Healthcare Crisis

Healthcare in Crisis

"Our current healthcare system is not only broken; it is in crisis. The problems with our current system are numerous. Recently Rand Corporation found that 60% of the care delivered in the United States in sub-standard. This study included some of the best hospitals to be found in this country.     There are other major problems: There is great inefficiency in the present healthcare system. California has over 1500 insurance plans. With a major portion of health dollars going to "administration" costs, including large executive salaries, commissions, and stockholder dividends, fewer dollars actually go to health care. 7 million Californians are uninsured. Millions more are underinsured Costs are rising for premiums, co-pays, and deductibles for less coverage. People have fewer choices. Hospitals, emergency rooms and trauma centers are closing. Half of personal bankruptcies are caused by medical bills. For-profit managed care maximizes profit (not our health) and rations care. Lack of insurance is the 7th leading cause of death in the United States.   World Health Organization ranked the U.S. health care system 37th in the world for quality and 55th for fairness. The United States is the only industrialized country that does not have universal health care.."

Fast Facts on the U.S. Health Care Crisis

From Infant Mortality to Preventive Care -- The Stats on American Health Care

Oct. 13, 2006

"Lack of universal health care is often cited as one America's leading

domestic concerns, yet states and the federal government have

failed to enact long-lasting, viable solutions

for reform and the United States remains the only industrialized

country that does not guarantee health coverage to all its citizens.

Here are a few statistics that put the crisis in sharp relief:

FACT: One-third of adults (31 percent) and more than half of all children

(54 percent) do not have a primary care doctor (National Medical Expenditure Panel Survey)

FACT: 46.6 million Americans, (15.9 percent of Americans --

about twice the population of Texas) were uninsured in 2005.

 (U.S. Census - August 2006)

FACT: More than two-thirds of uninsured adults in the United States,

worked in 2005. In other words, 39.8 million workers, who had no

health care -- more than the population of Canada.

FACT: Federal spending for health care totaled more than $600

billion in 2005, or roughly one quarter of the federal budget.

(U.S. Office of Management and Budget)

FACT: The total medical expenditures for full- and part-year uninsured in

2004 came to nearly $124 billion -- more than the combined

appropriations in 2004 for Iraq and the anti-terror programs.

FACT: Of 23 industrialized countries, the United States had the

 highest infant mortality rates. U.S. rates were similar to those of

Poland and Hungary. (OECD, Commonwealth

Fund Scorecard, 2006)

FACT: The United States ranked among the bottom of industrialized

countries on healthy life expectancy at age 60 -- meaning Americans

spend more years lived in poor health resulting

 from chronic illness or disability. (OECD, Commonwealth Fund:

Results from a Scorecard, 2006)

FACT: Barely half -- about 49 percent -- of adults receive recommended

preventive care and screening tests according to guidelines for their a

ge and sex. (Commonwealth Fund Scorecard 2006)

FACT: Close to 100,000 Americans die annually from medical

errors -- more than double the number of Americans who die annually

in car crashes (Institute of Medicine)."

The US Healthcare Crisis Rising Supply of American Patients

Jan 1, 2008 - JONATHAN S. EDELHEIT

"In traveling around the world, no matter what country I go to, the theme

is very clear.  One of the main marketing targets for international hospitals

is the United States.    People from

Canada or the UK may be a target, but the “icing on the cake” is still America. 

People who live outside of the

United States are shocked and amazed that that Americans do not have

nationalized healthcare, and that the

US government does not provide health services to Americans, not even

basic healthcare.  They are even more shocked to

 find out there are almost 50 million Americans who have no insurance, a

nd 120 million who have no dental insurance. 

Compared to Canada and the UK that have nationalized healthcare,

America seems like an amazing

opportunity for international hospitals to tap into the demand for quality

healthcare at affordable prices.  

To add to the potential marketplace, Insurance Companies and Self Funded

employers that represent hundreds of millions of Americans who do have

health insurance are now starting to

implement options to provide incentive to go overseas for care. 

This means the potential marketplace for international

hospitals is much bigger than simply the 50 million uninsured.  

How will insurance companies and employers offer incentives for employees

to go overseas?  Some will waive deductibles and coinsurance. 

This means if an employee has a $2,000

deductible and their coinsurance is an additional $3,000 per year, the

employee could potentially save $5,000

for going overseas for a surgery.  On top of that, some employers and

insurance companies are looking at giving

employees a cash incentive or in some cases a percentage of savings. 

This means an employee could not only

possibly save up to $5,000 or more on their deductible and coinsurance

but may have a significant cash

incentive and actually make a profit on going overseas for care.

Another reason why most international hospitals find Americans a target

marketplace is that while only a small percentage of Americans have passport,

most Americans really don’t have

a fear of traveling or going overseas for care, compared to other countries.  

Secondly, in surveys conducted by

the Medical Tourism Association with international hospitals, it was

determined that in other countries like the

UK, people can spend months or a year or more deciding if they want to

go overseas for surgery.   Like the cowboys

Americans are sometimes perceived to be, Americans are known for

“pulling the trigger” and making a decision

within days or weeks to go overseas for surgery.   This means when

hospitals focus their target on American

patients, it is the only marketplace where they can get the fastest return

on their investment than other countries

 like the UK or Canada.

Currently hospitals from India, Taiwan, Korea, Philippines, Israel,

Thailand, Vietnam, Singapore and Malaysia among countries are all

trying to figure out their marketing plans and how to tap into the American healthcare crisis.

In 2006 almost 500,000 Americans traveled overseas for medical tourism.

For Americans with no health insurance having to pay for a life saving

surgery in the US, such as a heart bypass or transplant, it is simply

unaffordable and unattainable.   More so,

expensive orthopedic procedures such as knee replacements,

hip resurfacing, back surgery also area unaffordable. 

For the 50 million Americans with no health insurance going overseas,

overseas care is the only option.  

One common misnomer people have is that the uninsured are poor. 

