07 November 2009

American Health Care : Monster Run Amok

Cartoon by RS Janes / LTSaloon.

Once the envy of the world...
The American health care disgrace

By Dr. Stephen R. Keister / The Rag Blog / November 7, 2009

Between 1910 and 1970 American medicine was the envy of the world. The giants of American culture were its physicians: William Osler. Howard Kelly, Harvey Cushing, Elliott Joslin, Charles and Will Mayo, W.W.G. Maclachlan, Jonas Salk, Alfred Sabin, to name a few. Mothers dreamed of their sons growing up to be physicians, who were considered on a par with clerics, or college professors.

From the 1970s on, many physicians ceased to be idealists who took care of the ill, regardless of ability to pay, and became content to make a decent living without idealizing money. Things have indeed changed. The physicians’ respect in the community has diminished to a point that is akin to that of the MBA, used-car salesman, or fundamentalist preacher. (My apologies to the used car salesman as I have several very honest, upright acquaintances in that area of business.)

The average American -- except those who are very well-to-do and count doctors among their golfing buddies -- think of medical care in terms of CT Scans, MRI machines, laboratories, and medical device purveyors. No longer, to most folks, is the doctor a friend and confidant.

With this surrender to the for-profit insurance industry the once proud, idealistic physician has morphed into the "provider,” paid and manipulated by the insurance executives. Happily, the current health care debate suggests that many idealistic physicians have survived -- as evidenced by the 60%-plus support among doctors for a government provided alternative to the insurance cartel's monopolistic rationing and manipulation of health care. My gratitude to Physicians for a National health Care Program and The American College of Physicians, with their thousands of dedicated members.

Currently the system of medical care in the United States is a blot on our international reputation. Most of those living in Western Europe, and many in the Third World, are baffled about how this great nation could countenance having 50 million individuals without regular medical care. And they wonder how we could allow 45,000 persons to die yearly for lack of insurance (according to a report from the American Journal of Public Health), and how we could have let 17,000 children die over the past two decades (according to a study released by the Johns Hopkins Children's Center).

They are confused why the richest country in the world needs to import physicians from the Third World to make up for the inadequacy of trained American physicians. (My thanks to the numerous very capable physicians from India that I have encountered, as well as many from Iran and other Middle Eastern nations.) Nowhere else in the world, save in the USA, do we see signs posted in malls announcing a spaghetti dinner at a fire house to help defray the costs of a child's brain tumor surgery.

And take this mind-boggling piece of information: according to The World Health Organization, only one of thirty companies producing H1N1 flue vaccine is based in the United States, that being Aviron/Wyeth/Lederle, which makes a nasal vaccine. Our main supplier is the U.S. branch of Sanofi Pasteur, a French company located in this country, Nearly all European nations have one or more companies producing the vaccine; Korea has three and China seven. When I retired in 1990 I recall that three U.S.-based companies were making influenza vaccine. I have been told that production was discontinued because of excessive unused inventory of the vaccine, which is dated, which diminished the profits of the manufacturer.

There are still many excellent if harried physicians remaining in the United States; however, getting into a physicians office on short notice has become a problem for most people. I am aware of a friend with a torn knee cartilage who was told that it would take six weeks to get an appointment with an orthopedic surgeon, while another older lady with digestive problems had to wait six weeks to have an esophagoscopy scheduled.

A third elderly acquaintance, with interstitial cystitis, has seen a urologist on three occasions, totaling approximately 20 minutes, was never examined, and on each occasion was prescribed antibiotics purely on the basis of a questionable, voided urine culture. Never did she receive an explanation of her condition, or its long term implications, or was cystoscopy suggested. I finally accessed her literature relative to the condition from the Mayo Clinic via Google.

Where I live, obtaining an appointment with a dermatologist may well take several months. Yet, the opponents of decent health care in the United States continue to spread the myth that ours is "the best system in the world" and that in other nations you can expect long waits to get an appointment -- which is most likely to be true only if you are seeking a specific physician at a major institution. Currently the U.S. Chamber of Commerce is in the forefront of the lies and deceit industry, joining the Health Insurance industry in promulgating ad after ad on television, and a large percentage of the unsophisticated American public tends to confuse this promotional material with factual information.

Last Thursday, Nov. 5, we saw a well choreographed demonstration in Washington, with thousands of the uninformed and misinformed brought in on busses and provided with placards which they frequently did not understand, and all this was paid for by institutions associated with the health insurance industry. In addition the mainstream TV programs continue to provide panels of talking heads to discuss health care, most of them provided by the conservative think tanks.

