In our interconnected world everything is connected to everything — that goes double for health care.

So a win in health care reform — more people covered, costs going down — is tied tightly to economic recovery.  That means a jobs recovery.

And that means we’re in trouble.  See this analysis by the Christian Science Monitor — “What will it take to bring back 7 million jobs?”

Here’s a back-of-the-envelope calculation: If jobs could grow at a mid-1990s pace of 3 million a year, it would take about five years. If jobs grow at a mid-2000s pace of 2 million a year, it would take a lot longer.

In the past, steep job losses have often been followed by strong rebounds in jobs. What’s different today is a historic erosion of household wealth: households amassed record levels of debt in the past decade, and then saw the value of homes and stock portfolios tank.

Against this backdrop, economists say the number of jobs needed is more than the government can afford to engineer.

A constant drive to create jobs will be part of the “new normal.”  How can health care reform help — and vice versa?

can I afford this?

Noted on the Truthout site, this McClatchey story reports a Consumers Union study of how people are cutting back on their health care costs.

The Consumers Union survey of 1,002 adults from Sept. 17 to 20 found that among the ways people have tried to cut back on health care costs:

• 28 percent put off doctors’ visits.
• 25 percent have been unable to afford medical bills or medication.
• 22 percent put off medical procedures.
• 20 percent declined medical tests.
• 20 percent skipped filling prescriptions.
• 15 percent took expired medication.
• 15 percent skipped scheduled dosages of prescriptions.

The problems were more prevalent among households with incomes of less than $50,000, in which about two-thirds said they’d cut back on health care because of costs. Even where income topped $100,000, however, about one-third made similar decisions.

Notice how the cutbacks are made by people way up the income scale.

And consider the implications: lowered overall public health, rising taxpayer costs in social safety net services when thoise cutbacks translate into increased sickness and job losses, lower productivity, etc.

Patrick Hagen, CEO of Seattle Children’s Hospital writes in the Washington Post that they’ve actually cut costs and increased quality by attacking “waste.”  Hagen defines waste rather broadly:

…only 5 percent of what we do actually provides value. The other 95 percent? Waste. While this figure may seem absurdly high, waste includes everything in health care that does not directly address a patient’s health. Some waste is necessary: registering patients, keeping records, moving a patient. However, most is unnecessary: errors, waiting time, unneeded complexity and avoidable complications.

Hagen says this “transformational approach is a blueprint for fixing the nation’s healthcare system. He found part of his answer at Toyota, on car-production assembly lines:

Here at Seattle Children’s Hospital, we were burdened by a costly, inefficient health-care model, and we had to look outside the health-care sector to find a way to provide patients better access, better care and better service at lower cost. We found it, of all places, in the automotive industry; the hospital adapted the principles of the Toyota Production System into a program called Continuous Performance Improvement (CPI). Improving overall quality is the goal — reducing waste is the means.

From the beginning, variation in care processes was the greatest source of waste. By standardizing and error-proofing, the quality of care was improved while costs were lowered.

The estimable Robert Fisk reports in the London Independent that a group of nations — the Arab oil-exporting states joined by China, France, Russia, Brazil and others — have been secretly talking about replacing the dollar with a basket of currencies for global oil trading.  OMG to the max for the US.

Fisk notes the ramifications of this self-protective move away from the volatility and declining value of the dollar not only are a blow to the already-reeling US economy but possibly portend increased US-China conflict.

The independent editorializes “the end of the dollar spells the rise of a new order.”

But the significance of this development goes much further. Since the end of the Second World War the dollar has been the bedrock of world trade. The pre-eminence of the American currency flowed naturally from the economic dominance of the US. Virtually everyone traded with America so it made sense to use their currency.

But the US is not the dominant power that it once was. The financial crisis has left it hobbled with significant government and household debts and sharply reduced prospects for growth. Developing nations such as China, Brazil and India, on the other hand, have weathered the economic storm significantly better. So while this latest proposal is born of financial calculation, it is also a reflection of a new economic world order.

