Revised July 12, 2012
The United States is the only one of the thirty-three developed countries that does not have universal health care. For decades, Republican members of Congress have consistently opposed universal health care and health care reform. One of their excuses is that "we have the best health system care in the world." Republicans who have recently made that claim include Sen. Richard Shelby (R-AL), Sen. John Barasso M.D. (R-WY), Sen. Chuck Grassley (R-IA), Rep. Brad Miller (R-NC), Rep. Peter King (R-NY), and former Sen. Fred Thompson (R-TN).
That statement might well be true if they are referring to themselves, their colleagues, and their families. The government pays approximately three-quarters of the cost of their health care. In other words, we the taxpayers are providing subsidized health care to Congress.
In addition, they can use the services of the Office of the Attending Physician. Its mission is to provide "primary care, emergency, environmental and occupational health services in direct support of the United States Capitol, visiting dignitaries, pages, staffs and tourists." It has several units in the capitol area, including the Hart Senate Office Bldg Health Unit, Cannon House Office Bldg Health Unit, U.S. Capitol Health Unit, Longworth House Office Bldg Health Unit, Rayburn House Office Bldg Health Unit, and the Ford Bldg, House Annex 2 Health Unit. At least two of the units remain open as long as Congress is in session. That service is available to members of Congress for $503/year. There are no deductibles and the members do not have to submit claims forms. Although the cost of health care has skyrocketed in recent years, the cost to members has barely changed in 17 years. Here again, we the taxpayers are providing subsidized health care to Congress.
For millions of other Americans, however, the health care available to them does not rise to the level of most other developed countries. The table below shows U.S. ranking in three health care categories. The numbers come from the Central Intelligence Agency (CIA) and the Institute for Health Metrics and Evaluation (IHME).
Life
ExpectancyInfant
MortalityMaternal
Mortality50 (CIA) 48 (CIA) 39 (IHME)
Among the 49 places with a longer life expectancy are Macau, Hong Kong, Italy, France, Sweden, Ireland Jordan, Greece, Malta, Puerto Rico, and Bosnia and Herzegovina.
Among the 47 places with a lower rate of infant mortality are Cuba, Italy, Czech Republic, Slovenia, the Northern Marianas, and Macau.
Among the 38 places with a lower rate of maternal mortality are Italy, Malta, Spain, Slovakia, Hungary, Poland, Albania, Serbia, Croatia, and Lithuania.
These appalling statistics are hardly due to insufficient expense. Health care expense per capita in the U.S. far exceeds that of any other country; as can be seen here. Many countries with better results have health care costs one-half than that of the U.S. or less. At least part of the reason is corruption by doctors, the health care industry, pharmaceutical industry, and members of Congress.
In 1997, the Justice Department announced that it was investigating Columbia/HCA, a health care company started by Rick Scott, the CEO, for what turned out to be the largest health care fraud case in American history. Scott resigned four months later. Among the charges against Columbia/HCA was that it "... engaged in a series of schemes to defraud Medicare, Medicaid and TRICARE, the military's health care program ..." Ultimately, Columbia/HCA plead guilty to fourteen corporate felonies and paid $1.7 billion in fines. On July 27, 2000, Scott was questioned in a civil suit against Columbia/HCA, the company he created and ran. He replied by invoking the fifth amendment 75 times. On Nov. 2, 2010, Rick Scott, running as a Republican, was elected Governor of Florida by a 1% margin.
For more than 20 years, the Dartmouth Atlas Project has documented variations in Medicare costs and results across the country. One study documents the variation in Medicare reimbursements per enrollee for 2006. One of the places with the highest Medicare reimbursements per enrollee is McAllen Texas. In 2006, Medicare reimbursements per enrollee in McAllen were almost twice as high as those in El Paso County, an area with similar demographics.
One of the people who analyzed the data is Dr. Atul Gawande, a staff member of Brigham and Women's Hospital and the Dana Farber Cancer Institute. He also "... turned to two private firms - D2Hawkeye, an independent company, and Ingenix, UnitedHealthcare's data-analysis company-to analyze commercial insurance data for McAllen." He detailed his findings in an article in the June 1, 2009 issue of The New Yorker magazine. One of the hospitals he visited in the McAllen area was Doctors Hospital at Renaissance. It is owned by the doctors. The more testing they prescribe, the higher their income. According to Dr. Gawande,
"Between 2001 and 2005, critically ill Medicare patients received almost fifty per cent more specialist visits in McAllen than in El Paso, and were two-thirds more likely to see ten or more specialists in a six-month period. In 2005 and 2006, patients in McAllen received twenty per cent more abdominal ultrasounds, thirty per cent more bone-density studies, sixty per cent more stress tests with echocardiography, two hundred per cent more nerve-conduction studies to diagnose carpal-tunnel syndrome, and five hundred and fifty per cent more urine-flow studies to diagnose prostate troubles. They received one-fifth to two-thirds more gallbladder operations, knee replacements, breast biopsies, and bladder scopes. They also received two to three times as many pacemakers, implantable defibrillators, cardiac-bypass operations, carotid endarterectomies, and coronary-artery stents. And Medicare paid for five times as many home-nurse visits."
