Thursday, January 26, 2012

It's enough to make you sick

Last evening, Occupy Greenville sponsored a Teach-In featuring a showing of Sick Around the World, followed by a spirited and lively discussion. There were maybe a dozen of us in attendance.

This follows our showing of Sick Around America last week--both shows produced by PBS Frontline.

It's a depressing situation: how did this country's health care system get so messed up? Can we fix it? Will 'Obamacare' make it better or stretch our existing makeshift solutions to the breaking point?

Sick Around the World profiled five rich, capitalist, Western countries, and how they have managed health care for their citizens: Taiwan, Switzerland, Germany, Japan, and the UK. All systems are far superior to ours, and running on less.

From the transcript of "Sick Around the World"--some highlights:

T.R. REID: [voice-over] Here's something else that's different. Japanese patients have much longer hospital stays than Americans, and they love technology, like scans. They have nearly twice as many MRIs per capita as Americans, eight times as many as the Brits.

So how do they keep costs under control? Well, it turns out the Japanese health ministry tightly controls the price of health care, right down to the smallest detail. Every two years, the physicians and the health ministry negotiate a fixed price for every single procedure and drug. Like the items in this sushi bar, everything from open heart surgery to a routine check-up has a standard price, and this price is the same everywhere in Japan.

If a doctor tries to boost his income by increasing the number of procedures, well, then, guess what? At the next negotiation, the government lowers the price. That's what happened with MRIs, which are incredibly cheap in Japan. I asked the country's top health economist, Professor Naoki Ikegami, to tell us how that happened.

[on camera] In Denver, where I live, if you get an MRI of your neck region, it's $1,200, and the doctor we visited in Japan says he gets $98 for an MRI. So how do you do that?

Prof. NAOKI IKEGAMI, School of Medicine, Keio Univ.: Well, in 2002, the government says that the MRIs, "We are paying too much. So in order to be within the total budget, we will cut them by 35 percent."

T.R. REID: So, if I'm a doctor, why don't I say, "Well, I'm not going to do them, then. It's not enough money"?

Prof. NAOKI IKEGAMI: You forgot that we have only one payment system. So if you want to do your MRIs, unless you can get private-pay patients, which is almost impossible in Japan, you go out of business.

T.R. REID: [voice-over] So that shafts the medical device makers and must limit innovation, right? Well, no. Japanese manufacturers of scanning equipment, like Toshiba, found ways to make inexpensive machines they could sell to doctors. And guess what? Now they're exporting those machines all over the world.
The whole show was like this, a series of PRICE REGULATING realizations that blew my little mind. (Why do we accept the AMA's flimsy-ass excuses for everything?)

In Taiwan, everybody must opt into the system, and they issue a standard government health care card that you just pop into a slot, like paying to park: Zip. All I could think, watching them flip that wonderful little card in and out of various slots, was how these rabidly-anti-government guys around here (waves to my radio-show callers!) would never go along with something like that: galdurnit, I won't get a guvmint ID card! I can hear it now--echoes of last week's Ron Paul rally dancing in my head.

What is interesting is that once they finally get it established, even conservatives in these countries appreciate (and want to continue) universal health care for all of their citizens. And at that point, it becomes another political football, as liberal politicians threaten the populace that conservatives want to cut benefits. (Could that actually happen here?)

In Switzerland, their system was a wreck as late as 1994. It took a lot of political will to change it. Their administrative costs are now 5% of their medical budget, compared to our whopping 22%. From the transcript:
[on camera] One of the problems we have in America is that many people -- it's a huge number of people -- go bankrupt because of medical bills. Some studies say 700,000 people a year. How many people in Switzerland go bankrupt because of medical bills?

President PASCAL COUCHEPIN: Nobody. It doesn't happen. It would be a huge scandal if it happens.

T.R. REID: [voice-over] But here's Switzerland's challenge. Having achieved universal health care, it has to decide how much citizens are willing to pay. Today, an average monthly premium for a Swiss family is about $750. But there's pressure to raise the premiums. And it's already the second most expensive health care system in the world, although still much cheaper than ours.

What's interesting about Switzerland is that after LAMal's success, people in this proud capitalist country see limits now to the free market.

[on camera] Could a 100 percent free market system work in health care?

Pres. PASCAL COUCHEPIN: No, I don't think that. If you do that, you will lose solidarity and equal access for everybody.
In conclusion, there appears to be three major factors to make universal health care work:
These capitalist countries don't trust health care entirely to the free market. They all impose limits.

