Today marks the first anniversary of this blog. Please allow me to again thank Brad Kleinman and David Toth of WorkSmart for teaching a class on eMarketing and social networking for the Beachwood Chamber of Commerce last January. Their motivation and the wonderful feedback I receive from you, my readers, keep me excited about producing these posts.

On September 21, 2009 I posted an article entitled Anthony Weiner Hates Me. Mr. Weiner is a Congressman from New York City who is entirely convinced that insurance companies are an unnecessary drain on our system. He has preached from the alter of single payer government run health plans on the Rachel Maddow Show, Countdown with Keith Olbermann and the Huffington Post. Mr. Weiner even shows up on the Sunday morning shows every now and then. His extreme views make for good television. Congressman Anthony Weiner was on the Daily Show with Jon Stewart last night.

Anthony Weiner and Jon Stewart have been friends for a long time. How long? Half the interview was dedicated to the threat of exposing incriminating photos from the 1980’s each still had in his possession. That was the interesting part of the interview. The rest? Nothing terribly new.

Realizing that he didn’t have a lot of time, Mr. Weiner spoke in bullet points.
• Medicare is a single-payer system that works.
• We should extend Medicare to people 55 and older. Why start at age 65?
• We should extend Medicare as an option to recent college graduates who are no longer covered by their parents’ policies.
• We should extend Medicare as an option to people who have lost their jobs.
• Medicare has a 1% overhead vs. the insurance companies at over 30%
• We should cap what insurance companies can charge.

Somewhere in this tangle of talking points, Mr. Weiner stopped to take a breath. And here is where the friendship, or the pictures from the 80’s, paid off. Jon Stewart didn’t challenge any of his friend’s assumptions. He allowed this fact-free, totally unsupportable, completely unrealistic presentation to proceed. Jon Stewart, someone unafraid to confront, intellectually, Jim Cramer and Keith Olbermann, devolved into the Memphis Grizzlies defense and watched LeBron James drive to the hoop. Mind you, I wasn’t looking for a hard foul (continuing the basketball metaphor), but I would have appreciated an attempt to protect the basket, or truth.

This blog has dealt with the good and bad of Medicare numerous times. I’m not sure you have the patience to reread much of that. It is still vitally important to note that Medicare does serve a purpose. Medicare is an important part of our current mish-mosh of payers. And of course, anytime the government is involved in writing checks, a lot of what services are, or are not, available are determined by Washington. But Medicare was never designed to pay all the costs of health care for anyone.

Let’s talk about the specifics of Medicare. It wouldn’t be fair, easy but not fair, for me to cherry-pick this. So this is what Medicare really does and doesn’t cover.

PREMIUM – $110.50 per month, assuming you make less than $85,000 per year.

MEDICARE Part A

Semiprivate room and board, general nursing, and miscellaneous services and supplies:
First 60 days – You pay $1,068
61st day through 90th – You pay $267 per day
91st day and after while using
Your 60 lifetime reserve days – You pay $534 per day
Thereafter – YOU PAY EVERYTHING

Skilled Nursing Facility Care
You must meet Medicare’s requirements, including having been in a hospital for at least three days and entered a Medicare-approved facility within 30 days after leaving the hospital.
First 20 days – You pay $0
21st day through 100th day – You pay $133.50 per day
101st day and after – YOU PAY EVERYTHING

Blood
First three pints – You pay everything
Additional amounts – You pay $0

Hospice Medicare pays for all with very limited coinsurance
For outpatient drugs and inpatient respite care

MEDICARE PART B

Medical Expenses – In and out of the hospital and outpatient treatment such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests and durable medical equipment,

First $135 of Medicare approved amounts – You pay $135
Remainder of Medicare approved amounts – You pay 20%

Part B Excess Charges, the amount above
Medicare approved amounts YOU PAY EVERYTHING

Blood
First three pints You pay everything
Next $135 of Medicare approved amounts – You Pay $135
Remainder of Medicare approved amounts – You pay 20%

Clinical Laboratory Services – You pay $0

Home Health Care
Medicare approved services
Medically necessary skilled care
Services and medical supplies – You pay $0
Durable medical equipment
First $135 of Medicare approved amounts – You pay $135
Remainder of Medicare approved amounts – You pay 20%

Foreign Travel – YOU PAY EVERYTHING

Sorry, there was no way easy way to explain this policy. Above are the basics, the shell. What does this really mean?
1. There is no prescription coverage.
2. There are huge gaps as to what is and isn’t adequately covered.
3. People who rely strictly on Medicare are woefully underinsured.