"Medicare ranks hospitals on twenty-five metrics of care. On all but two of these, McAllen's five largest hospitals performed worse, on average, than El Paso's."
Dr. Gawande also compared the Medicare expenses and results in McAllen to those in Rochester, Minnesota.
"Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country - $6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen."
The doctors at the Mayo clinic are on salary. They do not benefit financially from prescribing tests and only prescribe those tests they think the patients need. Across the country, doctors are opening medical facilities, including imaging facilities, that give them an incentive to over-prescribe. There is also a long, well-documented history of misconduct by health insurance and pharmaceutical companies. Without regulation and oversight, medical expenses will continue to rise without materially improving health.
In some states, the law allows physicians to dispense drugs. In some such cases, physicians have sold drugs at almost ten times the cost.
In 2009, Pfizer paid $2.3 billion to settle civil and criminal allegations that it had illegally marketed several drugs, including Bextra, Geodon, Zyvox, and Lyrica.
On Oct. 26, 2010, GlaxoSmithKline pleaded guilty to charges it had sold twenty contaminated or adulterated drugs for five years. They paid fines totaling $750 million. Among the 20 drugs affected were Avandia, Paxil, and Tagament; all widely used. The problems were first identified in 2002 by Cheryl Eckard, Glaxo's quality assurance manager. When she reported the problems to her boss, she was fired. In 2012, GlaxoSmithKline was again fined, this time $3 billion dollars after pleading guilty for promoting two popular drugs for unapproved uses and for failing to report important safety data about a diabetes drug to the Food and Drug Administration.
In May 2012, Abbott Laboratories paid a fine of $1.6 billion for improper marketing of the antiseizure drug Depakote
In April, a judge in Arkansas fined Johnson & Johnson $1.2 billion for minimizing or concealing the dangers of an antipsychotic drug, Risperdal.
A full account of fraud in the health care and pharmaceutical industries would fill a book.
In opposing the recent health care reform legislation, the health care industry spent $600 million on advertising, lobbying and campaign contributions. They got their money's worth. Not a single Republican senator voted for reform.
In addition to canards about "... the best health care in the world," Republicans have demonstrated egregious hypocrisy and dishonesty. They claimed they didn't have enough time to study the Democrats' proposal and that their ideas were ignored. Actually, they had six years during which Republicans controlled the government. During that time, President George W. Bush did not veto a single Republican spending bill but the Republican Congress did nothing to reform the health care system. As soon as President Obama signed the legislation, former Governor Mitt Romney (R-MA) called it an "unconscionable abuse of power." Yet Romney was proud of passing a comprehensive health care program in Massachusetts that served as a model for the national program. Perhaps the most contentious issue in the proposed legislation was the mandate that individuals purchase health insurance. Senator Chuck Grassley (R-IA) claimed it violates the 10th amendment of the Constitution. Yet sixteen years earlier in 1993, he, Bob Dole (R-KS), and other Republican senators including three still in the Senate (2010); Orrin Hatch (R-UT), Robert Bennett (R-UT), Christopher Bond (R-Mo), supported individual mandates. Grassley maintained support for "individual mandates" right up to the summer of 2009. As soon as the Democrats were ready to sign legislation containing such a mandate, Grassley decided, after sixteen years of support, that such mandates were unconstitutional. Apparently, for Republicans including Romney and Grassley, their ideas suddenly become unconstitutional if Democrats support them.
As soon as the legislation was signed, the health care industry immediately started lobbying and throwing money at members of Congress to get them to repeal the legislation. They want to keep their enormous profits even if it causes the U.S to lag behind dozens of other countries in significant indicators of health. As of September 20, 2013, House Republicans had voted more than forty times to defund the Affordable Care Act ("Obamacare"). If they had a shred of integrity, they would allow it to have a fair trial. If it works, fine; if it fails, there will be widespread support to repeal it. However, Republicans are so frightened that voters will like it and therefore credit President Obama, they will do anything to prevent that from happening.
In 2000, the World Health Organization ranked the health care systems of 190 countries. In spite of the fact that we spend more than any of them, the United States is ranked 37th. Republicans want to keep it that way.