As part of Reuters’ coverage of the U.S. healthcare reform, Reuters.com asked Peter J. Pitts, president of the Center for Medicine in the Public Interest and Stephen M. Davidson, a Boston University School of Management professor to discuss the issue. Here are their responses.

– David Magnus, Phd, is the director of the Stanford Center for Biomedical Ethics. The views expressed are his own. –

The public discussion of healthcare reform has been full of so many lies and myths that it is less a policy debate than bad theater.

Critics of reform (conservatives hoping to score political points and oppose Obama on anything; free market ideologues; those with threatened financial interests) have stooped to absurdity in their public pronouncements. One publication declared that severely disabled physicist Stephen Hawking would never get life saving medicine in a national health system, ignoring that Hawking is British—virtually all of his life saving treatments were done through their National Health Service.

As debate over reforming health care continues, these are some of the key myths that get in the way of truly meaningful discussion.

Myth #1—We have the best health care in the world

This is probably true for some Americans. But on the whole our system is among the poorest of all developed nations. We spend far more per capita than any of our peers on healthcare, yet health outcomes measures are no better in aggregate. The World Health Organization ranking of health systems rated 36 other countries as having better health systems despite spending far less. The U.S. was right behind Costa Rica (and only two spots ahead of Cuba).

But the reality of the failure of our health system is best seen by the thousands of people being turned away in Los Angeles last week at the massive free clinic set up by the Remote Area Medical Foundation (see Reuters story). When the country spending the most money can not meet the basic medical needs of so many of its citizens, it does not have a good (or just) health system, much less the best system.

Myth #2—Health reform will lead to less personal freedom

There is nothing in any of the proposals that requires anyone to give up her existing health plan. In fact, Medicare proves that public-private partnerships can result in individuals choosing their own plans and their own physicians. Opponents of reform have argued that any government involvement means loss of freedom. This ignores the reality that insurance companies, employers, and financial limitations are already curtailing freedom for many individuals. When co-payments are too high, or someone has no insurance and health care means going bankrupt, those are real losses of freedom. It is ironic that unwavering faith in the free-market (and contempt for any government role) is being expressed at the same time the country is recovering from an economic meltdown caused by too much greed and too little government oversight.

None of the proposed plans involve socializing medicine, creating a single payer system, or government run or owned hospitals. They merely acknowledge the reality that a morally defensible health care system will only come about with some government involvement.

Myth #3—Health reform will control costs by depriving patients of needed medical treatments

There is absolutely nothing in any of the reform measures that suggests or requires that needed medical treatments will not be available. In contrast, within our existing system, those without insurance or “under-insured” patients who can not afford rising out of pocket payments are denied needed medical treatments on a routine basis. Reform makes it more likely that patients will receive needed medical treatments (not less likely).

Myth #4—Health Reform will deny older Americans medical treatments at the end of life

The lies about “death panels” that Palin, Gingrich, and others have been spewing have led the Senate to withdraw one element of the House legislation that would have both reduced costs and increased patient freedom. This is the proposal that would have allowed payment to primary care physicians who spend time with their patients talking about the patient’s wishes with regard to end-of-life decision-making. Right now, 25 percent of Medicare is spent on the last two months of life. Families in these contexts often face difficult decisions with no idea of what a patient’s wishes are. In those settings, we typically default to providing more aggressive measures, even if it increases suffering and may be at odds with a patient’s wishes. Encouraging patients to make choices ahead of time–whether for more aggressive measures or for a greater focus on comfort at the end of life– promotes freedom and has the potential to reduce costs (since 80 percent of people prefer less aggressive care).

This is the precisely the role that government should be playing—creating incentives for good medicine that promotes patient autonomy—and to counter existing incentives which all too often lead to less choice, more suffering, and increased costs. When Palin, Gingrich and others portray talking about our wishes with our doctors as “death panels”, when they attack scholars’ work out of context, when they misrepresent what is in proposed legislation, they undermine any hope of rational dialogue about the ethical challenges presented by health care and the very important and very real challenges and trade-offs that should be the subject of debate.

