A most interesting and insightful article and op ed by Nicholas Kristof of the New York Times

Is it accurate and insightful or just slighted propaganda ?
The analogy of the  lines and lines of would be ( or denied ) patients at a Tennessee fair grounds – waiting to be assessed or treated is certainly a stark monument to the tales of American private health care – certainly when one invokes the proof source of the Micheal Moore landmark film Sikko, yet one wonders as well at the rigid and self serving bureaucracies of the medical care systems of such countries with  “socialized “  or state run medical care systems – such as Canada or Britain who would downright deny and forbid these patients to have any alternative health care by any means.  Indeed “private ” operations might well be shut down , or worse their professionals chastised and punished by any of a number of means.

The expression in the former Communist Soviet Unions was “They pretend to pay us …. we pretend to work”  along with the maxim everyone had a job but no one could eat ( properly).   That was except for the Communist party bosses.

Opponents suggest that a “government takeover” of health care will be a milestone on the road to “socialized medicine,” and when he hears those terms, Wendell Potter cringes. He’s embarrassed that opponents are using a playbook that he helped devise.

“Over the years I helped craft this messaging and deliver it,” he noted.

Mr. Potter was an executive in the health insurance industry for nearly 20 years before his conscience got the better of him. He served as head of corporate communications for Humana and then for Cigna.

He flew in corporate jets to industry meetings to plan how to block health reform, he says. He rode in limousines to confabs to concoct messaging to scare the public about reform. But in his heart, he began to have doubts as the business model for insurance evolved in recent years from spreading risk to dumping the risky.

Then in 2007 Mr. Potter attended a premiere of “Sicko,” Michael Moore’s excoriating film about the American health care system. Mr. Potter was taking notes so that he could prepare a propaganda counterblast — but he found himself agreeing with a great deal of the film.

A month later, Mr. Potter was back home in Tennessee, visiting his parents, and dropped in on a three-day charity program at a county fairgrounds to provide medical care for patients who could not afford doctors. Long lines of people were waiting in the rain, and patients were being examined and treated in public in stalls intended for livestock.

“It was a life-changing event to witness that,” he remembered. Increasingly, he found himself despising himself for helping block health reforms. “It sounds hokey, but I would look in the mirror and think, how did I get into this?”

Mr. Potter loved his office, his executive salary, his bonus, his stock options. “How can I walk away from a job that pays me so well?” he wondered. But at the age of 56, he announced his retirement and left Cigna last year.

This year, he went public with his concerns, testifying before a Senate committee investigating the insurance industry.

“I knew that once I did that my life would be different,” he said. “I wouldn’t be getting any more calls from recruiters for the health industry. It was the scariest thing I have done in my life. But it was the right thing to do.”

Mr. Potter says he liked his colleagues and bosses in the insurance industry, and respected them. They are not evil. But he adds that they are removed from the consequences of their decisions, as he was, and are obsessed with sustaining the company’s stock price — which means paying fewer medical bills.

One way to do that is to deny requests for expensive procedures. A second is “rescission” — seizing upon a technicality to cancel the policy of someone who has been paying premiums and finally gets cancer or some other expensive disease. A Congressional investigation into rescission found that three insurers, including Blue Cross of California, used this technique to cancel more than 20,000 policies over five years, saving the companies $300 million in claims.

As The Los Angeles Times has reported, insurers encourage this approach through performance evaluations. One Blue Cross employee earned a perfect evaluation score after dropping thousands of policyholders who faced nearly $10 million in medical expenses.

Mr. Potter notes that a third tactic is for insurers to raise premiums for a small business astronomically after an employee is found to have an illness that will be very expensive to treat. That forces the business to drop coverage for all its employees or go elsewhere.

All this is monstrous, and it negates the entire point of insurance, which is to spread risk.

The insurers are open to one kind of reform — universal coverage through mandates and subsidies, so as to give them more customers and more profits. But they don’t want the reforms that will most help patients, such as a public insurance option, enforced competition and tighter regulation.

Mr. Potter argues that much tougher regulation is essential. He also believes that a robust public option is an essential part of any health reform, to compete with for-profit insurers and keep them honest.

As a nation, we’re at a turning point. Universal health coverage has been proposed for nearly a century in the United States. It was in an early draft of Social Security.

