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How To Get Sicker, Die Sooner, And Pay More For It

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How To Get Sicker, Die Sooner, And Pay More For It

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It is painful that five years after passage of the Affordable Care Act, 19 states still have not taken advantage of its option to expand Medicaid. It becomes more so with each new report on the deeply flawed U.S. health system.

The latest, from the National Academy of Sciences, finds that rich people live about 13 years longer than poor people. The researchers note that consequently, rich people end up getting the lion’s share of Social Security benefits. Such inequity should be attacked at its root. At the very least, we could use available tools to help low-income people get health insurance.

The NAS report is far from the first to highlight problems in our approach and results. The Commonwealth Fund last year examined health systems in 11 western industrialized nations. For the fourth time in a decade, the United States system placed first in cost and last in what it delivers. Our system is less fair, less efficient, makes us less healthy and gives us shorter lives. All that for an average of $8,508 per person, way more than second-place Norway at $5,669. In case you were wondering, Britain’s socialized National Health Service was No. 1 at less than half the U.S. cost.

That information landed just as Allan Detsky published a New Yorker analysis of two 2013 reports on global health systems by the Organization for Economic Cooperation and Development and the National Institutes of Health. The study of the 34 OECD countries found an alarming trend: The United States ranked 20th for life expectancy at birth in 1990 and fell to 27th in 2010. On a measure combining level of health and length of life, we plunged from 14th to 26th.

The NIH report by the federal Institute of Medicine found that Americans fared worse than people in 16 “peer” countries in nine areas: infant mortality, injuries and homicides, teen pregnancy, HIV and AIDS, drug-related deaths, obesity and diabetes, heart disease, chronic lung disease, and disability. Why? The authors cite a larger uninsured population than peer countries, worse health habits, more poverty, and more neighborhoods designed to require automobiles.

We have gained a few new tools since some of those studies were done. Some, such as Michelle Obama’s “Let’s Move” initiative and money for electronic medical records in the stimulus law, are nudging us slowly in a better direction. Among the most significant advances are the ACA’s new marketplaces (where individuals can buy insurance regardless of their health status) and the law’s expansion of Medicaid (even though the Supreme Court transformed it into an option that states could take or leave).

The Medicaid expansion is designed for people who make too much to qualify for traditional Medicaid but too little to afford even subsidized private insurance plans. In states that have rejected the expansion, nearly 4 million people are stuck in an absurd coverage gap. That’s even though the federal government is footing the entire bill for the additional enrollees until 2016 and will pay at least 90 percent for them after that.

If we’re already spending a huge amount on health care, why should we sink more into it? It’s a good question — yet we might not have to spend more if we were spending more wisely. We could start by slashing our astonishing medical pricing. It costs more than eight times as much for an MRI here as in Switzerland, a typical example from a study of nine countries released last year by the International Federation of Health Plans. Just this month, The New York Times reported on a 62-year-old drug that went from $13.50 to $750 per tablet overnight.

How can we get a grip on costs? In part by getting a grip on politics. Medicare, overcoming “death panels” alarmism, recently announced it will reimburse doctors for discussing end-of-life choices with patients. That may lead to a decline in expensive, painful and futile treatments. Next, we should lift bans on research into gun violence, the better to reduce shootings and their public health costs.

Ideology is standing in the way on guns, as it is in the 19 states refusing so far to expand Medicaid. The struggles of purple-state Virginia have been among the most epic. Democratic Gov. Terry McAuliffe has been repeatedly thwarted by Republican lawmakers in his push to expand Medicaid. Last year, a disloyal Democratic lawmaker resigned and threw the state Senate into GOP hands. This year Democrats are trying to win back the chamber and, along with it, the slim chance of a Medicaid deal. In the meantime, some 350,000 Virginians are stranded in the coverage gap.

And this, dear readers, is how you get to be last place in the developed world.

Follow Jill Lawrence on Twitter @JillDLawrence. To find out more about Jill Lawrence and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate website at www.creators.com.

This is an updated and revised version of a column from June 19, 2014.

Photo: Taber Andrew Bain via Flickr

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Jill Lawrence

Award-winning journalist Jill Lawrence is a nationally syndicated columnist and a contributing editor to U.S. News & World Report. She also contributed to The Surge: 2014's Big GOP Win and What It Means for the Next Presidential Race (2015). Lawrence has discussed political and policy developments on television, radio, and many other media outlets. She was an adjunct professorial lecturer at American University in 2014, teaching on the relationship between politics and the media.

