http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/the-big-question-can-it-ever-be-right-for-the-nhs-to-reject-drugs-that-could-extend-life-888232.html

The Big Question: Can it ever be right for the NHS to reject drugs that could extend life?

By Jeremy Laurance, Health Editor
Friday, 8 August 2008

Why are we asking this now?

Cancer charities, kidney specialists and campaigners were outraged yesterday when the National Institute for Clinical Excellence (Nice), announced that it had rejected four new drugs for advanced kidney cancer as too expensive for the NHS. In draft guidance, the medicines watchdog said that the drugs can extend life by five to six months on average but they cost too much. The money would do more good if it were spent elsewhere in the NHS, it said.

Surely the NHS should provide these drugs?

Of course they should. There are 3,600 patients with advanced kidney cancer in the UK who might benefit from the drugs and who will now – if the draft guidance is confirmed – be left with only one option, interferon, to which many do not respond. Kidney specialists will be forced to turn away patients and families will be left without hope. Most people will instinctively feel it is inhumane to deny a clinically effective drug to terminally ill cancer patients which could give them even a few months extra of good quality life.

So why wouldn't Nice give the go-ahead?

Because, it said, the drugs were not "cost-effective". Nice does itself no favours by using the language of accountancy and business, which is likely to increase the public perception of it as an inhumane organisation. But it is difficult to see what other words it could have employed. The reality is that the cost of drugs – as of any treatment – cannot be ignored. If we did so, we would quickly find the country's entire Gross Domestic Product (GDP) spent on health. With a limited healthcare budget, the NHS, like public health systems around the world, has to decide what it can afford. A couple of decades ago it was called "rationing", but that was just as unpopular.

What do the drugs cost?

Between £20,000 and £35,000 per patient per year. But that is only half the story. We also need to know how much benefit they bring. Nice uses a complex formula to assess cost effectiveness based on the degree to which a drug extends life and improves its quality, known as a Quality Adjusted Life Year (Qualy). Broadly, it approves drugs with a cost per Qualy of less than £20,000 and rejects those above £30,000 (though there are exceptions). Between the two figures it accepts some and rejects others.

The cost per Qualy of the drugs for kidney cancer – Sutent (sunitinib), Avastin (bevacizumab), Nexavar (sorafenib) and Torisel (temsirolimus) – is a matter of dispute. According to the manufacturers it ranges from £28,500 to £90,600 but according to independent academics, who assessed the evidence for Nice, it is £71,500 to £171,300. That is a big gap and it is difficult to understand why it should be so large

Why are the drugs so expensive?

This is the question that dare not speak its name. It is incomprehensible that the manufacturers of the four drugs have so far escaped criticism. They are charging astronomical prices for drugs that offer little benefit – in effect, holding a gun to the heads of kidney cancer sufferers and saying to the NHS: "Give us the money or we shoot." Yet, not a single critic yesterday – from James Whale, the TV presenter who had kidney cancer and set up a charity for patients, to Cancer Research UK – had a word to say against the drug companies. Instead they turned their ire on Nice. Many charities are dependent on the drug companies for funding.

Are these sums too much to pay for an extra year of life?

Not if you have it to spare. But it is the ethical duty of any public health system to spend the available cash to get the best results for patients. Every pound spent on a patient for a less effective treatment is a pound denied to another patient for a more effective treatment. Drug spending has risen sharply and although many drugs save NHS money – by reducing the need for hospital treatment – others offer only marginal gains. Some experts believe this is the case with many of the new cancer drugs – whose costs are measured in the tens of thousands but which add only a few months to life.

Could the makers winNice approval?

Yes – by reducing their prices. They argue that they must recoup heavy research costs and that means high prices. But if the drugs are not approved they sell nothing (to the NHS). The real reason they are holding the NHS to ransom is because approval from Nice has a major influence in the global market. Nice has established an international reputation as an arbiter of cost effectiveness and health systems around the world, faced with similar cost pressures, are beating a path to its door.

Are these drugs available on the Continent?

Yes, and as a result Britain is frequently portrayed as the sick man of Europe. Cancer specialists complain that they are treated as the poor relations when they attend international conferences because they cannot prescribe the drugs. It is this that is fuelling criticism of Nice as a penny pinching bureaucracy. But other countries lack any means of systematically assessing drugs, and are feeling the cost pressures as a result. Increasingly they are moving to follow Nice's lead.

Aren't there treatments we should cut before cancer drugs?

Perhaps. Cosmetic surgery, varicose veins, fertility treatment are the usual examples trotted out in every debate about NHS rationing in the last 20 years. But the savings would be imperceptible – in the context of a £90bn NHS these represent the loose change. There is no avoiding tough decisions about what the NHS can and cannot afford – and the Nice approach is the least bad way of facing them.

