Why Health Care Reform Is So Difficult in the United States

Why is it so hard to change the American health care system? And so much easier to change other countries’ systems?

I pondered this question recently while attending the Commonwealth Fund’s International Symposium on Health in Washington where our latest survey comparing primary care in eleven countries was discussed. I heard presentations describing changes that have been, or are being, implemented in England, France, Germany, Norway, Sweden, Switzerland, the Netherlands, Canada, Australia and New Zealand. In some cases, these are fundamental reforms in how medical care is delivered and how providers are reimbursed. Many of these countries can demonstrate real improvements in the quality of care and efficiency in their systems.

Evidence of how much more difficult it to improve this country’s system is provided by the OECD data from nineteen countries on the number of “deaths amenable to medical care,” that is deaths that could have been prevented by appropriate medical care. It is bad enough that the United States has dropped to last place – with the highest proportion of preventable deaths – of all nineteen countries measured. The data also show that all the other eighteen countries had lowered the number of preventable deaths over five years by much more than this country’s modest 4% improvement.

I would suggest that all of the following are reasons why it is easier, in some countries much easier, to reform their systems than it is to change ours:

1. Their systems are so much simpler. Ours is much more complicated with our “thousand points of payment,” Medicare, Medicaid, Kaiser, the VA, the Mayo Clinic, HMOs, PPOs, and millions of employers and their different health plans.
2. They already have universal coverage, so they can focus on improving quality, efficiency and cost containment without a huge ideological debate about the roles of government and the private sector.
3. They have parliamentary systems, where their governments can usually win the votes of a majority of legislators and only a simple majority is needed. It is much, much harder for an American president to win enough votes in both houses of Congress, including a filibuster-proof sixty votes in the Senate, for controversial new legislation.
4. Lobbies, representing special interests, are much more influential in this county.
5. The power of money; elected officials in most other countries do not have to raise larger sums of money for their campaigns, and are therefore much less beholden to industries or professional groups.
6. They only need a bare majority of votes in their legislatures. None of them have anything like the US Senate’s ability to filibuster.

Another factor that may also make a different is the influence of partisan news networks, especially Fox News, and of talk radio, that spread emotional and often misleading arguments, fuel populist feelings and dumb down the debate.

I should note here that the ease with which parliamentary systems can enact major reforms is not always a good thing. After World War II, Britain’s Labour government nationalized its substantial steel industry. It was then privatized (i.e. denationalized) by the next Conservative government, nationalized again in the 1960s and then denationalized in the 1970s – by which time it had been almost wiped out.

However, when we look at the difficulties our presidents since Theodore Roosevelt have had when trying to pass major health care reforms, one wonders if the uniquely American barriers to change and reform are really desirable.

Voters Want Abortion-Neutral Health Care Reform

A few months ago, I warned that some folks were attempting to misuse healthcare reform to restrict access to abortion. They have come a long way since then, endangering the vital struggle for healthcare — indeed, torpedoing reform is a key goal for many involved in this effort.

Americans oppose using abortion as a means of derailing health care reform and oppose using health care reform as a means of restricting abortion. The more voters find out about what is happening on Capitol Hill with respect to this issue, the angrier they are getting, because language inserted in the House bill will take away coverage for abortion that tens of millions of women already have.

Taking away existing coverage not only violates the public will, but also does fundamental violence to Democrats’ explicit promise that if you like what you have, you will be able to keep it.

In a national survey we conducted for the Women Donors Network, nearly half (47 percent) of the electorate said, “Political differences should not prevent us from moving forward on an otherwise good health care reform plan.” Another 22 percent believe that health care reform should not move forward unless “a woman’s right to choose an abortion is protected.” Only a 26 percent minority believe that health care reform should not move forward unless “we are certain that government money will not be used for abortion.”

Voters clearly oppose the restrictions embodied in the House bill, rejecting even their underlying premise. By over a 20-point margin, voters believe that those who receive partial subsidies should be able to buy plans that cover abortion. By two-to-one, voters would feel less favorably toward a member of Congress who voted to prohibit subsidy recipients from purchasing an insurance policy with abortion coverage.

Indeed, voters’ antipathy to placing abortion restrictions in health care reform is so strong that their inclusion leads voters to oppose reform itself. By a 16-point margin, voters would oppose a health reform plan that prevented private insurance plans from covering abortion.

Debate on the issue strongly favors opponents of abortion restrictions. We presented voters with an argument against allowing coverage of abortion focused around the view that “taxpayer money should not fund abortion.” Matched against an argument in support of covering abortion that suggested, “health care — not politics — should drive” these decisions, 59 percent subscribed to the pro-choice viewpoint and just 36 percent took the anti-choice position.

At a more fundamental level, voters simply do not want Congress making these decisions. Just 14 percent favor Congress and the president making coverage decisions with respect to abortion. Indeed, despite popular disdain for insurance companies, twice as many would prefer they decide whether to cover abortion instead of having politicians make that determination. A significant plurality (43 percent) support empowering an independent commission to make coverage decisions on abortion.

Americans do not want reform to be an excuse for tightening restrictions on abortion or for taking away health coverage millions already have. Nor do they want an abortion debate to stop reform. Voters want an abortion-neutral health care reform.

