We recently discussed the stinging criticism of Sen. Chuck Schumer who called Obamacare a colossal political mistake and something that was not a priority for the American people. It was a remarkable admission from the third ranking and one of the most liberal Senate Democrats. Now, perhaps the most liberal departing member has given his own departing shot at the White House and Democratic Leadership. Retiring Sen. Tom Harkin of Iowa has gone public with criticism that the Affordable Care Act was badly written and should not have been passed. Like Schumer, he is not questioning the value of health care but said that the current law was not worth doing because of its inherent flaws.
Harkin’s criticism was a bit different from Schumer, who indicated that he would have preferred not to have passed health care in the first term at all. Harkin told The Hill newspaper that ObamaCare that the leadership and White House blew it when they had the majority and should have gone all the way to guarantee funding and a more logical structure to the program: “We had the power to do it in a way that would have simplified healthcare, made it more efficient and made it less costly and we didn’t do it. So I look back and say we should have either done it the correct way or not done anything at all.”
I spoke on Capitol Hill before the passage of the ACA and remarked that the legislation was in the worst condition that I had seen in 30 years in terms of a major piece of legislation. As someone who supports national health care, it was very disappointing, if not alarming, to see the condition of the law. The few sections that I reviewed read like a first draft from a LA’s computer. Democratic staffers told me later that they agreed and that the legislation was not ready. However, with the death of Kennedy (and the replacement by Brown), the Democratic leadership and the White House decided to push through the poorly crafted law on a muscle vote — which led to a number of Democrats being defeated on the marginal vote. The result is that the ACA has been a continual struggle as hundreds of serious drafting errors and flaws have had to be addressed.
Harkin is the retiring chairman of the Senate health panel and helped write the law.
My extra link post… 🙂
The degree of overweight/obesity in this country is reflected in our healthcare expenditures. According to the CDC, “The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars; the medical costs for people who are obese were $1,429 higher than those of normal weight.”
http://www.cdc.gov/obesity/data/adult.html
That’s one major reason we have high costs and poor outcomes.
Vixpix,
“people suffer from high blood pressure, obesity, smoking and other life style related poor choices in many countries.”
Thank you for your thoughtful response. With this comment, you seem to overlook the vastly different diets of people in other countries. For example, by and large, the people in France (and other healthier countries) eat REAL food, not the processed crap we Americans typically eat (pizza, frozen pre-made lasagna, Cream of Soup casseroles, etc.).
Heck, many people in the EU are ticked that there might be a free trade deal with the U.S. that would allow for the importation of our chicken and beef. (and I don’t blame them–eww!)
http://www.washingtonpost.com/world/europe/free-trade-with-us-europe-balks-at-chlorine-chicken-hormone-beef/2014/12/04/e9aa131c-6c3f-11e4-bafd-6598192a448d_story.html
People in other countries do not suffer from these lifestyle-related ailments at the same rates that we do. Our obesity rank is about 35% (that’s obese, not just overweight), whereas most of Europe is about 15%! That’s not from better doctors’ advice–that’s from a different way of eating.
http://www.oecd.org/els/health-systems/Obesity-Update-2014.pdf
Paul — it was their land, and they tried to defend it. We made countless treaties with them, and we broke them. We gave them blankets infected with small pox, and wiped out entire villages. We wiped out the buffalo, we forced them into reservations that had nothing to do with the life they had led, and to this day, we have left them with the worst school system in America. There is currently a huge problem with the rape of reservation women, preyed upon because of problems with whether the county or some other entity has jurisdiction. I don’t think they owe us any apologies.
Vixpix1 – like all tribal groups the Indians always tried to extend their territory. Ownership of tribal land is different than ownership as we see it. The same problem arose in Ireland. The English made a treaty with Irish lords, however those lords really did not have the power to sell the land or make the treaty. The latest scholarship shows that the Indians who sold Manhattan to the Dutch were actually just there for the summer. They were vacationers who were happy to sell what they did not own.
Read George Armstrong Custer’s My Life on the Plains to get a feel for what Indian treaties and warfare was like prior to the end of the Indian Wars. Read The Empire of the Summer Moon to see how the Comanche built their empire.
Karen S — your fevered imagination may be prolific, but it has no relation to the truth. I am on Medicare, and the care I receive is exactly the same as it was before I was on Medicare, the only exception being that I don’t have any copays on doctors’ visits. Medicare is great, extensive, cost efficient, and a model for what the American medical system ought to be.