The Average American without health insurance

makes approximately $50,000 US per year.   The poor people in

America are on Medicaid, which means they are

covered by the federal government.

In 2006 the US Census Bureau stated that the number of uninsured

Americans jumped from 2005 from 15.3% uninsured and a total of

44.8 million to 15.8 percent of people in

 2006 for a grand total of 47 million.  Based on these numbers one

can only estimate that we are close in 2007 to

having almost 50 million uninsured Americans.  To so many foreign

hospitals and foreigners this is absolutely mind boggling.  

How can a country like the USA, envied by so many and the “land of

opportunity” and “the American dream,”

 leave so many people without any access to healthcare.  

America’s misfortune is opportunity for

Medical Tourism and foreign hospitals.

There are hundreds of millions of Americans who do have health insurance.

The US Census Bureau reported in 2006 that 201.7 million Americans

were covered by private health insurance and 80.3 million were covered

by government health insurance programs. 

Surprisingly the number of Americans with health insurance did not change

significantly between 2005 and 2006. 

What does this mean?   The number of uninsured is growing while the

number of people insured is staying the

same or even possibly getting smaller as the American population grows.

In 2005 it is reported that 60...2% of those people with health insurance

were provided insurance through their employer.  In 2006, this percentage

decreased to 59.7%.   This means in

 2006, over 1 million Americans had lost their health insurance through their

employer.  Which signifies a trend

that everyone in US healthcare knows, more and more US employers are

canceling their employer based health

insurance leaving employees with no health insurance.

What’s even more interesting and should be taken into consideration

by everyone in the industry is the makeup by race/ethnicity. 

The percentage and the number of uninsured African

Americans increased from 19.0 percent and 7.0 million in 2005 to 20.5

percent and 7.6 million in 2006.   The percentage and the number of

uninsured Hispanics increased to 34.1 p

ercent and 15.3 million in 2006.   In America these

are some of the two largest ethnicities/races who are uninsured and in

need of some kind of solution, hospitals and

medical tourism companies should take notice.

In a report by the Agency for Healthcare Research and

Quality in 2006 (Issue #19, June 2006, Research in Action,

below are some very interesting facts:

• Five percent of the population accounts for almost half (49 percent) of total health care expenses.
• The 15 most expensive health conditions account for 44 percent of total health care expenses in the US
• Patients with multiple chronic conditions cost up to seven times as much as patients with only one chronic condition
• The proportion of healthcare spenders who remained among the top 1% of spenders for two years in a row doubled between 1996-97 and 2002-03, which means Americans with the most chronic conditions, are costing the US healthcare system more and more as each year goes on.
• The five most expensive health conditions in the US are heart disease, cancer, trauma, mental disorders and pulmonary disorders.
• Those in the top 5 percent spent, on average, 17 times as much per person as those in the bottom 50 percent of spenders.
• The elderly make up 23% of the major costs of our healthcare spending and each year more people are entering these age brackets as the baby boomers mature and get older.
• Over half the people in the top 5 percent of all health care spenders had out of pocket expenses (not including out of pocket health insurance premiums) over 10 percent of family income.
• More specifically: Thirty four percent had out of pocket medical expenses that exceeded 10 percent of annual family income.Eighteen percent had out of pocket expenses in excess of 20 percent of annual family income.

Here are some more interesting US healthcare facts:

• Heart disease and trauma ranked first and second as the two most expensive conditions in terms of total health care spending
• Researchers attribute to the increased costs of healthcare in the US and people seeking more medical treatment to three factors (1) the continued rise in the share of privately insured adults classified as obese,(2) changes in clinical treatment guidelines and standards for treating patients without symptoms or with mild symptoms only, and (3) the availability of new medical technologies to diagnose and treat patients.

Obesity

The future plans of many international hospitals for America are aimed at

obesity and surgical procedures that solve this growing need by Americans.  

Particularly important is the increase

in the number of people treated for conditions clinically linked to obesity. 

 From 1987 to 2002, the proportion

of the population treated increased 64 percent for diabetes (accounting for

80 percent of the increase in costs)

and increased 500 percent for hyperlipidemia (accounting for almost 90

percent of the increase in costs)

Baby Boomers

Hospitals should realize that there is also a very separate and growing

marketplace for medical tourism in the US – Baby Boomers.  

As the Baby Boomer generation gets older they will

place an extra burden on the US healthcare system, and many will

start looking overseas for their orthopedic

and cardiac procedures.

                    Here are some interesting facts about the Baby Boomer generation:
 

• The number of Americans aged 65 or over will double by 2050
• The number of people age 85 or over will quadruple by 2050
• By 2030 over half of U.S. adults will be over age 50
• More than six of every 10 Boomers will be managing more than one chronic condition.
• More than 1 out of every 3 Boomers – over 21 million – will be considered obese.
• One out of every four Boomers – 14 million – will be living with diabetes.
• Nearly one out of every two Boomers – more than 26 million – will be living with arthritis.
• Eight times more knee replacements will be performed in 2030 than today.
• 62% of 50 to 64 year olds reported they had at least six chronic conditions (hypertension, high cholesterol, arthritis, diabetes, heart disease and cancer). As Boomers age, this number will grow from almost 8.6 million today (about one out of every 10 Boomers) to almost 37 million in 2030.
• The increase in longevity of Boomers – on top of advances in medications, less invasive treatments and diagnostic testing – will greatly increase the demand for cardiology.

Now that you have this information, what will you do with it?   Do you

 want to go after the American marketplace, and if so what will your

approach you do?  What is your organizations

marketing plan for 2008?

So your hospital is interested in going after the American marketplace or

your hospital is already going after the American Marketplace with not

much success?  STOP!    Ask yourselves

how to effectively do so. 

