Vera’s Similitude – Part I

Vera’s a very bright woman who manages the very successful practice of one of Los Angeles’ best orthopedic surgeons, her husband, Dr. Harold Markowitz, who’s operated on me more than once. She knows that 31% of this country’s healthcare costs are drained by administering the program, she’s aware of the colossal savings that can be effected by a centralized medical database (with lots of privacy protection) to make sure authorized physicians and medical experts have what they need as well as track a patient’s progress on a longer-term basis (like the program already developed by Kaiser Permanente or the central system advocated by President Obama), and she believes passionately in preventive medicine.

But Vera is exceptionally distrustful of anything medical that looks and feels like a government administered “national healthcare system.” She is biased, because her and her husband’s income might be severely negatively impacted under certain healthcare plans under consideration, but with that bias in mind, she makes some good points.

Here’s Vera’s “take” on those countries, like France, the U.K., Sweden, Canada, etc. with national and universal healthcare. Because these massive medical structures are funded annually to a fixed budget approved by the legislature, there is a tendency for funds to run really low in the last quarter (sometimes even earlier). This results in long waiting periods, particularly late in the year, when on occasion even life-saving and immediately-necessary-but-very-costly-procedures are deferred (often with disastrous consequences) until the new fiscal year begins (and the program receives funds). The rich pay for access to a private network of super-doctors; everyone else just suffers.

Ezra Klein, writing for the April 7^th Los Angeles Times, supports Vera’s position (but not necessarily on life-threatening issues): “[I]]t’s it's true that in Canada and Britain, the two countries most often cited in discussions of what nationalized healthcare might mean, some patients report having to wait months for some elective treatments. Sometimes… But we've got waiting lines too -- along with 50 million uninsured and a system that costs more than twice as much per person as that of any other country. We've just managed to hide our lines through clever statistical gimmickry.” Uninsured Americans often wait, postpone or just avoid seeking medical help because they can’t afford the healthcare.

Why do we spend so much more per patient? Is it inefficiency or better health care? Klein notes (and also tracks Vera’s opinion): “Britain and Canada control costs in a very specific fashion: The government sets a budget for how much will be spent on healthcare that year, and the system figures out how to spend that much and no more. One of the ways the British and Canadians save money is to punt elective surgeries to a lower priority level. A 2001 survey by the policy journal "Health Affairs" found that 38% of Britons and 27% of Canadians reported waiting four months or more for elective surgery. Among Americans, that number was only 5%. Score one of [sic] us!” Of course, “elective surgery” might include fixing your knee, because you can’t walk without a walker or struggling with a bad back that pretty much prevents you from leading anything like a normal life… but these are not “life threatening” injuries.

Since the U.S. seems to be moving rapidly in that direction, as our nations’ core businesses are unraveling over the cost of healthcare (look at the $1,500-$2,000 included in the sticker price per car in healthcare costs which burdens the big three automakers under their collective bargaining agreements), and as the mass of those without any coverage rises with the unemployment statistics, I thought I might want to present Vera’s “national private healthcare” plan as an alternative. And I welcome readers to suggest alternatives. Unfortunately, you’ll have to wait for Part II of Vera’s Similitude until the next blog.

I’m Peter Dekom, and Vera and I thought you might want to know.