The way out of this conundrum is clear to voters, if not to legislators. A compromise offered by Rep. Lois Capps (D-CA) enjoyed majority support and was fully acceptable to the small minority that favors further restrictions on abortion. What opposition there was to the Capps compromise came primarily from pro-, not anti-choice voters. Nonetheless, the House swept it away in favor of language much more drastic and deeply unpopular.

The Capps language affords an opportunity to untie the Gordian knot in favor of the anti-choice forces, but does so in a way that is at least minimally acceptable to the pro-choice majority.

Coal in Your Christmas Stocking?

Is there anyone left, on either side of the political spectrum, who wants the Senate health care bill to pass?

Republican Mississippi Governor Haley Barbour had this to say about the Senate bill last week, “This health care plan is like mackerel in the moonlight. Longer that it's out there, the more that it stinks.”

And yesterday, MoveOn said this about the Senate Democratic health care bill in an email to its members, "America needs real health care reform—not a massive giveaway to the insurance companies. Senator Bernie Sanders and other progressives should block this bill until it's fixed."

When Haley Barbour and MoveOn are saying about the same things—this bill should be stopped in its current form albeit for very different reasons—that says a lot.

Weight Loss Simplicity: Don’t Diet

Losing weight has become a favorite pastime in the West, and more and more of a preoccupation in the East also. The effects of the western diet and lifestyle have been devastating for the weight management and healthy living of almost all people touched by it. The ever increasing availability of instant, often over processed and nutrient deficient food, to the daily commutes we make from one location of idleness to another, all while sitting down in the comfort of a car have had huge impact on obesity and general lowered the amount of physical activity that a person is faced with.

Losing weight and being thin, in contrast to these norms, is still seen as the only way to be, and the pressure society places on this ideal is immense. Everywhere you look, in the media, and even in interpersonal expectation, thin is in. In a society that places heavy emphasis on weight control while at the same time places every obstacle possible in your way at the same time can be very frustrating, and is probably one of the main reasons diets fail.

There are many options out there for the person trying to lose weight. There are the usual options of a good diet and exercise, and then there are the extra provided options of binge diets, herbal supplements, drugs, and even surgery. The sad fact is that while many people opt for the instant options such as binging, drugs, or surgery, the duration of weight loss is usually short lived, though dramatic. The risks to health are much higher than if pursuing to lose weight with a healthy diet and exercise and the end effect is a diminished health, relapse into weight gain, loss of energy and resources put into the attempt, and a further shattered self esteem, making coming back from setback even harder than before on many different levels.

The best way to lose weight is to start a healthy and active lifestyle, not just go on a diet. If you make consistent, health improving changes to your life and stick with them, no matter how small, the accumulated effect will be healthy weight loss that sticks, instead of yo yo diet failure or added health risks with few positive results. Knowing what you put into your body is the first step to controlling your diet, and the first step in exercise is to find simple activities to replace inactivity, such as walking to the market instead of driving. Simple changes in lifestyle are more effective in weight loss than inconsistent workouts and dieting attempts of any level.

Weight Loss The Herbal Way

Western society has a never-ending obsession with weight, while at the same time producing the most obese populations on the face of the planet with no side of subsiding the trend.

This strange irony has led to the multitude of products and services that are promoted to the public in order to help them with their weight loss dilemma. Everything from hypnotism, pharmaceuticals, to surgery has been offered as the sure fire solution to your overweight woes.

One often overlooked method of encouraging weight loss is the use of herbal supplements.

Our emphasis on getting what we want when we want it has created a society of “have it now”. While the positive effects of both natural and synthetic treatment are the same, many opt for the fast results of drugs or surgery at the risk of increased complication, and even death. One alternative to these risks is to opt for a sane progress schedule and the elimination of several of the risks involved with other options through the use of herbal weight loss products.

The use of natural foods and herbal products to control weight should be approached as any other medical decision. When used with physically altering goals, certain herb, though generally safe, may still produce side effects in certain individuals. as many herbal weight loss supplements and products are a combination of more than one ingredient, it is wise to read the label and decide if its contents are going to promote your personal weight loss goals or conflict with any medications you might take or conditions that you might have.

Many of the dietary supplements on the market contain one or more of the following ingredients:

Senna, a natural laxative is often one of the main components in herbal dietary supplements. They promote quick weight loss by stimulating the colon. Be aware that if using Senna, you should monitor to make sure you have a proper water intake, or dehydration may become an issue.

Some dietary supplements contain Chromium Picolinate. This is not a natural but a chemical additive, and has been known to cause genetic problems in high doses. It is best to be avoided if possible, but safe to use at recommended doses in most cases. The risk of dehydration is also a factor in its use, so you should drink plenty of water.

St John’s Wart is also very popular in dietary herbal supplements. This herb is not only used in weight loss solutions, t has shown promise in helping to promote cognitive ability. If abused however, the eyes and skin might become irritated, stomach ache may result, or fatigue may set in after ingestion.

Although Dietary supplements can be found in a variety of forms, two sources of natural weight fighting in their rawest forms are green tea, and organic food. Green tea has long been used to promote enhanced digestion and weight control, and the chemical application or use of chemicals in processing of non organic food can sometimes affect the ability for the body to process food correctly and efficiently.