There are three big ones. First, insurance companies must accept everyone and can't make a profit on basic care. Second, everybody's mandated to buy insurance, and the government pays the premium for the poor. Third, doctors and hospitals have to accept one standard set of fixed prices.

Can Americans accept ideas like that?

Well, the fact is these foreign health care ideas aren't really so foreign to us. For American veterans, health care is just like Britain's NHS. For seniors on Medicare, we're Taiwan. For working Americans with insurance, we're Germany. And for the tens of million without health insurance, we're just another poor country.

But almost all of us can agree that this fragmented health care mess cannot be ignored. The longer we leave it, the sicker it becomes, and the more expensive the cure.
I'll repeat the question here: Can Americans accept these ideas, do you think?


Update: Walkupy's recent bust in Madison County, Georgia, did not dim the hardy spirits of our Occupiers! We tweeted news of the arrest to the world and the Madison County Sheriff's Office was bombarded with phone calls from all manner of lefty busybodies such as your humble narrator. The Powers-That-Be responded by setting them free with all charges dropped--WOOT! Very happy about that, as one of our local Greenville Occupiers has joined up with Walkupy for a stint. (We love you, Lynne!)

From the Anderson Independent Mail, here are some very nice pictures of Walkupy on the roads.


At left: Daisy and the dangerous sign-carrier. (Would this man hit anybody with a sign?)

Speaking of busts, the official consiglieri/producer of the DAISY DEADHEAD SHOW, Gregg Jocoy, was cited for having a sign that was TOO BIG, outside the federal courthouse last week, during the Occupy the Courts action. Yes, there is some dopey Greenville County ordinance about the size of signs.

And what about Newt's enormous signs all over the county (that still haven't been taken down by his lazy supporters)? Well, they don't count, since it's a PICKETING ordinance! Big signs are okay, but not if you are walking around with it... I guess he might hit somebody with it? He'll poke his eye out!

So, an expensive citation, which I suspect was really because he was out there yelling about the courts. Occupy the Courts was a national succcess, if (as usual) receiving little media coverage.

I love seeing the Occupy movement stretch out in all directions!


JoJo said...

I'm still w/o health insurance. I sent in my appeal to the State of MA and they still haven't assigned me a hearing date. I sent a f/u letter to them and they called to say that it takes 8-10 weeks. I'm well over 10 weeks now. It sucks. I am concerned that if Obama isn't re-elected, the Republican Pres. will gut the plan.

MA requires everyone to have health ins. or face a penalty on their state taxes. So in my appeal I told them that since THEY require I be covered, THEY can pay for it as I have no income. But I don't meet their criteria b/c I don't have kids, I am not on disability or 'long term' unemployed.

Lisa Golden said...

I'm so glad you highlighted this because I missed the program.

I suspect many in our nation will have to be dragged kicking and screaming toward universal health care. I have noticed though that the quickest way to get at the people who want a free market solution to change their tune when they lose their employer provided insurance.

West said...

They actually deport their illegal aliens- so they don't drive UP medical costs due to NOT PAYING...

West said...


Japan has universal coverage, but it's not universal health care or socialized medicine... Please try and keep up...

Anonymous said...

I lived in Japan for close to 10 years - the health care insurance system starts out cheap (about $10 a month) but can rapidly go up and become a major monthly payment (according to long term residents - my bill was paid for by my job, so I have no idea).

Japanese pharmaceuticals are often ineffective and not well tested, doctors are not very well trained, and as far as Japanese dentists go, you can keep them.

Japanese are famous for not taking care of their teeth, and this is reflected in the quality of dentistry. A teeth cleaning in Japan consists of running a piece of floss around your teeth (ten bucks). They will often try to drill without Novocaine because 1)Novocaine takes 10 minutes or so to be effective and 2) in that stretch of time, multiplied, you could squeeze other patients in (more Yen).

It's difficult to compare systems between countries since Japan, like most Asian nations, is loathe to criticize itself - they are not going to be honest about the deficiencies and are blind as to the backwardness of their medical system.

For both dentists and trauma care, the US has some of the best. Mexico and Thailand have excellent dentists as well - one Thai dentist was dissing some work done on me as "typical cheap Japanese work" because they tend to use cheap metals that fall apart for bridge work.

