myles spicer

myles spicer
palm desert, California, USA
January 23
Retired owner of ad agencies in the Twin Cities (Minnesota) and San Diego -- 45 years. Graduate U of Minn; Veteran, officer USAF discharged as Capt. Licensed pilot. Published author. Unrepentant liberal

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APRIL 5, 2012 10:46AM

Why we are falling behind in global healthcare

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As we continue to get wrapped around the axle of intricate detail in the Affordable Care Act (ACA) now before SCOTUS, we are experiencing a classic case of not seeing the forest for the trees. While we debate the minutia of a several thousand page document, and critics such as  Michele Bachman claim it will “infringe on personal liberty”, what we really ought to be discussing is assuring that all our citizens will have affordable and universal health care – just as every developed nation in the world, except one, now provides its citizens!  The one developed nation without universal health care: the United States of America. And the arguments against the insurance mandate are so spurious and weak (when viewed globally), it is surprising they are even challenged. Indeed, that is precisely how the rest of the world is getting healthier, while we lag behind.


The United Nations has long had criteria as to what constitutes an “industrialized, developed nation”. There are currently 33 on that list. Of that number, 32 have Universal Health Care…all except the United States of America.  Further, without exception, all pay through some sort of mandatory fee, tax or other compensation from all its citizens.

 There are three basic methods of collecting needed funds so that all citizens get full health care: both preventive and treatment. And all three methods have been long standing and successful.

One is the Insurance Mandate, now being challenged in the Supreme Court. Among the nations that have such a plan, the most successful are several European countries (notably Germany with a highly regarded health care system). Very simply, the government mandates that all citizens purchase insurance, whether from private, public, or non-profit insurers; and if from private sources, no one can be rejected. 

Some countries have what is called a “Two Tiered Plan”.  The government provides or mandates catastrophic or minimum insurance coverage for everyone.  Additional voluntary insurance or fee-for service care can be purchased if desired.  Thus, the government provides a core policy which can be supplemented with private insurance.  But everyone is covered. We attempted to employ a variation of that idea with the “public option” in our legislative health care debates, but that was quickly rejected by conservatives in Congress. 

Then there is the Single Payer plan which about half the developed nations utilize. Again, rejected by conservatives, and badly mischaracterized as some sort of socialized medicine. The fact is, the actual medical care (with the exception of a couple of countries) is carried out by private providers. In short…your doctor. This is not unlike our highly successful and highly regarded  Medicare system.  Also, already government run, and widely accepted are the military Tricare and VA programs. And few complain about “infringement on personal liberty”.  

So, while we clearly are out of step with the rest of the developed world on universal health care programs, what is often lost in this debate are the effects this has in the overall health of our nation. There are a number of ways to determine the “health” of a country, but perhaps the simplest one, and most easily defined is life expectancy. Notably, virtually every country (of the 32 countries referred to above) with universal health care, are in the top tier of longevity. The United States now ranks 34th on that list, according to the World Health Organization. 

Another measure is infant mortality. According the 2009 CIA World Factbook which tracks such things, the United States is now 49th in the world in that statistic. But that is not the worst of it, because as far back as 1950, we ranked among the best in the world – now dozens of countries have passed us by.  Even more distressing, with our continuing slide down the slippery slope of declining health care results, is the fact that we now have the most expensive health care system in the world. 

Critics (and those who commenced the SCOTUS lawsuit), are now trying to find cover for scuttling the ACA under “Constitutional” grounds. While they may find success, it is widely acknowleged that such a decision will almost certainly be made by the court on political leanings rather than legal, as many of our previous 5 to 4 decisions have been in recent years. And that would be a significant loss for health care in America. 

The Affordable Care Act is an attempt to redress the weaknesses that have existed in our nation’s health care system. It provides a mechanism whereby the 45 million uninsured (about 15 percent of our population) are afforded essential availability to health care. It employs a payment plan which has been successfully adopted by every other developed nation in the world – and no nation has ever reversed the plan or characterized it as unfair or unreasonable. It is based on the pragmatic premise that if each of us sacrifices modestly, there will be a greater good for the whole – and from that we too will end up being enriched.  And that means we all will be living in a healthier, more vibrant, more robust America. 


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Thank you very much for posting this!
I appreciate your disclosures and details about the health care humanitarianism of other nations but Obamacare, with or without mandate, is a gift to the corporatists, and it is one more Trojan Horse. The mandate is the frosting on the cake of that gift. Thick and rich frosting, as well as toxic to us average and sinking fast Americans. imho.

