I’ve heard/seen Dr. Gawande, possibly on The News Hour, and I believe I’ve read at least one article of his in the New Yorker. The fact a well-connected and well-established physician chooses to advance the “checklist” idea in his book rather than directly to the American Medical Association mystifies me. Probably he’s explained it and his methodology for improving care is probably catching on as fast as fax machines and e-mail can transmit, and the book probably explains why the general public still needs to know. Or better yet, this doctor is soaring on to other challenges, with no book yet written.
Still, the elephant in the room at outset is this: Can’t the medical community fix itself (perpetrate its own checklists for surgical procedures, by word of mouth)? — without all the dirty laundry, so to speak (my recollection, unnecessary lapses in medical care, some very easy to fix)?
I heard over the weekend that Massachusetts can also apparently improve care by taking more responsibilities from the high-paid specialists and the costly high-tech medical centers like Brigham and Women’s, and make better and greater use of local clinics and nurse practitioners, which is what I believe Governor Deval Patrick is focusing on. Is Dr. Gawande part of a team with him: physicians for quality affordable care?

(Boston, MA)
Every time I look at the issue, I come to the same solution: get rid of the private insurance market (start with health but go on to car insurance too). I don’t see why profits are involved here. As any good economist would say, the moral hazard of letting profit come into conflict with life and death is juste unacceptable. You don’t have to be a socialist to see that.

Where is the incentive for people to be healthy? My rates should go down everytime I lose 10 lbs and keep it off. My rates should go down everytime I go for a mammogram and it’s clear. My rates should go down when my kid gets vaccines like Gardasil. My rates should go down when I check in to my spinning class faithfully for 6 months.

No ral reform will occur until you remove the profit motive from medicine.

Stop subsidizing corn. Make insurance cost less for people who eat moderately and exercise.

Tom, When I was in middle school, I remember reading a report on the relative yearly earnings for different careers. The average yearly income for an MD was $25k.
But now everyone who makes it into med school expects to be a millionaire. Why is the incredible greed and egomania of the medical profession never brought into the discussions? They have conspired to keep their product in demand by limiting admissions to schools and maintaining an shortage. Then we have to turn around and hire foreign MDs to service our sick. Why could France develop a system where they have enough MDs and a superior system (the average French MD sees a total of 12 patients a day much better than the couple minutes you get in US)

What we need to keep in mind about the present insurance model of US health care is that free enterprise requires that the consumer have the ability to opt out if the price goes beyond his/her comfort point or ability to pay. That is the only way free markets work efficiently.

Problem is, health care can not follow that model, since those in need of health care can not opt out! Insurers and providers both want prices to go up, but there is no free market mechanism to hold them down.

Therefore, the only cost effective model is one in which the entire society provides for every member of it.

Health care should be labeled a Public Good, not an industry. A Public Good can only effectively and morally be provided for by our government.

From Anchorage, Alaska

Dr. Gawande, we spend more money each year on things like movies and football than on medical research. We so not seem as concerned about access to care and quality of care as we should, given our shared mortality. Why do you think it is that we seem to have our priorities backwards as a society? (I realize this is more of a philosophical question, but I know that you have a degree in philosophy.)

tom could you please ask the guest his thoughts on the public option or single payer, also the possibility of repeal backfiring on conservatives through opening the door of this option having a second chance if current bill is repealed

Universal healthcare for everyone in America could save so much cost and time that is now spent on paperwork and rigamarole. It could allow employers much more freedom in hiring because they won’t have to worry about filing benefits, so people could move from job to job easier, and actually find work that they are interested in doing, rather than being stuck holding on to whatever they can get. This might actually allow people to enjoy their work so that overall morale increases, and the country can start picking itself up by it’s own bootstraps. This would make us less dependent on buying entertainment to stay happy enough to avoid suicide, and actually give people time to appreciate art and history again. Just imagine how health would improve if people were excited about life again. The thing holding this back though is that as long as health care is profit driven, it’s in their interest to keep people sick so they have to keep paying to get better. That’s not a very sustainable model though if you take more than a minute to think about it.

