Wednesday, June 30, 2004

Your Turn in the Hamster Cage 

If you win the lottery, of course, it's not a problem, but for the majority of us basic healthcare is increasingly expensive -- when it can be had at all. (And even the King is not immune: the royal insurance plan, for example, stopped paying for anti-psychotic medication four months ago. You are now reading the unfortunate result). Since the antiquated notion of the commonweal has no place in the market-driven, social-Darwinist paradise Grover Norquist and his soulmates are now erecting around us, political solutions remain elusive. But unless current trends are arrested, the disparity in health will soon rival the disparity in wealth, and the latter is already at Gilded-Age levels (ask Kevin Phillips). It is not at all difficult to envision a future in which access to medical treatment is, for Americans, anyway, the exclusive province of the rich:
Denver was the setting a few weeks ago, when more than 100 physicians from around the United States attended the first meeting of the American Society of Concierge Medicine. Concierge medicine is a special, high-end form of medical care that guarantees that if you need treatment you will get it, without a hassle, seven days a week-but only for an extra fee. If you can pay amounts that range from $20 to thousands of dollars a month, you can guarantee that your phone calls will be promptly returned by your doctor and that you'll get special attention whenever you're admitted to a hospital.

Now, one might wonder why it is necessary to pay a bounty to get a doctor to call you back, especially if you are already paying through the nose to belong to a managed care plan. The answer is that under the watchful eye of managed care and insurance companies, the quality of care has gotten so awful that doctors sneeringly refer to it as "hamster care." Only those patients who pay more are going to get treated by the "concierge" doctors who get off the daily treadmill and practice good medicine, providing the sort of attention and service that our parents and grandparents took for granted.

Think that giving the rich special access to health care is unfair? Consider what is going on at the same time in Tennessee.

It is making over its state Medicaid program known as TennCare. If this program gets implemented, many of the poor, elderly, children and disabled in Tennessee who rely on Medicaid will be told simply to get over it. And other hard-pressed states may well follow suit . . . .

Historically, decisions about what drugs or treatments a patient received were chosen by a standard of care known as "medical necessity." Doctors determined what was medically necessary based on local standards of medical practice, and if they did not practice according to this standard they could be found guilty of malpractice. TennCare does away with the established standard and replaces it with a new one - "adequate care." If a bureaucrat in the Tennessee department of health thinks a low-cost drug or treatment, or even no treatment at all, is "adequate," then that is what TennCare will provide.
What level of quality does the world's most expensive healthcare system deliver? In the Sunday NY Times, Bob Herbert asked Dr. Barbara Starfield of the Johns Hopkins School of Medicine, and the answer was not encouraging. Compared to other industrialized nations, all of which provide their citizens with basic healthcare at less expense, America trails the pack in almost every category:
"The fact is that the U.S. population does not have anywhere near the best health in the world," she wrote. "Of 13 countries in a recent comparison, the United States ranks an average of 12th (second from the bottom) for 16 available health indicators."

She said the U.S. came in 13th, dead last, in terms of low birth weight percentages; 13th for neonatal mortality and infant mortality over all; 13th for years of potential life lost (excluding external causes); 11th for life expectancy at the age of 1 for females and 12th for males; and 10th for life expectancy at the age of 15 for females and 12th for males . . . .

"U.S. children are particularly disadvantaged," she said, adding, "But even the relatively advantaged position of elderly persons in the United States is slipping. The U.S. relative position for life expectancy in the oldest age group was better in the 1980's than in the 1990's" . . . .

To get a sense of just how backward we're becoming on these matters, consider that in places like Texas, Florida and Mississippi the politicians are dreaming up new ways to remove the protective cloak of health coverage from children, the elderly and the poor. Texas and Florida have been pulling the plug on coverage for low-income kids. And Mississippi recently approved the deepest cut in Medicaid eligibility for senior citizens and the disabled that has ever been approved anywhere in the U.S.

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