Lawrence has covered every presidential campaign since 1988, as well as historic events such as the Three Mile Island nuclear accident, the 1994 Republican takeover of Congress, the Clinton impeachment, the Florida recount, and the 1993 and 2009 battles over health reform.

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36 Comments

  1. Dominick Vila September 24, 2015

    Yes, it is, and Republicans are trying to make it even worse and more expensive than it already is. Instead of trying to find ways to provide effective medical care to all Americans at affordable prices, instead of ensuring that all Americans get the medical care we need to live healthy lives, instead of trying to find ways to improve our dismal life expectancy (which is, admittedly, caused by many factors, not just healthcare), instead of trying to rein in abuses by the pharma industry, instead of trying to put in place a system that eliminates duplication or unnecessary testing, and so many other desperately needed steps, some among us are determined to take us back to the days when only the wealthy and those working for corporations had access to medical care, while the rest depended on ER services, often when it was too late to save them.

    Reply
  2. Larry Gagnon September 24, 2015

    Hi Dominick: You make several very good points. I think your most important point relates to cost. You probably know more than I do, but why blame Republicans for the failure to rein in medical costs. I thought that the ACA was basically a Democrat law. If our current medical insurance and medical delivery system is overly expensive, shouldn’t we blame the Democrats for not including remedies in the ACA? BTW: Life expectancy is a complicated figure. One measure is life expectancy at birth. In 1850 the life expectancy of a newborn American was 38, in 1890 it was 42, by 2011 it was 76. I think 76 is amazingly good, especially considering our penchant for over-eating and for using guns to resolve disputes. Here is source of my data: http://www.infoplease.com/ipa/A0005140.html

    Reply
    1. Dominick Vila September 24, 2015

      Hi Larry, the ACA is not a perfect system, it is just a baby first step in the right direction. As for blame, both parties share it. One for demanding clauses that limit the ability of the new program to rein in cost, and go after fraud and abuse, and the other for allowing that to happen. Let’s not forget that about two dozen states rejected the MEDICAID expansion, and that only 16 million Americans, about 5% of our population, is benefiting from it. What we need is cool heads, pragmatism, and objectivity’ which seem to be conspicuous by their absence.

      Reply
      1. Eleanore Whitaker September 24, 2015

        The ACA as originally proposed by President Obama was for single payer. If anyone bothered to study that plan in depth, they’d have seen that a single payer plan would have allowed the US to become more in line with other countries of the world.

        How is it the GOP doesn’t mind handing off things our taxes pay for to their befrigged states and then tells the rest of the states to pay out of state funds for what our states need?

        How is it the GOP is the biggest supporter of charities that support things our taxes already pay for?

        I tell you how…Republican states drain the economy by investing only in industries they know require federal tax subsidies every year. Where are the most prison industries? The most dollars for defense going? The Big Energy states who not only sink the economy taking tens of billions every year in tax subsidies, but then we get to help them pay for their spill clean ups and their spill fines. Not to mention forcing our states to pay double to clean up our own environmental from their filthy slime ball pollution.

        Reply
        1. David September 24, 2015

          Eleanore!!! Don’t you love to pay big oil every time you fill up your car?

          Reply
    2. Magnus Thunderson September 24, 2015

      The ACA was based on Romany care as Obama knew he could never could get single payer passed

      Reply
    3. johninPCFL September 24, 2015

      And amazingly in 1850 if you were 20 years old, it was likely you’d live to see 65. In 1890 if you were 20 years old, it was likely you’d live to see 65. Today, if you’re 20 years old, you’ll likely live to see 65.

      The greatest changes in life expectancy were the fewer deaths before age 5, which included newborns and still births.

      Reply
      1. Larry Gagnon September 25, 2015

        Hi JohinPCFL: Your point is exactly correct, although your numbers are slightly different than those in the source that I cited. That source says in 1850, a 20-yr old had a life expectancy of 40.1 years and in 2011 that 20-yr old had a life expectancy of 59.3 years. Clearly, greatest improvements in life expectancy at earliest ages. I guess we still wear out. At 70 years, my life expectancy … yikes, never mind.

        Reply
  3. Eleanore Whitaker September 24, 2015

    Larry Gagnon would love to absolve Republicans of the bilking of Americans on medical cost. So let me remind him and others of a direct quote from Kentucky Republican Mitch McConnell…March 2009…”We will get rid of Obama.”

