Worldview: Healthcare
by A Concerned Citizen
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Retired on 31 December 2007
Table of Contents
Universal Health Care
Drug Costs
Is UHC Taking Off?
Other Articles
Universal Health Care
Back to Healthcare Menu
Introduction (April 06): I am investigating the idea of some form of universal health care (UHC) for the United States. I am aware of the dangers of too much 'socialism', but I also think that the present system is highly flawed. The US is the only industrialized nation that does not have some form of UHC. About 40 million Americans lack health insurance; millions more are underinsured; and 20% of the uninsured rely on the emergency room for regular health care, which is much more expensive than a doctor's visit. Medical problems are a leading cause of bankruptcy, and most of those declaring bankruptcy actually have insurance! Furthermore, the lack of insurance leads to a lack of preventative care, which increases costs in the long run. Finally, most of our foreign competitors provide some form of public health insurance, which puts our companies at a big disadvantage. For example, health care costs add about $1500 to every General Motors car.
I have not yet formed any opinions. This is a complex and specialized subject, which is not readily accessible to the layman. And it is not discussed in the press nearly as much as it should be. (Is that a conspiracy?) Here are some online papers to consider, with a brief description of their main points.
The 'nonpartisan' Institute of Medicine estimates that the hidden costs to the economy of the uninsured, such as diminished health and shorter lifespans in the workforce, are at least $65-$130 billion a year. The uninsured would use an additional $34-$69 billion a year of health care if they had insurance, plus additional costs for 'out-of-pocket' expenses, depending on the generosity of public policy. In 2005, Dr. Kenneth Thorpe, an economist at Emory University, examined various UHC options, such as (1) a combined employer/employee mandate; (2) an expansion of Medicaid; (3) the creation of a program similar to FEHBP; and (4) a universal, public financed plan. Options (1) and (2) would save over $320 billion over 10 years; option (3) would save $370 billion over ten years; and option (4) would save $1.1 trillion over 10 years. However, this is all predicated on the containment of administrative costs, which essentially replaces the insurance industry with a centralized mechanism similar to Social Security. Most efficient of all would be a single-payer system. One can expect considerable resistance from the powerful insurance lobby. The extra cost to the economy of covering the uninsured is not as large as one might expect: only about 1% of GDP, and this neglects the elimination of the 'hidden costs'. One must also consider the 'cultural' benefits, such as improving public morale, having a closer family, more job freedom, etc.
The authors are actually doctors practicing in Connecticut. However, they seem to be members of the Green Party, which is hardly mainstream. They begin by providing some statistics to show that, contrary to the common perception, the US ranks poorly in health care compared to other industrialized countries, despite having the best medical infrastructure. Like Chua, they believe that the savings in administrative costs of UHC would pay for covering the uninsured. One indication is that the US spends 40% more per capita on health care than industrialized countries with UHC. Then they state that Federal studies by the Congressional Budget Office and the General Accounting Office show that single payer universal health care would save 100 to 200 Billion dollars per year despite covering all the uninsured and increasing health care benefits. Finally, they state that the US spends about 50-100% more on administrative costs than countries with a single payer system. Note that these facts, if true, indicate that the uninsured can be covered without managed care, i.e. without the government setting the fees of health care providers. In a word, UHC is not socialized medicine. They also cite statistics to show that UHC would not deprive Americans of services, as often alleged.
Back to Universal Health Care
Paul Krugman on Single-Payer (15 Nov 06): Here is an excellent article advocating the virtues of single-payer health care. To be sure, Krugman is candid that he considers this a prelude to socialized medicine, but I will concentrate on the single-payer aspect, which makes up the bulk of the article. Since the issue so important, I will take the liberty of excerpting at some length.
