Too much moral purity, eh? Ooooh kaaaaay.

But more on that later. Meanwhile...

The problem with equating our private insurance companies with European private insurance companies, is that ours are investor-owned and profit-driven, while theirs are non-profit and, in essence, not much more than private companies that are hired to administer what is in most cases a de facto government-run single-payer system. The government tells them what they will cover and what they will charge people for that coverage, and most of that coverage is paid for with taxes.

The private "insurers" that Maggie Mahar admires here, Group Health Cooperative and Kaiser Permanente, are non-profit, true HMOs and are basically miniature versions of the National Health Systems of Spain and the UK, where the government [the taxpayers!] owns the hospitals and clinics and employs the doctors and nurses and so forth. We have that here in the US: the VA system [and no, Walter Reed is an Army hospital, not a VA hospital].

The much-admired Cleveland Clinic and Mayo Clinic also operate this way, non-profits that own their own facilities and hire their personnel on salary.

All of which argues that the very best way to deliver superb care *and* contain costs is to just nationalize the whole damned system, where the taxpayers own the hospitals and employ all the nurses and doctors.

After a lot of study, this has become *my* preferred solution: open up the VA system to everybody in the country [we'd probably have to rename it though]. The VA even has a working electronic health records system already in place, for those of you who are turned on by that sort of thing.

Not everybody is up for that radical a change, and besides, I'm all for promoting small and medium-sized businesses, so I'm willing to compromise here.

Nationalizing the whole system [payers, providers, and facilities] is one far end of the spectrum of methods for providing health care [for convenience, we'll call it the left].

What we have right now is almost all the way at the other far end of the spectrum: totally privatized [we'll call this the right]. We've essentially established Medicare as our national high-risk pool, covering the elderly and disabled, as both are rather expensive groups that the private insurers don't want to have to pay for, but beyond that [and a few other imperfect safety nets such as Medicaid, state high-risk pools, etc], it's pretty much market-driven competition.

And this is where Barack Obama's plan, Max Baucus' plan, Jacob Hacker's plan, Ron Wyden's plan, Bill Clinton's plan, Hillary Clinton's plan, John Edwards' plan, [I could go on] fall down. The assumption in all these plans is that providers [doctors, dentists, hospitals, pharmacies, etc] are competing with each other for customers [patients] and that payers [insurance companies, and "a new public plan like Medicare"] will all be competing with each other for customers [individuals, employers].

The reality is that intra-group competition doesn't happen all that much. Your employer dictates who your insurer is, your insurer limits your choice of doctors / hospitals / pharmacies, and people generally pick the closest doctor from that list and go to whichever specialist or hospital that doctor sends them to.

Really, payers are in competition with providers, employers are in competition with payers, individuals are in competition with each other [for jobs] and with their employers [over who pays how much of the premium], and individuals who lack employer-sponsored coverage are in competition with payers.

To help various entities in this multi-sided argument compete with various other entities, we have:

- benefits managers [hired by employers to negotiate with insurance companies, and to explain benefits to employees]

- pharmacy benefits managers [to negotiate three-way with insurance companies, pharmacies, and drug companies]

- radiation benefits managers [presumably they do the same thing as PBMs but with imaging centers instead of pharmacies and drug companies]

- denial management companies [to help providers argue with payers]

- patient advocates [to help individuals argue with payers]

- utilization review and utilization management companies [iirc, they're hired by payers to check up on providers and patients both]

Plus, you can hire auditors to check up on all of the above. It's a terrific system for employing lots and lots of people and shoveling lots of $$$$$ throughout the economy, but it sucks at delivering health CARE.

Single payer and European-style multi-payer are right smack dab in the middle: nationalized insurance and private providers. Single payer [fully-nationalized insurance] is a bit to the left of center, and European style [mostly-nationalized insurance] is a bit to the right of center.

Getting back to the moral purity argument... neither of these centrist positions is one of moral purity, but moving to one or the other of them is going to be essential for our survival.

Single payer has several advantages over European style:

- less administrative complexity means lower costs [or more money available to be spent on actual care]

- the US is a big country with a mobile population, and one plan with every provider "in network" means fewer hassles for travelers

- why would anybody want to choose among *plans* and *payers* when we could all have the same plan and payer and just choose our *providers*?

