Don't miss this one in the busy December whirl

(NOTE:This terribly misnamed movie is about our insane sickness financing system, not forests.)

Escape Fire: The Fight to Rescue American Healthcare
Showing at Salem Progressive Film Series in The Historic Grand Theatre,
Thursday, December 13, 2012    7 p.m. (doors open at 6 p.m.)

ESCAPE FIRE: The Fight to Rescue American Healthcare tackles one of the most pressing issues of our time: how can we save our badly broken healthcare system?

American healthcare costs are rising so rapidly that they could reach $4.2 trillion annually, roughly 20% of our gross domestic product, within ten years. We spend $300 billion a year on pharmaceutical drugs – almost as much as the rest of the world combined. We pay more, yet our health outcomes are worse. About 65% of Americans are overweight and almost 75% of healthcare spending goes to preventable diseases that are the major causes of disability and death in our society.

It’s not surprising that healthcare is at the top of many Americans’ concerns and at the center of an intense political firestorm in our nation’s Capitol. But the current battle over cost and access does not ultimately address the root of the problem: we have a disease-care system, not a healthcare system. The film examines the powerful forces maintaining the status quo, a medical industry designed for quick fixes rather than prevention, for profit-driven care rather than  patient-driven care.

ESCAPE FIRE also presents attainable solutions. After decades of resistance, a movement to bring innovative high-touch, low-cost methods of prevention and healing into our high-tech, costly system is finally gaining ground.

Filmmakers Matthew Heineman and Susan Froemke interweave dramatic personal arcs of patients and physicians with the stories of leaders battling to transform healthcare at the highest levels of medicine, industry, government, and even the U.S. military. ESCAPE FIRE is about finding a way out of our current crisis. It’s about saving the health of a nation.

Related articles -

1) interesting thoughts in an essay here

• One doc's review of EscapeFire: It had drama, pathos, irony, and the graphics were good 2) too!
 

"Seeding Studies" -- more evidence that Big Pharma is a criminal enterprise

Imagine an industry with the morals of a sub-prime mortgage broker, the self-righteousness of Ted Haggard, the quiet good taste and class of Lady Gaga, and the restraint of Rush Limbaugh.  Ladies and Gentlemen, I give you the American pharmaceutical industry.

Daily Kos: The One Comic That Explains Just How Screwed America Is

Oh how I wish this wasn't so deadly accurate.

Depression Treatment: What Works and How We Know

A worthy article here.

On reducing the shortage of donated organs available for transplant

I attended a talk today where representatives of various religions discussed the funeral rituals in their traditions and how important the rituals were to them.  I asked about their views on organ donations, and two said that their traditions either outright forbade it (Muslim) or in effect did so as a cultural practice (Native American).  The liberal rabbi said that while liberal jews had pretty much decided that organ donation was acceptable, most conservative jews staunchly oppose it.

I've been thinking about the terrible shortages of organs for some time, and I keep coming back to the question of whether we shouldn't do several things:

1) Pass laws making organ donation the default position for everyone in society -- that is, it is assumed that your organs are available for donation to whomever will benefit unless you take specific, positive action to refuse donating your organs when they are no longer doing you any good; AND

2) Revise the rules on who gets the donated organs to put adults who refuse the default position and their children at the bottom of recipient lists. 

That is, if you are unwilling to donate your organs, you will only be given donated organs when there is no more suitable candidate for a transplant available who is also willing to be a donor for others.  And if you have opted out your children, same rule applies -- children of those who exempt themselves from donating will only be given organs from a child donor if there is no more suitable child available who can benefit from those organs.

It sounds terribly brutal or even bigoted to see it stated that way, though my intent is neither to be brutal nor to harm people of any religious group.  But in a pluralistic society where there are far more people who need organ transplants than there are donors, something has to be done to increase the odds of people donating.  It seems just (as in justice) to have organs preferentially given to those who have indicated a willingness, were the roles reversed, to be the donor as well as the donee.  It doesn't matter whether your organs are medically fit such that they would be accepted, it's whether or not you positively opted out when you didn't know whether you would need them that matters.

More importantly, this avoids the whole "Why shouldn't we let the rich arrange with the poor to sell their organs?" problem that crops up now and again.  The proposal above is even-handed and avoids any hint of privilege based on anything but your own willingness to contribute into the system that might benefit you in the same way that you might benefit.

