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Analysis & report regarding health spending in the current (2008-09) economic crisis. Health Update No. 7, produced by the International Coordination Group for Health (ICGH)

Discussion of barriers presented by health insurance procedures, protocols, and economics to direct and efficient delivery of medical care.

Among the top ten most challenging issues facing American doctors, 7 in 10 directly involve economics

Dr. Fisher is a professor of medicine and of community and family medicine, Dr. Bynum an assistant professor of medicine and of community and family medicine, and Dr. Skinner a professor of economics and of community and family medicine at Dartmouth Medical School, Lebanon, NH, where Dr. Fisher also directs the Center for Health Policy Research, Dartmouth Institute for Health Policy and Clinical Practice.

At a time when baby boomers are approaching the age of 65, some physicians attuned to this economic reality have simply stopped accepting Medicare patients.

I want to commend, and cry over, what WP wrote: "What I am seeing in needy areas are things/conditions I thought only existed in previous distant centuries. The patient populations have been well described by Charles Dickens and depicted graphically by Giordano in his opera set during the French revolution…a stream of ragged peasants limping across the stage, right here in the United States, in 2009." I can vouch for it here in Vermont…right next to Dartmouth's great Dartmouth-Hitchcock Medical Center in Hanover, NH…where - at BEST - most Blue Cross/Blue Shield of Vermont clients CANNOT find a primary care physician (PCP) taking new patients… and where - at WORST - several women I know are choosing to die from their breast cancer because they cannot afford medical care and will not burden their kids or society. One woman has an MA in Counseling, and the other a PhD in Human Nutrition. These are not uneducated people… But they are most definitely poverty-stricken…and were poor before the 2008 global economic collapse.

Workers, 20-30% of whom are uninsured, and an even larger percentage of whom are underinsured, continue to pay the bill for others to get coverage; their payroll taxes help support Medicare for the elderly, Medicaid for the disabled, for children of low-income parents, and those living in poverty.

In every industrialized nation, the movement to reform health care has begun with stories about cruelty. The Canadians had stories like the 1946 Toronto Globe and Mail report of a woman in labor who was refused help by three successive physicians, apparently because of her inability to pay. In Australia, a 1954 letter published in the Sydney Morning Herald sought help for a young woman who had lung disease. She couldn't afford to refill her oxygen tank, and had been forced to ration her intake "to a point where she is on the borderline of death." In Britain, George Bernard Shaw was at a London hospital visiting an eminent physician when an assistant came in to report that a sick man had arrived requesting treatment. "Is he worth it?" the physician asked. It was the normality of the question that shocked Shaw and prompted his scathing and influential 1906 play, "The Doctor's Dilemma." The British health system, he charged, was "a conspiracy to exploit popular credulity and human suffering."

McAllen TX is one of the most expensive health-care markets in the country. Only Miami-which has much higher labor and living costs-spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.

Why Paying for Health Care Reform Is Difficult and Essential - Numbers and Rules. In a short few paragraphs, Dr. Aaron elegantly simplifies and quantifies why finding the $1 trillion for universal coverage is so difficult. He concludes, realistically, soberly,

*In West Chester, Community Volunteers in Medicine treated 332 patients in February, up 26% from February 2008. The cost of care was up 21%. At the same time, the clinic was about $100,000 behind in fundraising for its $1.8 million annual budget. *Ohio's 40 free clinics treated 56,000 uninsured patients in 2008, up from 43,000 in 2007. Marjorie Frazier, executive director of the Ohio Association of Free Clinics, expects the number to increase in 2009. In January, one clinic in Cleveland closed because it lacked funding. Ohio, one of the few states that helps pay for free clinics' operations, is cutting funding. Its two-year allocation for 2008 and 2009 was $2.1 million; for 2010 and 2011, proposed funding is $1.5 million. *California's 800 community health centers saw increases of up to 20% in uninsured patients in the past six months. The state, facing a $42 billion budget shortfall, is eliminating payments for some services for poor adults, including dental care. As a result, the centers will lay off 1,000 dentists and other staff, leaving as many as 400,000 people without dental care, says Chris Patterson, spokesman for the California Primary Care Association.

If the uninsured were a political lobbying group, they'd have more members than AARP. The National Mall couldn't hold them if they decided to march on Washington. But going without health insurance is still seen as a personal issue...The grass-roots group Health Care for America Now plans to bring as many as 15,000 people to Washington this year to lobby Congress for guaranteed coverage.