POLICY/INTERNATIONAL: John Cohn puts the boot in….nicely

I told John Cohn a while back that he was just too nice, and that he shouldn’t engage in the pointless argument with the free-marketeers about whether we treat cancer better or worse than the Europeans—especially as we do so much worse on many other measures. But John doesn’t listen to me—instead he takes the cancer argument and uses it to stamp all over the free-marketeers. At some point the referee should step in and stop this fight…

Meanwhile here’s the real problem. Next to John’s article on the CBS site is a video of Bush, and this is the text below it:

CBS News RAW: President Bush announced new proposals for the tax code intended to improve health care. His ideas counter Democratic proposals to nationalize the system.

Please could someone at CBS or anywhere else find me an example of a democrat wanting to “nationalize” the system. “Nationalize” means the government owning the production/service a la the Post Office or UK NHS. Not even Dennis Kucinich seems to be in favor of that. So what the hell are they talking about? I don’t know but neither do they. And, as they’re controlling a major news organization’s output, that is the problem.

30 replies »

  1. Sonoma, you’ll find usage in universal/single-pay countries also rising and their HC costs going up as well, but not at the rate of U.S. HC. They put there private sector under sufficient pressure by cost controls – something the U.S. has not discovered yet.

  2. Well, if we had Chinese doctors fly en masse to the US to work for $100 a month, the cost would come down. But, the service sector dosen’t work that way.
    You missed the first part of my argument, which is that HC consumers are using more HC, so the cost per unit treated probably hasn’t gone up that much, if such a thing could be measured. So, combine better quality, more quantity, and a low elasticity of supply, and you’ve got your explanations.
    Now, I’m not saying that efficiency couldn’t improve. It could, and the private sector will help to improve it if placed under sufficient pressure.

  3. “Why do we not measure quality improvements in HC as we do in other sectors (computer technology, cell phones, TV’s, software, etc.).”
    Sonoma, the problem with your comparison is the cost of those items comes down as technology improves. Ever see the cost (to the patients/policy payers) of healthcare come down?

  4. “I think it is quite possible and even likely that the combined lobbying clout of all of these employer purchasers of health insurance could more than counteract the lobbying power of hospitals, doctors, drug companies and other beneficiaries of the current system.”
    Barry, it would be great if that kind of balance existed, but it seems that even the healthcare cost problems of the big three auto companies is not enough for their execs. to “in effect” go against their pals at the country club and sell out to the “socalists” for universal/single pay. This point was raised a while back on this blog. And I doubt that employers will work out a system for patient/payers over a system in favor of themselves as policy payers. I agree that the resilience of the U.S. economy is not to be underestimated, but there are a lot of bodies along the way.

  5. The real problem is the old 80/20 rule, whereby 20% of patients consume 80% of HC dollars.
    MH: as to your argument about real wages: the median worker is much older now than, say, 20 years ago. He consumes more HC and, more importantly, he understands that he will need more HC from here on out. So, yes, he’s paying more and it has come out of real wages, but he’s willing to pay more because he is or will be using more HC.
    One other bit: the quality of HC is much better than in the past. Think of knee surgery, or treatment of elevated LDL, or migraine HA’s, or glucometers, or gall bladder removal, or chronic myelogenous leukemia therapy. The quality of HC has improved vastly, yet we focus only on cost. Why do we not measure quality improvements in HC as we do in other sectors (computer technology, cell phones, TV’s, software, etc.).
    Let’s liberate ourselves from the truisms. Let’s apply 2.0 thinking to a 2.0 world.

  6. Sonoma;
    Another weakness in that argument is that you may be a well-insured, middle class person TODAY and be an uninsured or unemployed person TOMORROW – literally. (Even as a retired M.D. under 65, I am currently experiencing the joys of individual health insurance.)
    The current system is unsustainable no matter how you look at it – financially, patient safety-wise, continuity of care, access, whatever. Americans are famous for not seeing beyond the end of their individual-rights noses, but it will only take one good economic downturn with ensuing layoffs to change things….

  7. sonoma. The lose lose is that the increased cost of health care has represented ALL the growth in real income for most American workers in the last 30 years. It’s been a straight transfer payment to the health care industry.
    If health care was cheaper, real wages would be much higher. and it would be cheaper if the uninsured were in one big pool with everyone else because there would be no “saftey valve”.
    That’s the message that’s been rolled over by the industry’s trojan horse.

