"Waiting-room cure": the future of American health care?
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According to healthcareproblems.org, current health-care statistics are sobering:
Healthcare is one of the top social and economic problems facing Americans today. The rising cost of medical care and health insurance is impacting the livelihood of many Americans in one way or another. The inability to pay for necessary medical care is no longer a problem affecting only the uninsured, but is increasingly becoming a problem for those with health insurance as well.
- In 2012, nearly half (46%) of adults ages 19 to 64, or an estimated 85 million people, did not have health insurance for the full year (30%, or 55 million) or were underinsured and unprotected from high out-of-pocket costs (16%, or 30 million). (Source: Commonwealth Fund Biennial Health Insurance Survey 2012)
- The amount people pay for health insurance increased 30 percent from 2001 to 2005, while income for the same period of time only increased 3 percent. (Source: Robert Wood Johnson Foundation)
- The average annual premiums for single and family health insurance under employer-sponsored coverage was $5,615 and $15,745, respectively, in 2012. (Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2012)
- Healthcare expenditures in the United States exceed $2 trillion a year. (SOURCE: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group;) In comparison, the federal budget is $3 trillion a year.
Executive summary: Half of us are un- or underinsured, health-care costs are rising ten times as fast as our pay, premiums are going up, quality of service down, and we spend two million million dollars a year for all this.
Feeling better yet?
If not, have no fear: Depending on who you are, the worst is yet to come.
As a matter of statistical record: How long you’ll live, how healthy you'll be throughout your life, the respectful efficiency of your health care, and what will finally escort you off this mortal coil, are all practically predestined. The poorer you are, or the darker your skin, the worse your “health outcome.”
Of course, that’s statistics, and you know what Mark Twain said about them. Your actual experience may well be different. Let’s hope so, because when most studies on health care evaluate results as a correlate of income, “poor” turns out to mean “not extremely rich.”
Some Americans say they “can’t afford” needed health care.
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In most industrialized countries, government provides (in return for taxes) full life-long health care for all their residents. This is known as the “single-payer” system: a term many Americans will remember from 1992, when Bill Clinton made it the cornerstone of his campaign and the grand first initiative of his presidency, and then promptly abandoned it when the usual chorus of howls went up... and up and up.
Newt Gingrich then campaigned against all such communist nonsense, leading his party to triumph when the GOP took both houses of Congress in 1994 and made him Speaker of the House.
It is noteworthy that early in this process, Clinton (whom no one would call insensitive to public opinion as represented in the latest polling) found single-payer popular. According to a contemporary report:
In general, the survey found strong public support for some of the major goals the President has articulated for his plan: 83 percent, for example, said it was “very important” that “any health care reform plan” makes sure all Americans are covered. Sixty-seven percent said it was “very important” that such a plan cover long-term care for the disabled at home, another feature of the Clinton plan. And 73 percent said it was “very important” that preventive care be covered, which Clinton Administration officials say was a guiding principle in developing the basic benefit package.
However, the report also noted considerable skepticism and opposition, most of it partisan.
[...] Similarly, people were sharply divided when asked if “the health care reform plan Bill Clinton is proposing is fair to people like you, or not?” Forty percent said it was fair, 36 percent said it was not. Younger people were more likely to think it would be fair to them; older people tended to be more skittish. Again, this judgment followed party lines, with Democrats likely to think it fair, Republicans likely to think it unfair and Perot voters evenly divided.
But then Clinton, who may have swaggered a bit going into the fight, found himself staggering out after one hard punch in the form of a “$14 to $20 million year-long television advertising campaign funded by the Health Insurance Association of America.” The president was Harry-and-Louised into a chastening defeat from which he would never regain momentum, and health care reform was not again a major national political theme until 2008, when Barack Obama made it a cornerstone of his campaign.
Seemingly from nowhere, a creeping tide of fears about loss of choice in health-care coverage inundated the political landscape, and by the end of the ad campaign, support ebbed and Clinton found himself stranded in the face of a hostile Congress without the popular mandate he’d counted on. How the health insurance industry accomplished this is instructive and is a theme to which we shall return.
Meanwhile, poll after poll taken in the years to follow suggested that health care reform remained a significant public concern, and that some solution similar to Medicare but available to everyone remained the most popular option, although the solution proposed by Clinton had been discredited for the moment. In general, doctors also agreed that there was need for reform, and some felt it should be substantial. However, other and more recent polls framing the question in different terms found that 44 percent of respondents opposed the attempt at universal care embodied by the Affordable Care Act, with only 40 percent in favor. (Examining these statistics more closely, however, it appears that much of the opposition came from the left because the ACA makes care universal not by providing it, but by mandating that everyone sign up with a private provider.)
Meanwhile, direct comparisons of American health care with health care in other advanced countries continue to show a disappointing trend: Although we spend more on health care per capita than other people, the results as reflected in our longevity suggest that the standard of care is not “the best in the world,” as sycophantic politicians are fond of repeating when currying favor with potential campaign contributors. In fact, for many consumers, it is mediocre, providing minimal actual time with a physician, little respect for their preferred treatment options and often inattentive care from tired and overworked providers, and often fails to coordinate efforts among providers (sometimes with harmful results, as when physicians don’t inform themselves of what treatment a patient is getting elsewhere and therefore don’t protect the patient against drug interactions). We are also the only such nation that does not provide guaranteed lifelong health care to all of its citizens.
More bucks, less bang: Why do Americans pay more for health care and get less?