Posted by John, on January 4th, 2011 at 11:03 AM
“Stop subsidizing corn. Make insurance cost less for people who eat moderately and exercise.”

If everyone was in a single player arrangement then the people who take care of themselves should gain points that they can later spend on optional procedures like plastic surgery, or a stay at a health spa that is payed for by medicare, and the people who smoke and take drugs and blow themselves up in meth labs should get bargain basement care, not the top quality free care they now get when they blow themselves up.

I’ve read all Dr. Gewande’s books and completely agree with him, in particular with the checklist. Yet a letter to the Boston Globe last week and a comment from MD above show that many MDs are not on board with it. The letter writer called the checklist more bureaucracy when I see it as something that helps democratize surgery. I.e., everyone on team knows each other and works together, which helps eliminate errors. Letter writer personified perception that MDs are on a higher level and don’t bother me with more things that take my valuable time.
Re insurance: Profit (insurance companies) must be removed from medical care for real cost savings.
When you publish and if you broadcast my comment, PLEASE don’t use my name and town (Andover MA) because I am from the town of the letter writer and know him!

Gawande’s superintendent of schools can probably blame Blue Cross Blue Shield and Gawande’s for profit employer Partners HealthCare.

I’m curious where environmentally caused illnesses are going to fall in the national debate. I see by the White House site that a new law about lead in water is passed with I think 3 years for compliance allowed. If landlords have to limit the exposure of their water-provision, and therefore health is improved, well, super.
But lots of environmentally caused problems are barely acknowledged, let alone taken responsibility for.
If polluting industries paid their fair share for the medical damage they did, that would be, um, interesting. I’m not holding my breath. I still expect to pay for the damage they cause, through my insurance and my taxes, forever, actually. Those industries have lobbyists.

The issue is a fundimental debate between those that believe healthcare is a right and those that believe it is a privalage that should be gated by ones ability to pay for it personnaly.

Our fixation is with the idea that the free market is teh answer. It is not if one believes that a healthy work force is a national asset. Concervatives and those of a like mind view the work force as a low level commodity easily replaced by others around the world and insurance as a business first and formost were dollars are more important than an individuals health.

Let’s be honest here, the political climate and how the right frames this issue will mean it will be a stalemate.
As the good doctor just noted. Again, the entire system is broken.

The Republicans want a market based system. Well it seems to me it has not worked. So their solution seems to me to be prepared to die if you get a serious illness as you will be nickel and dimed to death. Literally.

Repost, with the word train

Dr. Atul Gawande, Could you a train a high school basket ball player the muscle memory to do the operation on that lymphoma? Does a surgeon need to have all the skills of an MD or do they need to know how to cut? You do the diagnosis and supervise ten Surgeons to do the surgery.

Sorry about that.

FYI – Vermonters from across the state will converge at the Statehouse January 5th to deliver thousands of petition signatures to lawmakers. The petition, to be delivered on the first day of the new session of the legislature, demands that Vermont adopt a healthcare system which meets human rights principles and leads the nation in the adoption of universal healthcare. This comes in anticipation of the release of the state mandated universal healthcare system options, designed by Dr. William Hsiao, following last session’s passage of the Universal Access To Healthcare Act.

“The time is now for Vermont to take the lead in creating an equitable healthcare system that recognizes healthcare as a public good,” said Peg Franzen, president of the Vermont Workers’ Center which coordinates the Healthcare Is A Human Right campaign. “Every year in Vermont, our neighbors, friends, and families are suffering and dying because they do not receive the healthcare that they need. Every day we wait more uninsured and underinsured people are losing their homes because of their medical bills, closing their family farm or business from a medical crisis or chronic illness, or are crushed by debt after getting sick. We need to act now to put people over profits.”

Tom,

Outstanding guest & topic this hour. We need articulate advocates like Dr. Gawande to improve (first save it from the reactionaries who are h-bent on repealing it) our health-care system.

Btw, I had 4-way open-heart surgery at the VA Hospital in Miami, FL in August 2010. As part of my recovery, my wife asked people not to say the words, “Republican”, “Conservative”, “Tea Party”, “Right-Wing”, “Conservative”, etc. in my presence. I think it helped my heart heal, and now I’m feeling great. Now, I’m ready for the reactionaries coming into office tomorrow…(I hope.)

