So we decided to pose our 10 Questions to two experts in the field: Robert Moffit, who's with the Heritage Foundation, a conservative think tank in Washington, D.C., and to Dr. Sidney Wolfe, the director of Public Citizen's Health Research Group, a more liberal-leaning consumer advocacy organization.
1) If you could change ONE thing about our health care system, what would that be?
Well, to get a handle on health care in this country, we fired off 10 Questions to two experts: On the right we had Robert Moffit, who's the director of the Heritage Foundation's Center for Health Policy Studies. We posted his answers last week.
One thing we found interesting: when we asked the two men our first question — to name the one thing they'd change about the health care system — they both began with the exact same words: The financing. And then they diverged.
1. If you could change ONE thing about our health care system, what would that be?
The financing. Instead of hundreds of profit-seeking health insurers, money should be collected and bills paid by a single government payer.
At present, insurance company overhead and the paperwork that inflicts on doctors and hospitals wastes more than $350 billion a year — money that could cover the uninsured and eliminate co-payments and deductibles for those who currently have partial coverage. Progressive income taxes would be paid, just as we now do for other financially socialized benefits such as libraries, the police, schools, Social Security and, in the health area, for Medicare. Because of the huge administrative savings, a single payer system could cover everyone without expending any more dollars.
2. Most people agree that the costs are out of control. What can be done about that?
By far, the fastest growing element of cost is wasteful health administration. The number of doctors increased 2.5-fold from 1970 to 2005, largely in proportion to growth in the population. The number of registered nurses grew a bit more slowly. But the number of health administrators increased 26-fold during the same interval.
Another rapidly growing cost is the price of prescription drugs. Unlike all other developed countries where prescription drug prices are negotiated or controlled — and as we do for the Department of Defense and for the Veterans' Administration — the costs for everyone else in this country are largely out of control and, for many, unaffordable.
The single payer approach could cut paperwork costs drastically, and force drug prices down.
3. What works in our system? What doesn't?
Our system of medical education and our medical research are as good as most places in the world. But, because of the enormous expense of U.S. medical schools, much higher than most countries in the world, many students from poorer economic backgrounds are less likely to go into medicine.
The success of U.S. medical research would not be possible without the huge public subsidy through the NIH, now funded at more than $28 billion a year, another example of a progressively taxed, financially socialized benefit for everybody.
As discussed above, the current multiple payer financing is unaffordably wasteful and forces a larger and larger proportion of the $2 trillion we spend on health each year to fund people who are not, in any remote way, delivering medical care. They are not doctors, nurses, pharmacists or other health care providers but, in many cases, health care deniers whose job it is to fight with each other (insurance administrator vs. hospital administrator or doctor's office administrator) to deny payments or even coverage for needed health services.
4. People come to this country from all over the world and get great medical care. But so many Americans slip through the cracks. What can be done to close this gap?
In what has been described as medical tourism, the United States, with its large pharmaceutical and medical-device industries and high-tech hospitals, has traditionally been a destination for patients, primarily those affluent enough to pay out-of-pocket, or those who have generous insurance coverage that extends beyond their countries of origin.
But recent years have also seen a flow in the opposite direction, with large numbers of American patients traveling abroad in search of less expensive and often more luxurious health care, frequently surgery.
The problem of Americans "slipping through the cracks" because of being uninsured or underinsured can only be dealt with by providing universal health coverage for all people in this country.
5. We hear a lot about the number of uninsured Americans. Just how many are there?
At the time of a government survey in 2006, about 43.6 million people in the United States, or 14.8 percent of the population, had no health insurance. But about 54.5 million people in the country, or 18.6 percent of the population, had no insurance for at least part of 2006.
An even larger problem is the growing number of people who are underinsured. Illness and medical bills cause about half of all bankruptcies, and three-quarters of these people forced into medical bankruptcy had health insurance coverage — at least when they first became ill. In many cases people cannot afford policies with optimal coverage, or they choose a policy with a relatively low premium but a massive deductible, often thousands of dollars a year. Such inadequate coverage keeps them from seeking care because of the unaffordable out-of-pocket expenses.
