What would a gold-plated Cadillac health care plan look like to you? By the sound of it, you might think it’d cover such superfluities as annual trips to Swiss medical spas, cosmetic surgery on demand and weekly thermal seaweed wraps …
Read the article at Salon here.
Until recently, the high-deductible health insurance plan – pay less up front, and more when you get sick – was something of a novelty product, marketed to the young and healthy. Now, however, high-deductibles are rapidly going mainstream – whether for young or old, professionals or poor alike…
Read the article at Salon here.
The story of healthcare reform in the United states begins not with Obama, Clinton or even Johnson, but almost a century ago, in the years leading up to World War I. Although the Socialist Party of America had called for insurance for workers “against accident, sickness and lack of employment” as early as 1904, it wasn’t until 1912, when the platform of Theodore Roosevelt’s Progressive Party called for a system of health insurance, that it emerged as a major political issue … Read this article in the July 2013 issue of In These Times
During the second presidential debate of 2008, Tom Brokaw asked Barack Obama and John McCain: “Is healthcare in America a privilege, a right or a responsibility?” Obama, unlike McCain, did not hesitate to respond plainly that healthcare “should be a right for every American.” He proceeded to make healthcare reform a major goal of his presidency…
Read this article in the July 2013 issue of In These Times.
A great human disaster is now unfolding in the many Eurozone countries that have agreed to slash spending, wages, and living standards to meet the demands of fiscal austerity. One facet of this story that has received far too little attention, however, is the effect of these measures on the health of these nations…
Find it here in the Spring 2013 issue of Dissent.
Americans die earlier than those in other high-income nations, despite spending twice as much on health care. This, of course, is old news.
What makes the National Research Council’s January 9 report, U.S. Health in International Perspective: Shorter Lives, Poorer Health, such an interesting read is its comprehensive approach to the tangled question of why, exactly, this remains the case.
A couple of facts first. Drawing on a substantial body of literature, the report compared the US to 16 other “peer countries,” i.e. developed, high-income nations, mostly in Western Europe. Among these 17 countries, life expectancy was lowest in the US among men and second lowest among woman, with particularly poor life expectancy for those under age 50.
No particular disease or demographic explained this rather dismal global performance: we had, for instance, the highest infant mortality rate, the highest homicide rate (6.9 times higher) and firearm homicide rate (19.5 times higher), the highest AIDS rate, and the second highest mortality rate when considering all noncommunicable diseases. Our death rate was worse than average with respect to cardiovascular, respiratory, infectious, endocrine, neuropsychiatric, skin, and perinatal conditions, with notable superiority only in the area of cancer and digestive disease. This despite spending more than twice as much on health care as other OECD countries (in 2009, $7,960 per capita versus $3,223), which amounts to about 18% of the total GDP.
While the explanation for these outcomes is clearly multifactorial, a couple of interesting points stand out. For instance, the frequently bemoaned health behaviors of Americans, while clearly a contributing factor, are not enough to explain our poor health. While we consume more calories, use seatbelts less, and consume more illicit drugs, we also smoke less cigarettes and imbibe less alcohol, on average. Socioeconomic factors also clearly play an important role, with higher rates of poverty and inequality in the United States, and less availability of safety-net programs. But interestingly, even when considering advantaged groups only (the insured, upper-income, educated), health outcomes remain inferior. Indeed, when we look only at “amenable” mortality, a metric of those deaths theoretically preventable with currently available medical therapies, the US performed worst among 16 countries.
Clearly, then, however much we might squirm and squeal, it is impossible to exonerate the contribution of our vaunted health care system. System factors cited in the study include less overall visits by US patients to health care providers; overall lower physician density; a lower percentage of physicians engaging in primary care; worse continuity of care; greater delays in care; greater financial barriers in accessing care, with Americans facing higher deductibles, copayments and out-of-pocket expenses at the time of health care utilization; and, of course, lower rates of insurance, with the US having the worst rate of coverage of all OCED countries except Mexico, Turkey and Chile.
Everyone therefore now finally acknowledges that the US has worse health outcomes than other high-income nations, and at a much higher cost. Yet oddly, it remains positively radical to conclude from this fact that perhaps we might benefit from borrowing from our better-performing peers. It is considered particularly inappropriate to suggest that we take on the one element common to essentially all of these other systems: their truly universal basis, and the advantages with respect to efficiency, coverage, and comprehensiveness that result.
On the contrary, the most commonly proposed solutions we hear involve making our system even less like those of our better-performing peers, and even more like itself. Our only salvation, it is frequently heard, is to further the commodification of health, to empower patients to become savvier care consumers, to drive down costs and improve quality by unleashing the inexorable power of the market panacea. More on why this is utter nonsense at a later date.
When the “Occupy Wall Street” protests first erupted in the autumn of 2011, few could have foreseen how rapidly the movement would at first swell, and then spread, over the face of the nation. Similarly, of course, few predicted that the abuse of a street vendor in Tunisia would spark a wave of uprisings throughout the Arab world. But such is the unpredictability of the politics of protest, particularly when the seeds of discontent are already deeply sown.
Adam Gaffney 