Yes! magazine is one of my favorite progressive publications. The reason is that they tend to take a positive view of everything. That is unlike a lot of politically-oriented publications, most of which somehow manage to make everything sound dire.
The latest issue has several articles on health care. Specifically, they examine the case for single-payer, universal coverage.
On the right is a graphic from one of the articles, Has Canada Got the Cure?
by Holly Dressel.
The article was adapted from Holly Dressel’s book God Save the Queen—God Save Us All: An Examination of Canadian Hospital Care via the Life and Death of Montreal’s Queen Elizabeth Hospital, to be published in 2007 by McGill/Queen’s Press.
Her main point is this: Prior to 1971, both countries had similar health care outcomes, and similar health care systems. In 1971, Canada created their single-payer, universal health care system. Now, health outcomes in Canada are better, while their health care costs are much lower.
The other articles are worth reading, too. There is one (If You Ask Maine) that described the health care reforms that have been undertaken in Maine. The interesting thing about that article, is that it describes the process the state government undertook to design their reforms.
Another article, A Growing Movement, describes the initiatives across the USA to improve health care delivery and reduce costs. The author implies that there is a growing trend toward acceptance of the need for a single-payer universal health care system. The authors refer to the effort by John Conyers to pass legislation that would bring about such change.
Conyers writes about the effort on his blog, here.
What is discouraging to me about the initiatives mentioned in A Growing Movement, is that, so far, the efforts in the USA really miss the main point put forth by policy experts who favor single-payer universal coverage. The only way to afford coverage for all is to get rid of the inefficiencies inherent in a multi-payer system. The efforts in the individual States are all patchwork programs that fail to streamline the bureaucracy. This argument is outlined by Steffie Woolhandler and David Himmelstein in their article on TomPaine.com, Massachusetts' Mistake.
I have no doubt that change is coming. Every medical student I have spoken to in the past year has been in favor of universal, single-payer coverage. Admittedly, it has been a biased sample, and I suppose they might have a tendency to tell me what they think I want to hear. But still, it does indicate that tomorrow's medical leadership is likely to be favorably disposed toward a system that makes sense.
Comments
I agree that anyone who believes the current health system is remotely sustainable is on drugs -- and anyone who believes "consumer driven health care" is the answer is on some really good ones.
I am not however sold on a single payer system. I think the French & German systems (which are universal, but not single payer) hold a lot of advantages:
1) They are more likely to pass as they will face less political resistance.
2) They are generally more effective. Time to visit specialists and time for non-critical operations/diagnostics are lower than in Canada/UK.
3) Canada arguably has the worst health system (for an industrialized country) outside of the US, I can't understand the progressives love affair with a system that would be considered failed in any comparison except to its completely unfunctional southern neigbor's.
Posted by: Dan R. | September 17, 2006 12:46 AM
Way to go. Americans need to realize that it doesn't have to be this way. So many accept the profiteering, the waste, the denial of care, and the unnecessary deaths as "just the way it is" in our perfect, free-market fantasy land. Studies like this are a wake-up call, showing people that the U.S. can and should learn from other countries.
Conyers' bill is our best hope, and let's not forget the popular SB 840 in California. After Arnold's veto, it will be reintroduced, and eventually passed.
Posted by: JN | September 17, 2006 1:43 AM
Having not read the California bill -- and not seen an in depth review (from a health policy standpoint), I am reluctant to comment. However, I am suspicious of how they will deal with the combination of ERISA plans, CMS dictated requirements for Medicaid, Medicare, etc.
The individual and small group market (the only insurance mechanism states have control of) isn't large enough to push systematic change in most areas.
Posted by: Dan R. | September 17, 2006 1:50 AM
"Canada arguably has the worst health system (for an industrialized country) outside of the US"
don't know about other countries, but having experienced both of these systems they both share a certain sloppiness and lack of overall management, i.e. an elderly hospitalized patient will have their recovery from hip replacement or whatever managed minutely, while the patient him or herself slips off into eternity due to nobody managing their overall condition, due to the hospital staff not knowing that they were pretty healthy before the stay and the patient's regular doctor not wanting to tread on the surgeon's territory in manageing the hospitalized patient. Ironically, the more progressive health insurers in the US are wading deeply into the waters of disease management and such themselves to overcome this problem, but for them it has to be an "intervention" as though the concept of keeping a patient alive while their acute problem was treated was somehow outside the normal scope of medicine.
Posted by: z | September 17, 2006 11:47 AM
The graphs make it appear so simple. But of course he statistics are not adjusted for anything, so are little better than the meaningless slogans and spin we get from our politicians. The Massachusetts plan is a fraud - lots of promises with no way to pay for them. The California plan that was vetoed was a fraud - ditto. The politicians who whine the most about the current system are the same ones responsible for driving up costs with more and more mandates. In California that includes "seismic retrofitting" costing untold billions with no additional benefits for anyone, and "mandatory nurse staffing", which sounds great in principle, but basically gives nurses more pay for less work, while making healthcare even less affordable for everyone.
After 20 years in healthcare economics, I know I'm not smart enough to figure out a system that will work well for most people at an affordable cost. But I know our politicians and political system cannot possibly figure it out either. I would rather take my chances with the crazy system we have, where I at least have some choice, than with a system designed by politicians and run by bureaucrats, most of whom understand neither healthcare nor economics.
Posted by: Paul | September 17, 2006 3:51 PM
Nobody knows how to do it. But we do know that a system with 25% overhead costs simply cannot last.
Obviously, we would not want a system deisgned by politicians. We would want it designed by people who know what they are doing. Proably a few politicians qualify, but most do not.
The comment about "bureaucrats" is unwarranted. Bureaucrats are people who work in government agencies. Some are good at what they do; others are not.
The VA health system, while not user-friendly, is highly efficient, and generally has good outcomes. (reference). It is run by bureaucrats. It also is not sufficiently scalable to expand to meet the needs of everyone. But it does show that government-run institutions can be both efficient and effective.
Posted by: Joseph j7uy5 | September 17, 2006 8:40 PM
"Every medical student I have spoken to in the past year has been in favor of universal, single-payer coverage."
This is because most medical school campuses make the Democratic party seem like Genghis Khan. It is simply unacceptable at most schools, especially the top ranked ones, to disagree with the idea that there should be universal health care. At least in the preclinical years. Once these people actually get out into practice, I've found the residents/young attendings generally give a big middle finger to a) more government intervention, and b) the prospect of substantially lower pay (which is inevitable, despite what SP proponents claim. yay for 60k a year surgeons in germany!). Academic medicine tends to be much more left-leaning than the profession as a whole.
Posted by: A medstudent | September 20, 2006 2:44 PM