Health Care Crisis? We are way beyond that. Americans are now dying from this nation’s lack of a comprehensive national public health policy. From a recent Washington Post report on a University of Washington Study
http://www.washingtonpost.com/wp-dyn/content/article/2008/04/21/AR2008042102406.html?hpid=topnews For the first time since the Spanish influenza of 1918, life expectancy is falling for a significant number of American women. In nearly 1,000 counties that together are home to about 12 percent of the nation's women, life expectancy is now shorter than it was in the early 1980s, according to a study published today.
The downward trend is evident in places in the Deep South, Appalachia, the lower Midwest and in one county in Maine. It is not limited to one race or ethnicity but it is more common in rural and low-income areas. The most dramatic change occurred in two areas in southwestern Virginia (Radford City and Pulaski County), where women's life expectancy has decreased by more than five years since 1983.
This does not normally happen in industrialized countries, not unless one of the Four Horsemen of the Apocalypse appears.
Disease, such an influenza pandemic that kills a large number of people can cause a temporary decrease in life expectancy, but the number rebounds quickly after the epidemic is over. War, like the U.S. Civil War, will cause a temporary decrease by killing lots of young men. Anything that causes massive crop failure and starvation could conceivably cause wide scale death, if the effect were global.
However, the U.S. has suffered none of these. We just have plain old
Death creeping up on people, mostly women, at earlier ages, because the government is doing nothing to combat the epidemics of obesity, lack of exercise and smoking which lead to hypertension, diabetes and heart disease. Rather than invest in a few cents of preventive health care through a European model universal health care or health insurance program, we deny care to many millions of Americans (almost 50 million are uninsured and another 16 million are under insured) and then offer expensive futile treatments at the end of life—at tax payers expense through Medicare. This results in a net loss to the tax payer, more suffering to the sick and earlier death.
We are buying death with our health care tax dollars rather than investing in life.
If you look at the original study
http://www.plos.org/press/plme-05-04-ezzati.pdfYou will see that while life expectancy rose for men and women between 1961 and 1980, during the 1980s and 1990s certain groups---poor people especially in the South and minorities, had a worsening of their mortality rates compared to the rest of the country. This included deaths from lung disease and cancer as well as the causes listed above. This despite the fact that the U.S. health system was supposed to be improving mortality rates for all Americans.
This health gap occurred the same time that the income disparity under Reagan began to widen, and it is quite likely that the two phenomenon are linked. Living in poverty in a society which actively promotes wealth disparity has been shown to increase the risk of certain health problems for those living in poverty. These problems include depression, suicide, drug and alcohol abuse, infant mortality, violence and domestic violence. The increase in these problems is worse for those living in poverty in a country with wealth disparity than it is for those living in the same degree of poverty in a country without wealth disparity—i.e. inner city USA vs. Jamaica for example.
In order to promote health lifestyles for those living in poverty , health care professionals may need to use more intensive measures. However, the current system in the U.S. ignores those who lack money. So, the ones who need intervention the most, get the least.
The government already pours money into programs that are supposed to remedy this situation. Unfortunately, as a series of articles published this week in the
Fort Worth Star Telegram reveals, many local governments, especially in the south, could care less about the health of their indigent populations. We all know that some states have abysmal rates of registering eligible citizens for Medicaid and SCHIPs, even though the programs are paid for mainly with federal dollars. There is a deep prejudice in some parts of the country against providing any sort of social service for the poor, so states will set up obstacles that make it difficult or shameful for people to apply for public services.
This Common Wealth Fund article describes fow 2/3 of children who qualify for Medicaid or SCHIP are not enrolled . The authors discuss how automatic enrollment (currently illegal by federal law) has helped other programs like Medicare B achieve near maximum enrollment. (This link is also useful in making the case for automatic enrollment in health insurance as opposed to voluntary enrollment.)
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=376814Here are links to the series in the Fort Worth paper about the shoddy treatment which the uninsured residents of Fort Worth (Tarrant County) receive at the tax payer funded hospital, John Peter Smith.
http://www.star-telegram.com/news/story/606891.html“JPS Patients Get Shortchanged as Cash Surpluses Keep Growing”The John Peter Smith hospital has managed to accrue a cash surplus from the taxes it takes in of $97 million last year. It actively courts private patients—people with insurance who can pay for their treatment. However, if you are one of the uninsured that the hospital is being paid all those millions to care for, you will stay in insect infested rooms with dirty toilets, filthy linen, you will be dumped on other ERs (illegally, just because), illegally detained and then find that the staff has destroyed your records. Equipment needed to sterilize equipment does not work. Charts can not be found. If this was a private doctor’s office, it would be shut down. Because this is a county hospital and the only place where people with no insurance can go, they are expected to be grateful and no one in a position of oversight says a word---what do the working poor expect? Decent quality health care? This is not western Europe where people like them matter. Note that the truly poor are all on Medicaid and Medicare and off in the community seeing private doctors at private hospitals.
http://www.star-telegram.com/804/story/608041.html“Trapped in a Waiting Game at JPS: Delays and Bureaucracy Discourage Some People From Obtaining Care”Read about the young man with 90% occlusions of his coronary arteries sent home from the JPS emergency room to die when he should have had a follow up stress test. Or the woman with the breast mass who will wait months for a mammogram—this in a city with dozens of radiology centers. Getting an appointment or a prescription filled is an near impossible task. I guess JPS wants to hang onto its $97 million .
