Donald K. Allen for President

Top of the Week

March 31, 2008

American Health Care

Providing health care insurance for all Americans has become a major issue in the campaign for president. It’s true that not everybody in the United States of America is covered by health insurance. About 16 percent of our population lives without coverage. Consider the following:

• With the passage of the Fair Tax Bill, disposable income will increase significantly by eliminating Federal income tax.

• Small businesses and larger corporations will also stop paying income tax, allowing that money to be invested in business expansion, research and development, and hiring more workers. A shift will occur bringing manufacturing jobs back to the USA.

• Employers will be better able to afford health care coverage for their employees.

• With more disposable income, America’s workforce will be better able to pay for health care insurance, or a part of it, themselves.

• Enactment of “loser pays,” or the “British rule,” regarding litigation in the USA will significantly reduce frivolous lawsuits, greatly reducing the cost of doing business for insurance companies, thereby reducing the cost of insurance premiums.

• Enactment of tort reform, with caps on medical lawsuit awards, will also reduce the expenses of insurance companies, reducing premiums again.

• Both legal changes will relieve pressure on health care providers to run every conceivable test for routine medical problems, reducing the expense of overall health care.

• Instead of health care procedures and policies being driven by insurance companies and malpractice attorneys, doctors can spend more valuable time treating patients instead of covering their liabilities.

• Medicare and Medicaid will still be available for Americans in need, as well as State Children’s Health Insurance (SCHIP).

• There will always be some people in America who choose not to spend one penny on insurance, even though they can afford it.

• The insurance industry and their lobbyists would love to have a mandated requirement for every American to purchase health insurance. It guarantees their income. This is what the Democratic candidates want to do, and for those who can’t afford it, they will tax the rest of the country to pay those premiums.

• Spending more money on preventive medicine and health education will relieve the burden on our health care system in the future.

• According to a landmark study, we can all live longer and stay healthier longer if we just stay lean and fit (Life Long Purina® Study), meaning 13-14 years longer for people.

• Physical fitness classes throughout K-12 grades must be mandatory for all schools, as well as nutrition education and obesity counseling for children and their parents beginning at early age, when lifestyle habits are formed.

• Basic first aid and self-care education must be taught in progressive segments throughout K-12 grades, beginning with simple sanitation and culminating with cardio-pulmonary resuscitation (CPR), automatic external defibrillator (AED) use, and military-based Self Aid and Buddy Care. This simple education will relieve health care facilities of many common problems and injuries because the patient simply didn’t know what to do.

• Mental health is often overlooked and underfunded. Again, mental health must be addressed from K-12 and beyond, but must be implemented as early in life as needed. The President’s New Freedom Commission on Mental Health explained what needs to be done, but the objective should be to AVOID use of psychoactive drugs as much as possible through behavior modification and adaption. The past three decades have witnessed far too much chemical behavior control in this country.

My plan for improving health care services to all Americans includes the above measures. They all work together to bring costs down, thereby making health care insurance more affordable. Along with governmental programs that provide medical care, virtually everyone in this country that needs medical insurance will have it, and everyone will receive the medical attention they require. To see what health care would be like in the USA if we nationalize health care, read on.

From the National Coalition on Health Care:

http://www.nchc.org/facts/world.shtml

 

What are the issues regarding health care in Canada?

Serious issues plague the Canadian health care system. Health costs total more than 40% of most provincial government budgets, while the federal government is expected to drop its percentage of health spending from 17% to 16% of its total budget in 2005, signaling a drop in financial support to the provinces. Currently, the federal government pays 16 cents of every health care dollar; the provincial leaders are asking for that percentage to be increased to 25 cents, as per the recommendation of a 2003 report by a royal commission on health care. The premiers of Atlantic Canada (representing the four provinces adjacent to the Atlantic) recently stated that the country’s health system could collapse without more federal funding.

