7 Great Websites for Information on Healthcare Reform

By Mary Ward, Guest Contributer

If you’re like most people, you’ve been interested in following the healthcare debate as it happens. But, if you’re busy like most people, you may find it difficult to keep up with this ever changing debate. Following are some great resources for keeping up with the healthcare debate – and they’re all online.

1. Twitter – Twitter’s not just a site for keeping up with your friends, it’s also a great way to keep up with the news. There are 25 different feeds on Twitter that provide updates on healthcare reform as they happen. Some of them are admittedly a bit biased, but some are also dedicated to simply delivering developments.


2. Senate Health Education and Pension Committee – This is a link to the committee that started it all! This committee formerly chaired by Senator Ted Kennedy keeps track of the bill as it progresses. On this site you can see the bill as authored as well as changes to it as it moves through the process. This is one of the few places where you can read the bill in its entirety with no commentary.


3. White House Office of Management and Budget – Peter Orszag is the chief of the Office of Management and Budget at the White House, and he posts a regular blog, which is lately often about healthcare reform. This is a great place for the White House take on things. New happenings are generally commented on frequently.


4. The Treatment – This is a blog, but it is written by Jonathan Cohn, the author of “Sick- the Untold Story of America’s Health Care Crisis – and the People Who Pay the Price”. Cohn is extremely knowledgeable and works hard to write a fair and informative blog.


5. Side By Side Comparison of Major Healthcare Proposals – Authored by the Kaiser Family Foundation, this site does a good job of comparing various major healthcare reform proposals. It takes a lot of the work out of the comparison for the consumer.


6. Covering Health – A website for journalists who report on healthcare, this site keeps very up to date on happenings regarding the healthcare debate. Since journalists use this website to assist them in their reporting on healthcare, you can count on it to be up to date and factual.


7. Healthcare Reform 2009 – This is the website for the New England Journal of Medicine. Most of the site requires membership, but anyone can access their extensive coverage on healthcare reform. This site offers commentary from several different points of view, and most of their commentators are experts in a particular area of healthcare.

There’s plenty of coverage out there right now on healthcare reform. Regardless of your opinion on the subject, you can find someone who’ll report exactly what you believe. But, if you want to know what’s really happening, these websites should give you plenty of information that is fairly reported and balanced. Sometimes, in any debate, the hardest information to come by is the factual information.

Mary Ward is a freelance writer and likes writing about medical education topics, such as how to research and choose among online X-ray tech schools, how to apply for online college grants, and more.

Blacklisting Progressives: The Untold Story Beneath the Daschle Headlines

THIS IS A MUST READ:

David Sirota (Open Left) reports:

"Amid the swirling headlines about Tom Daschle withdrawing his nomination for Health and Human Service Secretary is a very dark, very foreboding story that tells us a lot more about what to expect from the Obama administration than a single nomination fight. It is a story that every single voter who supported Barack Obama because of his progressive economic platform should know about - and worry about...."

Will John McCain's Health Care Plan Leave YOU out?

Find out. Click here to find out how many people in your state would lose their health insurance under John McCain's health care plan.

McCain Undermines Employer Insurance

An estimated 165 million U.S. residents under the age of 65 currently receive health insurance coverage through their employer. A linchpin of this system is the tax exclusion that allows insurance premiums paid for by employers to be not considered taxable income for employees. John McCain’s plan for health care reform would end this exclusion. EPI’s report concludes that as many as 27 million Americans nationwide could lose their employer health benefits as a result. (Learn more about why Senator McCain’s plan would have such a devastating effect on hard-working families across the country.)

McCain's Radical Health Plan, Once Ignored, Now Hotly Debated

Roger Hickey (Huffington Post):

"Growing voter concerns over the financial crisis are closely connected to worries about health care. The latest Institute for America's Future Op Ed ad in Tuesday's NY Times links the two issues directly, with the headline: WILL WE LET CONSERVATIVES DO TO HEALTH CARE WHAT THEY DID TO BANKING? As voters feel the economy go into a tailspin, they join the millions of Americans already fearful they will lose their jobs and their health coverage.

Conservatives generally ignore health care, but now all politicians are forced to say something. In just the last few several weeks, the national media have finally started to cover the stark differences between John McCain and Barack Obama on health care. And it took some active education to get them to report the story...."

Continue reading.

Related:

• Coalition of Liberal, Rights Groups Attacks McCain Health Care Plan | The Trail | washingtonpost.com


• Health Care -- Fact-checking FactCheck.org


• Countdown: The Dangers of McCain's Free Market Healthcare Plan | Crooks and Liars (VIDEO)

Is John McCain Physically Fit for Office?

TheRealMcCain.com reports:

"John McCain has not yet released his medical records to the public. McCain is 72 years old, and has been diagnosed with invasive melanoma. In May of this year, a small group of selected reporters were allowed to review 1,173 pages of McCain's medical records that covered only the last eight years, and were allowed only three hours to do so. John McCain's health is an issue of profound importance. We call on John McCain to issue a full, public disclosure of all of his medical records, available for the media and members of the general public to review."