As a nurse practitioner, I have prescribed many pharmaceuticals for a variety of conditions, but I have become more and more ‘alternative’ with the passage of time. I think we overtreat people with expensive drugs, all of which have side effects that may require the prescription of yet another drug. I think the best way to improve the overall health of the nation and to cope with costs is to focus more on healthy lifestyles. If we don’t get a handle on obesity, unhealthy eating habits, and sedentery lifestyles we will never be able to afford to provide high quality care to everyone with the chronic diseases that result . Prevention is the key to improved quality of life for Americans, and reduced medical costs at the same time.

McAllen Texas? Hmm. Massachusetts has the highest per capital health care costs in the nation. Why did Dr. Gawande need to go all the way to Texas to find waste fraud and abuse. He could have just wandered around the Longwood area.

On cost growth > 12% annually:

The major factor our representatives will not look at is MONOPOLY. Everywhere you look in our system are little ensconced monopolies, from local hospitals and insurers through doctor groups, drug companies, major insurers, among others. Not to mention the lobbyists running the legal side for them.

Obama’s law, for instance, ESTABLISHED further monopoly among the insurers for the additional 30 million covered (we hope).

There’s your cost, baby.

Why do we need insurance at all? It seems to me that insurance is simply a way of skimming money from the system without delivering any added value.
Please, what am I missing here!

If health care padding such as Gawande describes (excess profits) are truly winding down, doesn’t that squeeze the economy? Doesn’t that reduce the GDP, cut out “fat” jobs?
It’s part of steering the Titanic, has to be slow. Squeeze the insurers into their appropriate place.
I don’t think the congressmen understand how it works, and are planning to repeal it before they have to read the whole 2500 pages (whatever it is).

Since the Congress (house and senate) receive free health care why not allow them the privilege to select Health care for themselves, like we do – this would also help the Republican agenda lower big government costs!

My question is why do I have to pay for someone else’s health care – Medicare deductions from my part time job paycheck – but I am denied access to affordable health care myself?

The only way I can keep my house is to not buy health insurance. When the COBRA subsidy was being paid it really helped me out so I could continue to have health insurance and pay my mortgage while looking for full time work.

I have a very painful bone growth in my left wrist pressing on the thumb tendon and painful tendonitus in my right arm. If I had health insurance I could get treatment and be able to use my hands all day long so I could get a full time job and pay for my own health insurance.

- Christina in Providence, RI

Why not allow the Senate and House select and pay for their own Health Care rather than receive the best plan money can buy at Taxpayer expense. This would help shrink big government spending as well.
Andrew Sichel
New York, NY.

Recently our teenage daughter developed serious emotional problems which required frequent emergency room visits and psychiatric hospitalizations. These long-term placements were in several different adolescent units in the boston area and were very expensive. I lived in fear that BCBS would eventually refuse to pay and they did.

It wasn’t until she was admitted into the state mental health system when she was finally stabilized and is now, thankfully, doing quite well. One of the extreme costs I was shocked to learn about was ambulance services. Each time she was transported via ambulance the cost was roughly $1000 even for a trip as short as one mile! Added to this there were times when we had to call 911 for support at home. When we did so, police, fire and ambulance personnel were always dispatched. I have no idea the cost but can imagine it was also quite high.

In all, it would not surprise me if the overall cost of the 2-year period of our daughter’s illness was well over $250,000.

I learned from this experience that for mental health service delivery, there must be a relationship between private hospitals and the state mental health system that currently doesn’t exist. Emergency response is redundant and costly. And, health care policy discussions rarely include discussion of psychiatric services yet these are very costly and very important.

I think its disingenuous to say that medical profession want to limit the emergency room visits. I was just in Florida and saw dozens of billboard advertising emergency rooms, touting the convenience and wait times. ER make a lot of money for the hospitals, therefore hospitals have no interest in people not attending ER and seeing their primary care physicians.

Boston

From Nashville, TN. Member station: WPLN

Moving away from employer-based health insurance is essential in order for America to remain competitive from a business standpoint. As a self-employed entrepreneur, obtaining insurance has been extremely difficult. Obtaining insurance coverage for workers at a factory I recently acquired has also been costly, as we are a small group.