How underinsured? A study released today at the fifth annual
Community Oncology Conference in Scottsdale, Arizona clearly states that “Medicare covers only 56% of the actual costs of administering chemotherapy and providing related infusion room services to seniors with cancer”. We have already discussed how Medicare has reduced the payments to medical providers. According to the report, Mr. Weiner’s favorite single payer has reduced the payments for cancer drug infusion room services by over 25% since 2004. Are the doctors silently bearing these reductions? Are you and I paying more for these and other services as the cost for care is shifted, more each day, to those of us with private insurance?

There were lots of other holes in Congressman Weiner’s presentation. I appreciated that he has now reduced this imaginary overhead expense for Medicare from the unlikely 4% that he had claimed last summer to the impossible 1% of last night. But I know that this is already too long.

There was one saving grace to Congressman Anthony Weiner’s appearance on the Daily Show. When asking Mr. Weiner about his Mayoral ambitions, he wondered aloud whether Michael Bloomberg could have been defeated. Without hesitation Mr. Weiner opined “I would beat him like a rented mule”. See, I’m not the only person Anthony Weiner hates.

DAVE

www.bogartcunix.com

A threat? A promise? President Barack Obama ended his State of The Union speech with a clear statement of his personal resolve and optimism. He was forceful. He was clear. For one hour last night, Barack Obama was the guy who ran for the presidency last year. It was a strong performance.

How strong? The initial reaction on Fox News was subdued and restrained. MSNBC’s Keith Olbermann, Rachel Maddow, and Chris Matthews seemed reinvigorated and emboldened.

This blog, Health Insurance Issues With Dave, deals with one particular issue, health care, So what did the President say about our issue last night? The quick answer – not too much.

Thirty-two minutes into his speech, President Obama touched upon health care. He mentioned that he had gotten close to passing legislation. He noted that his plan was not politically popular. He admitted that they, he and the Democrats in Congress, had handled this badly. He acknowledged emerging trust issues. He dared the Republicans to offer alternate suggestions. But that’s it.

There were no specific goals. No mention of shared sacrifice. No direction. And in the end, at no point did President Obama take the time to explain what he was going to do to make changes in our health care system more possible, productive and palpable. He threw the ball back to Congress where the Democrats will muck it up and the Republicans will dig in their heels.

President Obama said that he won’t quit. Great. I don’t want him to quit. I want him to start.

DAVE

www.bogartcunix.com

“They’re doing it behind closed doors!” roared Susan Robinson. “Did you hear Nancy Pelosi say that the promise of transparency was just campaign talk?”

A lifelong resident of Bay Village, a lifelong Republican, Susan Robinson (yeah, yeah, yeah I changed her name) registered as a Democrat in the spring of 2008 and voted for Hillary Clinton in the Ohio primary. It is one thing to cross party lines and to cast one’s ballot, in the privacy of the voting booth, for a member of the other party. Susan Robinson did more. She publicly self-identified as a Democrat. She has the junk mail to prove it. And now she is a sort-of Democrat, a sort-of Republican, and totally ticked off.

Disillusioned and betrayed, Susan Robinson and countless others voted for change. It was as if the voters approved Issue 6 to reorganize Cuyahoga County government and then installed Jimmy Dimora as the new chief executive.

The latest news, appropriately for this discussion leaked by a nameless Democratic official, is that the President, the Senate and the House may have reached a compromise on the plan to tax so-called “Cadillac” health plans. As always, the words compromise means that the House caved. The deal is that the tax would be on family plans that cost $24,000 per year instead of $23,000. The other part of the deal is that the employees of state and local governments and all union employees would be exempt until 2017.

Feel free to take a moment to reread the last sentence. Do you understand why a tax should apply to everyone but state and local government employees and members of a union? Neither do I. Will the law specify which unions are official skip the tax unions or will any old union do? Can we form our own unions? Can each of us create our own unique, self-contained, tax avoiding union?

We’ve now crossed the line from short-sighted and ill-advised to just plain dumb. Divisive, too.

Please, somebody tell me, what happened to helping the working poor acquire affordable health insurance?