Here is a devastating critique of the idea of healthcare co-ops in place of a true public option (via Tim Foley at Change.org):

We’re guessing at the details, since they haven’t been divulged. How it would work? Does the government give seed money in the form of grants to set these up? Does it give loans? Who, pray tell, does it give this seed money to? How long would it take to get one of these co-ops up and running? How long would it take them to get a network of doctors? Since the co-op would start with no customers and presumably no bargaining power, how long would it take for insurance companies to be quaking in their boots?

That said, we do know a lot about them:

• We know that we used to have health care co-ops in this country. What happened to most of them? As Professor Timothy Stoltzfus Jost explains, “The Farm Security Administration withdrew support in 1947, and they collapsed. They had a hard time getting going anyway.”
• We know the ones that have been relatively successful have had their own network of providers, like Kaiser or the VA. However, the best of them took decades to develop – up to 60 years.
• The GAO looked at health insurance co-ops in 2000. These weren’t the same idea – they would allow small businesses to pool their employees in a co-op to shop for insurance. The GAO’s conclusion? They don’t work very well and did nothing to lower costs.
• The fact that a health co-op is a non-profit won’t in and of itself yield competition. As I pointed out earlier, “Conrad’s home state of North Dakota has 475,000 people enrolled in the not-for-profit North Dakota Blue Cross Blue Shield. That’s not just competition – it’s a monopoly, 60% of the market. Guess what? It hasn’t helped. Premiums jumped 74% in the past seven years.”
• Most co-ops won’t be as successful as already-existing Blue Cross plans, which means they won’t have market clout to lower costs or change the game for private insurance. Which is, you know, the whole point.
• Conrad introduced the co-op in June to solve a political problem – find common ground to allow the Senate Finance Committee to release their bill. So far, the Finance Committee remains at impasse, we’ve seen no bill, and every other committee has been done for weeks now. Great job.
• By the way, Republicans aren’t biting. They say the co-op is a public option in sheep’s clothing. So they’re against it.
• And, of course, progressives are furious at even the hint that there won’t be a public option, so they’re against it, too.

I guess Conrad succeeded in uniting the left and the right. Unfortunately, they seem to be united against his idea – the same idea whose sole existence is not to make American health care better but to win votes.

President Barack Obama has told Americans to be skeptical of reports of an end to the recession, saying the downturn has "many more months" to run. Given the recent retail sales data, Americans seem to be listening to their economist-in-chief.

Obama may well be right in his dour forecast. Whatever the next quarter or two of GDP numbers say, continuing high unemployment and depleted personal wealth should keep the vibe more recessionary than expansionary. It's tough to be cheerleader-in-chief, after all, when people's pocketbooks are telling them a starkly different story.

But another issue is exacerbating Americans' sour attitudes and raising doubts about the president's competence: healthcare reform. Indeed, a recent Gallup poll shows identical pluralities of 49 percent disapproving of both Obama's handling of the overall economy and his handling of healthcare policy.

Healthcare reform poses three problems for Obama. First, it seems to cost way too much in an era of trillion-dollar budget deficits. Americans are now as obsessed with budget deficits as they were in 1992, when fiscal concerns helped make Ross Perot a presidential contender. Second, many Americans are skittish about increased government involvement in the sector. Third, an inability to push healthcare reform through a Democrat-dominated Congress makes both the president and his Congressional allies appear ineffectual (as does the dithering over whether a public option needs to be part of any reform plan).

Now, political historians will note that a healthcare reform fiasco helped sink Democrats in the 1994 midterm elections -- despite a fairly strong economy -- and forced President Bill Clinton to shift to the right and work with congressional Republicans. Together, Clinton and the Republicans balanced budgets, cut taxes and reformed welfare.

But why wait for a political disaster to change course? If Obama wants to deliver meaningful change to the nation's healthcare system, why not a grand compromise with Republicans that would also bring along centrist Democrats.

Call it the Purple Plan, one that brings red and blue together. Make health insurance mandatory and subsidize those who can't afford it. (That's the blue part.) But at the same time dismantle employer-based health plans, which prevent consumers from understanding the true costs of their healthcare decisions. In any case, employer plans are just an accident of history. (That's the red part.)

The simplest way of dismantling them, according to an analysis by McKinsey, would be to make the money spent on health insurance by employers available as cash, tax free, to employees. "Insurers would then compete for customers with policies that offer better value for the money," according to McKinsey. "The combination of invigorated supply and demand is the only healthcare reform plan that will avert the economic disaster that otherwise awaits us."