Email this video to everyone you know and encourage them to send it on. Cross post and spread the word, folks. Should McCain become incapacitated or worse, the prospect of Sarah Palin as president becomes increasingly disturbing.

Technorati tags: John McCain, President, 2008 Campaign, YouTube, video, health, fit for office, medical records, secrecy, activism

Quote of the Day:

"There's a lot of profit in death. Under the guise of national security. And under the guise of health care."

-- Norman Solomon, AlterNet

Technorati tags: Normon Solomon, Health Care, War, Iraq, National Security

Pushing the Single-Payer Solution

Pushing the Single-Payer Solution | Amy Goodman:

"It's time for the candidates to stop dancing around real health-care reform and get behind a single-payer system.

As the media coverage of the Democratic presidential race continues to focus on lapel pins and pastors, America is ailing. As I travel around the country, I find people are angry and motivated. Like Dr. Rocky White, a physician from a conservative, evangelical background who practices in rural Alamosa, Colo. A tall, gray-haired Westerner in black jeans, a crisp white shirt and a bolo tie, Dr. White is a leading advocate for single-payer health care. He wasn't always...."

Technorati tags: Amy Goodman, Health Care, Universal Health Care, Single Payer Health Care, Democrats, President, Election

America, The Sick

• US Health System Ranks Last Compared to Other Countries: Studies | CommonDreams.org

  "The US health care system ranks last among other major rich countries for quality, access and efficiency, according to two studies released Tuesday by a health care think tank.
  
  The studies by the Commonwealth Fund found that the United States, which has the most expensive health system in the world, underperforms consistently relative to other countries and differs most notably in the fact that Americans have no universal health insurance coverage...."

• Cuba's Cure: Why is Cuba Exporting Its Health Care Miracle To The World's Poor? | CommonDreams.org

  "...The Cuban health care system is producing a population that is as healthy as those of the world’s wealthiest countries at a fraction of the cost. And now Cuba has begun exporting its system to under-served communities around the world—including the United States...."

Technorati tags: Healthcare, America, United States, Managed Care, Universal Health Care, Cuba

A HEALTH CARE SYSTEM TO DIE FOR

By Paul Krugman - New York Times Blog

Rudy Giuliani warned us about what would happen if a Democrat wins:

You have got to see the trap. Otherwise we are in for a disaster. We are in for Canadian health care, French health care, British health care.

And that would be a terrible thing:

In "Measuring the Health of Nations: Updating an Earlier Analysis" (Health Affairs, Jan./Feb. 2008), Ellen Nolte, Ph.D., and C. Martin McKee, M.D., D.Sc., both of the London School of Hygiene and Tropical Medicine, compared international rates of "amenable mortality"—that is, deaths from certain causes before age 75 that are potentially preventable with timely and effective health care.

And you see what that tells us:

(Click Chart for Larger View)

Technorati tags: Paul Krugman, New York Times, health Insurance, Managed Care, Universal Health Care, Medicine and Health, Medicare, Republican Party, Rudy Guiliani

No More Excuses

The Krug Man points out in today's Times op ed that "the opponents of universal health care appear to have run out of honest arguments."

The question is, what will Americans -- as in YOU -- do to demand universal health care?


The Waiting Game
By Paul Krugman
The New York Times

Being without health insurance is no big deal. Just ask President Bush. “I mean, people have access to health care in America,” he said last week. “After all, you just go to an emergency room.”

This is what you might call callousness with consequences. The White House has announced that Mr. Bush will veto a bipartisan plan that would extend health insurance, and with it such essentials as regular checkups and preventive medical care, to an estimated 4.1 million currently uninsured children. After all, it’s not as if those kids really need insurance — they can just go to emergency rooms, right?

O.K., it’s not news that Mr. Bush has no empathy for people less fortunate than himself. But his willful ignorance here is part of a larger picture: by and large, opponents of universal health care paint a glowing portrait of the American system that bears as little resemblance to reality as the scare stories they tell about health care in France, Britain, and Canada.

The claim that the uninsured can get all the care they need in emergency rooms is just the beginning. Beyond that is the myth that Americans who are lucky enough to have insurance never face long waits for medical care.

Actually, the persistence of that myth puzzles me. I can understand how people like Mr. Bush or Fred Thompson, who declared recently that “the poorest Americans are getting far better service” than Canadians or the British, can wave away the desperation of uninsured Americans, who are often poor and voiceless. But how can they get away with pretending that insured Americans always get prompt care, when most of us can testify otherwise?

A recent article in Business Week put it bluntly: “In reality, both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems.”

A cross-national survey conducted by the Commonwealth Fund found that America ranks near the bottom among advanced countries in terms of how hard it is to get medical attention on short notice (although Canada was slightly worse), and that America is the worst place in the advanced world if you need care after hours or on a weekend.

We look better when it comes to seeing a specialist or receiving elective surgery. But Germany outperforms us even on those measures — and I suspect that France, which wasn’t included in the study, matches Germany’s performance.

