What would Martin Luther King say about the state of our Health Care “System?”


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This is from San Clemente single-payer warrior Dr Don McCanne this morning; one of his daily “quote of the day” e-mails that Vern is subscribed to:

“Of all the forms of inequality, injustice in health is the most shocking and inhumane.”

Dr. Martin Luther King Jr., March 25, 1966

from Truthout, January 12, 2017
Noam Chomsky: The US Health System Is an “International Scandal” — and ACA Repeal Will Make It Worse (by C.J. Polychroniou)

Selected quotes of Noam Chomsky:

First, it is important to remember that the US does not accept the Universal Declaration of Human Rights — though in fact the UDHR was largely the initiative of Eleanor Roosevelt, who chaired the commission that drafted its articles, with quite broad international participation.

The UDHR has three components, which are of equal status: civil-political, socioeconomic and cultural rights. The US formally accepts the first of the three, though it has often violated its provisions. The US pretty much disregards the third. And to the point here, the US has officially and strongly condemned the second component, socioeconomic rights, including Article 25.

Rejection of Article 25, then, is a matter of principle. And also a matter of practice. In the OECD [Organization for Economic Cooperation and Development] ranking of social justice, the US is in 27th place out of 31, right above Greece, Chile, Mexico and Turkey. This is happening in the richest country in world history, with incomparable advantages.

All of this is part of the background for the US departure in health care from the norm of the OECD, and even less privileged societies. But there are deeper reasons why the US is an “outlier” in health care and social justice generally. These trace back to unusual features of American history. Unlike other developed state capitalist industrial democracies, the political economy and social structure of the United States developed in a kind of tabula rasa. The expulsion or mass killing of Indigenous nations cleared the ground for the invading settlers, who had enormous resources and ample fertile lands at their disposal, and extraordinary security for reasons of geography and power. That led to the rise of a society of individual farmers, and also, thanks to slavery, substantial control of the product that fueled the industrial revolution: cotton, the foundation of manufacturing, banking, commerce, retail for both the US and Britain, and less directly, other European societies. Also relevant is the fact that the country has actually been at war for 500 years with little respite, a history that has created “the richest, most powerful, and ultimately most militarized nation in world history,” as scholar Walter Hixson has documented.

For similar reasons, American society lacked the traditional social stratification and autocratic political structure of Europe, and the various measures of social support that developed unevenly and erratically. There has been ample state intervention in the economy from the outset — dramatically in recent years — but without general support systems.

As a result, US society is, to an unusual extent, business-run, with a highly class-conscious business community dedicated to “the everlasting battle for the minds of men.” The business community is also set on containing or demolishing the “political power of the masses,” which it deems as a serious “hazard to industrialists” (to sample some of the rhetoric of the business press during the New Deal years, when the threat to the overwhelming dominance of business power seemed real).

As for reasons, we can return to the more general question of social justice comparisons, but there are special reasons in the health care domain. To an unusual extent, the US health care system is privatized and unregulated. Insurance companies are in the business of making money, not providing health care, and when they undertake the latter, it is likely not to be in the best interests of patients or to be efficient. Administrative costs are far greater in the private component of the health care system than in Medicare, which itself suffers by having to work through the private system.

Comparisons with other countries reveal much more bureaucracy and higher administrative costs in the US privatized system than elsewhere. One study of the US and Canada a decade ago, by medical researcher Steffie Woolhandler and associates, found enormous disparities, and concluded that “Reducing U.S. administrative costs to Canadian levels would save at least $209 billion annually, enough to fund universal coverage.”

The facts about public support for universal health care receive occasional comment, in an interesting way. When running for president in 2004, Democrat John Kerry, The New York Times reported, “took pains .. to say that his plan for expanding access to health insurance would not create a new government program,” because “there is so little political support for government intervention in the health care market in the United States.” At the same time, polls in The Wall Street Journal, Businessweek, The Washington Post and other media found overwhelming public support for government guarantees to everyone of “the best and most advanced health care that technology can supply.”

But that is only public support. The press reported correctly that there was little “political support” and that what the public wants is “politically impossible” — a polite way of saying that the financial and pharmaceutical industries will not tolerate it, and in American democracy, that’s what counts.

Implicit submission is not imposed by laws of nature or political theory. It is a choice, at least in societies such as ours, which enjoys the legacy provided by the struggles of those who came before us. Here power is indeed “on the side of the governed,” if they organize and act to gain and exercise it. That holds for health care and for much else.

Comment by Don McCanne:

Of the OECD nations, the United States ranks near the bottom in health care justice. And yet Congress is moving forward with legislative action that likely would further diminish justice within our health care system. On this day dedicated to Martin Luther King Jr, it seems appropriate to ask what he would say. Well, we already know because he did say, “Of all the forms of inequality, injustice in health is the most shocking and inhumane.”

