Discussing Healthcare Reform: Views from Congressman Anthony Weiner and Some Reminders
Last week I heard Congressman Anthony Weiner discuss healthcare reform in Brooklyn, NY. Weiner, though I have disagreed with him at times in the past, is an amazing champion of healthcare reform and I wish we had Congress full of Anthony Weiners right about now because then we'd have real healthcare reform pretty damned fast.
Weiner briefly emphasized a point I have made many times and will reiterate below: that our current healthcare system is highly overpriced and yet delivers only mediocre care. I put it that we pay more than any other nation for our healthcare system and yet get a quality of care comparable to that of Albania, Slovenia, etc. (See below for a repeat of the details). Those "socialist" nations that the Republicans are scaring us with, namely Sweden, Finland, Israel, Britain and Canada, have cheaper and better healthcare systems. Doesn't it make sense to model our system after ones that are BETTER and CHEAPER than our own? The Republicans just don't get that for some reason.
Weiner emphasized another aspect of this problem that too often gets ignored. Our emergency rooms are overrun with uninsured patients who do not need emergency care but have no other access to healthcare. Their only option for healthcare is the emergency room. I can add to this, having worked in medical centers and for physician scientists, that most hospitals lose money, and they lose money specifically because of their emergency room load. The emergency room, if you pardon the phrase, hemorrhages money while the rest of a hospital's operations do alright. So Weiner is absolutely right that the excessive load on our emergency rooms because of the uninsured is a major reason for the high cost of healthcare, and for the fact that many hospitals are going under. Our failure to reform healthcare is driving hospitals deep into debt, forcing them to close (thus denying hospital coverage to parts of our country) or forcing local and state governments to use tax money to prop up hospitals. Above all else, healthcare reform must solve this waste of money that we force on our hospitals by having so many uninsured.
Anthony Weiner wanted a single payer system for our reform, which as I understand it is the best solution. But he said that the House Bill is a "pretty good" bill that will save taxpayers money and help solve the problems that America has because of so many uninsured. He said the Senate Bill is not worth supporting and would do little to solve our problems. What the Republicans advocate would be even worse, driving up insurance costs and reducing service. The Republican plan would be counter productive, hurting our country and making healthcare even LESS affordable.
Short of a single payer system, the Public Option is the next best solution. Weiner believes its value is sometimes exaggerated, but he emphasized several times that the Public Option WILL save us money. Furthermore, it introduces more competition into an industry that has little competition. Isn't competition what our economic system is all about? It's called capitalism and somehow the Republicans oppose it. SAVING MONEY AND INCREASING COMPETITION. Sounds good to me!
And as to that Republican/Lieberman opposition? Well, Weiner DIDN'T exactly say "MAKE the fuckers filibuster." But he almost did. And I agree with him. MAKE THE FUCKERS FILIBUSTER!!! He believes anyone who filibusters healthcare reform will be hurt by it in the next election. I think he is, in many instances, correct.
If the House Bill is more or less what we adopt, Weiner points out that for the vast majority of Americans things won't change much. People on Medicare or who have private insurance already will see only minor changes. Mainly, insurance companies will be slightly better regulated and so have to provide slightly better service. The people who will be most affected are the uninsured who will then be able have insurance and who will benefit from the competition that the Public Option will introduce into the system. This will save our hospitals money in a big way and save our state and local governments money.
And for those who aren't familiar with Congressman Weiner, here's a video of him in action:
(by the way, I strongly suspect he will be running for NYC mayor again someday).
Now I want to review my analysis of our healthcare system to emphasize just why we need reform. Those who have seen it before can move on. Those who haven't seen it before may well be surprised at just how much we pay for relatively bad healthcare.
I am comparing the US with several other nations, comparing how much we spend both per capita and as a % of GDP, what percentage of this expenditure is public spending, the availability of care (hospital beds, nurses and physicians per capita), and various health outcomes (healthy life expectancy, maternal mortality, chance of living to 65, etc.). Here are the numbers: (playing with http://www.nationmaster.com )
Total (private and public) Expenditure per capita (in US $):
1. US: $6,096.2
2. Luxembourg: $5,904
3. Switzerland: $5,571.9
4 Norway: $5,404.7
9. Sweden: $3,532
12. Netherlands $3,441.7
17. Canada: $3,037.6
18. UK: $2,899.7
19 Japan: $2,831.1
20 Finland: 2,664.3
27 Israel: 1,533.5 $
72 Cuba: 229.8 $
Bottom line: we spend the most, counting both public and private money, of ANY NATION IN THE WORLD on healthcare. Nations like Canada, UK, Japan, Finland and Israel spend about half of what we spend. So when you look at what is outlined below, consider whether we are getting twice as much as nations like Canada, UK, Japan, Finland and Israel are getting.
