Category Archives: Healthcare

Bismark on Rice

Late-Victorian economic doctrine answered the need for an intellectual response to the workers’ challenge, to trade unions, to socialism, to the land reform movement, and to Social Democracy. Liberal economists upheld the existing property order and its inequalities. In Western Europe, North America and Australasia, Social Democracy eventually prevailed over fascism and communism, established welfare states, safeguarded the structures of capitalism, and dominated policy during the first three post-war decades. It sustained economic growth and distributed it more equally. To do this, it had to challenge the assumptions of neoclassical economics, and sometimes to reject them. (Offer, Avner; Söderberg, Gabriel. The Nobel Factor (p. 6). Princeton University Press. Kindle Edition.

In contrast to the competitive free-for-all of orthodox economics, Social Democratic parties in post-war Europe (and in the English-speaking countries) defined a cluster of collective aspirations:

•  Collective insurance against life-cycle periods of dependency, regulated and administered by government and paid for through progressive taxation.
•  Good-quality affordable housing, by means of rent control, new construction, mortgage subsidies, and public or collective ownership.
•  Secondary and higher education, land use planning, scientific research, culture, sports, roads and railways.
•  A mixed economy with extensive public services, some nationalized firms, but leaving private ownership to manage production and distribution.
•  A special concern for disadvantaged groups.13

The United States also went along with a good deal of this programme, and if it failed to provide universal healthcare entitlement, it did provide one for the old and the indigent.

Offer, Avner; Söderberg, Gabriel. The Nobel Factor (pp. 6-7). Princeton University Press. Kindle Edition.

Japan: Bismark on Rice

DURING A DEBATE AMONG THE PRESIDENTIAL CANDIDATES in the spring of 2008, former New York mayor Rudy Giuliani offered a picture of health care in foreign countries: “These countries that say they provide universal coverage—they pay a price for it, you know,” Giuliani explained. “They do it by rationing care, by long waiting lines, and by limiting, or I should say by eliminating, a patient’s choice.” Judging from that, it seems safe to say that Rudy Giuliani has never visited Dr. Nakamichi Noriaki at the Orthopedic Surgery Department of Keio Daigaku Hospital in Tokyo. (Reid, T. R.. The Healing of America (p. 82). Penguin Publishing Group. Kindle Edition.)

In a society that is acutely conscious of hierarchy and rank, Dr. Nakamichi is generally recognized as one of the top orthopedic surgeons in all Japan; his clinic at Keio is perhaps the most respected place in the country for the repair of stiff, aching shoulders like mine. I was first told about him one Thursday morning in Tokyo when I was complaining, as usual, about my shoulder. I called his office to schedule an appointment—and was told to come in that same afternoon. After the familiar poking, patting, massage, and manipulation, Dr. Nakamichi suggested an assortment of different treatments that might work for me; in fact, it was the widest variety of care any doctor had proposed. The treatment available in Japan ranges from acupuncture to injections to manipulation to the total shoulder arthroplasty that my doctor back home had recommended. All the options, he told me, are covered by Japanese health insurance. When I asked how long I would have to wait if I chose the full-scale shoulder-replacement surgery, the doctor checked his computer. “Tomorrow would be a little difficult,” he said. “But next week would probably work.” (Reid, T. R.. The Healing of America (pp. 82-83). Penguin Publishing Group. Kindle Edition.)

In other words: no waiting, no gatekeeper, no rationing, and a broad array of patient choice. Prices are low; as we’ll see, the Japanese system has a rigid cost-control mechanism that favors the patient, at the expense of doctors and hospitals. My out-of-pocket cost for an office visit with the prestigious Dr. Nakamichi in his prestigious clinic came to ¥2,060, or $19 (the doctor charged $64, and insurance pays 70 percent of the bill in Japan). (Reid, T. R.. The Healing of America (p. 83). Penguin Publishing Group. Kindle Edition.)

(….) It’s worth noting that this happens in a largely private-sector system; Japan relies on private doctors and hospitals, with the bills paid by insurance plans. In fact, Japanese doctors are the most capitalist, and most competitive, that I’ve seen anywhere in the world. (Reid, T. R.. The Healing of America (p. 83). Penguin Publishing Group. Kindle Edition.)