The good news is that we know more about the economics of health care than we did when Clinton tried and failed to remake the system. There's now a large body of evidence on what works and what doesn't work in health care, and it's not hard to see how to make dramatic improvements in US practice. As we'll see, the evidence clearly shows that the key problem with the US health care system is its fragmentation. A history of failed attempts to introduce universal health insurance has left us with a system in which the government pays directly or indirectly for more than half of the nation's health care, but the actual delivery both of insurance and of care is undertaken by a crazy quilt of private insurers, for-profit hospitals, and other players who add cost without adding value. A Canadian-style single-payer system, in which the government directly provides insurance, would almost surely be both cheaper and more effective than what we now have. And we could do even better if we learned from 'integrated' systems, like the Veterans Administration, that directly provide some health care as well as medical insurance.
The bad news is that Washington currently seems incapable of accepting what the evidence on health care says. In particular, the Bush administration is under the influence of both industry lobbyists, especially those representing the drug companies, and a free-market ideology that is wholly inappropriate to health care issues. As a result, it seems determined to pursue policies that will increase the fragmentation of our system and swell the ranks of the uninsured.
1. Is health care spending a problem?
In 1960 the United States spent only 5.2 percent of GDP on health care. By 2004 that number had risen to 16 percent. At this point America spends more on health care than it does on food. But what's wrong with that? The starting point for any discussion of rising health care costs has to be the realization that these rising costs are, in an important sense, a sign of progress [i.e. the result of improved technology].
[. . .]
[However, there are problems.] Specifically, American health care tends to divide the population into insiders and outsiders. Insiders, who have good insurance, receive everything modern medicine can provide, no matter how expensive. Outsiders, who have poor insurance or none at all, receive very little.
[. . .]
2. The unraveling of employer-based insurance
In 2003 only 16 percent of health care spending consisted of out-of-pocket expenditures by consumers. The rest was paid for by insurance, public or private. As we'll see, this heavy reliance on insurance disturbs some economists, who believe that doctors and patients fail to make rational decisions about spending because third parties bear the costs of medical treatment. But it's no use wishing that health care were sold like ordinary consumer goods, with individuals paying out of pocket for what they need. By its very nature, most health spending must be covered by insurance.
The reason is simple: in any given year, most people have small medical bills, while a few people have very large bills. In 2003, health spending roughly followed the '80-20 rule': [. . .]
So the only way modern medical care can be made available to anyone other than the very rich is through health insurance. Yet it's very difficult for the private sector to provide such insurance, because health insurance suffers from a particularly acute case of a well-known economic problem known as adverse selection.
Here's how it works: You can see where this is going. The insurance company would quickly find that because its clientele was tilted toward those with high medical costs, its actual costs per customer were much higher than those of the average member of the population. So it would have to raise premiums to cover those higher costs. However, this would disproportionately drive off its healthier customers, leaving it with an even less healthy customer base, requiring a further rise in premiums, and so on.
Insurance companies deal with these problems, to some extent, by carefully screening applicants to identify those with a high risk of needing expensive treatment, and either rejecting such applicants or charging them higher premiums. But such screening is itself expensive. Furthermore, it tends to screen out exactly those who most need insurance.
Most advanced countries have dealt with the defects of private health insurance in a straightforward way, by making health insurance a government service. Through Medicare, the United States has in effect done the same thing for its seniors. We also have Medicaid, a means-tested program that provides health insurance to many of the poor and near poor. But nonelderly, nonpoor Americans are on their own. In practice, only a tiny fraction of nonelderly Americans (5.3 percent in 2003) buy private insurance for themselves. The rest of those not covered by Medicare or Medicaid get insurance, if at all, through their employers.
[. . .]
In 2004, according to census estimates, 63.1 percent of Americans under sixty-five received health insurance through their employers or family members' employers. Given the inherent difficulties of providing health insurance through the private sector, that's an impressive number. But it left more than a third of nonelderly Americans out of the system. Moreover, the number of outsiders is growing: the share of nonelderly Americans with employment-based health insurance was 67.7 percent as recently as 2000. And this trend seems certain to continue, even accelerate, because the whole system of employer-based health care is under severe strain.