Total expenditure (public and private) on health as % of GDP
1 United States: 14.6%
4 Switzerland: 11.2%
15 Canada: 9.6%
15 Norway: 9.6%
23 Sweden: 9.2%
25 Israel: 9.1%
30 Netherlands: 8.8%
43 Japan: 7.9%
47 United Kingdom: 7.7%
53 Cuba: 7.5%
56 Finland: 7.3%
79 Luxembourg: 6.2%
Bottom line: we also spend the most of any nation as a percentage of GDP on healthcare. We spend more than Switzerland. The UK, Finland, Luxembourg, and Japan spend about half what we spend as a percentage of GDP. Again, consider whether we are getting our money's worth in comparison with these nations that spend about half of what we do.
Public Spending as % of total healthcare costs:
(some nations I am looking aren't mentioned in regards to this figure)
3 Luxembourg: 85.4%
4 Norway: 85.3%
4 Sweden: 85.3%
7 United Kingdom: 83.4%
12 Finland: 75.7%
20 Canada: 69.9%
22 Switzerland: 57.9%
24 United States: 44.9%
Bottom line: we spend about half of the public money compared with nations like Luxembourg, Norway, Sweden and the UK. Keep in mind that we also spend twice as much total as many of these nations (as a percentage of GDP), so that means we are each PRIVATELY paying out of pocket the difference.
Next I want to consider some measures of whether we are getting comparable care in terms of things like available hospital beds, nurses and physicians per capita. Given that we are paying the top price for our care, do we have the healthcare providers available for the money we pay.
Hospital beds per 1000 people:
4 Japan: 14.3 per 1,000 people
21 Finland: 7.2 per 1,000 people
33 Israel: 6.1 per 1,000 people
36 Luxembourg: 6 per 1,000 people
36 Switzerland: 6 per 1,000 people
50 Cuba: 4.9 per 1,000 people
55 Netherlands: 4.7 per 1,000 people
62 United Kingdom: 4.2 per 1,000 people
69 Norway: 3.8 per 1,000 people
71 Canada: 3.7 per 1,000 people
72 Sweden: 3.6 per 1,000 people
81. US 3.3 per 1,000 people
Bottom line: we fall short when it comes to available hospital beds. It is true that Sweden, Canada and Noway are comparable, but they also spend far less than we do on healthcare. Other nations, also spending less than we are, have far more hospital beds per capita available. You want to know why hospital care tends to be inferior and rationed in America? It is because the money we spend on healthcare is NOT going to providing enough hospital space to meet our needs. Even Cuba does better by this measure than we do, and Israel, Finland and Japan have about twice as many hospital beds available than we do.
Nurses per capita:
(Cuba and Israel not reporting??)
1. Finland: 14.7 per 1,000 people
3 Netherlands: 13.4 per 1,000 people
4 Switzerland: 10.7 per 1,000 people
6 Norway: 10.3 per 1,000 people
7 Canada: 9.9 per 1,000 people
12 Sweden: 8.8 per 1,000 people
12 United Kingdom: 8.8 per 1,000 people
14 United States: 8.1 per 1,000 people
15 Japan: 7.8 per 1,000 people
Bottom line: once again we fall below. We are NOT getting the care we are paying for.
Physicians per capita
2 Cuba: 5.91 per 1,000 people
13 Israel: 3.82 per 1,000 people
26 Sweden: 3.3 per 1,000 people
34 Norway: 3.1 per 1,000 people 2003
34 Netherlands: 3.1 per 1,000 people
43 Luxembourg: 2.7 per 1,000 people
46 Finland: 2.6 per 1,000 people
52 United States: 2.3 per 1,000 people
55 United Kingdom: 2.2 per 1,000 people
58 Canada: 2.1 per 1,000 people
64 Japan: 2 per 1,000 people
Here we fall short, but Canada, Japan, UK, Finland and Luxembourg are comparable. All of these pay less than we do. So by this measure America pays more money for similar service.