As for losing groups like the Cleveland Clinic, the Mayo Clinic, Kaiser Permanente, and the Group Health Cooperative if we go to single payer, it's my understanding that under HR 676, such non-profit provider groups would still exist. I haven't called John Conyers' office and asked him about it though, so I could be wrong. Any volunteers?

/rant

The Fed thinks about biting back

at PredatorCards.

Even better, a few Congresspersons --- Senator Chris Dodd and Representative Carolyn Maloney are mentioned --- are saying that the rules need to be even more stringent. 


Predictably, there's some whining:

"This is a very aggressive regulatory intervention in the marketplace that will lead to higher prices and less credit options for everyday consumers," said Ken Clayton, senior vice president of card policy at the Washington-based American Bankers Association. "It basically says that we can't price for risk and we can't in a cost-effective way provide these low-cost options like balance transfer opportunities at zero percent interest because of the way they're mandating how these loans get paid back. We won't be able to make the loan."

Umm, dude... you're not pricing for risk now, and nothing you have on offer is low-cost.

How's that gold-plated HMO working out for ya?

And your prescription drug co-pays?

Persons who are bigger and more worthy than you are

CEO pay is not only outrageously high, it's handed out based not on performance but on ability to schmooze and scheme.

Monsanto already controls, and tinkers with the genetics of, a huge portion of our food supply, starting with some staple commodities like corn and soybeans, extending to milk, and now they want to produce novel, value-added vegetable seeds.

Speaking of novel, how about those new, improved, modernized financial instruments that have served the average homeowner, and the general economy, so well?

Drug companies track which drugs doctors prescribe, bribe doctors to prescribe certain drugs over others, and want to be able to lie and cover up their failures and mistakes.

The internet is spying on you.

If you don't know what the insurance companies are up to you haven't been paying attention, but here's yet another pie they've got fingers in: 'disease management' for Medicare patients. Yes, they really do claim they can cut Medicare costs by applying their expertise to helping direct the patients’ care.

KBR's human rights are being violated because some of their female employees think that submitting to being raped shouldn't be part of their job description.

Corporate personhood, the now-legally-enshrined idea that corporations are people just like you and me, entitled to the very same Constitutional rights, may not be directly responsible for each of the above abuses, or the many more I've left off the list, but it has unleashed a scourge upon us that we're going to have a hard time digging out from under.

Government of the people, by the people, and for the people requires some work on the part of the people. You can start by checking out which of your elected officials have voted for such "reforms" as tort reform and the bankruptcy bill and reminding them that they work for you, not for corporations.

Live fast, die young, stay pretty

Cost less. Just don't go to Mississippi.

One of the problems with all the candidates' health care policies is that they all tout losing weight and quitting smoking as one of the keys to our being able to afford universal health care. Besides the holier-than-thou moralizing and the infuriating paternalism embodied in this approach is something I've long suspected, just from looking at my own family:

good clean living is not the key to a cheap and painless death.

If you got stuck with the genes for cancer, it makes no real difference if you get the disease at 50 or at 80, it's still going to cost about the same amount to treat it. If you got stuck with the genes for heart disease, it makes no real difference if your first heart attack is at 40 or 70, it's still going to cost about the same amount to treat it.

And if you didn't get any of those genes, but instead got stuck with the genes for Alzheimers, why in the name of all that is cost conscious did you not take up smoking at a young age and have the grace to die of lung cancer? Because Alzheimers, besides the emotional havoc it wreaks on its victims and their loved ones, is a truly expensive and often lengthy way to shuffle off this mortal coil.

So, now we can finally get off this 'personal responsibility' kick and lay the blame for out-of-control health care costs where it belongs: at the feet of the health-care-industry vultures --- pharmaceutical companies and for-profit insurance companies being good ones to start with.

I can has privacy?

“How much control should an individual have over their personal information?,” Phillips muses as he shows me around. “I think individuals should have more control than they do, significantly more control. Individuals ultimately should be required to provide their explicit consent for the use of that information."

You would think these would be the words of a privacy advocate. You would be wrong. The man behind Aristotle Inc, John Aristotle Phillips, values his own privacy, but buys and sells every little piece of data about you that he can get.