DAVE

www.bogartcunix.com

“Goals. Why do you keeping harping about goals, Dave? The President said that we are going to cover the uninsured, make health care affordable, and we can keep our current insurance. Aren’t those the goals?”

Those are goals. In that same vein, I would like to start each day with a smile on my face and a song in my heart.

Real goals, well defined and achievable, are in short supply. This past Sunday’s Cleveland Plain Dealer illustrated our current goal-less struggle.

Let’s begin on Page 5 of Section A. A Chicago Tribune story entitled “Health bills can sink even those insured” comes with a picture of a kindly older gentleman helping out at a Christmas pageant. Even though he has insurance, he is getting clobbered with the copayments from his prescriptions following his heart transplant. Forget the fact that what Mr. Fraas really needed was disability insurance because his real problem is a lack of income, the theme of the article can be found in this sentence: “Meanwhile, Fraas learned that even with good insurance, medical care can break a family’s bank.”

We have heard before how unfair it is for unhealthy people to also suffer financially. So it must be safe to say that one of our goals is really comprehensive coverage that totally protects a family, NO MATTER WHAT.

Not so fast.

On Page 2 of Section G that same Plain Dealer had “A less than-honest policy is taxing” written by New York Times columnist Bob Herbert. This editorial page article discusses one of the more controversial details of the recently passed Senate bill, the tax on so-called Cadillac health plans. An excise tax of 40% will be imposed on family policies that cost more than $23,000 per year and individual plans in excess of $700 per month.

The Joint Committee on Taxation projects that this tax will generate over $150 billion over the next ten years. How? The deep thinkers behind this scheme think that your boss will refuse to pay this tax, buy a cheaper insurance policy, and since he or she just saved so much money, you will get a raise! The government will collect billions of dollars in new income tax. You will be forced to migrate to a health insurance policy with higher deductibles and copayments. You will be forced to become a better consumer.

So our goal is to have consumers (us) pay more of our health care expenses?

What do Hollywood romantic comedies and bad legislation have in common? The plot lines always revolve around the theory that opposites attract. Just because I really enjoyed Bruce Willis and Cybil Sheppard in Moonlighting, doesn’t mean I can suspend my disbelief about this bill.

DAVE

www.bogartcunix.com

Standing in line. I have been standing in line for over twenty minutes at the Beachwood Post Office, waiting for my turn, hoping to learn the fate of my missing mail. It is Monday, December 28th and there are only five of us in line. The women look inpatient, but remain silent. The guy in his late forties is visibly agitated. As more people join our line to see the one, and only, postal worker, Mr. Unhappy tells us that we should “get used to this. This is what life will be like once the government controls health care”.

How many times have we heard that refrain since Mrs. Clinton’s attempt at health care reform? Government Health Care will have the efficiencies of the Post Office with the compassion and customer service of the IRS! I think that statement is terribly unfair to the Internal Revenue Service. I have had to deal with the IRS, for my business, several times and found the agency professional and courteous. Seriously. The Post Office, however, can be a challenge.

The Post Office should serve as a cautionary example of what could happen if the government became too involved with the delivery of health care. How involved is too involved? I will have to leave that up to each of you. My personal opinion is that if we haven’t already crossed the line, we are probably very, very close.

At the top of this post I described the line at the Beachwood Post Office. The Post Office for 44122 is located on Green Road, about a block south of Chagrin Boulevard. Where is the Post Office for 44120? The SHAKER HEIGHTS Post Office is located on Warrensville Center Road, a few hundred yards south of Chagrin Boulevard, less than a mile away. Hell, the 44120 Post Office is located within 44122. The new Post Office was built while Stephanie Tubbs Jones was still alive and serving in Congress. It was placed next to the then Office Max Headquarters in the heart of a very powerful Congressional leader’s district.

You may be wondering whether 44120 really needed a separate Post Office or if one or possibly a few of these separate buildings could have been merged into one larger, more efficient structure. Surely you have guessed that the driving force was payroll taxes to the City of Shaker Heights and not the delivery of letters and catalogues. The more control government has in the actual delivery of health care, the more politicized it becomes. Is your representative powerful enough to make sure that there will be doctors’ offices near you?

“Dave, you’re being silly”, you scoff. “Congressmen and Senators would never exercise power that blatantly.” Ladies and Gentlemen, I give you Ben Nelson.