So the next thing to look at is whether the money we pay actually delivers good health in the end. I want to look at a series of very bottom line measures of health to see how we rank. Again, we pay the most, so we should be ranking the best in most of these measures if we are getting our money's worth. The fact that we rank mediocre on available hospital beds, nurses and physicians per capita already suggests we aren't getting what we pay for. But what about health out comes?
Healthy Life Expectancy:
(Cuba and Israel not reporting??)
1 Japan: 73.6 years
2 Switzerland: 72.8 years
3 Sweden: 71.8 years
10 Norway: 70.8 years
11 Luxembourg: 70.6 years
15 Finland: 70.1 years
17 Canada: 69.9 years
17 Netherlands: 69.9 years
20 United Kingdom: 69.6 years
22 United States: 67.6 years
Bottom line: we do relatively poorly here. Nations that pay half what we do, but using a higher percentage of public money to cover it, do comparably or better than we do.
Maternal Mortality:
(Luxemburg and Canada not reporting??)
95 Cuba: 33 per 100,000
116 Japan: 8 per 100,000
116 United States: 8 per 100,000
121 United Kingdom: 7 per 100,000
121 Netherlands: 7 per 100,000
124 Norway: 6 per 100,000
124 Finland: 6 per 100,000
130 Switzerland: 5 per 100,000
130 Sweden: 5 per 100,000
130 Israel: 5 per 100,000
One thing to note here is that this statistic is one measure where Cuba does poorly, though compared to other third world nations they do well. They pay about 1/30th we do for healthcare, but in this case they aren't faring well enough, I'd say. However, we do poorly compared with many of the nations that spend half what we do. So although we beat Cuba, I don't think that is something to be proud of.
% of life lived in ill health (female)
(Cuba and Israel not reporting??)
6 United States: 13.5%
8 Canada: 12.6%
9 Netherlands: 11.9%
15 Norway: 11.4%
18 United Kingdom: 11.3%
21 Sweden: 11.1%
22 Luxembourg: 11%
26 Finland: 10.8%
28 Japan: 10.6%
29 Switzerland: 10.2%
We do pretty comparably here with the other nations I am comparing us to. But I think again it is critical to realize we are not beating nations that spend half what we do on healthcare.
Probability of reaching 65 (Male)
1 Israel: 85.1%
2 Sweden: 84.8%
5 Japan: 84%
8 Netherlands: 82.7
9 Canada: 82.3%
10 Switzerland: 82.2%
10 Norway: 82.2%
14 United Kingdom: 81.5%
19 Luxembourg: 80.1%
28 Cuba: 78.1%
30 Finland: 77.9%
32 United States: 77.4%
Bottom Line: Well we are comparable with Cuba here, even though we spend 30 times what Cubans pay for healthcare.
The take home message: The American healthcare system is way too expensive, gives mediocre outcomes and puts the burden excessively on individuals and businesses. Nations that spend half as much but fund it more through public finances (yes...that means taxes) have far better out comes.
This is the same as what I saw last time I did this kind of analysis a couple of years ago. Last time I looked at a wider range of health outcomes and focused on the fact that we ranked with nations like Albania, Slovenia, and Croatia while the nations that ranked best were nations like Sweden, Japan, UK and Canada, nations with a far more "socialized" healthcare system. So I focused on the fact that socialized systems did better, and I took on faith that they also spent less.
Well, this analysis covers fewer healthcare outcomes (enough to confirm my previous analysis that we get mediocre outcomes) but includes data that shows we really do spend the most by any measure, put the burden more on businesses and individuals rather than using public funding, have worse coverage (meaning less actual healthcare services), AND have mediocre outcomes.
Folks, we are doing it wrong. It doesn't even make capitalist sense because we are spending more for less. That is BAD BUSINESS! Hell, even Switzerland spends less, puts in more public funding, and gets better outcomes. We have a failed system and we need to pay attention to how the nations with the best outcomes with half the cost do it. Those nations are Sweden, Cananda, Finland, Israel, the UK and Japan. They do it better by all measures. Why shouldn't we learn from them?