Olly — I appreciate your passionate defense of our nation’s founding principles, but I believe that at every level, you’re arguments are based on an idealized but untrue vision of what went on then, and what is going on now. You talk about equality. What equality was there when we massacred the Native Americans, or had centuries of slavery, followed by decades of violent discrimination. Life, liberty and the pursuit of happiness also didn’t apply in these situations, any more than they have in our relations with foreign countries. We have supported one brutal dictator after another in Latin America, as long as they allowed us access to their natural resources on the cheap. We waged a war that left two million Vietnamese dead rather than allow a promised reunification election that President Eisenhower said that Ho Chi Minh would have easily won. When a president was democratically elected in Iran who threatened Western oil interests, we sponsored a coup that killed him. We did exactly the same thing to Allende in Chile. Do you think that if the main export of the Middle East was broccoli, we’d be fighting ISIS? You talk about the government deriving it’s just powers from the people. A recent study showed that what the majority of people want has the least influence on what politicians do, and what rich corporations and individuals want is what gets enacted. In reality, we are an oligarchy rather than a democracy.
America’s vision was not overgrown by any foreign philosophy; it was sold by the pound to those who had the money to buy it, and the idea that it will be restored by your fourth self evident truth is a fantasy the NRA uses to promote gun sales.
Vixpix1 – you forget that Indians attacked Europeans first and were a constant threat, especially to those living on the fringes. Indians also attacked each other on a regular basis and committed genocide. The Last of the Mohicans does not have that title because whites wiped out the Mohicans. The idea of the ‘noble savage’ is a construct of the 19th century. One of the worst Indian massacres in Arizona was led by another Indian tribe who volunteered their services, because they wanted some payback. There is a lot of grey in Indian relations and some of it is dark grey. BTW, Indians enslaved their captives (usually females and children) and bought and sold slaves. Now, not every tribe did this, there were some that were very civilized and fairly peaceful. You will not hear about them.
Inga:
If you read the article, it stated that Congress steps in to stretch Medicare out longer.
So, the author’s assumption is that it doesn’t really matter, because Congress can step in and raise taxes or take some other measure, such as cuts to Medicare that have already happened through Obamacare. So the author urges to ignore the trustees.
Medicare recipients already receive far less benefits than the previous generation, compared with premiums paid, and the same will go for the next generation.
“The Federalist philosophy you dredge up is 240 years old, and most of us have outgrown it.”
Yeah, like a weed!
Vixpix,
You and whoever “us” is have outgrown the Federalist philosophy? Did you outgrow equality? Did you outgrow the unalienable right to life, liberty and the pursuit of happiness? Did you outgrow the principle that government derives its just powers from the citizens? Did you outgrow the right of the people to abolish the existing government when IT outgrows the power it was bestowed?
Do you understand strategic planning and change management? Do you understand just how difficult it is to change the culture of an organization let alone that of an entire nation? The founding fathers gave us, through the Declaration of Independence, a vision of what our nation aspires to be.
The founding generation didn’t live under a government in 1776 that believed in the principles of equality, liberty and unalienable rights and most definitely a government “of the people” wasn’t something the King had in mind. These founding principles were something they believed should be what every civil society should be built upon and it was that vision that gave energy to the cause for independence.
In every strategic plan there is a gap between the vision and the current state and we certainly had a gap to manage. The constitution is the framework by which our government is to be guided as we continue towards becoming “a more perfect union”; as they work in the “gap” towards the vision. The constitution has an amendment process that allows for the many changes society will go through.
We didn’t outgrow this philosophy; it was overgrown by a completely foreign philosophy that abandoned our vision’s first three self-evident truths. We will either weed this progressive overgrowth out or we will implement the fourth self-evident truth.
Chip S.– The French national health plan has produced medical outcomes that match ours, despite spending half as much per capita as we spend. All I’m trying to suggest is, why don’t we come up with a system that is as cost efficient. I don’t really care what the GDP number is. If both you and I manufacture widgets, and mine are as good as yours but cost half as much to make, wouldn’t you want to figure out how I as doing it? Why doesn’t this apply to medical systems? I don’t really care about a specific optimal number.
You are right, France doesn’t charge for medical school and it does control physicians fees. It also is much stricter regarding medical lawsuits, so that a French doctor pays for one year’s medical insurance what an American doctor pays for one month. However they’ve done it, they’ve put together a high quality medical system that covers every citizen at a much lower cost than what we pay. Once again, as one widget maker to another, don’t you think it would be worth looking at how they do it.