Conservative estimates are that about 100 million people in this country — one third of our population — are either uninsured or underinsured.
6. What's the lowdown on managed care? HMOs? Single payer?
In its origins, managed care was dominated by excellent not-for-profit HMO models such as Group Health Cooperative of Puget Sound, located in Seattle. The market is now dominated by large, non-local, for-profit managed care companies, whose quality of care has been shown to be significantly worse than that of the non-profits.
Single payer means the government collects the money and pays the bills. By having all people in this country covered by a single payer health system, not just those on Medicare, our current expenditures for health — in excess of $2 trillion a year — could go much further and all but eliminate the serious problem of one out of three people being uninsured or underinsured.
In Canada, for instance, people can choose any doctor or hospital they wish to go to, unlike the increasingly restricted lists of doctors that managed care companies in this country allow.
7. What role should the government play in providing Americans with health care? What role should the marketplace play?
The government should guarantee that everyone in this country has health insurance by collecting the money and paying the bills, cutting out the pick-pockets in private industry.
The role of the marketplace — and this includes for-profit health service entities such as HMOs, hospitals, nursing homes and kidney dialysis centers — has been succinctly stated by my colleagues, Harvard professors and doctors Steffie Woolhandler and David Himmelstein. They co-founded Physicians for a National Health Program, which now includes more than 14,000 physicians, medical students and health professionals who support single payer health insurance.
In an article eight years ago in the New England Journal of Medicine, they wrote: "In our society, some aspects of life are off-limits to commerce. We prohibit the selling of children and the buying of wives, juries, and kidneys. Tainted blood is an inevitable consequence of paying blood donors; even sophisticated laboratory tests cannot supplant the gift-giving relationship as a safeguard of the purity of blood. Like blood, health care is too precious, intimate, and corruptible to entrust to the market."
8. Is there a model for a health care system that you think works, that we might model our reformed system after?
The model we adopt for our single payer health care system can be crafted from the best elements of existing systems in the many countries, such as Canada and France, that already provide universal health care. All of these countries spend far less per capita than we do in this country, and everyone is covered.
The best models eliminate private health insurers, require that hospitals and other health institutions be run on a non-profit basis, and exercise strict control over the pharmaceutical industry. The multiplicity of state health insurance initiatives, with the exception of California state senator Sheila Kuehl's bill, which advocates a single payer, are doomed to fail. They are thinly disguised versions of the failing system we have now, one dominated by wasteful private health insurers.
9. The baby boomers are now starting to retire, and people question whether Medicare will be able to handle them. Will it?
At present, Medicare is wasting about ten billion annually overpaying private Medicare HMOs, which have been touted by pro-market enthusiasts as the solution to Medicare's problems. Doctors and hospitals drain tens of billions more for unnecessary, but profitable, procedures, drugs etc.
For instance, thousands of kidney dialysis patients have been given dangerous overdoses of epoiten because dialysis centers and drug companies have made huge profits from this drug. Similarly, about half of all cardiac stents are unnecessary, leaving the patient no better off, but gaining the hospital about $20,000 per patient. Eliminating HMOs from Medicare, reorienting Medicare payments to minimize incentives for over-treatment (as well as under-treatment), and encouraging primary and preventive care would go far to assuring the long-term viability of the program.
Assuring coverage for people under 65 would also save Medicare money. When the uninsured turn 65, their Medicare bills are far higher because they failed to get timely care.
Financing Medicare by a much more progressive tax, and improving Medicare coverage to eliminate current co-payments and gaps in coverage for prescription drugs would also broaden support for the program. Canada's universal coverage program, which is also called Medicare, shows that national health insurance is the best solution to rising costs.
When Canada's program began, in 1971, they spent the same proportion of GDP on health care that we did. Now they spend about 40% less.
10. What role will the health care issue play in the election? And is there a political candidate in this broad field who you think has the right idea?