And as for the Republican/Lieberman opposition: MAKE THE FUCKERS FILIBUSTER.
Weiner briefly emphasized a point I have made many times and will reiterate below: that our current healthcare system is highly overpriced and yet delivers only mediocre care. I put it that we pay more than any other nation for our healthcare system and yet get a quality of care comparable to that of Albania, Slovenia, etc. (See below for a repeat of the details). Those "socialist" nations that the Republicans are scaring us with, namely Sweden, Finland, Israel, Britain and Canada, have cheaper and better healthcare systems. Doesn't it make sense to model our system after ones that are BETTER and CHEAPER than our own? The Republicans just don't get that for some reason.
Weiner emphasized another aspect of this problem that too often gets ignored. Our emergency rooms are overrun with uninsured patients who do not need emergency care but have no other access to healthcare. Their only option for healthcare is the emergency room. I can add to this, having worked in medical centers and for physician scientists, that most hospitals lose money, and they lose money specifically because of their emergency room load. The emergency room, if you pardon the phrase, hemorrhages money while the rest of a hospital's operations do alright. So Weiner is absolutely right that the excessive load on our emergency rooms because of the uninsured is a major reason for the high cost of healthcare, and for the fact that many hospitals are going under. Our failure to reform healthcare is driving hospitals deep into debt, forcing them to close (thus denying hospital coverage to parts of our country) or forcing local and state governments to use tax money to prop up hospitals. Above all else, healthcare reform must solve this waste of money that we force on our hospitals by having so many uninsured.
Anthony Weiner wanted a single payer system for our reform, which as I understand it is the best solution. But he said that the House Bill is a "pretty good" bill that will save taxpayers money and help solve the problems that America has because of so many uninsured. He said the Senate Bill is not worth supporting and would do little to solve our problems. What the Republicans advocate would be even worse, driving up insurance costs and reducing service. The Republican plan would be counter productive, hurting our country and making healthcare even LESS affordable.
Short of a single payer system, the Public Option is the next best solution. Weiner believes its value is sometimes exaggerated, but he emphasized several times that the Public Option WILL save us money. Furthermore, it introduces more competition into an industry that has little competition. Isn't competition what our economic system is all about? It's called capitalism and somehow the Republicans oppose it. SAVING MONEY AND INCREASING COMPETITION. Sounds good to me!
And as to that Republican/Lieberman opposition? Well, Weiner DIDN'T exactly say "MAKE the fuckers filibuster." But he almost did. And I agree with him. MAKE THE FUCKERS FILIBUSTER!!! He believes anyone who filibusters healthcare reform will be hurt by it in the next election. I think he is, in many instances, correct.
If the House Bill is more or less what we adopt, Weiner points out that for the vast majority of Americans things won't change much. People on Medicare or who have private insurance already will see only minor changes. Mainly, insurance companies will be slightly better regulated and so have to provide slightly better service. The people who will be most affected are the uninsured who will then be able have insurance and who will benefit from the competition that the Public Option will introduce into the system. This will save our hospitals money in a big way and save our state and local governments money.
And for those who aren't familiar with Congressman Weiner, here's a video of him in action:
(by the way, I strongly suspect he will be running for NYC mayor again someday).
Now I want to review my analysis of our healthcare system to emphasize just why we need reform. Those who have seen it before can move on. Those who haven't seen it before may well be surprised at just how much we pay for relatively bad healthcare.
I am comparing the US with several other nations, comparing how much we spend both per capita and as a % of GDP, what percentage of this expenditure is public spending, the availability of care (hospital beds, nurses and physicians per capita), and various health outcomes (healthy life expectancy, maternal mortality, chance of living to 65, etc.). Here are the numbers: (playing with http://www.nationmaster.com )
Total (private and public) Expenditure per capita (in US $):
1. US: $6,096.2
2. Luxembourg: $5,904
3. Switzerland: $5,571.9
4 Norway: $5,404.7
9. Sweden: $3,532
12. Netherlands $3,441.7
17. Canada: $3,037.6
18. UK: $2,899.7
19 Japan: $2,831.1
20 Finland: 2,664.3
27 Israel: 1,533.5 $
72 Cuba: 229.8 $
Bottom line: we spend the most, counting both public and private money, of ANY NATION IN THE WORLD on healthcare. Nations like Canada, UK, Japan, Finland and Israel spend about half of what we spend. So when you look at what is outlined below, consider whether we are getting twice as much as nations like Canada, UK, Japan, Finland and Israel are getting.