    Not one month later, in the thick of the worst recession caused by 2 Bush tax cuts that the GAO 2004 report showed an 11% increase in the top 1%, McConnell and Boehner outraged at the ACA, McConnell states, “I know many HMOs.”

    We know he and the rest of the GOP thugs know HMOs and Big Insurance. That’s why the original ACA plan for single payer was tossed out under GOP obstruction.

    Sorry, Larry, but when you try to absolve the guilty when their fingerprints are ALL over the mess they created, you don’t get to blame the Democrats.

    As most of us over the age of 55 recall, it was Hillary Clinton vs. the Republican Speaker of the House Gingrich who refused to even consider healthcare reform at the start of the Clinton Presidency.

    It was George W. Bush who tried to sell the American public a Texas style snake oil BS of Healthcare Savings Accounts. Brilliant idea. You save up for 20 years of your life while some insurance thugs use what you pay for to fatten their offshore bank accounts. Comes time to use those HSAs, and you get a big zero from these CONservative CONs.

    So tell us, how much more do you expect Americans to pay for HMO copays and deductibles, outrageous prices on prescription drugs, all while you and your kind make every excuse in the book to delay and forestall the inevitable?

    Some all too crooked men in this country have been riding a gravy train for far too long. Time to kick them off.

    Try again, Larry. The Big Insurance industry went south the minute Hillary Clinton announced a plan to investigate the reasons for outrageous prescription drug costs this very week.

    All while some little 30 something hedge fund manager who owns HMO stocks in Big Pharma decided to jack the price of a $13.50 prescription drug to $750.

    So tell us Larry…what is that if not pure greed?

    Reply
    1. David September 24, 2015

      Eleanore!!! How long will the non credit receiving public pay the outrageous premiums and deductibles of Obomocare?

      Reply
      1. Eleanore Whitaker September 25, 2015

        David…Is your Republican state paying too much for your healthcare? Or, are you corporate welfare states enjoying the rest of us paying for yours? If your healthcare costs more, it has nothing to do with healthcare reforms.

        It was your asshat Gingrich who back in the Clinton Administration bashed hell out of healthcare reforms Hillary tried to put out there. So tell us you moron cowboy, in all that time to the present, is the cost of healthcare better or worse?

        Until you sucking teats of Texas stop feasting at the table of denial, you can check which states are doing just fine under the ACA…ALL OF THEM ARE DEM STATES. That the hell that does say about how much that political Mutton Chop McConnell makes from your idiot Republican states whose governors refused to set up state ACA agencies? It says you moron, that your own Republican governors knew all along that part of every HMO premium has kept Republicans in big campaign bucks.

        McConnell is one of the biggest suck ups of HMO campaign donations. Must be why in June 2009 he states and I quote, “I know lots of HMOs.” YES….WE ARE ALL SURE HE DOES!

        Wow…it is so easy to roll over a cowboy when he’s a total asshat.

        Reply
        1. David September 25, 2015

          Eleanore!!!! Ha Ha!!! Thank you for my morning laugh! Hmm….health care premiums are through the roof, but it doesn’t have anything to do with Obomocare. Oh, right. Now I see, the outrageous premiums are Bush’s fault!
          “Hey if you like your doctor, you can keep your doctor! If you like your plan, you can keep your plan!”. We are so lucky to have Obomo!
          I know your premiums haven’t risen because you live in New Joisey.

          Reply
          1. Eleanore Whitaker September 25, 2015

            You crooks in Texas would have higher premiums. After all, where did you think your loser Perry got is moolah?

            The last 3 NY papers printed reports that NY State had a drop in healthcare insurance costs by over 11%. And big mouth, dickhead, Check Senator Warrens speech in July 2015. It clearly indicated there is a huge drop in the cost of healthcare premiums.

            But a crook like you wouldn’t dare admit he can’t steal from the sick and dying so Big Rich Texas That Whole Other Country (read alien planet), can bitch how high healthcare costs are.

            Perhaps you want to blame yourself and the rest of the Texas crooks like you?

            Almost every state that has a state ACA agency reports lower insurance premiums. ONLY the GOP states are suffering the consequences of the Big Rich Politicians who refuse to step into 2015.

            You got medical expenses? Pay out of pocket jackass.