The other clever maneuver of the insurance industry is to incite the anti-abortion lobby and get them aligned against decent health care. These folks, who are interested primarily in ovocysts, and not in children once born, rail against decent health care as if the whole plan was devised as a scheme to provide abortions for the poor -- when the Hyde Amendment already makes it illegal to use federal funds to provide abortions. The opponents of decent care for all Americans are stooping to any ruse or deceit, as evidenced by the ads espousing Medicare Advantage as "good health care,” to influence the ill informed, culpable American public.

I write this on the eve of the intended House of Representatives vote on a bill for health care for all. Of course, we would hope that such bill would include the core features outlined by Health Care for America Now:
  1. A public health insurance option for all established by the federal government,
  2. One that is available to individuals and employers across the nation,
  3. Not merely a panel of private plans (such as FEHBP, the health insurance available to federal employees), and not limited to low income individuals,
  4. A government body, or independent entity established by government, sets policies and bears the risk for paying medical claims,
  5. May hire insurance companies, where efficient and appropriate, to handle administrative functions such as paying claims,
  6. Provides broad access to providers that meet defined participation standards,
  7. Consults with providers and nonpartisan experts to establish provider rates and develop and implement payment system reforms that promote quality care, prevention, and good management for chronic care,
  8. Operates separately from existing public programs such as Medicare, but may tap into their infrastructure (e.g. payment systems, claims processing, and appeals processes).
Further details cam be found here.

The next step, of course, is to try to inject some reason into the discussion in the Senate which appears at times to have abandoned any sense of logic. Take, for instance, the bizarre, suggestion that health care reform include coverage for "prayer treatment." Odd that we in the United States will even suggest the commercialization of prayer! Next, maybe we should claim airfare to Lourdes as a "medical expense" when we file our income tax deductions.

But, seriously, we keep hearing from Harry Reid that it will be difficult to get the 60 votes to pass a decent health care bill. This is undoubtedly true, if the Senate lies down and acts like a whipped dog. There is a solution under parliamentary rules and it’s called the “nuclear option.” Change to Senate Rules is discussed in detail on Wikipedia.

The key part reads as follows:
The nuclear option is used in response to a filibuster or other dilatory tactic. A senator makes a point of order calling for an immediate vote on the measure before the body, outlining what circumstances allow for this. The presiding officer of the Senate, usually the Vice President of the United States or the president pro tempore, makes a parliamentary ruling upholding the senator/s point of order. The Constitution is cited at this point, since otherwise the presiding officer is bound by precedent. A supporter of the filibuster may challenge the ruling by asking, "Is the decision of the Chair to stand as the judgment of the Senate?" This is referred to as "appealing to the Chair." An opponent of the filibuster will then move to table the appeal. As tabling is non-debatable, a vote is held immediately.

A simple majority decides the issue. If the appeal is successfully tabled, then the presiding officer's ruling that the filibuster is unconstitutional is thereby upheld. Thus a simple majority is able to cut off debate, and the Senate moves to vote on the substantive issue under consideration. The effect of the nuclear option is not limited to the single question under consideration as it would be in a cloture vote. Rather, the nuclear option effects a change in the operational rules of the Senate, so that the filibuster or dilatory tactic would therefore be barred by the new precedent.
The proponents of decent healthcare-for-all face the Rubicon. We the public must exert enough pressure on our elected representatives, and upon President Obama, to offset the chicanery in the House and Senate, and to try with reason and compassion to counter the bribing of our elected officials, and the misinformation and outright lies deluging the public. Time is short, but this old man would like to finish his later days with head high, once again seeing our country as a leader in health care.

We would like to see our nation respected as a leader in ethics and morality, rather than being looked upon as a Third World nation when it comes to treating the sick and disadvantaged. Ours should be a nation based on doing what is correct and not one subservient to the fringe manipulated by the big corporations, the financial elite, and those who allow their ambition to overcome our traditions of kindness and charity as expressed in the Sermon on the Mount and the Beatitudes.

Dr. Richard Wolff, economist at The University of Massachusetts, says that our economic collapse -- which has gradually developed over the past 150 years and has accelerated since 1970 with wage stagnation, and excessive profits -- may take years to correct, if it can be corrected at all. But let us show the humanity, the sense of community, that we see in the Western European nations. Their epiphany occurred after World War II, when they moved beyond the devotion to self interest, to accumulated wealth at all costs, that is inherent in the doctrine of "private enterprise" and neoliberal economics.

Perhaps those folks who keep pretending that this is a “Christian Nation" should review the true meaning of their alleged faith. Perhaps it is time to cast out the money changers and show some compassion for our fellow man. Remember what Lyof Tolstoy wrote in 1893 in The Kingdom of God Is Within You:
The Christian churches and Christianity have nothing in common save name: they are hostile opposites. The churches are arrogance, violence, ursurpation, rigidity, death; Christianity is humility, penitence, submissiveness, progress, life.
Let good Americans stand for life and good health.

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform. His writing appears regularly on The Rag Blog.]

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