Is there any hope on the horizon?

Yes. The drug industry is experimenting with the Department of Health on new ways of funding, which tie the prices charged for drugs to the results achieved. In addition, Sir Michael Rawlins, chairman of Nice, has suggested the existing Nice threshold of £20,000 to £30,000 per Qualy should be raised. Both moves could help patients get access to new drugs.

So did Nice do the wrong thing?

Yes...

* Patients in need of these drugs have few other options available to them

* Expensive or not, other European countries find the funds to provide the drugs

* It is inhumane to deny anyone the chance of living longer, even if the drug is not a cure

No...

* They are too expensive for the benefit they deliver, which is not ultimately life-saving

* This is a zero-sum game: a pound spent on one patient is a pound denied to another

* It is unrealistic to expect every drug to be approved: the NHS budget is not unlimited

http://www.alternet.org/healthwellness/83224/?page=entire

Just How Secure Is Your Employer-Based Health Insurance?

By Maggie Mahar, Health Beat. Posted April 23, 2008.

Last week, the Economic Policy Institute released a disturbing report revealing just how many white-collar workers have lost their employer-based health insurance in recent years -- even though they didn't change jobs.

Many workers believe that if they hold onto their job, their insurance is safe. Professionals with jobs near the top of the occupational ladder are especially likely to assume that their employer is not going to cut their coverage. That may well have been true in the 1990s, when the job market was tight -- but not today.

The EPI report shows that in just the first six years of this century, the share of U.S. workers with employer-provided health insurance (EPHI) fell from 51.1 percent to 48.8 percent. Moreover, workers in white-collar occupations -- including executives, managers and workers in professional specialties -- were just as likely as blue-collar workers to lose their safety net.

Perhaps this shouldn't come as a surprise, since employers typically pay a much larger share of premiums for higher-income employees. So as insurance premiums soar (up 78 percent since 2001), employers are beginning to chafe under the very costly burden of providing first-class benefits to white-collar employees. (Insurance premiums rose "only" 6.1 percent in 2007, but going forward, experts expect sharper increases because the cost of medical technology continues to skyrocket).

Most employers will just shift more costs to employees in the form of higher co-pays and deductibles. But some will decide that they cannot continue to offer insurance.

"No one is immune to the slow unraveling of the employer-based health insurance system," warns Heidi Shierholz, EPI economist and co-author, with Jared Bernstein, of the report "A Decade of Decline: The Erosion of Employer-Provided Health Care in the United States and California, 1995-2006."

"This dramatic loss of employer-provided health insurance since 2000 is not simply driven by the loss of high-quality jobs, such as those in the manufacturing sector," the report observes. "Rather, it is caused by the significant decline in employers providing coverage within existing jobs across the board. The burden of these employer cuts is not carried by part-time or marginal workers. Rather, the most dramatic loss is among workers with the strongest connection to the labor force."

Note, for example, the startling declines, from 2000 to 2006, in the share of workers covered by EPHI as shown in the bottom half of the table below (click for larger version). At the top of the job ladder, in the first three occupations listed, the percentage of executives, professionals and technicians with employer-based coverage fell by over 3 percent to 5.6 percent.

The top half of the table below shows what percentage of workers are employed in various occupations; the bottom half reveals what percentage in each occupation have employer-provided health insurance.

Drilling a little deeper, the bottom half of the table below tells you more about the people who lost their insurance. For example, from 1995 to 2006, workers with a college degree were just as likely to lose their EPHI as those who didn't have a degree. Meanwhile, from 2000-2006 the share of 45- to 54-year-old workers with EPHI -- which includes many people who are most likely to need health care -- fell by a fat 4 percent. (The small dip in the share of those over 55 with employer-based insurance is due to the fact that many people in this age group retire or partially retire, the report explains).

"EPHI is disappearing across the entire age and education spectrum, including prime-age workers and those with college degrees," the report's authors note. "These findings show that health insecurity is now a broadly shared American experience.

"As a consequence," they say, "the solution requires a broadly shared approach. The erosion of the employer-based system, with losses accumulating in even high-end sectors, along with the critical need to control healthcare costs, indicates that the provision of coverage needs to be at least partly 'taken out of the market.'"

As employers back out of the benefits business, individuals who try to get insurance on their own will discover just how expensive it is. Rates vary by state, but family coverage in a state like Virginia can cost as much as $24,000 a year.

This is why, in the very near future, "we will need 'universal programs 'that pool risk across large populations," Bernstein and Shierholz advise. Anyone who doesn't have EPHI (or doesn't like/cannot afford the EPHI that they have) could join these groups. In addition, if universal insurance is going to cover everyone at an affordable price -- even if they are sick -- the authors conclude that we will have to "mandate coverage, with subsidies for those unable to meet the mandate."

