The Great Health Reform Fiasco
Sep 10 '09 (Updated Nov 25 '09)
The Bottom Line The Democrats are screwing up the much needed health care reform
Let’s see…what’s happening these days? What would I write about if I had my own blog? Micheal Jackson is finally buried; Michelle Obama’s straight hair is the most debated issue in America; Italian PM Silvio Berlusconi has almost reached his dream of having sex at least once with every prostitute in Italy; Israel is about to declare war on Sweden because a Swedish journalist finally exposed the long-suspected Israeli organ theft from Palestinian corpses; traitor Oliver Stone has made a movie celebrating another enemy of America, Venezuelan leader Hugo Chavez, simply because he’s got more balls than anyone in America…and, yes, Barack Obama is a total failure as a president.
Poor Obama. He cannot do anything right. He is getting targeted by the usual rabid right-wingers because he has an un-American name and is supposedly a Socialist. His support from the left is eroding, because the change he promised and was the basis of the mandate he received isn’t quite materializing. He is a centrist and is preoccupied with getting the consensus of those Republicans who badmouth him on a daily basis. What a wimp! Let’s see: he bailed out the bankers with few strings attached, fueling a Wall Street mini-bubble instead of boosting the productive sector of the economy; he is escalating Bush’s wars, without a chance in hell of winning them (It’s a war of necessity, we hear. Wrong, it’s a war of stupidity). His loyalty to the military complex and to Israel’s insane genocidal policies is basically of neo-con derivation: Bush himself could hardly have topped him. Yet, there is no issue nowadays that sees Obama more battered and yelled at than the infamous health care bill that is painfully shaping up on Capitol Hill.
The Sorry State of US Health Care
A whopping 45% of Americans (68% among Republicans) believe the US medical system is the best in the world. This erroneous perception may be based on the fact that the US possesses the best medical research centers in the world, or can just be attributed to the well-known American provincialism. Indeed, when ther entire system is taken into consideration, no matter who does the analysis, the US comes close to the bottom in the Western world. Most EU countries deliver medical services that are vastly superior for 40-60% less money per capita. The US spends 17% of its GDP in health care, my host country of Belgium 8%, yet Belgians enjoy longer life expectancy, longer “healthy” lives, and have lower infant mortality and teen pregnancies.
These analyses often lead to the conclusion that the US ought to look at Europe for a way to reform its health care system. Such an analysis, however, is superficial. European societies are deeply different from America: Americans will not get a EU-style public health care system, because American society isn’t willing or ready to transform itself into a socialized democracy like the ones you see in Belgium, Switzerland or Holland.
Social Darwinism
If there is a belief that’s deeply rooted in the American psyche, this is the idea that life is a zero-sum game. In the dog-eat-dog world one experiences in the US, life is a competition, and there must be losers and winners. The whole song and dance about what the rich people do is at the center of American culture. Nobody wants to be labeled a loser, although –by objective analysis- the great majority of Americans end up being exactly that. Indeed the word “loser” is heard every day in American discourse, from the schools to the workplace, from the bar to the movie screen, indeed so much to make you nauseous.
Interestingly, in Italian there is no such word as “loser”. One can say “perdente” referring to a team that just lost a football match, but it is not used to label people. Interesting… the Italians, who possibly have the world’s largest vocabulary of disparaging words for people, don’t know how to label a man a “loser”. In Europe, life is not a zero-sum game. There are people with more money than others, but one fact is understood here: lots of money is unnecessary to enjoy life. The European bourgeois, by and large, loves a life devoid of competition. Here the idea that health care is a universal RIGHT, and the government should provide it, takes easily hold. Americans are skeptical about government-guaranteed universal benefits, and many of them would like to dismantle those which are already in place. On the other hand, Americans are very vocal and aggressive when campaigning for their own benefits and welfare. There are groups, lobbies, activists for any kind of narrow interests. Much less frequent are groups that campaign for “universal causes”. Sure enough, Americans are known for volunteer work, charity, generosity to those who don’t have enough. But only after the system has established that there be winners and losers, so the winners can be merciful to the losers. Without giving up the idea that life is NOT a zero-sum game, a EU-style system isn’t thinkable. In the US, the number one cause of personal bankruptcies is the high cost of medical bills. This simply does not exist in Europe.
