Category Archives: Brexit

Health Care Is Not a Market

For the next twenty-one months, there will be a national debate carried on during the presidential campaign regarding the direction this country will take about providing health care to all Americans.

However, to anyone who reads the articles, posts and comments on the social media site, LinkedIn, that debate is already occurring, and most of it is one-sided against Medicare for All/Single Payer. The individuals conducting this debate are for the most part in the health care field, as either physicians, pharmaceutical industry employees, hospital systems executives, insurance company executives, and so on.

We also find employee benefits specialists and other consultants to the health care industry, plus many academics in the health care space, and many general business people commenting, parroting the talking points from right-wing media.

That is why I re-posted articles from my fellow blogger, Joe Paduda last week and yesterday,  who is infinitely more knowledgeable than I am on the subject, and has far more experience in the health care field, that not only predicts Medicare for All (or what he would like to see, Medicaid for All), but has vigorously defended it and explained it to those who have misconceptions.

For that, I am grateful, and will continue to acknowledge his work on my blog. But what has caused me to write this article is the fact that most of the criticism of Medicare for All/Single Payer is because those individuals who are posting or commenting, are defending their turf.

I get that. They get paid to do that, or they depend on the current system to pay their salaries, so naturally they are against anything that would harm that relationship.

But what really gets me is that they are deciding that they have the right to tell the rest of us that we must continue to experience this broken, complex and complicated system just so that they can make money. And that they have a right to prevent us from getting lower cost health care that provides better outcomes and does not leave millions under-insured or uninsured.

However, not all these individuals are doing this because of their jobs. Some are doing so because they are wedded to an economic and political ideology based on the free market as the answer to every social issue, including health care. They argue that if we only had a true free market, competitive health care system, the costs would come down.

But as we have seen with the rise in prices for many medications such as insulin and other life-saving drugs, the free market companies have jacked up the prices simply because they can, and because lobbyists for the pharmaceutical industry have forced Congress to pass a law forbidding the government from negotiating prices, as other nation’s governments do.

Yet, no other Western country has such a system, nor are they copying ours as it exists today. On the contrary, they have universal health care for their citizens, and by all measures, their systems are cheaper to run, and have better outcomes.

None of these countries can be considered “Socialist” countries, and even the most anti-Socialist, anti-Communist British Prime Minister, Winston Churchill said the following, “Our policy is to create a national health service in order to ensure that everybody in the country irrespective of means, age, sex or occupation shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.”

Notice that Sir Winston did not say, free market competition. He knew that competition is fine for selling automobiles, clothing, food, and other goods and services. But not health care.

He also said that you can always count on Americans to do the right thing, after they have tried everything else. We’ve tried the free market in health care, and drug prices and other medical prices are through the roof.

However, another thing they have not done, and I believe none of the other OECD countries have done about health care, is to divide the “market” into silos such as the elderly with Medicare, the poor with Medicaid, children with CHIP, veterans with the VA, and their families with Tricare, etc.

No, they pay for all their citizens from a global budget, and do not distinguish between age level, income level, or service in the armed forces.

And their systems do not restrict what medical care their people receive, so that no only do they have medical care, but dental care, vision care, and hearing care. It is comprehensive. And if they have the money to pay for it, they can purchase private health insurance for everything else.

In the run-up to the debate and vote in the UK on Brexit, the point was raised that while Britain was a member of the EU, their retirees who went to Spain to retire, never had to buy insurance because the Spanish providers would bill the NHS.

However, once Britain leaves the EU, they will have to buy insurance privately, because the NHS won’t pay for it. But not all retirees can afford private insurance, so many British citizens will have a problem.

As I have mentioned before in this blog, I was diagnosed with ESRD, and am paying $400 every three months for Medicare Part B. I was doing so while spending down money I received after my mother passed away in 2017. My brother and I sold her assets and used that money to purchase property so that she could go on Medicaid, and eventually into a nursing home when the time came for her to be cared for around the clock.

Since my diagnosis, and prior, I was not working, so spending $400 every three months, and paying for many of my meds, has been difficult. I am getting help with some of the meds, and one is free because my local supermarket chain, Publix gives it for free (Amlodipine).