(….) Since medical care is so readily available, so easy to get, and so cheap, you might think that the Japanese use an awful lot of medical care. And you’d be right. The Japanese are the world’s most prodigious consumers of health care.1 The average Japanese visits a doctor about 14.5 times per year—three times as often as the U.S. average, and twice as often as any nation in Europe. If you can’t get to the doctor, no problem: Nearly all general practitioners in Japan make house calls, either daily or weekly. (Reid, T. R.. The Healing of America (p. 84). Penguin Publishing Group. Kindle Edition.)

(….) “Japan’s macro health indices, such as healthy life expectancy and infant mortality, are the best, or among the best, in the world,” says Professor Ikegami Naoki, the country’s best-known health care economist. “Now, that’s not all the result of health care. Japan has lower rates of violent crime than most countries, less illicit drug use, fewer traffic accidents, lower rates of HIV infection, less obesity. In terms of keeping people alive and healthy, those factors obviously help. But you also have to give some credit to the health care system for providing universal coverage and egalitarian access without long waiting lists, and we need to credit the doctors and the medical schools for providing a high quality of treatment.” (Reid, T. R.. The Healing of America (p. 85). Penguin Publishing Group. Kindle Edition.)

The Japanese system, in short, provides care to every resident of Japan, for minimal fees, with no waiting lists—and excellent results. This is a good deal for the people of Japan, and they take advantage of it, flocking to clinics and hospitals. To an American, it seems natural that this formula—heavy demand by an aging population, with almost no rationing of care—would add up to a huge national medical bill. But when it comes to costs, Japan has turned the predictable formula upside down. Despite universal coverage and prodigious consumption, Japan spends a lot less for health care than most of the developed nations; with costs running at about 8 percent of GDP, it spends about half as much as the United States. (Reid, T. R.. The Healing of America (p. 85). Penguin Publishing Group. Kindle Edition.)

(….) As we’ll see shortly, not everybody in Japan is happy with the system and its strict cost controls, because the system squeezes cost by sharply limiting the income of medical providers—doctors, nurses, hospitals, labs, drug makers. But if your goal is to provide quality care for everybody at a reasonable cost (which is not a bad goal for any health system), then the Japanese model could be a good one to follow. (Reid, T. R.. The Healing of America (p. 86). Penguin Publishing Group. Kindle Edition.)

Death by Despair

If the rich could hire other people to die for them, the poor could make a wonderful living.

— Yiddish Proverb

It is queer enough to see an author who certainly is unaware of the dialectic of repentance in the direction of sympathy but yet is aware of something resembling it, an expression of sympathy—to see such an author cure this suffering by making the sickness even worse. Börne, in all seriousness and not without some emotion at the thought of how easy it is for people in small towns to become misanthropes or even blasphemers and mutineers against the wise governance of providence, explains that in Paris the statistics on miseries and crimes contribute to curing the impression to which they probably have contributed—and contribute to Börne’s becoming a philanthropist. Well, well, what a priceless invention statistics are, what a glorious fruit of culture, what a characteristic counterpart to the de te narratur fabula of antiquity. Schleiermacher so enthusiastically declares that knowledge does not perturb religiousness, and that the religious person does not sit safeguarded by a lightning rod and scoff at God; yet with the help of statistical tables one laughs at all of life. And just as Archimedes was absorbed in his calculations and did not notice that he was being put to death, so, in my opinion, Börne is absorbed in collecting statistics and does not notice—but what am I saying! Oh, a person who is far from being as sensitive as B. will surely discover when life becomes too difficult for him, but as long as a person is himself saved from misfortune (for B. surely can easily save himself from sin by means of a non-Socratic ignorance) he certainly owes it to his good living to have means with which to keep horror away. After all, a person can shut his door on the poor, and if someone should starve to death, then he can just look at a collection of statistical tables, see how many die every year of hunger—and he is comforted.

Kierkegaard, Søren. Kierkegaard’s Writings, XI, Volume 11 . Princeton University Press. Kindle Edition.

Just like Jesus said, “The poor will always be with us.” There is a group of people [the poor] that just don’t want health care and aren’t going to take care of themselves Morally, spiritually, socially, [the poor, including the homeless,] just don’t wan’t healthcare.

Rep. Roger Marshall, Republican of Kansas, NPR caption above.