It is important for international hospitals to understand what their target

market is so they can better understand how to market to it.  Is your

hospital’s market the 50 million uninsured

or large US employers and insurance companies who are going to give

 incentives to their employees, or it is

both?  How will you reach your target market and how will you build a

brand reputation so that your hospital

is a preferred choice for American Patients?  Contact the MTA today so we can help!

Jonathan Edelheit is President of the Medical Tourism Association

with a long history in the healthcare industry, providing third party

administration services for fully insured,

self-funded and mini-medical plans to large employers groups."

by Seth Sandronsky

"(Swans - October 23, 2006)  The cost of US health care has climbed 43

percent over the past nine years, according to the Bureau of Labor Statistics.

This price jump is close to

 double the overall rate of inflation (price increases) of 26 percent in the

same nine years. David Leonhardt, in

The New York Times of September 27, wrote that the skyrocketing prices

for the US health care system "are slowly

creating a crisis."

However, he continued, we fool ourselves if we think that American health

care is over priced. In fact, the nation's health care is priced right for what

 the American people get. We are living

longer and as a result are paying more for health care that includes

"defibrillators, chemotherapy, cholesterol

drugs, neonatal care and other treatments that are both expensive and effective."

I have a question for Leonhardt. If US health care is such a great deal for

what it provides the people of the world's best democracy, please explain

how is it that a nation such as Canada

spends less per person for health care, while Canadians have longer life

 expectancies than Americans?

Total health expenditure per person for 2004 was $6,102 in the U.S.

versus $3,165 in Canada, according to the Organisation for Economic

Co-operation and Development (OECD).

As of two years ago, Americans were paying 45 percent more than what

Canadians pay for health care.

Spending on health care per person in the U.S. was $1,776 versus

$1,264 in Canada in 1985. Health care spending was $2,752 for the U.S.

and $1,737 for Canada in 1990. By 1995, US

health care spending per person was $3,670 compared with $2,055 in

Canada. US health care spending per person

reached $4,588 as Canadian spending was $2,503 per person in 2000..

Canada's per person health care costs

went from 71 percent of US levels in 1985 to 55 percent in 2004.

Meanwhile, Canadians can expect to live longer than Americans.

Life expectancy was 79.3 years for Canadians versus 76.8 years for

Americans in 2000, according to the OECD.

Canadians could expect to live 75.3 years compared with Americans'

73.7 years in 1980. Canadians' life

expectancy was 77.6 years in 1990 versus life expectancy of

75.3 years in the U.S.

As US per-person health care spending rose relative to Canada's

 expenditures, Canadians' life expectancies increased more than Americans'.

How can that be? The OECD does

not provide that answer. What we do know is that Canada provides its

 citizens with universal health care. The U.S. does not.

Leonhardt does not consider universal health care. Thus his column

echoed conventional thinking on US health care. Consider this:

The day after Sacramento County workers walked out, in no small

part due to management pushing them to pay more for health care,

California Governor Arnold Schwarzenegger

vetoed state Senator Sheila Kuehl's (D-Santa Monica) Senate

Bill 840 to provide all Californians with high-quality,

comprehensive health care.

"SB 840 relies on the failed old paradigm of using one source -- this

 time the government -- to solve the complex problem of providing

medical care for our people," the governor said in a

press statement.

Without a mention of this vetoed universal health care bill, an unsigned

Sacramento Bee editorial of September 7 urged county workers to get

used to health care costs, rising for "

everyone.." It is worth noting that Kuehl's bill would have done away

with a main force driving up the costs of

medical care -- private health insurance. These same insurers such as

Blue Cross/Blue Shield are also a source

of ad revenue for media such as The Bee and campaign cash for the political system.

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Internal Resources

America the 'beautiful'

Patterns which Connect

About the Author

Seth Sandronsky is a member of Sacramento Area Peace Action,

California, and a co-editor of Because People Matter, Sacramento's progressive paper.

Legalese

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This Edition's Internal Links

Change The Course - Jan Baughman

Thoughts On The US Midterm Elections - Louis Proyect

Get This: Imperialism Is Bipartisan - Aleksandar Jokic

US Midterm Elections: Recommendations - Jan Baughman & Gilles d'Aymery

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Fourth Generation Warfare And The Limits Of Empire - Robert Wrubel

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Dead Earnest - Charles Marowitz

The Insurgent Word: Survival - Gerard Donnelly Smith

Jack Kerouac In The Heel Of Italy - Book Review by Peter Byrne

Genesis Two - Poem by Guido Monte

Letters to the Editor"

'SiCKO' Factual Backup

SiCKO: There are nearly 50 million Americans without health insurance.

• "The Centers for Disease Control and Prevention actually reported that 54.5 million people were uninsured for at least part of the year. Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2006. Centers for Disease Control. http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur200706.pdf

• The amount of uninsured is rising every year, as premiums continue to skyrocket and wages stagnate. From 2004 to 2005 the number of uninsured rose 1.3 million, and rose up nearly 6 million from 2001-2005. Leighton Ku, "Census Revises Estimates Of The Number Of Uninsured People," Center on Budget and Policy Priorities, April 5, 2007 http://www.cbpp.org/4-5-07health.htm. With 44.8 uninsured in 2005, in 2007 the number will be much higher. Professors Todd Gilmer and Richard Kronick, in "It's The Premiums, Stupid: Projections Of The Uninsured Through 2013," Health Affairs, 10.1377/hlthaff.w5.143, "project that the number of non-elderly uninsured Americans will grow from forty-five million in 2003 to fifty-six million by 2013." According to these authors, by now the number of non-elderly uninsured by this date clearly would be nearly 50 million.

SiCKO: 18,000 Americans will die this year simply because they're uninsured.

• According to the Institute of Medicine, "lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States. Although America leads the world in spending on health care, it is the only wealthy, industrialized nation that does not ensure that all citizens have coverage." Insuring America's Health: Principles and Recommendations, Institute of Medicine, January 2004.
  http://www.iom.edu/?id=19175

SiCKO: Richard Nixon and John Ehrlichman are heard discussing the concept of a health maintenance organization in Oval Office Recordings.

