Friday, December 12, 2008

$18 for a Bag Full of Prescription Meds--in Italy

We visited an old friend of ours last year who has retired to Venice, Italy. Richard had a heart attack not long after he moved there, and had to be taken by boat-ambulance to the hospital in this magical city of canals.

He was most pleased by the care he received, and recovered very well. So well, in fact, that we had a hard time keeping up with him as he trotted us through the maze of alleys and up and over all the bridges as he showed us the city's fabulous sites. Then 79, Richard has just turned 80. 

One morning he told us we were on our own because he had to see his doctor to get renewals of his prescriptions. A few hours later, when we were all back at his apartment, he showed us a plastic bag full of his medications. Laughing gleefully, he asked us how much we thought he had paid for them.

Not knowing how he paid for health care in his adopted country, I guessed $1,000.

Oh no, he said. $18.

$18! Which prompted me to ask what he had paid for his stay in the hospital, all his follow-up care, and his regular visits to the doctor since then? A big fat zero. Zilch. 

To our amazement, as a permanent non-citizen resident who does not work, Richard pays only a few hundred dollars a year to be covered by Italy's system of universal health care. Wow.

I told this story the other night to a couple of acquaintances, and they both immediately raised the stereotypical objections to the U.S. switching to a similar system: So why do the Canadians all come here to the U.S. for surgery? Those systems make people wait for care. etc. etc. The government can't be trusted to run anything, and so on.

Now that Obama has appointed Tom Daschle to be his new Secretary of Health & Human Services, it's urgent that we re-open this discussion of how best to reform our unconscionably expensive and income-based health care system. Solving the inequities of our system and lowering its cost is fundamental to solving many of the persistent social problems we face as well as making our businesses more competitive.

While some doctors continue to see their self-interest in continuing our present system, the 60,000 members of Physicians for a National Health Program disagree. In a section on their website , they point out, for example, that "the government" wouldn't be running a single-payer system--doctors and patients would be.

As far as people having to wait for operations--a form of health care rationing--they point out that rationing of health care also occurs in the U.S. It's just done differently here. Instead of being based on the urgency of a person's need as in Canada and elsewhere, here we base it on ability to pay. Here, an estimated 18,000 Americans die every year because they can't afford care. 

Besides providing coverage for everyone regardless of means, moving to a universal, single-payer health care system, would eliminate a big source of corruption in our society. The Boston Globe recently reported that AARP earned nearly $500 billionin  2007 alone by selling seniors 17 varieties of insurance policies, including Medicare supplemental insurance for drugs. Despite the opposition of consumer organizations, AARP worked against the interest of its own members in 2003 by backing a form of coverage of prescription drug costs that raised costs for seniors with low income. For all seniors, the new plan also increased the complexity of Medicare, which is now so complicated that even a careful reading of explanatory booklets leaves you scratching your head. 

But the change was good for AARP: After its passage, AARP expanded its contract with the United Health Group to sell the new policies which, according to the Boston Globe article, are not the lowest cost choice available despite advertising to the contrary. 

Health care system lobbyists, of course, are one of the largest special interest groups that have a big hold members of Congress--from both parties--thanks to campaign contributions and other perks they offer.

It's time to put this whole bunch out of business.

Of course, a lot of Americans currently have jobs in the huge bureaucracy that wastes so much of our health care dollars. Moving to a single payer system can't be accomplished over night. 

But as the Obama Administration addresses this problem, it should be working to implement changes that in increments, over time, move us to a universal, single-payer system. Daschle understands the advantages of a single-payer system but, apparently, believes it is too radical an idea to promote since it's been smeared by opponents as socialized medicine..

But if not now, when change is in the air, when?  I fear we'll have to wait a very long time for another opportunity to move toward a universal system. 


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