We can not only hope that health care plays a major role in the coming presidential election but also that the ideas put forth are more progressive than those currently being espoused by all of the so-called leading candidates. Representative Dennis Kucinich is the only candidate with the guts and honesty to tell it like it is, instead of pretending that versions of our failed system can work. His support for the current single payer House Bill (HR 676) sets him apart from all the other candidates.
What she has done in the 25 years since "She's So Unusual" is experiment, stretch her skills, and thumb her nose at an industry that loves its talent delivered in easily definable boxes. Admittedly, that isn't always a recipe for commercial success.
"Bring Ya to the Brink" is Lauper's first album of original material in 12 years, and a world apart from the moody, raw covers on "The Body Acoustic" or "At Last." It's full on, sweaty, gritty dance. Not the overly electronicized version one generally hears from pop divas of a certain age, but a kind of sound that says "retro" in a good way. "Into the Nightlife" will wear a groove into your iPod as you click play again and again, transported to the Limelight circa 1995. It's infused with dry ice and beer stains, like the club scene before it was wrapped in velvet.
Don't call his work "ripped from the headlines." Novelist Richard North Patterson may write about some very timely themes, but he is generally ahead of the headlines.
His latest novel, "Eclipse," his fifteenth to date, was inspired by some historic events in Nigeria, but its implications will reach far into the future.
We had a chance to chat with him via email and telephone.
Everyone could use a refresher course in American history. And we're not just talking about Dana Perino, the White House press secretary who didn't know what the Cuban Missile Crisis was—and then admitted it publicly.
1. Noah, what's your favorite entry?
My favorite is about Victoria Woodhull, the first woman to ever run for president. She was a colorful character. She was an advocate of free love. It's one of those awesome little barroom trivia topics that form the rich tapestry of American history.
The "Primary Questions" series has sparked lots of conversations worth sharing on the blog. Katie interviewed 10 presidential contenders, and asked them 10 key questions ranging from their biggest fears to their biggest mistakes.
In the installments already aired on the CBS Evening News, the candidates have revealed something of their character and judgment--and given voters a better picture of who they really are.
Katie sat down earlier today to answer my 10 Questions about her 10 Questions.
Gao had uncovered a scam irrigation project in his home province—a striking example of local authorities' self-aggrandizement and corruption. For writing that story, Gao spent eight years in prison; he was released last December. When CPJ asked us if we wanted to talk with him (through a translator), we of course leaped at the chance.
1. Mr. Gao, thanks so much for speaking with us, and let's start, more or less, at the beginning. Tell us about the story you wrote that ultimately put you in prison.
It was about a fake irrigation project in Yuncheng, a city in Shanxi Province, which is southwest of Beijing. This project was costing the government about $38 million, and it was a scam.
It's a region that doesn't get much rain, so people are very dependent on the weather. In 1995, local leaders learned about a foreign irrigation technology that they thought might solve the region's problems. It involved
building these large pools with pipes in the bottom to collect water. But the soil wasn't the right quality. It was sandy and sticky, not suitable for this type of irrigation. Agriculture experts agreed from the start that it wouldn't work, but the leader of the district, Huang Youquan, wanted personal glory, he wanted to enrich himself and enhance his reputation, so they began this huge building project.
2. Who were you working for at the time? Was this a story that your editors assigned?
I was working for the Xinhua News Agency, the state news agency. I found the story myself. One day I was traveling to Yuncheng from my home in Taiyuan, which is the provincial capital, and I overheard people on the train making jokes, in the form of a rhyme, or a proverb, about how whenever you walked down a road, there were these empty pools being built.
Of course I was very interested when I heard them talking, and I worked on the story for about a month.
I sent it off to a few publications, including the People's Daily. It was published in the version that circulates to top Party officials. The South China Morning Post heard about it, and I went with them to see the irrigation project. Then many TV stations came too. All this was based on the reporting I had done.
3. The authorities weren't pleased...
On April 5, 1998, the investigators showed up to see me, and I was quite glad. I thought they wanted to hear more about the scam. But they didn't ask me anything about the project, they asked about me and any problems I had had. "You're supposed to be investigating the fake engineering problem," I told them, "but instead you're investigating me." I was very angry.