Yet each time, it has been defeated in part by fear-mongering industry lobbyists. That may happen this time as well — unless the Obama administration and Congress defeat these manipulative special interests. What’s un-American isn’t a greater government role in health care but an existing system in which Americans without insurance get health care, if at all, in livestock pens.

http://www.nytimes.com/2009/08/27/opinion/27kristof.html?em=&pagewanted=print

The line in the former Soviet Union was that “They pretend to pay us and we pretend to work.” During Stalinist times of the Soviet Union the one ( if not only ) safe means of providing criticism of current economic or social conditions or of providing a comment on the current situation that the citizens were living with and through was through humour – the telling of a joke . It was considered safe tradition. Nothing new here. The basis of most fairy tales are based in political or situational humor – to make light of something very serious and dark. The tale of “Humpty Dumpty . sat on a wall, Humpty had a great fall”- was a description of the Royalty at the time – “Off with your head could be the edict in a flash”. “Ring around the Rosie … A pocket full of poesy – Hush they all fall down” relates tales of the “Black Plague” which caused untold numbers of death and disease in the dark ages.

In the same way Canadians with their health care systems , find that their only recourse to poor service levels with corresponding staggering growth of bureaucracies and their infrastructures and systems find that their only recourse seems to be the telling of jokes and humor related to the current state of the Canadian
“Health Care System” and Systems.

Medical economist M. Labovitch pointedly notes that the butt of the anger is safely directed at doctors rather than taking a risk to the health care of the teller of the tale and their families.

Bureaucrats it seems , while putting in their full days , compiling reports and printing graphs and charts on the high end colour laser printer , have little sense of humour and the telling of jokes:

Five Canadian Surgeons are discussing who makes the best patients to operate on.

The first, an Ontario surgeon says, ‘I like to see accountants on my operating table, because when you open them up, everything inside is numbered.’

The second, a Quebec surgeon responds, ‘Yeah, but you should try electricians! Everything inside them is colour coded.’

The third a B.C. surgeon says, ‘No, I really think librarians are the best; everything inside them is in alphabetical order.’

The fourth, an Alberta surgeon chimes in: ‘You know, I like construction workers…those guys always understand when you have a few parts left over.

But the fifth, a Newfoundland surgeon shut them all up when he observed: ‘You’re all wrong. Politicians are the easiest to operate on. There’s no guts, no heart, no balls, no brains and no spine, and the head and the ass are interchangeable.

At least Canadians currently have the escape valve of private medical care in the US afforded to them at present , at least for the time being.

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It is true that many patients who are in dire straights are not  given a choice.  They are deathly ill or without other access and must take what they are given.

In spite of its apparent costs the beauty of the American system is that is available.  Costs are what they are , however when oil sheiks need treatment – and money is no object – where do they run – its to the US.  Its not even to “private British hospitals ” nowadays.

Hence the American medical system remains an escape valve .  If a patient in dire straights in behind the ques in a country with socialized or limited medical care he or she can always go to the States for treatment.  Money has limited value if you are dead or in no shape to enjoy its mettle.

The interesting thing is that although Canada is held up as a model of available medical care with a socialized medical care system that when major political figures – not even the wealthy , have serious illness , its to the US that they run in a snap.  This is so widely reported and so common , Canadians ( who may well be in a treatment ques for an extended period for serious or debilitating medical illness )  do not even bat an eye towards this and question it.  Nothing much that can be done when it comes to the slowness of the medical system and all its bureaucracies .

Thus in spite of its failing , high costs etc the value of the American medical system , among other paradoxes is that it remains a good safety valve – available always when needed and in addition providing pressure as a good example in point to other less available or efficient medical systems of the world.

TheSpec.com – Local – Hotline will find you family doctor – A doctor shortage exists partly because in past years there were not enough students taken into medical schools to make up for those who were retiring. Also, Ontario’s population has grown, among other factors. …

HealthZone.ca – News & Features – New hotline to find MDs – A doctor runs through the medical history of a new patient on her first time visit to a health clinic in Toronto. Studies indicate that nearly one in every 13 Ontario residents does not have a regular family physician. … Natalie Mehra, director of the health-care advocacy group, the Ontario Health Coalition, said the doctor shortage is a “big problem” all over the province, particularly in Kingston, Windsor, Sarnia, Brockville and northern Ontario. …

Doctor Shortage? – We all know there is a doctor shortage in the US. There aren’t enough doctors to care for the patients. Especially, primary/family doctors. The bottleneck is said to be in the number of available residencies and rotations. …

Hospitalists,nocturnalists,admitologists,anyone rember personal … – A recent perceptive,poignant, essay has attracted the attention of two of my favorite medical bloggers. Dr. RW and DB have both blogged about this entry by Dr. Cherie Glazner. At least the patient described in the narrative saw a …

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