While I take care of myself with better food and natural supplements, etc. and try to stay away from pharmaceuticals, if I ever get in a car accident, (God forbid) I hope it happens in the US. What I'm worried about is downgrading of care in the US, which will bring us more to a level with the rest of the world (not a good thing).

There are countries that have excellent medical care in specialty clinics (there are books on medical tourism) but I will bet you find that Japan is not listed in any of them.

DaisyDeadhead said...

Anon, I'm sure you're right, but there are people in the USA with no health care at all, and even an inferior system would be better than none. (I've also had some very BAD experiences with American dentists, so what you say terrifies me! I always forget how much worse it could be.)

West, if there was a national ID card provided only to citizens, that would in effect prevent any undocumented workers or foreigners from participating. There are many foreign workers in Switzerland and Taiwan, and that is how they restrict it: citizens only, proof is the ID card.

Would you go along with a national ID card, in that case?

Anonymous said...

"Anon, I'm sure you're right, but there are people in the USA with no health care at all,"

Yes, and some of us still have jobs, some still have COBRA for 3 years or so after losing a job, and can afford to pay. Those who don't should prove citizenship and get some sort of government coverage.

We already had coverage for no income or low income in this state, however no checking for residency and the system got strained. Universal health care is not necessary if not everyone wants it or needs it.

I do believe in safety nets, but I don't believe in trashing good care for a one size fits all (and it usually doesn't) program.

Frankly I think the trillions that went to bail out Chase, et. al. should be considered a loan, paid back with interest and partly used to fund homeless and health care issues, partly used to get people back into their foreclosed homes, but that will be a cold day in hell when it happens - I'm sure.

TheDom said...

NOTE: I posted this on Shakesville, and received the following comment from someone named "TheDom" and re-posting it here.

Hi there; tried to leave a comment on your blog re: health care outside the U.S., but I couldn't get past the word verification (I tried ten times, then tried the accessible option, and no go; and couldn't find your contact info). So here's all about Canada:

I'm Canadian, and we've had endless debates about how to fix what's wrong with our system. However, very few people will go bankrupt due to medical bills, unless it's for extremely expensive drugs or devices (not covered by most health plans).

The problem here is timely access and the issue of shortages. For example, data from a few years ago showed that almost a third of Canadians didn't have a family doctor. That causes problems in terms of prevention and access to specialists.

Due to the lack of primary care, and the dearth of walk-in clinics in many areas, people often go to hospital emergency departments for non-emergency illnesses like colds and minor sprains. As a result, emergency room wait times in some areas, like Montreal, can rise to 24 hours after triage for non-life-threatening illnesses.

Meanwhile, not all areas are equal. As an example, Quebec has some of the most severe health care shortages for primary care, specialists and hospital services. Though the Canada Health Act requires health care be portable everywhere in the country, Quebec often doesn't refund the full amount of care charged by other provinces, because it wants to limit costs. As a result, if you move to Quebec and get a Quebec health card, you will have trouble traveling outside the province. Many service providers in Ontario, B.C., etc., just won't accept your card. I've been told personally not to expect service with such a card and physicians have told me about instances of not getting paid by the Quebec Ministry of Health.

Each province has set rates which it pays its health care providers for each procedure (physicians, lab staff, specialists, etc). One of the consequences is that higher rates elsewhere attract physicians away from lower-paying jurisdictions. This is also true for Canada in general vis-a-vis the U.S., which has much higher prices and doctor incomes, and makes Canadian health care much more expensive, and gives Canadian doctors much more bargaining power, than is the case in European countries such as France.

The Mighty Doll said...

I'm in Ontario, Canada. Most of my health bills are paid for, and I don't see a bill. I don't see wait times for urgent care, as I'm told by american relatives I do. In fact, many of my american relatives have received far inferior care to what I receive.

The primary care physician thing is improving from TheDom's report, and I've never experienced a hospital wait time in excess of 8 hours, and only then when it was non-urgent (stitches late at night-after walk ins were closed). Further, the emergency rooms I've been in have been excellently managed, and in one case, my son was bumped up the second he took a turn for the worse.

I love my health care system, I truly do.

veejayem said...