• On February 17, 1971, Richard Nixon met with John Ehrlichman to discuss the Vice President's position on health maintenance organizations, as heard in the film. The Miller Center of Public Affairs has this audio recording (conversation number 450-23. "Richard Nixon - Oval Office Recordings,"
  http://millercenter.virginia.edu/scripps/digitalarchive/presidentialrecordings
  /nixon/oval?PHPSESSID=b813e56b3017d097cd176720bc10fc74

• The next day, Nixon called for a "new national health strategy" that had four points for expanding the proliferation of health maintenance organizations, or HMOs. "Special Message to the Congress Proposing a National Health Strategy," February 18th, 1971, http://www.presidency.ucsb.edu/ws/index.php?pid=3311

• The term "health maintenance organization" was coined by Nixon advisor Paul Ellwood. Patricia Bauman, "The Formulation and Evolution of the Health Maintenance Organization Policy, 1970-1973, Social Science & Medicine, vol. 10. 1976. After Congress passed Nixon's HMO Act in 1973, HMOs in America increased nine-fold in just ten years. N. R. Kleinfield, "The King of the HMO Mountain," New York Times, July 31, 1983.

SiCKO: The American Medical Association distributed a record featuring Ronald Reagan discussing the evils of socialized medicine.

• Ronald Reagan's recording was widely available in the 1960s, and was a part of the American Medical Association's "Operation Coffee Cup," a coordinated rebuttal to Democrats' push for Medicare. Max Skidmore, "Ronald Reagan and Operation Coffee Cup: A Hidden Episode in American Political History," Journal of American Culture, vol. 12. 1989..

SiCKO: $100 million spent to defeat Hillary's health care plan.

• "Even before debate began in Congress, a powerful coalition had been cobbled together to fight Clintoncare, as opponents labeled it - congressional Republicans, the insurance industry, the pharmaceutical industry, the National Federation of Independent Businesses, the Business Roundtable, the Christian Coalition, the conservative radio talk show network. Those groups spent between $100 million and $ 300 million to defeat it. And the battle was fought like a presidential campaign - with a TV advertising campaign, a network of field operatives and public relations experts to lobby members of Congress back in their districts.." Rob Christensen, "Who killed health care reform? Answer: Everyone," News & Observer, June 19, 1996.

• "In 1993-94, the Health Insurance Association of America, a trade group, spent about $15 million on advertising to defeat Clinton's proposed overhaul of the nation's health care system." John MacDonald, "Proponents, Opponents Join Battle Over Drug Price Limits," Hartford Courant, June 21, 2000.

• "'We spent $1.4 million to fight President Clinton's plan,' [Mike Russell of the Christian Coalition] says." Harold Cox, "Business will spearhead Health Reform II ; Old enemies of Clinton's plan in lead," Washington Times, December 27, 1994.

• "A study by Citizen Action, a consumer group, reports that doctors, hospitals, insurance companies and other providers of medical services made campaign contributions of $ 79 million during the 1993-1994 election cycle. The insurance industry passed out $16 million. The American Medical Association, which objects to cost-control measures, contributed $ 3 million." Froma Harrop, "The big lie about health reform," Rocky Mountain News, August 20, 1995.

• "According to [Citizens for a Sound Economy] spokesman Brent Bahler, the group has not bought any airtime for commercials but has 'tentative plans' for a grassroots advocacy effort that would include an advertising component. Last year, Bahler said, the CSE spent more than $2 million on print, radio and television advertising to defeat Clinton's health care reform plan." James A. Barnes, "RNC Turns To TV Ads On Budget," National Journal, 5.16.95.

SiCKO: The United States is ranked #37 as a health system by the World Health Organization.

• "The U. S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds.." "World Health Organization Assesses The World's Health Systems," Press Release, WHO/44, June 21, 2000. http://www.who.int/inf-pr-2000/en/pr2000-44.html

SiCKO: Health industry companies accused of wrongdoing in Sicko.

• Aetna: "Aetna Inc. … settled with the plaintiffs, which include the medical associations of California and Texas. Aetna agreed to pay the plaintiffs $120 million." Milt Freudenheim, "Class-Action Status Is Upheld for Doctors Suing Insurers," New York Times, September 2, 2004. See also, Susan Beck, "HMO Postmortem," American Lawyer, October 10, 2003. Settlement Agreement, http://www.aetna.com/provider/agreement_with_physicians.html

• Blue Cross/Blue Shield: "Sixty-seven Blue Cross/Blue Shield companies across the nation have paid the United States a total of $117 million to settle government claims that Medicare made primary payments for health care services that should have been paid by the Blue Cross/Blue Shield private insurance companies, the Department of Justice announced today." "Blue Cross/Blue Shield Companies Settle Medicare Claims, Pay United States $117 Million, Agree To Share Information," Department of Justice News Release, October 25, 1995.
  http://www.usdoj.gov/opa/pr/Pre_96/October95/551.txt.html

• Cigna: "Cigna Corporation, [has] settled with the plaintiffs, which include the medical associations of California and Texas. … Cigna agreed to pay $85 million." Milt Freudenheim, "Class-Action Status Is Upheld for Doctors Suing Insurers," New York Times, September 2, 2004.

• "HCA Inc. (formerly known as Columbia/HCA and HCA - The Healthcare Company) has agreed to pay the United States $631 million in civil penalties and damages arising from false claims the government alleged it submitted to Medicare and other federal health programs, the Justice Department announced today. … Previously, on December 14, 2000, HCA subsidiaries pled guilty to substantial criminal conduct and paid more than $840 million in criminal fines, civil restitution and penalties. Combined with today's separate administrative settlement with the Centers for Medicare & Medicaid Services (CMS), under which HCA will pay an additional $250 million to resolve overpayment claims arising from certain of its cost reporting practices, the government will have recovered $1.7 billion from HCA, by far the largest recovery ever reached by the government in a health care fraud investigation." "Largest Health Care Fraud Case In U.S. History Settled; HCA Investigation Nets Record Total Of $1.7 Billion," Department of Justice News Release, June 26, 2003.
  http://www.usdoj.gov/opa/pr/2003/June/03_civ_386.htm

SiCKO: Executive Compensation

• Michael B McAllister earned $3.33 million in compensation as CEO of Humana.
• "Forbes 2006 Executive Pay list," April 20, 2006.
  http://www.forbes.com/lists/2006/12/AG0Q.html.