His metier is marrying voter registration lists to everything else and selling that information to politicians for microtargeting voters.

“What we do is help a campaign run more and more like an effective business,” Phillips says as he types on his laptop, bringing up on a large projection screen the profile of an actual voter in Atlanta, whom we’ll call John Smith.

Phillips hits a button and up pops Smith’s basic information—address, phone number, etc. A click of the mouse brings more personal information—his photograph, his age and occupation, the names of his adult family members, his party affiliation and approximate income. Another click summons the exact amounts of political donations he has made. Phillips clicks once more, and a kind of molecular model appears on-screen, showing every political donor and potentially influential person Smith is linked to, in Atlanta and beyond, with dozens of interlocking nodes. Each node leads to the profile of another voter, about whom Aristotle knows just as much or more.

And when he's not selling your data to politicians, he's selling it to anybody who's got a credit card.

kuhm-plis-i-tee

Jay Newton-Small has been covering the horse-race aspects of the Edwards campaign for Time magazine, and in her latest article Why Edwards Never Caught On she writes this:

But even Edwards' boundless optimism and energy has his limits, and today he admitted what all the pundits and politicos have been saying for the past month: the Democratic contest is a two-person race, and Edwards is not one of them.

She left out a few words:

But even Edwards' boundless optimism and energy has his limits, and today he admitted what all the pundits and politicos have been saying for the past month: the Democratic contest is a two-person race, and we're doing our best to ensure that Edwards is not one of them.

She's written a whole string of articles [in no particular order]

• Has John Edwards' Moment Arrived?
• A Second-Place 'Victory' for Edwards?
• Edwards Fights To Stay Relevant
• South Carolina: No Haven For Edwards
• Huckabee Surges, Edwards Fades

It's not quite the hatchet job that was done on Al Gore, but with press like that, you're better off without coverage.

Becuase FICO scores have been such a rousing success

in determining who should get mortgages and credit cards, soon we'll be able to similarly contain the rising cost of health care with the implementation of MedFICO scores.

Dear Health Insurance Companies:

Y'all are afraid of competition from the government, eh?

I wonder how that could be.

Could it be because you won't sell your product to otherwise perfectly healthy individuals with only minor afflictions, even some childhood afflictions that they outgrew years ago?

Could it be because you will sell your product to a group, and then renege on the contract with the entire group? What? 8000 people isn't a large enough risk pool?

Could it be because you sell your product to an individual, but cancel them when they fall ill and need the coverage they've paid you for? And then reward your employees handsomely for it too.

Could it be because, instead of denying your customers coverage outright, you just drag the process out until they go away [downsized from their jobs, for example]?

Could it be because you're still trying to suck money out of your customers even after they die? [h/t]

Nah, can't be.

And yet, posses of your customers and former customers are forming against you, with blood in their eye and all manner of weapons to hand.

PS. Your brethren in the property and casualty business might want to go crawl back into their coffins too.

Dear Fraser Institute:

This is how you report on drug pricing. I've cherry-picked just the one table [above] from the report, but you'll note that the VA, which negotiates with Big Pharma, gets substantially lower prices on some very pricey drugs, while Medicare, which does not negotiate anything, pays through the nose.

The Bush administration has once again successfully defended the rights of the poor beleaguered drug companies from those predators, the patients.

Oh, wait... I may have the predators confused with the prey, which is easy enough to do in our current only-huge-multinational-corporations-can-has-welfare climate. Fortunately there's this report The Choice: Health Care for People or Drug Industry Profits to help clear up a muddied picture. Some cherry-picked tables for you, on just exactly where Big Pharma chose to spend those billions of dollars that we shelled out in 2004:






I had another anti-Fraser Institute post planned for tonight, but fortunately Cliff dropped by in the comments below and saved me from myself. If you missed it, he links to a couple of his blog posts rich in keeping an eye on the opposition so hipparchia doesn't have to Fraser Institute debunking.

The Masters of Mendacity

The Fraser Institute's Fighting Retreat on Healthcare

He's got a whole slew of posts on the Fraser Institute, in all its shenanigans, and healthcare, Canadian and American. Just in case I'm not already drowning you in this stuff on my own.

Also, Who funds the Fraser Institute?