I hope to be on Medicaid soon, but would much rather see me and my fellow Americans get Medicare for All, and not have to pay so much for it. (a side note: we have seen that Medicaid expansion has been haphazard, or reversed, even when the government is paying 90% of it)

So why are we not doing what everyone else does? For one thing, greed. Drug companies led by individuals like Martin Shkreli, who is now enjoying the hospitality of the federal government, and others are not evil, they are following the dictates of the free market that many are advocating we need. No thanks.

For another, Wall Street has sold the health care sector as another profit center that creates a huge return on investment by investors and shareholders in these companies and hospital systems. Consolidation in health care is no different than if two non-health care companies merge, or one company buys another for a strategic advantage in the marketplace.

There’s that word again: market. We already have a free market health care system, that is why is it broken. What we need is finance health care by the government and leave the providing of health care private. That’s what most other countries do.

So those of you standing in the way of Medicare for All/Single Payer, be advised. We are not going to let you deny us what is a right and not a privilege. We will not let you deny us what every other major Western country gives its people: universal, single payer health care.

Your time is nearly up.

Words and Phrases: Global Healthcare or Whatever You Want to Call It

This past Saturday, while waiting for power to be restored in my area due to a pesky lizard’s venture where lizards don’t belong, I was able to use my cell phone to read some posts on LinkedIn.

I came across a discussion by three of the top medical travel personnel answering the question, “Is the term “Medical Tourism” obsolete?”

This discussion thread was begun by Stella Tsartsara, and followed by Ilan Geva and Elizabeth Ziemba, including yours truly, who put his two cents into the conversation.

Since Stella has given me her approval to use her comments, and I suspect that Ilan and Elizabeth would not mind, I am going to quote them verbatim here for the reader to digest. There will be some names that I will leave out, because one, I have not contacted them, and two, they were mentioned in passing by the individual who I am quoting.

Stella I. Tsartsara:

“I see Elizabeth Ziemba talking about carrying capacity of HC systems. XXXXXXXXXXXXXXXXXX told me half of the international projects I do have nothing to do with Medical Tourism, XXXXXXXXXXXXXX told me we are dealing with “International Healthcare” anymore, we are passed the term “Medical Tourism ” probably instigated by people traveling to another destination for (cheaper) surgery not covered by their insurance where the “patient” had time to do some sightseeing. But once the demand came to more serious interventions like heart surgery then the only organization needed was a reliable MTF and good research from the patient to guarantee results. Here the “tourism” is at the 4-5th place after doctor, hospital reputation, waiting list time, safety, post- surgery follow up, price and cost reimbursement from insurance.

Now with the Cross Border Healthcare and the Trade in Services Agreement (TiSA) Wikileaks revelation on the globalization of healthcare officially by the states, things take a completely new turn and the fact that we are talking about Medical Tourism is raising some eyebrows. Or at least it should be split from Healthcare delivery.”

https://data.awp.is/international/2015/02/04/22.html

Stella I. Tsartsara:

“I have no possibility for edit, I rephrase here that XXXXXXXXXXXXXXXXXX told me some time ago that her projects deal with international healthcare mostly which is a healthy sign of evolution in the industry although XXXXXXXXXXX says this word does not exist either, to which of course I agree.

Terms are the beginning of taking the trend seriously by the demand. It’s about shaping policy in the end.”

Ilan Geva:

“Stella, I think that the term Medical Tourism was pushed upon us by an association. The fact is no one, except our circle of Professionals, is using it or cares about it. In the effort to differentiate and stand out, many started to use Medical Travel, Global Healthcare…whatever. Patients don’t really care what you call it, they have a need or a want that requires a solution. Many of them are not looking for the “Tourism “aspect of a medical issue. Have you noticed that even the MTA is not using their name as much as they used to? They are now pushing the GHA brand.

Is that an indicator that medical tourism is dead? Who knows, and frankly, who cares? Globally, there are enough tremors in the healthcare sector, enough to guarantee continued movement of patients from one region to another. Maybe we should start calling it “Medical Voyages”?”