  8. Interesting piece in the Politico today:
    Gist is, “reform” HC at your own political peril. As we have learned in Massachusetts, HC resources are limited. Are you, the middle class suburban voter with good health care coverage, prepared to share your doctor, your surgeon, your hospital, your nurses, your pharmacist, your PT, etc. with the uninsured? Universal HC is a lose-lose for the well-insured American. Why? It requires that he pay to subsidize the invasion of his own waiting room.
    If, somehow, the “reformers” succeed in this effort to seriously degrade the health coverage and access of middle-class suburban voters (ie, the swing voters in competitive districts), the blowback will be intense and long-lasting.
    Kudos to the sly foxes who have designed the trojan horse called Schip. You can boil the frog alive if you do it very slowly.

  9. Peter;
    The answer to your question about black women and breast cancer is “both, sort of.” That is, due (presumably) to lower socio economic status they tend to present at later stages, but, when compared to white women stage for stage and given the same treatment, tend to have poorer prognosis anyway. So there is something qualitatively different with at least some black women’s cancers. (I’ll find a reference on that sooner or later.) And that’s a good argument for carefully designed clinical trials in medicine which don’t mix apples and oranges – similar to the finding that women and men are different in terms of symptoms and response to treatment of heart disease, and should be trialed separately.
    I do not know the answer to the Medicaid question – but I bet we can guess.

  10. Peter,
    There are, I believe, between 150 and 160 million people who currently get their health insurance through their employer in the U.S. By contrast, there are, perhaps, 15 million people or so who work in the healthcare field. As the rapidly rising cost of health insurance moves to the top of the priority list for more and more employers (including state and local government employers), I think it is quite possible and even likely that the combined lobbying clout of all of these employer purchasers of health insurance could more than counteract the lobbying power of hospitals, doctors, drug companies and other beneficiaries of the current system. I don’t think your characterization of the fight as between individuals writing letters and healthcare industry lobbyists buying access and results is fair. That said, it generally does take a crisis or the perception that a crisis is near to force political action on an issue like this. On the bright side, our economic system has proven to be extremely resilient over the course of our 231 year history. As Warren Buffett puts it, anyone who has ever sold America short has been wrong!

  11. Mr. Bawer’s reference to breast cancer mortality in the U.S. does not show what the mortality rate is for low income women. From what I’ve been able to find black women’s mortality is about 34%. So is that due to relative low economic status or the types of cancer they get. I wonder what the survival rate of medicaid patients is?
    “What’s different is that Americans are keenly aware of their system’s problems, are arguing vigorously about those problems, and are trying to decide how best to fix them.”
    I see, those countries with single pay are not aware and are not arguing about how to fix/improve/change their healthcare policy? Do you really believe that? How is change going to happen here? If political spinelessness is any indication it will be a crisis before much is done. What we see here is vested profit interests investing in political arm twisting (lobbyists/campaign donations/plum private sector jobs) so that the voters can write letters while the industry gets access and results.

  12. Posted by: jane blow
    “Didn’t you learn in kindergarten to ignore such people, not stoop to their level?”
    Was that a “rude” commentary on Stuart Browning? Most people have learned that a rational conversation cannot be had with Mr. Browning as he is trapped in is own ideology – or the ideology of the people he serves . But I think it important to answer him at least once in a while to uncover his agenda and counter his points, if his red-baiting can be called “points”. Rush Limbaugh learned quickly that a good buck could be had by being the lap dog of the neo-conservative movement.

  13. Of course, there’s absolutely, positively nothing to learn from any of the 25 nations with superior health systems than ours if there’s anything wrong with any of them.
    Perhaps people of other nations are less aware of the problems with their health coverage because they actually have health coverage.

