Monday, November 18, 2013

But Americans don't have to wait for health care ... do we?

[Lovis Corinth, Self-portrait with skeleton, 1896]
The Commonwealth Fund's just-released annual report on health care in 14 developed countries shows that, once again, America spends more than anybody else on health care--50% more per capita than the next-most-expensive nation, Norway, and 182% more than the least expensive nation in this survey, Italy.

Well, yes, say some proud Americans, and we get what we pay for. We have the best health care in the world.

Maybe not. Other surveys regularly report that Americans die younger than people in other developed nations. Commonwealth reports that America leads the pack in avoidable deaths per 100,000 population: 96 in America compared with 55 (France) to 83 (U.K.) in the other nations surveyed. I was surprised to learn that America has fewer doctors per 1000 population than all the other countries except Japan.

OK, say defenders of America's health care, but people in those other countries have to wait much, much longer to see a doctor, and they wait nearly forever for elective surgery such as hip replacement.


Commonwealth surveyed wait times in eleven of the countries, and here's where America stands:
  • If you're sick and need a same-day or next-day appointment, you're more likely to get it in Australia, France, Germany, the Netherlands, New Zealand, Sweden, or the U.K.
  • If you need care after hours, you're more likely to find it in Australia, Germany, the Netherlands, New Zealand, Norway, Switzerland, or the U.K.
  • America has a lot of specialists, but you're still more likely to get a speedy appointment with one in Germany or Switzerland.
  • America is quick to schedule elective surgery, but not quite as quick as Germany and the Netherlands. France, New Zealand, Switzerland, and the United States are all a little slower than those two, but not by much.
Ethical question: If a nation has poor access to basic health care but good access to expensive specialized health care, what does that say about its priorities?

Practical question: If Germany, which spends about half of what the U.S. spends per capita on health care, can insure nearly everybody and still maintain speedier access to all forms of health care, why can't we?

Tuesday, November 12, 2013

In the bleak midwinter (or dreary midautumn) - watch a British TV series!

[Foyle's War - one of the best!]
Yesterday I posted this update on my Facebook page:

During the months when it's too cold to walk my little dogs, I ride an exercise bike planted in front of my TV. I love watching long British TV series while I pedal: Upstairs, Downstairs, Doc Martin, As Time Goes By. I just finished Foyle's War. Any suggestions for what I should watch next?

The response was amazing - more than 70 comments to date. I decided to make a list for future reference, and I thought you might like to see it too.

First, to keep the list focused, I weeded out Irish, Australian, and American productions as well as stand-alone films, though some good ones were recommended. Then I added links for all the series that made the cut. As I was doing this, I remembered more UK series I've enjoyed--Midsomer Murders, Poirot, Miss Marple, the House of Cards trilogy with Ian Richardson, The Amazing Mrs Pritchard, Fawlty Towers (of course), Inspector Morse, Cadfael ... and the names keep coming.

Here are the British TV series my Facebook pals recommended. Ones I've watched and enjoyed are in bold.

Seven friends recommended Call the Midwife. I started watching once but forgot to continue. Tonight I re-watched the first episode, and this time I'll persist. It won't be hard. I read Jennifer Worth's first book last year and enjoyed it very much (see my review here).

Four friends recommended Prime Suspect. Yes! One of my all-time favorites. Helen Mirren is fantastic.

Three each suggested Lark Rise to Candleford, Miranda, and Rev. Winter in Illinois is long. I'm glad to have these to look forward to.

Two each mentioned Ballykissangel, The Bletchley Circle, Broadchurch, Downton Abbey, Dr Who, The Inbetweeners, Inspector Lewis, Luther, Monarch of the Glen, and Sherlock. I watched the first episode of The Bletchley Circle tonight. A bit grisly in places, but promising.

These made the list too:

At Home with the Braithwaites, A Bit of Fry & Laurie, Black Adder, Bleak House, Brideshead Revisited, Cranford, Father Brown, The Grand, The House of Eliott, Hustle, Inspector George Gently, Jeeves & Wooster, Kingdom, Land Girls, Little Dorrit, Lovejoy, Misfits, Mr Bean, New Tricks, The No. 1 Ladies’ Detective Agency, Our Mutual Friend, Parade’s End, The Promise, Rosemary & Thyme, Rumpole of the Bailey, The Sandbaggers, Seven Up (a film series, really, but close enough), Sharpe, To the Manor Born, The Tudors, Vera, The Vicar of Dibley, The White Queen, Wives & Daughters, A Year in Provence.

