04 November 2011

Dr. Stephen R. Keister : I Cry for my Country

I cry for my country:
The state of health care in America

"Laissez-faire, supply-and-demand, -- one begins to be weary of all of that. Leave all to egotism, to ravenous greed of money, of pleasure, of applause; -- it is the gospel of despair." -- Thomas Carlyle, 1843.
By Dr. Stephen R. Keister / The Rag Blog / November 4, 2011

[Happy Birthday Steve Keister!!!

Our dear friend, Dr. Stephen R. Keister, turned 90 on Sunday, October 9. For the last three years Steve has written -- with a unique and singular voice -- dozens of columns about the sad state of our health care system. And in that time he has become the heart and soul of
The Rag Blog. He claims this is his last column, but we promise not to hold him to that commitment! We hope he will continue to share his wisdom with us for many months to come.

In the meantime, look for Sarito Carol Neiman's
Rag Blog feature article on the life and times of Dr. Stephen R. Keister. Coming soon to a Rag Blog near you!

-- Thorne Dreyer, for everyone at
The Rag Blog.]

Having passed the age of 90 I wish that my final days could be days of happiness and good wishes for those about me; however, it appears that fate has ordained otherwise. It would be a great course of satisfaction to see an enlightened, progressive United States as a homeland for my grandchildren. Instead we find a nation that is descending into quasi-feudalism and subservience of the many to the few.

With that in mind, I approach my final column for The Rag Blog with a few observations about medical care in the United States.

Rarely do I watch television as I find it stultifying, by and large, save for a few generally open and informative presentations on MSNBC. I did, however, watch on ABC news report about a day of free medical care at the Los Angeles Coliseum where hundreds of the poor, underprivileged, uninsured stood in line -- many of them all night -- to gain admission to a day of free care provided by volunteers from the L.A. area.

This is my country! This is the nation that spends twice what any other civilized nation spends per capita on health care! This is what the corporate leaders and their political prostitutes have to offer for the coming years! This is what the Republican presidential candidates condone and would promote for the future health care of our country, and for which the current administration has crafted, for political purposes, a faux health care bill, dictated by the insurance consortium and the pharmaceutical industry.

We, in the United States, have the ultimate in health care rationing -- and it's rationing based on one's ability to pay.

Nation of Change featured an article by Noam Levey titled, "U.S. Health Care Falls Further behind Peers, Report Finds." The article, notes that "The U.S. health care system is lagging further and further behind other industrialized countries on major measures of quality, efficiency, and access to care, according to a new report from the nonprofit Commonwealth Fund, a leading health policy foundation." The report in full is available here.

In its fall newsletter, Physicians for a National Health Policy (PNHP) reveals many more facts that surprised me and may surprise you. For instance:
  • 60.3 million Americans (19.8%) were uninsured for at least part of 2010, up from 58.5 million people in 2009, according to the National Center for Health Statistics. 48.6 million Americans (16 %) were uninsured at the time of the interview for the 2010 survey, up from 46.3 million people in 2009, with the majority, 35.7 million Americans (11.7% of all Americans), uninsured for more than one year, up from 32.8 million people the previous year, according to an analysis of data from the National Health Interview Survey.

  • Nine million working-age Americans -- 57% of people who had health insurance through a job that was lost -- became uninsured between 2008 and 2010, according to a survey by the Commonwealth Fund.

  • Health care premiums will rise 8.5% in 2010, according to a PricewatterhouseCoopers survey of 1,700 firms. Employers are offering workers more meager plans in response to rising costs; 17 % of employers surveyed most commonly offered high-deductible health plans to their workers this year, up from 13% in 2010 (Merrill Goozner, The Fiscal Times, 5/18/11).

  • The total cost of a health care plan for a family of four covered by a VA Preferred Provider Plan (PPO) in 2011 is estimated to be $19, 393, up 7.3% from 2010, according to Milliman Medical Index. Employer contributions account for 59%, $11,385, of the total, while employees pay 41% of the cost, $8,008. Employees will pay an average of $3,280 in out of pocket costs. (The Milliman Medical Index ).