The Senate Democrats needed 60 votes to get their bill through. Technically, that meant that any one of them could have prevented passage. Technically but not really. Some, like our Senator, Sherrod Brown, were going to vote for this bill no matter what. They had no position to bargain.

Joe Lieberman was one of the first to stand up. He said that he wouldn’t accept a bill that had a Public Option. He wasn’t the only Senator. He was just the one who took the heat. Because he was willing to take a leadership role, he got his deal. Ben Nelson, coming from Nebraska, was willing to take the very public position of opposing any bill that might use taxpayer money to pay for abortions. Again, he wasn’t the only Democratic Senator who would have voted NO. He was the one willing to take the heat. For this he got the promise of millions of dollars. His fellow Senators offered to pick up the tab for Nebraska’s Medicaid bill. Poor people in Omaha may one day owe their free health care to the residents of Parma.

The Republican state attorney generals will eventually threaten to sue the federal government. I suspect that several Republican governors will also make noise. I really don’t think it matters since I doubt that the Nebraska deal clears the conference committee. But this is the start.

My letter carrier was on vacation and I may, or may not, start to receive all of my mail soon. One of the pieces of mail I may have missed was how our Congresswoman and Senator are bringing jobs and programs to our district. I’d sure like to see the report Ben Nelson sent to his.

DAVE

www.bogartcunix.com

My one and only trip to Washington DC was about twenty years ago. This is odd for someone as politically active as me. I was attending a B’nai B’rith national policy conference. What a trip! I had the opportunity to tour the White House and Senate, visit the Lincoln Memorial and Washington Monument, and talked, one on one, with several Senators. But the most inspiring person I met, the guy who made the biggest impression, was one of the featured speakers, the young Ohio Secretary of State, Sherrod Brown.

I have been a Sherrod Brown fan for twenty years. And now I am truly disappointed.

OK, Sherrod Brown and I do not see eye to eye on the health care debate. That’s not news. What is shocking, at least to me, has been the way he has argued his case. I expected more from Sherrod Brown than the factless, emotional presentations of late. This Sherrod Brown plays well to most of Rachel Maddow’s audience. He appears on her show and Keith Olbermann’s Countdown to feed the base. No Problem. Sunday, December 20, 2009, he was on Face The Nation, the venerable CBS show. It was a cringe-worthy presentation.

Bob Schieffer, the moderator of Face The Nation, tries to give his guests enough time to talk in complete sentences. Used to speaking snippets and catch phrases on television, many politicians falter when given the extra time. Senator Brown must have misplaced his index cards. He kept on talking about the evil insurance companies charging women more than men. He also briefly mentioned that age is also a pricing factor, but quickly retreated back to gender.

I touched on this very subject in my October 19th post. In the past I would have wished that Mr. Brown had seen my blog. Now I’m not so sure that it would matter. Will Sherrod Brown let the facts get in the way of a good argument?

I had a client contact me today. She was worried that her health insurance policy was all screwed up. After watching TV, she couldn’t understand why her premium was substantially less than her husband’s even though he is four years her junior. Her policy is fine, it is our politicians that are screwed up. So I ask for your patience while we discuss a real issue with real numbers.

Case Study #1
Bob and Jane are healthy 21 year olds living in Cuyahoga County. They are both single, non-smokers, and have clean driving records. They need to purchase liability auto insurance from their neighborhood Erie Insurance agent. I wasted a half hour of Brian Ritzenberg’s time. They also need a basic health policy from Anthem Blue Cross with a $1000 deductible, office visit copays and an Rx card. And while they are at it, they are each going to purchase a twenty year term policy for $250,000 from North American. Auto, Health, and Life Insurance. Nothing out of the ordinary.

Bob
Auto – $731 per year
Health – $123.45 per month
Life – $217.50 per year

Jane
Auto – $630 per year
Health – $157.54 per month
Life – $205 per year

The price of insurance reflects the risk. Young men have more accidents. They pay more for auto insurance. Young women have more medical claims. They pay more for health insurance. Some young women may need to purchase their own health insurance. Almost all young women, at least here in Northeast Ohio, drive.

Case Study #2
Joseph and Pamela are healthy 61 year olds living in Cuyahoga County. Everything, including the amount of time I wasted of Brian’s, is the same as above except for their ages.

