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Insanely dysfunctional – the US healthcare system November 4, 2016

Posted by WorldbyStorm in Uncategorized.

Here’s a good piece by the brilliantly named Vann R. Newkirk II in the Atlantic on the curious fact that while under Obamacare there are now less uninsured US citizens than at any time previously the measure itself is less rather than more popular, with 47% of people agin and 44% supportive. That latter figure isn’t bad, but it’s not the highest it has been. As the piece notes;

If Donald Trump’s candidacy weren’t so unusual—and if he wasn’t currently fighting off a monumental and unparalleled campaign of self-sabotage—anxiety about Obamacare probably would have been one of the most important issues in the months leading to the election.

Well, let us be grateful for small mercies!

Still, if you want to get a sense of just how crazed the system in the US actually is how about this paragraph?

Much of the existing historical research on health-insurance “churn,” or the number of times people change insurance coverage types over a given year, indicates that people’s level of coverage falls along a continuum of statuses—more volatile for some than others—rather than in a solid state of existence. Even over the course of a single year, people’s insurance status often changes as they gain or lose jobs; slide in and out of eligibility for public insurance; experience major life events; face employer changes in coverage offered; or make choices to change insurance based on price or benefits. Many of these transitions are accompanied by gaps in insurance coverage or major changes in costs, doctors, and health-care regimens. Those things—the actual cost and experience of seeking and receiving necessary health-care services—are the most salient effects of any health policy on the daily lives of people.

There’s something brutal about the fact that healthcare – something so important, so central, can be subject to such randomness in terms of events.

What’s perhaps even more telling is the fact that there is a perception, 46% of US citizens who believe that the level of uninsured is the same as it was before Obamacare was introduced. For those of us on the left Obamacare is a partial and problematic approach in and of itself. But given the forces arrayed against its introduction and continuation one has to bear in mind just how important in the individual and collective senses it can be. Not enough, not nearly enough, but something that could be worked upon.

Perhaps, actually, it is a pity that it isn’t a bigger issue.


1. CMK - November 4, 2016

Those memes that circulate on Facebook with invoices issued in the US for healthcare are scary. The recent one where a woman was charged 39 dollars for skin-to-skin contact with her newborn immediately after a caesarean section was a case in point. Of course, the commodification of care is progressing rapidly here. For example, the Beacon Hospital are now advertising their latest high-tech heart scanner which can greatly assist patients with emergency heart problems. It is the only one in Ireland (hint, hint) so if you want to be sure to be sure you’d best take out some health insurance to make sure you’re covered. Were the HSE to order one I am sure there would be ferocious resistance from cardiac consultants who want to keep an edge for their private, paying, patients.

It is insane how people in the US respond to the relentless propaganda about publicly funded health care, to the great detriment of tens of millions. Obamacare is ‘something’ but clearly ‘single-payer’ is still needed but I think the experience of Bill Clinton’s first term where that was the first thing to be dropped, shows it will be a long time, if ever, before the US gets a decent, comprehensive, publicly funded health system.


Joe - November 4, 2016

Yep, that Beacon Hospital ad says a lot about our own dysfunctional system(s) here. The Social Democrats proposal on an agreed 10 or 15 year health strategy is being tossed around in a Dáil committee, I believe. Health really is the service that all the mainstream parties are afraid of – no-one willing to try to do much with the dysfunctional systems, just carry on as best we can seems to be the policy.


CMK - November 4, 2016

Personally, I think there is a deeper, much longer term, agenda at work in the health system. For instance, the nursing profession, the bedrock of the system, is in crisis, with established nurses heading for the exits in droves and young graduate entrants coming in on poor terms and conditions and pay. The HSE ran a ‘Bring them Home’ competition for nurses working abroad last year and only succeeded in getting 80 to return. While thousands of nurses leave the system for private healthcare (you can see where this is going) or abroad (to work in private hospitals) the HSE is recruiting nurses from India and the Philippines who, when they arrive here, are poorly treated. There is a clear agenda to run down the health system so that people, in desperation, will accept wholescale privatisation. There is an intuitive resistance, I think, to private healthcare as many recognise that a integral part of it is denying vital care to those who can’t pay, so those who want to privatise the system need to take a long view and go about their business methodically and carefully over decades. I think the neo-liberals have also learned that ‘great leaps forward’ in privatisation are risky and that incremental change yields better longer term results, and profits, for them.

Liked by 1 person

LeftAtTheCross - November 4, 2016

Hard to disagree with than analysis CMK, especially when we see the game being played out across the water with the NHS. One thing I’ll say about the public hospital system here is that once you get access to it the standard of care is very good, there’s not really much there to complain about. The problem of course is access. Whether it’s 18 months on a waiting list for an out-patient appointment, or 48hrs on a trolley in A&E waiting to be admitted. The problem is one of capacity, not one of quality of care. Of course there are still issues around the latter, we just have to look at the Savita case and the regular items on the RTE 9 o’clock new about high court settlements for cases that went badly wrong. But the point is that the public health service is far from dysfunctional, it works by and large, and is something that everyone in the country has interactions with. It will have to be a very clever long game by the privatisers to dislodge the system from the state and hand it over to the profiteers.