BTW, Americans believe that the government controlling doctor’s fees will lead to doctors abandoning medicine and becoming Wall Mart greeters. France has more doctors per capita than we do.
As to the issue of “quality health care”, what I meant was “quality health care”. That is, the kind of health care that keeps people healthy and cures them when they’re sick. If any of the types of health care you mention don’t do that, then they should.
That is what “single payer” means — a government monopoly on payment will mean a government monopoly on service (even if ‘privately owned’), and that always guarantees worse service.
Lol, I’ve had much better service with MediCare. No screwups that require me to have a bruising phone fight with an insurance company. No grey areas. Simple, affordable and effective.
If you have a plan that provides quality health care to all Americans, and reduces the percent of GDP spent on health care to match that of France, and isn’t a national health plan, let’s hear it.
My fingers are tired, so I’ll be brief.
1. Why is France’s pct of GDP the optimal one to spend on HC? I say the optimal amount is what people freely choose to spend, in the absence of price distortions. (Not saying our current system lacks price distortions. Just saying I don’t know how to pick a magic number representing optimal spending for anything.)
2. I don’t know how France computes its HC spending. For example, if it subsidizes med school and then controls physicians’ fees, some part of HC spending may be categorized as education spending. (BTW, is there such a thing as spending “too much” on education, the way there seems to be wrt HC?)
3. You dodge a huge issue by saying “quality health care” w/o specifying the level of quality to be provided “to all Americans”. Do you mean “VA quality”, “Medicaid quality”, “Medicare quality”, or “Blue Cross quality”? I’m fine with Medicaid, and even some expansion of it. But I’m not fine w/ that being the standard of care for all, nor am I fine w/ providing “platinum” coverage for all.
Prairie Rose — people suffer from high blood pressure, obesity, smoking and other life style related poor choices in many countries. Getting a heads up from a doctor is one thing that might get people to rethink their choices. But I think that what causes us to lead the world in preventable deaths is that, unlike countries with national health plans, we have tens of millions of citizens for whom a doctor’s visit is prohibitively expensive, so they get neither the benefits of an early preventative warning or the benefits of early treatment.
I totally agree that diet and exercise could prevent many of the conditions from which we suffer.
vixpix, thanks for your thoughtful reply @12/5, 9:54 pm. Here are my answers to the questions you posed:
I do not challenge that the American medicine is among the best in the world. Wouldn’t that lead you to wonder why it’s the 37th ranked system in the world?
You don’t say what ranking you’re referring to, but I assume it’s based on llife expectancy at birth, in which case I have a couple of responses. First, countries differ in their criteria for reporting “live births”. (See Table 1 here.) The US is one of the 13 countries (counting the UK as one country) that reports all live births. France, by contrast, only reports live births after 22 weeks of gestation. This is a big deal, as preterm births are a major driver of infant mortality. How big? According to the CDC:
The main cause of the United States’ high infant mortality rate when compared with Europe is the very high percentage of preterm births in the United States.
And what causes the high percentage of preterm births in the US? I think a large factor is mothers’ “lifestyle” choices, but I can’t say for sure.
What about mortality rates for non-infants? Lifestyle and genetics play huge roles. A mortality-rate study I’d like to see would compare the rates of Norwegians to Americans of Norwegian descent, French to Americans of French descent, etc. As for the US lifestyle, I don’t think our homicide rate can be blamed on the US health-care system.
Your proposed explanation of the poor US ranking is non-universal insurance coverage: 41 million people don’t have medical coverage, and people without it are 40% more likely to die.
You don’t offer a source for your “40% more likely to die” figure, but I do know that most studies of the relation b/w HI and health outcomes are unable to distinguish correlation from causation. This is important, b/c people who are already in poor health have to pay more for HI if they’re able to get it at all. That’s the reason extending coverage to people with pre-existing conditions has been a goal of most or all HI reform proposals. But the relation b/w HI and health outcomes isn’t entirely clear. The most recent, and best-designed, (nejm.org/doi/full/10.1056/NEJMsa1212321) study of the effects of Medicare expansionfound
no significant effect of Medicaid coverage on the prevalence or diagnosis of hypertension or high cholesterol levels or on the use of medication for these conditions. Medicaid coverage significantly increased the probability of a diagnosis of diabetes and the use of diabetes medication, but we observed no significant effect on average glycated hemoglobin levels or on the percentage of participants with levels of 6.5% or higher.