We can identify several reasons for that strain, but mainly it comes down to the issue of costs. Providing health insurance looked like a good way for employers to reward their employees when it was a small part of the pay package. Today, however, the annual cost of coverage for a family of four is estimated by the Kaiser Family Foundation at more than $10,000. One way to look at it is to say that that's roughly what a worker earning minimum wage and working full time earns in a year. It's more than half the annual earnings of the average Wal-Mart employee.
[. . .]
Fortunately, some of the adverse consequences of the decline in employer-based coverage have been muted by a crucial government program, Medicaid. But Medicaid is facing its own pressures.
3. Medicaid and Medicare
[. ..]
Today, Medicaid is a crucial part of the American safety net. In 2004 Medicaid covered almost as many people as its senior partner, Medicare — 37.5 million versus 39.7 million.
Medicaid has grown rapidly in recent years because it has been picking up the slack from the unraveling system of employer-based insurance. Between 2000 and 2004 the number of Americans covered by Medicaid rose by a remarkable eight million. Over the same period the ranks of the uninsured rose by six million. So without the growth of Medicaid, the uninsured population would have exploded, and we'd be facing a severe crisis in medical care
But Medicaid, even as it becomes increasingly essential to tens of millions of Americans, is also becoming increasingly vulnerable to political attack. To some extent this reflects the political weakness of any means-tested program serving the poor and near poor.
[. . .]
Medicare's situation is very different. Unlike employer-based insurance or Medicaid, Medicare faces no imminent threat of large cuts. Although the federal government is deep in deficit, it's not currently having any difficulty borrowing, largely from abroad, to cover the gap. Also, the political constituency behind Medicare remains extremely powerful. Yet federal deficits can't go on forever; even the US government must eventually find a way to pay its bills. And the long-term outlook for federal finances is dire, mainly because of Medicare and Medicaid. The chart in Figure 1 illustrates the centrality of health care costs to America's long-term budget problems.
[. . .]
To be fair, there is a demographic component to Medicare and Medicaid spending too — Medicare because it only serves Americans over sixty-five, Medicaid because the elderly, although a minority of the program's beneficiaries, account for most of its spending. Still, the principal factor in both programs' rising costs is what the CBO calls 'excess cost growth' — the persistent tendency of health care spending per beneficiary to grow faster than per capita income, owing to advancing medical technology. Without this excess cost growth, the CBO estimates that entitlement spending would rise by only 3.7 percent of GDP over the next twenty-five years. That's a significant rise, but not overwhelming, and could be addressed with moderate tax increases and possibly benefit cuts. But because of excess cost growth the projected rise in spending is a crushing burden — about 10 percent of GDP over the next twenty-five years, and even more thereafter.
Rising health care spending, then, is driving a triple crisis. The fastest-moving piece of that crisis is the unraveling of employer-based coverage. There's a gradually building crisis in Medicaid. And there's a long-term federal budget crisis driven mainly by rising health care spending.
So what are we going to do about health care?
4. The 'consumer-directed' diversion
[. . .]
We've already alluded to the underlying view behind the Bush administration's health care proposals: it's the view that insurance leads people to consume too much health care. ... The view that Americans consume too much health care because insurers pay the bills leads to what is currently being called the 'consumer-directed' approach to health care reform. ... And the way to reduce public reliance on insurance, reformers from the right wing believe, is to remove the tax advantages that currently favor health insurance over out-of-pocket spending. ... The administration, recognizing how politically explosive such a move would be, rejected the proposal. Instead of raising taxes on health insurance, the administration has decided to cut taxes on out-of-pocket spending. ... [Some analysts] call for making all out-of-pocket medical spending tax-deductible, although tax experts from both parties say that this would present an enforcement nightmare. ... The administration's proposals so far are more limited, focusing on an expanded system of tax-advantaged health savings accounts.