Besides, not all medical delays are created equal. In Canada and Britain, delays are caused by doctors trying to devote limited medical resources to the most urgent cases. In the United States, they’re often caused by insurance companies trying to save money.

This can lead to ordeals like the one recently described by Mark Kleiman, a professor at U.C.L.A., who nearly died of cancer because his insurer kept delaying approval for a necessary biopsy. “It was only later,” writes Mr. Kleiman on his blog, “that I discovered why the insurance company was stalling; I had an option, which I didn’t know I had, to avoid all the approvals by going to ‘Tier II,’ which would have meant higher co-payments.”

He adds, “I don’t know how many people my insurance company waited to death that year, but I’m certain the number wasn’t zero.”

To be fair, Mr. Kleiman is only surmising that his insurance company risked his life in an attempt to get him to pay more of his treatment costs. But there’s no question that some Americans who seemingly have good insurance nonetheless die because insurers are trying to hold down their “medical losses” — the industry term for actually having to pay for care.

On the other hand, it’s true that Americans get hip replacements faster than Canadians. But there’s a funny thing about that example, which is used constantly as an argument for the superiority of private health insurance over a government-run system: the large majority of hip replacements in the United States are paid for by, um, Medicare.

That’s right: the hip-replacement gap is actually a comparison of two government health insurance systems. American Medicare has shorter waits than Canadian Medicare (yes, that’s what they call their system) because it has more lavish funding — end of story. The alleged virtues of private insurance have nothing to do with it.

The bottom line is that the opponents of universal health care appear to have run out of honest arguments. All they have left are fantasies: horror fiction about health care in other countries, and fairy tales about health care here in America.

Photo Credit: Paul Krugman. (The New York Times)

Also See:

• "Relatively modest Cuban medical programs"

Technorati tags: Paul Krugman, New York Times, Health Insurance, Managed Care, Universal Health Care, Medicine and Health, Medicare, Bush, news, commentary, op ed

Dr. Gupta's Bias

Bill Scher reports (Campaign for America's Future):

Michael Moore and CNN's Dr. Sanjay Gupta faced off yesterday on Larry King Live, following Moore's on-air criticism of Gupta's anti-SiCKO piece which accused Moore of "fudg[ing] some facts."

Moore, on his website, is ably taking Gupta to task on the factual points.

And as Huffington Post’s Rachel Sklar notes, during Larry King Live, “Moore cites his source for every statistic offered ... yet Gupta ignores it, all of it, including Moore restating, again, that all of this was available in this email [sent by Moore’s team to CNN] from June 28, 2007.”

But what was most striking was when Gupta showed the heart of his bias, a bias against having our government guarantee universal health care.

Gupta says to Moore, “You criticize the government so soundly. But you're willing to hand over one of our most precious commodities, our health care in this country, to the government.”

Moore rebutted, “I actually love our government ... It does a great job of administrating Social Security ... the problem is who we've put in power who holds office.”

Then in response, Gupta made a completely misleading attack on Medicare:

Michael, one of the best examples of health care, at least some sort of universal health care, would be Medicare. I think you would agree with that.

It's going to go bankrupt by 2019. It's going to be $28 trillion in debt by 2075...would you say that this is going to be still a working system 20 years from now?

Is this some evidence that our government can’t be directed to fix our broken health care system? Economist-blogger Dean Baker doesn’t think so:

CNN’s health care analyst is now telling people that Medicare is going bankrupt. What does this mean?

Medicare’s costs are projected to exceed its revenue and drain the surplus from its trust fund in a bit over a decade, but this has been true at several points in the past. Did Congress tell tens of millions of beneficiaries to get lost? No, Congress appropriated the money needed to keep the program going...

...If Dr. Gupta meant to imply that Medicare, as a government program is uniquely inefficient, then he is way off the mark. According to the Center for Medicare and Medicaid Services (Table 13) per beneficiary costs have risen in nominal dollars by 519.5 percent since 1980. By contrast, the cost per enrollee of private insurance has risen by 676.6 percent over this same period.

That gets at the heart of Gupta’s bias.

The pressures on Medicare’s finances are not the fault of our government, but of skyrocketing health care costs across the board.

Yet Gupta’s cherry-picks his facts to attack a government guarantee of universal care, and raise the prospect of dismantling Medicare, just like how conservatives sought to do the same with Social Security.

Health care costs are a major problem, but as Baker notes, “Eliminating Medicare would raise health care costs, not lower them.”

Whereas directing our government to ensure universal health care, as Medicare already does for seniors, can contain costs by pooling risk and maximizing bargaining power.

In the Health Care for America plan -- a Medicare-style public plan for those under 65 which would compete with private insurance – policy architect Jacob Hacker writes:

Because Medicare and the Health Care for America Plan would bargain jointly for lower prices and join forces to improve quality, they would have enormous combined leverage to hold down costs. Cross-national evidence and the historical experience of Medicare show conclusively that concentrated purchasing power is by far the most effective means by which to restrain the price of medical services...

