- Two bills introduced by U.S. Congresswoman Katherine Clark to address the nation’s opioid crisis passed the House on Wednesday, May 11.
- Part of an Obamacare initiative meant to reward quality care, the Centers for Medicare and Medicaid Services (CMS) is allocating some $1.5 billion in Medicare payments to hospitals based on criteria that include patient-satisfaction surveys. Among the questions: “During this hospital stay, how often did the hospital staff do everything they could to help you with your pain?” And: “How often was your pain well controlled?”
- The U.S. health care system pays physicians based on a fee for service financial model.The result is that health care costs over the past several decades have risen twice as fast as general inflation. Without the right financial disincentives we would expect physicians to act in ways that maximize their own economic benefit. And they do. But it’s not the doctors or hospital administrators who are the fundamental problem. It’s the financial model.
- The OxyContin Clan: The $14 Billion Newcomer to Forbes 2015 List of Richest U.S. Families.
- The United States makes up only 4.6 percent of the world’s population, but consumes 80 percent of its opioids — and 99 percent of the world’s hydrocodone, the opiate that is in Vicodin.
It is clear, that our health care system is beyond being a costly mess. It is now, an epidemic. The front runner on the Democratic Ticket calls replacing Obamacare with a European model, a theoretical debate that will never ever happen. The presumptive Republican candidate wants to end Obamacare and return to more of a market based “sales motivated” system.
Our opioid epidemic is just like everything else that is wrong with the USA. It attacks us all and only benefits the .1%. No, Hillary and Donald are not trying to kill Americans, not trying to addict us, not trying to enrich one family with billions of dollars, but they paradigms they hold as inevitable “best possible” outcomes are at the root of our epidemic. Passing laws is just re-arranging the deck chairs on the Titanic.
As long as medical care is so strongly coupled to capitalism, this will be our fate.
That must make you happy (since she IS the Dem front runner)!
I don’t want to speak for John, but I *think* he meant that Clinton is calling “[the replacement] of Obamacare with a European model” a theoretical debate. Quite different meaning from saying that she is calling *for* it! I’ve seen nothing to indicate that she has changed her mind about this; she still thinks it will never happen.
I misread and did interpret it as calling “for” – mea culpa. (I think the comma after model threw me off.)
It seems to me that agreeing that the VISION of a “European model” is itself significant.
There is a world of difference between tactics and strategy. The strategy is the aspect we have the most control over. Once a strategy is set, many of the tactics end up being external constraints that one way or another must be responded to.
I hear Ms. Clinton saying that she has spent several decades seeking tactical alternatives for adopting a European model and has so far failed. I hear Mr. Sanders waving his hands about the issue. I have seen no indication that EITHER candidate has an actionable plan for putting a European model in place in the next four or eight years.
I think one can make a case that something that neither candidate suggests is possible in the administration of the victorious candidate might as well be labelled “never”. I would like to see each Democratic candidates celebrate the perspective of the other. When Mr. Sanders emphasizes the need for a European model, I’d like to see Ms. Clinton acknowledge and build on those observations — they add to the information needed to put the tactics in place. When Ms. Clinton emphasizes the tactical challenges and the timeframe those challenges imply, I’d like to see Mr. Sanders acknowledge and build on her extensive knowledge and expertise in such matters.
I think that the primary process forces every tiny difference between the two candidates to be greatly magnified. It creates a false either-or dichotomy, and we all suffer as a result.
How is “never ever happen” a tactic?
We have the ACA today. It is not what either candidate wants in the long run.
Ms. Clinton asserts that the political reality is that single-payer government-sponsored health care isn’t going to happen in administration of the next President. I interpret that to mean that she does not see the legislative landscape changing sufficiently to allow it.
Legislators — senators and representatives — control that landscape. “Never” is a tactic if it can be used to change the makeup of the House and Senate.
