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... it's unwillingness to reform health care.
For many of us who live in Canada and Europe it seems like implementing change should be a no brainer but when I watch the news it looks like some Americans are ready to fight to keep the status quo. Am I missing something???
<span style="font-size: 17pt"><span style="font-weight: bold">Why Americans can't talk about health care</span></span>
<span style="font-style: italic">August 15, 2009</span>
BUFFALO, N.Y.–Leo Astyk and Bob Smith are slumped into old chairs just inside the garage door of Best Automotive Service, the repair shop Smith has run for the past 23 years.
It's a broiling, sticky day and business is slow. Astyk, a retired steamfitter, is trying to pry loose the broken blade of a utility knife as Smith wipes his hand with an oil rag.
Everything about their body language speaks of a long friendship, guy friendship, the kind that doesn't require a lot more than wordless ease in each other's company.
In more than three decades, they've never had a major fight about anything. Until now.
When it comes to the U.S. health-care system, they might as well be on different planets. And the raw kernel of their dispute just happens to reveal why American debate about health-care reform has become so primal, so reflexively nasty, as if nothing less than the soul of the nation were at stake.
"I'm very anti-big government," says Astyk, who clearly hews to the "rugged individualism" side of American history. "I'm not a moron. I don't need someone telling me what to do every step."
Unlike 46 million other Americans, he has his own health insurance, courtesy of the steamfitters union.
Not so Smith. If he weren't covered by the insurance plan of his wife, a retired New York state employee, Smith wouldn't qualify for Medicaid, the government plan mostly aimed at poor families with kids, pregnant women and those with disabilities. As a single man, says Smith, he'd "be screwed."
But just the hint of more government involvement is enough to send Astyk reeling with disgust. "I think President Obama is a socialist."
<span style="font-weight: bold">For Canadians and Europeans, who tend to view medical care as a civic right alongside the vote, the current debate over the U.S. health-care system can often seem puzzling – not just in its intensity, but how a government role marks such an emotional divide.</span>
<span style="font-weight: bold"><span style="font-size: 14pt">The United States spends more on health care than any other country on the planet, about 16 per cent of gross domestic product, compared with 10 per cent in Canada. Nearly half of all that spending already passes through government hands via the likes of Medicaid and Medicare, the program for seniors.</span></span>
<span style="font-size: 14pt"><span style="font-weight: bold">And yet there are still nearly 50 million Americans without insurance of any kind. Why?</span></span>
For starters, they're not among the 66 per cent of adults under the age of 65 who have either employer-sponsored insurance or private insurance, according to the pro-reform Kaiser Commission on Medicaid and the Uninsured.
Nor are they among the 16 per cent who qualify for Medicaid, a national program but with funding and coverage thresholds set by the states, which vary wildly. New York State, for instance, is relatively generous, since you can be at or above the poverty line and still qualify.
But in 33 states you have to earn less than the poverty level, and in 12 of those, you have to earn less than half the poverty line to get coverage.
Overwhelmingly, the uninsured are the working poor not quite poor enough to get Medicaid. More than 80 per cent of them come from households where at least one member has a job, but often part-time or at companies that don't provide health insurance. And even for those at companies offering insurance, it's not always affordable.
<span style="font-weight: bold">A basic, family health policy in the United States typically costs between $12,000 and $13,000 (U.S.) a year, with the employer picking up 75 per cent of the tab. That leaves at least $3,000, which many Americans simply can't shoulder.</span>
<span style="font-weight: bold">"If you're making $22,000, you're not exactly able to buy insurance for your family," says Diane Rowland, executive director of the Kaiser Commission.
</span>
The Obama-inspired reform packages now wending their way through Congress are wide-ranging and complex, but the core would mandate that every American have some form of health insurance.
There would also be an affordable public alternative to private insurance, which is where the trouble started. "That immediately interjected into broad, health-care reform this issue of government-run versus private sector, and it's continued to dominate the debate," says Rowland.
Did she anticipate how ferocious that fight would be, with brawls, firearms and pitchforks becoming a feature of fiery town hall meetings across the country? "I guess I would have to say I was shocked."
