Internal Medicine

The U.S. has free choice of private medical plans, but no generally available governmental alternative unless you fall into one of several limited categories (Medicare for the elderly, Medicaid for the poor, the VA for our veterans, some state programs, mostly focused on children, but some programs are more encompassing). We spend about $2.3 trillion a year on healthcare, 31% of which relates to administrative costs, and we have about 46 million human beings without health insurance. Healthcare costs have been given a substantial degree of credit for the demise of General Motors and Chrysler as well as dozens of other businesses; smaller employers are dumping the healthcare plans by the thousands as unaffordable. Medical costs bankrupt a million Americans a year. So everybody here wants universal healthcare, right?

I’m listening to radio programs, reading news reports, stating with credible voices that the elderly will be cut off from the benefits as they grow older, being allowed to die from whatever ails them… after all, President Obama told everyone that “end-of-life” healthcare is hugely expensive with limited comfort or medical benefit to the recipient. Costing about $20,000 a week, the question was raised if the nation could continue to support such formidable costs with limited results… costs that account for the bulk of all medical costs. Rumors of a future with hospice consulting in lieu of real medical treatment terrified large numbers of our older citizens. As you get older, your empathy for illness rises exponentially – you feel the ravages of time.

The elderly want to know they are not being put out to pasture, set out on an ice flow to drift into a timed end of their days. The anti-healthcare-reform groups have seized on this issue, but how much of this fear is justified? There is the fact that a vast number of elderly would opt for “comfort care,” which is focused on the quality of life, not merely extension by all means possible; is this all the administration is saying? Americans also want to keep their existing private plans, even with healthcare premiums doubling every ten years. But we want manageable costs, healthcare at all levels of earning (or non-earning power) and as much choice as possible.

In Canada, with the national government acting as the single insurer, all residents have free access to hospital and physician care. No deductibles. No co-pays. Provincial programs supplemental coverage with shared costs (with the patient) for pharmaceuticals, long-term care, in-home care and medical equipment required at home. Canadians see doctors more and use prescription drugs more than Americans, on average.

Canadian physician, Dr. Michael Rachlis, writing for the Los Angeles Times on August 3^rd notes: “On costs, Canada spends 10% of its economy on healthcare; the U.S. spends 16%. The extra 6% of GDP amounts to more than $800 billion per year. The spending gap between the two nations is almost entirely because of higher overhead. Canadians don't need thousands of actuaries to set premiums or thousands of lawyers to deny care. Even the U.S. Medicare program has 80% to 90% lower administrative costs than private Medicare Advantage policies. And providers and suppliers can’t charge as much when they have to deal with a single payer [insurer].”

Rachlis notes that all is not perfect, but it works pretty well all things considered: “The Canadian system does have its problems, and these also provide important lessons. Notwithstanding a few well-publicized and misleading cases, Canadians needing urgent care get immediate treatment. But we do wait too long for much elective care, including appointments with family doctors and specialists and selected surgical procedures. We also do a poor job managing chronic disease.

“However, according to the New York-based Commonwealth Fund, both the American and the Canadian systems fare badly in these areas. In fact, an April U.S. Government Accountability Office report noted that U.S. emergency room wait times have increased, and patients who should be seen immediately are now waiting an average of 28 minutes. The GAO has also raised concerns about two- to four-month waiting times for mammograms.”

Republicans have vowed to do everything in their power to stop the U.S. national healthcare movement – taking down healthcare is, to many such politicos, the same as taking down Obama. Ranks are closing. Filibusters are in the planning stages. Democrats are also divided... Blue Dogs (fiscally conservative) versus liberals. The healthcare coalitions are unraveling. Will they be put together again?

Industry lobbying groups are whittling away at the government’s “intrusion” into private healthcare. As President Obama gathered various “industry segments” to focus on “cost reductions” in anticipation of a new national program, apparently previously unpublicized government promises were made. The August 5^th New York Times: “Pressed by industry lobbyists, White House officials on [August 5^th] assured drug makers that the administration stood by a behind-the-scenes deal to block any Congressional effort to extract cost savings from them beyond an agreed-upon $80 billion… [T] the industry successfully demanded that the White House explicitly acknowledge for the first time that it had committed to protect drug makers from bearing further costs in the overhaul. The Obama administration had never spelled out the details of the agreement.”

What other secret agreements were made? Will a plan be adopted? Will it cover everyone? Will the “protests” that were being organized by plan opponents derail national healthcare and perhaps even the President himself? What exactly do you want to see happen?

I’m Peter Dekom, and what do you want?