And then there are the wonderful Adam Dalgleish series starring Roy Marsden, based on mysteries by P.D. James, and the Inspector Lynley series based on Elizabeth George's sprawling novels, and ... well, there are just too many to name. They almost make me want to ride my stationary bike--or at least sit in the recliner in front of the TV.

Friday, November 8, 2013

"We hate the government, except for the large part of it that helps us"

[Colin Woodard's map of 11 American nations]
I just got back from another nation.

According to Colin Woodard, author of American Nations (and this recent article summarizing that book's thesis), the United States comprises eleven distinct cultures. By upbringing and acculturation, I belong to two of them, The Left Coast and Yankeedom. Earlier this week, I got together with friends in The Far West. I am still scratching my head.

Some of these friends hate the federal government, especially its Democratic representatives, and particularly the Obama administration. My views about government, Democrats, and Obama are radically different from theirs, though I understand why some people fear government overreach, I accept that good Republicans exist, and I occasionally disagree with President Obama myself.

But here's what baffles me. Everyone in the group of Far West friends I saw this week is a huge fan of VA hospitals, even though the US Department of Veterans Affairs is the second-largest department of the US government, and even though, as T.R. Reid points out in The Healing of America, VA healthcare is one of the world's purest examples of "socialized medicine."

Everyone in the group is also a huge fan of Medicare, even though Medicare is a US government program that closely resembles Canada's National Health Insurance, often derided by Obamacare opponents.

When I suggested that it would be nice if everybody in America had access to healthcare as good as that provided by VA hospitals or Medicare, everyone nodded. I think they were agreeing with me, though perhaps they were just being polite.

The thing is, we wouldn't have VA hospitals or Medicare if we didn't have a strong federal government.
  • The Veterans Health Administration, established during the Truman years as the Department of Medicine and Surgery, today "operates the nation’s largest integrated health care system."
  • Medicare, signed into law by Lyndon B. Johnson with Harry S Truman by his side, accounts for 14% of today's national budget--and that's without including the government's healthcare programs for the poor. Add Medicaid and the Children's Health Insurance Program (CHIP) and you bring the total up to 21%.
Of the seven of us gathered around a table at El Adobe Cafe earlier this week, five get Medicare, one gets VA benefits, and one is a caregiver. My friends love these programs because they need them, and they know what their lives would be like without them. At the same time, some of them hate the federal government that makes the programs possible.
I don't get it, but I've learned that arguing gets me nowhere. Even if these people are biting the government's outstretched hand, I'm glad they're getting fed. And speaking of food, El Adobe Cafe serves some of the best Mexican food I've ever eaten. The Far West gets some things exactly right.

Friday, November 1, 2013

Gimme that old-time health insurance ...

Yes, President Obama said that if we like our health insurance, we can keep it

Yes, that turned out to be false for a few million people.

Yes, the President chose his words poorly. Whether or not health reform became the law of the land, there’s no way any President could have known if we’d be able to keep our health insurance from one year to the next.

And with the changes mandated by the Affordable Care Act, insurance continuity would be even more of a crap shoot. Companies would tinker with benefits and prices in hopes of keeping the cash flowing after the reforms kicked in. They would certainly cut unprofitable policies or raise their prices stratospherically, or both. This was happening long before Obama took office; surely it would happen even more as insurance companies were required to, well, insure people.

So President Obama should not have made a promise he couldn’t keep.

However, I don’t think the President intentionally lied. I don't think he was naïve about insurance companies. I think he was naïve about Americans. I suspect he had no idea that so many Americans would actually like and want to keep those individual policies that 
  • cost significantly more than work-based policies 
  • hire people for the express purpose of finding trivial reasons to deny payment on claims
  • respond to claims by shutting down people’s policies or raising their prices way beyond affordability
  • refuse to insure people with any pre-existing conditions (e.g., people who have been kicked off their previous policies because they actually had to use them)
  • set limits on how much they will pay that are way lower than the cost of treating most serious illnesses
And that pretty much describes most of the policies that have shut down as a result of the Affordable Care Act.

Oh, how they will be missed.