Thoughts?

Sanity on End of Life: Quality of Life and the importance of Oregon's Death with Dignity option

Image via WikipediaThere are still a lot of people who would be delighted to see Oregon return to the dark ages of enforced suffering through repeal of its landmark "Death with Dignity" act.   So it's worth listening to people like this gentle, decent man:

Cancer Patient Believes Quality of Life Should Come Before Treatment

John Wish, diagnosed with bladder cancer earlier this year, says it’s time to ration healthcare for people his age and focus on quality of life rather than more treatment

Diane Lund-Muzikant 

October 27, 2011 -- Faced with cancer, it’s very unusual to hear someone talk about refusing to have chemotherapy or enduring more surgeries -- even though it might increase their chance of living longer.   

But this decision came easy to John Wish, who was diagnosed with Stage 3 bladder cancer earlier this year and had surgery to remove his bladder, prostate and the lymph nodes surrounding his groin.

“Old folks like me don’t deserve as much care as younger folks,” said Wish, who’s 77.  “The problem is, we don’t have a good way of defining who gets what. We need to talk about it, and have a moral and political discussion so we can get healthcare costs under control.  As a Quaker, I find it easy and helpful to talk about these matters of illness and death -- they are matters of equality and justice.”

Quality of life is just as important as having another medical intervention said Wish, who’s had arguments with his doctors. . . .

After his surgery, they urged him to have four rounds of chemotherapy, where he could have lost his hearing, had kidney failure and neuropathy. One chemotherapy treatment alone would have cost $10,000, he learned,while the total cost of his care could have reached into the tens of thousands of dollars.

Quality of Life Came First   

“Is that quality of life?” he asked. “I’m 77 years old. How much more expensive care is worthwhile to me or the community?” Even without the chemotherapy, he estimates Medicare has spent more than $35,000 on his medical care.

“There’s something wrong in our society with people believing they’re never going to die, and they only need another medical intervention and will have a happy life forever, Wish said. “It’s ridiculous. There comes a time when we need to let go. This is an important conversation that’s not yet occurring. We have to face it, or medical costs will continue going up. We’re 20 years behind with the Oregon Health Plan on figuring out what a procedure is worth, and how much the taxpayers should pay for.”
From an economic standpoint, his family is secure, his wife is capable, and Wish doesn’t want her devoting months on end taking care of him. . . .

His primary care physician argued with Wish about not wanting any further interventions. “When it came right down to it, he felt he had more responsibility for my body than I do, and we had a very distressing big time argument. It should be easier for me to make those choices and not have to fight with my doctors. It’s my body.”

Since then, he’s found a palliative care specialist in Portland -- Dr. Angela Kalisiak – calling her his advocate.

“She likes to see people who’ve made a choice about their condition, and aren’t in denial, and has been very helpful to me,” he said.

He believes in Oregon’s Death with Dignity law and wouldn’t hesitate to get the prescription for the cocktail from Kalisiak if his cancer returns, and he has less than six months to live. Fortunately, his family hasn’t raised any objections.    

“Given my diagnosis, I’m interested in high quality life – being in control of the choices I make, where I go and what I do,” Wish said. “Having a kidney infection is not high quality life. Having someone change my diaper is not high quality life. Or, having a stroke and not being able to make decisions about how much medical intervention I want.”

And, happily, we have an attorney general who gets it.

(And it's also good that we have a knowledgeable, independent reporter on issues within the medical-industrial complex in Oregon, the nonprofit Lund Report.  Send her some money if you have it to spare.)

Word: Recognizing the elephant in the doctor's office

From The Lund Report:

http://www.thelundreport.org/resource/it%E2%80%99s_time_for_doctors_to_reclaim_ownership_of_their_profession

It‚s Time for Doctors to Reclaim Ownership of Their Profession We can't sustain rising healthcare costs and, more urgently, we can't sustain the aftershocks of a healthcare bubble bursting

By: Dr. Kris Alman . . .