JOYCE BUTTS ought to be the pinnacle of contentment, sitting on a veranda in east Buffalo, surrounded by masses of hanging flowers and little American flags. She isn't.
Last weekend, she went off to the dentist with a sore tooth, only to be told her Medicaid plan, which she has because of a car accident, doesn't cover dental work. "I paid my taxes all these years, paid to charities, and when I need services, they're not there."
She looked into supplemental private insurance, hoping to add dental and vision care, but the cost – $300 a month – was "astronomical" for someone who's mainly been unemployed since 2003 and, at 57, doesn't hold much hope of landing another job.
She used to work at GE Capital as a senior adjuster, calling up those who'd fallen behind in their car payments, trying to work out new repayment plans or, if that failed, arranging for the vehicle to be repossessed.
What rankles most is not just that she lost her job when the work moved to India. It's that she and her colleagues spent nearly two years training groups of workers who had been brought over from India. "We sat next to those people."
Does she think the health-reform packages will go through and change the landscape for people like her? "I'm not optimistic, at all, at all."
Her friend on a nearby settee, who wouldn't give his name, suddenly rises to high dudgeon about all the "greasy-assed politicians. We can come up with all this money to bail out the auto industry, but something people need like health care? It just doesn't make sense to me."
Why, at a policy level, is a larger role for government in health care so anathema to so many Americans?
Joseph Antos, a resident scholar with the right-wing American Enterprise Institute in Washington, says a dominant government thwarts innovations that might be beneficial. "My concern is that big-government solutions tend to drive out the kind of risk-based entrepreneurial activity that permits failure and encourages success."
If government is "the only player in the game," Antos adds, "you may not know that you got it wrong. You need a standard of comparison."
The real cause of soaring costs, he argues, is a tax system that fails to treat employer-sponsored insurance plans as a taxable benefit in the hands of employees. Instead of a (taxable) increase in salary, there's an incentive to reward employees with evermore generous (non-taxable) benefits that cover more health care, and with greater costs. It amounts to a huge subsidy, with higher income Americans deriving the most benefit.
"Everything in our system pushes us toward richer and richer benefits, higher and higher premiums," he says.
It also meshes with a health-care system that, partly because of fear of lawsuits, can prompt physicians to practise "defensive medicine," ordering tests and procedures that might not be crucial.
And increasingly, those tests and procedures are being performed, not at hospitals, but at for-profit clinics owned by doctors.
Lawrence Zielinksi, president of the not-for-profit Buffalo General Hospital, concedes the system isn't "lily white," but he doubts there's much abuse in New York State, where Medicaid runs regular audits with potentially heavy sanctions.
He thinks one of the key problems with the U.S. system, and one not much addressed by the Obama plan, is the emphasis on treating disease rather than preventing it.
"The whole primary-care system and infrastructure, I think, is approaching a state of, certainly concern, and some people might tell you a state of crisis."
But there are two, big hurdles to changing that. An old-fashioned family doctor makes around $150,000 in Buffalo. Specialists make at least two or three times that, and culturally, patients have come to expect they'll see a specialist at some point.
The other problem, notes Rowlands, is simple politics. Better primary care might prevent disease, but that outcome is in the distant future. You won't get credit for it now.
<span style="font-weight: bold"><span style="font-size: 14pt">"IN AMERICA, it's all wooden nickels," Doug Keho says from the top of a ladder, where he's scrapping old paint off the wood siding of a three-storey house in the leafy Elmwood Village part of Buffalo.
"We spend more than any other country (on health care). If you go to emergency, you will get care."
But if, like him, you don't have insurance or qualify for Medicaid, it could cost you a lot of money you don't have.
"You go give blood," he jokes. "That's the best insurance. They do all the tests."
So, yes, he could find out if he happened to be anemic or HIV positive, or had anything from hepatitis and syphilis to West Nile virus. He'd also get a cursory physical and have his blood pressure taken.
But he still wouldn't have a regular doctor. That would cost him $500 a month in insurance premiums, money he says he can't afford as a self-employed painter.
