Re: [PEN-L] walter reed, privatization, and public health care
Here's a comment from a good friend in Canada, quite active in healthcare struggles./m From: Colleen Fuller [EMAIL PROTECTED] To: 'michael a. lebowitz' [EMAIL PROTECTED] Subj: RE: Re: [PEN-L] walter reed, privatization, and public health Interesting discussion. I tend to agree with the last fellow who said that there does seem to be evidence that having government act as health insurer rather than primary direct employer of medial labor weakens (but does not eliminate) its ability to cut funds for its healthcare system. Single payer systems are insurance-based. The main difference between public and private insurance is that public insurance operates on a non-profit basis and the risk is spread among a larger population which pays taxes instead of premiums. Public insurance is not usually burdened with deductibles and co-pays, so such systems are better able to embrace the principle of universality. However, health insurance systems as a whole are less efficient than publicly-funded models. The main reason Canada has such a system is because physicians aggressively insisted on fee-for-service, something that is difficult to maintain in a publicly-funded system. The Douglas government in Saskatchewan had initially introduced something that resembled the NHS; the compromise with the striking medical profession was a publicly-insured system of medical care. Hospitals were not technically in the insured system -- they were and are publicly-funded institutions mandated to provide insured services. But they aren't reimbursed on an insured service basis like physicians are. By law hospitals are publicly funded and non-profit -- and currently global funding of hospitals is under attack by private providers. In publicly-funded systems, governments are much more than just primary direct employers of medial labour. They are able to play a more effective role in ensuring equitable distribution of health resources across the population, for example. Evidence does suggest that these systems are more efficient because of the more effective use of resources to meet specific public policy objectives. I'm not sure what the last writer means when he says that Sweden and Finland, though decent systems, have worse results than France. OECD data show very little difference in major indicators like infant mortality and life expectancy. Japan and Iceland typically show better results -- and Japan's life expectancy is over 85 years, compared to ~82 years for France and Canada. If, by results, he means health outcomes then Japan's system would be the best by these measures. But health outcomes don't have to do with health systems exclusively. Access to care and medicine is important but so is a roof over your head and the general level of equality and equitable distribution across the economy. That must be one reason that Cuba's population is healthier than many other wealthier countries. It doesn't matter what kind of economic system one is talking about: all health care systems are a reflection of public policy. Even the American one. Colleen Fuller (604) 255-6601 Vancouver, B.C. Michael A. Lebowitz Professor Emeritus Economics Department Simon Fraser University Burnaby, B.C., Canada V5A 1S6 Currently based in Venezuela. NOTE NEW PHONE NUMBERS Can be reached at Residencias Anauco Suites Departamento 601 Parque Central, Zona Postal 1010, Oficina 1 Caracas, Venezuela (58-212) 573-6333, 571-1520, 571-3820 (or hotel cell: 0412-200-7540) fax: (58-212) 573-7724
Re: [PEN-L] walter reed, privatization, and public health care
On 3/25/07, ken hanly [EMAIL PROTECTED] wrote: I don't know why you think that the Canadian system is better than the UK system. WHO ranks Canada as 30 in the world whereas UK is 18. Coverage is far superior in Great Britain. Certainly the system has gone downhill but this is virtually universal in developed capitalist countries. US is certainly bad at 37 (just above Cuba at 39)--although I recall an efficiency ranking that puts Cuba above the US. Indeed the US spends more of GDP on healthcare than almost any other country with meager results: That rating is base on how well the UK does compared to the very limited resources it spends on health. However in terms of actual results according to the U.S. Census International Data Base.: Canadian Infant Mortality Rate 2007: 4.63 per thousand UK Infant Mortality Rate 2007: 5.01 per thousand Canadian Life Expectancy at birth 2007: 80.34 UK Life Expectancy at birth 2007: 78.7 According to the WHO Report you cited: Disability Adjusted Life Expectancy Canada 1999 74 UK1999 73.7 http://www.nao.org.uk/publications/Int_Health_Comp.pdf 2002 Doctors per 1000 -Canada 2.1 UK 1.8 2000 Nurses per 1000 Canada 7.6UK 5.3 Canada had the same beds (3.3) in 1999 as UK in 2000 - though same year comparision shows slight difference in Canada's favor here too. http://www.ijcim.th.org/past_editions/2004V12N3/ijcimv3n1_article8.pdf 1998 1998 Physicians per 1000Beds Per 1000 Canada 2.1 4.7 UK 1.7 4.2 I think you will find Canada has more doctors, nurses and hospital beds per thousand of population as well. UK does amazingly for the money it spends. But in absolute results you are better off with the Canadian health system.
