The Body Economic (34 page)

36
. “Iceland: Cracks in the Crust,” The
Economist,
Dec 11, 2008. K. Connolly, “Germany Approves 50 Billion Euro Stimulus Package,” The
Guardian
, Jan 27, 2009. Available at:
http://www.guardian.co.uk/world/2009/jan/27/germany-europe

At the World Health Summit 2012, Daniel Bahr explained, “without our social security system, Germans economic growth would never have been possible.” UHC Forward. Nov 11, 2012. Available at:
http://uhcforward.org/headline/german-federal-minister-health-daniel-bahrs-opening-remarks-world-health-summit-focus-stron

37
. Cited in D. Stuckler and M. McKee, “There Is an Alternative: Public Health Professionals Must Not Remain Silent at a Time of Financial Crisis,”
European Journal of Public Health
v22(1): 2–3. Krugman also referred to austerity as “collective punishment.” Cited in D. Aitkenhead and Paul Krugman, “I'm Sick of Being Cassandra. I'd Like to Win for Once,” The
Guardian,
June 3, 2012. Available at:
http://www.guardian.co.uk/business/2012/jun/03/paul-krugman-cassandra-economist-crisis

38
. One former Labour MP in the UK went so far as to argue, “Just as Germany destroyed Europe once in World War II, it is now bent on doing so for a second time.” See “Athens Police Fire Tear Gas in Crackdown Clashes at Anti-Merkel Protest,” RT, Oct 8, 2012. Available at:
http://rt.com/news/greece-protests-germany-merkel-946/

PART III: RESILIENCE

Chapter 6: To Care or Not to Care

1
. Name changed for confidentiality.

2
. J. Steinhauer, “California budget Deal Closes $26 Billion Gap,”
New York Times,
July 25, 2009. Available at:
http://www.nytimes.com/2009/07/25/us/25calif.html?hp
IRS, Administrative, Procedural and Miscellaneous.
http://www.irs.gov/pub/irs-drop/rp-09–29.pdf

Routine care was often covered, but not all Americans were aware of what was covered and what was not. See C. Fleming. “New Health Affairs: High-Deductible Health Plan Enrollees Avoid Preventive Care Unnecessarily.” Health Affairs Blog, Dec 3, 2012. Available at:
http://healthaffairs.org/blog/2012/12/03/new-health-affairs-high-deductible-health-plan-enrollees-avoid-preventive-care-unnecessarily/

3
. A. Wilper, et al. 2009. “Health Insurance and Mortality in US Adults,”
American Journal of Public Health
v99(12): 2289–95.

4
. Ibid. People who are uninsured are just one emergency room visit away from bankruptcy. During the recession about one-quarter of uninsured persons used their entire savings to pay medical bills. About three out of every four Americans are now struggling to cope with medical bills or healthcare-related debt, which is more than those with mortgage-payment difficulties. New Hampshire Medicaid Enrollment Forecast, SFY 2011–2013 Update. Available at:
http://www.dhhs.nh.gov/ombp/documents/forecast.pdf
. K. Carollo, 2010. American Medical Association condemns insurance “purging.” Available at:
http://abcnews.go.com/Health/HealthCare/american-medical-association-condemns-insurance-purging/story?id=10920504

5
. Prior to the Affordable Care Act in order to qualify for Medicaid the applicant had to be poor
and
a) a family with children who met certain eligibility requirements (e.g. disabled), b) elderly, disabled or blind, c) with child less than six years old or pregnant mother, d) with school-age children ages six to eighteen.

6
. Kaiser Commission of Medicaid and the Uninsured, State Fiscal Conditions and Medicaid Program Changes, FY 2012–2013, Nov 28, 2012. Available at:
http://www.kff.org/medicaid/7580.cfm
; Erica Williams, Michael Leachman, and Nicholas Johnson, “State budget Cuts in the New Fiscal Year Are Unnecessarily Harmful—Cuts Are Hitting Hard at Education, Health Care, and State Economies,” Center for budget and Policy Priorities, updated July 28, 2011. Available at:
http://www.cbpp.org/cms/index.cfm?fa=view&id=3550

7
. A. Haviland, et al. “High-Deductible Health Plans Cut Spending but Also Reduce Preventive Care.” RAND Health Fact Sheet, 2011. Available at:
http://www.rand.org/pubs/research_briefs/RB9588.html
; M. Buntin, et al. 2011. “Healthcare Spending and Preventive Care in High-Deductible and Consumer-Directed Health Plans,” The
American Journal of Managed Care
v17(3): 222–30.

