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Break the link between employment and healthcare!

Byoliveridley

Cross-posted from Interrobang:

The US Supreme Court ruled along political lines on the 30th of June, 2014 that “closely held corporations”, over 90% of all US businesses, are now free to discriminate against women (and it was specifically women and birth control) if their religion leads them to believe birth control kills babies, or that women who use birth control are Satan’s spawn (the belief does not have to be factual).

The Supreme Court says corporations can hold religious objections that allow them to opt out of the new health law requirement that they cover contraceptives for women.

The justices’ 5-4 decision Monday is the first time that the high court has ruled that profit-seeking businesses can hold religious views under federal law. And it means the Obama administration must search for a different way of providing free contraception to women who are covered under objecting companies’ health insurance plans.

Salon AP coverage

I am not going to debate the wrongness of this decision, the notion that businesses can have religious beliefs, and can use them to discriminate against certain types of people is not up for debate. And, the discrimination is very specific and targeted…

The other, more ubiquitous discrimination is in the notion that the health care you get has anything to do with the work-for-pay arrangement you have with the organization you work for. I am probably the millionth person to mention this, and whole books have been written on the subject, but, the link between healthcare and your employer is wrong because it anchors discrimination. This particular egregious case goes one step further and discriminates based on gender as well, not just work status.

The US had a chance to sever health benefits from employment when they had a three-year debate on expanding health insurance coverage. Thanks to the ability of small political minorities to filibuster and block action, and a corporate-funded reluctance for change, the US kept their employer-based health insurance system in place, and with it, all the discrimination that entails. Uwe Reinhardt reiterated a number of these points recently in the New York Times.

Back Home

Is BC any better? Yes and no. Thanks to Canada’s Medicare, parts of our health care system are universal and not subject to employment ties. But, there are several exceptions making us a two-tier health care system:

  1. The health insurance tax or MSP (what our government cutely calls a “fee” in order to not call the yearly increase in this fee a tax increase): Many employers will pick up part/all of this tax for their employees, whereas one that doesn’t can pay more than 1000 dollars a year for a family. While there is an element of progressiveness to the pricing with very low-income people paying less/nothing, it is weak, families making > 30K per year pay full price.
  2. Drugs: For some reason, drugs are not covered by our “universal” healthcare system and are provided by workplace “supplemental benefits”, as if taking a thyroid pill every day is a “supplement”. The CCPA makes an excellent case for universal pharmacare, if you need more convincing. 10% of Canadians cannot fill prescriptions for financial reasons.
  3. Our public health insurance system assumes people don’t have eyes or teeth. So, if you want your cavities filled, a root canal, or want to see clearly, you need “supplemental benefits”, and these are mostly employer-provided. Oral health is a clear marker of health inequality.
  4. Mental health is not covered, this is inexcusable, as Andre Picard notes.
  5. Treatments that improve overall health, like massages, are not really covered. Once again, your employment status determines whether you have the “luxury” of holistic preventative measures to reduce stress, pain, and many other issues.
  6. Historically and currently oppressed groups, Canada’s indigenous people for example, get a short shrift on the benefits like massage, nutrition, counselling and holistic treatment they need because of disparity in employment availability.

This quote from the Andre Picard article I mentioned summarizes the discrimination.

The well-to-do pay. The middle-class scrape together the money the best they can, sacrificing so their child can get care. And those without the means wait, or do without care.

There are other side-effects. Because “benefits” are expensive, companies have a vested interest in only having certain “valuable” employees benefit. The rest get treated as contractors, have their hours strategically reduced, and much more.

It’s almost as if there’s an unspoken moral argument here, you don’t deserve good teeth or a massage if you don’t work for a living.

Yes, you can buy individual supplemental insurance, or pay per use, but neither of these are cheap because you as an individual have no bargaining power.

We in BC also have a long way to go to break the link between healthcare and employment. Will it cost the average BC resident more money? Let’s consider:

  1. A simpler system with one buyer is administratively efficient. It takes the thousands of decision points every HR administrator or group in every company/union has to make and transfers that to a single entity. Public universal plans are about four to ten times more efficient (pdf) than fragmented private plans.
  2. A bigger entity can negotiate much better rates for you, whether it is for drugs, or for dentistry, or for anything else (a bigger risk pool). If all of Canada administered one simple pharmacare system, we would negotiate much lower prices with pharmaceutical companies. We would also have better funding to run and evaluate effectiveness studies.
  3. Funding preventative, holistic healthcare means fewer hospital visits. In a universal system, there are no artificial barriers between a massage, drug treatment, surgery, stress reduction counselling, or ergonomic counseling for back pain. You don’t have to prove your work injured you in order to get the right treatment, your first point of contact with a medical professional (not necessarily a doctor) decides which path works best. You do not have to get sick enough to go to the hospital before you get treatment covered by insurance.