Joseph
Auto – $358 per year
Health – $539.64 per month
Life – $1960 per year

Pamela
Auto – $358 per year
Health – $515.66 per month
Life – $1550 per year

Life insurance is less expensive for adult women, young and old. Auto insurance is the same price or less for women at every age. Health insurance is sometimes less, sometimes more. With all of the online rating services, anyone can recreate this little test from the comfort of their home or office. In other words, you know that Senator Brown’s argument is specious at best.

We have almost a year invested in this process. That means that I have been sitting here for twelve months waiting for the Sherrod Brown I met in Washington twenty years ago to show up. The current Sherrod Brown is no longer inspiring. Imagine my disappointment.

DAVE

www.bogartcunix.com

Senator Harry Reid is fighting a deadline. The President may have wanted a bill before Labor Day, but they want ice water in Hell, too. Reid, the pragmatist, knows the real target, December 31st. The last thing he wants is to be holding a hot potato of a health care bill in January, or worse, February.

Senator Reid has a problem.

Regular readers of this blog know that I have been asking one question from the start, What is our Goal? It is unfortunate that even though our political leaders may not have had well defined, easily explained goals, they all had solutions. Creating questions to given answers is the basis of the television show Jeopardy! Creating legislation to preconceived answers puts all in jeopardy.

It is hard to describe the pending legislation as health care reform. In fact, it is not even insurance reform. The current bills appear to reposition the government’s role in the payment of health services. Based on the numbers coming from the Congressional Budget Office, some critics think that this is just Washington once again proving that it can turn wine into water.

Let’s take a quick look at a few of the issues:

PUBLIC OPTION – Previous blogs have dealt with this particular issue. If nothing else, the Senate does not have 60 votes to pass a bill containing a Public Option.

MEDICARE OPENED TO PEOPLE AGE 55 TO 64 – This idea had a two minute life span. Nancy-Ann DeParle, the director of the White House Office of Health Reform, is quoted in the December 12th Plain Dealer. “Let me be clear, it’s not adding 55 year olds to Medicare.” If this is only Medicare-like coverage, it is really the Public Option. Please see the above.

ABORTION – Once you get the government involved, really involved, in the delivery or payment of health care, abortion is almost always the first serious question. Conservatives, Democrats and Republicans, won’t allow federal money to pay for this procedure. Liberals want to pretend that they won’t back down. Again. Couples suffering from infertility issues want to insert coverage for in-vitro into this discussion.

NEW TAXES AND FEES #1 – The pharmaceutical industry thought that it had a deal with President Obama at a very fudgeable $80 billion. The House of Representatives passed a bill that would hit the drug makers for $140 billion. The Senate’s version has yet to be released.

NEW TAXES AND FEES #2 – The Senate has proposed a new, non-deductible, tax of $6.7 billion a year on the health insurers. The easiest way to make health insurance more affordable is to add huge new costs to the health insurance companies. Makes perfect sense. To Congress. You and I might also wonder if, as the President suggested, the purpose of a Public Option was to give the insurers real competition. The best way to compete? Give the insurers huge new taxes.

NEW TAXES AND FEES #3 – The Senate has proposed a new tax on cosmetic surgical procedures. The bill currently includes a 5% tax on tummy tucks, facelifts, etc… This is a tax on medical procedures that are not usually covered by insurance. The doctors are howling. Their first line of defense is to note that the majority of these procedures are performed on middle class women with an average income of $30,000 to $50,000 per year. The second line of defense will be to add that other elective procedure, abortion, which should end the conversation.

NEW REDUCTIONS IN MEDICARE PAYMENTS – The Senate bill anticipates significant cost cutting at hospitals and nursing homes. They are so sure of this happening that they are lowering Medicare payments now. We already have Medicare’s underpayments shifted to those of us with private insurance. Reductions in Medicare reimbursements simply mean more costs shifted to us which just means higher insurance premiums. The Government’s Centers for Medicare and Medicaid Services (CMS), according to that same Plain Dealer article, states that the other option from these cuts will be the forced closing of about 20% of these institutions.

Today is December 15th, nine days till Christmas Eve. Can Reid deliver a bill for Christmas? If the President and the Democrats, and at this point it is a one party bill, enact legislation, the Republicans will have a winning campaign next fall. If legislation is blocked by the Republicans, the President and his party can paint the opposition as obstructionists who were too busy saying “NO” to help solve the problems of average Americans.