...Other nations spend much less for the same medical services than we do because their insurance systems bargain for lower prices. And though Medicare covers less than a seventh of the U.S. population, it has still controlled costs substantially better than the private sector, especially since the introduction of payment controls in the mid-1980s.

When was the last time you saw a mainstream media report that merely raised the possibility that our government’s Medicare plan does a better job at containing costs than private insurance companies?

There is one thing said by Gupta that I have no disagreement with: “It makes it very hard to advance the argument if you're not getting the numbers right.”

Thanks to TomPaine.com.

Cartoon Credit: How to Save the World

Related Articles:

• MichaelMoore.com : An Open Letter to CNN from Michael Moore


• E-Mail Shows CNN, Gupta Given The Right Facts Before Getting Them Wrong - The Huffington Post


• AlterNet: Michael Moore On CNN's Dr. Sanjay Gupta: "He's Not Telling the Truth" [VIDEO]


• The Carpetbagger Report: � Moore v. Blitzer/Gupta


• Fixing Health Care: Not Government vs. Market

  Dean Baker writes for Truthout: "With 'SiCKO' rallying popular support for universal health care coverage, defenders of the insurance and pharmaceutical industries are shifting into high gear with their scare tactics. The key to their efforts is to frighten people about the prospect of the government managing their health care."

• VIDEO - CNN.com - Michael Moore Talks About Healthcare


• Michael Moore Blasts Blitzer: "Why Don't You Tell The Truth To The American People?" - The Huffington Post

Technorati tags: Michael Moore, SICKO, Dr. Sanjay Gupta, Health Care, Health Insurance and Managed Care, news, commentary

Surgeon General Sees 4-Year Term as Compromised

The New York Times reports:

Former Surgeon General Richard H. Carmona told a Congressional panel Tuesday that top Bush administration officials repeatedly tried to weaken or suppress important public health reports because of political considerations.

The administration, Dr. Carmona said, would not allow him to speak or issue reports about stem cells, emergency contraception, sex education, or prison, mental and global health issues. Top officials delayed for years and tried to “water down” a landmark report on secondhand smoke, he said. Released last year, the report concluded that even brief exposure to cigarette smoke could cause immediate harm.

Dr. Carmona said he was ordered to mention President Bush three times on every page of his speeches. He also said he was asked to make speeches to support Republican political candidates and to attend political briefings.

And administration officials even discouraged him from attending the Special Olympics because, he said, of that charitable organization’s longtime ties to a “prominent family” that he refused to name.

“I was specifically told by a senior person, ‘Why would you want to help those people?’ ” Dr. Carmona said.

The Special Olympics is one of the nation’s premier charitable organizations to benefit disabled people, and the Kennedys have long been deeply involved in it.

When asked after the hearing if that “prominent family” was the Kennedys, Dr. Carmona responded, “You said it. I didn’t.” ...

Continue reading.

Photo Credit: Richard H. Carmona. (The New York Times)

Technorati tags: Richard H. Carmona, Bush, Medicine And Health, Politics, Government, news

The Ravages of War

A Student, a Teacher and a Glimpse of War
By Nicholas D. Kristof
The New York Times

MALEHE, Congo

I’m taking a student, Leana Wen, and a teacher, Will Okun, along with me on this trip to Africa. Here in this thatch-roofed village in the hills of eastern Congo, we had a glimpse of war, and Leana suddenly found herself called to perform.

Villagers took what looked like a bundle of rags out of one thatch-roof hut and laid it on the ground. Only it wasn’t a bunch of rags; it was a woman dying of starvation.

The woman, Yohanita Nyiahabimama, 41, weighed perhaps 60 pounds. She was conscious and stared at us with bright eyes, whispering answers to a few questions. When she was moved, she screamed in pain, for her buttocks were covered with ulcerating bedsores.

Leana, who had just graduated from medical school at Washington University, quickly examined Yohanita.

“If we don’t get her to a hospital very soon, she will die,” Leana said bluntly. “We have to get her to a hospital.”

There was nothing special about Yohanita except that she was in front of us. In villages throughout the region, people just like her are dying by the thousands — of a deadly mixture of war and poverty.

Instead of spending a few hundred dollars trying to save Yohanita, who might die anyway, we could spend that money buying vaccines or mosquito nets to save a far larger number of children in other villages.

And yet — how can you walk away from a human being who will surely die if you do so?

So we spoke to Simona Pari of the Norwegian Refugee Council, which has built a school in the village and helped people here survive as conflict has raged around them. Simona immediately agreed to use her vehicle to transport Yohanita to a hospital.

The village found a teenage girl who could go with Yohanita and help look after her, and the family agreed that it would be best to have her taken not to the local public hospital but to the fine hospital in Goma run by Heal Africa, an outstanding aid group with strong American connections (www.healafrica.org).

Now, nearly four days later, Yohanita is on the road to recovery, lying on a clean bed in the Heal Africa Hospital. Leana saved one of her first patients.

What almost killed Yohanita was starvation in a narrow sense, but more broadly she is one more victim of the warfare that has already claimed four million lives in Congo since 1998. Even 21st-century wars like Congo’s — the most lethal conflict since World War II — kill the old-fashioned way, by starving people or exposing them to disease.