Canadians express serious disillusionment with their health care system. A recent poll sponsored by the Canadian Medical Association found that “two thirds of those polled said their families had to wait longer for medical service in the last year than they thought was reasonable.” Among the issues that concerned them were waiting for specialists (75%), for emergency room services (74%), and for diagnostic tests such as MRIs (73%). This may be because resources are scarce; a study by the Canadian Medical Forum found that the country had 2.1 doctors per 1,000 persons – listed as “25% lower than the average in other leading industrialized countries.” Yet doctors are also unhappy; family doctors are currently asking for a 30% increase in their fees.

As a response to this crisis, the province of Alberta has threatened to pull out of the Canada Health Act in order to provide health care on its own terms. Alberta is considering adding facilities fees, deductibles for doctor visits, and delisting certain medical procedures in order to address rising costs and preserve its health care system, although doing so would force it to forgo 1.3 billion dollars of money from the federal government. Still other provinces have established contracts with U.S. providers for services that require long waits in Canada.

 

What are the primary issues in France regarding health care?

Because of this high level of reimbursement and coverage, French health care is among the most expensive in the world. France’s health care budget is the world’s third largest, accounting for 9.8% of GNP. If spending continues at this rate, the health service may be 11 billion euros in debt by the end of 2004 and 70 billion euros in debt by the end of 2020. Part of this cost stems from alleged waste within the system; some sources suggest that patients “shop” for doctors, visiting multiple specialists until they receive the diagnosis they want. Another cause may be the overuse of prescription drugs; one fifth of the country’s health spending goes to pharmaceuticals. French patients on average are happy with their health care system; a 1999 poll found that 78.2 percent of French citizens were very or fairly satisfied with their health care system, while 21.1 percent were dissatisfied. In particular, France has avoided the long waits for elective care that have plagued Great Britain and other countries. Yet reforming the system may be difficult. France has attempted to limit spending by setting health care budget targets, but these measures failed since there was no mechanism to correct for overspending. Attempts by the current President Jacques Chirac to cut back on France’s generous social welfare system were sharply rebuffed in midterm elections, as French voters overwhelmingly chose the Socialist and other left-wing parties over President Chirac’s conservative Union for a Popular Movement party. According to one report, “the unpopularity of Mr. Chirac’s domestic economic program ha[d] become a dominant issue here and was the major theme in the elections, which were effectively a midterm referendum on his administration.”

 

What are the primary issues in Germany regarding health care?

The German health system does not meet with unqualified approval by the German public. In a 1999 poll, 49.9 percent of respondents said they were very or fairly satisfied with their health care system, while 47.7 percent replied that they were fairly or very dissatisfied with it. The German health ministry concluded in May 2003 that their health care system suffered from a lack of competition; superfluous, insufficient or inappropriate care; shrinking revenue and an aging population. Long waits for care are a particular problem in Germany; in a 1990 poll, 19.4% of Germans reported waiting more than 12 weeks between being seen by a specialist and receiving surgery. To fix these issues, the ministry suggested, among other measures, that they provide incentives to promote cost-effective care; perform a therapeutic benefits/cost analysis of prescription drugs by the Centre for Quality in Medicine; and finance benefits not covered by health insurance by increasing the taxes on cigarettes.

German chancellor Gerhard Schroeder recently passed a landmark health reform package, with the intent of reducing German health spending and bringing down health insurance premiums, which currently cost more than 14% of an individual’s monthly salary. The changes approved include a.) charges for non-prescription drugs, b.) an end to free treatments, such as health farm visits, c.) an end to free taxi rides to the hospital, d.), and the reduction of health insurance premiums.14 The measures (see above in “What does health care cost in Germany?”) have proved immensely unpopular.

 

What are the primary issues in Japan regarding health care?

The Japanese social system as a whole is expected to struggle in the future, as its population of young working citizens will increasingly be outnumbered by elderly retirees. “By 2050 Japan is projected to lose 35 million workers, with 35 percent of the population in retirement…. The median age of Japanese population will have risen by 12 years to 53…. One question being asked is how a shrinking workforce – expected to be 50 million in 2050 – can support such a large number of retirees.” To offset current and future deficits in the nation’s health and pension funds, the government recently asked employers to pay more for their employee’s pension contributions, which already total 14% of the employee’s annual income, shared between the employer and the employee. Employers are staunchly opposed to this idea.