It must be understood that doctors no longer own their own shingle. When post-World War II America ceded healthcare to employers, insurance companies inherited a cash cow. Individuals, families and businesses now realize that insurance companies cannot deliver a product that can be consumed for their benefit when profits are involved. The conundrum is very basic. Health is a societal investment and not a commodity that can be consumed and marketed as healthcare. For-profit healthcare creates perverse incentives for those who profit from the unhealthy and the worried well. Employers, tired of insurance companies profiting from their employees, are marketing a new paradigm of managed care through self-insuring. Consumers should be wary of "roadmaps" for employer health management and value-based benefit designs. Values will be compromised for the sake of value. Market-based healthcare demoralizes the doctor. I left my career as an internist and endocrinologist over ten years ago, when I was at my prime. My integrity was too compromised by the compromises the market demanded of me. Many of my physician friends envy my good fortune married to a radiologist who gives me that choice. But I still mourn the loss of my career especially since I know there are critical needs for primary care doctors. Market-based health care won't work. Quality healthcare depends on a trusting relationship between the doctor and patient, an art that that is unquantifiable. Yet we're reassured that healthcare reforms will be evidence-based. Even a spoonful of sugar doesn't help swallow "evidence-based" research cooked by PhRMA and medical device companies. Healthcare reforms were adopted from the evidence-based playbooks of No Child Left Behind. I assure you doctors will be treating to the HEDIS test. This approach is impersonal and non-specific. . . .

We already have rationed care. The question is who should who should determine how we ration care: doctors or employers and insurance companies? Doctors must reclaim ownership of their profession and demand full transparency of healthcare costs. They'll better grasp the inherent inequities that arise from the multiple payers and deniers of employer-based healthcare. In doing so, doctors can reassert true value to the care they give and to healthy values we, as patients, must embrace. We can't sustain rising healthcare costs and, more urgently, we can't sustain the aftershocks of a healthcare bubble bursting. ================== Dr. Kris Alman retired from healthcare to become a citizen activist for a healthier democracy. She advocates for fair taxation to invest in our common goods--prioritizing education, renewable energy, campaign finance and healthcare policies and laws.

Wrong direction in a hurry

As times get harder, access to health care is going to be tougher and tougher to provide. One of the best things you can do for yourself and your loved ones is to be the exception to this scary trend.

The cynical exercise known as "health care reform"

Image by @mjb via Flickr

Tikkun has a nice summary of the gory details and a prescription for better.

The whole Obama health care reform charade finally removed the mask of the caring health insurance company and revealed them for what they are: mafioso who would rather see us suffer and die miserably with them in the picture than face a world that lets us live well without them.

After the Reform: Aiming High for Health Justice

. . . The Public Option Was Ruled Out at the Start

From the beginning of this process, it was clear that the administration and leadership had developed a strategy based on an outcome they believed they could achieve. The path was predetermined. All of the steps along the way, from the house parties that started during the winter of 2008 to the hearings, to the media spin, were planned so that the resulting "debate" was a drawn out performance of political theater. In order to disarm the corporate interests, the health industries that had opposed previous reforms were included on the inside.

In order to disarm the Right, bipartisanship was at the forefront. In order to disarm the supporters of a single-payer plan, who are the majority, a campaign was developed around a promised "compromise," the public option, and given tens of millions of dollars for organizing and advertising. The public option succeeded in splitting the single payer movement and confusing and distracting it with endless discussion about what type of public option would be effective.

Despite all of the attention, the public option was never meant to be part of the final legislation. As early as March 2009, Senator Baucus admitted that the public option existed as a bargaining chip to convince private insurers to accept increased regulation. And a year later, Glenn Greenwald and others confirmed that the public option had been privately negotiated away, although members of Congress continued the charade and "fought" for it.

Toward the final vote, supporters of the public option were hearing the same excuses that single-payer advocates have heard for decades. We are always told that single-payer is not politically feasible. However, we know that political feasibility can change. We are told to be pragmatic, yet we know that the reform being passed was not practical, in that it failed to guarantee health care to everyone and to be financially sustainable. We are told we are asking for too much and should accept incremental change. However, we know that the smallest effective step we can take in health reform is the creation of a publicly funded health system. Beyond that, there is much more to do in order to create a health system that raises us into the top ten in the world.