A Purple Plan for the centrist - or purple -- president many Americans thought they were voting for. It would bolster the president's popularity, lift American spirits and help restore the economy.

The debate over healthcare reform heated up this weekend when a top U.S. health official called into question the government-run health insurance option favored by President Barack Obama.

Health and Human Services Secretary Kathleen Sebelius said on Sunday a public option was “not the essential element” of any overhaul, and that non-profit cooperatives being considered by a Senate panel could also fulfill the White House goal of creating more competition on insurance.

Democratic dissenters of this view come out in full force.

“You can’t have reform without a public option,” Howard Dean, a former Democratic National Committee chairman and a vocal supporter of an overhaul, said on CBS’s “Early Show.”

“I don’t think it can pass without the public option,” Dean said. “There are too many people who understand, including the president himself, the public option is absolutely linked to reform.”

Democratic Representative Anthony Weiner of New York, who backs a public option, said in a statement “leaving private insurance companies the job of controlling the costs of healthcare is like making a pyromaniac the fire chief.”

Reuters.com asked a panel of experts to weigh in on the debate. Here are their responses:
(Updated at 8:15 pm ET)
Ted A. Okon is the executive director of the Community Oncology Alliance, a professional organization representing community oncologists. The views expressed are his own.

A government-run insurance program — the public plan option — is not essential to health care reform and could even be detrimental. The government should focus first on creating a consumer-friendly insurance exchange that provides transparency and easy comparison of private health care options. This combined with regulatory reform at the federal level will foster greater competition within the private insurance sector.

Proponents of a public plan want a low-cost, government-run insurance option that will force private payers to reduce premiums to compete. This would be achieved in large part by basing provider reimbursement on Medicare, or a nominal percentage above Medicare. Thus, between Medicare and the public plan, the government would have the leverage to virtually control provider payments.

Greater government control over provider payments would force practitioners to close their practices because in many cases Medicare rates are not realistic. For example, Medicare already pays for approximately 45 percent of cancer care at rates that are forcing community cancer clinics, which treat over 80 percent of Americans with cancer, to cut staff and close facilities. In 2010, Medicare is planning further payment cuts for the administration of life-saving cancer drugs by over 20 percent.

Extending the influence of Medicare pricing through a public plan offering would have catastrophic consequences on the cancer care delivery system in this country.

Dr. Steffie Woolhandler and Dr. David Himmelstein are both associate professors of medicine at Harvard Medical School and primary care doctors at Cambridge Hospital. They co-founded Physicians for a National Health Program. The views expressed are their own.

Even with a strong public option the president’s plan for health reform was far too timid, falling well short of the single payer reform that would resolve the health care crisis.  Dropping the public option assures that reform will merely pump more money into private insurers’ coffers and reinforce their stranglehold on America’s health care system. The measure the president appears ready to accept would do little or nothing to help patients, and much to help the corporate interests who profit from care.

Wendell Potter is the senior fellow on healthcare for the Center for Media and Democracy in Madison, Wisconsin. The views expressed are his own.

I’m hoping the comments from the White House over the past few days are part of a trial balloon to gauge the reaction to the possibility of throwing the public option overboard–and that the reaction from the president’s core supporters has been swift and clear.

There can be no meaningful reform without the public option. The suggestion that nonprofit co-ops can be created as an effective alternative to the public option is fantasy. The insurance industry would love to see the idea of co-ops included in the bill that reaches the president because insurance executives know co-ops would have no chance of ramping up to be competitive in any market.

Sen. Conrad should spend more time learning about what has happened to the insurance industry in recent years before championing an idea that would ensure the continued profitability of insurers at the expense of his constituents and millions of other Americans.

For full Reuters coverage on the healthcare reform debate, click here.

Peter J. Pitts is president of the Center for Medicine in the Public Interest and a former FDA associate commissioner. The views expressed are his own.

In SiCKO, Michael Moore portrayed the British National Health Service and the Canadian health system as particular exemplars of excellence. He backed it up with a lot of statistics, but statistics, as the saying goes, are like a bathing suit. What they show you is interesting, but what they conceal is essential.