It could be the Ms. Clinton is mistaken. If so, then in my view the onus is on the person making that claim to show HOW. If somebody thinks that single-payer government-sponsored healthcare CAN happen in the next administration, I want that person to tell us HOW. What votes are going to be changed? What seats are going to change? What chairmanships are going to be revoked, and who is going to replace them?
I am not aware of any candidate who has made any semblance of such a demonstration. Angrily shouting “we demand …” does not make it happen.
is the hope that Trump poisons the well for the GOP. Otherwise, its a GOP Congress. The lack of Team Bernie Congressional candidates, or Senate candidates, rather strongly suggests that the Sanders “movement” is essentially a Potemkin village.
She is on record, sadly, insisting that anything other than health care purchased in the market is not a reality and is a fruitless debate over something that will “never ever happen”. Why you ignore this of her puzzles me.
ACA is the plan that Republicans came up with, that a Republican governor implemented in one state, and that the health insurance companies will allow.
…and even if she said never it’s more political analysis than desire. Work the Congress for single-payer. If it actually hits her desk I’m sure she will sign it.
She insists that health insurance for many needs to be the domain of private corporations who operate at a profit for the benefit of their wealthy shareholders.
Her words, not mine.
website says,
Affordable health care is a basic human right.
Classic double speak from a Clinton.
How does one put “affordable” and “right” in the same sentence?
Does Hillary stand for “affordable” GLBT rights?
Does Hillary stand for “affordable” women’s rights?
Look up the definition of “affordable” and “rights”…
So in your book human right means “free”?
Is shelter a human right? Is having adequate food a human right? It would be strange if you considered healthcare to be a human right, but not those. So does that mean you think that the government should therefore give *everyone* free food and housing?
intellectually dishonest people I’ve seen commenting this campaign season.
…you think that basic rights must be purchased…and call intellectually dishonest…
You’ll be more intellectually honest when you’re less interested in winning an argument or scoring points and more interested in pursuing the complexity of issues.
Thinking you have the answers and knowing, just knowing you’re right, makes your comments uninformative, uninteresting, and unprogressive. You’re still a conservative in thinking, you’ve just changed sides.
Your food = health care is a silly argument.
Most of her specific health care proposals are aimed at lowering costs AND making sure everyone has access regardless of ability to pay. These are achievable goals and not the magic wand waving of a dictator.
..that we must BUY it from corporations, corporations that in turn, donate to her political campaigns.
We do not need a dictator to accomplish this most basic health care reform, unless you think that Canada, the UK, France, Germany and the rest are governed by dictators.
word. She doesn’t “insist.” She’s dealing with reality. Reality insists that we work from Obamacare.
Comparing 21st century America, to post-World War II Europe is another intellectual lie on your part, JTM.
..dug in opposition Congresses, but rather parliamentary systems. Mark is right – she does not insist. If by some miracle single-payer lands on her desk I suspect she will sign it. However, given all she has been through and seen up close over the past quarter century I’m sure she’s thinking, “O God, please not ANOTHER health care fight right now!”
health care, interested in incremental improvements. Bernie has the right ideal, and his pushing it has led to Clinton to start talking about extending the Medicare. This is Bernie’s value.
Bernie is inaccurate when he preaches revolution. There’s never been one. There’s no way to make it happen. Clinton, on the other hand, will be working on evolutionary changes on health care.
Where has Clinton called for a European model?
I misread what you wrote.
“The United States makes up only 4.6 percent of the world’s population, but consumes 80 percent of its opioids — and 99 percent of the world’s hydrocodone, the opiate that is in Vicodin.”
Wow. And how will Congress address that? We’re not hearing much in terms of practical, effective ideas.
http://www.cnn.com/2016/05/11/health/sanjay-gupta-prescription-addiction-doctors-must-lead/?iid=ob_lockedrail_bottomlarge
The whole piece is very worth your time, as a one-stop explaining the problem. In essence, too many doctors prescribe opioids for too long for too many patients who don’t need them – and the harm caused by these prescriptions has been immense.
If they don’t prescribe drugs, Obamacare does not send them a bonus and if they do not prescribe meds, they hurt their wallets.