What's wrong with consumer-directed health care? One immediate disadvantage is that health savings accounts, whatever their ostensible goals, are yet another tax break for the wealthy, who have already been showered with tax breaks under Bush. ... A deeper disadvantage is that such accounts tend to undermine employment-based health care, because they encourage adverse selection. ... Yet another problem with consumer-directed care is that the evidence says that people don't, in fact, make wise decisions when paying for medical care out of pocket.
But perhaps the biggest objection to consumer-directed health reform is that its advocates have misdiagnosed the problem. They believe that Americans have too much health insurance; the 2004 Economic Report of the President condemned the fact that insurance currently pays for 'many events that have little uncertainty, such as routine dental care, annual medical exams, and vaccinations', and for 'relatively low-expense items, such as an office visit to the doctor for a sore throat'. The implication is that health costs are too high because people who don't pay their own medical bills consume too much routine dental care and are too ready to visit the doctor about a sore throat. And that argument is all wrong. Excessive consumption of routine care, or small-expense items, can't be a major source of health care inefficiency, because such items don't account for a major share of medical costs. Remember the 80-20 rule. ... When you think of the problem of health care costs, you shouldn't envision visits to the family physician to talk about a sore throat; you should think about coronary bypass operations, dialysis, and chemotherapy.
But what would real reform look like?
5. Single-payer and beyond
How do we know that the US health care system is highly inefficient? An important part of the evidence takes the form of international comparisons. Table 1 compares US health care with the systems of three other advanced countries. It's clear from the table that the United States has achieved something remarkable. We spend far more on health care than other advanced countries — almost twice as much per capita as France, almost two and a half times as much as Britain. Yet we do considerably worse even than the British on basic measures of health performance, such as life expectancy and infant mortality.
One might argue that the US health care system actually provides better care than foreign systems, but that the effects of this superior care are more than offset by unhealthy US lifestyles. Ezra Klein of The American Prospect calls this the 'well-we-eat-more-cheeseburgers' argument. But a variety of evidence refutes this argument. ...
So why does US health care cost so much? Part of the answer is that doctors, like other highly skilled workers, are paid much more in the United States than in other advanced countries. But the main source of high US costs is probably the unique degree to which the US system relies on private rather than public health insurance, reflected in the uniquely high US share of private spending in total health care expenditure.
Over the years since the failure of the Clinton health plan, a great deal of evidence has accumulated on the relative merits of private and public health insurance. As far as we have been able to ascertain, all of that evidence indicates that public insurance of the kind available in several European countries and others such as Taiwan achieves equal or better results at much lower cost. This conclusion applies to comparisons within the United States as well as across countries. ...
The cost advantage of public health insurance appears to arise from two main sources. The first is lower administrative costs. Private insurers spend large sums fighting adverse selection, trying to identify and screen out high-cost customers. Systems such as Medicare, which covers every American sixty-five or older, or the Canadian single-payer system, which covers everyone, avoid these costs. In 2003 Medicare spent less than 2 percent of its resources on administration, while private insurance companies spent more than 13 percent.
At the same time, the fragmentation of a system that relies largely on private insurance leads both to administrative complexity because of differences in coverage among individuals and to what is, in effect, a zero-sum struggle between different players in the system, each trying to stick others with the bill. Many estimates suggest that the paperwork imposed on health care providers by the fragmentation of the US system costs several times as much as the direct costs borne by the insurers.
The second source of savings in a system of public health insurance is the ability to bargain with suppliers, especially drug companies, for lower prices. Residents of the United States notoriously pay much higher prices for prescription drugs than residents of other advanced countries, including Canada. What is less known is that both Medicaid and, to an even greater extent, the Veterans' Administration, get discounts similar to or greater than those received by the Canadian health system.