And what SiCKO concealed was that systems such as those in the United Kingdom and Canada are cost-based rather than patient-centric models. Facts, no matter how inconvenient to one’s argument, must not be ignored.

Citizens of countries with government-run health care systems experience long wait times, a lack of access to certain treatments and, in many instances, substandard medical care. For example:

• The five-year survival rate for early diagnosed breast cancer patients in England is just 78 percent, compared to 98 percent in the U.S.

• A typical Canadian seeking surgical or other therapeutic treatment had to wait 18.3 weeks in 2007, an all-time high, according to The Fraser Institute.

• The average wait time for bypass surgery in New York is 17 days compared to 72 days in the Netherlands and 59 days in Sweden.

• More than half of Canadian adults (56 percent) sought routine or ongoing care in 2005. Of these, one in six said they have trouble getting routine care.

• Eighty-five percent of doctors in Canada agree private insurance for health services already covered under Medicare would result in shorter wait times.

• Approximately 875,000 Canadians are on waiting lists for medical treatment.

“Congress has an important role to play in healthcare reform” said United States Representative John Shadegg, (R-Arizona), who has introduced healthcare legislation in support of free-market competition. “We can help patient in this country, not by setting up a massive new government bureaucracy, but by empowering individuals to make the best choices for themselves and their families.”

If we’re going to look to other healthcare models for solutions, we must uncover and study their problems. Health care is too important to allow reform by sound bite. “Drugs from Canada” is as much a false promise as “free” healthcare.

Last autumn, my organization the Center for Medicine in the Public Interest interviewed people on the streets of New York City and asked them if they’d prefer “government” healthcare or “universal” healthcare. They overwhelmingly chose “universal” healthcare. But when we asked them to explain the difference between the two, they generally just shrugged their shoulders.

And when we asked them how much more in taxes they’d be willing to pay to support universal healthcare, they shook their heads and said, “No, we want it to be free, like in Europe and Canada.” Such are the fallacies that political rhetoric hath wrought.

Equally as prevalent is the notion of “free” or “low cost” drugs “like in Canada and Europe.” And here too we need to be honest and examine the other side of the coin — that of cost-savings for the payer (often in the guise of healthcare technology assessment programs such as Britain’s National Institute for Health and Clinical Excellence) versus care denied for the patient. What is overlooked is that price controls equals choice controls.

Our national conversation about health care has to go beyond vague concepts of reform and convenient political rhetoric. We must all be part of the solution and suspicious about false choices.

– James Pethokoukis is a Reuters columnist. The views expressed are his own —

Time for a political reality check. Government-run public health insurance that competes with private plans — a Democratic dream since President Truman suggested it in 1945 — may not be dead for now on Capitol Hill, but its vital signs are awfully faint.

Of course, many proponents are hoping to use the congressional August recess to rally the grassroots and the netroots for one final push come September. And maybe that will work.

But it’s more likely that Democratic leaders in Washington will use the break to tell the outside-the-Beltway crowd the cold truth: If they want something that can be legitimately called “healthcare reform” to pass in 2009, they need to quit wasting time, energy and money on the fading dream of a public plan and instead work to get other key elements passed.

And what might those elements be?

Analyst Daniel Clifton of Strategas Research makes an educated guess. He thinks President Obama may get the chance to sign an $800 billion (over 10 years) bill that would contain features such an individual mandate to buy health insurance, subsidies up to 300 percent of the poverty limit to purchase a regulated plan through a health insurance “exchange”, and an expansion of Medicaid.
Obama might even get his commission that would try to determine what Medicare pays doctors and hospitals — now that the Congressional Budget Office has determined it would pretty much be powerless.

As one lobbyist put it: “I would see this as mostly a symbolic victory (for Republicans), as the Dems can get most of what they want without calling it a public option. Frankly. it’s pretty close to the Massachusetts model.”

Ah yes, the Massachusetts model. The state passed sweeping reform in 2006 under Governor Mitt Romney. What would a similar approach mean for America?

Well, there would be a lot fewer uninsured people. Massachusetts has halved the number of people without health insurance, with just 2.6 percent not currently covered.

But the reform has been far less successful bringing down costs. For starters, original cost estimates for Commonwealth Care projected the program would cost $400 million in 2008 and $725 million in 2009. The actual numbers were $628 million in 2008 and $869 billion for this year.