Although an individual mandate requiring that everyone join an insurance pool is not a popular concept, the report's authors are correct. Note that they are economists -- not politicians. And while economists can be dreary, the nice thing is that they are not worried about whether you will vote for them. And therefore, rather than telling people what they want to hear, they tend to address the reality of the numbers. Even better, these are excellent economists (I know Bernstein). So, not only are they confronting the numbers, they truly understand the numbers.

Unless a mandate requires that everyone have insurance, some young, healthy people would wait until they became sick to join a pool, expecting people who had been paying premiums into that program for years to now cover them. If that happened, ultimately only the sick and the elderly would buy insurance -- and prices would levitate to a point that virtually no one could afford it. If we are going to have a mandate, however, we have to provide adequate subsidies on a sliding scale for those who cannot afford the coverage.

How do we do that? This brings me back to the "basics" of healthcare spending, a series that I've been doing over the past few months, showing where our healthcare dollars are going -- and where we might pare waste, while pushing back against healthcare manufacturers who are gouging America.

http://www.alternet.org/healthwellness/79281/?page=entire

The Failed Health Care Reform Plan of 2009

By Vicente Navarro, CounterPunch. Posted March 14, 2008.

A major problem -- if not the major problem -- for many people living in the U.S. is the difficulty of accessing and paying for medical care when they are sick. For this reason, candidates in the presidential primaries of 2008 -- the Democrats more often than the Republicans -- have been recounting stories about the health-related tragedies they have encountered in meetings with ordinary people around the country (an exercise conducted in the U.S. every four years, at presidential election time). These stories tell of the enormous difficulties and suffering faced by many people in their attempts to get the medical care they need. I have been around long enough -- I was senior health advisor to Jesse Jackson in the Democratic primaries of 1984 and 1988 -- to know how frequently Democratic candidates, over the years, have referred to such cases. The only things that change are the names and faces in these human tragedies. Otherwise, the stories, year after year, are almost the same.

In the Democratic Party primaries of 1988, for example, candidate Michael Dukakis talked about a young single mother who had two jobs and still could not afford medical insurance for herself and her children. In 1992, Bill Clinton did the same, changing the story only slightly. This time it was the case of a woman with diabetes who could not get health insurance because of her chronic condition. And now, in the 2008 primaries, Hillary Rodham Clinton (whom I worked with on the White House Health Care Reform Task Force in 1993) describes a similar case. This time it is a single woman, with two daughters, who cannot pay her medical bills because her congenital heart defect makes it impossible for her to get medical insurance coverage. And Barack Obama describes similar cases, with the eloquence that characterizes all of his speeches. He frequently refers to his own mother, who had cancer and had to worry not only about her illness but about paying her medical bills.

All these cases are tragic and are representative of a situation faced by millions of people in the U.S. every year. But, I am afraid that unless the winning Democratic candidate, once elected president (and I hope he or she will be), develops a more comprehensive health care proposal than any of those put forward in the primaries so far, we will see the same situation continue. Democratic candidates in the 2012 primaries, and in the 2016 primaries, will still be referring to single mothers with chronic health conditions who cannot pay their medical bills. The proposals put forward by Obama and Clinton underestimate the gravity of the problem in the U.S. medical care sector. The situation is bad and is getting worse: the number of people who are uninsured and underinsured has been growing since 1978.

Let's start with the uninsured, those people who do not have any form of health benefits coverage. There were 21 million uninsured people in the U.S. in 1972. By 2006, that number had more than doubled to 47 million. And this increase has been independent of economic cycles. The number of uninsured grew by 3.4 million from 2004 to 2006, even as a resurgent economy raised incomes and lowered poverty rates. Meanwhile, during those years, the Democratic Party establishment distanced itself from any commitment to resolving these problems. Even though the 1976, 1980, 1984, 1988, and 1992 Democratic Party platforms included calls for health care benefits coverage for everyone (what is usually referred to as "universal health care"), that call was usually made without much conviction. In the primaries of 1988, when I was involved in preparing the Democratic platform, Dukakis (the winner of the primaries) resisted including universal health care in the party platform. He was afraid of being perceived as "too radical." He had to accept it, however, because Jesse Jackson agreed to support Dukakis (Jackson had 40 percent of the Democratic delegates at the Atlanta convention) only if the platform included this call for universal care.