I don’t understand how doctors are paid extra for prescribing a specific med. You’re saying this is indirect, because patients won’t give doctors good surveys, thus doctors have an incentive to medicate patients to keep them happy?
In “Obamacare”, payments are made/adjusted to hospitals based in part by patient surveys that ask how their pain was managed. More pain = fewer Medicare dollars.
To begin with “European model” is extremely vague, given that every European country does things differently. Switzerland requires the purchase of private insurance, Britain runs all its medical services directly, Germany has a state run health insurance that you can opt of out of, etc.
Assuming we had adopted one of these models, how would it have prevented the overprescription of opiods? You mention pain rating in evaluations. How would a different health system have prevented the overly strong focus on pain control as metric? Advocacy groups like the American Pain Society would still exist. The pharmaceutical industry would still exist. Do you think by changing the role of insurance companies or taking them out of the picture entirely these issues will magically vanish?
Yes, but they all share a common aspect wherein health care is seen more as a right, protected and supplied by the government, in slightly different ways, from one nation to the next.
Assuming we had adopted one of these models, how would it have prevented the overprescription of opiods?
We know that the Europeans are not having this level of over prescription. Why is a complicated answer, but in many ways it is a simple one.
I’m happy to hear either the simple or the complicated version.
I want to know, specifically, what Germany (for example) is doing differently from the US, and why whatever that is can’t be done here.
Please don’t misunderstand me — I would MUCH prefer the German model to what we have today. I’d also love to have the rail transportation system shared by Germany, Austria, the Czech Republic, Switzerland, etc.
The barrier blocking movement from “here” to “there” is real and high. If a concise, cogent, and valid argument exists showing what the Germans do differently, and showing that the German approach cannot be done here, then we’ve got evidence to support single-payer government-sponsored healthcare.
The barrier is only going to come down in the presence of real, persuasive, and objective evidence.
And the rest of the world (with the exception of the USA and New Zealand) prohibits the advertising of prescription drugs. Why it can’t be done here is all about money. Follow the money. Follow the money. Follow were the money is and follow the politicians it flows to, in the form of super pacs and “payment for speeches”. And that’s why it can’t get done in the USA. We keep electing those people who take that money.
My wife is German, grew up in Germany, and knows the German health care system.
The reality is far more complex than you suggest.
Just to be clear — people in Germany also have money. Wealthy people in Germany also have more power and influence than non-wealthy people in Germany.
Electing Bernie Sanders, Donald Trump, or anybody else as President is not going to make a material difference in the role that wealth plays in the US health care system and the US government. The needed changes are pervasive and will take decades (and generations) to accomplish.
The primary season is essentially over. Continued attacks like this on Ms. Clinton do not accomplish any constructive purpose.
…why pharmaceutical companies are not allowed to advertise prescription drugs over there as we do so much over here.
without understanding why we got into the opiod crisis to begin with seems like the worst possible strategy. I recommend Sam Quinones’s book Dreamland, which explores the topic in depth, though I’m sure there’s other good writing on the issue.
…it’s simply looking at ALL the nations with health care as a human right, not a market commodity and NONE of them have the opioid crisis that we have here in the USA where health is considered a commodity to trade for profit, something that the leading Democrat for the presidency is in favor of…..ads it helps fund her campaign?
So clearly the difference between our two healthcare systems does not explain the problem.
In any case, while I do dislike American drug ads, I really cannot think of ever seeing one for a narcotic pain medication. And while overprescription is a serious problem, most opioid abusers were not prescribed opioids but obtained them from friends or family members. The leading risk factor for opioid abuse is youth, not bad prescribing practices.
Drug Use Soars in Denmark
While indeed a crisis is not even close one we have here in the USA. It’s all a matter of degree, eh? They have prisons in Canada and Denmark but here in the USA, we have the largest prison population on the planet. Why are we “#1” in drug abuse and crime?
The crisis in Canada is not much different than here.