Moreover, health insurance premium costs continue to rise at a rapid clip of 9.4 percent a year, compared with 7.7 percent for the United States on average. As the Urban Institute found: “Health spending in Massachusetts is higher than the United States on average and is growing at a faster rate. Furthermore, health insurance premiums are growing even faster than health care costs in the state.”

So America might find itself in 2012 with lots more people covered, but in an ever more expensive system. And President Obama might find himself doing what Romney’s Democratic successor, Governor Deval Patrick, is doing: cutting back the subsidies that allow poorer residents to buy insurance.
The state is also considering moving away from from fee-for-service medicine, where doctors are incentivized to perform lots of pricey procedures rather than focusing on results.

But Obama and Democrats might also make this argument: We expanded coverage and now it’s time to finish the job by getting costs under control. And the only way of doing that is … a public insurance option!

Indeed, the Urban Institute makes the same argument that Team Obama surely would: that the presence of a national plan would force insurers to compete with a plan with strong bargaining power and, as an arm of government, a powerful financial interest in containing costs.

What’s happening in Washington isn’t the end of healthcare reform, it’s  merely the end of the beginning.

– Peter Pitts is president of the Center for Medicine in the Public Interest and a former FDA Associate Commissioner. The views expressed are his own. –

As part of its healthcare reform bills, Congress is calling for a more aggressive use of comparative effectiveness research (CER). What does this mean? Is comparative effectiveness the same thing as cost effectiveness?

No. There’s a big difference.

Cost effectiveness research is what The United Kingdom’s National Institute for Health and Clinical Excellence (NICE) does. NICE uses a measure known as a Quality Adjusted Life Year (QALY) to assess whether or not a treatment is cost-effective or not. If providing an additional year of life costs more than $50,000 — the average price of a fully-loaded Land Rover — NICE won’t recommend that treatment.

For example, NICE’s preliminary decision was that four new kidney cancer drugs — Torisel, Avastin, Nexavar, and Sutent — should not be reimbursed by the National Health Service (NHS) because, despite clinical evidence that these drugs can actually help, they weren’t “cost effective.”

Currently, the only available treatment for metastatic renal cell cancer is immunotherapy. This halts the disease’s progress for just four months on average. But if a person isn’t a candidate for immunotherapy, or the treatment doesn’t work, that’s it. They have no other treatment options.

NICE agreed that patients tended to live longer when they were given these drugs. But when they put the data from the trials into their QALY-driven computer models, they found that the drugs cost about £20,000 to £35,000 ($39,000 to $68,000) per patient each year. NICE deemed this too pricey, and didn’t recommend that the NHS cover these drugs.

The result is that government saves money and patients receive an expedited death sentence. That’s not hyperbole, that’s the simple truth about cost effectiveness research.

Comparative effectiveness research is different.

It strives to show which medicines are most effective for a given disease. In other words, CER asks whether drug A or drug B is the “more effective” statin. It examines which of a variety of therapies is the “more effective” treatment for depression. Most of the world refers to comparative effectiveness research as Healthcare Technology Assessment.

But CER raises some serious problems. For instance, how do you compare two molecules (or three or more) that perform differently depending on a patient’s personal genetic make-up?

It’s for this reason in particular that CER often leads to a “one-size-fits-all” approach to treatment.

That’s because the concept behind comparative effectiveness research is good, but the tools aren’t.

CER relies heavily on findings from randomized clinical trials. While these trials are essential to demonstrating the safety and efficacy of new medical products, the results are based on large population averages that rarely, if ever, indicate which treatments are “best” for which patients. This is why it is so important for physicians to maintain the ability to supplement study findings with their own expertise and knowledge of their patient in order to make optimal treatment decisions.

Government sponsored studies that conduct head-to-head comparisons of drugs in “real world” clinical settings are a valuable source of information for coverage and reimbursement decisions — if not for making clinical decisions.

Two studies — the Clinical Antipsychotic Trials in Intervention Effectiveness (CATIE) study, and the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) study — are examples of “practice-based” clinical trials, sponsored in part by the National Institutes of Health, to determine whether older, less expensive medicines were as effective in achieving certain clinical outcomes as newer, more expensive ones.