Re: [PEN-L] walter reed, privatization, and public health care
On 3/24/07, ken hanly [EMAIL PROTECTED] wrote: The Canadian system is extremely limited in what it covers. Most dental care is not covered, long term care for the aged. Provinces have add ons but over the last long while the ad-ons are being subtracted or weakened. A good example is the various pharmacare plans in different provinces. Also doctors are now able to bill patients for certain costs. How do Canadians usually pay for things and services that are not covered? Pay out of pocket or buy insurances to cover gaps? -- Yoshie
Re: [PEN-L] walter reed, privatization, and public health care
I don't know why you think that the Canadian system is better than the UK system. WHO ranks Canada as 30 in the world whereas UK is 18. Coverage is far superior in Great Britain. Certainly the system has gone downhill but this is virtually universal in developed capitalist countries. US is certainly bad at 37 (just above Cuba at 39)--although I recall an efficiency ranking that puts Cuba above the US. Indeed the US spends more of GDP on healthcare than almost any other country with meager results: Press Release WHO/44 21 June 2000 WORLD HEALTH ORGANIZATION ASSESSES THE WORLD'S HEALTH SYSTEMS The World Health Organization has carried out the first ever analysis of the worlds health systems. Using five performance indicators to measure health systems in 191 member states, it finds that France provides the best overall health care followed among major countries by Italy, Spain, Oman, Austria and Japan. The findings are published today, 21 June, in The World Health Report 2000 Health systems: Improving performance. The U. S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. The United Kingdom, which spends just six percent of gross domestic product (GDP) on health services, ranks 18th . Several small countries San Marino, Andorra, Malta and Singapore are rated close behind second- placed Italy. The Scandinavian social democratic countries are falling further behind as the capitalist welfare system is eroded more and more: Norway 11, Sweden 23, Finland 31, Denmark 34. To answer Yoshie's question. Canadians pay some out of pocket, some through supplemental insurance at the work place, and some individual insurance. Blue Cross is widely purchased and there are many other plans. I purchase Blue Cross in case I have to use an ambulance which is not covered. Provincial plans vary widely and supplement the overall coverage. --- Gar Lipow [EMAIL PROTECTED] wrote: On 3/24/07, joel blau [EMAIL PROTECTED] wrote: Gar Lipow wrote: Assertion unbacked by evidence - for discussion purposes: Single payer health is better than a National Health Service under capitalism, because a National Health Service is more vulnerable to conservative sabotage. Joe Blau This doesn't sound right to me. When he was finance minister in the mid 1990s, Paul Martin cut the budget for the Canadian single payer system. In England, Thatcher did the same to the National Health Service. Both systems seem equally vulnerable to the vagaries of budgetary politics. What distinction are you making that leads you to believe otherwise? Joel Blau There are two systems that are clearly worse than Canada's. One is the U.S; system, the other the UKs. The UK has gotten away with cutting their National Health to a much lower % of GDP than Canada has. The distinction I'm making is that in a capitalist nation with a weak working class, independent contractors will be able to fight cuts better than employees. Ken Hanley Many European plans are far superior to the Canadian systems. Both National Health Services and single payer systems can be sabotaged where there is the will and political climate that allows it. But most European plans are closer to single payer than to a National Health Service. France, the worlds best health system, is in practice a single payer system. (It is techncially a multiple payer system - but in practice the multiple payers are non-profit administrators for a single government plant, which sets both coverage for patients, and compensation rates for providers.) Sweden and Finland in Europe, and Cuba among the poor nations are counterexamples - well functioning National Health Systems. But Cuba does not have an internal capitalist class, and Sweden and Finland have strong working class movements even though reaction is strong there. Also Sweden and Finland, though decent systems, have worse results than France. I'm not wedded to this hypothesis, but there does seem to be evidence that having government act as health insurer rather than primary direct employer of medial labor weakens (but does not eliminate) its ability to cut funds for its healthcare system. Blog: http://kenthink7.blogspot.com/index.html
Re: [PEN-L] walter reed, privatization, and public health care
On 3/24/07, Leigh Meyers [EMAIL PROTECTED] wrote: When exactly was the 'golden age' of the VA health delivery system? Certainly not right after WWII: Reading back up to the beginning of this thread, I just noticed your remark. I think that the VA system could and did work when the nation was not fighting a big war. The present system was shaped on the assumption of volunteer soldiers going only on occasional peace-keeping missions and the like, the government having failed to adjust the system to the level of casualties that obviously would result from wars like the Iraq and Afghanistan wars. -- Yoshie
Re: [PEN-L] walter reed, privatization, and public health care
Nobody was speaking of a Golden Age. The idea was that under Clinton, the agency got very efficient in some respects, then privatization a flood of soldiers for whom they were not prepared. Some of my students from the 1st Gulf War told me horror stories about the VA under Clinton, though. 1 could not get treatment, even though he needed his wife to carry his book to class. On Sun, Mar 25, 2007 at 05:10:30PM -0400, Yoshie Furuhashi wrote: On 3/24/07, Leigh Meyers [EMAIL PROTECTED] wrote: When exactly was the 'golden age' of the VA health delivery system? Certainly not right after WWII: Reading back up to the beginning of this thread, I just noticed your remark. I think that the VA system could and did work when the nation was not fighting a big war. The present system was shaped on the assumption of volunteer soldiers going only on occasional peace-keeping missions and the like, the government having failed to adjust the system to the level of casualties that obviously would result from wars like the Iraq and Afghanistan wars. -- Yoshie -- Michael Perelman Economics Department California State University Chico, CA 95929 Tel. 530-898-5321 E-Mail michael at ecst.csuchico.edu michaelperelman.wordpress.com