Being forced to buy crap insurance and being under-insured so the profits go into the golden wallets of the 1 percent. 2000 pages of loopholes and fog ("forces of greed" Zeese calls it) and mirrors. The original HR bill was simple and honest and humanitarian and something like thirty something pages if I recall correctly. Mendacity likes to bury itself with words. It was clear.

Lower Medicare to birth will work and save $400 billion a year. Let that saving pay for those who can't begin to afford insurance. Help the homeless, not the bastard in CT pulling in $9,000 an hour as an insurance exec!

45,000 Americans a year will continue to die until Obamacare kicks in seriously in 2014 but that was no biggie to Congress or the Obama administration to rush anything or the media, God forbid, and I am betting that deaths from under-insurance will be tragic post 2014, but myopic and amoral administration along with media will pretend it is a big ol' American team win.

Parent Salon puts its Obama-pro thumb on the scale once again imho for political propaganda purposes. libby
Well Libbyliberal, perhaps you have a short memory. Sure, there are bad flaws in what was finally passed as ACA, but did you forget, it was done with Republican obstruction in both the House and Senate? The better concepts (single payer and/or public option which we would all like to have happened) had no chance of passing. If I have learned anything in life, it is that sometimes (especially in politics) you have to choose between bad choices, and pick the "least" bad one. Obamacare is a hell of a lot better than the crappy system that preceeded it, with vicous private insurers calling the shots and charging outrageous premiums -- while leaving all the high risk people to fend for themselves.

Indeed, if you do not like Obamacare, you are likely to see it scuttled, and we will return to the bad old days again. careful what you ask for.
Wow. It is disheartening to see this. At this stage, any progress is progress. It does no good to hold out for single payer (which makes the most sense to me) with the dysfunctional government we have now, so I guess we will have to look at changing our health care system as a many step process. Personally, I do think we will eventually get to Single Payer.
Thank you for this.
Thanks for this informative piece. R! I'm just curious. You mention a "couple" of modern societies that have what can accurately be called "socialized" medicinal systems. I know that one is Great Britain. Do you happen to know which others (?). I'm so tired of fact-free right-wing cliches about "socialized medicine" -- some, ironically, from military folk and veterans who wouldn't be without their government-provided medical care.
P.S.: Make that "medical," not "medicinal," though some medical care is indeed medicinal.
You spoke eloquently with excellent points. I am a bit discouraged with ACA, but it is a step in the right direction. SCOTUS is leaning so heavily conservative that I don't hold out much hope. I am amazed that so few Americans understand how far behind we are in this area. Single payer makes so much more sense, especially with the Alzheimer's and dementia epidemic we boomers are facing. There are many others on OS who have some understanding of your struggle with your wife's condition.
You've provided a lot of good information in one place here. It's hard to believe that there's so much opposition to the modest US plan. Purely politics, I guess. And sad for us all. Nice job.
Interesting. I worry so much about the the SCOTUS will do. I am holding my breath that we don't revert back to our terrible system. And that there won't be justified rioting after, by people who have a right to heath insurance.
Too much common sense here myles. Some might say that you're a dreamer, but you're not the only one.
Your argument seems funny. We were better in 1950 before the introduction of Medicare in 1965. Yet, the solution now is to get the government further involved in healthcare?
This is an interesting subject and one I can contribute to. The list of “industrialized, developed nation”s with better health care than ours is often noted. France is on that list and has one of the best health care systems in the world and I live much of the year in France. They do have a "mandate" for citizens but allow non residents (like me) to use their health care anyway. Unlike America where the very first question at the hospital is: "Are you insured?", in France, they ask for your green card which is your health care card. When I say I don't have one, they don't immediately recalculate the bill as in America. They just smile and hand you the same bill. The price is the price. No smoke and mirrors of what the procedure costs. The whole French health care mandated enrollment is about paying the costs BUT the costs are very reasonable. A doctor visit is about $30. A specialist similar. An x-ray maybe $50, etc. Remember these are not the "copays" These are the costs of care and insured or not these are the prices for anyone. America, and "ObamaCare" has not got a grip on costs and it is for that reason that we will suffer if we move on to mandating "Insurance purchase" first. Doing that only adds insurance company profits to the bill. How about some blog time on WHY costs are so high? It is not a given for the quality of our care which is mediocre.
I am reading this from Johannesburg, and realizing that if I had not seen most of Africa in the last five years I would be swayed to believe 100% of what you've written. The truth? Nationalized medical care is not the solution, only a "response" to a problem, and has varied results. By the way, Greece has to be one of the 33 right? Not a place to get sick right now.
To Daniel, I believe some other countries that have "socialized" medicine (i.e.government run hosipitals etc) Spain, Finland, Israel, and Cuba. Perhaps otherrs as well -- but this is not a recommendation for such a plan -- it is strong reasoning for the United States to adopt some form of universal health care system. Health care for ALL our citizens, just as other developed nations have done.