That’s what makes wars in the developing world so deadly, for they kill not only with guns and machetes but also in much greater numbers with diarrhea, malaria, AIDS and malnutrition.

The people here in Malehe were driven out of their village by rampaging soldiers in December. Yohanita’s family returned to their home a few months later, but their crops and livestock had been taken. Then Yohanita had a miscarriage and the family spent all its money saving her — which meant that they ran out of food.

“We used to have plenty to eat, but now we have nothing,” Yohanita’s mother, Anastasie, told us. “We’ve had nothing to eat but bananas since the beginning of May.” (To see video of our
visit and read blogs by Leana and Will, go to nytimes.com/twofortheroad.)

I’m under no delusion that our intervention makes a difference to Congo (though it did make quite a difference to Yohanita). The way to help Congo isn’t to take individual starving people to the hospital but to work to end the war — yet instead the war is heating up again here, in part because Congo is off the world’s radar.

One measure of the international indifference is the shortage of aid groups here: Neighboring Rwanda, which is booming economically, is full of aid workers. But this area of eastern Congo is far needier and yet is home to hardly any aid groups. World Vision is one of the very few American groups active here in the North Kivu area.

Just imagine that four million Americans or Europeans had been killed in a war, and that white families were starving to death as a result of that war. The victims in isolated villages here in Congo, like Yohanita, may be black and poor and anonymous, but that should make this war in Congo no less an international priority

Photo Credit: By Will Okun

Technorati tags: Nicholas Kristof, The New York Times, Africa, Congo, Starvation, Food, Shortages, Medicine, Health, news, commentary, op ed

At What Price War?

The War Inside
By Dana Priest and Anne Hull
Washington Post

"As many as one-quarter of all soldiers and Marines returning from Iraq are psychologically wounded, according to a recent American Psychological Association report. By this spring, the number of vets from Afghanistan and Iraq who had sought help for post-traumatic stress would fill four Army divisions, some 45,000 in all, an Army study found...."

(Click on Picture above for Special Report: "The Invisibly Wounded: Walter Reed and Beyond")

Technorati tags: Iraq, Post Traumatic Stress Disorder, Medicine, Health, Military, news, The Washington Post

What 'Support Our Troops' Entails

NY Times Editorial:

Whenever and however American troops withdraw from Iraq, a flood of wounded and psychologically damaged veterans will present the nation for decades to come with costly needs that already are overwhelming government services.

The backlog of disability claims stands at more than 405,000, with cases averaging 177 days to be processed — almost twice the backlog for civilians. Experts estimate that an additional 400,000 claims will be filed in the next two years.

At the same time, better battlefield care is sending veterans home with severe brain traumas that might have been fatal in earlier wars. Complex new treatments are required for these survivors and for veterans suffering from post-traumatic stress disorder and symptoms of depression that veterans groups fear are driving up suicide rates.

Congress is taking the lead in prodding the Bush administration, which shamefully underestimated the cost of treating the wounded. The House is sensibly budgeting $6.6 billion more than last year for veterans health care and processing claims. A series of other measures approved by the House tackle only some of the problems but point in the right direction. The Senate should act quickly on these proposals, which include:

¶Creation of up to five new brain trauma research centers to create comprehensive treatment programs. This is a whole new field of intensive care prompted by the signature injury of the Iraq and Afghanistan wars, inflicted in roadside bomb attacks.

¶Extending open-ended care for combat veterans to the first five years after their return, from the current two years. This is needed not only because of the backlog in claims and appeals but also because of the slower-evolving nature of postwar stress trauma and other illnesses.

¶A more intensive program to contact veterans who need to know about their rights.

Blue ribbon studies are under way, while the Department of Veterans Affairs scrambles to add claims processors and case managers to deal with such problems as outpatients who slip through the bureaucratic cracks. Far more is needed — especially speeding up the disastrously slow pace of judging benefit claims and appeals, and reforming anachronistic disability standards from World War II that focused on returning wounded veterans to factory and farm jobs, not the modern work world.

Clearly, the administration has failed in more than its battle strategy in Iraq and Afghanistan. While talking a lot about supporting the troops and using them shamelessly in Congressional battles and election years, the administration has systematically shortchanged the wounded and maimed who make it back from harm’s way. The nation has a moral obligation to help them face a whole new challenge of survival.

Cartoon Credit: Overcompensating: Actual Things That Happen to Jeffrey Rowland

Also See:

• In Clash With Marines, Reservists Gain Ally in VFW

  "The national commander of the proud, patriotic, 2.4 million strong Veterans of Foreign Wars (motto: 'Honor the dead by helping the living') took one look at the mushrooming dispute between three antiwar Marine reservists and the US Marine Corps, and knew where his sympathies lay: with the protesters...."

Technorati tags: New York Times, Iraq, Veterans, Medicine and Health, Military, editorial, op ed

Kristof on Health Care

Amen.

