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Context of 'June 21, 2006: Review Article Argues that Non-Profit Health Care Providers Often Provide Superior Service'

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Betsy McCaughey.Betsy McCaughey. [Source: Newsday / Gawker (.com)]Elizabeth “Betsy” McCaughey (R-NY), a lawyer and future lieutenant governor of New York, writes a scathing analysis of the Clinton administration’s health care reform plan. The article, “No Exit,” is published in the New Republic, and sparks not only a detailed rebuttal from the Clinton administration, but numerous editorials and responses praising the article and joining in the attack. Echoing McCaughey’s arguments, Newsweek writes, “The plan would reduce the quantity and quality of health care and medical technologies by vastly expanding government’s coercive role.” McCaughey and Newsweek question the proposed creation of a seven-member “National Health Board” which will, she claims, “guess the nation’s health care needs and decree how much the nation may spend meeting them.” According to Newsweek: “Everyone would be locked into one system of low-budget health plans picked by the government. Fifteen presidential appointees, the National Quality Management Council, not you and your doctor, would define the ‘medically necessary’ and ‘appropriate’ care a doctor could give you. Escaping government control to choose your doctor or buy other care would be virtually impossible. Doctors could be paid only by the government-approved plans, at rates set by the government. It would be illegal for doctors to accept money directly from patients, and there would be 15-year jail terms for people driven to bribery for care they feel they need but the government does not deem ‘necessary.’ Government would define a minimum level of care and herd people in particular regions into dependence on the lowest-cost organization able to deliver that level. Doctors would be driven into organizations in which they would be punished financially for giving more treatment than the organizations’ budget targets permit. The primary care physician assigned to you would be, McCaughey notes, a gatekeeper with an incentive to limit your access to specialists and high-tech medicine. The premise of the Clintons’ plan is not just that government knows best, but that government knows everything relevant, including how many specialists there should be no more than 45 percent of all doctors [sic]. McCaughey says many medical students will be told that the specialties they prefer are closed, or closed to them because they are not the right race or ethnicity. Yes, the plan subordinates medical values to ‘diversity.’” Prescription drug prices would be controlled through the Department of Health and Human Services, and, McCaughey and Newsweek claim, would “certainly suppress research” that might benefit patients of incurable diseases and disorders. [Newsweek, 2/7/1994]
Refuting McCaughey - The Clinton administration details the “numerous factual inaccuracies and misleading statements” contained in McCaughey’s article. The administration’s response says that doctors and patients, not “government bureaucrats” or a board of governors, will decide what treatments are “necessary and appropriate.” The government will not decide what treatments are, and are not, provided: “If anything, the ‘necessary and appropriate’ care provision in the bill delegates authority to the medical profession—rather than imposing further government bureaucracy between the patient and the doctor.” The plan will not block Americans from opting into private health care plans just as they do now, nor will it block doctors and hospitals from accepting payments from “non-approved” health care plans. Nor does the plan require doctors and hospitals “to report your visit to a national data bank containing the medical histories of all Americans,” as McCaughey writes. And the so-called “National Health Board” will not “decide how much the nation can spend on health care beginning in 1996,” as McCaughey claims. The plan will not seek to reduce quality of care in the interest of saving money, and it does not contain price controls. [White House, 1/31/1994] A year later, author and columnist James Fallows will call the article “a triumph of misinformation,” and refutes McCaughey’s (and others’) claims point by point. [Atlantic Monthly, 1/1995]
Instrumental in Derailing Reform - The article will later be cited by House Speaker Newt Gingrich (R-GA) as “the first decisive breaking point” in the plan’s initial support; the plan will never be implemented. The article itself will spark tremendous controversy, winning the National Magazine Award while being attacked for being fundamentally inaccurate. (In 2006, the new editor of the New Republic, Franklin Foer, will apologize for his magazine having run the article.) In 2009 McCaughey will be a fellow at the conservative Manhattan Institute and will soon join the equally conservative Hudson Institute. Both are heavily funded by health care corporations. [Daily Beast, 5/15/2009]

Entity Tags: Newt Gingrich, Franklin Foer, Elizabeth (“Betsy”) McCaughey, Clinton administration, James Fallows, US Department of Health and Human Services, Hudson Institute, Manhattan Institute

Timeline Tags: US Health Care, Domestic Propaganda

A study conducted by Harvard University and the Canadian Institute for Health Information finds that administrative costs in America’s health care system are almost twice that of Canada. The study, published in the New England Journal of Medicine, reports that the US health bureaucracy consumes 31 percent of total health care spending. By comparison, Canada’s administrative expenses amount to only 16.7 percent. Steffie Woolhandler of Harvard, who led the team, says if the US were to adopt a single-payer health care system like Canada, the funds saved would be enough to provide insurance for the more than 41 million uninsured Americans. [Woolhandler, Campbell, and Himmelstein, 2003; Toronto Star, 8/21/2003]