Then, in 1992, Bill Clinton (who borrowed extensively from Jackson's 1988 proposals) put the call for universal health care at the center of his program. But, once president, his closeness to Wall Street and his intellectual dependence on Robert Rubin of Wall Street (who became his Secretary of the Treasury) made him leery of antagonizing the insurance industry. It was President Clinton's unwillingness to confront the insurance companies that led to his failure to honor his commitment to work toward a universal health care program (see my article "Why HillaryCare Failed," Counterpunch, November 12, 2007). The type of reform President Clinton called for was a health insurance based model called "managed care," in which insurance companies remain at the center of health care. An alternative approach could have been to establish a publicly funded health care program (which was favored by the majority of the population) that would cover everyone, providing medical care as an entitlement for all citizens and residents. This could have been achieved, such as by expanding the federal Medicare program to cover everyone. To do so, however, would have required neutralizing the enormous power of the insurance companies with a massive mobilization of the population against them and in favor of a comprehensive and universal health care program.

But President Clinton's loyalty to Wall Street prevailed. His administration's top priorities were reduction of the federal deficit (at the cost of reduced public social expenditures) and approval of NAFTA (without amending President George H. W. Bush's proposal, which Clinton had inherited, and refusing to address the concerns of the labor and environmental movements). These actions antagonized and demoralized the grassroots of the Democratic Party. Clinton lost any power to mobilize people for the establishment of a universal health care program. This frustration of the grassroots, and especially the working class, also led to the huge abstention by the Democratic Party base in the 1994 congressional elections and the consequent loss of the Democratic majority in the House, the Senate, and many state legislatures. At the root of this disenchantment with the Clinton administration was its unwillingness to confront the insurance companies and Wall Street. Could that happen again?

The health care mess (Nixon dixit)

Before addressing this question, let's look at the problems people face in the U.S. But first, I should stress that the country has sufficient resources to provide comprehensive, high-quality medical care to everyone who needs it. The U.S. spends 16 percent of its GNP on medical care, almost double the percentage spent by Canada and most countries of the European Union (E.U.) on providing universal, comprehensive health care coverage to their populations. We in the U.S. spend $2.1 trillion on medical care, making the medical care sector one of the largest economies in the world (if the medical care sector were a country, rather than a massive sector within a country). And it has been estimated that this spending will reach 20 percent of GNP in a few years (7 years according to some, 12 years according to others). Lack of money is not the root of the medical care problem in the U.S. We spend far, far more than any other developed country, and far more than what we would need to provide comprehensive health care coverage for everyone. The frequently heard argument that the U.S. cannot afford universal, comprehensive care has no credibility. It is a poor rationale for keeping the situation as it is.

Despite the huge amount of money spent on medical care, the situation of the U.S. medical care sector is a disgrace. Even Richard Nixon, in an unguarded moment, defined it as a mess. And as noted above, it has gotten much worse since Nixon was president: in 2006, 47 million Americans did not have any form of health benefits coverage, and 108 million had insufficient coverage. And people die because of this. Estimates of the number of preventable deaths vary, from 18,000 per year (estimated by the conservative Institute of Medicine) to a more realistic level of more than 100,000 (calculated by Professor David Himmelstein of Harvard University). The number depends on how one defines "preventable deaths." But even the conservative figure of 18,000 deaths per year is six times the number of people killed in the World Trade Center on 9/11. That event outraged people (as it should), but the deaths resulting from lack of health care seem to go unnoticed; these deaths are not reported on the front pages, or even on the back pages, of the New York Times, Washington Post, Los Angeles Times, or any other U.S. newspaper. These deaths are so much a part of our reality that they are not news. How can this be tolerated in a country that claims to be a civilized nation?

The Democratic candidates' proposals

The proposals put forward by the current Democratic candidates for president, Barack Obama and Hillary Clinton, will improve the situation. They will diminish somewhat the number of those not covered by health insurance and will reduce the level of undercoverage. But the major problems will remain unresolved, including the problems the candidates have referred to during their campaigns. People will still experience incomplete coverage, and many millions will continue to be uninsured and underinsured. Not even the mandatory health insurance called for by Hillary Clinton will resolve these problems. Her plan proposes that, just as a car driver in the U.S. must have car insurance, so a citizen or resident will have to have health insurance. The problem with this mandate is not only -- as Obama has pointed out -- the matter of enforcement (note that according to some estimates, up to 20 percent of car owners drive without car insurance), but the assumption behind the policy. The assumption is that most people who are not insured are "free-riders," people who could afford to buy insurance but choose not to, and choose to let someone else pay for their care when they get sick. But the vast majority of people who are uninsured are people who cannot afford to pay for it. It's as simple as that. Massachusetts passed a mandate of this sort (under Governor Mitt Romney), but 198,000 people still remain uninsured. The subsidies and tax incentives proposed to help the uninsured pay for health insurance premiums under plans of this type are insufficient.