Another comment left at the Shakesville open thread:

Britain has the National Health Service (still) although the present government wants to fiddle around with it. It works very well in my experience. My sister was treated for Stage 2 cancer, when one of her regular mammograms worried the technician, my sister had further tests within a week (fortunately it turned out to be some scar tissue form previous surgery). My mother developed heart disease in her later years, her care included surgery at a leading hospital, several stays in intensive care with one-to-one-nursing, a battery of medication and a succession of doctors who strove to keep her in good health and, at the end, maintain some quality of life for her. The NHS picks up the slack when things get too complicated or dangerous for private hospitals ~ a number of women have gone into private maternity hospitals and ended up in the nearest NHS facility with state medical staff fighting to save them and their babies. There are NO state hospitals in England with religious affiliations, which can make a big difference to women's reproductive health. Such care is expensive ~ theoretically it is paid for through National Insurance, which the government automatically deducts from people's salaries. This contribution should probably be increased.

My own medical history ~ asthma, dodgy thyroid, close relatives with heart disease and cancer ~ would make me an expensive and unattractive proposition for health insurance companies. Luckily the NHS saves me from having to worry about that.

sheila said...

VERY interesting! I'm excited about Japan's "way" and didn't know this until now. And I agree with Lisa GOlden (above comment) we'll be dragged kicking and screaming... sort of like a little child at the store who can't get what they want, and they end up being happy in the end.

I think most people have resigned themselves and secretly LOVE the idea of "Obamacare".

My only fear is like many, that if we elect a republican, it'll be gone. GREAT article Daisy.

p.s. to anonymous... I think the point Daisy is trying to make is not to adopt the exact way the Japanese do their healthcare, but that regulations/caps/etc work.

zhinxy said...

Radical anarchist socialist libertarian that I am, still bereft of any real medical insurance, and suffering for it, I say that the free market and socialism, are both wonderful things, that universal health care is our goal, our only endpoint, and all of that.

But I shudder at the idea that the only way we'll ever do it is to put it in the hands of the Nation-State.

When, oh WHEN and WHY did so many on the Left abandon healthy anti-government sentiment to the right wing! When did we decide the only way to get our socialism or democracy or unionization on is to use the channels of State power?

Long time ago, few on the left or right remember (And it wasn't THAT long ago) poor working people used to organize, usually through Fraternal Lodges, pool resources, and buy the services of physicians for their members.

So effectively, the US gov. stepped in to RAISE the costs of poor people's healthcare by banning the practice.

What could we do with this model, and others today?

Organizing, paying in, forming Health Credit Unions, and open source models.

Unionizing and driving costs down, forming public hospitals that are genuinely PUBLIC, held directly by us and for us! Private hospitals that are genuinely private, not some strange, murky HMO creation.

All of that, and more, I think, could give us universal, abundant health care. A fine mix of non-corporate free marketeering and good old voluntary socialism, that would spread out a thousand interlocking, overlapping safety nets.

You want to cap and bargain down prices? What would a thousand worker's unions be able to do to bargain down prices?

A possibility? A goal? A whole new paradigm for the hippies of the future? I think so. Anarchist, and all that.

The hollow right wing notion of private insurance and "private charity" is rightly laughed off by the Left. But "The force of the State" is the only option we can come up with against it? All of it completely elides the options of us taking real, collective, direct action.

And of course, another danger, a big danger - The "This is our money" problem. The problem that denies the care to the "illegals," that casts a dim eye on "Wasting" our money on trans-people's surgery. The thing that puts the vulnerable in the hands of the system.

Now, that said, would an NHS style public option actually be more sensible and LESS government controlled than the state-corporate soup we have now?

Damn right it would.

And would regular Americans, even with their (Very healthy, if twisted by the darker sorts of propagandists) Anti-gov sentiment accept it? Damn right they would, once they had it, and Democrats with any guts would know that, and pass it through.

Streamline the messy government/corporate system we have into a less messy government/corporate system. Do it now, and do it well. America will accept it, and the Republicans, for all their posturing, know their base won't be lured back to the hysteria once they can finally get their backs fixed and their prescriptions filled. The Democrat with the guts to realize this may not now exist, however.

But once we're at that point, once we've got our health needs met. let's be careful, and vigilant, and imaginative and not just accept that it's the best we can do. Because a real "Public Option" is public as in OURS and not dependent on whims of the powers that be.

zhinxy said...

Second link was supposed to be to this, phooey!

SnowdropExplodes said...

veejayem is wrong that the NHS is paid out of National Insurance. When the Welfare State, including the NHS, was set up, that was the case, but for a long time NI and income tax have been indistinguishable, and the same money from either could go to any purpose in government.

