[Marxism] US versus Cuba healthcare efficiency and equity

["acpollack2@xxxxxxxx" <acpollack2@xxxxxxxx>]

In the Times and the Post (and presumably many other papers) today are 
reports of the latest government report on US healthcare spending. The 
focus is on how much spending has increased, and the blame is put on 
increased payments to physicians and hospitals.
http://www.nytimes.com/aponline/health/AP-Health-Care-Spending.html
http://www.washingtonpost.com/wp-dyn/content/graphic/2006/01/10/GR2006011000048.html
http://www.washingtonpost.com/wp-dyn/content/article/2006/01/09/AR2006010901932.html

Now certainly many docs are overpaid, and hospital execs, especially at
for-profit hospitals, are extremely wasteful. But we all know that's 
not the source of the spending problem (think private insurers and Big 
Pharma. If you're not up on the basics check out PNHP's website, pnhp.org).

The spending report comes from Health and Human Services' Centers for 
Medicare and Medicaid Services. Two companion reports on healthcare 
quality (or rather lack thereof) came out the same day from HHS's 
Agency for Healthcare Research and Quality, one on overall quality, and
one on racial disparities.

As we've all heard the US spends more on healthcare and gets far, far 
less per dollar than any other country. For a quick but thorough view 
of that, and a good contrast to the bang for the buck Cuba gets, see:
http://ucatlas.ucsc.edu/spend.php

Now here's what's new. As I mentioned above the reports are going to be
used as ammunition to cut spending to docs and hospitals, NOT to deal 
with the core problems of a market-based healthcare system and the 
discrimination that comes with it. In the 1980s and 1990s various 
schemes were used to "reform" our market-based system, such as 
capitation, managed care, HMOs, etc. Those are now universally admitted
to have failed. The latest panaceas are consumer health saving plans 
and "Pay-for-Performance." The former forces people to save for their 
own health plans; it's a way of shifting responsibility from insurers 
to the insured (this overlaps with the drive to increase healthcare 
premiums as we've just seen in NYC transit). Pay-for-Performance (or 
P4P) is a scheme to direct monetary payments to docs and hospitals who 
show the greatest improvement in specific quality measures for specific
illnesses (i.e. was pneumonia vaccination given, did heart attack 
victims get aspirin or beta blockers, etc., etc.). P4P will also be 
used to shuffle money toward the richest docs and hospitals. More 
importantly, the amount of money shifted, while it will be a blow to 
those losing it, still will have almost no net impact on the 
countrywide quality of care (the measures themselves are very worth 
doing and with proper education most healthcare providers would do them
anyway even without monetary incentives -- if their workload allowed, 
of course).
What P4P will NOT do is reorient healthcare spending in a way that 
moves us toward's Cuba's ability to universalize and make equitable 
healthcare provision. (And don't get me started on the irrationality
of the Medicare Part D drug fiasco that is right now endangering
seniors' lives; can you imagine Cuba organizing drug spending in such
a psychotic fashion?)
One final example of this: this week the Times is also running a 
story on the horrific increase in diabetes, especially (see today's
paper) in neighborhoods like East Harlem. P4P, and the broader 
market-based system, will do nothing to alleviate this. Contrast that 
failure with the clear, simple, transparent and effective measures 
taken by Cuba -- or Venezuela, or Cuba in collaboration with Venezuela
and many other countries -- to target people and money toward specific 
healthcare problems and SOLVE them.


________________________________________________
YOU MUST clip all extraneous text before replying to a message.
Send list submissions to: Marxism@xxxxxxxxxxxxxxxxxxx
Set your options at: http://lists.econ.utah.edu/mailman/listinfo/marxism