We're talking about large cost savings. Indeed, the available evidence suggests that if the United States were to replace its current complex mix of health insurance systems with standardized, universal coverage, the savings would be so large that we could cover all those currently uninsured, yet end up spending less overall. That's what happened in Taiwan, which adopted a single-payer system in 1995: the percentage of the population with health insurance soared from 57 percent to 97 percent, yet health care costs actually grew more slowly than one would have predicted from trends before the change in system.
If US politicians could be persuaded of the advantages of a public health insurance system, the next step would be to convince them of the virtues, in at least some cases, of honest-to-God socialized medicine, in which government employees provide the care as well as the money. Exhibit A for the advantages of government provision is the Veterans' Administration, which runs its own hospitals and clinics, and provides some of the best-quality health care in America at far lower cost than the private sector. How does the VA do it? It turns out that there are many advantages to having a single health care organization provide individuals with what amounts to lifetime care. For example, the VA has taken the lead in introducing electronic medical records, which it can do far more easily than a private hospital chain because its patients stay with it for decades. The VA also invests heavily and systematically in preventive care, because unlike private health care providers it can expect to realize financial benefits from measures that keep its clients out of the hospital.
In summary, then, the obvious way to make the US health care system more efficient is to make it more like the systems of other advanced countries, and more like the most efficient parts of our own system. That means a shift from private insurance to public insurance, and greater government involvement in the provision of health care — if not publicly run hospitals and clinics, at least a much larger government role in creating integrated record-keeping and quality control. Such a system would probably allow individuals to purchase additional medical care, as they can in Britain (although not in Canada). But the core of the system would be government insurance — "Medicare for all," as Ted Kennedy puts it.
Unfortunately, the US political system seems unready to do what is both obvious and humane. The 2003 legislation that added drug coverage to Medicare illustrates some of the political difficulties. ... Back to Universal Health Care
Criticism of Canada (& UK etc) (20 May 06): Sally Pipes describes how her Canadian father couldn't get Rituxan, which may have helped save his life from cancer. The drug was not on the list of government approved medications, because it was too expensive. She also argues that drugs are not really that expensive, because they save a lot of health care dollars by keeping people out of hospitals. Most American seniors can afford their drug bill, which is comparable to their gas or entertainment bill.
This seems like a red herring to me. Universal health insurance could be written to allow those who can afford it to purchase extra care. I am inclined towards some kind of a basic safety net so that the poor don't have to resort to the emergency room. Also, I think insurance should be available to all for catastrophes, including for the unemployed, provided they are actively seeking work. There are many possible solutions, such as preventing insurance companies from cherry picking their customers. A typical bogus conservative argument against any form of 'socialism' is that it is a question of all or none. Furthermore, though drugs may save dollars, the exorbitant cost of some drugs still seems very suspicious to me; it looks like price gouging based on the exploitation of a patent monopoly. I do favor limiting extravagant lawsuits against drug companies. And I do agree with the conservatives that public programs are susceptible to politicization, corruption, over-indulgence, fiscal recklessness, and all the rest. However, we've seen this same behavior from 'conservatives' lately, once they are in power.
Like many Canadians, I've found my future south of the 49th parallel, not north of it. Yet, looking at the debate in the United States and the quiet creep of government, it seems that the mistakes made previously by Canadians are now being made by Americans.
[. . .]
American health care is so expensive because it's so cheap. That is, with Americans paying just 14 cents out of pocket for every health dollar, there has been little incentive for people to economize their health expenses.