Webbery

I was reading about the high price of free credit reports the other day, and decided to look up the text of the Fair Credit Reporting Act, since I think as highly of credit bureaus as I do of for-profit health insurance.

So, while I was composing a post in my head on the FCRA, I was also surfing some of my favorite blogs, which lead me to the EFF's FOIA Litigation: Abuse of National Security Letters (NSLs).

They've gone to some trouble to get this information, and will be putting a lot more effort into the project it looks like:

EFF received these documents as the result of a FOIA request made through our FLAG project. We ask that you please mention EFF if you use these documents in any way. We're a nonprofit organization, and our funding for this project depends on showing that our work is important and relevant. For more information about these documents or EFF's FLAG project, please contact EFF Staff Attorney Marcia Hofmann at marcia(at)eff.org.

I'm a fan of EFF, and not a fan of being spied on, so I thought I'd take a crack at some small portion of the project. I'm on page 45 [of 199] of the very first background documaent, A Review of the Frderal Bureau of Investigation's Use of National Security Letters, so I may not get around to actually contributing much.

A couple of years ago, I was reading in one of the magazines that only a geek could love about the FBI's antiquated computer system and their buggy database, and I remember thinking even I could do better than that. 45 pages into it and I'm glad they can't get their act together. I think.

via

Sermonizing and stuff

• I've added a link in the sidebar to BibleGateway.com. Not to worry, though, I haven't got religion. I just want to be able to recklessly throw around Bible quotes. I used to be able to do this from memory, but have since decided to devote those brain cells to other functions.



• Verse of the Day for today, when I did happen upon BibleGateway.com, was “But the Lord is faithful, and he will strengthen and protect you from the evil one.”- 2 Thessalonians 3:3 I'm not sure if Jesus can save me from Darth Cheney, but Thessalonians is just a fun word to say.



• Speaking of whom, in Ron Suskind's book The One Percent Doctrine, Cheney justifies the GWOT and all of his other actions basically, by saying that if there's even a 1% chance of ___insert fear-of-the-day here___ happening, we must act as if it is true. Not that he ever bothers to show his work on those calculations. What goes into deciding that there's a 1% chance that Saddam Hussein had WMDs? I'm betting Cheney just pulled a number out of the ether.



• Speaking of pulling numbers out of ethers, in that same book, Cheney or some henchperson figures out that if you follow the money, you can maybe track terrorists. Rather than hurriedly cobble together a computer program and/or database, they just went to FirstData and got all their data. Yep, that's right, FirstData would be the company that handles abut half the credit card transactions in the US. Cheney didn't even have to snarl at them to get them to hand over the info, they were plumb tickled to do their patriotic duty and help their country. Nor is this the first-ever time in history that the government has asked a huge corporation to hand over their records of their customers' transactions and the corporation has complied.



• Speaking of credit: a small public service announcement



• Google Street View is still just a fun toy, no way are we anywhere near living in a panopticon society, right? Well, maybe just in New York City and London and a few other places and a few remote spots in sunny Florida.

A brief history of US health insurance

I've cherry-picked another quote for you:

At the forefront of these service (non)providers was U.S. Healthcare, which grew out of the first for-profit HMOs in the 1970s. By the early 1990s, it was the largest publicly traded HMO, with annual revenues of more than $1 billion. The company -- a notorious proponent of gag clauses in physician contracts that prevented doctors from giving patients a thorough description of their treatment options -- took on the mission of revolutionizing the insurance industry. In a 1992 interview with Business Week , U.S. Healthcare founder and chairman Leonard Abramson expressed scorn for traditional carriers, calling them "dinosaurs" and saying they operated in "a dying world." [emphasis mine]

We should be giving tax dollars to this industry? One that prevents your doctor from telling you about all possible treatment options for whatever ails you? No.

It's a readable and not overly techincal review of the industry's morphing from social insurance [premiums are the same for everyone, and risks are spread over as large a pool as possible] to actuarial insurance [individual premiums are based on individual risk, and high-risk members are "encouraged" to drop out of the pool].

Those "dinosaurs" mentioned in the quote above were of the social insurance persuasion, whether they were for-profit or non-profit, and they predominated until about the 1970s. There were flaws, and health care costs were rising*, but our present-day system is almost entirely actuarial now, and things are just worse. Much worse.