• John W Rowe earned $22.2 million in compensation as CEO of Aetna.
• Rowe has since left Aetna. "Forbes 2004 Executive Pay list," April 21, 2005.
  http://www.forbes.com/static/execpay2005/LIRS5NI.html?passListId=12
  &passYear=2005&passListType=Person&uniqueId=S5NI&datatype=Person

• Bill McGuire has stock options worth $1.6 billion at the end of 2005, as CEO of UnitedHealth Group. Robert Simison, "SEC Investigates UnitedHealth
• Over Stock-Options Practices," Bloomberg News, December 27, 2006; Michael Regan,
• "Business 2006: Who Won, Who Lost," Associated Press,December 26, 2006.

SiCKO: There are four times as many health care lobbyists as there are members of Congress.

• According to the Center for Responsive Politics (www.opensecrets.org),
• in 2005 there were 2,084 health care lobbyists registered with the federal government.
• With 535 members of Congress, that's 3.895 lobbyists per member.

SiCKO: Hillary Clinton became the second largest recipient in the Senate of health care industry contributions..

• "As she runs for re-election to the Senate from New York this year and lays the groundwork for a possible presidential bid in 2008,
• Mrs. Clinton is receiving hundreds of thousands of dollars in campaign contributions from doctors, hospitals, drug manufacturers and insurers.
• Nationwide, she is the No. 2 recipient of donations from the industry, trailing only Senator Rick Santorum of Pennsylvania, a member of the Republican leadership."
• Raymond Hernandez and Robert Pear, "Once an Enemy, Health Industry Warms to Clinton," New York Times, July 12, 2006.

SiCKO: Drug industry money to members of Congress, and the president, who led the effort to pass the Medicare Part D prescription drug plan.

• "The health industry gave $14 million total to the eleven elected officials largely credited with negotiating the bill. Pharmaceutical company PACs, employees, and their families gave more than $3 million in campaign contributions to (those) eleven elected officials." Buying A Law: Big Pharma's Big Money and the Bush Medicare Plan, Campaign Money Watch, January 2004.
  http://www.ourfuture.org/docUploads/donnelly$_1-15-04.pdf

SiCKO: The Medicare Part D plan will hand over $800 billion of our tax dollars to the drug and health insurance industry.

• According to the Congressional Budget Office, for the ten-year period, 2006 through 2016, the projected spending is $848 billion. "The Budget and Economic Outlook: Fiscal Years 2008 to 2017," Congressional Budget Office, January 2007. http://www.cbo.gov/ftpdocs/77xx/doc7731/01-24-BudgetOutlook.pdf

SiCKO: The elderly could end up paying more for their prescription drugs than they did before under Part D - and a majority of senior citizens could still pay over $2000 a year.

• "For all patients, Medicare covers 75 percent of the first $2,250 worth of drugs. But after that, coverage drops to zero - and doesn't resume until the patient hits $5,100 in expenses. Then Medicare kicks in again, paying 95 percent of costs. But it's this gap - of almost $3,000 - that many sick and disabled seniors call unaffordable." Medicare's 'Donut Hole,' CBS News, July 26, 2006.
  http://www.cbsnews.com/stories/2006/07/26/eveningnews/main1839288.shtml

• "Nearly 7 million seniors and individuals with disabilities who purchased stand-alone prescription drug coverage are now at risk of falling into the 'doughnut hole.'
• According to a report released today by Senior Democrats on the House Ways and Means Committee… nearly 88 percent of new drug plan enrollees,
• roughly 7 million individuals, are at risk of losing coverage for their medications while they continue to pay monthly premiums to their insurers. The report further details how few individuals have enrolled in plans without doughnut holes, presumably because of the prohibitive cost of such plans."
• "88% Of New Medicare Drug Program Enrollees At Risk Of Falling Into The 'Doughnut Hole,'" Joint News Release From Representative Charles B. Rangel, Ranking Democrat, Committee On Ways And Means, Representative Pete Stark, Ranking Democrat, Subcommittee On Health, Committee On Ways And Means, Representative Sander M. Levin, Ranking Democrat, Subcommittee On Social Security, Committee On Ways And Means, September 21, 2006.
  http://www.house.gov/list/press/wm31_democrats/060921_88
  _of_new_medicare_drug_program_enrollees_at_risk_of_falling
  _into_the_doughnut_hole.html

• "Over the past year, Part D drug prices have increased several times faster than the rate of inflation.
• Families USA analyzed the prices for 15 of the drugs most frequently prescribed to seniors. We examined prices for each of the plans offered by the largest Part D insurers, which together cover about two-thirds of all Part D beneficiaries.
• We then compared the lowest available Part D price for each drug in April 2006 with the lowest available price for the same drug in April 2007.
• The lowest price for every one of the top 15 drugs prescribed to seniors increased, and the median increase was 9.2 percent." Medicare Part D Prices Are Climbing Quickly, FamiliesUSA, April 2007.
  http://www.familiesusa.org/assets/pdfs/medicare-part-d-drug-prices.PDF

SiCKO: Fourteen Congressional aides went to work for the industry; Billy Tauzin left Congress to become CEO of PhRMA for a $2 million annual salary.