Profit-Driven Insurers Cannot Prioritize Care

While politicians claim that we have finally achieved comprehensive health reform and that now all Americans will have guaranteed affordable health care, we in the single-payer movement experience a sense of déjà vu. We have seen the same scenario occur at the state level from Oregon to Maine to Tennessee, and most recently in Massachusetts. Every state that has passed a health reform package has made these claims, only to find that within a few years they were unable to cover the number of people they had hoped to cover and that their health care costs exceeded their budget. The reason for this is that every state, and now our federal government, ignored the data showing that we cannot achieve universal and affordable health care as long as we retain private insurers as an integral part of health care financing. This truth has been documented both in practice and in numerous economic studies.

We cannot control health care costs, without severe rationing, as long as we retain multiple private insurers, because this model wastes at least a third of our health care dollars on areas that have nothing to do with direct health care: marketing, high CEO salaries, profits, and administration. We cannot guarantee that patients will be able to afford needed care using private insurers because the private insurance model is profit driven. These corporations profit by avoiding the sick and denying and restricting payment for care. Their bottom line is profit, not improved health. And no amount of industry regulation to date has been successful in changing that bottom line. Likewise, the new federal legislation is full of loopholes that will allow private insurers to continue to skirt the regulations.

The White House and Congress claimed throughout the process that we must retain private insurance because Americans desire choice, and this has been framed as choice of insurance. However, this is a false concept. No person can anticipate what their health care needs will be or which insurance will be best. Health care needs change the day a patient has a serious accident or is diagnosed with a serious illness. We all need the same health insurance: one that covers all medically necessary care when and where we need it. Those of us who travel and listen find that people in America desire choice of health care provider and choice of treatment: the two choices that private health insurers restrict. . . .

When it comes to health reform, compromise on the fundamentals is unacceptable because the human costs are continued preventable deaths, continued suffering as patients fight for needed care, and continued bankruptcy from medical debt as families struggle to pay for deductibles and uncovered services. In a study published in Health Affairs in January 2008 that looked at the top nineteen industrialized nations, the United States ranked the worst—we have the highest number of preventable deaths (101,000 each year) because we lack a health system. . . .

We Can Still Create a National Health Program!

. . . It is possible to create a national health program in which every person living in this country is able to receive the same high standard of medical care whenever and wherever they need it, without fear of financial consequences. We call this health security. Other advanced nations have achieved this goal. The United States has not, and is currently ranked thirty-seventh in the world for health outcomes. We spend more per capita on health care than every advanced nation, yet leave a third of our
population either completely on the outside or vulnerable to financial ruin should they have a serious health problem.

Physicians for a National Health Program, founded in 1987, educates and advocates for a health system that will improve our health outcomes and provide health security based on the evidence of what has worked in our nation and what is effective in other advanced nations. We envision a lifelong universal health system—much like traditional Medicare—that is nationwide. We envision a system that allows patients to choose where they receive their care, permits caregivers and patients to determine the best course of treatment with assistance from evidence-based data, controls costs in a rational way through simplified administration and negotiation of fair prices, and is progressively financed. Its publicly funded nature would make it transparent and accountable. Because it would be privately delivered, it would allow caregivers to compete based on quality of care provided. Private health insurers would be relegated to a position of offering supplemental plans and possibly providing administrative support.

. . . Please join us. You can learn more at www.pnhp.org or join the grassroots
movement at http://www.healthcare-now.org.

WORD: An apt description of our "health care" "system"

. . .

We are left, finally, with a so-called health care system so cruel and unjust that the Devil himself in consultation with the most demonic lobbyists, and perhaps a little input from historical politicians such as Caligula, Ivan the Terrible, Heinrich Himmler, and Pol Pot could not construct a worse way of deploying the fruits of modern science. It has gotten to the point for most of us where we dread a visit to the doctor more for the bureaucratic consequences than the health issues themselves. Your gall bladder may have to come out, but it's much harder to face the booby-trap clause in your health insurance that will result in you getting stuck with a $123,000 bill for surgery and attendant procedures (including the $500 tylenols). Three months later, of course, the re-po man is towing your car and the mortgage "servicer" has foreclosed on your house, and your life (even without that pesky gall bladder) has become a permanent camping trip next to a drainage ditch. . . .