Introduction
Krugman on Single-Payer
Criticism of Canada (& UK etc)
Ezra Klein is Optimistic
Kao-Ping Chua (AMSA): The Case for Universal Health Care
Battista & McCabe: The Case For Single Payer, Universal Health Care
60 Minutes: The High Cost of Drugs
Wyn Snow: FDA Strangling Consumer Health
CPI: How the pharmaceutical industry gets its way in Washington
Kevin Drum: Malpractice Again and Again and Again
CATO Institute: The DEA's War on Prescription Painkillers
Peter W. Huber (Commentary): In Defense of Big Pharma
Harvard Gazette: Docs overwhelmingly endorse single-payer insurance
Timothy Noah (Slate): Time To Socialize Medicine
Website: Physicians for a National Health Program
THE HEALTH CARE CRISIS AND WHAT TO DO ABOUT IT
Paul Krugman, NYRB, 23 Mar 06
Medical costs are once again rising rapidly, forcing health care back into political prominence. Indeed, the problem of medical costs is so pervasive that it underlies three quite different policy crises. First is the increasingly rapid unraveling of employer-based health insurance. Second is the plight of Medicaid, an increasingly crucial program that is under both fiscal and political attack. Third is the long-term problem of the federal government's solvency, which is, as we'll explain, largely a problem of health care costs.
HOW CAPITALISM CAN SAVE AMERICAN HEALTH CARE
David Gratzer, FPM, 15 Nov 06
Gratzer: I grew interested in health policy several years ago when, as a Canadian medical student, I discovered how badly that system functioned. I remember one day particularly well — cutting across a hospital ER on my way to class, stumbling upon the complete chaos, with elderly patients having waited 3 or 4 or even 5 days for a bed, the smell of sweat, and urine, and fear in the air. It made me re-think much of everything I thought I knew about health care.
Daily Mail: Dentist shortage leads man to superglue his tooth
Back to Universal Health Care
Ezra Klein is Optimistic (27 Dec 06): According to the LA Times, Ezra Klein is a writing fellow at the American Prospect and a blogger. He thinks that some form of Universal Health Care is inevitable, and he cites as evidence that the insurers themselves can see the writing on the wall and are taking pre-emptive action.
UNIVERSAL HEALTH CARE IS COMING
Ezra Klein, LA Times, 26 Dec 06
THE STATISTICS, by now, are well known. Forty-seven million uninsured Americans. Premium increases of 81% since 2000. Small businesses failing, big businesses foundering, individuals priced out and, amid all this, skyrocketing profits for insurers, hospitals and pharmaceutical manufacturers.The American health system, put simply, is a mess. An expensive one. Indeed, in 2002, we spent $5,267 per capita on healthcare — $1,821 more than Switzerland, the nearest runner-up. And yet we had higher infant mortality, lower life expectancy, more price inflation and an actual uninsured population, a phenomenon virtually unknown in the rest of the developed world, where universal healthcare is, well, universal.
[. . .]
But health insurance is not only the inexplicable responsibility of business; it is a big business, which is why the system survives. The medical-industrial complex is a massive, remarkable beast, consuming a full one-ninth of the American economy and offering astonishing profits to many of the participants (indeed, Big Pharma was the most profitable industry in the U.S. from the 1980s until 2003, when energy companies wrested away the top spot). As with any lucrative industry, the winners are resistant to reforms, and they have a formidable army of politically lobbyists, PR specialists and image consultants helping to preserve their position, to preserve a mistake.
[. . .]
But there is evidence, finally, that their castle is being stormed. Massachusetts has passed the nation's first near-universal healthcare plan, creating a structure that should cover 95%-plus of its citizens by making healthcare as mandatory as car insurance. Nationally, the Democratic resurgence has returned universal healthcare to the agenda and its advocates to power. In the House, Rep. Pete Stark (D-Fremont), a staunch Medicare-for-all advocate, is expected to be chairman of the health subcommittee.
[. . .]
The most compelling evidence that resistance to reform is futile, however, is coming from the insurers themselves. Cognizant that Congress and the nation are tiring of the current dystopia, the insurance industry recently released its own plan for universal healthcare.
It's a bad plan, to be sure. Its purpose is more to preserve the insurance industry's profits than improve healthcare in this country. But the endorsement of universality as a moral imperative, and the attempt to get in front of the coming efforts at reform, mark the emergence of a distinct rear-guard mentality within the insurance industry. Their game is up, and they're turning some of their attention to shaping their future rather than betting that they can continue protecting their present.
