costs by forcing insurers to provide gold-plated coverage – even for such voluntary medical services as in vitro fertilization.

I did not know this about New Jersey, so I looked it up. Under what’s called the “Family Building Act” passed in 2001, insurance policies that cover more than 50 people and provide pregnancy-related benefits are required to cover the cost of the diagnosis and treatment of infertility. I believe that means it would not apply to private health insurance, only to group health insurance. Even with the group insurance IVF may be covered in some circumstances, but only after the beneficiary has jumped through a number of hoops.

New Jersey also follows New York and Massachusetts – two other high-cost states – in requiring so-called “guaranteed issue.” That allows New Jersey residents to avoid buying health insurance until they get sick, which means they can avoid paying premiums until they need someone to pick up the bill.

As a purchaser of private health insurance in New York, I assure you one cannot wait until getting sick to purchase insurance and expect the insurance company to pay for treatment. If you acquire a new policy while already being treated for a medical condition, you’re on your own to pay for those treatments for several months before the insurer is required to take over payments.

“Guaranteed issue” means an applicant, whether an employer or an individual, cannot be turned down for insurance. According to the Kaisar Family Foundation,

Federal law (and all states) requires all plans sold to small groups (employers with 2-50 employees) to be guaranteed issue. That means small employers cannot be turned down by insurance companies because somebody in the group is sick. Small employers might be ineligible to buy coverage from private insurance companies for other reasons. For example, insurers might have requirements that small employers contribute a minimum percentage of the premium payment on behalf of employees, or that a minimum percentage of a small firms employees participate in the health plan. Federal law does not require guaranteed issue for self-employed persons (with no other employees). However, states can and often do apply broader guaranteed issue requirements. Health insurance sold on a guaranteed issue basis cannot turn applicants down based on health or risk status.

According to this Kaisar Foundation chart, neither New York nor New Jersey have “guaranteed issue” requirements for the self-employed purchasing individual insurance. My experience in New York is that if you apply for a private policy within a certain amount of time of losing another policy, such as COBRA benefits — I think it’s one month — the private policy must accept your application no matter what health problems you have. However, my understanding is that if you have been uninsured for several months and apply for a private policy, you can be turned down.

Back to the Wall Street Journal:

This one-policy-fits-all system tends to cause the young and healthy to drop insurance, which only raises the cost of insurance for the sick, which in turn makes coverage unaffordable for ever more families. It’s no accident that about 1.2 million people – one of every eight residents – is uninsured in the state.

But guess who’s Number One in the percentage of uninsured citizens? Good ol’ free-market Texas, m’loves. Based on the three-year average from 2004 to 2006, Texas had an uninsured population rate of 24 percent. That’s, like, about twice as bad as New Jersey, right?

The New Jersey uninsured rate is only shocking until you compare it to the other states’ uninsured rates.

Wall Street Journal:

Opponents of interstate insurance say families would be pushed into bare-bones health plans. Not so. Families could still buy the more extensive coverage, but those with modest incomes would have options other than going uninsured. The goal of public policy shouldn’t be to cover every medical procedure or doctor’s visit, but to prevent families from catastrophic expenses due to a health problem that is no fault of their own.

In other words, they’d be pushed into a bare-bones health plan that doesn’t cover routine and preventive care, just major medical expenses.

New Jersey is turning into a microcosm of the national debate on health care. Democrats in Trenton are rallying behind a plan to require that every uninsured individual in New Jersey purchase health insurance from a new state-administered program. So a state that is already so broke that its politicians are contemplating mortgaging its highways might now add a $1.7 billion health subsidy.

What the Wall Street Journal is saying, without admitting it, is that states can’t get to the root causes of the crisis and create substantive solutions on their own. National policy is required. Further, if “market based” solutions worked, they would have done so already. What we’ve got now are a mess of state and federal policies created to patch those parts of the ‘free market” system that had already failed.

But I still don’t understand how purchasing insurance across state lines worked. If you buy into a network in another state, wouldn’t you have to choose a Primary Care Physician in that state? Meaning you’d have to travel to that state for medical care? While you’re sick? I don’t think so.

Massachusetts instituted what’s called a universal health care program — about 340,000 of Massachusetts’ estimated 600,000 uninsured have gained coverage, — and now supply is no longer adequate to meet demand. Kevin Sack writes in today’s New York Times —

Once they discover that she is Dr. Kate, the supplicants line up to approach at dinner parties and ballet recitals. Surely, they suggest to Dr. Katherine J. Atkinson, a family physician here, she might find a way to move them up her lengthy waiting list for new patients.

Those fortunate enough to make it soon learn they face another long wait: Dr. Atkinson’s next opening for a physical is not until early May — of 2009.

A 13-month line for a physical? But the wingnuts tell us only Canadians have to wait in line!

In pockets of the United States, rural and urban, a confluence of market and medical forces has been widening the gap between the supply of primary care physicians and the demand for their services. Modest pay, medical school debt, an aging population and the prevalence of chronic disease have each played a role.

This is something I’ve written about before. The fact is that “market forces” have skewed the way health care is delivered in this country away from basic services like preventive care and emergency rooms. That’s because the real money is in providing boutique medical care products and services for those with means to pay for it. About a year ago, I wrote,

Basically, our health care system is good at delivering difficult and expensive stuff but blows at simple, ordinary stuff, like preventive care, compared to other nations. This means we save some lives that might have been lost in Europe, but we also lose lives that would have been saved in Europe.