That study did find some positive outcomes, specifically: Medicaid coverage decreased the probability of a positive screening for depression and it nearly eliminated catastrophic out-of-pocket medical expenditures.
It’s not clear to me that expanded Medicaid is the most efficient way to achieve those gains, however.
Finally, there’s the elephant in the room: equality. I admire your forthrightness in admitting that the American left would never tolerate a medical system that had a great disparity between the rich and the poor. I think this is really the fundamental point of disagreement on the HC issue.
By your criterion, it would be fine if we wound up with a system that slightly raised the HC provided to the poor at the cost of greatly reducing the HC available to the non-poor. I think this is a bad outcome for several reasons.
First, I see no sound ethical argument that says I shouldn’t be allowed to spend my money on better HC if that’s my choice. I don’t know how you can defend a policy that says it’s ok to purposefully increase mortality rates among the non-poor (not “the rich”).
Second, you neglect dynamics. Take the case of pharmaceuticals. The cheap generics available today are the result of R&D that was funded by the high prices of brand-name drugs while they were under patent protection. If we revoked patent protection, we’d get much cheaper drugs today for sure. But what do you think would happen to the flow of new drugs? The same thing is true of many HC innovations. To make my point in a different way: housing is also important to all people. If you mandated equal-quality housing to the poor and non-poor, what do you think would happen to the quality of the housing stock in the long run?
Third, your goal is unrealistic in a diverse society. Singapore is (hsph.harvard.edu/news/features/singapores-health-care-system-holds-lessons-for-u-s/) often held up as a shining example of country with an excellent HC system, with one of the highest life expectancies in the world. But there is a big disparity in the (ncbi.nlm.nih.gov/pmc/articles/PMC3924730/)LE by ethnic group there, ranging from 86.6 years for a Chinese female to 74.8 years for a Malay boy. (For comparison, in the US a white female’s LE is 81.2 years, while a black male’s is 71.1, so the gap between high and low in the US is lower by a year than it is in Singapore. We’re doing better, by your criterion.)
If people are uninsured b/c they lost their coverage while sick, I’m all in favor of helping them out. That can be done fairly easily thru a national high-risk pool. If people are uninsured b/c they’re here illegally, they should get legal. And if people are uninsured b/c they simply don’t want to buy it, that’s their choice.
None of these instances of a “lack of access” to health insurance is a good reason to remake a system that provides a very high standard of care–probably the best in the world.
The low-info types here may now proceed to blast away w/ their anecdotes or their misunderstood (or defective) statistics or their name-calling.
Chip,
You might not have been aware but the website only allows two hyperlinks per comment. I edited yours to remove all but two of them so they would post. For the future, if you would like the readers to have more than two links, additional comments can be made to include the extra links.
Chip S. — America probably has the highest quality of medical care in the world, but until recently one in six Americans couldn’t afford it. I think this is an intolerable situation; I think access to quality medical care is a human right. You don’t seem troubled by this. Your comments never deal with this fatal flaw in our system. Our medical outcomes are comparable to those of France, but we spend twice as much per capita. This also seems to not be of interest to you.
You scorn the study Inga cited, because it was based on talking to patients and doctors. Talking to the people in the medical system is of value. People are funny like that. If they feel that their system treats the haves no differently than the have nots, that goes a long way toward making people feel that their government cares. This is a feeling that is becoming harder to find in oligarchy that America has become.
I don’t wish to be a rigid ideologue. If you have a plan that provides quality health care to all Americans, and reduces the percent of GDP spent on health care to match that of France, and isn’t a national health plan, let’s hear it.
Vixpix1,
““Death from Preventable Causes” is the result of, until recently, having 50 million people without health coverage. People in this situation put off doctor’s visits for as long as possible, and what might have been curable in it’s early stages has gone too far.”
This is not the original result of not having health coverage; not eating well or smoking causes most of the diseases. According to the Harvard School of Public Health, “smoking, high blood pressure and being overweight are the leading preventable risk factors for premature mortality in the United States, according to a new study led by researchers at the Harvard School of Public Health (HSPH)”.
““To have hundreds of thousands of premature deaths caused by these modifiable risk factors is shocking and should motivate a serious look at whether our public health system has sufficient capacity to implement interventions and whether it is currently focusing on the right set of interventions.””
(http://www.hsph.harvard.edu/news/press-releases/smoking-high-blood-pressure-overweight-preventable-causes-death-us/)
Smoking, high blood pressure, and being overweight are ALL lifestyle-related. Many cancers are lifestyle-related. I will not quibble with you that many of these problems are highly treatable if caught early. That doesn’t change how people got sick in the first place.