SOME OF THE industry's more enlightened members are going even further. In California, the heads of Kaiser Permanente — a historical "good cop" insurer amid the almost cartoonish villainy of the industry — have proposed a serious, albeit extraordinarily complicated, plan for achieving universal coverage in the Golden State. The details of the plan are unimportant; it's the constructiveness of the proposal that matters.
And joining them in calling for reform is Schwarzenegger, who recently seized on a report by the New America Foundation showing that cost-shifting caused by the uninsured population costs each family in the state the equivalent of $1,186 in annual premiums. His plans for reform will be announced at the State of the State address Jan. 9.
The work is not done, of course. There are arguments yet to be had, wars yet to be fought.
Back to Universal Health Care
Drug Costs
2006
2007
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Is UHC Taking Off?
Simply saying that people have health insurance is meaningless. Many countries provide universal insurance but deny critical procedures to patients who need them. Britain's Department of Health reported in 2006 that at any given time, nearly 900,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the cancellation of more than 50,000 operations each year.
In Sweden, the wait for heart surgery can be as long as 25 weeks, and the average wait for hip-replacement surgery is more than a year. Many of these individuals suffer chronic pain, and judging by the numbers, some may well die awaiting treatment. In a 2005 ruling of the Canadian Supreme Court, Chief Justice Beverly McLachlin wrote that 'access to a waiting list is not access to health care'.
[. . .]
Another common concern is that the young and healthy will go without insurance, leaving a risk pool of older and sicker people. This results in higher insurance premiums for those who are insured. But that's only true if the law forbids insurers from charging their customers according to the cost of covering them. If companies can charge more to cover people who are likely to need more care — smokers, the elderly, and others — then it won't make any difference who does or doesn't buy insurance.
Finally, some suggest that when people without health insurance receive treatment, the cost of their care is passed along to the rest of us. This is undeniably true. Yet it is a manageable problem. According to Jack Hadley and John Holahan of the left-leaning Urban Institute, uncompensated care for the uninsured amounts to less than 3 percent of total healthcare spending — a real cost, no doubt, but hardly a crisis. Back to Healthcare Menu
Other Articles
2006
2007
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CPI: How the pharmaceutical industry gets its way in Washington
Peter W. Huber (Commentary): In Defense of Big Pharma
60 Minutes: The High Cost of Drugs
Chicago Sun-Times: A dose of Wal-Mart may ease Rx costs
Sen. Carl Levin: Cosponsors Bill to Allow Importation of Drugs
Leaked drug company memo: Santorum loss creates big hole
Benjamin Zycher (RCP): The Human Cost of Drug Price Negotiations
Robert Pollock (WSJ): Of Politics and Pills
Sen. Dick Durbin: Feds Should Negotiate Drug Prices
Karen Davenport: Let the government bargain with drugmakers
Richard A. Epstein (LA Times): The myth of the big bad drug companies
Yahoo News: Pfizer's Outgoing CEO To Get $180 Million...
Mercury News: Lawsuit a bid to slash drug costs
Douglas Schoen: Public Opinion on Negotiating the Price of Rx Drugs
Robert B. Reich: Drug Bill Doesn't Go Far Enough
Peter Rost, MD: The Fine Print on Drug Industry Kickbacks
60 Minutes: Lobbyists' Role in Passing Bill That Keeps Drug Prices High
Introduction (10 Jan 07): First it was Massachusetts, now it's California. It seems that the governors are starting to intervene to do something about the health care crisis: 47 million uninsured, the poor using the expensive emergency room (which cannot refuse patients), businesses dumping health benefits, etc. For years, Congress did nothing, stymied by the powerful medical interests. Fortunately, our resilient political system has other ways. Naturally, it would be 'intelligent' states like Massachussetts and California that take the lead. I can't help pointing out a certain correlation between these states and the Democratic party, notwithstanding that Schwarzenegger is nominally a Republican. This may be a modest beginning, but the logjam has been broken, if only because the uninsured were being payed for by higher premiums on the insured! Schwarzenegger's plan even extends to the children of illegal immigrants, which seems most un-Republican and has sent conservatives ballistic. Call him a saint or a political opportunist — he's certainly his own man! Or maybe his Democratic Kennedy wife got to him. Arnold, you can strut around with a big cigar in your mouth. You earned it!