Re: [PEN-L] walter reed, privatization, and public health care
Gar Lipow wrote: Assertion unbacked by evidence - for discussion purposes: Single payer health is better than a National Health Service under capitalism, because a National Health Service is more vulnerable to conservative sabotage. This doesn't sound right to me. When he was finance minister in the mid 1990s, Paul Martin cut the budget for the Canadian single payer system. In England, Thatcher did the same to the National Health Service. Both systems seem equally vulnerable to the vagaries of budgetary politics. What distinction are you making that leads you to believe otherwise? Joel Blau
Re: [PEN-L] walter reed, privatization, and public health care
The Canadian system is extremely limited in what it covers. Most dental care is not covered, long term care for the aged. Provinces have add ons but over the last long while the ad-ons are being subtracted or weakened. A good example is the various pharmacare plans in different provinces. Also doctors are now able to bill patients for certain costs. Many European plans are far superior to the Canadian systems. Both National Health Services and single payer systems can be sabotaged where there is the will and political climate that allows it. --- joel blau [EMAIL PROTECTED] wrote: Gar Lipow wrote: Assertion unbacked by evidence - for discussion purposes: Single payer health is better than a National Health Service under capitalism, because a National Health Service is more vulnerable to conservative sabotage. This doesn't sound right to me. When he was finance minister in the mid 1990s, Paul Martin cut the budget for the Canadian single payer system. In England, Thatcher did the same to the National Health Service. Both systems seem equally vulnerable to the vagaries of budgetary politics. What distinction are you making that leads you to believe otherwise? Joel Blau Blog: http://kenthink7.blogspot.com/index.html
Re: [PEN-L] walter reed, privatization, and public health care
On 3/24/07, joel blau [EMAIL PROTECTED] wrote: Gar Lipow wrote: Assertion unbacked by evidence - for discussion purposes: Single payer health is better than a National Health Service under capitalism, because a National Health Service is more vulnerable to conservative sabotage. Joe Blau This doesn't sound right to me. When he was finance minister in the mid 1990s, Paul Martin cut the budget for the Canadian single payer system. In England, Thatcher did the same to the National Health Service. Both systems seem equally vulnerable to the vagaries of budgetary politics. What distinction are you making that leads you to believe otherwise? Joel Blau There are two systems that are clearly worse than Canada's. One is the U.S; system, the other the UKs. The UK has gotten away with cutting their National Health to a much lower % of GDP than Canada has. The distinction I'm making is that in a capitalist nation with a weak working class, independent contractors will be able to fight cuts better than employees. Ken Hanley Many European plans are far superior to the Canadian systems. Both National Health Services and single payer systems can be sabotaged where there is the will and political climate that allows it. But most European plans are closer to single payer than to a National Health Service. France, the worlds best health system, is in practice a single payer system. (It is techncially a multiple payer system - but in practice the multiple payers are non-profit administrators for a single government plant, which sets both coverage for patients, and compensation rates for providers.) Sweden and Finland in Europe, and Cuba among the poor nations are counterexamples - well functioning National Health Systems. But Cuba does not have an internal capitalist class, and Sweden and Finland have strong working class movements even though reaction is strong there. Also Sweden and Finland, though decent systems, have worse results than France. I'm not wedded to this hypothesis, but there does seem to be evidence that having government act as health insurer rather than primary direct employer of medial labor weakens (but does not eliminate) its ability to cut funds for its healthcare system.
Re: [PEN-L] walter reed, privatization, and public health care
When exactly was the 'golden age' of the VA health delivery system? Certainly not right after WWII: [March 05 2007] Travus T. Hipp Morning News Commentary: It's YOUR Fault - My Experience Hangin' Out At The Presidio In San Francisco At The End Of WWII Showed Me Why We Need A Functional Veterans Administration... And I'm Still Waiting http://www.archive.org/details/tth_070305 He describes wounded soldiers at Letterman hospital begging bait to go fishing for lunch. Michael Perelman wrote: I have a three part posting about privatization, medical care, and Walter Reed on my blog -- to much to post here. The first part consists of an extract from an excellent article form the Boston Globe describing how the Veterans Administration managed to create one of the best health delivery systems in the country -- suggesting the potential of national health care. The second piece discusses Linda Bilmes's important work estimating the enormous cost of the care of Iraq war veterans, which could come to $2.5 trillion. Her estimate might be high, not because she overestimates the cost, but because of the efficiency of the government in denying health care -- HMO behavior writ large. The article also describes how the government has taken measures to obfuscate the looming costs by fudging figures. The third piece consists of notes from Henry Waxman to Major General George W. Weightman, former commander of Walter Reed Army Medical Center. This letter details how privatization has violently cut the number of personnel at Walter Reed and led to the voluntary departure of many skilled workers. As a result of this screw up, the reputation of government health care will be tarnished. -- Michael Perelman Economics Department California State University Chico, CA 95929 Tel. 530-898-5321 E-Mail michael at ecst.csuchico.edu michaelperelman.wordpress.com