Noam Chomsky explains the appalling truth of how this could be in the United States – the wealthiest nation on earth. Yet, he explains, we do not have to accept health care injustice since power is on the side of the governed if we organize and act to gain and exercise it.

Postscript from former Florida Congressman Alan Grayson

Dear Vern,

I broke my leg a few months ago, playing basketball with my kids. (Note to self: stop lunging for every loose ball I see.) I actually sat cross-legged on the court for a few minutes, thinking that the pain would go away. It certainly did not.

My wife took me to the hospital, where X-rays showed that the part of the bone inside my hip looked like someone had hit it with a sledgehammer. My surgeon expressed extreme skepticism that he could put it back together again. He recommended a hip replacement, which puts a metal head and a plastic shell in place of the ball and socket inside your hip. I said fine.

Not being Henny Youngman, I refrained from asking him whether I would ever be able to play the piano again.

The surgery took place the morning after I was admitted to the hospital, and I was released two days after that. Less than 72 hours from in to out.

The hospital bill was $69,240.

That’s just the hospital bill. The surgeon, emergency room doctor and physical therapist all billed me separately.

Admittedly, this bill was on the high side. According to a report by the International Federation of Health Plans, the average hip replacement in the United States in 2015 cost $29,067. Only the most expensive five percent of hip replacements here cost $57,225 or more. Somehow, my hospital bill alone was more than that astronomical sum. But even $29,067 is a very pretty penny.

(Blue Cross, my insurance carrier, said no to the $69,240 hospital bill, and paid $32,395 instead – which is still a lot of money. I paid a $500 copayment, having already paid my deductible for the year.)

I worked for four years as an economist. Economists associate the price of things with their cost of production. (Specifically, their marginal cost of production, but for present purposes, that’s an unnecessary nuance.) In a free market, competition is supposed to drive prices down to the cost of production.

What did it cost the hospital to host me for those three days? It had to pay the nurses, but there certainly were fewer nurses than patients, so at most we’re talking about three days of nurses’ pay. It had to pay for the metal and plastic parts that the surgeon put inside me, and the surgical glue that was used to close me back up, which are mass-produced. (2.5 million Americans have replacement hips.) The hospital had to buy the medicine that it gave to me, which was modest, because I’m really not into opiates. It had to buy my gown, the kind that ties in the back. It had to feed me eight meals of hospital food. It had to pay for the electricity and water for my room (and the cable TV, which I did not use, but thanks anyway.)

The hospital had to pay for one hour’s worth of time in a surgical room, which I never got to see because I was under general anesthesia during that hour. (I hate the sight of blood, especially mine.) It had to pay for three days’ worth of time in the room where my hospital bed was located, one of 211 in that hospital. My hospital opened in 1993, so those costs have been amortized over 24 years already.

Let’s say that each bed cost $100,000 to build, 24 years ago. Amortize that over a quarter of a century, and it works out to $11 a day.

The hospital didn’t have to pay the doctors, because they billed me directly. It didn’t have to pay taxes, because it’s a non-profit.

Perhaps I’m simply obtuse, but I’m not seeing $69,240 in costs here.

The International Federation of Health Plans helpfully notes that the exact same surgery costs $16,225 in the UK, one of those “socialized medicine” countries that Fox News always warns about. That’s half as much as the cost here. In Spain, a hip replacements costs $6757, less than a quarter of the cost in the United States, and less than a tenth as much as my hospital bill.

Why would the same surgery cost $29,067 in the United States, $16,225 in the United Kingdom, and $6757 in Spain? Well, our hospitals don’t really compete against each other; in Orlando, two hospital chains own pretty much everything. Our insurance companies don’t really compete against each other; in Florida, Blue Cross alone has almost half of the market. (Across the state line, in Alabama, it’s 92%.) Both the hospitals and the insurance companies can charge almost whatever they want, provide as little as possible in return, and keep the difference.

My hip replacement surgery went very well. Two weeks later, I was walking without assistance. Two months later, I walked eight miles in one day at Petra, in Jordan. As to the quality of my care, I have no complaints. And I concede that my health is more important than the cost of care.

But $69,240 for one hour in surgery and three days in the hospital? Come on!

We spend more money on healthcare than any other country, our life expectancy is fiftieth in the world, and even now, one tenth of us have no health coverage. People wonder how we can spend so much, and enjoy so little in return.

As I see the GOP begin its ruthless gutting of Obamacare, I feel constrained to point out that regress is not progress.

Better health, less cost. What’s so complicated? And is that asking so much?

Courage,

Alan Grayson.

“These prices are insane!”

“Crazy Eddie” pitchman Jerry Carroll


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"Admin" is just editor Vern Nelson or associate editor Greg Diamond sharing something that they mostly didn't write themselves, but think you should see. Before December 2010, "Admin" may have been former blog owner Art Pedroza.