A serious message for the Dems

Possibly NSFW, depending on where you W.

The Healing of America: The one health care book to read if you're reading only one

Americans, learn from others?!? Are you mad? But seriously folks, great book.

He's an engaging writer and, in a fairly short book, manages to provide both a great overview of the principal systems for financing health care and a down-to-earth level view of how the systems work in practice (a perspective gained by actually seeking and getting, or not getting as the case might be, care in each of the countries).

A most telling graphic

The discussions we need to be having before we need them

Image by Flatbush Gardener via Flickr

Have you prepared your end of life care instructions?

Because, if not, you risk winding up getting what someone else thinks is the right thing for you. Unless you make your wishes known, you could be turned into a hockey puck for monstrous, morally bankrupt and vicious people to try to use to score political points.

Tuesday 12/1 -- A chance to untangle the tangled web some

If you're a cat with questions, this meeting might be for you. Image by silgeo via Flickr

Every week we hear something new about the debate on reforming our broken health care system. As we gear up for the home stretch, its important that we are all on the same page. So, we are holding a series of meetings to clear up any confusion, frustration, or misinformation that comes with following the process in Congress. Come join us and your fellow health care activists for an evening of lively discussion.

Salem - Tuesday, December 1st
5:00 - 6:30 pm
Salem Central Library
585 Liberty St, SE, Salem, OR

If you can't make it to a meeting, but still have questions please feel free to email me and I will do my best to get back to you by the end of the week. Hope to see you soon.

To your health,

Betsy Dillner
Oregon Health Care for America Now

On the so-called "Health Care" bill

Healthcare in America
Mary Vorachek, M.D., Salem, Oregon

Now that we have the worst healthcare bill that our representatives in government could contrive there is no place lower to go except the grave. Our government wants our money and the money of all our descendants for the enrichment of Wall Street, Detroit and the corporations; and our government wants the limbs and lives of your fathers, mothers, brothers, sisters and children so they can kill people in the Middle East, Africa, Colombia, Honduras, etc. (poor countries that are not respectful enough with people who are not quite white enough but with coveted resources that we wish to exploit because we think we can).

Our representatives in government give our taxpayer money to the corporations that then give some of it back to our representatives so they can continue giving more of our money to the corporations that impoverish America’s citizens. President Obama took money from millions of people who placed their hopes for a better America and a better world in a man who could talk a good talk but who has not delivered and seems reluctant to deliver anything substantial to the American people. A few crumbs may fall off the kakistocracy’s (rule by the most reprehensible elements of society) table, and we can scramble over our friends, neighbors and fellow citizens to lick crumbs off the floor but we will never have a seat at the table. Is it any wonder that Americans do not care about government? The government does not care about us, and the corporations that run the government do everything possible to disenfranchise voters.

The House of Reprehensibles has given us a bill that:

1) does not rein in insurance premiums,
2) has a public option with co-pays and deductibles that will continue to make insurance unaffordable and bankrupt its consumers,
3) ensures the pharmaceutical industry will never have to worry about losing patents on new drugs,
4) mandates the purchase of unaffordable insurance, and
5) will not cover comprehensive reproductive needs of women.

On the plus side, the Reprehensibles have given us an unaffordable bill that:
1) eliminates discrimination against people with pre-existing conditions.

The House bill enriches the private insurance and pharmaceutical companies and ensures the Reprehensibles of continued re-election coffers full to the brim. The insurance industry will get millions of new customers plus $500 billion for public option subsidies. And you will be charged with a federal crime if you do not qualify for the unaffordable public option but refuse to buy private insurance.

WORD: Insurance parasites and the razz-ma-tazz of distraction

Awesome op-ed by a doc in the Big O. Excerpt:

Tobacco only affected the 40% of the population that smoked when the cigarette-cancer association began in the 1950s and the 20% of us who still do. The health insurance industry, on the other hand, affects every one of us. Its monopoly of health care financing extracts $500 annually from every citizen for its own administrative costs (not entirely devoted to lobbying and profit -- let's give the industry some credit), causes 45,000 annual deaths from inadequate access to health care (that's as many as die in automobile accidents), and precipitates most bankruptcies in the U.S. The money spent by our health insurance industry on administration could extend essential health care to every American. But we don't discuss that, do we?