            Reply
  4. Eleanore Whitaker September 24, 2015

    Any American today who believes HMOs are not using the copays, deductibles and profits from dropped healthcare policies to fun GOP campaigns needs a lobotomy.

    Check out how much campaign funding McConnell gets from HMOs. Nearly all 6 major HMOs contribute to his and Boehner’s campaign funding. You’d have to be pretty stupid not to figure out that the additional price gouged costs of healthcare are a direct result o HMOs defrauding Americans to fund GOP campaigns.

    Reply
  5. Magnus Thunderson September 24, 2015

    When will this county wake up an relies that the GOP talk about helping the middle class is simply lip service as actions speak louder the words as health care is totally B-partisan as it benefits every one. and the reason we Have the highest medical costs in the world along with no were near the best care the Would health organization used rate each county give a rating on several factors and we were always second the marshal islands are the number one but then again we used the Marshall Islands as nuclear bomb tests and now it the most contaminated place in the world.

    The reason thought they no longer it bush threated to cut US funding to the WHO if they did not stop producing that that report embarrassed the GOP at the time as the single payer frech system rated number one in world and if we adopted it is would save trillions

    Reply
  6. Otto Greif September 24, 2015

    Who cares how “fair” the system is?

    Reply
    1. Larry Gagnon September 25, 2015

      Hi Otto: You just raised the most interesting issue in the whole debate. If a society does its best to assure that everyone has access to good health care, why would it be a bad thing to allow people to buy excellent health care? Does “fair” require that everyone have access to the same level of care? If so, then what about access to the other luxuries of life such as steaks, vacations, luxury cars, football tickets. etc.

      Reply
      1. Otto Greif September 25, 2015

        You could increase “fairness” by making everyone’s health care worse. It’s a stupid measure.

        Reply
    2. Magnus Thunderson December 13, 2015

      People who are not Satanists if you call your self Christian you should

      Reply
  7. Otto Greif September 24, 2015

    Claiming higher US homicide rates are caused by lack of health insurance is idiotic.

    Reply
  8. Otto Greif September 24, 2015

    The statement “Our system is..less efficient, makes us less healthy and gives us shorter lives” is simply a lie.

    Reply
    1. johninPCFL September 24, 2015

      Yea, that IS your opinion. But the facts tell a different story.

      What the facts say is that IF you can AFFORD the cost of your treatments, your health will climb to be equal to the other developed countries in the world. Of course, the folks in the rest of the world are not spending nearly as much as you are…

      Reply
      1. Larry Gagnon September 25, 2015

        Hi JohninPCFL: I am not sure that your facts support your conclusion. It seems logical that poorer people have somewhat more difficulty accessing the best care. But they (probably) exercise less, eat less healthy foods, live in more dangerous places, drive cars that are less safe, work jobs that are more dangerous, etc. Having lived in abject poverty earlier in my life, I experienced all these risks.

        Reply
      2. Otto Greif September 25, 2015

        It’s not an opinion, it’s a fact the US health care system does not make Americans less healthy and have shorter lifespans.

        Reply
    2. Magnus Thunderson February 11, 2016

      Get you head out of the sand and simply look at the facts that we have the most expensive universal heath care system on planet as we cover at last resort the hospitals so yes everyone is covered and a crappy heath care system
      c v

      Reply
      1. Otto Greif February 11, 2016

        We do pay a lot, but the quality of care is high.

        Reply
        1. Magnus Thunderson February 11, 2016

          again get you facts strait just look at reports of the quality of the USA system heath system compared to the other
          first world nations and you find not in first by far

          Reply
          1. Otto Greif February 12, 2016

            Real comparisons of quality show the US has higher quality health care.

            Reply
          2. Magnus Thunderson February 12, 2016

            Then link those reports as I never seen them

            Reply
          3. Magnus Thunderson February 12, 2016

            Yes we do have the best cancer care in the world but that a very small part of heath care and it sad Canada does such a crappy job on MRIs but they pay half what do on heath care and on the bottom of all single payer plans so you still not made your point

            Reply
          4. Otto Greif February 12, 2016

            So you agree we do pay a lot, but the quality of care is high.

            Reply
          5. Magnus Thunderson February 12, 2016

            No Not at all as the other areas we suck

            Reply
          6. Otto Greif February 12, 2016

            Except that’s not true.

            Reply
          7. Magnus Thunderson February 12, 2016

            Then again prove it
            As you have not
            Nor even come close

            Reply

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