Mark this day on your calendar.  If these folks succeed we’re in for another huge blow to our economy — a fundamental reset.  One more reason to get our financial house in order — most especially including health care reform — faster than asap.

Update: Here is the Washington Post following with a useful survey of the pressures on the dollar. This underscores how precarious is our situation.

Steven Pearstein of the Washington Post writes one of the good economics columns. In this one, “a new bubble of the Fed’s creation” he offers some insights and cautions that make a lot of sense to me.   Highlights:

• Yes, the financial crisis has passed and the economy is growing again, but there’s a good chance that growth will be temporary …  a sustained recovery in 2010 isn’t looking very likely.
• To its credit, the Obama administration has never lost its focus on the goal of creating the conditions for sustained growth.
• Less encouraging is what’s happening on Wall Street. It turns out that all those bold and necessary steps by the Federal Reserve to prevent the financial system from collapsing wound up creating so much liquidity that it has now spawned another financial bubble.
• But the lesson I prefer to focus on is the one from this decade, which is that central bankers ignore financial bubbles at their peril. … As Alan Greenspan discovered, it is also a mistake for central bankers to assume that they can quickly sop up excess liquidity whenever they decide the moment is right.

Translation: a) the 2010 growth we’ve been counting on may not be there, b) the risks of the next bubble crash are already growing.  And c) banks and central bankers still don’t have this right.

Polls showed Obama’s approval ratings dropping during angry August — and sinking with him health care reform.

If the polls are to be believed that mood has shifted.  As the chart shows from this new New York Times/CBS poll, the dominant theme now is uncertainty:  people don’t feel like they know enough.

And I’ve lost the link, but I saw another major poll the other day showing that 3/4ths of people are tracking the health care issue closely or very closely.  That is an extraordinary degree of public focus on one issue.

That mirrors what I’m finding here in the district.  Almost everyone is engaged, few — including me — feel like they know everything they need to know as this historic quest unfolds day by day.

Where does this leave the politicians who are involved in the scrap?  Politico opines that there are so many polls reporting different results from different questions that the pols are uncertain where the public leans.

My recommendation for our national reps: note the high voter uncertainty and focus more on feeding good information to the public than trying to stampede them one way or the other.

For those of you wishing to hear from some experts, here is an excellent, 20 minute discussion online among three experienced researchers in health care economics. Note this is moderated by the now-famous Dr. Atul Gawande, Harvard surgeon and New Yorker author.

Click here.  Note that the discussion is sub-divided into 7 topical parts if you wish to skip around.

Definitely worth your time.

Go here for an excellent, interactive graphic showing year by year the many, many pieces of legislation since Teddy Roosevelt.

At a glance:

An article in the prestigious New England Journal of Medicine reports a survey of physicians and surgeons across the country found very strong support for the inclusion of a public option in the health care reform package.  Their bottom line:

…it seems clear that the majority of U.S. physicians support using both public and private insurance options to expand coverage. A majority of physicians also support the expansion of Medicare [to include the near-elderly]. Support for the public option is consistent across physician specialties, practice settings, and regions of the country, and therefore should be carefully considered by lawmakers as they finalize legislation to reform health care and provide coverage for 47 million uninsured Americans.

Click the ‘read the rest….’ tab below to see a chart showing just how strong the doctors’ support is.

And for a very interesting summary of the last century of health care legislation go to this interactive NEJM graphic — fascinating; will make a good PowerPoint add-on.

Read the rest of this entry »

One picture tells it all.

This maps the main roots of our current political-economic woes.

Note the time line — this didn’t start with last year’s recession.  But the speed and the depth of this “worst since the Depression” downturn is directly related.

This is not just a map of poor wages.  It also shows how serious are our problems with education and health care and politics and energy policy.

PS — US national productivity shot UP again last week — and so did unemployment!

Credit: the chart is from this lecture, courtesy Prof. Juan Cole in his Informed Comment blog.