Another proposed mandate (put forward by Clinton more strongly than by Obama) is that all employers must provide insurance coverage to their employees -- a policy proposed by President Nixon back in the 1970s. But with this proposal, unless you force employers to provide comprehensive coverage at an affordable cost to everyone, the problem will still not be resolved. An even greater problem with the employer mandate, however, is that it continues to tie health benefits to employment, which is a perverse system and a nasty one. The reason employers, in 1948, pushed to make health care benefits dependent on employment (in the nefarious Taft-Hartley Act) was that this was a way of controlling workers. The Taft-Hartley Act forced the labor force to get health care benefits through collective bargaining agreements that are highly decentralized and are negotiated at the place of employment. In the U.S., workers who lose their jobs lose not only wages, but also health benefits coverage for themselves and their family. And if these workers want to keep their insurance, they have to pay prohibitive premiums. So, a worker will think twice before striking. This is one reason why the U.S. has fewer working days lost to strikes than other developed countries. Until recently, employers have been the major force -- besides the insurance companies -- for keeping the current system of funding and managing health care. This system, then, is based on an alliance between employers and the insurance industry.

It is this alliance that is responsible for the biggest problem of health care benefits: undercoverage. Most people believe that because they have health insurance, they will never face the problem of being unable to pay their medical bills. They eventually find out the truth -- that their insurance is dramatically insufficient. Even for families with the best health benefits coverage available, the benefits are much less comprehensive than those provided as entitlements in Canada and in most E.U. countries. And paying medical bills in the U.S. is a serious difficulty for many people. In fact, inability to pay medical bills is the primary cause of family bankruptcy, and most of these families have insurance. Furthermore, 20 percent of families spend more than 10 percent of their disposable income on insurance and medical bills (the percentage is even higher for those with individual insurance: 53 percent). In 2006, one of every four Americans lived in families that had problems in paying medical bills. And most of them had health insurance.

The inhumanity of this situation is made evident by the fact that nearly 40 percent of people in the U.S. who are dying because of terminal illness are worrying about paying for care -- how their families are going to pay the medical bills, now and after they die. No other developed country comes close to these levels of insensitivity and inhumanity. Meanwhile, the federal government parades around the world as the great defender of human rights, ignoring the fact that among the developed democratic nations, the U.S. is the most deficient in human rights. The basic right of access to health care in time of need does not exist in the U.S. The United Nations Human Rights Declaration includes this right in a prominent position, but this is a declaration that the U.S. Congress has never signed. It should come as no surprise that the world's people do not believe the U.S. government is a great defender of human rights abroad, since it does not guarantee even basic rights at home.

And here again, things are getting worse. The percentage of uninsured and underinsured has been increasing. The proportion of people with employer-based health benefits coverage declined from 67.8 percent among the non-elderly in 2000 to 63 percent in 2006 -- even though the economy was booming during those years. In the same period, the number of adults without coverage increased by 8.7 million, and from 2004 to 2006 the number of children without coverage increased by 1 million.

Why does this situation persist in the U.S.?

For any society, medicine is a mirror of the power relations in that society. And nowhere is the lack of human rights more evident than in the house of medicine. In the U.S., insensitivity toward human needs goes hand-in-hand with enormous profits made from that suffering. The root of the problem, as noted earlier, is not lack of money but the channels through which that money is managed and spent. The problem is the privatization of the funding of medicine that allows profits to boom. The insurance and pharmaceutical industries enjoy the highest rates of profit in the U.S. Just last year, insurance industry profits reached $12 billion, and pharmaceutical industry profits $49 billion, the highest in the U.S. and in the world. According to Fortune Magazine, health-related industries are among the most profitable industries in the country. A lot of money is being made from people's suffering. This scandalous situation is easy to document. For example, lanzoprasol, a gastric secretion?reducing medicine widely used in the U.S., costs $329 in Baltimore, U.S.A.; the same medicine (same number of doses) costs $9 in Barcelona, Spain! And the current Bush administration signed legislation for a program that, in theory, covers drug costs for elderly people, but in practice this is an enormous rip-off. It forbids the government to negotiate with the drug industry on the cost of drugs -- that is, the price of their products. What this means is that the federal government pays the prices dictated by pharmaceutical companies.

Now, one might well ask, Why does this continue? Why hasn't our government done something about it? Is it that the government could not provide comprehensive health benefits coverage? It certainly could. All E.U. governments do so. All provide publicly funded, comprehensive health care coverage to their entire population. And on this side of the Atlantic, Canada (which once had a system identical to ours, health insurers included) also provides this entitlement to all its citizens. In Canada in the 1960s, a social democratic government in Saskatchewan did a very logical thing. My good friend, Dr. Samuel Wolfe, who was then Chief Health Officer of Saskatchewan, proposed to the province's social democratic government that rather than paying premiums to insurance companies, people would pay earmarked taxes to a public trust fund, controlled by their representatives. This trust fund would negotiate with doctors and hospitals for the payments they would receive for the care they provided. This saved a lot of money by bypassing the insurance companies. The Saskatchewan Health Plan provided comprehensive care to everyone in the province at a much lower cost than before. Soon, the other provinces adopted similar plans, establishing Canada's nationwide health plan that now covers everyone. The overhead for the public system in Canada is only 4 percent, compared with 30 percent in the U.S. insurance industry -- 30 percent that goes to marketing, administration (a lot of paper shuffling goes on in U.S. health care), and the salaries of extremely well-paid executives and insurance lobbyists. One of the best-paid individuals in this country is William McGuire, CEO of an insurance company -- United. He makes $37 million a year, plus $1.7 billion in stock options. And all of this money comes from premiums paid by people, many of whom have insufficient coverage.