• See, e.g., The Medicare Drug War: An Army of Nearly 1,000 Lobbyists Pushes a Medicare Law that Puts Drug Company and HMO Profits Ahead of Patients and Taxpayers, Public Citizen Congress Watch, June 2004,
  http://www.citizen.org/documents/Medicare_Drug_War%20_Report_2004.pdf

• "Retiring Rep. Billy Tauzin, R-La., who stepped down earlier this year as chairman of the House committee that regulates the pharmaceutical industry, will become the new president and CEO of the drug industry's top lobbying group…Public Citizen, a non-profit consumer advocacy group, called Tauzin's hiring 'yet another example of how public service is leading to private riches.'
• Tauzin gets a pay package reportedly worth at least $2 million a year, making him one of the highest-paid lobbyists in Washington." "Tauzin switches sides from drug industry overseer to lobbyist," USA Today, December 15, 2004.. http://www.usatoday.com/money/industries/health/drugs/2004-12-
  15-drugs-usat_x.htm

SiCKO: Canadians live three years longer than we do.

• The 2006 United Nations Human Development Report's human development index states the life expectancy in the United States is 77.5, and the life expectancy in Canada is 80.2. Human Development Report 2006, United Nations Development Programme, 2006 at 283.
  http://hdr.undp..org/hdr2006/pdfs/report/HDR06-complete.pdf.

SiCKO: Tommy Douglas, who pioneered Canada's health care system, was heralded as the nation's singular most important person.

• "In November 2004, Canadians voted Tommy Douglas the Greatest Canadian of all time following a nationwide contest. Over 1.2 million votes were cast in a frenzy of voting that took place over six weeks as each of 10 advocates made their case for the Top 10 nominees in special feature programs on CBC Television… . From his first foray into public office politics in 1934 to his post-retirement years in the 1970s, Canada's 'father of Medicare' stayed true to his socialist beliefs -- often at the cost of his own political fortune -- and earned himself the respect of millions of Canadians in the process." "The Greatest Canadian," CBC, 2004. http://www.cbc.ca/greatest

SiCKO: Canadian "wait times" not nearly as long as some try to allege.

• According to Statistics Canada, the official government statistical agency, "In 2005, the median waiting time was about 4 weeks for specialist visits, 4 weeks for non-emergency surgery, and 3 weeks for diagnostic tests. Nationally, median waiting times remained stable between 2003 and 2005 - but there were some differences at the provincial level for selected specialized services.… 70 to 80 percent of Canadians find their waiting times acceptable" "Access to health care services in Canada, Waiting times for specialized services (January to December 2005)," Statistics Canada, http://www.statcan.ca/english/freepub/82-575-XIE/82-575-
  XIE2006002.htm

• A recent study of emergency care in Ontario found that overall, "50% of patients triaged as CTAS I [most acute] were seen by a physician within 6 minutes and 86% were seen within 30 minutes of arriving at the [Emergency Department]. In contrast, the 50% of patients triaged as CTAS IV or V who were seen most quickly waited an hour or less, while 1 in 10 waited three hours or more. Understanding Emergency Department Wait Times: How Long Do People Spend in Emergency Departments in Ontario? Canadian Institute for Health Information, January 2007.
  http://www.cihi.ca/cihiweb/dispPage.jsp?cw_page=reports_
  wait_times_bulletins_e

• "Gerard Anderson, a Johns Hopkins health policy professor who has spent his career examining the world's healthcare, said there are delays, but not as many as conservatives state. In Canada, the United Kingdom and France, 'three percent of hospital discharges had delays in treatment,' Anderson told The Miami Herald. 'That's a relatively small number, and they're all elective surgeries, such as hip and knee replacement.' John Dorschner, "'Sicko' film is set to spark debate; Reformers are gearing up for 'Sicko,' the first major movie to examine America's often maligned healthcare system," Miami Herald, June 29, 2007.

SiCKO: Drugs in England only cost $10.

• For much of 2006, the standard charge for a prescription was £6.65. "The cost of an NHS prescription in England is to rise by 15p to £6.65 from the start of April." "Prescription charge to rise 15p," BBC News, March 13 2006.

• From April 1 2007 to present, the charge is £6.85. "There are many unacceptable inequities and anomalies in the present system. Although around four out of five prescriptions are exempt (see below for list of exempt categories), the price of a prescription (£6.85 from 1 April 2007) often hits those who cannot afford such charges. There are many people with chronic conditions who are not exempt and those on low incomes find it very difficult to pay. This causes a disproportionate levy on a limited section of the population." British Medical Association, "Funding - Prescription Changes," March 2007. http://www.bma.org.uk/ap.nsf/Content/FundingPrescriptionCharges

SiCKO: After losing 42,000 civilians in eight months during a vicious bombing campaign during World War II, Britain pulled together and instituted a National Health Insurance program in 1948.

• "The Blitz was September 7, 1940 through May 11 1941. "42,000 civilians are estimated to have died during the campaign, with over 50,000 injured, and around 130,000 houses destroyed." See, "Remembering the Blitz,"
  http://www.museumoflondon.org.uk/archive/exhibits/blitz/intro.html; "Living With War; Air Raids," The Discovery Channel,
  http://www.discoverychannel.co.uk/ww2_home/ww2_living_with
  _war/index.shtml
  
• "The NHS was set up in 1948 and is now the largest organisation in Europe. It is recognised as one of the best health services in the world by the World Health Organisation but there need to be improvements to cope with the demands of the 21st century." "About the NHS," NHA website,
  http://www.nhs.uk/Aboutnhs/howthenhsworks/Pages/
  HowtheNHSworks.aspx

SiCKO: In a study of older Americans and Brits, the Brits had less of almost every major disease. Even the poorest Brit can expect to live longer than the richest American.