A Short American Life
By Nicholas D. Kristof
The New York Times

How’s this for a glimpse into America’s health care mess:

The student winner I’ve chosen to accompany me on a reporting trip to Africa next month is a superb medical school student named Leana Wen. She receives her M.D. this month, and will research health care access this summer at a Washington think tank.

I asked Leana about her health insurance coverage, just in case she catches leprosy on the Africa trip.

“Actually, I was going to become one of the 45 million uninsured for the summer,” she said. “The think tank does not provide insurance for ‘temporary’ employees, and my school did not allow extension of health insurance post-graduation. I still haven’t found a reasonably priced insurance plan for this period.”

Aaaaargh! When a newly minted doctor investigating Americans’ access to medical care has no insurance — then you know that our health care system is truly bankrupt.

Let’s hope that the presidential campaign helps lead us toward a new health care system. John Edwards has set the standard by proposing a serious and detailed plan for national health care reform, and other candidates should follow.

The medical and insurance lobbies have been busy blocking national health care programs since they were first seriously proposed back in the 1920’s — and the result has been millions of premature deaths in this country because of people falling through the cracks. Doctors fighting universal coverage have been saving lives in their day jobs while costing lives with their lobbying.

Over all, a person without insurance is less likely to have diseases diagnosed early, less likely to get routine preventive care — and faces a 25 percent greater chance of dying early.

Americans with good jobs and complex needs receive superb medical care. But a child in Costa Rica born today is expected to live longer than an American child born today.

The U.S. now spends far more on medical care (more than $7,000 per person) than other nations, yet our infant mortality rate, maternal mortality rate and longevity are among the worst in the industrialized world. If we had as good a child mortality rate as France, Germany and Italy, we would save 12,000 children a year.

It is disgraceful that an American mother has almost three times the risk of losing a child as a mother in the Czech Republic. According to a new report from Save the Children, a woman in the U.S. has a 1-in-71 chance of losing a child before his or her fifth birthday.

Some speculate that America’s high infant mortality rate is partly a result of greater honesty about neonatal deaths or of more in vitro fertilizations. But even if those are factors, they don’t explain why a woman is 50 percent more likely to die in childbirth in the U.S. than in Europe.

The existing medical financing system also creates perverse incentives for expensive procedures; that may be why Americans are far more likely than Europeans to get C-sections. Meanwhile, the burden of paying for these second-rate statistical outcomes is crippling American business. By next year, the average Fortune 500 company will spend more on health care than it earns in net income, according to Steve Burd, the head of Safeway. Mr. Burd and other executives have formed the Coalition to Advance Healthcare Reform, creating a corporate constituency for national health reforms.

There’s evidence that the most efficient financing system would be a single-payer structure, such as that found in most Western countries. Some 31 percent of U.S. health spending goes to administration, more than twice the rate in Canada.

So bravo to Physicians for a National Health Program, a group of 14,000 doctors and other health professionals that favors a single-payer system.

But universal coverage is only part of the answer. We also need far greater attention to public health programs focusing on prevention. Two of the most important life-saving health interventions in recent decades weren’t medical at all: the cigarette tax and laws mandating air bags and seat belt use. A national public health campaign on obesity (similar to the one Gov. Mike Huckabee started in Arkansas) should be an essential component of health care reform.

Even if a single-payer system isn’t politically possible right now, universal coverage is feasible through other mechanisms — as Massachusetts has shown. We need to hold the presidential candidates accountable, for universal coverage is an idea whose time came in the 1920s. We should insist we get it before the 2020s.

Photo Credit: Nicholas Kristof. (Fred R. Conrad/The New York Times)

Technorati tags: Nicholas Kristof, The New York Times, Health Insurance, Managed Care, Medicine and Health, Doctors, 2008 Presidential Election

An F In Health Care

MUST READ: A new report on health care by Alec Dubro, TomPaine.com, discovers that it's not only the uninsured who get substandard care—it's everybody.

Cartoon: via Physicians for a National Health Program | Single Payer Resources

Technorati tags: Alec Dubro, TomPaine.com, Healthcare, news

Bad Medicine, Sneaking In

By Atul Gawande
Guest Columnist
The New York Times

As I read about the melamine-tainted pet food, and about the hundreds in Panama killed by phony glycerin from China, I remembered a patient I once saw. She was a dancer in her 40s who had hobbled into the emergency room one October night with a painful, bulging mass in her groin. I gently put my fingers to it. It was beet-sized and firm. When I placed my stethoscope on it, I heard gurgling. This was, I told her, a strangulating hernia — a rent in her abdominal wall had trapped a loop of intestine. The swelling was the knot of bowel; the gurgling, the fluid inside.

She was at risk of gangrene and agreed to an emergency hernia operation. It’s not a complicated procedure. But there are still plenty of ways it can go wrong. Inside her, I found the hernia defect — a one-inch gap in her muscle wall — and, protruding through it, a choked-off, purple, six-inch length of bowel. I opened the gap wider, pushed the bowel back in, and thankfully it pinked back to life. We’d gotten there in time. I closed the hernia with a polypropylene mesh cut to size. It was like sewing a patch onto a torn couch cushion. The next day, she went home. I saw her two weeks later. No infection. No troubles. She’d done beautifully.

