Healthcare Reform in the United States: Somethings Missing Up Until Now

by Alex

I read an interesting article from the journal Comparative Politics today. The article, entitled "Parting at the Crossroads: The Development of Health Insurance in Canada and the United States, 1940-1965", dissected the development of our current healthcare system between said years. These 15 years were crucial in the founding of healthcare in the United States and Canada. Antonia Maioni, the author, writes about some interesting facts and findings. The most striking difference I noticed was this: When the proposal for some type of national health insurance was proposed in Canada, there had already been an experiment of the sort in one of the provinces. In Saskatchewan, as Maioni mentions,

"A medical program that combined private fee-for-service delivery with public administration and financing was introduced in 1961..."

In the United States on the other hand had no Saskatchewan, as Maioni concludes,

"The Saskatchewan experiments established the principles of universal health insurance, tested the limits of reform opponents, and ultimately demonstrated the success and shortcomings of such programs...In the United States there were few state-level initiatives in health insurance..."

This finding was still relevant until very recently. States have recently began to take the initiative in the road to universal coverage. Massachusetts's reform is right now the most provincial experiment so far, but many other states are trying to do the same. Now the only problem for states in experimenting is getting around the Employee Retirement Income Security Act or ERISA, which

"shields businesses from state and local regulation of the benefits they offer workers, including health insurance. Without the law, national companies in particular could achieve little uniformity in their benefit plans."

You can find an explanation of the ERISA problem here.

Intersesting Facts from "Sick Around the World"

by Alex

Today I watched PBS Frontline's documentary on healthcare entitled "Sick Around the World." In it, correspondent T.R. Reid travels around the world to five different countries to examine their healthcare system. I took extensive notes and I figured I would share the most interesting fact I wrote down from each country. I also did some investigative journalism to give you a little bit more. So here we go...

1. In the United Kingdom, citizens and the newspapers alike rail against the National Health Service. Of all the countries Reid examined, citizens in the U.K. are the least satisfied. Now let me get more detailed, even though they have problems, the numbers still show that about 77 percent of citizens are "satisfied" with the NHS coverage. You can read more about patient satisfaction in the U.K., here in an article by Nigel Hawkes of The Times in London.

2. In Japan, 80% of hospitals and nearly all practices are private (which is more than in the United States.)

3. In Germany, Insurers, or "sickness funds", are not allowed to take a profit. Wouldn't this stiffle competition? Actually, it is quite the opposite. Instead, the insurers get paid more for insuring more people. Sickness funds negotiate prices of treatments on a schedule with medical providers, this cuts their cost of administration down.

4. In Taiwan, everybody gets a "smartcard", that is a card that has your medical records on them. They are simply swiped into the computer and all patient's records come up. This lowers administrative costs, provides for full information assimilation, and makes sure their are no overlaps in services.

5. In Switzerland, "LAMal", the name of their health system was actually voted on by the citizens. In 1994, the same year healthcare reform was being proposed in the United States, the Swiss went to the polls and barely passed the measure to move to a "single-payer" style system. Even though the measure barely passed, that is it was nearly 50/50, over a decade since its inception citizens are pretty happy with what they got.

If you want to learn anymore, you will just have to watch the film.

Addressing Income Elasticity Problems Caused By Basic Coverage

by Alex

In most healthcare systems that cover a basic benefit there are of course those treatments or services which are simply too expensive for average citizens to afford. When allocating services in these countries, certain questions must be answered. As Greg Mankiw explained on his blog,

"But does that mean those of above-average income should be excluded as well? Should they lose basic benefits if they choose to pay for these marginal services with their own money?"

Moreover, Mankiw explains what the United States might have to address shortly,

"Achieving both efficiency and equality in the provision of these goods [the treatments or services]is impossible. Dealing with this conflict will provide a major challenge to the political system in the years to come."

If you were at all interested, Greg Mankiw is an economist at Harvard University. You might have used his Economics 101 book in college.

Healthcare Links!!!

by Alex

Here is a primer article on "speciality" drugs from the New York Times. These expensive yet priceless drugs are in the middle of a growing market. Costs are increasing and more benefit managers (those companies that help negotiate drug prices for employer-plans) are getting into the business. Also, there might be a conflict of interest.

The New York Times reports that an article will be published, explaining Merck's involvement in writing research reports in-house and then getting physicians to put there name under the title. Over the course of this semester, one of the main topics I have been studying is the pharmaceutical industry. I read earlier this year, on the blog Freakonomics, in a quorum with healthcare experts the same thing this article will highlight. You can read Dr. Harlan Krumholz, professor of medicine, epidemiology, and public health at Yale, take on the same practice and others here.

The Wall Street Journal reports that the Massachusetts's General Court (their state legislature) is proposing to ban doctors from taking gifts from pharmaceutical industries. This is an interesting article, because it brings up a relatively new issue to hit the healthcare limelight. The issue is the relationship between doctors and pharmaceuticals. I read an article from the New England Journal of Medicine earlier this year which reported that 94% of physicians have some relationship with the pharmaceuticals. It could be free bagels or drug samples.

Final Shoot...Maybe???

by Alex

Today I hitched a ride with the telecommunication students on their final shot. We went to Ball State's Amelia Wood Health Center to film the introduction of our film. In the introduction, Laura
briefs the audience on what is to come.

The shot went well, even though Laura took like 25 takes. No...she actually did a really good job. It made it a little harder for her to
speak because she was walking towards the camera at the same time.

It's "crunch-time"!!! Only 12 days till the showcase at Cornerstone.

Healthcare Links!!!

by Alex

The Institute of Medicine published a report today saying that a health worker shortage is looming. You can read an article about the report here.

An op-ed piece in the Wall Street Journal by Jonathan Kellerman suggests that it would be better if fewer people were insured. Check out his rationale. I find it very interesting. He certainly makes a good argument.

An interesting piece also in the Wall Street Journal talks about the trend towards arbitration in nursing home disputes. Nursing
homes are having more and more patients sign waivers saying
they will not sue and instead arbitrate in case problems insue. Is
this right? Arbitration professionals think it is taking advantage
of people. Check it out.