In The Great Escape, published in 2013, one of us told a positive story about human progress over the last two hundred and fifty years. The story there was one of previously unimaginable material progress, a decline in poverty and deprivation, and extensions in the length of human life. The generation and application of useful knowledge made this progress possible. A star of the show was capitalism, which freed millions from dire poverty, supported by the positive forces of globalization. Democracy spread around the planet, allowing more and more people to participate in shaping their communities and societies. (Case and Deaton 2020, Preface)

This book is much less upbeat. It documents despair and death, it critiques aspects of capitalism, and it questions how globalization and technical change are working in America today. Yet we remain optimistic. We believe in capitalism, and we continue to believe that globalization and technical change can be managed to the general benefit. Capitalism does not have to work as it does in America today. It does not need to be abolished, but it should be redirected to work in the public interest. Free market competition can do many things, but there are also many areas where it cannot work well, including in the provision of healthcare, the exorbitant cost of which is doing immense harm to the health and wellbeing of America. If governments are unwilling to exercise compulsion over health insurance and to take the power to control costs—as other rich countries have done—tragedies are inevitable. Deaths of despair have much to do with the failure—the unique failure—of America to learn this lesson. (Case and Deaton 2020, Preface)

There have been previous periods when capitalism failed most people, as the Industrial Revolution got under way at the beginning of the nineteenth century, and again after the Great Depression. But the beast was tamed, not slain, and it brought the great benefits laid out in The Great Escape. If we can get the policies right, we can ensure that what is happening today is not a prelude to another great disaster but rather a temporary setback from which we can return to rising prosperity and better health. We hope this book, while not as heartening as The Great Escape, will help put us back on track to make the progress in this century that we have generally made in the past. The future of capitalism should be a future of hope and not of despair. (Case and Deaton 2020, Preface)

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Rep. Roger Marshall (R-Kan.), a member of the GOP Doctors Caucus (comments made in interview with Stat News). He further said, “The Medicaid population, which is a free credit card as a group, do probably the least preventative medicine and taking care of themselves and eating healthy and exercising. And I’m not judging; I’m just saying socially that’s where they are,” he told Stat News, a website focused on healthcare coverage. “So, there’s a group of people that even with unlimited access to healthcare are only going to use the emergency room when their arm is chopped off or when their pneumonia is so bad they get brought to the ER.”

The poor; when will they every learn! Going to the ER when you chop-off your arm! Sheesh, put a band-aid on it and take an aspirin such little faith! It will get better soon like a miracle. Of course, the real solution is education and early and easy and affordable access to preventative healthcare. What the GOP and ilk like Roger Marshall are doing is scapegoating the poor while ignoring the bigger issues in American healthcare, such as insurance companies seeking to deny coverage based upon pre-existing conditions or drug companies charging predatory prices for life saving drugs.

In reality, this is the twisted anti-gospel of the GOP’s evangelical fundamentalist idolatry libertarian unprincipled conservatism and its worship of wealth qua the prosperity gospel qua the gospel of greed the monstrous abomination of a hybrid twisted gospel of evangelical fundamentalism and market fundamentalism, to wit:

Of course, anyone who knows THE ONE TRUE Biblicist gospel, Jesus instructed the poor to feed the rich, for the poor shall fill their empty bellies with good tidings of the prosperity gospel preached to them by the rich they don’t need (or want) good healthcare for their treasures are in heaven. Have you not heard, “Happy are the poor and sick, for their treasures are in heaven waiting for them, and the sooner they get there the better for the rich.” Jesus had a firm sense of justice for the poor, but it was always Trumped by fiscal conservatism and his love for his favorite apostle Ayn Rand. The elderly, widowed, and disabled poor who would receive Medicaid must work or die quickly! What do they expect, mercy? Where do they think they are, heaven on earth? Have they not read, “Whoso stops his ear to the cry of the rich, he also will someday cry for help and no one will hear him.” Jesus also said to the rich man who invited him to dinner, “When you give a dinner or banquet serve caviar and champagne; invite your friends, your GOP fellows and political allies, all your rich republican neighbors, for they also will invite you in return and you’ll be repaid. But when you give a feast, leave some for the poor birds, and you’ll be blessed, for they cannot repay you they are, after all, just sparrows. But not one of these little birdies falls to the ground without the Father knowing. Just don’t leave anything outside the gated community for the poor, the crippled, the lame, the blind and sick human beings or they’ll start dumpster diving and then their goes the neighborhood!