Total expenditure (public and private) on health as % of GDP
1 United States: 14.6%
4 Switzerland: 11.2%
15 Canada: 9.6%
15 Norway: 9.6%
23 Sweden: 9.2%
25 Israel: 9.1%
30 Netherlands: 8.8%
43 Japan: 7.9%
47 United Kingdom: 7.7%
53 Cuba: 7.5%
56 Finland: 7.3%
79 Luxembourg: 6.2%
Bottom line: we also spend the most of any nation as a percentage of GDP on healthcare. We spend more than Switzerland. The UK, Finland, Luxembourg, and Japan spend about half what we spend as a percentage of GDP. Again, consider whether we are getting our money's worth in comparison with these nations that spend about half of what we do.
Public Spending as % of total healthcare costs:
(some nations I am looking aren't mentioned in regards to this figure)
3 Luxembourg: 85.4%
4 Norway: 85.3%
4 Sweden: 85.3%
7 United Kingdom: 83.4%
12 Finland: 75.7%
20 Canada: 69.9%
22 Switzerland: 57.9%
24 United States: 44.9%
Bottom line: we spend about half of the public money compared with nations like Luxembourg, Norway, Sweden and the UK. Keep in mind that we also spend twice as much total as many of these nations (as a percentage of GDP), so that means we are each PRIVATELY paying out of pocket the difference.
Next I want to consider some measures of whether we are getting comparable care in terms of things like available hospital beds, nurses and physicians per capita. Given that we are paying the top price for our care, do we have the healthcare providers available for the money we pay.
Hospital beds per 1000 people:
4 Japan: 14.3 per 1,000 people
21 Finland: 7.2 per 1,000 people
33 Israel: 6.1 per 1,000 people
36 Luxembourg: 6 per 1,000 people
36 Switzerland: 6 per 1,000 people
50 Cuba: 4.9 per 1,000 people
55 Netherlands: 4.7 per 1,000 people
62 United Kingdom: 4.2 per 1,000 people
69 Norway: 3.8 per 1,000 people
71 Canada: 3.7 per 1,000 people
72 Sweden: 3.6 per 1,000 people
81. US 3.3 per 1,000 people
Bottom line: we fall short when it comes to available hospital beds. It is true that Sweden, Canada and Noway are comparable, but they also spend far less than we do on healthcare. Other nations, also spending less than we are, have far more hospital beds per capita available. You want to know why hospital care tends to be inferior and rationed in America? It is because the money we spend on healthcare is NOT going to providing enough hospital space to meet our needs. Even Cuba does better by this measure than we do, and Israel, Finland and Japan have about twice as many hospital beds available than we do.
Nurses per capita:
(Cuba and Israel not reporting??)
1. Finland: 14.7 per 1,000 people
3 Netherlands: 13.4 per 1,000 people
4 Switzerland: 10.7 per 1,000 people
6 Norway: 10.3 per 1,000 people
7 Canada: 9.9 per 1,000 people
12 Sweden: 8.8 per 1,000 people
12 United Kingdom: 8.8 per 1,000 people
14 United States: 8.1 per 1,000 people
15 Japan: 7.8 per 1,000 people
Bottom line: once again we fall below. We are NOT getting the care we are paying for.
Physicians per capita
2 Cuba: 5.91 per 1,000 people
13 Israel: 3.82 per 1,000 people
26 Sweden: 3.3 per 1,000 people
34 Norway: 3.1 per 1,000 people 2003
34 Netherlands: 3.1 per 1,000 people
43 Luxembourg: 2.7 per 1,000 people
46 Finland: 2.6 per 1,000 people
52 United States: 2.3 per 1,000 people
55 United Kingdom: 2.2 per 1,000 people
58 Canada: 2.1 per 1,000 people
64 Japan: 2 per 1,000 people
Here we fall short, but Canada, Japan, UK, Finland and Luxembourg are comparable. All of these pay less than we do. So by this measure America pays more money for similar service.