"What can I do? Try to stay healthy." He laughs. "And here I am working on a ladder."</span></span>
For many of us who live in Canada and Europe it seems like implementing change should be a no brainer but when I watch the news it looks like some Americans are ready to fight to keep the status quo. Am I missing something???
<span style="font-size: 17pt"><span style="font-weight: bold">Why Americans can't talk about health care</span></span>
<span style="font-style: italic">August 15, 2009</span>
BUFFALO, N.Y.–Leo Astyk and Bob Smith are slumped into old chairs just inside the garage door of Best Automotive Service, the repair shop Smith has run for the past 23 years.
It's a broiling, sticky day and business is slow. Astyk, a retired steamfitter, is trying to pry loose the broken blade of a utility knife as Smith wipes his hand with an oil rag.
Everything about their body language speaks of a long friendship, guy friendship, the kind that doesn't require a lot more than wordless ease in each other's company.
In more than three decades, they've never had a major fight about anything. Until now.
When it comes to the U.S. health-care system, they might as well be on different planets. And the raw kernel of their dispute just happens to reveal why American debate about health-care reform has become so primal, so reflexively nasty, as if nothing less than the soul of the nation were at stake.
"I'm very anti-big government," says Astyk, who clearly hews to the "rugged individualism" side of American history. "I'm not a moron. I don't need someone telling me what to do every step."
Unlike 46 million other Americans, he has his own health insurance, courtesy of the steamfitters union.
Not so Smith. If he weren't covered by the insurance plan of his wife, a retired New York state employee, Smith wouldn't qualify for Medicaid, the government plan mostly aimed at poor families with kids, pregnant women and those with disabilities. As a single man, says Smith, he'd "be screwed."
But just the hint of more government involvement is enough to send Astyk reeling with disgust. "I think President Obama is a socialist."
<span style="font-weight: bold">For Canadians and Europeans, who tend to view medical care as a civic right alongside the vote, the current debate over the U.S. health-care system can often seem puzzling – not just in its intensity, but how a government role marks such an emotional divide.</span>
<span style="font-weight: bold"><span style="font-size: 14pt">The United States spends more on health care than any other country on the planet, about 16 per cent of gross domestic product, compared with 10 per cent in Canada. Nearly half of all that spending already passes through government hands via the likes of Medicaid and Medicare, the program for seniors.</span></span>
<span style="font-size: 14pt"><span style="font-weight: bold">And yet there are still nearly 50 million Americans without insurance of any kind. Why?</span></span>
For starters, they're not among the 66 per cent of adults under the age of 65 who have either employer-sponsored insurance or private insurance, according to the pro-reform Kaiser Commission on Medicaid and the Uninsured.
Nor are they among the 16 per cent who qualify for Medicaid, a national program but with funding and coverage thresholds set by the states, which vary wildly. New York State, for instance, is relatively generous, since you can be at or above the poverty line and still qualify.
But in 33 states you have to earn less than the poverty level, and in 12 of those, you have to earn less than half the poverty line to get coverage.
Overwhelmingly, the uninsured are the working poor not quite poor enough to get Medicaid. More than 80 per cent of them come from households where at least one member has a job, but often part-time or at companies that don't provide health insurance. And even for those at companies offering insurance, it's not always affordable.
<span style="font-weight: bold">A basic, family health policy in the United States typically costs between $12,000 and $13,000 (U.S.) a year, with the employer picking up 75 per cent of the tab. That leaves at least $3,000, which many Americans simply can't shoulder.</span>
<span style="font-weight: bold">"If you're making $22,000, you're not exactly able to buy insurance for your family," says Diane Rowland, executive director of the Kaiser Commission.
</span>
The Obama-inspired reform packages now wending their way through Congress are wide-ranging and complex, but the core would mandate that every American have some form of health insurance.
There would also be an affordable public alternative to private insurance, which is where the trouble started. "That immediately interjected into broad, health-care reform this issue of government-run versus private sector, and it's continued to dominate the debate," says Rowland.
Did she anticipate how ferocious that fight would be, with brawls, firearms and pitchforks becoming a feature of fiery town hall meetings across the country? "I guess I would have to say I was shocked."