  14. Conservative gay American expat writer Bruce Bawer talks about the HC system in Norway, where he lives:
    “Norwegians boast of their system’s “total coverage” – but total coverage doesn’t mean guaranteed care, or care on demand. Far from it. Even the media here, which generally push the official line that Norway’s system is far superior to its U.S. counterpart, run occasional stories about Norwegian children who’ve been turned down for life-saving medications, who’ve had to fly to the U.S. to get the care they needed, or who’ve died while waiting for treatment. In America 20% of women with breast cancer die from it; in Norway, owing to the long queues for treatment, the figure is 27%. Fewer than one out of five American men with prostate cancer die of it; in Norway, one out of three die.
    Yes, America’s health-care system has serious problems. But so do Canada’s and Europe’s. What’s different is that Americans are keenly aware of their system’s problems, are arguing vigorously about those problems, and are trying to decide how best to fix them. In Norway, by contrast, the people have been taught from earliest childhood to be grateful for the wonderful health-care system their social-democratic government has given them. (A patient who had to wait four months for a knee operation told Aftenposten: “I don’t think it was long to wait.”) They’ve also been fed a lifetime of lies about America’s system: most people here firmly believe that only rich Americans get good health care and that Americans without health insurance are routinely turned away from hospitals.
    None of which is meant to suggest that the U.S. system doesn’t need fixing. It does. But the solution to its problems doesn’t lie in copying the Canadian and European systems.”

  15. Matthew’s case is interesting, because if that occurred in the U.S., the treating oncologist would be accused of treating her only for his own profit.

  16. Matthew. I am so sorry for your close friends loss. And I’m also surprised (well, not really) by the treatment, at 82 years of age (and without the benefits of testing the tumor first). A tough issue indeed. The survival benefit obtained with adjuvant chemotherapy can vanish in the elderly. Putting unreasonable limits on expectations for a person at 82 is not same as someone at 52. That is not age bias, it is just making appropriate medical decisions in the face of competing risks and the expected course of illness. Perhaps the Brits are heading in our direction? They are already there!

  17. To Mr. Browning and to all who reply to him in kind. Didn’t you learn in kindergarten to ignore such people, not stoop to their level? Berry says it well, too.

  18. Posted by: jane blow
    “I have always wondered why the rudeness level escalates exponentially whenever Mr. Browning comments.”
    From Mr. Browning, or to Mr. Browning?

  19. Barry. I would probably agree with you, however, let me share one anecdote.
    A very close friend of mine’s mother was diagnosed with a relatively advanced case of ovarian cancer last November in the UK. She had surgery immediately, and 4 rounds of chemotherapy over the next 6 months. All courtesy of the NHS. Sadly it was ineffective and she died in June.
    Here’s the bit that will surprise you, and certainly why her treatment surprised me. She was 82.
    Perhaps the Brits are heading in our direction.

  20. Jane, I agree with you. It would be great, for a change, to have a rational, civil debate about issues important to our country without resorting to exaggeration and name calling.

  21. Cancer treatment is an interesting topic. For me, if I had cancer, I think I would rather be treated in the U.S. if I have decent insurance and in Western Europe (but not the UK) if I don’t. To assess overall quality of a healthcare system, I think more weight should be given to how the system deals with the sickest people who need healthcare the most as compared to primary and preventive care.
    That said, I’m also a believer in efficient resource allocation. Most of the manufacturers of the ultra expensive specialty cancer drugs tell me that they try to price them essentially the same across the world. I think there may well be very different decisions among countries as to whether or not the health insurance system will pay for them. Given my frequent comments about the U.S.’ need to reassess its approach to end of life care, I think the Europeans are closer to getting this right than we are. Even if it ultimately costs me or a family member access to one of these drugs that might extend our lives by a couple of months at enormous cost, I think our society would be net better off if we employed more rigorous cost-benefit analysis in determining our coverage decisions and to what extent, if any, we should limit access to a range of possible treatments based on age. I say again and again that resources are finite which means tough, difficult choices have to be made unless the patient or his or her family is prepared to self-pay.

  22. As an apolitical reader of this blog (apolitical in that I am cynical about all politics, politicians, and pundits), I have always wondered why the rudeness level escalates exponentially whenever Mr. Browning comments. Lo and behold, this exchange elucidates the answer – radio talk shows. One must be insulting to get people’s attention so they will tune in. A sad commentary on our U.S. population, no?