The Inefficiency of the Private Enterprise System
Another myth Americans subscribe to is that private enterprise is always more efficient than the government. “Keep the government away from my health care” you hear from many Republicans. Another absurd idea that is hard to eradicate. One fact, which is recognized by most analyses I have read, is that the US system is inefficient because of the high administrative costs. The presence of 1,300 or so private insurance companies should lead to a competitive environment. Far from that, it delivers a system that expends 25-31% of its budget in administration, much more than the EU-style state-run system.
In each doctor’s office in the US there is a large staff of people figuring out bills, reimbursements, or arguing with the insurance companies regarding approval of procedures. Americans spend an average of $1,059 per person to pay for these book-keepers, and are treated to a cumbersome system which requires them to fill out form after form BEFORE receiving care, unless they are literally dying. A Canadian spends $307/year. A Belgian even less than that. Like in many EU countries, here we have our medical history on a chip (something the US, almost alone in the Western, world does not have, still relying on stone-age paperwork), we are never asked to fill out forms or provide sources of payment. You scan your card, and wait for the doctor. Of course, estimates on administrative expenses vary greatly depending on what one defines as “administration”, but the results are qualitatively clear. EU and Canada spend much, much less in the area because they have a simpler system: the government is heavily involved in administering and regulating health care. Just another case of a public system beating a private one.
Many Americans, quite simply, will never believe it. This allows the insurance lobby and fat idiots like Rush Limbaugh to invoke the ugly specter of Socialism. The health insurance lobby is well entrenched in Washington. The fat they have been skimming over the last few decades has made them cozy with the politicians, and nobody dares go against them, least of all Obama, although they are a drag on the economy and provide a lousy service. He has actually invited them to Washington to help him draft the bill. “Rather than rebuild the system from scratch, we will work with the system we have and modify it” says the president, which means “I am too much of a chicken to take on Big Business”. Far from Socialism creeping into the US system, you have Corporate Fascism raising its ugly head.
US Senate: Bribes are Us
And this leads to another problem: the nature of campaign financing in the US allows a large portion of private funds to pour into campaign coffers, which is much less common in Europe, where parties and candidates are usually financed by a federally sanctioned system. When senators receive millions of dollars from the insurance or Pharma lobby, what are the chances that they will choose the welfare of the people? This level of corruption extends to the presidency. OK, it is not corrpution if it is legal. The American system has legalized corruption. In their great tradition of democracy, Americans are allowed to know how much Sen. Baucus has received from the health insurance lobby (over $ 2 million), but in the spirit of an increasing undemocratic country, they can do nothing to prevent it, because BOTH parties are on the same payroll.
The Unhealthy American Lifestyle
A fact that must weigh in substantially has to do with lifestyle: Americans have a lifestyle that is probably the most unhealthy in the developed world: they consume large amounts of fatty food and they do not exercise. This leads to a rate of obesity that is now well over 30%. In the European capitals of good cuisine, France and Italy, the rate is 9%, due to a better diet, more mobility, and balance in life. In wealthy Asian countries like Japan or Korea, obesity is almost unheard of. Even neighboring Canada has only 14% of obese people. Americans have a lower life span and consume a lot more medications than Europeans. Other factors that are rarely considered, and which I haven’t seen quantified, but nevertheless MUST have an effect, are that Europeans work less than Americans, as measured by all relevant statistics, not only because our work week is 35-37.5 hours instead of 40, but also because Europeans enjoy more paid vacation per year (a minimum of 30 days in France vs. 15 for the US). Europeans enjoy longer maternity leaves, can take unpaid vacation to care for children or elderly parents without being fired, and enjoy all kind of perks (e.g. long stays in clinics after burnout, fully paid) that reduce stress. To achieve the health of the average Europeans, middle-class Americans would really have to revolutionize their lifestyle, and the fabric of the workplace on top of that.
Overpaid Doctors
The doctors have their lobby too. American doctors don’t want to see federal bureaucrats set standard fees for their services. MDs in the US are paid substantially more than their EU counterparts, and specialists fabulously more so. In spite of that, access to care is good in the EU, and there are more family doctors per capita than in the US. American doctors make, on average, three times more than French doctors, who nevertheless deliver the best health care in the world, according to a WHO survey. So much for the idea that underpaid doctors would lead to a health care crisis! Of course, US doctors must pay malpractice insurance, which is higher than in France, where suing doctors is not a favorite sport like in the US. But this is more than offset by the higher tax structure in France, or anywhere in Europe. Thus, an MD here is likely to be taxed at the 50% bracket (I pay 59% of my salary in federal taxes, here in Belgium), substantially more than in the US. Add to that the high sales tax (21% in Belgium, 19% in Germany) on everything they buy. Then add the fact that in most cases they cannot even deduct mortgage payments from their taxes, and you have the picture: American doctors would have to take a big pay cut for Americans to enjoy a EU-style health care system, and they are not likely to roll over and accept it. How many American MD couples do you know who live in a two-bedroom apartment? I know a few in Germany….