Then I got an e-mail notice. The mesh manufacturer, Johnson & Johnson, was reporting that the mesh I’d put in was counterfeit. It was fake.

Someone had infiltrated the supply chain somewhere between Sherman, Tex., where the authentic mesh was manufactured, and Boston, where I’d operated on the patient. Apparently, mesh can travel through many hands. The original lot had gone to a Memphis warehouse, and then through at least two hospital goods distributors, which sell and trade medical supplies on what turns out to be a worldwide market, like oil. Somewhere along the way a counterfeiter replaced the lot with fake mesh packaged exactly like Johnson & Johnson’s, right down to the lot number. It is believed this happened someplace in Asia. But no one really knows.

The material looked like ordinary mesh to me. But according to the alert from the Food and Drug Administration, it wasn’t sterile. And although it seemed to be polypropylene, the fibers and weave were different from the manufacturer’s. It wasn’t clear what should be done. I called the patient to come see me.

I also began to wonder how I could trust anything I use. My sterile gloves come from the Philippines, surgical sponges from China, devices and instruments from Taiwan to Texas. The ingredients for medications come from all over the world.

This is how it is now. That’s not bad, I know. But it’s not all good, either. In the effort to get the best possible results for people, it seems hard enough make sure one’s decisions are right. I’d never considered that I had to worry about my supplies, too.

So what to do?

In the name of safety and simplicity, we could try to restrict medical manufacturing and distribution networks to our borders. This is, for example, the argument for blocking the sale of medications from Canada. It’s folly, though. Medicine’s success and affordability already critically depend on materials and distribution from around the globe. Yet market forces aren’t weeding out the shady operators, either.

So we’re left only with vigilance — police work. Put enough F.D.A. inspectors on the ground and tracing technology on the goods and we actually could block those who would put an industrial solvent in children’s cough medicine and fake, unsterile material in our surgical supplies.

This we don’t do, though. The number of F.D.A. inspectors has actually been cut — partly because of small-government ideology and partly because of tight budgets. And still they’re finding more cases than ever. (In recent years, they’ve found counterfeit Lipitor, Viagra, Botox, Zyprexa and birth control pills, among others.) We need many times more inspectors. But nothing like it has been considered. That is no longer acceptable.

I saw my patient and told her about the fake mesh. She was stunned. We then considered what to do. It wasn’t clear the mesh would hold; and in many other patients, it became infected and had to be removed. But she’d done all right so far, and redoing the repair is major surgery. So she decided to wait and see what happened.

Given the alternative, doing nothing and hoping for the best was a wise choice for her. But it’s a bad choice for the rest of us.

Atul Gawande, a surgeon at Brigham and Women’s Hospital in Boston and a New Yorker staff writer, is the author of the new book “Better.” He is a guest columnist this month.

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Curing the System

Curing the System
By Atul Gawande
Guest Columnist
The New York Times

The American health insurance system is a slow-creeping ruin, damaging people and increasingly the employers that hire us. Yet there is another truth as well: the vast majority who have decent coverage are happy with the care we get — I am writing this, for instance, as I sit with my 11-year-old son waiting for an M.R.I. to check the cardiac repair that has saved his life for a decade. So most have resisted large-scale change, fearing that it could make some lives worse, even as it makes others better.

And the truth is it could.

There are two causes of human fallibility — ignorance and ineptitude — and health system change is at risk of both. We could err from ignorance, because we have never done anything remotely as ambitious as changing out a system that now involves 16 percent of our economy and every one of our lives. And we could err from ineptitude, underestimating the difficulties of even the most mundane tasks after reform — like handling all the confused phone calls from those whose coverage has changed; ensuring that doctor’s appointments and prescriptions don’t fall through; avoiding disastrous cost overruns.

Health systems are nearly as complex as the body itself. They involve hospital care, mental health care, doctor visits, medications, ambulances, and everything else required to keep people alive and healthy. Experts have offered half a dozen more rational ways to finance all this than the wretched one we have. But we cannot change everything at once without causing harm. So we dawdle.

We don’t need to, though. It is possible to alter our system surgically enough to minimize harm while still channeling us onto a path out of our misery.

Option 1 is a Massachusetts-style reform, which follows a strategy of shared responsibility. Enacted statewide last year, the law has four key components. It defines a guaranteed health plan that is now open to all legal residents without penalty for pre-existing conditions. Using public dollars, it has made the plan free to the poor and limited the cost to about 6 percent of income for families earning up to $52,000 a year. It requires all individuals to obtain insurance by year end. And it requires businesses with more than 10 employees to help cover insurance or pay into a state fund.

The reform gives everyone a responsibility. But it leaves untouched the majority with secure insurance while getting the rest covered. As a result, it has had strong public approval. Experience with delivering the new plan is accumulating. And best of all, it offers a mechanism that can absorb change. The guaranteed health plan may cover 5 percent of the state at first, but as job-based health care disintegrates, the plan can take in however many necessary.

