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Jill Lawrence
Jill Lawrence
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How to Get Sicker, Die Sooner, and Pay More for It

Comment

Could someone please send a copy of the latest Commonwealth Fund report on the U.S. health care system to the 21 states that are not moving to expand Medicaid under Obamacare?

Sometimes a bunch of news comes together in ways that make you want to hit your head against a wall. This is one of those times.

The Commonwealth Fund report examined health systems in 11 western industrialized nations. For the fourth time in a decade, the United States system placed first in cost and last in what it delivers. Our system is less fair, less efficient, makes us less healthy and gives us shorter lives. All that for an average $8,508 per person, way more than second-place Norway at $5,669. In case you were wondering, Britain's socialized National Health Service was No. 1 at less than half the U.S. cost.

That information landed just as Allan Detsky published a New Yorker analysis of two 2013 reports on global health systems by the Organization for Economic Co-operation and Development and the National Institutes of Health. The study of the 34 OECD countries found an alarming trend: The United States ranked 20th for life expectancy at birth in 1990 and fell to 27th in 2010. On a measure combining level of health and length of life, we plunged from 14th to 26th.

The NIH report by the federal Institute of Medicine found that Americans fared worse than people in 16 "peer" countries in nine areas: infant mortality, injuries and homicides, teen pregnancy, HIV and AIDS, drug-related deaths, obesity and diabetes, heart disease, chronic lung disease, and disability. Why? The authors cite a larger uninsured population than peer countries, worse health habits, more poverty and more neighborhoods designed to require automobiles. "The panel was struck by the gravity of its findings," the report says.

We should all be struck by that. But we should also note that we have gained a few new tools since those three studies were done. Some, such as Michelle Obama's Let's Move initiative and money for electronic medical records in the stimulus law, are nudging us slowly in a better direction. Among the most significant advances are Obamacare's new marketplaces (where individuals can buy insurance regardless of their health status) and the law's expansion of Medicaid (even though the Supreme Court transformed it into an option that states could take or leave).

The Medicaid expansion is designed for people who make too much to qualify for traditional Medicaid but too little to afford even subsidized private insurance plans. In states that have rejected the expansion, some 5 million people are stuck in an absurd coverage gap. That's even though the federal government is footing the entire bill for the additional enrollees until 2016 and will pay at least 90 percent for them after that.

If we're already spending a huge amount on health care, why should we sink more into it? It's a good question — yet we might not have to spend more if we were spending more wisely. We could start by slashing our astonishing medical pricing. It costs more than eight times as much for an MRI here as in Switzerland, according to a study of nine countries released in April by the International Federation of Health Plans. Heart bypass surgery costs nearly five times as much as in the Netherlands; having a baby costs more than four times as much as in Argentina.

We could reimburse doctors for discussing end-of-life choices with their patients, and we might find their choices are less expensive than aggressive treatment to the end. We could reduce shooting deaths and injuries, and their public health cost, by lifting bans on research into gun violence. Both of those steps seem like common sense — but they would require that conservatives in Congress set aside ideology and fears of primary challenges from the right.

The same political dynamic is at work in the 21 states refusing so far to expand Medicaid. The most dramatic saga has been unfolding in purple-state Virginia. Gov. Terry McAuliffe, a Democrat who made Medicaid expansion a top issue in his campaign last year, has been repeatedly thwarted by Republican lawmakers and most recently by a disloyal Democrat who resigned and threw the state Senate into GOP hands.

McAuliffe now has a budget on his desk that does not expand Medicaid. He could sign it, veto it (thereby risking a government shutdown), sign it but veto a section meant to make sure he can't act on Medicaid, or sign it and expand Medicaid unilaterally (the last two being surefire ways to become embroiled in expensive lawsuits). He has no good choices. Nor do the 400,000 Virginians that McAuliffe estimates are stranded in the coverage gap.

And this, dear readers, is how you get to be last place in the developed world.

Follow Jill Lawrence on Twitter @JillDLawrence. To find out more about Jill Lawrence and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate website at www.creators.com.

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Comments

1 Comments | Post Comment
Ma'am;... People are not dying of bad medicine... People are dying because of the combined desires of everyone to see everyone else drop dead... I have a metaphysical theory that we die because everybody wants us to...And they die too because everyone wants them to... If we did not so hate each other, want what others have, and care so little for our own lives we might live forever... No; If I am rich it must mean more than money... It must mean that I am happy and you are sad, that you die, and I live, that I can dream without the need for drugs, and you must pump poison to escape your reality... People die because death is wished into being, invoked, implored upon, and bribed... What DH Lawarnce said of American Literature, that it is all about death is true for the whole world... If we put a fraction of the life we now spend on death into the encouragement and nurturing of life we might all live for ever, or at least not face death with such bitterness and the thought that those we hate have had their way...
The destruction of our health and health care would not be possible without the unfounded belief that we are the best of all possible worlds.
Comment: #1
Posted by: James A, Sweeney
Wed Jun 18, 2014 10:07 AM
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