http://www.star-telegram.com/817/story/609395.html“Copay Means No Treatment for Some”And you can only talk about one problem per visit. Even if you have to wait 3 months for an appointment. As a doctor, I know that people’s number one concern is often not their number one health problem. They may be bothered by their back, and their chest pain when climbing the stairs may be an “Oh doc, by the way, I have to take the elevator now, because I get indigestion every time I climb the stairs.” That one complaint a visit policy is a death sentence.
http://www.star-telegram.com/local/story/609399.html“Aggressive Price Hikes at JPS Hurt Many”Public hospitals all do this, raise their prices through the roof to maximize their insurance reimbursements. Guess what happens when no insurance people come through? They pay $5 for a Tylenol. When I took my own son to my old residency ER ( John Sealy Hospital) in Galveston for asthma and my insurance delayed paying, they wanted to charge $2000 for doing one albuterol updraft. That is a crime. And it hits the uninsured, leading to bankruptcies that people can no longer write off.
What is wrong here? No one cares. The folks in charge of JPS do not think that they are partners with the people that they serve. They think that they are opponents. Their job is to keep the riff raff from “stealing” public money for their frivolous health needs. So, they have created a system that discourages people from seeking medical care until they are at death’s door. It tells people “You have no right to good health or health care. Never mind that this hospital is tax payer funded. That money is not for
you you uninsured, indigent deadbeat. You are poor. You are worthless. That money is meant for more important things. “
Which is pretty much what the whole Reagan-Gingrich-Bush health care ethos has been about. Funnel all the health care spending into the pockets of the pharmaceutical companies which have been allowed to raise the prices of the top ten drug which they sell to the elderly under Medicare (when any sane government would have used its purchasing clout to force them to lower their prices). And into the pockets of so called Medicare Advantage HMO’s which are helping the drug companies bankrupt traditional Medicare by getting extra high reimbursements from the government for treating cherry picked healthy seniors who require little care. The money goes towards a FDA that rubber stamps bad drugs and bad procedures that cost us lots of money but do not help us. The budgets for research are cut. Who needs prevention? Not the companies that make up the Medical Industrial Complex. They get rich off preventable disease.
Here is more bad news.
http://www.ama-assn.org/amednews/2008/04/28/prl20428.htmWhile medical costs continue to sky rocket, quality of care is lagging. That is right. We are pouring money into health care like never before. It is practically a black hole. But we are getting less and less improvement for our dollar.
The pace of health care quality improvement appears to be slowing, according to the Agency for Healthcare Research and Quality's fifth annual report compiling federal and state data on more than 200 quality metrics.
A composite measure of health care quality improved at a 2.3% average annualized rate between 1994 and 2005, with the rate falling to 1.5% from 2000 to 2005. And in a first stab at examining the cost efficiency of the American health care system, AHRQ noted that costs, as estimated by the Centers for Medicare & Medicaid Services, jumped 6.7% from 1994 to 2005.
You know, if the American health care system was a business and quality health for Americans was supposed to be its product, most of us would call it a failure. However, in these days of corporate welfare, throwing money into the black hole of John Peter Smith Hospital or the American health care system as a whole and getting diminishing returns---why, that is just
sound business! Maybe there is a
Fifth Horseman of the Apocalypse, Greed. 
Meanwhile, a companion AHRQ report on disparities found that while some gaps were reduced or even eliminated, most metrics of racial and ethnic minorities' access to quality care have stayed the same or worsened.
You can read both reports here as pdf files.
http://www.ahrq.gov/qual/qrdr07.htm.It is great to do annual reports on disparities and on quality and on mortality, but I think by now we get the picture. As long as health care is viewed as discretionary---and as long as it is up to the discretion of someone in a suit and tie with an advanced degree who thinks that members of the working class who lack health insurance because they work at a store that does not offer it do not
deserve the same health care that they and their college educated friends get---as long as that is how the health care system in America is run, we are going to be going backwards instead of forwards in this country.
The only sane way to spend our health care dollars is on universal health insurance or health care, and the only sane way to start such a program is through automatic enrollment, since this will ensure that everyone, including the people who need it most, participate. We do not need two thirds of the most vulnerable population failing to sign up, as they have failed to sign their kids up for Medicaid or SCHIP. Once everyone is covered, then there will be no need for “public hospitals” and the John Peter Smiths of the world will have to clean up their act or be driven out of business by market forces. As people begin to see good health as a right not a privilege they will begin to think about taking care of their bodies. As the government begins to see health care costs as something that can be managed through prevention (since everyone will have access to health services) it will have a financial incentive to invest in disease prevention.
Here is a different health solution, the one proposed by the group Physicians for National Health Program which is different from that of both the Democrats since it cuts the insurance companies out of the equation altogether and puts everyone on an equal playing field. It is very democratic. And it eliminates
Greed . I like it.
http://www.pnhp.org/publications/proposal_of_the_physicians_working_group_for_singlepayer_national_health_insurance.php
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