I had to cooperate, they had been sent by orders from above. They asked me, "Where did your cell phone come from? Where did your beeper come from?" They checked out my receipts, and the facts checked out with what I had told them.
4. But it didn't stop there...
In July they came back and started asking me, "Why did you write that story? What was your motivation? And who gave you the information?" I answered that I wanted to fight corruption, and I said I couldn't tell them who my sources
were. But they were very persistent. They kept emphasizing that they were representatives of the Central Communist Party and that as a party member, I should believe the party above all else. They promised they would not retaliate.
But my source, a local figure in the administration, was arrested.
5. What happened next?
I went to Beijing to lodge a complaint because I'd received threatening phone calls. I also received a phone call from a friend who said he'd be in Beijing, and when I went to meet him, it turned out it was the police. They kidnapped me and took me back to Shanxi, and I had no chance to communicate with my family.
The trial was on April 28, 1999, and the whole thing lasted one day. It was conducted in secrecy. My lawyers pled not guilty on my behalf, but the authorities didn't listen.
I was charged with fraud, bribes, even pimping. I hadn't heard any of the crimes before. I was sentenced to 13 years.
While I was in prison, my wife, who is an accountant, was working extremely hard running around on my behalf. She was constantly traveling to Beijing; sometimes after work she'd take the overnight bus. My daughter, whose name is Gao Ya, wasn't told her father was in prison, she was told I was overseas.
6. Your sentence was 13 years, but you got out early. How did that happen?
Because I studied while I was in prison and took part in labor activities--I worked on the prison newspaper--and put on a good face, they lightened my sentence.
One day, out of the blue, they said I could go.
7. With the Olympics coming up, the eyes of the world are poised to be on Beijing, even though many journalists are still in jail. Do you think that might have had anything to do with your being released?
Not particularly. But I do think that because everyone's busy dealing with the Olympics, the authorities might have been preoccupied. I had been petitioning for release the whole time, so one time they didn't take the time to review my case, and they just let me go.
8. You were released in December of last year. What have you been doing?
At the moment I'm unemployed. I came out of prison and tried to find another job as a journalist, but no one dared employ me. I've been thinking about two things: writing about my experiences, and figuring out ways to help people when they get into difficult situations such as mine.
And...she introduced us to Julia Child. When "Mastering the Art of French Cooking" wasn't enough for Jones, she turned to finding talented cooks who could bring into our kitchens the secrets of Italian cooking (Marcella Hazan), Chinese cooking (Irene Kuo and Nina Simonds), Indian cooking (Madhur Jaffrey), good American cooking (James Beard and Edna Lewis), and more.
(By the way, the tenth muse is Gasterea, so summoned by Brillat-Savarin, a French politician and lawyer who lived during the French Revolution and loved food: "Tell me what you eat," he wrote, "and I will tell you what you are.")
And we just celebrated Veterans Day. We thought it might be time to reach back into history for some perspective on today's events, so we posed our 10 Questions to David Andelman, who's written a book called "A Shattered Peace: Versailles 1919 and the Price We Pay Today." It's set in Paris just after World War I (how ironic that it was once called "the war to end all wars"). Its major characters are the peacemakers who were present for the conference that would culminate in the Treaty of Versailles. But rather than building a lasting peace, Versailles helped set the stage for later conflicts and wars—World War II, Vietnam, Kosovo, the Middle East, Iraq.
Andelman is Executive Editor of Forbes.com, a former New York Times foreign correspondent and Paris correspondent for CBS News.
Born in London in 1933, Dr. Sacks is a neurologist who trained at Oxford University and has lived and worked in New York since 1965. He's taught at Albert Einstein College of Medicine and New York University. Just this past summer, he was appointed a professor of clinical neurology and psychiatry at Columbia University.
One of Dr. Sacks's early books was "Awakenings," based on his experiences with a group of patients in the Bronx who contracted sleeping sickness after World War I and were frozen in sleep for decades. He treated them with L-DOPA, then a new drug, which, remarkably, "awakened" them. (The book was turned into an acclaimed film starring Robin Williams and Robert DeNiro.)