Our health insurance industry succeeds as well in this century as the tobacco industry did in the last. Witness the congressional "reforms" -- all variants on a theme: Make every citizen buy our insurance. And if our price is too high, make our government buy it for them. All hail this great victory for free enterprise. But what about our health?

American spending on health care outstrips every other nation on earth, yet we lead in not one significant measure of public health. Can it be that our doctors, nurses and hospitals are that bad? Or is that we pay for them through private insurance? Our health insurance industry would have us believe our problem stems from spending too little on their profitable insurance, not spending too much.

The most brutal evidence of the insurance industry's success is the intensity with which all of us debate perennial unsolvable social challenges -- the role of government in private lives, how America's free enterprise system makes us special, whether tax dollars should fund abortion, whether people who work should provide free services to those who don't, how illegal immigrants sap our country's strength, the evil of socialist programs in foreign countries, the insidious threat of death panels, and the inherent inefficiency of any government to run anything. In short, the health insurance industry successfully diverts our attention from the root problem--that our method of financing health care through for-profit private insurance is driving our families and government into financial ruin.

So here we are, fighting not with the insurance industry but with each other: healthy against sick, insured against uninsured, libertarians against liberals, employed against jobless. Fear runs amok. Medicare recipients fear reduced benefits. Employers fear compulsory medical entitlements. Unions fear for their negotiated benefits. And everyone fears skyrocketing policy costs and decreasing access to physicians. We are paralyzed with terror.

Meanwhile, health insurance executives dab their collective brows, having successfully diverted us from realizing that their industry created and sustains our dilemma.

Can we escape this maelstrom?

Yes. With the health insurance industry spending $1.4 million daily on distractions, it takes grit to stay on target. But we must. We must demand our elected officials address the only three questions that matter: "What have you done to provide essential health care to all regardless of ability to pay, employment status or medical condition? What have you done to reduce costs? What have you done to improve our health? Everything else is irrelevant.

Can we stop the health insurance industry from killing Americans in this century faster than we stopped the tobacco industry in the last? Let's hope we don't have to wait another 50 years to find out.

Speaking of a broken system dominated by the health insurance leeches, an on-point documentary on the subject (intro video clip above):

Thursday, November 12, 2009
Salem Progressive Film Series: Health, Money and Fear
Doors open 6:15 p.m., film begins at 7:00 p.m.
Grand Theater, 191 High Street NE Adults $3, Students $2
America spends more than twice as much money on health care per person as other countries, yet gets much less in return. An ER physician looks at reasons for this and offers several prescriptions to cure the problem. For more information: http://www.salemprogressivefilms.net or 503-588-8713 or 503-779-5288.

Crucial graphs

Amazing set of graphs (pdfs) from the International Federation of Health Plans. (H/t, Ezra Klein, WA Post.)

MinnPost: Good health may have less to do with our health-care system than you think

From MinnPost: Good health may have less to do with our health-care system than you think

By Eric Black | Published Mon, Oct 12 2009 9:41 am

Should failure to finish high school be punishable by early death and by poor health for the dropouts' children?

Who deserves a healthy heart more, the rich or the poor?

My opening questions are ridiculous and absurd, designed to be provocative in hopes you are will take some of the facts below as hard as I have.

• Fact: On average, in America, college graduates live about five years longer than high school dropouts.
  
  
• Fact: Rates of poor or fair health are about seven times higher among children in poor families than among children in affluent families.
  
  
• Fact: In America, low-income adults are about 50 percent more likely to suffer from coronary heart disease, the leading cause of death in the United States, than are affluent adults.
  
  
• Personal responsibility? Yes, maybe, to some extent, but tell it to infants who won't reach their first birthday.
  
  
• Fact: The rate of infant mortality (defined as death before the first birthday) for babies whose mothers did not graduate from college is almost twice the rate for children whose mothers graduated from college.

This post is not, at least not fundamentally, another one about the importance of expanding access to affordable health insurance. It is a prism held up to that debate to deflect attention for a nonce to another set of facts and ideas about health (not health care) in America.