Scot Lehigh (Boston Globe): A healthcare idea with mileage
NAF: Governor Schwarzenegger and NAF highlight costs of uninsured
LA Times: Schwarzenegger seeks health care for all in California
Newshour: Schwarzenegger Proposes UHC in California
David Henderson: Schwarzenegger writes a prescription for disaster
MyWay News: Sen. Kennedy Seeks Universal Health Plan
Stephen Fleischman: National Health Insurance Now, Not Later
John Stossel: Schwarzenegger's Folly
CBS Poll: Most Americans Favor Universal Health Care
TP: Candidates Should Catch Up to American People on UHC
Roger Hickey: Universal Care: Getting The Right Mix
Karen Tumulty: Democrats Battle on Universal Health Care
THE TROUBLE WITH UHC
Michael Tanner, CSM, 11 Apr 07
What these politicians and many other Americans fail to understand is that there's a big difference between 'universal coverage' and actual 'access' to medical care.
LA Times: Physician Shortage Looms, Risking a Crisis
Seattle Post-Intelligencer: The Pension Storm Bearing Down
Ezra Klein (Slate): The Medical Malpractice Myth
Tijn Touber (Alternet): Is Water the Best Medicine?
Scot Lehigh (Boston Globe): A healthcare idea with mileage
Gene Sperling: Fix Medicare by Limiting Health-Care Inflation
Kaiser: Health Care Spending in the US and OECD Countries
Ezra Klein (Prospect): Conditions for Progressive Health Care
Robert Reich: Bush Punts on Universal Health Care
Robert Samuelson: Hiding Health Care's Costs
Peter Brown: Health Care, Not Social Security, the Third Rail of 2008
LA Times: Hospital 'dumps' homeless paraplegic on L.A.'s skid row
WP: Wal-Mart, Union Join Forces on Health Care
Philip Mattera: Saving Private Insurance
Jacob S. Hacker: A Healthy Health Care Debate
WSJ: The Political Limits of UHC
Neiman: As Medicare goes private, the press just stands by
Barrack Obama: A 21st Century Health Care System
Richard Horton (NYRB): What's Wrong with Doctors
Health & Pharma groups launch Michael Moore smear campaign
WHO IS HILLARY CLINTON?
Barbara Ehrenreich, The Nation, 26 Jun 07
Hillary's attempt to create a national health insurance system — which she will have to undertake a second time as a presidential candidate — was a disaster in every way. Procedurally, she screwed up by conducting the planning under conditions of extreme secrecy, not even bothering to reach out to potentially supportive members of Congress, never mind the usual populist trimming of few televised town meetings. What Bernstein omits is her out-of-hand dismissal of the kind of single-payer system the Canadians have, which led to a tortured 1300-page piece of legislation that almost no one could comprehend. The bottom line, unnoted by Bernstein, is that, despite the right's charges of 'socialized medicine', her plan would have maintained the nation's largest private insurance companies' death grip on American health care.
Ronald Brownstein: The plague or the cure?
Kurt Loder: 'Sicko': Heavily Doctored
Think Progress: Moore's 'SiCKO' passes fact-check test
Eunice Wong: Movie Review: Michael Moore's 'SiCKO'
Video: Michael Moore blasts Wolf Blitzer
Ezra Klein: Spring Training for Universal Health Care
IBD: Canadian Doctor Blasts Socialized Medicine
Joe Conason: The GOP's Big Health Scare
Philadelphia Inquirer: Doctors Endorse Single-Payer
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