8
. The Commonwealth Fund, “Help on the Horizon,” March 2011. Available at:
http://www.commonwealthfund.org/~/media/Files/Publications/Fund%20Report/2011/Mar/1486_Collins_help_on_the_horizon_2010_biennial_ survey_report_FINAL_v2.pdf
; S. Dorn, et al. 2012. “Impact of the 2008–2009 Economic Recession on Screening Colonoscopy Utilization Among the Insured,”
Clinical Gastroenterology and Hepatology
v10(3): 278–84. Available at:
http://www.sciencedirect.com/science/article/pii/S154235651101278X
; J. D. Piette, et al. 2011. “Medication Cost Problems Among Chronically Ill Adults in the US: Did the Financial Crisis Make a Bad Situation Even Worse?”
Patient Preference and Adherence
v5:187.

9
. Since 2008, more than 49,000 state and local public health department jobs have been cut. “Kaiser Commission on Medicaid and the Uninsured. Emergency Departments Under Growing Pressures,” 2009. Available at:
http://www.kff.org/uninsured/upload/7960.pdf

10
. Emily Walker, “Health Insurers Post Record Profits,” ABC News, Feb 12, 2010. Available at:
http://abcnews.go.com/Health/HealthCare/health-insurers-post-record-profits/story?id=9818699

See, for example, Emily Berry, “Health Plans Say They'll Risk Losing Members to Protect Profit Margins,”
American Medical News,
May 19, 2008. Available at:
http://www.ama-assn.org/amednews/2008/05/19/bil10519.htm

F
IGURE 6.1
For-Profit Insurers—Profits for the First Nine Months of 2010

Source: Third quarter earnings reports compiled by the office of Congressman Pete Stark

11
. Kenneth J. Arrow, “Uncertainty and the Welfare Economics of Medical Care,” The
American Economic Review,
Dec 1963; P. Krugman, “Why Markets Can't Cure Healthcare,”
New York Times,
2009. Available at:
http://krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-healthcare/

12
. J. Hart. 1971. “The Inverse Care Law,” The
Lancet
v297(7696): 405–12. As the paper notes, “this inverse care law operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced.”

13
. Contrary to conventional wisdom, Americans don't visit the doctor as much, or use more expensive technologies, either—for example, they get fewer MRIs per person than Japan and fewer expensive hip surgeries than much of Europe, but are simply being charged more for the same MRI. The nursing home population is also smaller, proportionally. Institute of Medicine. “U.S. Health in International Perspective: Shorter Lives, Poorer Health,” 2013. Available at:
http://www.iom.edu/Reports/2013/US-Health-in-International-Perspective-Shorter-Lives-Poorer-Health.aspx
. The reasons for high US healthcare spending are reviewed in a report by the Commonwealth Fund, available at:
http://www.commonwealthfund.org/Publications/Issue-Briefs/2012/May/High-Healthcare-Spending.aspx
. For the data on drug research and development spending, see Families USA. “Profiting from Pain: Where Prescription Drug Dollars Go,” 2009. Available at:
http://www.policyarchive.org/handle/10207/6305

14
. Institute of Medicine, “U.S. Health In International Perspective: Shorter Lives, Poorer Health,” 2013. Available at: “
http://www.iom.edu/Reports/2013/US-Health-in-International-Perspective-Shorter-Lives-Poorer-Health.aspx
. The United States now ranks last in male life expectancy among developed countries (even after taking into account its exceptionally high death rate from firearms).