Two weeks ago (and I'm embarrassed its taken me this long to write about it) I attended a fine but poorly attended and mostly un-covered presentation at the Humphrey Institute. The main speaker was Wilhelmine Miller, associate director of the Robert Wood Johnson Foundation Commission to Build a Healthier America. It was titled "Beyond Health Care." Perhaps you can understand why it attracted only a couple of dozen and was ignored by the news media.

Even among the health-care obsessed, most of us are not ready to look "beyond health care" to look for other difficult ways to "build a healthier America."

Furthermore, Miller was mostly presenting data from a 2008 report by the Healthier America Commission documenting the kind of health disparities by income, education and race that I sensationalized above, along with a follow-up report from April of this year in which the commission offered recommendation for reducing those disparities.

But as I watched Miller's powerpoint presentation and its graphics illustrating those disparities of health by income, education and race, I was hit hard by this:

America's horrible showing in all international comparisons of health outcomes (despite spending by far the most on health care of any nation) is not just about who has access to a doctor. Probably more than it is about the absurd shortcomings of the U.S. system of health insurance, those disparities are about class and, to a lesser degree, about race.

Take a look at the table just below. It shows how many more years an individual can expect to live, on average, beyond age 25, sorted by gender and family income.

Robert Wood Johnson Foundation

The first -- and shortest -- bar in each gender group reflects the life expectancy of individuals in families with incomes below the federal poverty level. The fourth and tallest shows families with incomes at least four times the poverty level. The gap between the the tallest and shortest bars, on the men's side, is eight years. Eight extra years of life for the affluent. Eight fewer for the poorest. Eight years. That's a lot of years.

In 2009, for a family of four, a lowest bar would cover families with incomes at or below $22,050. The top bar therefore covers families at $88,200 and up.

Please note that while the figure shows a huge gap between top and bottom, the overall graphic shows not just a disparity between the richest and the poorest but a steady increase in life expectancy at each step. The poorest families qualify for Medicaid, whereas the middle two bars include many families that do not qualify. In class terms, the "working poor" families -- too rich for Medicaid but holding crummy jobs with little or no health benefits -- are the group mostly likely to be living without health insurance.

That's another short-cut to the argument that poor health outcomes are not just, and maybe not primarily, about access to healthy care. Of course it is better, speaking health-wise, to have insurance than not. I hope that our Congress and our country will soon complete the short-term legislative task of removing various barriers to health access, whether caused by unaffordability or by pre-existing conditions or some other cause. But this graphic and those to follow make a strong argument that simply being poor is bad for your health, even if you have access to health care. I suspect it also means that the United States will continue to look bad in international health comparisons, even if more people have health insurance, because our country has more poverty.

If you can stand this stuff, the full report (pdf) slices and dices the comparative health data many ways, including by education level and race and many combinations thereof. The graphs in this post are just a selection. Below is the infant mortality rate for children born to mothers who reached various levels of education.

Robert Wood Johnson Foundation

Education and income are obviously highly correlated. I include this one because for the benefit of those whose thinking on issues like these runs strongly toward the idea of personal responsibility. America is a land of opportunity. Education, at least through high school, is free. If you stay in school, don't join a gang, stay off drugs, get a job and have a good work ethic, you do not have to be poor. So to what degree should the relatively affluent taxpayer have to pay for the poor life choices made by a stranger? It's a complex discussion.

It is certainly easier for some young people to get on and stay on the path to the middle-class American dream than others. In the context of the larger liberal-conservative argument over what the government should do, this is important. But it is also complicated by issues such as those illustrated by the graphic above, which I sensationalized in my opening. A significant factor influencing the odds that a newborn child will survive to its first birthday is whether its mother has a high-school diploma. Without being cavalier about the challenges facing a particular young woman versus another, the mother has some control over whether she stays in high school. The baby has none.

The Robert Wood Johnson commission also found that if you ignore income and education but focus on race, there are significant disparities. Among black adults, 20.8 percent report that their health is poor or only fair. Among whites, just 11.4 percent say that. Hispanics are in between with 19.2 percent.

So race matters. Members of minority races are also more likely to have low incomes. But if you sort by both income and race, it's pretty clear that class is much bigger than race as a predictor of health. In other words, poor blacks are still more likely to report poor health than poor whites, and the same for higher income groups. But income still appears to be the more powerful factor of the two, as illustrated by the figure below.