The Lawsuit Mentality
To be fair, it is not MDs only who are filling their pockets. Lawyers and insurance companies are leeches that take another substantial chunk. Estimates vary on the portion of the health budget spent on “defensive medicine”. I have seen figures between 5 and 10% of the whole enterprise. But it is clear that US doctors carry out more tests and useless procedures than the EU counterparts (famous are the milliions of needless C-sections and bypasses performed in the US), all because of the frivolous lawsuits that are commonplace in the US. In Belgium, I have been told, it is almost impossible to sue a doctor, unless he does something unbelievably stupid. To have a EU-style systems, Americans would have to give up their cherished ability to sue. This is unlikely to happen. I believe for Americans a botched medical procedure is a bit like winning the lottery, and is tied to the myth of success. Occasionally, indeed, courts award fabulous sums to plaintiffs. Recently, Merck was sentenced to pay $253 Mill due to a single death caused by its anti-inflammatory drug Vioxx. This single patient, or rather her able lawyer, singlehandedly caused Merck’s stock to drop 8% in one day! There is poetic justice in this, but it is also what makes the US system so expensive. All taxpayers, indirectly, paid dearly for the right of a little lady to fight the system. Americans may have to decide whether to keep playing the lawsuit lotto or have a cheaper health care system that may be able to cover everybody.
And here is something strange: in many ways Americans are a people who prefer personal responsibility and initiative rather than waiting for the government to provide for them. But like everything American, there is a profound dichotomy: just as most Americans cannot even accept the responsibility of disposing properly of their own garbage, or to balance their checkbooks and finances in a responsible way, they don’t seem to accept the idea that things can go wrong in life: somebody else, other than themselves, must be to blame. Again, we have a responsible, resilient people full of initiative, and at the same time obsessed with blaming others for everything. A rooted mentality which is unlikely to change overnight.
Big Bad Pharma
Finally, I could not end without mentioning the much maligned Pharma industry, which pays my salary. Pharma has the biggest lobby on Capitol Hill, it’s got Republicans and Democrats on the payroll, and that’s why nobody dreams of mentioning price controls (almost universal in Europe), or formularies in which drugs that deliver minimal or no care aren’t reimbursed. The Pharma lobby spends $100 Mill per year on Washington, and US citizens indirectly foot the bill. In addition, companies advertise directly to the consumer, which leads to more pressure on doctors to prescribe newer, expensive medicines which deliver little more than the old, generic ones. Pharma spends over 35% in marketing, and less than 20% in R&D. Again, this translates into a high cost of prescriptions. Americans believe in the free market and pay the highest prices in the world. A box of Lipitor (the best-selling drug in the world) costs $362 in the US, $215 in socialist Canada and $121 in destitute India. The reasons are complex, but can be simplified: of all the goverments in the world, the one that is most intimately in bed with the Pharma lobby is the US, and this largely due to campaign financing.
Don’t do it like the French
Whether you have Obama or Clinton, it is just not possible in the US to reform the health care system along more sensible lines, i.e. a EU-style single-payer system. Current proposals will achieve “universal” coverage by forcing people to pick one of the many private health providers, which will continue to blossom, overcharge and deny care. This means people will still be uninsured or, in the best case, under-insured. People will still be denied care or will go bankrupt because of the preposterous medical bills that are designed to fill the pockets of insurance executives, Pharma CEOs, medical specialists, tort lawyers and the like.
Don’t hold your breath for the American health care system to go and copy the successful French model, precisely as you shouldn’t hold your breath for Americans to start embracing the lifestyle of those (to quote the historic Rumsfeld invective) “cheese-eating monkeys”. If a majority of Americans want to realign themselves along European lines, they’d better start making a lot of noise, because those in power sure don’t have any intention of going that way!
The welfare of the American people is the last thing on their mind.
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Location: Antwerp, Belgium and Aachen, Germany
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