More specific problems can also be found within the Japanese medical system; in addition to the strain posed by the aging of Japan’s population, the style of its medical system also tends to make it highly expensive. For example, “Western countries have about the same number of doctors and nurses as Japan, in proportion to the size of the population, but they have about one-third or one-half fewer hospital beds. In Japan, hospital stays are two to three times longer than in the West, so the number of beds is consequently larger.” Due in part to such practices, in FY1999 the national health expenditure exceeded 30 million yen for the first time, equaling 8% of the national GDP. The Ministry of Health, Labor, and Welfare wrote that “it is urgent to implement a radical reform of the medical care insurance system to minimize the growth of inflating medical expenditure, while allowing all people to receive quality medical care.”

 

What are the issues regarding health care in the United Kingdom?

The British health care system is experiencing serious problems with its funding, service, and staff that vary in severity across the region. A long-standing problem has been long waiting times for care, particularly for elective services and procedures. In the United Kingdom in 1990, 41.2 percent of Britons reported waiting more than 12 weeks between seeing a specialist and receiving surgical care. A NHS watchdog group reported that some PCTs lack essential senior staff, forcing “some practices to close their lists, while other areas suffer from a severe lack of district nurses. There are also long waiting lists for therapists, particularly physiotherapists.” Another study found that for the past several years, waiting to see a specialist and waiting for elective surgery have been ranked as the first and second most critical failures of the NHS. There are also allegations of declining quality of equipment and staff; another group, Audit Scotland, found that a quarter of all NHS equipment in Scotland has become dangerously outdated, while “only half of Scotland’s health trusts could demonstrate that staff had a proper understanding of the equipment.” Together these factors have contributed to serious dissatisfaction with the health care system. In the London Telegraph, Sheila Lawlor declared that the question was “who provides the healthcare and whether we get value for money. The answer, patently, is that we do not.” Those who can afford it may opt for private care: conservative shadow health secretary Liam Fox suggested that the number of people opting for private care rose by 29% in 2001 because of dissatisfaction with the NHS. A recent poll found that 35% of British citizens ranked health care the most pressing national issue. A 1999 poll found that a slim majority of 55.7 percent were very or fairly satisfied with their health care system, while 42.3 percent were fairly or very dissatisfied with it.

An additional hot-button issue is the idea of “health tourism.” The Daily Mail in London recently alleged that “Migrant health tourists jump NHS queue (and we foot the bill)”. In June of 2003 the shadow health secretary Liam Fox claimed that the NHS was becoming “’the health equivalent of Disneyland’ as many people came from abroad to get free treatment.” One study suggested that such abuse costs up to 200 million pounds per year, although exact figures on the scope of the problem are lacking. To correct this problem, the NHS released new rules governing care; most controversial is the new requirement that “those seeking routine care will have to pay in advance if they cannot prove their NHS entitlement.”

The government has introduced various efforts to improve the health care system, including performance targets that emphasize “safety, clinical cost effectiveness, governance, patient focus, accessible and responsive care, health care environment and amenities, and public health.” Additionally, in 2001 the NHS began ranking Public Care Trusts with a star system, similar to that used with hotels. Those trusts that score highest in categories ranging from staff absence rates to the length of time a patient wait see a GP are awarded three stars, while the worst receive none. However, “very few people outside the government believe the start ratings provide an accurate picture of how the NHS is doing.” The British Medical Association has pointed out that the system fails to consider the quality of patient care or survival rates.

In terms of cost containment, the NHS recently announced that hospitals would, for the first time, receive a standardized fee for 48 different types of treatments for NHS patients as part of an effort to standardize the cost of care and reduce costs. The British Medical Association, however, has protested that “some tariffs will be far lower than the real costs of providing care, putting undue pressure on hospitals to make cuts.” The NHS is also experimenting with a system in which patients can receive treatment in other countries, provided that demand for that treatment far exceeds supply in Great Britain.