Pitfalls

There are concerns with a universal single-payer system:

  1. As Vox points out, if a government administering the single-payer system decides not to pay for contraception, then no one gets it. So, getting good universal healthcare is about constantly winning political battles. The good thing about universal healthcare in Canada is that it is incredibly popular, polling near 90% approval (pdf). So once quality is improved, governments will find it hard to cut back.
  2. Like any other public system, the quality of the institutions drafting policy and administering the system is vitally important. Well run public systems are efficient. But conservative movements in the last 30+ years have worked hard to dismantle the quality of public institutions and trust in such institutions. In this reality of shrinking budgets and staff levels where bureaucrat is a term of insult, ensuring that public system expansion is handled efficiently is no given. There is an entire industry of political parties, think tanks and media devoted to tearing down the concept of a publicly administered good, and ready to pounce on every little misstep (Remember the Obamacare roll out anyone?)
  3. Will employers raise wages from all the savings they get from not providing health benefits, and will these raises cover the increase in taxes we will pay for universal healthcare? Probably not right away, but it will happen eventually.

Transitions

Clearly, we can’t transition tomorrow. A public system would need to be in place and functioning before our employers get out of the health insurance business. I would phase universality in the following order:

  1. Drugs
  2. Teeth and eyes
  3. Preventative and palliative care.

We would also need to rethink the”fee for service”, where healthcare providers are paid per widget, and think about a different system closer to a salaried model, more on that in future blog posts.

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    California Ban on Diacetyl?

    Byoliveridley

    Flavoring-Factory Illnesses Raise Inquiries – New York Times

    For a good background on flavoring-factory lung disease (formerly known as popcorn worker’s lung), check out the Pump Handle’s many posts, especially this recent one. Short primer, diacetyl is the chemical that gives popcorn its so called buttery taste (and smell, it’s fake!!). Well, there’s pretty good evidence that diacetyl causes bronchiolitis obliterans. Some symptoms…

    Bronchiolitis obliterans renders its victims unable to exert even a little energy without becoming winded or faint.

    “The airways to the lung have been eaten up,” said Barbara Materna, the chief of the occupational health branch in the California Department of Health Services. “They can’t work anymore, and they can’t walk a short distance without severe shortness of breath.”

    OSHA has been unwilling to seriously regulate diacetyl, so California, as it is wont to do, is considering banning this killer chemical.

    But in California, which has 28 flavoring plants known to use diacetyl, some legislators and government officials seem unwilling to wait. A bill to ban diacetyl in the workplace by 2010 has passed two committees in the State Assembly and could be taken up by the full body this summer. It is the first proposal of its kind in the nation. Assemblywoman Sally Lieber, the author of the bill, said she introduced it because of what she said was the slow response by the flavoring industry, which is largely self-regulating on occupational safety. “What we’ve heard is that the flavoring industry has known for years that this is potentially a problem, and they haven’t taken action,” said Ms. Lieber, a Democrat.

    I am all for California’s regulation. But as written, this law will only protect workers in California. They should also consider going one step further by restricting the use of diacetyl in food sold in California. Only then can the giant market that is California exert its influence on the diacetyl manufacturers and users.

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    High fructose corn syrup makes you fat

    Byoliveridley

    This well designed and well executed study provides rather conclusive proof that High Fructose Corn Syrup, the sweetener most commonly used in North America, makes you gain weight in a way not explained by calories alone. These rats gained more weight on HFCS compared to a sucrose (regular sugar) diet even though they were fed the same calories. The effect was seen in the short term and in the long term, and abdominal fat increased the most. Gut fat, if you did not know is related to the infamous metabolic syndrome, causing diabetes, hypertension, coronary disease, etc.

    High-fructose corn syrup (HFCS) accounts for as much as 40% of caloric sweeteners used in the United States. Some studies have shown that short-term access to HFCS can cause increased body weight, but the findings are mixed. The current study examined both short- and long-term effects of HFCS on body weight, body fat, and circulating triglycerides. In Experiment 1, male Sprague–Dawley rats were maintained for short term (8 weeks) on (1) 12 h/day of 8% HFCS, (2) 12 h/day 10% sucrose, (3) 24 h/day HFCS, all with ad libitum rodent chow, or (4) ad libitum chow alone. Rats with 12-h access to HFCS gained significantly more body weight than animals given equal access to 10% sucrose, even though they consumed the same number of total calories, but fewer calories from HFCS than sucrose. In Experiment 2, the long-term effects of HFCS on body weight and obesogenic parameters, as well as gender differences, were explored. Over the course of 6 or 7 months, both male and female rats with access to HFCS gained significantly more body weight than control groups. This increase in body weight with HFCS was accompanied by an increase in adipose fat, notably in the abdominal region, and elevated circulating triglyceride levels. Translated to humans, these results suggest that excessive consumption of HFCS may contribute to the incidence of obesity.

    Miriam E. Bocarsly, Elyse S. Powell, Nicole M. Avena, Bartley G. Hoebel. High-fructose corn syrup causes characteristic of obesity in rats: Increased body weight, body fat and triglyceride levels. Pharmacology Biochemistry and Behavior, 2010; DOI: 10.1016/j.pbb.2010.02.012

    For a more layman friendly summary of the article, read the sciencedaily release.