So the next thing to look at is whether the money we pay actually delivers good health in the end. I want to look at a series of very bottom line measures of health to see how we rank. Again, we pay the most, so we should be ranking the best in most of these measures if we are getting our money's worth. The fact that we rank mediocre on available hospital beds, nurses and physicians per capita already suggests we aren't getting what we pay for. But what about health out comes?
Healthy Life Expectancy:
(Cuba and Israel not reporting??)
1 Japan: 73.6 years
2 Switzerland: 72.8 years
3 Sweden: 71.8 years
10 Norway: 70.8 years
11 Luxembourg: 70.6 years
15 Finland: 70.1 years
17 Canada: 69.9 years
17 Netherlands: 69.9 years
20 United Kingdom: 69.6 years
22 United States: 67.6 years
Bottom line: we do relatively poorly here. Nations that pay half what we do, but using a higher percentage of public money to cover it, do comparably or better than we do.
Maternal Mortality:
(Luxemburg and Canada not reporting??)
95 Cuba: 33 per 100,000
116 Japan: 8 per 100,000
116 United States: 8 per 100,000
121 United Kingdom: 7 per 100,000
121 Netherlands: 7 per 100,000
124 Norway: 6 per 100,000
124 Finland: 6 per 100,000
130 Switzerland: 5 per 100,000
130 Sweden: 5 per 100,000
130 Israel: 5 per 100,000
One thing to note here is that this statistic is one measure where Cuba does poorly, though compared to other third world nations they do well. They pay about 1/30th we do for healthcare, but in this case they aren't faring well enough, I'd say. However, we do poorly compared with many of the nations that spend half what we do. So although we beat Cuba, I don't think that is something to be proud of.
% of life lived in ill health (female)
(Cuba and Israel not reporting??)
6 United States: 13.5%
8 Canada: 12.6%
9 Netherlands: 11.9%
15 Norway: 11.4%
18 United Kingdom: 11.3%
21 Sweden: 11.1%
22 Luxembourg: 11%
26 Finland: 10.8%
28 Japan: 10.6%
29 Switzerland: 10.2%
We do pretty comparably here with the other nations I am comparing us to. But I think again it is critical to realize we are not beating nations that spend half what we do on healthcare.
Probability of reaching 65 (Male)
1 Israel: 85.1%
2 Sweden: 84.8%
5 Japan: 84%
8 Netherlands: 82.7
9 Canada: 82.3%
10 Switzerland: 82.2%
10 Norway: 82.2%
14 United Kingdom: 81.5%
19 Luxembourg: 80.1%
28 Cuba: 78.1%
30 Finland: 77.9%
32 United States: 77.4%
Bottom Line: Well we are comparable with Cuba here, even though we spend 30 times what Cubans pay for healthcare.
The take home message: The American healthcare system is way too expensive, gives mediocre outcomes and puts the burden excessively on individuals and businesses. Nations that spend half as much but fund it more through public finances (yes...that means taxes) have far better out comes.
This is the same as what I saw last time I did this kind of analysis a couple of years ago. Last time I looked at a wider range of health outcomes and focused on the fact that we ranked with nations like Albania, Slovenia, and Croatia while the nations that ranked best were nations like Sweden, Japan, UK and Canada, nations with a far more "socialized" healthcare system. So I focused on the fact that socialized systems did better, and I took on faith that they also spent less.
Well, this analysis covers fewer healthcare outcomes (enough to confirm my previous analysis that we get mediocre outcomes) but includes data that shows we really do spend the most by any measure, put the burden more on businesses and individuals rather than using public funding, have worse coverage (meaning less actual healthcare services), AND have mediocre outcomes.
Folks, we are doing it wrong. It doesn't even make capitalist sense because we are spending more for less. That is BAD BUSINESS! Hell, even Switzerland spends less, puts in more public funding, and gets better outcomes. We have a failed system and we need to pay attention to how the nations with the best outcomes with half the cost do it. Those nations are Sweden, Cananda, Finland, Israel, the UK and Japan. They do it better by all measures. Why shouldn't we learn from them?
And as for the Republican/Lieberman opposition: MAKE THE FUCKERS FILIBUSTER.
posted by mole333 | 11:18 PM
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