The NHS, of course, *is* socialism - indeed, introduced by the only socialist government this country has had, and it's basically the third rail of British politics: they are trying to muck about with it now, but it could cost them dearly if people get the idea that they're doing away with any part of its services.

I'm unemployed, and get my prescriptions for free; it would cost me about £8 a month for my current medication requirements if I lost that eligibility. When I needed my citalopram for depression, this was vital.

I also get free dental checks, although I don't get free cosmetic work, only fillings and such to keep my teeth and mouth fully functional.

It hasn't been truly great for a long time, but it was set up in 1947 - the world has changed a lot since then and the demands we make of healthcare have expanded. But it is still one of the most fundamental expectations we're brought up with in this country: fall ill, and there will be someone there to help look after you, as part of the social contract. It's no accident that when the debate about Obamacare was raging and Republican politicians laid into the NHS, that lots of Brits stepped up to defend it online. Us Brits love our socialised healthcare, and are more willing to pay taxes that they believe will be targeted for the NHS than otherwise.

Sarah@APV said...

Here from Shakesville! *g*

I live in Ontario, Canada, in the area of Toronto but not in the City itself.

The universal health care in this country is not perfect, but I tell anyone that asks I would rather pay my higher taxes and have health care then have no health care at all.

Let's say my husband and I get into a car wreck. He has a head injury that's not too serious but requires a hospital stay of a few days and I have a broken leg and arm. All the necessary care required to make both of us better is covered. Casts, hospital stay (everything from bed to meds to nurses care), any emergency room care needed, any care provided by police/fire and in the ambulance to the hospital. No charge.

Now, on leaving the hospital, should we need medication we would have to pay for it. Should I need physical therapy, the government only pays up until a certain amount of money has been spent, then the rest is up to the client. However, say my arm starts causing me pain and I need to go to the doctor to have it looked at and they decide to take an MRI to see if things are looking good. The doctor visit and MRI are no cost.

My husband, through his work, has 100% coverage for medication which is nice, because I take a fair few all the time. We pay out of pocket then send the slips to the insurance company for refund. Not everyone has coverage through work however, but there are programs in place for people that need help. If a person makes less than a certain amount per year, the government will pay for medication once the client has paid a deductible.

As I said, it's not perfect, and there are some people that need to use alternate means for coverage. There are non-government programs in place for people needing coverage that don't qualify for government help.

We don't have any dental coverage. So unless someone has it through work, it's out of pocket. However, if someone is uninsured, almost all dental offices charge significantly less.

Eyes aren't covered either far as I can remember; the eye test or spectacles. Last time I had my eyes tested the test was around $110. A fair amount of places offer the test free or discounted if you purchase glasses/contacts at their place after the test.

I'm lucky in that I do have a family doctor and have had her as my doctor for about 15 years. She took my husband on because he's considered a relation. The shortage of family doctors however, is very real. But there are tonnes of walk-in clinics! Between me and the closest hospital (a 10 minute drive straight down a main thoroughfare) there are at least seven! Unfortunately, most of them close by 7pm most every night.

The downfall of our health care system is the mental health area. My family doctor can't find out who's accepting patients outside her area and I can't call up a psychiatrist and ask if they're accepting new patients because, and I'm not kidding here, I'm the patient. I've been without a permanent psychiatrist for almost five years now because the system is so messed up and psychiatrists are so few. One thing that makes it harder for me to get a psychiatrist is that I'm not newly diagnosed or needing a diagnosis.

West said...

Word of the Day: Dhimmitude
Dhimmitude is the Muslim system of controlling non-Muslim populations
conquered through jihad. Specifically, it is the TAXING of non-Muslims in exchange for tolerating their presence AND as a coercive means of converting conquered remnants to Islam.

ObamaCare allows the establishment of Dhimmitude and Sharia Muslim
diktat in the United States . Muslims are specifically exempted from the government mandate to purchase insurance, and also from the penalty tax for being uninsured. Islam considers insurance to be "gambling", "risk-taking", and "usury" and is thus banned. Muslims are specifically granted exemption based on this.

zhinxy said...


Amish, also exempt.

Occupy! said...

For interested parties:

Comprehensive Slide show explaining US Health Care Reform act.

Anonymous said...

Nice post, I found this on google

john q. public said...

if i could afford it i'd move to any of these countries & adios uncle sam.