Robert Wood Johnson Foundation

Blacks and hispanics with poverty-level incomes are much more likely to be in ill health than members of the same racial groups who have higher incomes. The gaps by class are bigger than the gaps by race. The RWJ commission went out of its way to make this point, perhaps because differences by race, that may be purely genetic, are more difficult to overcome, or perhaps because the politics of race are deep-seated.

But poverty and poor health -- even unto early death -- tend to run together. This is probably true for all countries but is especially costly to health outcomes in our country because we have so much more poverty. Take, for example, this graphic displaying the rate of child poverty in the 25 member nations of the Organization for Economic Cooperation and Development, basically a club of the wealthy nations of the Western world, plus a couple of other nations that we don't usually think of wealthy or western.

Robert Wood Johnson Foundation

As you can see, in this data from the second half of the 1990s, the United States ranks 24th out of 25. In Denmark, which has the lowest rate, 2.4 percent of children live poverty. In the United States: 21.7 percent. This is really a national disgrace, for such a wealthy nation as ours.

So, after amassing and analyzing all of this data in 2008, the Commission to Build a Healthier America published in 2009 a second study, titled "Beyond Health Care," which I take to mean that we need to move beyond just trying to get more Americans insured and get them into the health care system. The commissioners compiled a list of 10 recommendations toward a healthier America that don't have much to do with doctors and hospitals but are targeted more on reducing the deficits that cause poor people to be less healthy. The recommendations focus on things like diet, exercise, smoking cessation, healthy housing and on developmental education for small children.

We're talking about things like feeding healthier meals to kids when they are in school, requiring that every kid get some exercise every day during school.

Here's another example that wouldn't occur to middle-class folks who have easy access to plenty of good and healthy groceries. From the report:

"Many inner city and rural families have no access to healthful foods: for example, Detroit, a city of 139 square miles, has just five grocery stores.Maintaining a nutritious diet is impossible if healthy foods are not available, and it is not realistic to expect food retailers to address the problem without community support and investment. Communities should act now to assess needs to improve access to healthy foods and develop action plans to address deficiencies identified in their assessments."

That leads to this recommendation: "Create public-private partnerships to open and sustain full-service grocery stores in communities without access to healthful foods."

When most of us think about improving health in America, we probably don't start thinking about the shortage of grocery stories in Detroit.

If you haven't seen SICKO yet . . . don't miss it!

Cover of Sicko (Special Edition)

With the insurance company parasites -- the blood-engorged leeches who suck the lifeblood out of sick and injured people in order to lavish wealth on a tiny few -- fighting like cornered rats to deny the public any semblance of real reform, it's important that people are reminded of the horror stories that our dysfunctional health care financing "system" inflicts on everyday Americans. And it's important to everyone know that there is another way.

Many, many people left the theaters in tears and enraged after seeing SICKO -- and that's just the intensity we have to regain if we're to get anywhere with reform. So don't miss it!

You're Invited!
Join us for Marion County Dem's First MOVIE NITE [sic] SOCIAL!
No Charge; Donations Accepted
Wednesday, October 14, 7 PM
It's all happening at Marion Dems Headquarters,
250 Liberty SE, Salem.

This month's features:
Michael Moore's "SICKO"
PLUS... SNEAK PREVIEW OF a 'must see' health care documentary!

And plan to attend the "We're Counting on You!" rally earlier that same day if you can (RSVP at the link):

'We're counting on you!' Rally

Front steps of the Capitol (across from the Capitol Mall), 900 Court Street (Map)
Salem, OR 97303, Wednesday, October 14th, 12:00 PM

Let's keep the momentum going!

Message from your host, Tricia M.: Come join other MoveOn members for our "
WE’RE COUNTING ON YOU--PUBLIC OPTION NOW" – RALLY in SALEM on Wednesday, OCTOBER 14 at NOON.

Most of Oregon’s national representatives support a public health insurance option. The Salem-Keizer MoveOn Council wants to recognize that and encourage other Or...(more)egonians who also support a public option in upcoming national health care legislation to speak out and support them.

Noon to 1 PM, on Wednesday, October 14th, we are holding a rally at the Capitol in Salem, 900 Court Street, on the steps across from the Capitol Mall.

See you there!