Monday, July 16, 2007

Waiting for health care

Subject: The Waiting Game
Date: July 16, 2007 7:35:58 PM PDT
\The Waiting Game
by Paul Krugman

Published on Monday, July 16, 2007 by The New York
Times, distributed by Common Dreams

Being without health insurance is no big deal. Just ask
President Bush. "I mean, people have access to health
care in America," he said last week. "After all, you
just go to an emergency room."

This is what you might call callousness with
consequences. The White House has announced that Mr.
Bush will veto a bipartisan plan that would extend
health insurance, and with it such essentials as
regular checkups and preventive medical care, to an
estimated 4.1 million currently uninsured children.
After all, it's not as if those kids really need
insurance - they can just go to emergency rooms, right?

O.K., it's not news that Mr. Bush has no empathy for
people less fortunate than himself. But his willful
ignorance here is part of a larger picture: by and
large, opponents of universal health care paint a
glowing portrait of the American system that bears as
little resemblance to reality as the scare stories they
tell about health care in France, Britain, and Canada.

The claim that the uninsured can get all the care they
need in emergency rooms is just the beginning. Beyond
that is the myth that Americans who are lucky enough to
have insurance never face long waits for medical care.

Actually, the persistence of that myth puzzles me. I
can understand how people like Mr. Bush or Fred
Thompson, who declared recently that "the poorest
Americans are getting far better service" than
Canadians or the British, can wave away the desperation
of uninsured Americans, who are often poor and
voiceless. But how can they get away with pretending
that insured Americans always get prompt care, when
most of us can testify otherwise?

A recent article in Business Week put it bluntly: "In
reality, both data and anecdotes show that the American
people are already waiting as long or longer than
patients living with universal health-care systems."

A cross-national survey conducted by the Commonwealth
Fund found that America ranks near the bottom among
advanced countries in terms of how hard it is to get
medical attention on short notice (although Canada was
slightly worse), and that America is the worst place in
the advanced world if you need care after hours or on a

We look better when it comes to seeing a specialist or
receiving elective surgery. But Germany outperforms us
even on those measures - and I suspect that France,
which wasn't included in the study, matches Germany's

Besides, not all medical delays are created equal. In
Canada and Britain, delays are caused by doctors trying
to devote limited medical resources to the most urgent
cases. In the United States, they're often caused by
insurance companies trying to save money.

This can lead to ordeals like the one recently
described by Mark Kleiman, a professor at U.C.L.A., who
nearly died of cancer because his insurer kept delaying
approval for a necessary biopsy. "It was only later,"
writes Mr. Kleiman on his blog, "that I discovered why
the insurance company was stalling; I had an option,
which I didn't know I had, to avoid all the approvals
by going to 'Tier II,' which would have meant higher

He adds, "I don't know how many people my insurance
company waited to death that year, but I'm certain the
number wasn't zero."

To be fair, Mr. Kleiman is only surmising that his
insurance company risked his life in an attempt to get
him to pay more of his treatment costs. But there's no
question that some Americans who seemingly have good
insurance nonetheless die because insurers are trying
to hold down their "medical losses" - the industry term
for actually having to pay for care.

On the other hand, it's true that Americans get hip
replacements faster than Canadians. But there's a funny
thing about that example, which is used constantly as
an argument for the superiority of private health
insurance over a government-run system: the large
majority of hip replacements in the United States are
paid for by, um, Medicare.

That's right: the hip-replacement gap is actually a
comparison of two government health insurance systems.
American Medicare has shorter waits than Canadian
Medicare (yes, that's what they call their system)
because it has more lavish funding - end of story. The
alleged virtues of private insurance have nothing to do
with it.

The bottom line is that the opponents of universal
health care appear to have run out of honest arguments.
All they have left are fantasies: horror fiction about
health care in other countries, and fairy tales about
health care here in America.

Paul Krugman is Professor of Economics at Princeton
University and a regular New York Times columnist. His
most recent book is The Great Unraveling: Losing Our
Way in the New Century.

(c) 2007 The New York Times

BTW. The California effort is not much better.

This from Hana Beth Jackson on the California Progress Report blog:

With Senator Kuehl's SB 840, the true reform measure of the year having advanced another step last week, this week highlighted the lesser but still reform-minded bill, AB 8 which is authored by Senate Leader Perata and Assembly Speaker Nunez. After 2 hours and 50 or so witnesses later, the measure passed on a party-line (no surprise there). The bill is being touted as a landmark bill that will overhaul our state's $186 Billion health care system. In doing so, it would extend medical insurance coverage to 3.4 million working Californians by requiring employers without health plans to pay a 7.5% payroll tax to buy insurance for all its workers. Employees would be required to put in 4.5% of their income as a match.

Of course, when all is said and done, it still keeps the insurance industry alive and well and taking out lots of money that would otherwise go to provide health care, not health insurance. But until we're willing to buck up and create a Medicare-for-all type program, this has some legs and hopefully some benefit to the millions of Californians without any health insurance or access to adequate health care. This one will end up in a "Conference" where the Governor will put forward his still orphaned plan. Not surprisingly, no Republicans will support any of these discussions. It's the same old song---just another "job-killer" with the current Republican leadership demonstrating, sadly, that it is only interested in protecting its big corporate owners/donors.


That is, if you leave the insurance companies in place, as does AB 8, you leave the insurance companies richer and the health care system paying a 30% over cost. Then, if you do this, health care will be too expensive.
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