For UncleCrhi, I did not say our infant mortality rates were BETTER before Medicare(indeed they are better now than 1950) -- but did note that relative to the rest of the world, in 1950 we rated better than most countries, which have now passed us by in improving their health care, while we have remained relatively stagnant with our archaic private insurance health-based system.
To Beauty 1947, your comment is espeically relevant to me personally (the author of this piece). My wife is in memory care with severe dementia. the cost is a backbreaking $5000/month. What is often overlooked as we attempt to bring better and more affordable care to all our citizens is the fact that many countries also offer assistance for long term care. While we are quibbling (with and absurd court case) about adding just 15% of our population to health care, the rest of the world is so far ahead of us in caring for its citizens that it is pathetic the resistance we are getting for making our system better and bringing it into the 21st century.

During any period in which we evaluate our healthcare outcomes, isn't the most frequently used comparison one that relates our performance to others, whom we consider otherwise equal? In fact, isn't your post full of such relative comparisons?

Therefore, relative to others we were better (at least in some areas) before Medicare according to these types of comparisons; and now, as you note, we are not. In the intervening years, health care costs have risen from 5.7% of GDP in 1967 to over 18% of GDP today. Yet, your plea is for MORE government in healthcare.

In this context, does your thesis make sense, even to you?
You have disproven your own argument. It is true that medical costs have gone up to 18% of GDP -- blame that on the private insurance industry. Their administrative costs average about 20% of premiums (of which there are huge profits for the companies). Medicare adminstrative costs average between 3-6%, depending on inclusion of some collateral costs -- and it has not risen since it started.

I wish I could plea for MORE government involvement i our helath care system, but that is not happening, nor what my article is about. It is simply about having UNIVERSAL HEALTH CARE FOR ALL OUR CITIZENS; and the method eventually chosen was a simple mandate that everyone carry some sort of health care innsurance. That hardly seems radical, a loss of liberty, or onerous considering every other develped country has it, and their outcomes are better than ours.

I wrote a blog post directed at UncleChri (who claims that Medicare is driving down the U.S. economy), but he still hasn’t been able to dispute anything I wrote:

Ballooning health care cost: is Medicare the culprit?

I wrote several well-received blog posts about the health care systems here and abroad, which are relevant to your piece. You can find them going to my OS web page.

Note that UncleChri is one of several people who are known here to provide good comic relief. Thus, you can generally disregard his comments.
I think that a state run healthcare system is one of the most important systems, which modern states need to have. Private health care companies are the most effective means to rob citizens.
to thundering applause during the republican primaries we heard all sort of things such as "....let him die...." or "....if you are poor is your own fault" and countless other pearls of republican wisdom.....
if you let them compile the statistics, they will take out the 45+ millions and you will magically regain a few spots globally (but significantly you will still not be in the top 10 in my opinion).....but a lot of my american friends of both parties still claim that the USA have the best, citing all the foreigners (as well to do as themselves, of course) that go to the USA for the latest and greatest....
as i have blogged and commented myself on this subject, your health care situation makes a mockery of ".....the pursuit of happiness...." phrase in one of your founding documents.....
saluti e "salute"
"Some countries have what is called a “Two Tiered Plan”. The government provides or mandates catastrophic or minimum insurance coverage for everyone. "

Um...we have a variation of this in the US (no one can be denied emergent care, whether in a public or private facility, when life or death is at stake). It sucks.

We need public, preventative, whole health care for all people for the plan to work. The only way to have a good, affordable national health care plan is to have a healthy citizenry, and with nearly 1/3 of our population type 2 diabetic, or on the brink of that condition, The US is a long way from a healthy citizenry.
MalcolmXY wrote: 'We need public, preventative, whole health care for all people for the plan to work.'