• "The US population in late middle age is less healthy than the equivalent British population for diabetes, hypertension, heart disease, myocardial infarction, stroke, lung disease, and cancer. Within each country, there exists a pronounced negative socioeconomic status (SES) gradient with self-reported disease so that health disparities are largest at the bottom of the education or income variants of the SES hierarchy. This conclusion is generally robust to control for a standard set of behavioral risk factors, including smoking, overweight, obesity, and alcohol drinking, which explain very little of these health differences… Level differences between countries are sufficiently large that individuals in the top of the education and income strata in the United States have comparable rates of diabetes and heart disease as those in the bottom of the income and education strata in England." (See also Table 1 - for example, prevalence of diabetes among high-income Americans is 8.2 per thousand, while it's 7.3 among low-income Brits.) Banks, Marmot et al., "Disease and Disadvantage in the United States and in England," Journal of the American Medical Association, 2006;295:2037-2045.

SiCKO: A baby born in El Salvador has a better chance of surviving than a baby born in Detroit.

• According to the United Nations Statistics Division, Population and Vital Statistics Report, the rate of infant deaths per thousand in El Salvador is 10.5. "Table 3, Live births, deaths, and infant deaths, latest available year, June 15, 2007." http://unstats.un.org/unsd/demographic/products/vitstats/serATab3.pdf

• According to the Michigan Department of Community Health, the rate of infant deaths for Detroit is 15.9 per thousand. "Number of Infant Deaths, Live Births and Infant Death Rates for Selected Cities of Residence, 2005 and 2001 - 2005 Average," Michigan Department of Community Health Web Site, http://www.mdch.state.mi..us/pha/osr/InDxMain/Tab4.asp.

SiCKO: Around 65 percent of young Americans can't find Britain on a map.

• "About 11 percent of young citizens of the U.S. couldn't even locate the U.S. on a map. The Pacific Ocean's location was a mystery to 29 percent; Japan, to 58 percent; France, to 65 percent; and the United Kingdom, to 69 percent.." "Survey Reveals Geographic Illiteracy," National Geographic Today, November 20, 2002. http://news.nationalgeographic.com/news/2002/11/1126_021120_
  TVGeoRoperSurvey.html.

SiCKO: Companies that no longer offer pensions to new employees.

• These can be found on a list prepared by the Center for Retirement Research at Boston College. Pension Change Fact Sheets, http://www.bc.edu/centers/crr/PFFS.shtml In addition, the Pension Rights Center has also compiled a near-comprehensive list. Companies That Have Changed Their Defined Benefit Pension Plans, http://www.pensionrights.org/pubs/facts/company_list.html

SiCKO: Like Canadians and Brits, the French live longer than we do.

• The 2006 United Nations Human Development Report's human development index states the life expectancy in the United States is 77.5, the United Kingdom is 78.5, France is 79.6, and Canada is 80.2. Human Development Report 2006, United Nations Development Programme, 2006 at 283.
  http://hdr.undp.org/hdr2006/pdfs/report/HDR06-complete.pdf.

SiCKO: The productivity rate per hour in France is higher than in America.

• According to the Organisation for Economic Co-operation and Development, France has a higher labor productivity (GDP per hour worked) than the United States. "OECD in Figures 2005, 2005/Supplement 1 at 84.
  http://213.253.134.29/oecd/pdfs/browseit/0105061E.PDF

• "Britain has yet to catch up with its rivals on productivity. Gordon Brown, the chancellor, has long wished to close Britain's productivity gap with other countries. It is proving a long haul. In 2004, output per hour worked was 19% higher in France, 15% higher in America and 5% higher in Germany than it was in Britain." "Poor show; International comparisons," The Economist, January 21, 2006.

SiCKO: French policy on childcare and household assistance for new parents.

• According to the French-American Foundation comprehensive review of child care, "For non-working parents or parents who work part-time, haltes garderies (drop-in centers) provide part-time, occasional, and drop-in care. Haltes garderies are also subsidized (by municipality and the National Family Allowance Fund), with parents paying a portion of the costs based on a sliding scale (parents pay an average of $1 per hour). … For working parents [there are] licensed family day care providers (assistants maternelles), licensed babysitters at home (social security costs and salaries subsidized by the National Family Allowance Fund)." Peer, Shanny., "The French Early Education System," French-American Foundation, November 13, 2003.,
  www.eoionline.org/ELC/Presentations/Peer4.pdf

SiCKO: There is a company in France, SOS Medecins, which will perform doctor house calls at any time.

• SOS Medecins has an English website, viewable here: http://www.sosmedecins-france.fr/en/smf_en_present.htm.

SiCKO: The government initially refused to pay for the health care of 9/11 volunteers, because they were not on the government payroll. It remains difficult for the volunteers to access the $50 million fund that has been appropriated for their care.

• The Department of Defense and Emergency Supplemental Appropriations for Recovery From and Response to Terrorist Attacks on the United States Act provided a total of $175 million for workers compensation programs - $125 million to NYS Workers Compensation Review Board, and an additional $50 million to reimburse the NYS Uninsured Employers Fund, including for benefits paid to volunteers. However, there have been major delays in getting money to volunteers. See. e.g. "Statement of Robert E. Robertson, Director, Education, Workforce, and Income Security Issues," "September 11, Federal Assistance for New York Workers' Compensation Costs," United States Government Accountability Office, (GAO-04-1068T) September 8, 2004.

• "With strong advocacy from New York's Congressional Delegation and labor leaders, a portion - about $52 million - of the $125 million in federal funding that had been allocated for administering workers compensation claims was re-allocated to provide some funding for medical treatment programs, but it will only meet a fraction of the need. Congress approved the legislation authorizing this funding in late December 2005." Devlin Barrett, "Congress Gives New Life to 9/11 Programs," Newsday, December 22, 2005.

• A $52 million fund for volunteers was eventually established, but experts agree it's inadequate. The New York Times reported on September 6, 2006 that "Dr. John Howard, who was named the federal 9/11 health coordinator in February, has already said that the $52 million the federal government has appropriated for treatment late last year is inadequate. He said in an interview yesterday that the new study will very likely mean that the gap between funds and the need for them is going to grow." Anthony DePalma, "Illness Persisting in 9/11 Workers, Big Study Finds," New York Times, September 6, 2006.