Timeline Tags: US Health Care

An article published in the journal Health Affairs reports that on average nonprofit nursing homes and hospitals provide better quality service than those operating for a profit. The authors of the report, whose conclusions are based on a review of 162 studies comparing nonprofit and for-profit health care providers, found that the evidence suggests that nonprofit hospitals have lower mortality rates. Eight of the studies surveyed by the authors concluded that nonprofits have lower death rates while only one study reported that for-profits have lower mortality rates. The article also reports that non-profit hospitals have lower expenses on average. For nursing homes, the opposite is true. The review says that evidence suggests for-profits tend to mark their prices up to improve the bottom line. There is also evidence that they receive more complaints. Sixteen percent of all hospitals are for-profit, a five percent increase since the early 1990s. [Reuters, 1/21/2006]

Timeline Tags: US Health Care

In an op-ed, the New York Times calls the idea that the US has “the best health care system in the world,” as recently stated by President Bush, or provides “the best medical care in the world,” as recently stated by former New York City Mayor Rudolph Giulani, a “delusion.” “That may be true at many top medical centers,” the Times writes. “But the disturbing truth is that this country lags well behind other advanced nations in delivering timely and effective care.” The Times notes that in 2000, the World Health Organization (WHO) ranked the health care systems of 191 nations. France and Italy were first and second; the US came in 37th. The Times notes a more recent study by “the highly regarded Commonwealth Fund,” which “has pioneered in comparing the United States with other advanced nations through surveys of patients and doctors and analysis of other data”; the latest Commonwealth Fund study put the US last among six highly developed nations (see May 15, 2007). “Other comparative studies also put the United States in a relatively bad light,” the Times notes.
Lack of Universal Coverage - Unlike every other major industrialized nation, the US does not provide universal health coverage. In the US, some 45 million people have no health insurance whatsoever, and millions more suffer with poor coverage. The Times writes, “Although the president has blithely said that these people can always get treatment in an emergency room, many studies have shown that people without insurance postpone treatment until a minor illness becomes worse, harming their own health and imposing greater costs.”
Lack of Access - While citizens of foreign nations often face longer waits before they can see specialists or undergo elective surgery than do Americans in comparable situations, “[t]he real barriers here are the costs facing low-income people without insurance or with skimpy coverage.” However, “even Americans with above-average incomes find it more difficult than their counterparts abroad to get care on nights or weekends without going to an emergency room, and many report having to wait six days or more for an appointment with their own doctors.”
Unfair Disparities - The dichotomy between the care provided to economically well-off Americans and their more economically challenged fellows is worse than in any other industrialized nation. “Americans with below-average incomes are much less likely than their counterparts in other industrialized nations to see a doctor when sick, to fill prescriptions, or to get needed tests and follow-up care.”
Unhealthy Living - The US ranks last among 23 nations in its infant mortality rate—more American children die in infancy than in 22 other countries. “But the problem is much broader,” the Times continues. “We rank near the bottom in healthy life expectancy at age 60, and 15th among 19 countries in deaths from a wide range of illnesses that would not have been fatal if treated with timely and effective care. The good news is that we have done a better job than other industrialized nations in reducing smoking. The bad news is that our obesity epidemic is the worst in the world.”
Varying Quality - The Commonwealth Fund study notes that the US ranks first in providing the correct care for a given condition, and does very well in providing preventative care to its citizens. But it does much worse in coordinating the care of chronically ill patients, in protecting the safety of patients, and in meeting the needs and preferences of patients. Overall, the quality of health care in the US is the lowest among the six nations profiled by the study.
Varying Survival Rates - US citizens live longer than their foreign counterparts with breast cancer, and second-longest with cervical cancer and childhood leukemia. But US citizens rank last or next-to-last in life expectancy for patients with kidney transplants, liver transplants, colorectal cancer, circulatory diseases, respiratory diseases, diabetes, bronchitis, asthma, and emphysema.
Poor Patient Satisfaction - Only 40 percent of Americans are satisfied with the nation’s health care system. Of 17 countries surveyed, the US comes in 14th. The US ranks first in negative public perceptions, with a third of Americans calling for a system-wide revamp of American health care.
Poor Use of Information Technology - American health care providers are years behind their foreign counterparts in their use of information technology, electronic medical records, electronic prescriptions, and more. “This makes it harder to coordinate care, spot errors, and adhere to standard clinical guidelines,” the Times writes.
Conclusion - “With health care emerging as a major issue in the presidential campaign and in Congress, it will be important to get beyond empty boasts that this country has ‘the best health care system in the world’ and turn instead to fixing its very real defects,” the Times concludes. “The main goal should be to reduce the huge number of uninsured, who are a major reason for our poor standing globally.… The world’s most powerful economy should be able to provide a health care system that really is the best.” [New York Times, 8/12/2007]

Entity Tags: Commonwealth Fund, Rudolph (“Rudy”) Giuliani, World Health Organization, George W. Bush, New York Times

Timeline Tags: US Health Care

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