Having access to a larger insurance pool would help people like me (self-employed, small business owner) add jobs. I would be able to have health insurance for myself and my employees without having to bear a disproportionate amount of the cost as compared to people with “regular jobs” employed at larger companies.

Dr. Gawande, I am a big fan of your books and appreciate all that you have done to bring attention to this matter.

Cheers,
Ajay

It seems that technology innovations in some cases drive up the cost of health care (in the case of over use, use of a much more expensive technique or equipment with marginal benefits…), and in some cases might drive the cost down (less tests that can find problems more efficiently…).

What a conflict for an engineering researcher in health care like myself! What can be done with technology to drive down the cost?

I’m sure the costs are much more driven by politics, companies, and a few powerful people making a lot of money, but I hold some naive hope that I could do something to contribute to the problem just by going to work everyday…

Does anyone have any thoughts to keep my naive hope alive?

Hi,

I am interested in hearing about Dr. Gawande’s thoughts on the Patient Centered Medical Home model and what he thinks about the potential for the use of “Nudges” in healthcare – choice architecture, defaults, and libertarian paternalism as outlined by Thaler & Sunstein.

Thanks!

I’d like to hear some discussion about innovative practice models like direct care and concierge care, now called private medicine. These models have increasing amounts of data demonstrating significant cost savings while improving care quality. And it is being done in ways that are accessible to almost everyone, not just the wealthy. I have teachers and retired teachers on fixed incomes in my practice.

Thanks for covering this topic today–very timely.

If the Congress and the state governments would spend their time and energy AND our tax dollars on finding SOLUTIONS as recommended by the fabulous Dr. Atul Gawande in fixing and reforming health care instead of re-litigating it in Congress and shoving it through the courts, we would all benefit.

It’s complicated people!! Get smart – and demand more than platitudes and political reindeer games from your elected representatives.

Demand innovation from your doctors or change doctors.

Your life may depend on it – your healthcare already does. Read everything and anything Dr. Gawande has written. He makes the complex easy to understand. He rocks!

Janice Evans, Salt Lake City

Tom,
Good conversation but both you and your guest are stuck in the paradigm that gov’t is the answer. An earlier guest correctly pointed out the scepticism that gov’t can really enact these solutions across the country – and yet we have successful private industry examples of complex processes being reliably implemented nationwide and even worldwide! Fedex, UPS, phone companies, data providers – heck, even food franchises! While we would have to search far and wide to find the same success in ANY gov’t program (TSA – don’t think so, VA – nope, etc).

The protest is not against reform but against THIS reform! Give us real reform that spurs on the private competitive market place and watch cost come down and coverage expand. Look what happened when we remove gov’t control from the old Ma Bell and force private competition! Not advocating total abandonment of gov’t oversight in Health Care but its goal should be to encourage competition, not strangle it.

@Rich “Why do we need insurance at all? … Please, what am I missing here!” — What you and policy makers are missing is the purpose of insurance. Individual mandate advocates love to use the example of car insurance saying “Everyone has to have car insurance.” WRONG. Only drivers need car insurance. But more important, car insurance does not pay for incidental wear and tear or car maintenance. You have mandatory car insurance to protect others from your bad driving.

OTOH health insurance pays all routine health care because Americans would rather pay their cable company $100 instead of their doctor $100 to see them. It also pays for all kinds of dubious procedures and meds that have nothing to do with keeping us healthy. Why should I help some horny geezer pay for ED pills. What’s next? Do I also pay for romantic dinner and wine for two?

In Massachusetts insurance will pay for fertility treatments helping a women get pregnant with triplets then pay for the premature birth of those triplets. That’s like a car insurance company paying crooks to steal your car then paying you to replace it.

Insurance should pay for catastrophically expensive unforeseen health events.

WHY can’t re just IMITATE everything that the individual Scandinavian countries do? Investigate which of those countries does things the best, then just DO THE SAME THING!

When I say “everything”, I also mean add childcare, eldercare, disability care and/or disability work programs — add those programs to health care — an American health care that was just like that of those countries.