  23. Stuart, how do you define community fire departments, a fascist charade or outright nationalization?

  24. Well, it’s good that Mr Browning understands the “real” intent of the Democratic candidates and is able to see through their stated and staked-out positions. Pity that their critics on the single-payer left cannot do so.
    And I bring up his wealth because I am highly cynical about very rich people defending a status quo which visits huge financial and health miseries on predominantly lower-income people. I just wonder if Mr Browning was poor, uninsured and had a chronic health condition whether he’d be quite so firm in his “beliefs”.
    But well done to Mr Browning on “cashing in” in the heyday. I’m a capitalist and I have no problem with that. I merely hope that the investors who bought stock in his company did just as well. Did they Mr. Browning?
    And he’s on neo-con talk radio too? Damn that is an intellectual recommendation and a half.

  25. I’m well aware of the positions taken by the various democratic contenders. I regard all of them as dishonest incrementalism towards total government-run health care – no different from the SCHIP debate currently before Congress.
    And once again we have Mr. Holt’s obsession with my personal wealth. What gives? Is Mr. Holt still sore about his own failed attempts to cash in during the 1990s?
    Oh – and by the way … Mr. Holt didn’t mention the several radio shows across the nation that I do almost every day.

  26. Perhaps Stuart’s just following the line of reasoning that if commercial insurance companies must compete on their abilities to manage health (instead of underwrighting) that many of them will fail miserably.

  27. Mr. Browning, not for the first time, reveals that his comprehension of basic policy positions is completely inadequate. None of the major Democratic presidential candidates are in favor of the “fascist” single payer system which he — and the insurance brokers and underwriters with whom he allies himself with — so deeply fear. If he could struggle through the position statements of Clinton, Edwards, and Obama he’s learn that none of them are advocating an end to either private insurance or employment based insurance. (Ron Wyden is advocating a transition to regional pool based individual insurance). Only Kucinich is advocating single payer, and even that keeps private medicine in place.
    It’s just even further problems in comprehension that lead Mr. Browning to believe that private medicine funded by the government is the same as nationalized medicine in which the government provides it. To make the analogy, does Mr. Browning believe that American defense contractors are not private companies? I’m sure than in the vast stock portfolio that a wealthy millionaire like Mr Browning must have, there are probably some shares of Boeing or Haliburton. Presumably Mr. Browning believes that these shares are owned by the American people and not by him–after all their defense income comes from government contracts. Perhaps he’d like to hand them over to the rest of us?
    But having a clue about what you’re talking about, or being able to get a simple definition right, luckily is no a pre-requisite for making one-sided movies or appearing on right-wing TV shows. Nor apparently for writing summary headlines on CBS News.

  28. A study by the Karolinska Institute in Sweden reported that the American health care system outperforms the European health care system in getting new medicines to cancer patients. According to the study, the proportion of colorectal cancer patients with access to the drug Avastin was 10 times higher in the United States than it was in Europe.
    In other words, if you are a colorectal cancer patient, you are far better off in the United States (if you are lucky enough to have health insurance) than in Europe. It is said that our health care system is good at delivering expensive drugs, but what is also said is that our health care system is not so good at simple medicine like preventive care, compared to Europe. Our profit-based health care system is very good at creating new health care products that will make a lot of money, but if it’s something that has no chance of profit, forget it.
    Our health care system is very good at creating new drugs and technologies and marketing them to hospitals, physicians and patients. And where our health care system isn’t profitable, it is a total failure. It doesn’t take a rocket scientist to figure out that the United States does a good job of developing and delivering new and expensive drugs to cancer patients, because that is the only thing we’re good at. But it’ll take a rocket scientist to figure out how this is a better health care system.

  29. No, Mr. Browning, you are once again manufacturing Mr. Holt’s meaning from whole straw. Kindly stick to the subject instead of defining what would be your worst evil and pinning it to those who would be reasonable.
    Please prevent cruelty to strawmen everywhere.

  30. Mr. Holt is being intentionally misleading again. (What’s new?)
    From a doctor’s – or a patient’s – point of view, it makes no difference whether the govenment owns the hospitals and directly employs the doctors (as in the UK) – or, as in Canada, they create a legally-enforced monopsony. The results are the same. Government defines health care and rations health care.
    The fact that Holt and others like the PNHP prefer a fascist charade to outright nationalization doesn’t change the essential nature of government-run medicine.