Considering how awful this legislation is, will Senator Reid win now and lose next November or has he already realized that the reverse, losing now and winning later, is much better? Is this program designed to fail?

DAVE
www.bogartcunix.com

“It’s the insurance company’s fault that there are drug addicts walking the street.”

I did not know that. I needed the twenty year old junkie to explain this to me. After alienating her parents and step-parents, dropping off their coverage even though she is a full-time student, and suddenly getting married, she was surprised that insurance companies weren’t standing in line to welcome her in their warm embrace.

Of course, she was in my office for over a half an hour before she finally told me the truth. Thirty one years in this business has to be worth something. I could tell, I could feel that there was more than what she was disclosing. Bit by bit she released more information to me. It wasn’t until I had begun a pre-screen application that she dropped the bomb, her fourth on-going medication was an opiate blocker that costs $900 per month!

Forget everything but the math for a second. She wants to be allowed to pay $100 per month to Anthem Blue Cross so that the insurer can buy her $900 drug and three other medications. Shockingly, Anthem, Medical Mutual, et al… said “No Thanks”.

It was at this time that she informed me that her addiction is “genetic, like cancer”. Her mother is an alcoholic, so it is natural for her to have been hooked on heroin and methadone. “It is a disease. That’s what you learn at Alcoholic’s Anonymous.”

She spent an hour and a half in my office alternatively complaining about her parents who don’t want to have anything to do with her and the insurers who don’t want to have anything to do with her. She has options. Unwilling or unable to make the calls, I grabbed my phone and contacted her previous insurer, her mother’s employer, and went online to research the local university’s student policy. She can be covered, but it will take some time and effort on her part.

She will not be covered.

Which part is more frustrating, the self destructiveness of the drug addiction of a teenager or the delusion that someone else is to blame for one’s behavior; the refusal to take the necessary steps to solve one’s problems or the anger that there are lifelong consequences for one’s actions? She sat there whimpering while I tried to solve her most immediate problems.

Will any of the proposed changes in Washington solve her problems? NO! Even if we have a policy that would take everyone and provide any known pharmaceutical remedy, there is no guarantee that she would even sign up. More importantly, Congress is incapable of passing a law that would force Americans to take responsibility for their actions.

DAVE

www.bogartcunix.com

By the way, Jeff Bogart,my business partner, and Michael Saltzman, my attorney, went ballistic when they read the original post of this blog. So I have made a couple of key changes to completely hide the identity of the man/woman subject of this story. I guess you can’t be too careful.

Office space was at a premium in East Podunk, Kansas. Approximately 90% of the buildings were occupied on any given day. The building owners were getting fat and sassy. There was no need to reinvest or renovate their properties. At least, that’s what the mayor was saying. How could the mayor and city council solve this problem?

The mayor of East Podunk convinced the city council to strengthen the zoning laws. The new regulations were a hassle, but the building owners quickly adapted, made the required renovations, and profitably passed the costs to their tenants. Rents went up. The mayor seethed.

An office in East Podunk, Kansas carried a certain cache. It also carried a heavy price tag. The mayor heard the complaints. None of the councilmen worked in East Podunk, not even the ones who owned their own businesses. Something had to be done to make East Podunk more affordable without reducing the quality of the office space. How could the mayor keep the building owners honest? The landlords needed competition.

East Podunk, Kansas needed a public option.

The city of East Podunk purchased a building and began to compete with the landlords. The building owners immediately noticed:
1. Their new competitor, the government, owned a building that couldn’t pass the new code.
2. Private businesses must build property tax, snow removal, and other maintenance costs into their rent. The city did not.
3. Private businesses pay property taxes which benefit the schools. Again, the city did not.
4. The city fathers of East Podunk, embarrassed by the prospect of a large empty building, cut any deal to find tenants.

Yes, the city of East Podunk succeeded in keeping the building owners honest. Honestly mad. Governments can compete, one city or one state versus another, but they don’t compete with businesses.

Building owners? Health insurance companies? You can change the names. You can change the venues. What won’t change is the behavior of government entities with too much money and too little talent.