The findings of both CATIE and ALLHAT were highly controversial, but one thing is not: even well-funded CER can be swiftly superseded by trials based on better mechanistic understanding of disease pathways and pharmacogenomics. And, since most comparative effectiveness studies are underpowered, they don’t capture the genetic variations that explain why different patients respond to medicines in different ways.

But it’s important to move beyond criticizing comparative effectiveness in its current form, and instead focus on a policy roadmap for integrating more patient-centric science into comparative effectiveness research.

Much like the U.S. Food and Drug Administration created something called the Critical Path Initiative to apply 21st-century science to the development of personalized medicine, another national goal should be to create a Critical Path Initiative to apply new approaches to data analysis and new clinical insights to promoting patient-centric healthcare.

Why? Because comparative effectiveness research should reflect and measure individual responses to treatments based on a combination of genetic, clinical, and demographic factors. The first steps have been taken. For example, the Department of Health and Human Services has invested in electronic patient records and genomics.

One way to complement this would be to encourage the Centers for Medicare and Medicaid Services to adopt the use of data that takes into account individual patient needs.

We also need to develop proposals that modernize the information used in the evaluation of treatments. Just as the FDA Critical Path Initiative uses genetic variations and biomedical informatics to predict individual responses to treatment, we must establish a science-based process that incorporates personalized medicine into reimbursement decisions.

For instance, the FDA has developed a Critical Path opportunities list that provides 76 concrete examples of how new scientific discoveries in fields such as genomics and proteomics could be used to improve the testing of investigational medical products.

We need to begin the process of developing a similar list of ways new discoveries and tools (such as electronic patient records) can be used to improve CER.

It’s a complicated proposition, but the goal is simple and essential: cost must never be allowed to trump care, and short-term savings must not be allowed to trump medical outcomes. Just as we need new and better tools for drug development, so too do we need them for comparative effectiveness research.

Michael Goldfarb serves as a GlobalPost correspondent in the United Kingdom, where this article first appeared.

In America, the health care debate is about to come to a boil. President Barack Obama has put pressure on both houses of Congress to pass versions of his flagship domestic legislative program prior to their August recess.

Good luck.

Opponents are filling the airwaves with the usual litany of lies, damned lies and statistics about socialized medicine and the twin nightmare of bureaucratically rationed health care and high taxes amongst allies like Britain, France and Germany. So here is a brief overview of health care in some of Europe’s biggest economies: Britain’s National Health Service is paid for out of a social security tax. Services are free at the point of provision. No co-pay, no reimbursement. The budget last year was 90 billion pounds (about $148 billion). That makes the average cost per person about 1,500 pounds ($2,463).

The NHS is big — huge, in fact. With 1.5 million employees it is one of the largest employers in the world. Only China’s People’s Liberation Army, India’s state railways and good old Wal-Mart employ more folks. Sixty percent of the NHS budget goes toward salaries.

The French system is run on a compulsory purchase of insurance through the workplace. The insurance cost is based on how much a worker earns. Low-income workers pay nothing. The average contribution per person is about $4,000. The government sets fees for services and negotiates the price of drugs with pharmaceutical companies. (See related GlobalPost story “Why French doctors still make house calls.”)

Service is not free at the point of provision. But reimbursement for costs is swift and in the case of catastrophic illness all fees are waived. People are free to purchase supplementary insurance from private companies.

With a compulsory insurance plan, as in France, German care is universal and equitable. Germans pay approximately 14.3 percent of their earnings to buy this insurance. As in France, people are free to buy supplementary private health insurance. Each system is unique (as are all the systems around Europe) but they have two things in common that make them different from the United States: Coverage is universal and the cost of care as a percentage of GDP is significantly less.

For Europeans — even those who would label themselves conservatives — American attitudes to setting up a universal health care system with strong state participation and management seem bizarre. The peace of mind that comes from knowing that in an emergency you will be taken care of and you won’t be financially ruined has no price. Why resist it?

Beccy Ashton, policy adviser at health care think tank The King’s Fund, worked for more than half a decade in the U.S. She explains the difference this way: “In Europe healthcare is regarded as a human right. In America, people think of it as a commodity that you buy.” If you look at how the Big Three’s health systems came into being you realize changing American attitudes may be difficult.