I don’t understand your point in conflating our country’s unfortunate penchant for throwing people in prison with single-payer healthcare. I don’t see that they are related. There is simply not much actual evidence to suggest that our lack of single payer healthcare is the cause of our high prison population.
The opioid crisis is more probably a product of a permissive youth culture combined with greater availability of pain medications and other recreational drugs. Whether those pain medications are paid for by private or public insurance doesn’t appear to matter all that much, which is not all that surprising given that they are relatively cheap to produce as medications go.
I don’t think you can back up your statement that we are “#1 in drug abuse and crime? Where do you get that from?
For point 2 the impact of satisfaction surveys as noted here are overstated. It would be foolish to think that it is linked to opiate crisis. Back in 2012 or 2013, the very beginning of ACA, they was a 1% drawback of funding, health care providers could get back bonuses to get back some of that 1% based survey feedback. Now, pain management was one of many questions within that survey, not the sole deciding factor, so it’s a percentage of that 1%. The real basis of ACA is OUTCOMES not SATISFACTION. That point is just nonsense.
Plus, it’s getting smaller and smaller in each passing year which leads me to your point 3. Fee for service model is exactly what the ACA is changing. It’s the exact opposite of what you are stating. Fee for service WAS are model, ACA is adding a global payment model and ACOs. In reality, is a management and outcome based model, NOT a fee for service model. Each passing year, this model is growing including Medicaid and Medicare payments. So going back to your point 2, these payment models continue to decrease the connection to satisfaction surveys and that 1% pull back no longer exists, they’ll get a bonus, but if you are saying that physicians on a whole will push opiates because of this you have a screw loose.
Sure, you can take it apart piece by piece and call it overstated, but the root of our problem is the reality that we have been convinced that medical care is best managed, protected, and provided by the private sector in “free markets” as opposed to “socialized medicine” that lacks the profit motive.
Here’s a little fact: In Cuba, life expectancy is slightly higher than it is in the USA and their infant mortality is the same as ours, and yet they spend less than $1,000 per person per year in health care while we spend close to $8,000 per person per year.
*Everything* is cheaper in Cuba because wages are very low and the economy is stagnant. If you could pay doctors and nurses and other healthcare workers in the US what they get paid in Cuba you would see healthcare costs drop dramatically here. Switching to single payer isn’t going to make that happen. We will save money to be sure, but not to that degree.
I also don’t know where you get your information on life expectancy. For instance on the WHO site they show the US as being slightly ahead of Cuba (but behind Chile, Costa Rica, and Canada). But there is no question that Cuba has a very good healthcare system for the money and we should be able to learn from that.
What does that mean? A constitutional right? A human right? Why does it matter?
as in “what you get from your society regardless of social status”. It’s provided by the whole to the ones that need it. It’s not for sale and no own makes a profit. Why does it matter? Ask anyone in any of the developed nations why it matters and why they see us as barbarians.
What you’re talking about is not a right in a practical–i.e. legal right, human right–sense. You’re talking about “what you get from your society regardless of social status.” You ought to say that instead of covering up what you mean with an abstraction. I agree that everyone should have health care regardless of their social status. You say that Hillary Clinton doesn’t?
…believes that health care (or health insurance to be precise) is something that I must purchase from private corporation that has a fiduciary obligation to deliver a profit to its shareholders, much like carpeting for our homes, a Snickers Bar, or movie tickets.
I believe that health insurance is something that ought to be provided to me from a the collective of all of us in the form of taxes and provided to those of us in need, much like police protection, highways, education from K-12.
…but have no patience for the single-payer or bust attitude. HRC has more scars from health care fights over the past generation than all of us put together. She has every reason and right in the world to take a more pragmatic approach to improvements.
She tried to revamp health care once and failed miserably, in part because she is an inept politician with poor judgement. This whole martyr image really bothers me. She makes $225,000 a pop to talk to billionaires, spends $600 on a hairdo, $50,000 on a week’s vacation, is worth hundreds or millions of dollars and I am supposed to feel sorry for poor, poor Hillary and her scars?
like Berwick?
the same person who voted for the Iraq War.