How did this come to pass? Certainly we Americans value creation and innovation. But it’s also the fact that our private, profit-based health care system is very good at creating new health care products that will make a lot of money. But where there’s no chance of profit, forget it.

This is what the “magic of the marketplace” has given us. You know how markets work; where there’s a demand, someone will hustle to provide a supply, and competition encourages the creation of better products at lower cost. Our system is very good at creating new drugs and new technologies and then marketing them to hospitals, physicians, and even potential patients. And I’m not saying this is a scam; many of us have benefited from the drugs and gizmos. The problem is that some parts of the health care process just don’t make any money. And where it isn’t profitable, our system is falling apart. …

… Here’s what the “free market” people never seem to wrap their heads around: Unprofitable demands do not generate supply, even when those demands are desperately needed.

Put another way, not everything that’s worth having can generate enough profit to pay for itself. …

… By now “market forces” have so skewed our health care delivery system that, even if we began to allocate our health care dollars according to need rather than profit, it would take years before the neglected parts of our system were built back up to where they should be.

Every now and then there will be a news story about our shameful infant mortality rates or our less-than-stellar life expectancy rates or that emergency rooms are closing or the number of hospital beds per capita is shrinking, and you can count on some wingnut to come out of the woodwork and declare that we are number one at delivering new drugs to colorectal cancer patients that increase their life expectancy by a whole 4.3 months, so take that.

One occasionally finds the claim that the U.S. has too many doctors, rather than a shortage of doctors. The problem is that the “oversupply” seems to fall short in primary care. Kevin Sack of the New York Times explains,

While fewer American-trained doctors are pursuing primary care, they are being replaced in droves by foreign medical school graduates and osteopathic doctors. There also has been rapid growth in the ranks of physician assistants and nurse practitioners.

A. Bruce Steinwald, the accountability office’s director of health care, concluded there was not a current nationwide shortage. But Mr. Steinwald urged the overhaul of a fee-for-service reimbursement system that he said undervalued primary care while rewarding expensive procedure-based medicine. His report noted that the Medicare reimbursement for a half-hour primary care visit in Boston is $103.42; for a colonoscopy requiring roughly the same time, a gastroenterologist would receive $449.44.

My understanding is that there are adequate numbers of medical students who graduate as general practice doctors, but since they carry an average of $120,000 debt for student loans they can’t afford to go into primary care.

This is unfortunate, because comprehensive health care reform requires better primary care so that health problems are prevented or treated at earlier stages. But in the U.S. “market forces” are better at creating and marketing expensive drugs and gizmos to hospitals to treat seriously ill patents. Ain’t no money to be made in preventive care. Money to be saved, yes, but not to be made. So emergency rooms rot, and people in Massachusetts wait 13 bleeping months for a bleeping checkup.

The situation may worsen as large numbers of general practitioners retire over the next decade. The incoming pool of doctors is predominantly female, and many are balancing child-rearing with part-time work. The supply is further stretched by the emergence of hospitalists — primary care physicians who practice solely in hospitals, where they can earn more and work regular hours. President Bush has proposed eliminating $48 million in federal support for primary care training programs. [emphasis added]

Of course he has. You can count on Bush to do exactly the wrong thing.

Anyway, just because real-world experience proves beyond a shadow of a doubt that “market forces” will not provide anything approaching halfway decent health care for all Americans doesn’t mean the wingnuts will lose faith in market forces. There’s no point even arguing with them. And because wingnuts dominate media, few Americans hear all sides of this argument. All they ever hear about are waiting lines in Canada.

Of course, the only reason we haven’t had worse waiting lines here is that so many people have been kicked out of the health care system altogether.

Be sure to read Paul Krugman’s most recent column, “Voodoo Health Economics.” GOP presidential candidate John McCain’s health care plan is, essentially, to allow the “magic of the marketplace” to provide inexpensive health care for everyone. Krugman explains in no uncertain terms why this is nonsense. The Boston Globe has more about McCain’s not-even-half-assed heath care proposals.

I’m not enthusiastic about either Hillary Clinton’s or Barack Obama’s health care proposals. They both fall under the heading of “better than nothing” in my book, McCain’s proposals being “nothing.”

The two Dems may not be beyond hope on health care, however. From an editorial in today’s Toledo Blade:

At one time or another, both Senator Clinton and Senator Obama have said they could support a single-payer national health insurance system, a kind of “Medicare for all,” as a solution to the health care crisis, but they have apparently calculated that it is not politically feasible to advocate it today.

The new survey of the nation’s doctors suggests otherwise.

These findings dovetail with those of an AP/Yahoo public opinion poll last December showing 65 percent of Americans favor a similar approach.

National health insurance is not only necessary, but increasingly popular.

Winston Churchill is remembered to have said of Americans that we always do the right thing, after we have exhausted all the other possibilities.

It is time for our political leaders to stand up for the health of the American people and implement a nonprofit, single-payer national health insurance system.

In part I blame news media for not presenting anything approaching a balanced, fact-based debate on health care. We get only the Right’s POV and more of the Right’s POV. I think if the American people understood the facts, we’d have national health care already.