15
. A. Lusardi, D. Schneider, P. Tufano, “The Economic Crisis and Medical Care Usage,” Dartmouth College. Available at:
http://www.dartmouth.edu/~alusardi/Papers/healthcare_031610.pdf

16
. Many factors contributed to the rise in the NHS. It was implemented as part of a suite of major reforms that launched the British welfare state in the postwar period. See D. Stuckler, A. Feigl, S. Basu, M. McKee, “The Political Economy of Universal Health Coverage. First Global Symposium on Health Systems Research,” Nov 2009. Available at:
http://www.pacifichealthsummit.org/downloads/UHC/the%20political%20economy%20of%20uhc.PDF

17
. Jeremy Laurance, “NHS Watchdog Is Winning the Price War with Drug Companies,” The
In de pen dent,
Dec 21, 2009. Available at:
http://www.independent.co.uk/life-style/health-and-families/health-news/nhs-watchdog-is-winning-the-price-war-with-drug-companies-1846352.html
. See NHS core principles, 2013. Available at:
http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspx

18
. The Commonwealth Fund and the OECD had previously labeled the NHS the most efficient, effective, and responsive system in the world; the Tory government is now turning it into an unresponsive market-based healthcare system like that in the US.

19
. Sunny Hundal, “Revealed: The Pamphlet Underpinning Tory Plans to Privatise the NHS,”
Liberal Conspiracy,
June 3, 2011. Available at:
http://liberalconspiracy.org/2011/06/03/revealed-the-pamphlet-underpinning-tory-plans-to-privatise-the-nhs/

Andy McSmith, “Letwin: ‘NHS Will Not Exist Under Tories',” The
In de pen dent,
June 6, 2004. Available at:
http://www.independent.co.uk/life-style/health-and-families/health-news/letwin-nhs-will-not-exist-under-tories-6168295.html
. Austerity went a step further: “For unto every one that hath shall be given, and he shall have abundance: but from him that hath not shall be taken away even that which he hath.”

20
. The big difference in costs were coming from private healthcare, which added 1.6 percent in the UK, 2.6 percent in France, 2.7 percent in Germany, and 9.1 percent in the US. The Commonwealth Fund 2010 International Health Policy Survey. See also Rita O'Brien, “Kent, Keep Our NHS Public.” Available at:
http://www.keepournhspublic.com/pdf/howdoestheNHScompare.pdf

21
. The British Medical Association held its first emergency meeting in two decades, calling on the government to withdraw the bill.

Helen Duffett, “Nick Clegg's Speech on NHS Reform,”
Liberal Democratic Voice,
May 26, 2011. Available at:
http://www.libdemvoice.org/nick-cleggs-speech-on-nhs-reform-24260.html

22
. Tom Jennings, “Action to Turn Round Health Centre Wins Praise,”
Oxford Times,
Jan 16, 2013. Available at:
http://www.oxfordtimes.co.uk/news/yourtown/witney/10162757.print/

23
. “Further Privatisation Is Inevitable Under the Proposed NHS Reforms,”
British Medical Journal,
May 17, 12012. Available at:
http://www.bmj.com/content/342/bmj.d2996

24
. Randeep Ramsh, “Public Satisfaction with NHS Slumped During Reforms Debate, Thinktank Finds,” The
Guardian,
June 11, 2012. Available at:
http://www.guardian.co.uk/society/2012/jun/12/public-satisfaction-nhs-thinktank
. These patterns were consistent with research of a natural experiment in Italy's National Health Service, which found that those regions undergoing greater privatization of healthcare delivery had worse healthcare performance. C. Quercioli, G. Messina, S. Basu, M. McKee, N. Nante, D. Stuckler. 2013. “The Effect of Health Care Delivery Privatization on Avoidable Mortality: Longitudinal Cross-Regional Results from Italy, 1993–2003,”
Journal of Epidemiology & Community Health
v67(2): 132–38.

25
. “A&E Waits Highest for a De cade,” BBC News, Feb 13, 2012. Available at:
http://www.bbc.co.uk/news/health-21444444

26
. “NHS Shakeup Spells ‘Unprecedented Chaos,' Warns Lancet Editor,” The
Guardian
, March 24, 2012. Available at:
http://www.guardian.co.uk/society/2012/mar/24/nhs-shakeup-chaos-lancet

27
. Under current EU competition law, the NHS would be fully opened up to compulsory competitive markets, and private corporations are to be eligible to receive the same government subsidies as publicly funded services.