Please do NOT say that their countries are uniform genetically speaking. People say that so often that I want to SHOUT, “but WE are supposed to be a country that believes in liberty and equality for ALL!!! WHY would the relative homogeneity of the Scandinavian countries make any difference?” Hearing the guest say that people originally fought medicare because of racism, makes me wonder if that homogeneity issue is more of THAT??!!!

Ahh — yes, the Scandinavian countries have high taxes. But, guess what?!!, the individual there GETS something for their taxes — their taxes do NOT go toward profits for the war industrialists!

We do NOT have to re-invent the wheel. Other countries HAVE tackled these issues and solved them with elegance, not exotic complexity! The Danes are said to be amongst the happiest people on earth, along with the people of Bhutan, who also have universal health care! Our country is run as if it were still part of the British Empire with its WRETCHED CLASS SYSTEM!!!!!

Thanks!

A friend of mine works in the oncology dept at Geisinger Med center in Danville Pa. The head of her department makes oveer 900k a year in salary. This same guy walked into an appointment with my dieing mother without his white coat, bent down and wiped something off his fine wingtip shoes then touched and examined her infected drug port without washing his hands. No one in the room had the guts to say anything to him.
Posted by at from laughing at your guest, on January 4th, 2011 at 11:47 AM

900K a year for a department head! You want to know why health care is so messed up in this country that man is one of the reasons.

Nothing will be done. It’s going to be ideological based arguments that drive this and our nation will slip further down into the abyss of a third world country or banana republic.

It was fun getting up in time to interact with you fine folks during the show this morning. Even though I am in my sixties I must now take your leave to play a little Modern Warfare 2 which is now a healthful substitute for a morning cup of coffee (actually makes me more awake than coffee) then its off to the gym so I don’t become a burden in my old age — when ever that will come around.
Live Long and Prosper (in the higher realms)

Anne, on imitation it will take more than a generation for a positive outcome. Education and health are closely related. I wonder the number of Meth labs busted in Sweden? A cold climate may also have an effect on health as well.
We are obese, lazy, addicted, and poorly educated.
We exploit a large segment of our population. Our nation is built on a model of exploitation.
How do we change tracks of history that feeds the system we currently have?
Yes, the idea is good, but how to get there?
I would start with universal coverage for contagious disease.
Buy the rest of health insurance by pound, or at least by the BMI.
A heart disease rider, or a diabetes policy as additional coverage but basic health is covered for all.
I prefer single payer.

Posted by at from a beautiful Santa Cruz morning, on January 4th, 2011 at 11:07

Tom, When I was in middle school, I remember reading a report on the relative yearly earnings for different careers. The average yearly income for an MD was $25k.
But now everyone who makes it into med school expects to be a millionaire. Why is the incredible greed and egomania of the medical profession never brought into the discussions? They have conspired to keep their product in demand by limiting admissions to schools and maintaining an shortage. Then we have to turn around and hire foreign MDs to service our sick. Why could France develop a system where they have enough MDs and a superior system (the average French MD sees a total of 12 patients a day much better than the couple minutes you get in US)

Well Tom asked this question on the air, even read a good deal of it. And, ok the doc sort of gave it short but kindly shrift, then there I am in the flavale of Rio fighting against insurmountable odds when I realize (I am getting old — darn) His answer was that the problem wasn’t greedy docs, and his proof was that most docs wanted to go into specialty surgery like him because there wasn’t enough money in pediatrics and such. Listen to it. THIS IS UNBELIEVABLE — we are so enmired in a culture of smoke and mirrors that this kind of doublethink goes unnoticed by almost everyone. — according to the doc The proof that greed is not the problem is that we are greedy and act accordingly. — UNREAL, they have us, we are lost.