We all live in East Podunk, Kansas.
DAVE

www.bogartcunix.com

By the way, I heard from a lot of people who wanted to post a comment to one of the last few blogs. I am trying to see if there is an easier way. My offer still stands. You may email me at thecunix@bogartcunix.com and I will post your comment for you.

79.3% of all statistics are created at the moment of citation. (margin of error +/- 4%)

Last Sunday’s Cleveland Plain Dealer reprinted a New York Times column written a few days earlier by Nicholas Kristof. Forum section. Page 2, directly beneath the Darcy cartoon. The great thing about appearing on the Opinion Page is that reporting and facts are optional. Mr. Kristof is convinced that our health care pales in comparison to the incredible medicine practiced in Canada, Great Britain or even Slovenia.

I was about to put this article away in favor of a better use of my time, Sudoku, when I saw the claim that Canadians live longer than Americans (his word, not mine) after a kidney transplant. That got my attention.

Regular readers of this blog know that I am not going to disparage the Canadian health care system. I’m not a huge fan, but there aren’t Canadians dying in the streets. So, is post-kidney transplant care significantly better in Canada than here in the US? Possibly, but it just seemed too easy. I had the feeling that Mr. Kristof did just enough research.

Let’s start with the source of this information. Mr. Kristof doesn’t cite his source, but a quick GOOGLE search turns up Nicholas Skala, a staff person for Physicians for a National Health Program. Mr. Skala wrote his report for the organization dedicated to single payer health care in 2006. It has been cited numerous times by publications such as The Washington Monthly. One of Mr. Skala’s assertions was that kidney transplants were more numerous in Canada since they didn’t have the profit motive of keeping patients on dialysis. I read that twice and knew that I needed to do more research.

Population as of November 9, 2009
United States – 307,897,484
Canada – 33,838,720 about 11%

Kidney transplants performed in 2007 (last data available)
United States – 16,517
Canada – 1,200 about 7%

Not more, but less. So are US citizens 50% more likely to need a kidney transplant? Does the Canadian system cherry pick who is eligible for a kidney? There are actually several issues involved.

1. I found the actual 2005 study which was published in the American Journal of Transplantation in 2006. The study compared post-transplant mortality among adult recipients between January 1, 1991 and December 31, 1998. Mr. Kristof’s article made this appear to be current information. It is not.
2. Canada did not have a national registry until this year. They have had a real problem matching donors to potential recipients. This will help.
3. 23.2% of the kidney recipients in the study were African Americans as opposed to 2.6% of the Canadians. As the study indicated, factors such as diabetes mellitus, age, and the number of donors of African descent may have an impact in the outcome of the report. The authors noted the lack of detailed donor data from CORR (Canadian Organ Replacement Register).
4. Is there equal access to kidney transplants in Canada? The answer is “No” according to Dr. Jeffrey A. Zaltzman of Toronto’s St. Michael’s hospital. That was published August 29, 2006. “No” wrote the Calgary Herald on November 9, 2009 when they noted that “the disparities in the medical treatment received by First Nations people compared with other Canadians have attracted growing national and international attention.”

I don’t have the research staff of the New York Times. Felicia, my secretary, and I spent a couple of hours following links on GOOGLE. I learned far more than I ever wanted to know about kidney transplants, everything from how much dialysis costs (a fortune, up to $150,000 a year) to how few transplant facilities there are in Canada.

What I learned is that Canadians who live near a major hospital and have the good fortune of a live donor have an excellent chance of survival. There are a lot more facilities and options here in the United States. In other words, the Peace Bridge is not going to be bumper to bumper with Americans searching for kidneys.

DAVE

www.bogartcunix.com

One more thing. The Kristof article also stated that “An African-American in New Orleans has a shorter life expectancy that the average person in Vietnam or Honduras. Found that too! The original report was posted on WWLTV’s website on September 18th. The Update was posted on October 22nd. The doctors noted that African-Americans are sicker longer, have lower incomes and a large portion are uninsured. It was crime and the murder rate, however, that got the most focus. Dr. Kevin Stephens, the director of the city’s health department said “All of these things work together. We just can’t fix health care. You’ve got to fix education. You have to fix the crime. Your have to fix the entire community.” It was also noted “that whites in Louisiana, on average, will live four years longer than African Americans in the state, but even that is still lower than the US average.”

I’m sorry this was so long. I just think that the details are important.