Britain and France created their systems out of the rubble of World War II. Pushed from below, the leaders of both nations sought to bring greater social equality to their societies. Social security systems were set up with equal access to health care given pride of place.

This wasn’t done without facing down doctors and insurance companies, but politicians are never so bold as when the public will for something is clear. In 1945 in both Britain and France, there was no going back to the status quo before the war started. Germany’s system has the weight of history behind it. Its origins can be traced back to the first era of German unification when Chancellor Otto von Bismarck created the First Reich. In the 1880s he set up a system of compulsory health insurance by workers and employers and other forms of social security. He did not invent the system out of nothing. There had been a tradition among the German guilds going back to the Middle Ages of members making compulsory contributions to help their brothers in old age or if a colleague had to stop working because of injury.

Clearly, America at this moment in time has not recently experienced an epoch-shattering historical event like a World War and despite Obama’s comparative popularity, he doesn’t have the clout of an Iron Chancellor to simply decree what he wants and know that Congress will rubber stamp it.
Beccy Ashton points out, “The President must be aware of the fine line he has to walk. If he goes forward with a radical agenda, he knows you’ve lost before you’ve started.”

So people in Europe continue to watch with bemusement as American legislators grapple with reforming a system that basically needs to be junked. Professionals like Ashton answer calls from reporters and try to refute right-wing misinformation that floats around the debate. Those damned lies and statistics.

The only statistics on health care systems that really matter are life expectancy and infant mortality. Both speak to accessibility and affordability. If you want to know how the U.S., the wealthiest nation on earth, stacks up, here you go:

In life expectancy, the U.S. ranks 38th or 45th depending on whether one uses the United Nation’s statistics or those compiled by the CIA. (In both cases, life expectancy in Cuba is higher!) According to the CIA World Factbook, the U.S. has many more infant deaths than its EU counterparts or northern socialist (to right-wing ideologues) neighbor, Canada. While the U.S. has 6.26 deaths per live births, Canada had 5.04. Britain, France and Germany? 4.85, 3.33 and 3.99, respectively.

Other health links from GlobalPost:

Winter in the time of swine flu

Coming home from school with strawberry condoms

(Pictured above: Healthcare reform supporters rally outside U.S. Senator Sam Brownback’s office in Overland Park, Kansas, July 9, 2009. REUTERS/Carey Gillam)

The chances of sweeping healthcare reform have dropped dramatically over the past month or so.  (I still think the president will have something to sign by year end.) Mark Halperin of The Page gives his reasons why healthcare reform still has a good chance of happening, though what "healthcare reform" means is left undefined -- and that is kinda important:

1. Reid, Pelosi, and the applicable committee chairs all are still on board (no one has taken their marbles and left, in part because the White House congressional affairs office has a great ear and many eyes).

2. Senators Grassley and Snowe haven't given up.

3. Rahm Emanuel knows what's possible.

4. If he can get a bill to conference committee, the press will start implicitly cheering more for success, and stop obsessing over every setback.

5. The health care industry and business community are still largely supportive.

6. Labor unions are likely to give in (maybe) at one or two critical moments.

7. Obama is not rattled.

And this article from The Hill makes some counterpoints:

If Democrats in the lower chamber do not pass a healthcare reform bill before the recess, it would be seen as a major step backward from the legislative timetable President Obama initially outlined. As recently as last week, leading Democrats were predicting they would pass bills through the House and Senate before adjourning for the summer. ... In another blow to the Democrats’ healthcare reform efforts, the U.S. Chamber of Commerce on Tuesday launched an advertising campaign targeting a key aspect of Obama’s healthcare plan — a government-run “public option.” Another powerful industry group, America’s Health Insurance Plans, stated on Tuesday that a “government-run plan is a roadblock to reform.” ... Hoyer on Tuesday confirmed that opposition was not limited to the Blue Dogs. ... “It’s the spending and the cost. The [Congressional Budget Office score] last week was really a hit across the bow,” said Rep. Baron Hill (D-Ind.), a Blue Dog leader and member of the Energy and Commerce Committee. ... Some members want to wait to see what the more conservative Senate will do so that members don’t have to make tough votes on issues, like raising taxes, that are difficult to get through the upper chamber. Complicating the healthcare reform effort is the fact that the Senate Finance Committee still hasn’t released its bill or indicated how it will be offset.