It’s classic once bitten, twice shy. I’m not saying anything about her personal wealth – that’s completely irrelevant, though for the record I believe she has donated the bulk of her speaking fees to charity.
Isn’t having enough food a basic human right? So by your logic, we should not be buying food from “private corporations” but instead should be issued it by some government entity?
While I think it is not unreasonable to suggest that it is good policy for the government to provide healthcare or at least healthcare insurance for all, I don’t see that it has much to do with any abstract principle that the government must be the sole guarantor of all human rights.
I think you and many others have latched on to the human rights rhetoric as a way of emphasizing how important the issue is to you personally rather than actually thinking through the logical consequences of your statements.
Yes, if I was starving, broke, and unable to feed myself, yes I would expect the government to help me. Wouldn’t you?
However, most of us can provide ourselves with food so this is a silly argument on your part.
Can any of us afford six months of chemotherapy, a heart bypass? Can we do it on our own? No.
The question is whether the government will “help” you, it is whether they must do so directly. You are specifically trying to tie the human right idea to whether or not private entities are involved in the delivery. Both Clinton and Sanders want to ensure that 100% of Americans get healthcare that they can afford no matter what their income. So how is that different from food? Yes, the government should and does help people through food stamps and other programs (and I am sure we could do better BTW), but I don’t hear you objecting to the fact that food does not follow a single payer model or that you must redeem your food stamps at privately run stores.
No most of us cannot afford an expensive procedure out of our income or savings, but many if not most people can afford some kind of private insurance that will pay for that. It does not immediately follow that the only way for everyone to afford insurance is for the government to be the sole provider. Single payer really does make a lot of sense because it is a more efficient, and I am definitely in favor of eventually getting to that model, but the human rights aspect isn’t whether the system is efficient but that everyone has access to it and can afford it. If everyone can get healthcare through a non-single-payer system, I think that satisfies the human rights goal.
You tell me that both Clinton and Sanders want to ensure that 100% of Americans get healthcare that they can afford no matter what their income. That’s not true. I can prove it with Sanders. He wants it to be provided at 100% cost to the community, no fee to the individual regardless of their income, just a it is true with our use of highways, early education (K-12), police protection, and so. Prove to me that Clinton wants to do this. Go on, prove it.
which is that you are using your “human right” line of rhetoric inconsistently and illogically. My point isn’t really about Clinton vs Sanders. You claim that because health care is a “human right” that the ONLY way the government can satisfy that right is to have the government to be the sole provider regardless of income. However, you refuse to consider that the government should provide food or housing in the same fashion if you believe that having adequate food or shelter are also human rights. So it is crystal clear that either food and shelter aren’t really human rights or your chain of argument justifying the form of single payer you are describing above cannot rest on “human rights”.
As far as I am concerned guaranteeing everyone access to adequate healthcare they can afford (or get for free if they cannot afford anything) should be a human right. Providing that healthcare through some sort of single-payer government run system makes a lot of sense and probably is the right thing to strive for, but I don’t see that as a human right in any meaningful sense.
Like it or not, our economy is overly dependent on the healthcare sector. While that does mean that there is a lot of waste and profit taking that could eventually be eliminated to everyone’s benefit. It also means that a lot of American worker’s livelihoods depend on the way things work now. You cannot eliminate the current system overnight without drastically shrinking our economy and putting hundreds of thousands of people out of work.
While I am in favor of single payer as a general principle, I really want to see a plan that is (A) politically possible, (B) economically feasible and (C) takes into consideration how changes will affect workers and students that will be severely affected by the changes. I am not convinced that Sander’s plan addresses any of these points.
I would love to see a healthcare plan that provided the qualities of Sander’s plan but with the practicality of Clinton’s plan, but given the current choice, I would have to go with the plan that has a chance of being implemented and that is Clinton’s. You clearly are more interested in the final goal than in how or whether you get there, so it makes sense that you prefer Sander’s plan.