The insurance companies have enormous power, both in Washington and in most state legislatures. In Maryland, for example, a former governor arranged for candidates for Insurance Commissioner to be interviewed by the insurance associations before he made his final selection. But, insurance industry influence is strongest in Washington. In the U.S., money is the milk of politics. The electoral process is also privatized. And the insurance companies pay a lot of money to candidates. According to the Center for Responsive Politics, the insurance industry has contributed $525,188 to Hillary Clinton, $414,863 to Barack Obama, and $274,724 to John McCain. As a consequence, not one of the candidates is asking for a publicly funded system. The major players in medical care in the U.S. -- insurance companies, drug companies, professional associations, etc. (the list is long) -- have given a lot of money to the candidates. The splendid document called the U.S. Constitution, which begins "We the people " should have a footnote "and the insurance companies, the drug companies, " The U.S. Congress is indeed the best Congress money can buy (for a further discussion of how money corrupts the electoral system, see my article "How to Read the U.S. Primaries: Guide for Europeans," Counterpunch, February 13, 2008). The privatization of the electoral process (with most of the money that pays for campaigns coming from economic, financial, and professional interests, and from 30 percent of the nation's highest-income earners) corrupts the democratic process. I am not implying that politicians are corrupt (although some are). I am willing to admit that most are honorable persons. But the need to constantly raise funds for their campaigns (election and re-election) corrupts the democratic system. And the unwillingness of most members of Congress to change this situation makes them accomplices in that corruption. Such practices are illegal in most democratic countries.

And people know all about this. In surveys, 68 percent of people believe the U.S. Congress does not represent their interests, but the interests of the financial and economic groups that fund political campaigns. But the establishments, including the political, media, and academic establishments, want everyone to believe that the reason we don't have a universal health program is that people don't want it. They would like people to believe that Congress legislates what people actually want. Meanwhile, the long list of public policies that people want but do not get from their government is growing: 65 percent of people want a publicly funded health care system similar to that in Canada, a system that in academic language is called single-payer. In a single-payer system, the government, rather than the insurance companies, negotiates with providers -- doctors, hospitals, nurses, etc. -- for the provision of medical care. We already have a system of this type in Medicare (with an administrative overhead of only 4 percent, compared with the 30 percent in the insurance system). By eliminating the huge administrative expenses, we could provide comprehensive health care coverage for everyone without spending an extra penny.

The possibilities for major change

Obama and Clinton are ready to admit that single-payer may be better than any other alternatives. Obama spoke out in favor of it at one time:

"So the challenge is, how do we get federal government to take care of this business? I happen to be a proponent of a single payer health care program. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody. And that's what Jim is talking about when he says everybody in, nobody out."

"A single payer health care plan, a universal health care plan. And that's what I'd like to see. And as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, we have to take back the House." (Barack Obama in 2003 before the Illinois AFL-CIO)

But, something happened on the way to Washington. The train derailed. Now Obama claims that his declaration was taken out of context. And Hillary Clinton, in 1993, told me that while single-payer might be the most logical model, it was politically infeasible.

I hope both candidates will reconsider. At this time, neither candidate's proposal will resolve the health care crisis we are facing. And in 2012, candidates will still be talking about single mothers who cannot pay for medical care for themselves or their children. The candidates of 2008 should be asking for government mandates rather than individual mandates. It is not people who should be mandated to get insurance. It is the government that should be mandated to provide insurance for everyone as an entitlement.

The need to mobilize

Obama has been able to capitalize on the anti-establishment mood in the country. And he has inspired many. While I believe that large numbers of people -- the grassroots of the Democratic Party who support him -- do want change and are firmly anti-establishment, I am concerned that they are putting too much faith in one individual. Without diminishing what candidate Obama has achieved, the fact is that he has already shown himself to be adaptable to the political context. He was once against the war in Iraq. But, in Congress, his votes on Iraq have been indistinguishable from those of Hillary Clinton. And in health care, his rather disappointing proposal will not resolve the problems. I am very worried that once in power, he will not have the courage to confront the extremely powerful lobbies primarily responsible for the lack of health care coverage and the undercoverage of the American people. It happened with Bill Clinton's administration and it may happen again. Contrary to what Obama and others have said, the main problem with Hillary Clinton's Task Force in 1993 was not its secrecy (although secrecy was indeed a problem) but a conceptual framework based on an insurance model -- managed care -- that was pushed on the political, media, and academic establishments by the insurance companies. The ideologues of managed care were clearly in charge of the Task Force. It could happen again.