* Just thought I'd point out this sentence fragment [top of page 2 of the article]: "... escalating health costs -- a problem that was greatly exacerbated by the growth of for-profit hospital chains."

What I'm reading

You've seen those widgets in people's sidebars, variously titled What I'm Reading or Book List or so forth. Then there are the various blogoland book clubs, some of which I even secretly follow, and there's no dearth of good reviewers out there in cyberspace either. I've got a list of books to read th-i-i-i-i-i-s lo-o-o-o-o-ong that I won't be able to reach the end of, even if I outlive Methuselah and all his grandkids, but there's a special section titled What Keifus Read that resides near the top of the list.

Not to mention a little light reading I was wading through at lunch today:

• Multinational Monitor


• Halliburton Watch


• The Effect of Taxes on Royalties and the Migration of Intangible Assets Abroad*


• Controlled Foreign Corporations, 2000

Just in case you wanted to follow along.

Russian roulette is probably safer

Drug companies, the FDA, and some doctors, don't appear to have your health as one of their top priorities. Newsflash.

First up, clinical trials in general:
After Sanctions, Doctors Get Drug Company Pay
By GARDINER HARRIS and JANET ROBERTS
Published: June 3, 2007
[NYT article, may require registration to view]

A decade ago the Minnesota Board of Medical Practice accused Dr. Faruk Abuzzahab of a “reckless, if not willful, disregard” for the welfare of 46 patients, 5 of whom died in his care or shortly afterward. The board suspended his license for seven months and restricted it for two years after that.

But Dr. Abuzzahab, a Minneapolis psychiatrist, is still overseeing the testing of drugs on patients and is being paid by pharmaceutical companies for the work. At least a dozen have paid him for research or marketing since he was disciplined.

Medical ethicists have long argued that doctors who give experimental medicines should be chosen with care. Indeed, the drug industry’s own guidelines for clinical trials state, “Investigators are selected based on qualifications, training, research or clinical expertise in relevant fields.” Yet Dr. Abuzzahab is far from the only doctor to have been disciplined or criticized by a medical board but later paid by drug makers.

An analysis of state records by The New York Times found more than 100 such doctors in Minnesota, at least two with criminal fraud convictions. While Minnesota is the only state to make its records publicly available, the problem, experts say, is national.

But we have the FDA looking out for us, keeping up with this, keeping us safe, because that's why the agency was created in the first place, right? Wrong.

Drug makers are not required to inform the agency when they discover that investigators are falsifying data, and indeed some have failed to do so in the past. The F.D.A. plans to require such disclosures, Dr. Woodcock [deputy commissioner and chief medical officer of the Food and Drug Administration] said. The agency inspects at most 1 percent of all clinical trials, she said.

Just a side note, but it looks like Minnesota is a good state to practice in if you're not a very good doctor:

The records most likely understate the extent of the problem because they are incomplete. And the Minnesota Board of Medical Practice disciplines a smaller share of the state’s doctors than almost any other medical board in the country, according to rankings by Public Citizen, an advocacy group based in Washington.

And here, one drug in particular:
Doctor Says Drug Maker Tried to Quash His Criticism of Avandia
By STEPHANIE SAUL
Published: June 2, 2007
[NYT article, may require registration to view]

I don't think I'll pick out any quotes from this one, it's difficult to tell from this article whether the drug company suppressed data, or the doctor has an axe to grind because he has some kind of interest in a competing drug. Looks like it could be either or both or some of each, but none of it gives me a warm fuzzy feeling about clinical trials.

Stuff you might ought to know about.

Or not.

I've been running a bit of a spoon deficit lately, so I'm not up for actually writing [or even thinking] right now, but I thought I'd point out some items I found at the Public Citizen Consumer Law and Policy Blog. What they said.


Food

• Preventing Contamination Of Our Food Supply: Is FDA Up To The Task?

Privacy

• The Spy Act Protects Corporations, Not Consumers


• More Google Privacy Fears


• Uncle Sam: Dangerously Careless With Our SSNs

Corporations behaving badly and Lobbyists run amok

• Is There A Relationship Between Predatory Mortgage Lending And Political Contributions?

