Thursday, November 19, 2015

The United States, North Korea, Zimbabwe and Venezuela

We like to think of the United States as a modern, progressive nation that takes great care of its citizens. Yet we still have one of the least accessible, most expensive healthcare systems in the developed world, one where even the Affordable Care Act has catered to the insurance and pharmaceutical industries at the expense of consumers. Republicans, where they have a policy at all, would repeal that minimal statute and revert to an era of market-rate healthcare policies, with pre-existing conditions and aggregate benefit caps factored into the cost structure. For so much of America, particularly in the “gig” economy, where recourse is often only getting individual policies for any coverage, not having access to a group where costs and bargaining power can be amortized over a bigger body of covered individuals, would be nothing short of disastrous.
Our costs per individual coverage healthcare costs per annum remain thousands of dollars over the second most expensive nation, Switzerland, so you’d think that we are the best protected people with the best medical care on earth. By objective measurements, not only do we have the most expensive medical costs in the world, but the results are abysmal by western measurements.
The primary standards for measuring healthcare success include life expectancy and maternal mortality. As far as life expectancy goes, according to the World Health Organization, there are 38 countries – including virtually all of Europe (the laggards in Europe are former CIS and Eastern Bloc nations) and countries like Cuba, Chile and even war-torn Lebanon – with longer life-expectancies than the United States. Guess we are not getting our money’s worth; rich folks can afford that cutting edge stuff, but the rest of us get what we get.
So if life expectancy isn’t reflecting well on American healthcare, you’d think we’d do well on that other measurement at least: maternal mortality. We fail even more miserably under that standard. A woman giving birth in the United States is twice as likely to die as one delivering in Canada, a country with universal healthcare provided free for all.
According to a World Bank report released on November 12th: “The United States was… one of only 13 countries to have worse rates of maternal mortality in 2015 than in 1990 - a group that also includes North Korea, Zimbabwe and Venezuela… [T]he U.S. average has slipped from 12 deaths to 14 per 100,000 live births over the past 25 years, while Canada's is where it was in 1990, at seven.
“Over the same period Belarus has cut its maternal death rate from 33 to four, making it one of the safest places to have a baby, just behind the world leaders - Iceland, Finland, Poland and Greece - where only three mothers die for every 100,000 births… The world average is 216 deaths, ranging from 12 in rich countries to 546 in sub-Saharan Africa.”, November 12th. Ah, it is less than reassuring to know that things are steadily getting worse.
Not only are we slowly becoming a plutocracy, not only is the middle class contracting and sliding downwards and not only have 70% of working Americans generated less buying power every year for decades, but our healthcare standards simply are not keeping up with the rest of the developed world. That the big insurance and pharmaceutical companies are quite profitable, thank you, may be great for shareholders and the one-percenters, but the resulting rise in healthcare costs coupled with the decline in the quality of coverage just cannot be acceptable to most Americans. That Republicans – who initiated the call to universal healthcare during the Nixon administration and under Governor Mitt Romney’s tenure as governor of Massachusetts – now want to revert to the old world of exclusionary policies with staggering costs for those who need the care the most is amazing to me.
The schism between a White traditional society mired in the past and the growing progressive demographic diversity that is redefining the future of America perhaps reflect the irreconcilable differences that may rend this nation into a new groupings of fractious separate nation-states. It does seem that except for out-and-out slavery, the issues that defined our Civil War remain the great divisions between us. Nevertheless, if the healthcare system bothers you, perhaps it is time to fix the healthcare law we have – one that was passed only by catering to the profit desires of insurers and pharmas – and make it represent what’s best for most of us.
Think anything near this notion is remotely possible with the current congressional configuration? The majority in congress benefit greatly by leaving the law without the obvious and necessary fixes; it gives them a platform to rail against. Repair the statute and make it work? Lose the argument that “Obamacare” is a failure by fixing it, like every other piece of seminal social legislation – from income taxes to Social Security – ever enacted in this great nation? Reality seems to be a really difficult factor to deal with for our elected representatives. And running away from reality never works… ever.
I’m Peter Dekom, and we really need to replace inaccurate and sloganeering with hard, fact-driven policies that actually make life better for most of us.

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