JOYCE BUTTS ought to be the pinnacle of contentment, sitting on a veranda in east Buffalo, surrounded by masses of hanging flowers and little American flags. She isn't.
Last weekend, she went off to the dentist with a sore tooth, only to be told her Medicaid plan, which she has because of a car accident, doesn't cover dental work. "I paid my taxes all these years, paid to charities, and when I need services, they're not there."
She looked into supplemental private insurance, hoping to add dental and vision care, but the cost – $300 a month – was "astronomical" for someone who's mainly been unemployed since 2003 and, at 57, doesn't hold much hope of landing another job.
She used to work at GE Capital as a senior adjuster, calling up those who'd fallen behind in their car payments, trying to work out new repayment plans or, if that failed, arranging for the vehicle to be repossessed.
What rankles most is not just that she lost her job when the work moved to India. It's that she and her colleagues spent nearly two years training groups of workers who had been brought over from India. "We sat next to those people."
Does she think the health-reform packages will go through and change the landscape for people like her? "I'm not optimistic, at all, at all."
Her friend on a nearby settee, who wouldn't give his name, suddenly rises to high dudgeon about all the "greasy-assed politicians. We can come up with all this money to bail out the auto industry, but something people need like health care? It just doesn't make sense to me."
Why, at a policy level, is a larger role for government in health care so anathema to so many Americans?
Joseph Antos, a resident scholar with the right-wing American Enterprise Institute in Washington, says a dominant government thwarts innovations that might be beneficial. "My concern is that big-government solutions tend to drive out the kind of risk-based entrepreneurial activity that permits failure and encourages success."
If government is "the only player in the game," Antos adds, "you may not know that you got it wrong. You need a standard of comparison."
The real cause of soaring costs, he argues, is a tax system that fails to treat employer-sponsored insurance plans as a taxable benefit in the hands of employees. Instead of a (taxable) increase in salary, there's an incentive to reward employees with evermore generous (non-taxable) benefits that cover more health care, and with greater costs. It amounts to a huge subsidy, with higher income Americans deriving the most benefit.
"Everything in our system pushes us toward richer and richer benefits, higher and higher premiums," he says.
It also meshes with a health-care system that, partly because of fear of lawsuits, can prompt physicians to practise "defensive medicine," ordering tests and procedures that might not be crucial.
And increasingly, those tests and procedures are being performed, not at hospitals, but at for-profit clinics owned by doctors.
Lawrence Zielinksi, president of the not-for-profit Buffalo General Hospital, concedes the system isn't "lily white," but he doubts there's much abuse in New York State, where Medicaid runs regular audits with potentially heavy sanctions.
He thinks one of the key problems with the U.S. system, and one not much addressed by the Obama plan, is the emphasis on treating disease rather than preventing it.
"The whole primary-care system and infrastructure, I think, is approaching a state of, certainly concern, and some people might tell you a state of crisis."
But there are two, big hurdles to changing that. An old-fashioned family doctor makes around $150,000 in Buffalo. Specialists make at least two or three times that, and culturally, patients have come to expect they'll see a specialist at some point.
The other problem, notes Rowlands, is simple politics. Better primary care might prevent disease, but that outcome is in the distant future. You won't get credit for it now.
<span style="font-weight: bold"><span style="font-size: 14pt">"IN AMERICA, it's all wooden nickels," Doug Keho says from the top of a ladder, where he's scrapping old paint off the wood siding of a three-storey house in the leafy Elmwood Village part of Buffalo.
"We spend more than any other country (on health care). If you go to emergency, you will get care."
But if, like him, you don't have insurance or qualify for Medicaid, it could cost you a lot of money you don't have.
"You go give blood," he jokes. "That's the best insurance. They do all the tests."
So, yes, he could find out if he happened to be anemic or HIV positive, or had anything from hepatitis and syphilis to West Nile virus. He'd also get a cursory physical and have his blood pressure taken.
But he still wouldn't have a regular doctor. That would cost him $500 a month in insurance premiums, money he says he can't afford as a self-employed painter.
"What can I do? Try to stay healthy." He laughs. "And here I am working on a ladder."</span></span>
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