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.

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.

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.

Writing in the prestigious New England Journal of Medicine, two doctors say the current health care reform bills do not do enough for cost control.  They propose an all-payer regulation strategy.  The full text of their short article is below the jump.  The spine of their argument:

Successful health care reform requires effective control of health care spending - without it, rising costs will continue to strain federal and state budgets, businesses, and families, jeopardizing gains in insurance coverage. The reform legislation now before Congress, however, cannot be relied on to control spending.

…

The missing link in reform legislation, then, is any mechanism with the potential for systemwide control of medical spending. One straightforward way to achieve that goal would be to adopt a single-payer plan - but that would displace the private insurance industry and remains politically infeasible.

There is, however, another option that could control spending across both the public and private insurance pools. Other countries that have multiple insurers, such as Germany, Japan, and the Netherlands, use all-payer regulation to control costs. In these countries, insurers come together to negotiate, or the government takes the lead in setting, common payment rules for medical care. With a few exceptions, payments to all doctors in a given geographic area follow a standard fee schedule. Hospitals are also paid on comparable terms.

They see 4 advantages: lower overall costs, less cost shifting, simplicity, and successful coexistence of public and private plans — advantages which ought to appeal to business, citizens and the health care industry alike.   Good thinking, definitely worth considering.  Click below to read the whole article.

Read the rest of this entry »

The New York Times carries this chart:

Doesn’t leave much doubt about how import health care cost control is, does it?

Washington Post economics reporter-columnist Steven Pearlstein in a column about a missed opportunity for a single payer health bill during the Nixon era summarizes what he understands to be the general consensus in the Congress on health care reform.  Here is that quite impressive list:

Universal coverage — everyone has insurance.

State-run exchanges — a ‘connector’ or marketplace where one can shop for policies. (We already have the framework ready in WA state.)

Insurance options — alternative forms of coverage allowed.

Subsidies – help for low income people up to 300% of federal poverty level.

Employer mandate — all except smallest businesses required to participate.

Tax on ‘extravagant’ plans — gold plated coverage would be taxed.

Malpractice reform — a federal cap on punitive damage awards (not, apparently, on actual damages).

Independent cost containment board — biennial package of reforms and rate adjustments from expert panel.

Evidence-based best practices — increased research on medical procedure effectiveness.

.

That is one heck of a list.  Pearlstein goes on to report that this framework could gain significant number of Republican votes because it includes a number of “Republican” ideas.

I’m going to use this as the start of a checklist to see just how much the Congress and the White House can achieve in the 2-3 months ahead. Pearlstein suggests it could take longer. If we get all that done this entire effort will definitely be worth the candle.

Health care reform:  Which party is misplaying its hand at this historic moment?

The Rs seem to make a fatal mistake: In what seems like a self-defeating move, national Republicans have decided to stop health care reform — the public’s number one issue.  Here’s the Washington Post report.  Here is reporter Dana Milbank’s story on how a Republican consultant’s memo was picked up and used, almost word for word by RNC Chairman Steele. But before the Ds get too smug…

The Ds seem to make a fatal mistake. Here is NYTimes columnist David Brooks arguing that it is the Democrat’s leaders that are taking themselves over the cliff.

And below is what is likely to be the public’s judgment.  Your view?