2. Gewerkschaftler - November 4, 2016

The US health-care system is certainly maximally dysfunctional in terms of providing health-care.

In delivering profits it works rather well. That’s it’s purpose under capitalism.


3. LeftAtTheCross - November 4, 2016

The young one was on a J1 this summer and had to visit the GP equivalent while she was there. Insect bite infection. She attended a walk in health centre, was seen by a doctor for all of 20 seconds who proscribed an anti-biotic steroid cream. She was told that her insurance would cover the visit. The bill arrived in the post back here in Ireland. USD692. The health insurance of her employer (summer camp) covered USD592. The remainder is still unpaid needless to say. Moral of the story, don’t get sick in the USA. Moral eile of the story, it’s not a health system over there, it’s a conspiracy of health service providers and health insurance providers. Six Hundred and Ninty Two dollars for a 20 second consultation. Insane. At least the anti-biotic cream only cost a couple of dollars afterwards.


WorldbyStorm - November 4, 2016

That’s abysmal latc. I’ve a fair few friends in NY who’ve been there since the 90s, they’re open about the fact that if they got seriously ill if they were able to they’d come back to Ireland.


sonofstan - November 4, 2016

Yeah, my late mother ended up in hospital for two days in Kansas City about 20 years ago,and the bill would have comfortably covered a not small car


Gewerkschaftler - November 4, 2016

That rings a bell with me – the years I worked over there I went a couple of times to the doctor and was always gobsmacked by the bills for simple things, and the fact that the Blue Cross I was paying (I think it was) never ever covered the full amount.


4. makedoanmend - November 4, 2016

True story…

An elderly US aquaintance (with access to both medicare and private insurance) went to a clinic to get prescription strength pain killers due to a horrendous flu last year. Individual knows that common viruses cannot be treated. – just needed pain relief in order to rest and sleep. Was seen by 3 doctors in 2+ hours and he just kept repeating his simple request to each doctor. After 2+ hours left without anything after determining from admin that there was no communication between the doctors and anyone else.

Within a week a bill for …. drum roll …. $7,500 arrived at his home!

When better, he had to fight medicare from sending these people money! He sent checks for several hundred dollars back to medicare. (Medicare had determined the cost of the visit too high but still worth several hundred dollars?)

And the Tories are salivating at privitsing the NHS.

Wonder why? Shares and bubbly anyone?

It’s a sick world.


5. CL - November 4, 2016

As a percentage of GNP, the U.S spends on health about twice as much as other advanced countries, and half of this is public expenditure. So public expenditure on health in the U.S is, as a percent of GNP, roughly equal to the percentage spent in European countries. Metrics of well-being,-life expectancy, infant mortality,etc, are I believe lower than in Europe. Dysfunctional, yes.


6. 6to5against - November 5, 2016

I lived in the US during the (first) Clinton administration and watched as they tried to create a health system that I think in its essence wouldn’t have been much different to Obamacare. The media/lobbying onslaught against it was ferocious.

I don’t think you can understand how powerful a campaign like that can be without being on the receiving end; every ad break in the TV contained horror stories of what was about to be unleashed on the public, every news bulletin, every newspaper headline covered the political game, with a disproportionate focus on any slight political mis-step from Hilary, who was fronting the initiative.

I came into that time a little politically naïve, but if there was one thing I knew, it was that healthcare can and should be publicly funded and be free at the point of delivery. And yet after six months of that propaganda, I could no longer formulate the arguments why. Not only could I not engage in an argument on the topic with anybody else, I remember watching an ad one night and realising that I simply could not formulate the counter argument – even to my own satisfaction.

A lot of the extreme right wing animosity towards Hilary developed around that time.


WorldbyStorm - November 5, 2016

I’m no great fan of HC but I do agree re that – I wasn’t in the us at the time but the volume and intensity of bile directed against her personally and the proposal was staggering. And the Dems fractured over it with far too many not supporting the proposals


6to5against - November 5, 2016

I’m no HC fan either, but I do find the level of personalised animosity she faces a little strange. And it was like that all through the 90s.


WorldbyStorm - November 5, 2016

It certainly was and again I’d agree. Lots of reasons to find her policies problematic but a lot of stuff does come across as very exaggerated. I also worry that that undermines serious critiques of her ( and that dynamic applies to.more than her too ).

Liked by 1 person

CL - November 6, 2016

Maybe its the greed and the influence peddling, Or what Bob Woodward has called corruption:

“The Clintons have earned $230 million over the last 15 years, and if Hillary becomes the first woman president and Bill becomes the first first lad, they will reap many tens of millions more in book money and speeches afterward. So why buckrake on the eve of her campaign with Goldman Sachs speeches?”

“But the mixing of speech fees, the Clinton Foundation, and actions by the State Department, which she ran, are all intertwined and it’s corrupt.”


7. 6to5against - November 6, 2016

They’re all good reasons to oppose her politically, CL. As is her US centre right, pro-wall St political agenda. But she was the object of real hatred from the early 90s, before any of that had happened. That’s the level of bile I’m talking about.

I see plenty about Clinton that I dislike, but I still hope she wins on Tuesday. Trump is worse.


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