Skip the above if you like, but read the links in this post

• Poverty in Business Week

The plural of anecdote IS data [part 1]

I've grown tired of that stoopid shibboleth: the plural of anecdote is not data. But I have grown even more tired of that other shibboleth: health care rationing. Just try to get good hard data on that from insurance companies. Pretty much leaves us with just anecdotes to analyze.

I, for one, do not believe we'd have a serious rationing problem if we went to single-payer universal health care. But if we did, I'd much rather the rationing get decided based on my fellow citizens' health care needs or even on a first-come-first-served basis outside of emergencies. I do not consider it right that rationing be based on the profit margins of corporations.

Besides, I'm old enough [just barely!] to remember when doctors were the medical experts, not accountants. I'm also old to remember when insurance companies really and truly sold you insurance, rather than just bet with you on the state of your health and then welsh on their bets. I'd really, really, really like to go back to that era. I'd even be happy with high-deductible, major-medical, guaranteed-coverage, for-profit insurance. That guaranteed coverage is a sticker though. This country has already gone way far past the point where we hold corporations to the same standard of responsibility that we demand of the fellow in the street.

Speaking of insurance company profits, check out the Industry: Health Care: Insurance & Managed Care Fortune 500 list for 2007.



So, anyways, excuse the tangential rant, back on topic: rationing. Anybody who doesn't think we already have rationing right now, here, today, in the good ol' US of A, hasn't been paying attention. Some of the forms that rationing takes:

• waiting periods for coverage


• partial coverage with none for pre-existing conditions


• complete refusal of coverage because of particular conditions, past or present [asthma, once had anti-depressants prescribed, had cancer, ...]


• not to mention deciphering all the gobbledygook in the fine print, which basically leaves them lots of weasel room when deciding how much of any one charge for any one service they will pay for [and argue with you about till you decide it's easier or cheaper to pay it yourself].


• [add your example here]

Data to be updated periodically*

[compilation of anecdotes]

• pregnancy, followed by baby with rare genetic disorder [more examples in the comments]


• video interviews [4 so far] of people who have been denied health care


• a loophole [soon to be closed?]


• Sticker shock -- Twisty can afford can afford to pay for the cancer drugs that her insurance won't cover, but few of us could


• Suspicious breast lump? Sorry, go away.


• Lose your job, your money, your house when you get cancer. Oh yeah, and you'll never be able to get insurance again. [1st comment, by Spinning Liz]


• Moral of this story: Don't get old. [the long-term care insurance industry is just as good for you as the health insurance industry]


• Bob Herbert would start with guaranteed coverage for all kids, but he's still looking like a pro-corporatist shill here [thanks, syd]


• Using ethically questionable methods to sell "privatized Medicare" [Medicare-replacement insurance] to the elderly, then hitting them with high costs, such as huge co-pays [and not all doctors accept these plans either]


• “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. [quoting Kristof becuase I'm too lazy to condense it for you]


• [this space to be filled at a later date]


• [this space to be filled at a later date]


• [this space to be filled at a later date]


• [this space to be filled at a later date]


• [this space to be filled at a later date]


• [this space to be filled at a later date]

* I'm much better at starting projects than keeping up with them. If you didn't already know that, you haven't been paying attention.

Newsflash: Men don't like to wear condoms.

Women have to take birth control pills; men don't. Girls have to get shots for HPV; boys don't.

I'm all for women taking steps to protect themselves, but making it into a law?! And while I like the idea of Women in Government banding together to get things done, in, around, behind, or in spite of, the good-ol-boy network that all too often pervades government, I'm horrified that they seem to be pushing this.

If we're only going to force one sex to get shots, why can't it be the other one? They're the ones who are going to be infecting the women of tomorrow. Let them take the responsibility. Well, ok, maybe both sexes can get the shots.

Still, I'm opposed to making anti-cancer vaccinations required by law, no matter how benign the intent. Required vaccinations ought to be limited to those diseases that are highly communicable and that a whole crowd of people can quickly catch just by being in the same room for only a few minutes or hours with one sick person.

And requiring vaccinations against one specific cancer? How many cancers are there now, that we know of? I dunno, I think the allegations that Merck may have been lobbying a little too hard for these laws might be valid.