POSTED ON DECEMBER 23, 2009:
Full Coverage or None
To be the richest country in the world, our health coverage seems to be in poor condition
FACT: We pay twice as much for healthcare as our peer countries, and they provide coverage for everyone.
FACT: The United States is the only industrial country in the world that does not provide healthcare to all its citizens. Germany figured it out under Otto Von Bismarck in 1883. England brought universal care to its citizens in 1907.
FACT: About 45 million Americans have no health insurance. In his book The Healing of America, T.R. Reid cites a number of other troubling facts about the U.S. healthcare system in comparison to other industrialized countries:
We rank last in healthy life expectancy at age 60 -- a Commonwealth Fund measurement.
We rank low in treatment for asthma, diabetes and kidney disease--though we pay much more in treatment costs for these chronic diseases.
The death rate in the United States from avoidable medical and surgical mistakes is higher here than any other peer country.
Infant mortality rate is twice as high in the United States than in Sweden, Japan, Norway, France and more than 50 percent higher than in England, Germany, Switzerland and Canada.
We do not offer prenatal and neonatal care to all women and their babies. Every other peer country does.
Zero people go bankrupt because of unpaid medical bills in Europe, Scandinavia, Japan and Canada. Under our system, 700,000 Americans file bankruptcy each year because of medical bills.
There is a reasonable fear that current health care reform would allow the government to ration care. But who makes these decisions now? We turn over healthcare decision making to for-profit private insurance companies.
Why is it that when you visit a doctor, receive treatment at a hospital or fill your prescription, your insurance company calls the transaction a "loss?"
Their profit model is determined by their "medical loss ratio"--the difference between premiums collected and the use of healthcare services. In other words, they make money by denying their policyholders the care doctors say their patients need.
Given the market structure, and I use the term "market" very loosely here, it comes as no surprise that insurance companies discriminate against the sick. They cancel coverage from their own members (paying customers) once serious and expensive illness strikes. Such practices are illegal in every other industrialized country.
The U.S. Department of Health and Human Services found that 12.6 million non-elderly adults--36 percent of those who tried to buy insurance on the private market--were discriminated against by for-profit insurance companies in the past three years.
Robin Beaton of Waxahachie, Texas lost her health care coverage when she was diagnosed with breast cancer after her insurance company discovered she allegedly lied about her health history. What was the lie? She failed to mention she had been treated for acne on insurance application.
Otto Raddatz was diagnosed with Hodgkin's disease and lost his health insurance for failing to disclose that a CT scan five years earlier had indicated gall stones and a weakening of blood vessels in his heart. The reason he hadn't provide this information to his insurance company is because his doctor had not mentioned these medical conditions to him.
A House Subcommittee on Oversight and Investigation uncovered 20,000 instances of insurance cancellation, allowing insurance companies to avoid over $300 million in claims. Recently, Wendell Potter, a health insurance executive with 20 years of experience in the industry, revealed that insurance companies routinely dump patients who are sick to help meet company earnings expectations.
To be sure, denying coverage is not a widespread practice, but it has a great effect since such a small percentage of patients account for all health care spending.
The United States spends 35 percent of all health care costs on about 1 percent of the population.
The Committee also discovered that insurance employees receive performance reviews that include a metric for successfully canceling insurance coverage for policyholders who require expensive medical care. WellPoint's Blue Cross praised an employee for dropping thousands of policyholders and avoiding almost $10 million for medical payments. In 2007, the L.A. Times reported that one insurer paid bonuses to its employees for their involvement in canceling policies.
Who can defend this?
Apparently, Senator Tom Coburn. In his latest diatribe in the Wall Street Journal, Senator Coburn makes the hysterical claim that Medicare will kill senior citizens if health reform passes. It is true that healthcare, like any other good or service, is subject to the basic laws of economics--we all live in a world of scarcity. In other words, we have always rationed care in this country.
But this is a strange claim to make from someone who doesn't really support Medicare in the first place and knows full well the widespread provider abuse of the Medicare program. Indeed, Senator Coburn has written and spoken extensively about Medicare fraud.
A recent Dartmouth University study found that health expenditures in the last six months of life vary greatly from region to region with no demonstrable impact on health status or longevity. If you live in Miami, Fla., Medicare will spend $50,000 more in the last six months of your life than if you live in Minneapolis, Minn. But you won't live longer, and you won't be any healthier.
If you live in El Paso, Texas, Medicare will spend about $15,000 per enrollee, three times more than it will spend for enrollees in Grand Junction, Colo. Again, there is no difference in health outcomes despite the threefold advantage in expenditures.
T.R. Reid tells the story of Nikki White, who contracted lupus shortly after graduating from college. Ms. White, like millions of other Americans, made too much money to qualify for public health insurance and could not receive private insurance because of her pre-existing medical condition, an automatic disqualifier for coverage. Had she lived in any other industrialized country, she would have received medical care to treat her lupus and lived her normal life span. But she lived in the richest country in the world. She died at the age of 32.
Our present system kills 20,000 Americans each year in the prime of life simply by denying treatment for treatable disease. That's rationing. Like the United States, other rich countries don't cover everything but ... they cover everybody. And they have results that put the American system to shame.
I'm ready for reform that covers everybody. I'm ready for reform that ends discrimination against the poor and the sick. I'm ready for reform that helps every citizen receive the care the doctors say is needed. Aren't you?
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