The reform has its hurdles, no question. Some residents are angry about being made to buy health coverage — 6 percent of income is not nothing. Next April, when the tax penalty kicks in (refusers will lose their personal tax exemption), you will hear about it. As enrollment and costs in the guaranteed plan rise, there will also be intense public pressure to increase the minimum employer contribution (currently just $295) and clamp down on the costs. But this is what a real system is for: gathering everyone in and enabling the hard choices.

The approach is not just a crazy Massachusetts idea (though Mitt Romney is running from parts of it). Reform plans recently put forward by everyone from the Republican Arnold Schwarzenegger to the Democrat John Edwards to a major new business coalition take the same tack. People don’t want the mess we have — not families, not employers and not health professionals. This offers a viable way forward.

If it’s still too much for people to accept, however, there is a second option, a fallback: we could guarantee coverage for today’s children — for their lifetime. It could be through private insurance or through a Medicare plan that families must enroll them in. Either way, the subsidies required are very much within our means.

We might even pass the fallback plan first. Then, while we are stymied fighting about how to fix the rest, there’d be at least one generation that could count on something more.

Atul Gawande, a surgeon at Brigham and Women’s Hospital and a New Yorker staff writer, is the author of the new book “Better.” He is a guest columnist this month.

Cartoon Credit: Blue Washington

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Our Malignant Health Care System

Can This Patient Be Saved?
By ATUL GAWANDE
Guest Columnist, New York Times

As a surgeon, I’ve seen some pretty large tumors. I’ve excised fist-size thyroid cancers from people’s necks and abdominal masses bigger than your head. When I do, this is what almost invariably happens: the anesthesiologist puts the patient to sleep, the nurse unsnaps the gown, everyone takes a sharp breath, and someone blurts out, “How could someone let that thing get so huge?”

I try to describe how slowly and imperceptibly it grew. But staring at the beast it has become, no one buys the explanation. Even the patients are mystified. One day they looked in the mirror, they’ll say, and the mass seemed to have ballooned overnight. It hadn’t, of course. Usually, it’s been growing — and, worse, sometimes spreading — for years.

Too often, by the time a patient finally seeks help, I can’t help much.

We are adaptable creatures, and while that is generally good, sometimes it’s a problem. We have no difficulty taking prompt action when faced with a sudden calamity, like a bleeding head wound, say, or a terrorist attack. But we are not good at moving against the creeping, more insidious threats — whether a slow-growing tumor, waistline or debt.

It’s as true of societies as of individuals. We did not muster the will to reform our long-broken banking system, for example, until it actually collapsed in the Great Depression.

This is, in a nutshell, the trouble with our health care crisis. Our health care system has eroded badly, but it has not collapsed. So we do nothing.

For at least two decades, polls have shown that most consider our health system seriously flawed. With family insurance premiums now averaging $12,000 a year, the insured fear it will become unaffordable, and businesses regard health benefit costs as their single greatest obstacle to competing globally.

People without insurance are proven to be more likely to die, and 28 percent of working-age Americans are now uninsured for at least part of a year. Emergency rooms, required to care for the uninsured, have become so full they turned away 500,000 ambulances last year. As a result, large majorities support the idea of fundamental change.

Surveys also show, however, that 89 percent of Americans remain satisfied with their own health care and that 88 percent of the insured are satisfied with the coverage they have. So time and again, when confronted with the details and costs of any thoroughgoing reform, our enthusiasm evaporates.

I learned this lesson the hard way. I was in the Clinton administration when we lost health reform, partly because of special interests’ attacks, but mostly because the insured feared change more than the status quo. When voters in Oregon, one of our most liberal states, voted down a single-payer plan in a referendum in 2002, it was just the most recent sign of the pattern.

The only time the country has enacted a large-scale health system change was after a collapse. In 1965, when Medicare was created for the elderly and disabled, some 70 percent had no coverage for hospital costs. We’re not that badly off yet. Our health care system is like one of those tumors growing in my patients. The only questions are: When will it become bad enough to make us act? And will that be too late?

Reformers think we’re on the verge of waking up some morning, looking in the mirror and noticing the size of this tumor with enough alarm to do something radical about it. But isn’t it more likely we won’t?

Malcolm Gladwell has argued that when health care costs drive General Motors into bankruptcy, and 300,000 workers lose coverage overnight, that will be the next big crisis to prompt wholesale change. I thought so, too. But it now looks as if G.M. will instead wither slowly, shedding a plant here, a division there. And faced with a slow withering, we all just muddle on.

The case for sweeping reform — for severing health insurance from the workplace and creating a new system — is undeniable. But it’s going to be a long time before the large majority of Americans with decent coverage are persuaded to risk changing what they have. How then to cure a malignant health care system? Can we act before the patient collapses?

The answer is yes, but only if we make changes that alter most people’s coverage gradually, while still providing a path out of this mess. My next column will describe just that.

Atul Gawande, a general surgeon at Brigham and Women’s Hospital and a New Yorker staff writer, is the author of the new book “Better” and a guest columnist this month.

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