To prevent this, there is a need to mobilize. History is not made by extraordinary figures but by ordinary people who can move mountains when they believe in a cause and get organized. It has happened all over the world, and it has happened in the U.S. We saw it in the establishment of the New Deal, Social Security, unemployment insurance, job creation, minimum wage, and subsidized housing, among other programs. These were not just the outcome of President Roosevelt's position, but the result of huge social agitation and mobilization. As usually happens in historical moments of societal change, government leaders were not so much leading as trying to catch up with what millions of people were demanding. Similarly, the Great Society Programs -- Medicare, Medicaid, Environmental Protection Agency, NIOSH, OSHA, and many other examples of progressive legislation -- were the outcome of massive mobilizations. Candidate John Kennedy's proposals for change were rather moderate, and his domestic policies, once he was elected, were also disappointing. But the mobilization triggered by his election was followed by many more, such as Appalachian coal miners' strikes against their working conditions, the splendid civil rights movement led by Martin Luther King, and the ant Vietnam War movement led by student groups. They all established a political climate in which progressive legislation could occur. History, indeed, does not repeat itself. But it offers us pointers on where to go. And it should be obvious that change will not occur unless there is a huge mobilization to complete the unfinished agenda of civil rights: a full development of social rights, with the human right to access to health care at the center.

To achieve that right, we need reforms more substantial than those put forth by either Democratic candidate. The splendid slogan first used by the great trade union leader Cesar Chavez, founder of the United Farm Workers of America, was Yes, We Can! This should guide the call for establishing the right to health care. But, for that to happen, the current holders of the slogan must heighten their expectations and become more ambitious in their proposals. This is what the electorate expects from them in their promises of change.

See more stories tagged with: health care, health care reform, single-payer, medicare, american health care

Dr. Vicente Navarro is Professor of Health Policy, Public Policy, and Policy Studies at the Johns Hopkins University. He has written extensively on economics, health, and social policy, and has been advisor to many governments and international agencies. The views expressed in this article are his own, but are shared by millions across the United States.

http://edition.cnn.com/2008/POLITICS/03/18/candidate.poll/

Poll: McCain, Obama, Clinton in dead heat in election matchup

(CNN) -- Barack Obama and Hillary Clinton would both statistically tie Republican John McCain in a general election matchup, a new CNN/Opinion Research Corporation poll indicates.

According to the poll released Tuesday morning, both Obama and Clinton are locked in a dead heat with the Arizona senator.

If Obama were to win the nomination, he would get 47 percent of the vote compared to 46 percent for McCain -- a statistical tie given the poll's 3 percentage point margin of error. Should Clinton win the nomination, the poll suggests she would get 49 percent compared to McCain's 47 percent -- another statistical tie.

While Clinton and Obama match up equally with McCain, CNN Polling Director Keating Holland notes the two Democrats appear to be drawing support from different groups of voters.

"Clinton appears to do a little bit better than Obama among older voters, women, and self-identified Democrats against McCain; Obama's numbers may be slightly better among younger voters and those who describe themselves as Republicans and Independents," Holland said.

The poll also shows all three presidential candidates get high marks from voters on the issue of the economy -- roughly two-thirds of those surveyed say each of the candidates would do a good job handling the issue. This appears to be good news for McCain, given that the incumbent president's party is often blamed for economic woes.

"The fact that McCain is currently holding his own on the economy with the two Democratic candidates does help to explain why the general election matchups are so close even though most Americans think the country is in a recession," Holland said.

McCain is also aided by his strength on the terrorism issue. Roughly three-quarters of all Americans think McCain would do a good job fighting terror while Obama and Clinton score significantly lower -- although a majority of those polled think either Democrat would do a good job.

But Obama and Clinton both get higher points than McCain on handling health care. More than two-thirds say the two Democrats would handle that issue well, while 57 percent who say the same for McCain. And nearly 1 in 5 voters say that the nation's health care system is their top concern -- almost twice as many as the 10 percent that cite terrorism.

I created the above group as a result of this post and this post. In the former I questioned why single payer health care was not the defining issue in the 2008 U.S. election. Some Voxers, including Henesua, replied with their reasons as to why they thought this was so. In the second post, Kirk posted on the tired state of the Right in the U.S. today. Several Voxers commented, and one comment from Patricia Velonakis Davis regarding the divisiveness of politics seemed to resonate with my thoughts on Universal Health Care, (UHC). If there is one issue that may unite people across the political spectrum, it is this.