SiCKO: American officials claim that detainees at Guantanamo Bay receive excellent health care.

• "There is still acute care 24 hours a day, in which surgical procedures, everything, can be performed right there in the detainee camps, but as those wounds healed and as the detainees got further and further away from acute injuries, there has been increasing emphasis on preventative care.
• Indeed, the immunization rate there is higher than in the United States of America….. Things such as screening for cancer have taken place there. Colonoscopies--a procedure which, as we all know, is used commonly in this country to screen for colon cancer--are performed there on a routine basis.
• The health personnel-to-detainee ratio is 1 to 4--remarkably high.
• That is all health personnel who are there. And I guess, as I left this briefing and the opportunity to talk to the doctors and the nurses and the psychologists and the psychiatrists, I left with an impression that health care there is clearly better than they received at home and as good as many people receive in the United States of America." Sen. Bill Frist (R-TN), remarks on Guantanamo Bay, U.S. Senate, September 12, 2006.

• "They go out, they do sick call on the blocks three times per week, care for them there, if they can… We have diabetes. We have high blood pressure, high cholesterol. Those detainees -- we've created a population health database so that we can track those detainees to make sure we're seeing them frequently, monitoring their labs and their overall health." Statement of Navy Commander Cary Ostergaard. "Hearing Of The House Armed Services Committee Subject: Detainee Operations At Guantanamo Bay," June 29, 2005.

• "Detainees receive medical, dental, psychiatric, and optometric care at U.S. taxpayers' expense. In 2005, there were 35 teeth cleanings, 91 cavities filled, and 174 pairs of glasses issued." "Ten Facts About Guantanamo," Department of Defense, September 14, 2006. http://www.defenselink.mil/home/dodupdate/For-the-record/documents/
  GuantanamoBay_Top10_ATTACHMENT2.doc.

SiCKO: Cuba is one of the most generous countries in providing doctors to the third world.

• "WHO statistics show that the incidence of AIDS in Cuba is the lowest in this hemisphere, and there are now more than 800 Cuban doctors in Haiti alone working to control the AIDS epidemic. President Castro has offered an almost unlimited number to be sent to Africa, to be paid by the Cuban government with only a small stipend from the host countries." "President Carter's Cuba Trip Report By Jimmy Carter," May 21, 2002.
  http://www.cartercenter.org/news/documents/doc528.html

• "The close friendship between Cuban leader Fidel Castro and Venezuelan President Hugo Chavez has netted Venezuela a loan of 20,000 Cuban health workers -- including 14,000 doctors, according to the Venezuelan government -- who work in poor barrios and rural outposts for stipends seven times higher on average than their salaries at home. Castro has vowed to send Chavez as many as 10,000 additional medical workers by year's end." "As Cuba Loans Doctors Abroad, Some Patients Object at Home," Boston Globe, August 25, 2005..

• "President Evo Morales on Friday heeded the wishes of six visiting U.S. senators by acknowledging the positive effects of American aid in his country - but added that
• Cuban doctors had had a greater impact on Bolivia than their U.S. counterparts…
• [I]n a Friday interview with Bolivian radio network Fides, Morales said the assistance of Cuban leader Fidel Castro - who has sent Bolivia some 1,700 doctors and paramedics this year alone, setting up free hospitals and eye clinics throughout Bolivia -- outshines the United States' own medical aid." "Morales Says Cuban Doctors top U.S. Medical Aid," Boston Globe, December 29, 2006.

SiCKO: In the U.S., health care costs run nearly $7,000 per person.

But in Cuba, they spend around $251 per person.

• United States health spending per capita is $6,697 per person according to Catlin, A, C. Cowan, S. Heffler, et al, "National Health Spending in 2005."
• Health Affairs 26:1 (2006). As with the number of uninsured, the number continues to increase and is projected to be $7,092 per capita in 2006, $7,498 per capita in 2007 and reaching $12,782 by 2016, according the Department of Health and Human Services Center for Medicare and Medicaid Expenditures, National Health Expenditures Projections 2006-2016,
  http://www.cms.hhs.gov/NationalHealthExpendData/downloads/proj2006.pdf

• The 2006 United Nations Human Development Report says Cuba spends $251 per capita on health care. (Human Development Report 2006, United Nations Development Programme, 2006. http://hdr.undp.org/hdr2006/statistics/indicators/52.html)

SiCKO: In Cuba, access to health care is universal.

• "Cuban dissatisfaction with their personal lives does not mean they are negative about the revolutionary government's achievements in health care and education.
• A near unanimous 96 percent of respondents say that health care in Cuba is accessible to everyone.
• Gallup polls in other Latin American cities have found that on average only 42 percent believe health care is accessible."
• Gallup/ Consultoría Interdisciplinaria en Desarrollo,
• "Cubans Show Little Satisfaction with Opportunities and Individual Freedom Rare Independent Survey Finds Large Majorities Are Still Proud of Island's Health Care and Education," January 10, 2007.
  http://www.worldpublicopinion.org/pipa/articles/brlatinamericara/
  300.php?nid=&id=&pnt=300&lb=brla

SiCKO: Cuba has a lower infant mortality rate and a longer average lifespan than the United States.

• The 2006 United Nations Human Development Report's human development index states the life expectancy in the United States is 77.5, and is 77.6 in Cuba. Human Development Report 2006, United Nations Development Programme, 2006 at 283. http://hdr.undp.org/hdr2006/pdfs/report/HDR06-complete.pdf.

• According to the United Nations Statistics Division, Population and Vital Statistics Report, the rate of infant deaths per thousand in Cuba is 6.2 per thousand, and in the United States is 6.8. "Table 3, Live births, deaths, and infant deaths, latest available year, June 15, 2007."
  http://unstats.un.org/unsd/demographic/products/vitstats/serATab3.pdf"