    Do reconsider your food habits to avoid HFCS. Note that this whole corn syrup boondongle is made possible by the US government’s insistence on providing billion dollar subsidies to its farmers to grow corn while imposing tariffs on cane sugar from the tropics to make it less attractive. Free trade, my A$$.

    Thanks to Tom Laskawy at grist for the blog post.

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    Circumcision and AIDS – Revisited

    Byoliveridley

    condom.jpg

    A post I wrote quite a while back on circumcision and AIDS remains my most commented post ever. In it (if you’re too lazy to click) I said that while research indicating a reduction in HIV infection in circumcised men was promising, there were a couple of concerns. One, that this could be a distraction from the single most effective prevention measure (no, not abstinence!), condom use. And two, that in certain cultures, especially among Hindus, this would be an absolute no no because circumcision is identified with being Muslim.

    Anyway, in a review article, the Cochrane Centre in South Africa summarizes results from a meta analysis of a number of trials indicating a 50% reduction in HIV incidence among circumcised males. At this point in time, it is clear that circumcision is effective in reducing HIV incidence among heterosexual males. Based on this, the institute encourages the widespread use of circumcision as an AIDS prevention strategy.

    So, am I still circumspect? Absolutely. I am still concerned that this research will be misinterpreted in a way that discourages condom use. In fact, the authors note that circumcised men indulged in more risky behaviour. Also, the incidence of HIV in the women these men were sleeping with increased from 9.6% to 13.8%, a 40% uptick. This increase was not statistically significant. No arguing with that, though the study was stopped early once it was clear that the men were helped, never mind the women, or reaching statistical significance in their case.

    Given that it is very unclear what the effects of circumcision are on anything other than circumcised penises, which are only one half of the equation (or less!), I don’t think it is responsible to call for widespread use of circumcision as a public health strategy for the prevention of HIV until its effects on the other parties are known. While people are aware of this issue, I don’t think the science or the cultural landscape promote the use of circumcision as a HIV prevention strategy until its proven that women are not at risk from increased HIV incidence either biologically from a yet unknown mechanism, or socially from increased risk taking.

    Men have more power in most societies to demand and receive sex on their terms. So the male centric nature of this research, and the conclusions drawn are disturbing. How irresponsible is it to encourage a public health strategy that appears to increase risk taking behaviour among men when the effects on the women are yet unknown, with only a statistically “insignificant” 40% increase in HIV incidence among women being observed?

    I am. for very good reason, still circumspect on circumcision.

    Whisky flavoured condoms courtesy bruno  girin’s photostream used under a creative commons license. Now how’s that for a turn on, whisky!

  • Government fights to prevent testing slaughtered cattle for mad cow

    Byoliveridley

    Imagine a country where the government will go to great lengths to prevent you, a small business, from holding your products to high safety standards because it is concerned that big business will be hurt. Well, if you live in the US of A, it is your government! Yes, it sounds anti-competitive to me, and it is, but the USDA is in the hands of big business, and the plutocracy protectionary principle is in full force here, I can only laugh! Wouldn’t you like it if you’re suspected of a crime and try to argue that you don’t want to be fingerprinted because there might be a false positive identification on you? I suspect you would not get very far with that argument!

    That being said, it would be interesting to compare the incidence rate of mad cow disease with the incidence rate of false positives, would settle this question…

    U.S. government fights to keep meatpackers from testing all slaughtered cattle for mad cow – International Herald Tribune

    The Bush administration said Tuesday it will fight to keep meatpackers from testing all their animals for mad cow disease.

    The Agriculture Department tests fewer than 1 percent of slaughtered cows for the disease, which can be fatal to humans who eat tainted beef. A beef producer in the western state of Kansas, Creekstone Farms Premium Beef, wants to test all of its cows.

    Larger meat companies feared that move because, if Creekstone should test its meat and advertised it as safe, they might have to perform the expensive tests on their larger herds as well.

    The Agriculture Department regulates the test and argued that widespread testing could lead to a false positive that would harm the meat industry.

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    Colonialism, Pharmaceutical style

    Byoliveridley

    Legal wrangle puts India’s generic drugs at risk – health – 29 January 2007 – New Scientist

    Tens of thousands of people being treated for AIDS will suffer if Swiss pharmaceutical company Novartis succeeds in changing India’s patent law, the humanitarian agency Medecins Sans Frontieres warned on Monday. Novartis is challenging a specific provision of India’s patent law that, if overturned, would see patents being granted far more widely, heavily restricting the availability of affordable generic medicines, MSF says.

    In 2000, antiretroviral (ARV) treatment cost was estimated at $10,000 per patient annually. But the availability of generic drugs produced mainly in India, allowed costs to plummet to about $70 per patient per year, Mwangi adds.

    You’ve got to love the friendly multinational arguing to make extra billions while people die. But I don’t think any Indian judge will overthrow Indian patent law. And there is a national interest  exemption built into most patent statutes, per the TRIPs agreements.

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