Elizabeth Ziemba:

“Thanks for starting a very interesting conversation, Stella. The term “medical tourism” isn’t dead yet because it is still the top search term in the sector and is heavily used by the media. But the sector itself has outgrown the term. I will be giving a presentation at the IMTJ/World Health Care Congress about this very topic. The sector is changing but it is hard to get away from “medical tourism” when SEO rules. I must admit that the name of my company, Medical Tourism Training, was selected because of its SEO and familiarity to people. Even now, people react to it favorably even though I hate it. Time to look past the label to the substance.”

Stella I. Tsartsara:

“Ilan Geva “medical tourism” is not dead and maybe never dead as there are interventions where tourism plays an important part and here individual consultants have a bigger profit margin. But definitely movement of patients for elective treatment is not and cannot be called this way.

In EU we call it “Cross Border Healthcare” because we established the Institutional parameters for its organization and delivery.

This is what is lacking from an international perspective for the term to have a meaning. By the way trained eyes in institutional development like XXXXXXXXXXX will see immediately that the TiSA is exactly the same (with 2 additions on insurance and compulsory post-surgery monitoring & liability) with the EU Directive 24/11/EC on the Cross Border Healthcare in EU.”

Me:

“I have used “Medical Travel” in my posts, but for the purpose of selecting a category to place them in, or to tag them when I write, I use both “Medical Tourism” and “Medical Travel”.”

Stella I. Tsartsara:

“Elizabeth Ziemba & Richard Krasner, MA, MHA I tend to agree more with Ilan Geva on the matter. However as I said there will always be room for the “tourism” side for hundreds of treatments where tourism plays a very significant part like Medical SPA, cosmetic surgery, diagnostics, dental etc, although still I do believe that it’s not a priority. What Ilan said it’s a revelation for the “association”. Who else would give international care such a limited meaning maybe pushed by its operators back then.

But what is coming ahead e.g. Institutional and Regulative development of international healthcare (among public hospitals as well) has absolutely nothing to do with “tourism”. We have to set things straight if we want to be taken seriously by those who will be in our path in the consultation activities for its future development. Those who were (are still) building the TiSA are not going to look or refer to “medical tourism”.”

Stella I. Tsartsara:

“I also have the impression that something is moving in layers that are not yet visible to us, on the management of this new trend. I believe that actors are organizing themselves differently and as there is not yet a market (it’s still a taboo internationally exactly because it involves also public HC, we in EU have solved this but it’s not the case at global level) and the demand is still hybrid, there is no business development and marketing yet of this new consulting set of skills and delivery. But very soon we are going to see a new type of developers in this perspective catering for the state development of international HC. I have proposed years ago through this group the organization of such Groups combining inevitably many specializations and some do exist already run by big Hospital Groups.”

It would seem there is not clear consensus on what term is appropriate for the activity of leaving one’s home country and travelling to a second country for medical care, no matter what the reason for travel may be.

If, as Stella said, it was for heart surgery, doubtless the patient would not be doing much sightseeing post-operation. Yet, on the other hand, if it was for less invasive, and less stressful surgeries and procedures, and if the patient was cleared by the physician and physically able, then the tourism part would apply.

The revelations by Wikileaks of the negotiations on the TisA is no doubt a concern to the entire industry, whether one calls it medical tourism, medical travel, health tourism, health travel, etc. The result is the same. Knowledge of the existence of such an agreement may forestall that agreement being finalized, if not totally scrapped altogether if the right individuals lead a campaign against it in member countries.

Such was the case with Brexit, and such was the case with the 2016 U.S. elections that Wikileaks had a hand in derailing.

The solution, therefore is a stronger effort on the part of all stakeholders to develop strategies, plans, and standards to regulate the industry and to promote it effectively. Relying on an association we know is unreliable is not going to work. Before TiSA is tossed aside like the TPP, or the Paris Climate Treaty by nationalistic dunderheads, the industry must do more.

P.S. The rest of the thread can be seen here: https://www.linkedin.com/groups/4304089/4304089-6368077962927050755