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Historically, it is interesting to note certain persistent patterns in public opinion on health care. Among them: Most Americans seem to think rather poorly of the quality of health care in general, but most also say they’re satisfied with their own medical care. Whether this reflects false negative expectations belied by experience or confirmation bias (or some of both) is not clear. They think it is essential to provide universal care for everyone who needs it, but are divided on whether to trust government to provide it. They are willing to pay more taxes for a better system, but have not clearly articulated what that system would be. And thanks in part to such confusion, they are highly susceptible to the influence of money in the form of well-designed and -executed public relations offensives, most of which rely on distraction and misrepresentation to discredit solutions that the industry finds subversive to its grip on the medical “market.”
But then, if such tactics didn’t work, political advertisers wouldn’t keep using them.
Special-interest political functionaries in California have worked out a formula for electoral success: Every dollar spent to influence a previously neutral voter increases by four percent the probability that he will vote as desired. Similar formulae exist for “turning” those hostile to the interest’s desired position, and doubtless they are known to operatives in other jurisdictions as well.
Whether in the form of attack ads or something blander, money makes its voice heard above yours and mine and even a sitting president’s. If there is enough of it, it shouts us into inaudibility, dinning our own speech into a whisper unheard by any ears that matter. And as our evermore laissez-faire “democratic republic” is now constituted, those with the money also own the media; this puts an amplifier to the mouth of every shill, the better to shout down dissent. And when amplified voices repeat the same message enough times, it sometimes begins to appear true; certainly, this is what psychology has found.
Well, you might point out, this has been going on in various forms at least since Rome, and probably since civilization began. The wealthy, seeking more and little aware of the consequences for others, successfully manipulate not only government, but much of the population, to perpetuate a status quo that has worked well for them. If in so doing they deprive multitudes of any means to have their vital needs met, they are so insulated from the deprived that they seldom spare a thought for them.
But today the stakes are far higher. We live in an age science calls the anthropocene, when for the first time in Earth’s history, the single most powerful influence on our environment is us.
Ask yourself how far you’d have to travel from your present location before you could reach a place where you would confidently expect not to meet constantly with other people and their habitations, roads and works.
How high in the mountains must you climb to escape manmade pollution? How deep in the ocean must you dive to avoid manmade trash? At what level of the atmosphere will you never see an aircraft, and how high an orbit must you assume to look down on all our satellites?
As never before, because there are billions of us, and our numbers and industrial output are still growing exponentially, and because our reach is not only across the planet, but at every height and depth of it, our actions matter.
There are those who’d like to deny this, and play up the false humility card: “How could man, so puny on a world so large, possibly be so arrogant as to think he could affect that world?”
It’s easy to fall for this, but only until you start to factor in our numbers and our pervasive pollution: the plutonium on Everest, the plastic at the bottom of Mariana Trench. Then you realize: Yes. This is now our world; more than any other factor, we shape its conditions; we cannot help but do so.
Our power is enormous and growing. So, many of us think, is our responsibility.
That’s some of us. But how often do we make the decisions, and how often are they made by the worst of us: those who simply don’t care about anyone but themselves (and in some cases perhaps their children) or anything that doesn’t directly contribute to their own power, wealth and social prestige?
There are various names for people of this kind: malignant narcissists, sufferers of anti-social personality disorder, sociopaths, psychopaths. Whichever term you prefer, these are the fundamental facts: They do not understand empathy; your suffering means nothing to them, unless possibly a source of sadistic amusement. They do not know conscience; if they cause harm, it is always the fault of those harmed. They do not experience shame; what to anyone else would be mortifying mistakes from which to draw lessons about life are also someone else’s fault, so there is no need for them to admit error or learn from experience. And they never really internally accept that the consequences of their behavior may be harm to themselves and their families.
Now, if you’ve been sufficiently inured to narcissistic thinking by your media environment, you may deem much of this adaptive behavior. And indeed, living without conscience does provide an individual competitive advantage, especially in political or economic systems that contain built-in rewards for unethical conduct. This is surely as true of modern “deregulated” capitalism as of the tax farming scheme in the foreign “provinces” of classical Rome. One might even call people who get rich by such means “smart,” and (unsurprisingly) many do.
But sometimes what seems smart locally, privately and for the short term is actually far from smart. Health care provides a cogent example.
Unlike many of the effects of poverty, disease is proverbially no respecter of borders. It is also no respecter of private estates. The rich die like everyone else, although perhaps a little later and with better care before they do.
This is where we begin to see how really pathological the pathocrats are. For they are not stupid; they know, in principle, that diseases left untreated can spread, and that people debilitated by deprivation are a perfect spawning ground for pandemics. They know that it is a matter of time: Sooner or later, their children (if not they themselves) will be among those crying out in anguish for the completely unnecessary death of a loved one.
In principle they know this; intellectually, they can grasp it. But because it never reaches their hearts, it does not move them or change their behavior. They can “know” that if they do X, Y will happen, but they can never really know it in any way that counts. Or they “know,” but do not really believe. Some of them are intellectually brilliant, but all of them are moral morons.
And that is why, in this richest and post powerful nation the world has ever known, a nation whose people know the system is broken and not serving their needs, good health and long life remain beyond the reach of those who cannot afford them, and every day that means more of us. And because we live under pathocracy, those with the power to change all this just ... don’t ... care.
Until that changes, nothing else will. Until the psychopaths who dominate our institutions have been identified and removed from all positions of power, human needs will go unmet so that perverse and inhumane desires can be satisfied.