Yes, I think the same way. And I think it is a long way to go. The whole structure should be built...

If I may, let me refer you to a couple of articles to counter the pet Socialist canard that greedy insurance companies are responsible for the skyrocketing costs of healthcare since the introduction of Medicare and Medicaid.

In fact, greedy doctors abandon Medicare and State-administered Medicaid patients because both programs pay like a Chicano Chevrolet – low and slow. Both payment characteristics are antithetical to profit.

Further, maybe you can deduce what happens when scheduled (State-administered) Medicaid payments or the total of Medicare and patient supplied payments do not cover the costs of certain medical tests or therapies. In those cases, healthcare suppliers can do nothing other than raise the price for these procedures on those who are not covered by either national program in order to recoup losses or to raise their margins to an acceptable level.

Of course, the reasoning of those employed by the national government to determine what our national healthcare programs for the elderly and indigent should pay for covered procedures is that they are attempting to ‘control’ (as in ‘keep low’) medical costs. Precisely. It’s too bad that these burrocrats aren’t as smart as, or as adaptable as, free markets.

Free markets in healthcare? Exactly.

Healthcare insurance and non-emergency healthcare would be free markets if governments would stay out of them, as they once did. Only emergency care could be considered a market in which its consumers purchase without the normal considerations of costs and benefits one would associate with an unencumbered exchange between a willing buyer and a willing seller.

Don’t believe me? Do some research.

The costs of uncovered, elective, medical procedures like Lasik and cosmetic surgeries have dropped over the last three decades. Covered medical procedures, on the other hand, have risen dramatically.

This is not only because of the effects of the above-described governmental intervention in what otherwise might be free markets. There is also a ‘moral hazard’ in the Socialism you desire.

When access to medical care is ‘free’, demand for it goes up. Perhaps you still subscribe to the law of supply and demand. If not, then I would be willing to cough up the money for you to renew.

Let me make two more points for you and those who are now ready to make the argument about how National Socialism in healthcare is the only answer to all those who show up at the emergency room uninsured.

First, showing up at the emergency room uninsured does not imply that a medical bill is not paid. Many choose to self-insure and can afford the average $1,318 average cost (2009). The median, or most typical, cost that year was $615.

Second, approximately $56.8 billion in healthcare billings went unpaid in 2010. Granted, that’s a lot of money. However, total healthcare revenue that year was . . . . . . (wait for it) . . . . . about $2.2 trillion. Hence, (for PJOR) about 2.5% of all healthcare billings went unpaid. That’s not enough to justify what you want from all of us, in my humble opinion.

I am empathetic to your situation. I understand perfectly how it is that you conclude that we should all pitch in to help you. After all, someday we might be where you are, correct?


However, you are allowed to remain unrepentant.

You have my best wishes,

Another display of UncleChri "logic!"

First, he ignores that elective services like Lasik begin with expensive equipment and little competition and, as equipment prices lower and competition/demand grows, prices come down. A digital calculator cost around 80$ when first introduced, but went lower for the same reasons. The same is true of flat screen TVs.

Blissfully ignoring the difference between single-service elective and multiple service, wide scope, impossible to accurately pre-calculate essential medical care, our resident master of "logic and facts" offers them in like comparison.

The hilarious thing about having an idiotic idea and then looking for confirmation bias is Chris either ignores or doesn't find enough applicable facts to make a rational assessment. Of course, being incapable of that also hinders arriving at accurate results.

Under Chris' ambiguous definition of "socialist," most doctors in America are "socialists," as well as most Americans, both groups preferring a single payer system.

Confirming that fact is relatively easy if you don't limit your analysis to conflating lowering Medicare payments with a rejection of public health insurance as a model. I can see the difference between the two concepts, and I'm sure rational people with adequate minds do as well.

"New research by the Indiana University School of Medicine shows that 59 percent of doctors support legislation to establish a national health insurance system, up from 49 percent in 2002. Only 32 percent of doctors said they were opposed."

New England Journal of Medicine:
"Overall, a majority of physicians (62.9%) supported public and private options. Only 27.3% supported offering private options only."

Dr. SALOMEH KEYHANI (Researcher, Mount Sinai School of Medicine): The results of the study demonstrated that the majority of physicians support a public option in the United States of America.