at, I think people have heard for so long that doctors want to become specialists because specialists make significantly more money, heard that for so long that it is not, as you say, remarkable, worthy of pointing out.
This has been the case — I am mid-’60s — for most of our lives. I recall in the early ’80s that an MD who was smart picked a specialty for the financial promise associated with it.
In the last couple decades, you can add on top of the financial factor the additional complexities of running a staff that can handle insurance billing and to some extent insulate the physicians from the kind of triage that insurance foists upon the consumers (us). A primary care physician who in the allotted 15 minutes manages to get a good “read” on a person’s condition should probably also get a good read on the fact that the necessary care is completely beyond the capacity of the particular patient to afford, at least not outside of Medicare. It’s a race to get to the safety of that net. The costs will still be there, but at least the costs will not be ON TOP of the cost of private insurance. Of course it varies person to person, but I suspect there is an underlying truth to it by virtue of about 15 years of noticing this Tyvex shield between providers and the reality of what care is costing their patients. It would probably be much easier on the human psychology of an actual concerned MD to care exclusively for those on MassHealth (the subsidized care for low-income people in my state) or Medicaid or Medicare. I remember seeing a physician circa 1972, and the fee was $5, and the doctor (personally) told me he would not accept that money. He somehow knew without being in any way hinted at that I would be forgoing other needed things if I paid him. He knew he had other patients who would keep him whole. Nowadays doctors don’t have any sensory organ that tells them, “I can’t see this person because money issues might get in the way.” So bizarre things happen, and a physician wrings the hands and says “I’d need more than three appointments to address this and that,” or the equivalent. And “three appointments” also means there are “other issues” that would be hand-wringingly forbidding (the patient’s time and money; the physician’s office’s resources and parameters). To a 25-year-old, a physician can maybe “misrepresent” about something, because a 25-year-old’s body may still be mostly a mystery to the patient (with no spouse there to complain, no parents to be pestering, no dependent children either), but older people, can we be dismissively skimmed-over? Not so much. We are more savvy.
Life is like that, we have to conclude. Or for now, it is. (Who would WANT to be a primary care physician under these circumstances, even without the cost differential? Actually, there are some. Would you rather be a used-car salesman or a caregiver?)

Let everyone choose from govenment run clinics that provide complete wellness programs. Total care from head to toe, and this should include dental/eye care. On site specialists would be available as needed daily. All care is based on sliding scales that is addressed quarterly based on total of income proved by IRS records. The mecical, and business employees are all trained by the goverment in a Manhatten project type program to get medical cost on non-profit basis only, and quality care for all available. From first intake of a new patient they are tracked with their own electronic medical record. One is kept on site of clinic, one record will be back-up at cloud location set up by government, and the other could be as simple as a flash drive that would be kept with each person as they go about their life. This will stream line all care, and help with medical errors. Also, put a lot of people to work with training, and grants to set these clinics/workers are trained ASAP. If individuals want to keep the helth care they have now let them, but they will see that no one can afford what we have now for much longer. Help make medical care a human right just like all other well off countries on the earth.

My email to many:
I saw a news bleb that said Atul Gawande, MD would be on “On Point” on NPR this afternoon for one hour and I found him on U. of Tulsa’s, KWGS, HD 3, at 5PM. Could not record it, but here it is for you to hear. I share his concerns, 300 million people in the US, spend 8K each in 2007 or 2 trillion 400 billion for health care, wow this will destroy our budget. It was expected to rise by 6-7%. OH NO!!! The Census says we are now 310 million, in 2010 and health care experts expect costs to be 9% per person in 2008, we are rising like a rocket. If you use the the “rule of 72″ this means if you divide 9 into 72, the number compounded is the number of years for the original number to double, thus in 8, yes in EIGHT years, by 2020 conservatively, the individual cost of health care will double. So, go figure a financial plan to take care of paying for our U.S citizens health care, and save us. Thanks, Jerry
Click below to hear Atul.
http://www.onpointradio.org/2011/01/atul-gawande-health-reform

A simple but factual number to keep in mind for all who are concerned about health care costs. Our nation spends 17.2% of its GDP on Health Care and we have 40,000,000 (forty million!) uninsured. Other countries with universal Health Care spend 10.5% of their GDP, have better outcomes (lower infant mortality, longer lives, etc.) and everyone is covered! It’s called a no-brainer.
In the words of Earl Pitts- “Wake Up America!”