Yes, I know as soon as the issue is raised, some will retreat to their preconceived notions about "socialised medicine" and so on. But I think that the mainstream, who really only want to see affordable, accessible health care, would be keen to investigate the possibilities. I can only speak of the Australian Universal Health Care system, Medicare, with which I am familiar. Anyone expecting a system without any problems need read no further. In common with all health systems Medicare has its problems. The newly elected Federal Government together with the states is addressing those problems.

That said, Medicare does have some very real pluses which I would like to outline. Anyone who wishes to delve further into Medicare may do so here. I should point out that the U.H.C. system Australians enjoy provides for both Public and Private health care.

Every Australian is entitled to "free" health care. That is, every Australian can choose their own private doctor. Any consultation will either incur no charge, or a partial charge subsidised by Medicare. If necessary, that doctor can prescribe medication which can be obtained at a private pharmacy. There is NO consultation with any health fund as to whether the medication can be prescribed. This is purely a matter for the doctor to decide. When the prescription is filled, there will be maximum charge of $30 if the medication is on the Government Pharmaceutical Benefits list. If not, the patient will pay full price. Most of this can be recovered if the patient cares to take out "Extras" private health insurance.

Any Australian is also entitled to "free" hospitalisation at any public hospital, where there is no charge for all treatment including Xrays, CAT scans, MRI scans, or medication. If they so choose, they can take out Government subsidised Private Health Insurance which will cover their stay in a private Hospital. I have Private Top Hospital and Extras cover which costs me $220 a month for my wife and myself. If you want to know what this covers you can find out here.

So, is the system really free? No, of course not. It is paid for through taxes and the Medicare levy.  Is there any chance of anyone being bankrupted through medical bills? No. Is that all there is?  No. There is much more, but that is enough for now to give anyone interested in UHC an overview of how it works in Australia.

So, where to from now? This group was created as a meeting place for those interested in advocating UHC in their own countries, including the U.S. If you wish to join the group, you can do so here. The group is public. I look forward to answering any questions that I can answer, and any future discussion. 

Michael Moore and Oprah Ask Audience: Why Should US Health Care Be for Profit?

http://www.alternet.org/blogs/video/63935/

As one living in a country with Universal Health Care, I find some of the soul searching questions being asked about Americans' attitude to Government to be quite illuminating. It will be interesting to observe the fight unfolding between the good of corporate America v the public good. Democrat politicians accepting corporate Health Fund donations, who are also appealing for the votes of the masses, will be walking quite a tightrope. I think this could be the defining issue in the U.S. elections. And maybe a defining moment in U.S. values.

I try to restrict my political comment on this blog to issues that are relevant to my country, However, some issues, such as the invasion of Iraq, are intertwined with U.S. politics, so I engage in vigorous debates with those U.S. Voxers with whom I can do so in an atmosphere of mutual respect. Other U.S. issues, such as immigration, are none of my business, so I look on. So it is with some hesitation that I comment on an issue such as the U.S. Health Care system. This was prompted by watching this. I would think the debate will hot up as the U.S. elections get closer. As I watch the debate unfolding, I am rather bemused by some of the claims that are made by opponents of "socialised medicine". So, I offer the following observations from someone who has lived under such a system for 30 years. I can tell you that any government that tried to get rid of it in Australia could expect to spend a long, long, time in the political wilderness. That's assuming there was anyone left after the lynching....

I really can't get my head around the fact that if you can't afford health insurance in the U.S., you just don't have access to medical treatment. Or, even if you can afford it, your Health Insurance provider can deny you treatment that your doctor prescribes. At least, that's how it appears to me from watching Michael Moore's "Sicko" here.  Such a concept is completely foreign to Australians. Here, if you are sick, you go to a doctor. If he prescribes drugs, you have your prescription filled at a pharmacy, without reference to anyone else as to whether it is permitted. Need is the only criteria. The cost of most drugs is government subsidised, so that they will not cost in excess of $30. If you need to be hospitalised, you go to hospital. If you need drugs, surgery, CAT scans, MRI scans, etc, you get them. And, in the public system, this costs you nothing, Does the system have problems? Yes, it does, mainly with waiting lists for elective surgery, but it is true to say that there are other problems. But the point is, that no-one is denied medical treatment. It is Universal Health Care.

If you want to avoid the problems in the public system, you can take out Private Health Insurance. The Federal Government encourages people to do this by subsidising the premiums. This ranges from 30% to 40%. At my age it is advisable to have Top Cover. You can check it out here. This costs me $219 a month, and allows me to use Private Hospital facilities if I so choose.

If you've read this far, you may care to read the thoughts of an expat American now living in Australia, here, here, and here. I hope this information is of use to anyone in the U.S. seeking information on socialised medicine. I think you'll find that there is much to like.