There is a nice long list at the aforementioned link breaking down the lifestyle-related causes of preventable death (most of them have to do with our diets). Here’s what the authors have to say about it:
“All of the deaths calculated in the study were considered premature or preventable in that the victims would not have died when they did if they had not been subject to the behaviors or activities linked to their deaths.”
However, no amount of doctors’ visits will prevent problems in the first place if people’s diets are not addressed. No amount of health insurance will prevent these problems either if people’s diets are not addressed.
Prairie Rose – one of the major risk factors is being male. We tend to ignore it hoping it will cure itself or hope it will fall off (as long as it is not necessary).
Inga, you’re the very definition of an ideologue, uninterested in facts, waving absurd “studies” like a bloody shirt.
According to the Commonwealth Fund, the world’s best healthcare is provided by the UK. Do you really believe that?
Do you know what the CF’s methodology is? Hint: not actual outcome data, b/c…
International health outcome measures that are comparable across nations are limited…
Also, as the stats I have linked to above indicate, they don’t give the answers that the CF is looking for.
So what are the CF’s rankings based on? cross- national surveys of patients and their physicians. Sorry, but I’m not nearly as interested in what people say as in what their actual health outcomes are. People’s reported satisfaction with most things depends as much on their expectations as it does on their subsequent experience.
But maybe you’re fine w/ survey data. OK, what are the questions asked? Let’s just say they vary widely in terms of seeming importance, and are not exactly comprehensive in their coverage. For example, the evaluation of the treatment of chronic conditions doesn’t include anything about 5-year survival rates for various cancers, but it does include “Physicians reporting it is easy to print out a list of patients by diagnosis.”
There’s also a subtle but highly effective bias in favor of single-payer systems in some of the questions asked. This is the most obvious one:
Has chronic condition and did not receive recommended test, treatment, or follow-up 2011 care because of cost.
On this one,the UK ranks best and the US the worst. But this is necessarily so, since the UK uses rationing rather than pricing to allocate treatment. Needless to say, there are no questions about waiting times for treatment in this survey.
This “study” is utter tripe, using “survey data” (with no reporting on exactly how the surveys are administered) representing responses to wholly arbitrary questions to generate rank orderings that are aggregated in a wholly arbitrary fashion to generate meaningless results that just so happen to conform to the stated objectives of the foundation performing the study.
It is ideology masked as statistical analysis.
But if you insist on using it to justify a complete overhaul of the US system, please note that in terms of “quality care” it ranks the US ahead of Germany, France, Canada, all of which I’ve seen held up as paragons of health care quality in this thread.
Olly — The Federalist philosophy you dredge up is 240 years old, and most of us have outgrown it. It applied to a sparsely populated, largely agricultural America. It denied women the vote, but permitted slavery. It tried to give democracy only to rich, white property owners. We have long since realized that we have communal responsibilities, even ones that don’t directly benefit us. I pay taxes for schools, though I have no children in school. I pay taxes to build taxes to build roads I wii never use. Hell, I even pay taxes to fight wars I oppose. If a health plan costs you a few bucks extra to provide contraception, it ain’t gonna kill ya.
Of course, if we go back 240 years, we can get rid if health insurance and just apply leeches to our body to cure our ill humors.
I am for repealing all health care provisions. VA, Medicare, Medicaid, Obama this, Obumbo that. Allow all humans in America to pay what the capitalists who have strict control over prices to charge for the arm and the leg. Chumps.
“From time to time, some of us wonder how we got here. We hear quaint expressions like “freedom of contract” and ask, whatever happened to that? How is it that two people are no longer allowed to enter into an enforceable contract without running afoul of some government restriction?
A recent example is that I can no longer agree to a contract with a health insurance company that does not cover contraceptives. Why? If I and an insurance company are both willing to sign such a contract, how is it that the government says we cannot?”
http://thefederalist.com/2014/12/04/the-supreme-courts-reign-of-terror-1937-1944/?utm_source=The+Federalist+List&utm_campaign=9dfccdaa24-RSS_DAILY_EMAIL_CAMPAIGN&utm_medium=email&utm_term=0_cfcb868ceb-9dfccdaa24-79248369
Msjettexas — how about a law that says you have to buy car insurance or stop driving, or one that says you have to go into the army and be sent to some faraway country where you might get killed?
When a government passes a law that forces people to buy healthcare insurance or get penalized or go to jail. . . I have a problem with that!