Ellen @ 12:34 _ I believe you will be very pleased with your Medicare experience. My parents loved it. My trouble is I am at the exact age that now makes me a target of the “reformers” of Soc Sec and Medi (54!). I don’t mean to be paranoid, but this is getting ridiculous. Also FEMA wants to tear my house down this year! Any suggestions?

AJ North @ 1:09 It is my Senator McConnell who is fond of saying “We have the best health care in the world”, what no one seems to realize is that he is the most self-centered person in the world. He is correct in saying it, it is just that his world of “We” is the members of Congress.

The clear and rational solution, already implemented across the civilized world:

Establish a single payer health insurance system, with universal coverage in order to reduce costs, expand coverage and improve quality. A single, public health insurance system would allow the US to spend, in line with the world’s top 10 health systems (all of which provide universal coverage), about 1/2 to 2/3 per capita of what we currently spend. In 2009, the US federal, state and local governments, corporations & individuals, together spent $2.5 trillion, $8,047 per person, on health care. This amount represented 17.3% of the GDP, up from 16.2% in 2008 (Jones, Brent. “Medical expenses have ‘very steep rate of growth’”. 4 Feb 2010. USA Today). Canada and most of the G20 nations, contrastingly, spend around 10% of GDP on Health Care (OECD Health Data, June 2009; 2010) and pay, on average, 1/2 per capita of what the US spends on Health Care. Yet in Sept 2010, the US Census Bureau reported that 50.7 million Americans (16.7% of population) are now without any form of coverage (up from 46.3 Million of 15.4% of the population in 2007). Many millions who are “insured” have high deductible plans with coverage caps which, should any serious procedure be required, result in bankruptcy (the leading cause of personal bankruptcy in the US, though non-extant in the civilized world). All of the other G20 nations, contrastingly, cover all of their citizens for most treatments and procedures. Even when adjusted for obesity and life-style related mortality, our comparatively low life expectancy bears testimony to this disadvantage. The ‘one size fits all’ criticism is addressed with the provision of supplemental, private insurance plans – something available for those who desire it in Canada and France, to list two examples.

If we were to establish a single payer insurance system with price controls in the USA (like every one of our competitors, including Singapore, which rigorously controls supply of medical services and institutes a sliding payment scale), we’d be able to drastically lower costs via monopsony and drastically expand and improve coverage. If the government is the only or at least the major buyer in every town, then provider costs must adapt to the reasonable rates that buyer is willing to offer. In terms of cost & efficacy, all the systems of Western Europe, Canada, Japan, NZ, Aus, etc. are superior to that of the US. USA healthcare under-performs the majority of developed nations’ systems on every measure (including the treatment of preventable diseases), such that the WHO ranked us 37th in 2000. Even when completely removing the equity parameter, the conservatively-biased WSJ reckoned that we’d still be at 15th place in 2009.

Why is it that the US is the only industrialized country on earth to require everyone to learn how to read and do sums but refuses to ensure that they and their working parents are treated for life-threatening or debilitating illnesses without entering into bankruptcy? No one, except on the ultra, ultra-right is calling for the end of the public school system, the removal of public sewage systems, the end of public road, highway and train maintenance or the repeal of traffic laws, yet these were all impositions on individual “choice” and “liberty” enacted to achieve the obvious, collective benefit. Health care is no different, whatsoever: we all have bodies, they have common characteristics and there are common solutions to ailments, which can be provided for in common. In certain areas, Socialism is good: health, education, transport, retirement security, unemployment and disability insurance.

We don’t need another “testing ground” or “experiment” when every other nation in the industrialized world has already successfully completed the experiment. Their uncontested verdict? Establish a single-payer public health insurance system with universal coverage in order to cut costs, expand coverage and improve quality.

Republicans want the poor to DIE! Period!!

Hi, Tom, I have given up on health care reform. The insurance companies are always in the way, always more interested in making money than in helping people care for their health. Eugenia Renskoff

I second what geffe said – the system is broken and needs to be fixed. We need to stop saying America is the greatest place in the world to live. That is an outdated statement. Our health care – or lack of it, sucks. Period.

why not have undergraduate medical school like most other countries? that would reduce education costs and medical doctors wouldn’t have the excuse to charge us so much.