Sam Stein of the Huffington Post reports today the results of an On Message, Inc (OMI) Republican Party sponsored poll on healthcare. He traces many of the GOP’s talking points back to conclusions drawn from the results. Story and link to full poll report: http://www.huffingtonpost.com/...
Since the poll results appear the basis for GOP action (I heard the “best healthcare in the world” claim and the “why the rush to reform” tactic at the Rick Larsen townhall meeting Saturday in WA), let’s take a detailed look at the factual reality versus the opinions. Because if we want to undercut the GOP’s tactics of capitalizing on current, usually badly informed opinions to bolster their case, we need to pinpoint key public misconceptions they are building their case upon and then figure out how to turn the facts on the misconceptions.
First, Stein notes: “Listing the White House talking points -- that health care reform would be budget-neutral, that a public plan was necessary to stimulate competition, that consumers would be able to keep their coverage, and that Republicans are being obstructions -- the survey concluded: "If Obama Is Allowed To Sell This... He Wins."
The points Obama launched healthcare reform on won the opening debate and need to be restated again and again. However, the poll found key weakpoints in the opening gambit that provide an opening for the GOP to slow or divert the reform campaign. These need to be addressed by Democrats now.
As Stein points out: Since then, the Republican Party has worked mightily to avoid that Obama victory. And many of their moves appear to have been derived from that OMI survey. Turning to time-tested rhetorical devices, the GOP has shifted the debate onto more friendly terrain. For example, Republican officials have begun stressing that America has "the best health care in the world" (a sentiment supported by 54 percent of the OMI survey respondents) while simultaneously insisting that the system is "badly in need of reform" (which 70 percent of respondents said was true). Case in point: "You know the bottom line is that we have the best health care system in the world, there's no doubt about that," RNC Chairman Michael Steele declared two weeks after the memo was finalized. "But this is a health care system that needs reform, and the reform that we've been trying to focus on is the cost side of this."
There are two fact-challenged points here: 1. The “best healthcare system in the world” claim; 2. The cost, not the results or basics of the system needs reform.
Let’s start with the claim, believed by 54% of Americans according to the poll, that we have the “best healthcare systems in the world.” By a variety of measures, this is not only not true, it is far from true.
US Rankings:
Infant mortality Best rate: 1st Singapore 2.3 deaths per 1,000 live births
US rate: 37th 6.37 deaths per 1,000 live births
In providing for the health and survival of infants, the US is behind Cuba and South Korea, barely ahead of Belarus and Croatia.
Source: http://www.geographyiq.com/...
Longevity Best: Japan, to average of age 83 at birth in 2006
US: 30th, to average age 78 at birth in 2006
Probability of living to age 60:
Best: Iceland at 5.9 percent probability of dying before 60
US: 27th with 11.6 percent probability of dying before 60
Source: http://rankingamerica.files.wordpres...
From a comprehensive study on women and children that includes a variety of weighted measures such as longevity, infant survival, maternity leave, etc, sponsored by Save the Children (http://www.savethechildren.org/campaigns/state-of-the-worlds-mothers-report/2007/mothers-index.html
) :
Mother’s healthcare and conditions:
Best: Sweden
US: 26th
Women’s healthcare and conditions:
Best: Sweden
US: 21st
Children’s healthcare and conditions:
Best: Italy
US: 30th
Source: http://www.savethechildren.org/...
Years lost to communicable diseases (a measure of quality of public health systems)
Best: Austria, 3 percent of expected lifespan lost to communicable diseases
US 44th at 9 percent of expected lifespan lost
Source: WHO, http://apps.who.int/.... (you can pick your own measures from a long list and then sort in Excel)
This website below as well as the WHO website provides nearly infinite ways to discover just how miserably far from the best our healthcare (and other government services) are:
http://rankingamerica.wordpress.com/...
It is terrifically disheartening to see just how badly GOP dominance has damaged the US during the past 30 years it has been in ascendancy.
Where the US is number 1:
Anxiety disorders: 19 percent of Americans report anxiety disorders according to the World Mental Health survey, tops in the world
Source: http://rankingamerica.wordpress.com/... (reporting based on site:
http://www.hcp.med.harvard.edu/...
The GOP has done a terrific job of stirring up fear and anxiety in the US, to the point that anxiety alone is killing people and making them sick. There is no other single measure more damning in my mind than this to their heartlessness and unconscionable tactics. This is a direct measure of their rejection of empathy in justice and policy.
The US is also number 1 in bankruptcy caused by medical bills. In fact, uncovered and unreimbursed medical costs are the number one cause of bankruptcies in the US. No other developed country with a public option healthcare system has any such level of medical related bankruptcy, and most have no such bankruptcy cause at all. We are unquestionably first in evicting people from their homes, emptying their pockets and bank accounts and wrecking their credit due to medical costs. We are first in forcing small and large businesses to close or cut pay and benefits due to medical costs.
We should give the GOP full credit for making America number one in medical related bankruptcy and home foreclosures.