SHAPIRO: That included the 63 percent who say they'd like to see patients get a choice of public or private insurance and another 10 percent who favor a public option only. They'd like to see a single-payer system. When the public in general is surveyed, support for a public option has run between 50 and 70 percent.

Co-author Dr. Alex Federman - he is also at Mount Sinai - says it shouldn't be a surprise that doctors favor a public option in numbers even greater than Americans in general.

Dr. ALEX FEDERMAN (Researcher, Mount Sinai School of Medicine): Probably the most important reason is grounded in physicians' experience with Medicare.

SHAPIRO: Doctors already have lots of experience with that government-run health insurance. The survey also asked the more than 2,100 doctors about how they compared Medicare with private insurance.

Dr. FEDERMAN: Physicians favored Medicare when it came to delivering care to patients. They thought Medicare was better when it came to autonomy and their decision making and their ability to get patients the care that they thought the patients needed.

I could explain why Medicare is more efficient than private insurance, or demonstrate the history of private v. public or non-profit insurance, or ask Chris to explain why countries with public insurance have lower costs and better results.

But I'll let others have at him. No sense in not sharing my pigeon pie.

Don't worry about hurting his feelings. He has as much capacity for shame as he does for logic and reason.
Boils down, seems to me, whether you want a humane society or a dog-eat-dog one. If the former, why not look into systems in other countries that work. Supporters of the latter position better save their pennies in case of catastrophe...which, of course, they want to be free to take care of w.o. any help.
Myles, how is it that conservatives blocked single payer? If the dems could and did pass ACA why could they not pass single payer. My understanding is that enough dems would not vote for single payer. Am I incorrect?

When you say ALL people in Germany must buy insurance, does that include the poor? How do they pay?
Yes, everyone (with a few exceptions) must pay for either government or private health insurance in Germany.
If employed, the employer contributes too.
The system goes back to circa 1872 - Bismarck. Most pay into the state system. Private health insurance offers few benefits - it's more expensive (often much more) but the medical treatment received must be (by law) the same as for the government insured (same hospitals, doctors etc.).
The poor (On "Hartz IV") who have been working and are unemployed
will have their contributions paid by the state unemployment agency (unlimited) - they will have paid obligatory unemployment insurance for this (there is an employer contribution).
Other "poor" (e.g. pensioners with very low incomes) will have their
contributions paid by one or other government or state institution.
People totally without means - "down and outs" are also covered - the German Federal States pay their contributions.
There are no limits on costs whatever - for anyone.
No one has a fear of being long-term chronically (and expensively) sick.
Overall, the system gives total coverage and is effective.
Having had EUR 30,000 + worth of surgery in the last 12 months - including 4 weeks rehabilation - I am a very satisfied customer!
The downside is high admin costs - as in the US -
23% of all money going in is spent on administration.
The UK system is similar but funded out of general taxation.
Far lower admin. (and overall) costs than for the German system and similar results (Don't believe the horror stories you read in the US about the NHS - it's pretty good, and delivers universal coverage in an effective and efficient way. I have worked in health admin. (and had medical treatment) in both the UK and Germany, so am able to compare the systems).
There is too much competition and too many hospitals in Germany - this puts the costs up greatly without bringing in many benefits (and has other serious drawbacks like over-treatment and failure to refer patients to more appropriate treatment centres).
The way we do it in Canada is health bills are paid to doctors and hospitals out of taxes. Therefore, some who is too poor to pay taxes is still covered. You may not like the idea of From Whom is Able, To Whom is Needing, that being a Marxist idea and all, but the overall cost per capita in Canada for health care is less than in the U.S. (since we don't have ER over-use and inflated hospital costs to cover uncollectable bills AND NO VAMPIRE INSURANCE COMPANIES). The U.S. could have such a system if it weren't for the ideology hurdle and the made-for-deadlock (and legalized bribery) congressional system.
J. Cole: You need to realize that being a Democrat doesn’t mean that you cannot be “conservative.” My former U.S. Rep was a Democrat, but most of his policies or political views were in line with the Republicans. Although he was an excellent representative (despite of his political views and because he worked hard for his district), he was voted out of the office simply because of the letter D on his back.

"Sure, there are bad flaws in what was finally passed as ACA, but did you forget, it was done with Republican obstruction in both the House and Senate?"

Myles, let's just cut to the chase. Are you forgetful or dishonest? Not 1, none, zero Republican votes were needed to pass the ACA. So please explain how the Republicans obstructed this bill?