  • U.S.Physicians spend nearly four times more on billing and related overhead each year ($82,975 vs $22,205) per physician than their Canadian counterparts, with U.S. medical practice staff spending over 20.6 hours per week on bureaucratic tasks, compared to just 2.5 hours per physician week under Canada/s single-payer program (Morra et al., "U.S.physicians practices vs Canadians," Health Affairs, 8/11.)

  • The nation's five largest for-profit health insurers netted $11.7 billion in profits for 2010, up 51% from 2008, because medical costs grew more slowly than forecast, as insured patients skimped on medical care to avoid costly co-pays and deductables during the severe recession. UnitedHealthcare was the leader in profitability, taking in over $4.6 billion in profits, followed by WellPoint ($2.9 billion) and Aetna ($1.8 billion).

  • CEOs at the nation's five largest for-profit insurance companies garnered $55.4 million in compensation in 2010. The top paid was Cigna's David Cordani ($15.2 million), followed by WellPoint's Angela Braly ($13.5 million), United Healthcare's Stephen Hemsley ($10.8 million), Aetna's Mark Bertolini ($8.8 million), and Humana's Michael McAllister ($6.1 million). (Executive Pay-Watch, AFL-CIO, 2011).

  • The pharmaceutical industry spent $6.1 billion in 2010 to influence American doctors, and another $4 billion on direct to consumer advertising, according to IMS Health.
And then there's hospice care:
  • For-profit hospices are expanding rapidly and may be cherry-picking the most profitable patients, according to a recent study. The number of for-profit hospices increased from 725 in 2000 to 1,600 in 2007, while the number of nonprofit hospices remained stable at 1,205 in 2007. Overall, 52% of facilities are for profit, 35% are non-profit, and 13% are government owned.

  • Hospice care is funded by Medicare on a per-diem basis, with a fixed rate ($143 in 2010) paid to providers for each day a patient is in a facility. Because the first and last days of care are more expensive, to provide, longer care generates higher profit. The study found that patients in for-profit facilities averaged a 20-day stay, compared to 16 days in nonprofit centers. (Your author has a question. In view of the fact that hospice care is designed to provide compassionate, painless death with dignity, what is the method of four days longer survival in the for-profit hospice?)

  • Hospice care costs for nursing home patients jumped nearly 70% between 2005 and 2009, from $2.5 billion to $4.3 billion, while the number of hospice patients increased by only 40%, according to the Office of the Inspector General. Hospices with a large share of patients in nursing homes were typically for profit and appeared to seek out patients with certain characteristics associated with life expectancy and lower demand for care. The Medicare program paid for-profit hospices more for patients than it paid non-profit and government owned hospices in 2009. For profit hospices received about $12, 600 per patient while nonprofit and government entities received between $8,200 and $9,800 per beneficiary.
One bit of light is the California Medical Association's resolution to legalize marijuana. A tiny bit of encouragement, but a very long way to go.

This old geezer can find nothing to relieve my depression regarding the future of health care in our fair country. The moral decay, the worship of wealth, and the lack of Christian charity appear to create a situation that worsens by the day.

I find no hope within either political party as both are whores to the corporate interests that dominate our society. The sole voices of hope that appear to reach the public in general come from the "99%" movement and Dylan Ratigan's campaign for a constitutional amendment to do away with money in politics.

Unlike in Europe, where the populace has a basic understanding of the existing domestic situation, the average American appears to be entirely moved by nothing but the sloganeering of the political Right.

I cry for my country, and while asleep I hear in my dreams the mass gatherings of my youth singing, "Arise ye prisoners of starvation, arise thee wretched of the earth, for justice thunders condemnation, a better world's in birth."

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform and is a regular contributor to The Rag Blog. Read more articles by Dr. Stephen R. Keister on The Rag Blog]

Graphic from The New York Times.

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