That is the point.
You want to know if single payer is “feasible”?
Take a trip to France, or Canada, or Denmark, or an other developed nation and find out for yourself.
Hint: It’s not a “theory that will never ever happen”. It actually exists in most of the world.
in the long run, but not what Bernie Sanders is proposing. You cannot magically transform our system overnight. Sander’s plan is not politically possible, is not financially sound, and has absolutely no consideration for the hundreds of thousands of working people who depend on the current system to pay their bills. For someone who says he cares about the concerns of working people, you would think he would take that into consideration, but he has not.
If you really care about implementing a better healthcare model in this country, you should be focussing on putting control of both the White House and Congress back into the hands of the Democrats or others on the left.
of stating an intellectual truth on these topics. He’s right, you’re wrong. He just has to throw up enough crap to justify his opinions to himself.
….that would be great.
Hillary wants health care insurance to be handled by the private sector from the time a citizen reaches the age of 26 where their parents cover them in one way or another until they reach the age of 65 when a government supplied “right” or entitlement kicks in. Why? Can anyone explain to me why, at my present age of 61 I cannot be covered by Medicare but some how, magically on the day of my 65th birthday, single payer of a sort is suddenly NOT a theory that will never ever happen?
is now talking about extending Medicare. Thanks to Bernie. Hillary doesn’t necessarily want the private sector to cover things. She doesn’t see a realistic alternative at the moment. Dropping the age for Medicare would be the kind of thing that she might actually work on. Almost everyone who thinks about this stuff thinks single-payer is the most effective, efficient way to provide health care. It’s the obstacles, not the idea, that are the problem.
You know can’t be covered at 61 because of the law, politics (insurance companies, health care providers), and the money to pay for it. So why do you ask?
Obama was fond of saying, don’t let the perfect be the enemy of the good. To a certain extent, he was right. Obamacare was an important move. It got a lot of people insured and markedly improved people’s lives. Does it have a lot of problems? Yes. But it got the government in the game of health insurance. It is the first move in the war to provide affordable health care to everyone. Hillary will continue that war.
…supporters like me who Clinton supporters are telling to shut up, fall in line, and back Hillary. Yeah, we’re the ones moving Hillary to the left. All she sees are her own, personal political ambitions and maybe she sees that without us she cannot win. The only problem with that is once elected, she forgets us.
Who made the law that I can’t be covered at 61? Hint: Not the labor class.
While I appreciate Obamacare, it’s not enough, not even close. Again, it’s like telling the people in the life boats that saved them from the plight of others on the Titanic that those life boats are enough, and we just need more of them, not a rescue ship, not better built ships, just more lifeboats. And Hillary’s campaign contributors are selling lifeboats….
Nobody is telling you to “shut up” or “fall in line”, or for that matter “back Hillary”.
What some of us are telling you is, instead:
1. Stop spreading Trumpist lies about Ms. Clinton
2. Stop trolling
I have not lied about anything any Clinton has said or done.
If you can prove that I have, please do so. It not, stop trolling and please stop attacking Sanders supporters, setting us up as your scapegoat.
Even when they act like trolls.
after calling them trolls and after telling them they are stupid and being mislead? ….really?
you’re the troll. Your last comment starts by accusing me and backs itself up with a link to Hillary Clinton. This is typical of your comments.
I guess you believe what you say. More’s the pity. Because you don’t learn. You are right. Everyone else is wrong. Clinton is evil. Bernie is good. Your comments are meant to win the argument, not improve your understanding or anyone else’s. Once in a while, you try to bolster your credentials with, “I’m just a poor working class guy.” You still have the closed mind of a conservative and the identity politics to match.
You want to be a progressive? Open your mind. Stop being a polemicist. BMG is a lot of things, but one of them is a collective endeavor to achieve greater knowledge and understanding. Aside from your first post, you don’t participate in this endeavor. Instead, with very sloppy logic, you obsess about blaming Clinton and anyone who supports her.