In terms of costs, Mr. Steele and the GOP have it almost correct:
Expenditures per capita:
Highest: Monaco $7,154 per capita
US is Second highest at $6,715 per capita
Of course, Monaco has much greater wealth per capita than the US. In that measure, per capita wealth, and not only in real distribution among income groups, the US is far from the top or far from the best. Two healthcare systems that have much better results in the terms measured above than the US but which spend far less to get them:
France: $3554 per capita
Canada: $3672 per capita
Both these systems are government dominated if not fully driven by the public option that the GOP is resisting at all costs. So Mr. Steele is correct in that US healthcare costs need reform. But the high cost/poor results of our system are directly related to the distorted incentives in the private sector. I constructed the table below from Yahoo.com information on the Healthcare industry. Some sectors, such as major drug manufacturers, are getting very fat margins of profit. Others, such as makers of diagnostic chemicals and tests, are far from profitable. According to capitalist theory, results like this mean more investment should go into manufacturing drugs and companies making diagnostic substances should cut production or close up shop altogether. But look at the margins for healthcare plans, hospitals, long term care, and medical practitioners, the very core of real health care. All have very low or negative profit margins, though healthcare plans and hospitals manage 12.9 percent and 18.2 percent return on equity. Do we need more long term care facilities? Not according to capital investment signals. And how are hospitals making such low net profits yet such high return to equity? These kinds of gaps appear to indicate management is seizing the very large difference between returns on the equity and the reported net profit, reducing the signals to investors (clearest in the net profit margin and dividend yield). You can find the dividend yields, which most attract fixed income investors, at Yahoo.com.
Healthcare Industry, by Sector
Sector Net Profit Margin Return to Equity
Biotech 6.7 5.2
Diagnostic Substances -13 0
Drug Delivery 13.5 20.9
Drug Manufacture (major) 16.5 19.1
Drug Manufacture (other) -0.3 0
Drug related products -0.6 0
Drugs, generic 6.6 10.1
Healthcare plans 3.3 12.9
Home healthcare 8.4 17.7
Hospitals 3.6 18.2
Long-term care Facilities -3.3 0
Medical appliances -4.3 0
Medical instruments & supplies 6.8 8.0
Medical Labs & Research 8.2 17.1
Medical practitioners 0.2 0.6
Specialized health services -1.2 0
Source, Yahoo.com, Industry sector
The US healthcare system not only needs the public option to provide competition, it needs a public healthcare system that invests and operates rationally according to real needs.
For example, we know beyond doubt that the US and the world faces pandemics, with at least one real threat arising right now in swine flu (and the much more serious bird flu lurks just over the horizon). We know that small communities and inner cities are ill provided with medical services. We know that our aging population will need more long-term care facilities, profitable or not, as baby boomers age. But our for-profit system is not designed to respond to demonstrated needs or foreseeable emergencies or demographic trends. It is designed to respond to investor profits and losses and management enrichment opportunities. In sum, according to objective data, the healthcare system we have costs more, delivers less, and raises more anxieties. It is number one only in terms of its failures and structural irrationalities—and in resistance to change. Yet people think, according to the survey, that we need to slow down reform.
Why delay reform? Obviously the answer is not in order to get reform right. We have, starting in 1912, had public option healthcare reform plans proposed by Theodore Roosevelt, Franklin Roosevelt, Harry Truman, Lyndon Johnson (who actually got some improvements), Richard Nixon (his was actually more liberal than Clinton’s!), Bill Clinton and now, nearly a century after Republican Teddy Roosevelt started the push for a comprehensive public healthcare, Barack Obama. We have persisted in retaining and expanding the for-profit aspects of our healthcare system while gutting much of the public hospital and healthcare system erected in the 1930s to 1960s. Reagan turned out those with mental problems onto the streets. Republicans ever since Reagan have denied healthcare every chance they had to children and, even while mouthing “support” and “patriotism” for troops, done the same kind of cuts and neglect of veteran’s health, especially their mental health. There is no rush to reform. There is a rush to keep the Republicans from pulling yet another ruse in their no holds barred campaign to protect the ill-gotten gains and ill-tempered contributions of their corporate sponsors.
We do not have the best healthcare system in the world by any objective measure. We may have the best government money can buy, though. And the Republicans are determined to keep it that way. That is the real reason for their call for delay.
Obama and Democrats are trying to play a divide and conquer strategy here by pitting some corporates against others. Perhaps that is the only way to win even a little in this nearly century long battle for a basic right to healthcare. But perhaps, if this strategy fails, Democrats or at least progressives should consider taking the gloves off themselves and make the 2010 elections a referendum on healthcare reform. One good place to mine for votes is among Democrats Abroad and other Americans living abroad. (I'm one of those who can't afford the risk of coming home until I'm old enough for Medicare). There are many among the over 2 million Americans living overseas who are there mainly because they cannot get insurance or who cannot risk losing everything to a medical emergency or crisis. Democrats Abroad should consider sending out a "snowball" poll to their members on this issue. They could construct an electronic questionnaire (there are several sites that do this) and send out invitations to DA members to fill it in, and ask them for other Americans' email addresses that DA members know living abroad so they could be invited to fill in the poll.
It wouldn't be scientific, but it surely would be interesting to see just how many Americans the Republicans have been driven away from home due to "the world's best healthcare". Since Americans overseas are often our best educated and many times most entrepreneurial, the opportunity costs and lost taxes from these folks just might bump Monaco from the top slot and make us number one in healthcare expenditure after all!