My husband and I live in a state that already has health care reform.  We live in Massachusetts.

On April 12, 2006, our state legislature enacted a law requiring all residents to have health insurance.

They could buy it themselves, they could buy it from their employer through a group plan or, if their income was below a certain level, they could buy it from the state at a reduced rate. This is the so-called public plan. If people are totally disabled and therefore unemployable, and have no assets to cover the costs, the state pays for it. Very few people fit the last category.  

Employers – even small-business owners – are required to provide basic minimum health care plans. If they do not, they are fined (a whopping) $295 per employee, per year.

To date, the vast majority of employers – even small-business owners – have found a way to provide health insurance plans for their employees. Few have paid the fines. In fact, the number of small-business employers in the state that do offer insurance rose from 88% to 92% from 2007 to 2008, according to a recent story in Investors Business Daily. 

This program has been in effect almost three years. As far as we can tell, the world has not come to an end.

When the law was enacted, my husband was already enrolled in Medicare and I was buying my own individual policy (a high-level HMO) from a business association group I joined specifically to buy insurance at a discount. The last year I had it, I paid $620/month, plus $175/year for association membership dues.

Today, we’re both on Medicare, but buy a mid-level Medicare supplement HMO plan from Blue Cross/Blue Shield of Massachusetts. The supplement includes a drug plan and costs $119 a month, brining our total outlay for health insurance to $216 a month/per person.  

Thanks to Medicare and the supplement plan, we’re saving about $800 per month for the two of us. Thank you, US taxpayers and government bureaucrats.

We weren’t sure we liked the idea of mandatory universal health care when it was first presented to the people of Massachusetts. We worried about reduced care, higher bills, and all the other things you worry about when you’re facing change.

Here’s what has happened to us as a result of mandatory, universal health care:

1.    We still go to the same doctors.

2.    We’re still on the same medications.

3.    We still use the same pharmacy.

4.    All other medical facilities we use – imaging labs, hospitals, blood testing labs, physical therapy -- have not changed.

5.    As far as we can tell, our insurance premiums have not changed or have changed slightly ($5, maybe, per month).

6.    Our co-pays are lower, but we’re on Medicare.

7.    If I had stayed in the same HMO plan I had before Medicare, some of my co-pays would have increased for things such as substance abuse treatment and prosthetic limb fittings, not that I used any of those benefits.

8.    I have greatly reduced my drug regimen and we both have increased our weekly exercise, in part, because our insurance now encourages prevention by paying a nice benefit for going to the gym.  

9.    We feel more comfortable being in crowds at the grocery store, movie theaters, or in close quarters at the barber shop and hair salon, knowing everyone there has access to health care. That means everyone we deal with is less likely to be spreading infectious disease than they were three years ago.

10.  We’ll feel even better when this year’s flu season comes around, since school children, teachers, bank tellers, store clerks and others dealing with the public can get the necessary vaccines or treatment to contain this year’s flu, no matter how rich or poor they may be.

And that’s the truth. 
For related stories, click on Health Care Reform, under Posts in the right-hand column.

If you’re listening to the health care reform debate, you’ll hear over and over again how great US health care is and how we don’t want to mess up a good thing.

Well, I don’t know where those people get their facts, but they won’t find them in any US medical school or school of public health where real data rules, not jingoism.

I learned this while covering stories at Harvard School of Public Health. Here are the facts:

FACT: The US ranks 37th in overall quality of health care, in a world ranking published by the World Health Organization in 2000. 

WHO spent years collecting and compiling data, taking into consideration expenditure, efficiency, life expectancy and other factors.

We’re behind Morocco in quality but ahead of Barbados! See for yourself.  

*The World Health Organization's ranking of the world's health systems 

Rank       Country
1         France
2         Italy
3         San Marino
4         Andorra
5         Malta
6         Singapore
7         Spain
8         Oman
9         Austria
10        Japan
11        Norway
12        Portugal
13        Monaco
14        Greece
15        Iceland
16        Luxembourg
17        Netherlands
18        United  Kingdom
19        Ireland
20        Switzerland
21        Belgium
22        Colombia
23        Sweden
24        Cyprus
25        Germany
26        Saudi Arabia
27        United  Arab  Emirates
28        Israel
29        Morocco
30        Canada
31        Finland
32        Australia
33        Chile
34        Denmark
35        Dominica
36        Costa Rica
37        United States of America
38        Slovenia
39        Cuba
40        Brunei
41        New Zealand
42        Bahrain
43        Croatia
44        Qatar
45        Kuwait
46        Barbados
47        Thailand
48        Czech Republic
49        Malaysia
50        Poland

I cut it off at 50, by the way, to spare you the pain.

Dollar for dollar, we're paying more and getting less than most of our friends and relatives in Europe, some areas of the Middle East and parts of Asia. Why is that? 

Those who think we don't need to improve quality -- just reduce expenses -- should think again. Look at our competition. Consider the countries -- such as Costa Rica and Saudi Arabia -- that, according to WHO, are doing a better job of meeting the health care needs of their citizens.  

Of course, this is little to do with the quality and quantity of our research, just delivery. Nor does it take into consideration the existence of something like the National Institutes of Health, or the National Library of Medicine, or the Centers for Disease Control and Prevention (all government funded and run).

Here's a 2007 New York Times story that examines the significance of the WHO data.

*Sources: WHO World Health Report 2000
See also
Spreadsheet Details (731kb)
See also:
Healthy Life Expectancy By Country
See also:
Health Performance Rank By Country
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Total Health Expenditure as % of GDP (2000-2005)
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Main Country Ranks Page

I urge anyone seriously interested in issues surrounding the debate  over health care reform to read Kevin Pho's blog. is one of the most widely read medical blogs on the Web, with more than 26,000 RSS subscribers and 12,000 Twitter followers.

He updates it several times a day and last week, held his own "town hall" forum in a live chat format. Pho is a frequent contributor to USA Today, has his own radio program on the ReachMD satellite radio channel, and publishes one of the most respected medical blogs in the US. 

Here is one of today's posts:

When it comes to health care reform, winners and no losers? August 18, 2009

And that’s precisely what’s obstructing any meaningful reform.

Princeton economist Uwe Reinhardt talks about how the American people wants to have their cake and eat it too, and devises an “all-American wish list” of what ideal reform should look like to the American public.

It includes such items as, “Cost-effectiveness analysis should never be the basis of any coverage decision by public or private third-party payers in health care, for to do so would put a price on human life — which, in America, unlike everywhere else, is priceless,” and, “Americans have a moral right to life-saving and potentially highly expensive medical care, should they fall critically ill, even if they are uninsured and could not possibly pay for that care with their own financial resources.”

He’s not joking. Nobody, and that means patients, doctors, hospitals, insurance companies, and Big Pharma, is willing to make any sacrifices. And, in effect, that means any proposed reform should not create winners or losers, “but only winners.”

Good luck devising such a plan.

Kevin Pho, M.D.
New Hampshire-based Kevin Pho, M.D., believes most physicians – especially family docs, like himself – will welcome comparative effectiveness research, but drug and device companies “will be resistant.” Specialists, too, might balk because, he believes, some testing and procedures they do might not be “deemed necessary.”

In an interview for Progress Magazine, Pho told me he currently pays for a service providing online, peer-reviewed, evidence-based data to help him make everyday decisions on patient care. He, for one, will be quite pleased when he can access a larger, free service.

“Physicians need an authoritative source of unbiased data, untainted by the influence of drug companies and device manufacturers,” Pho wrote in a recent post on his blog,

Will the publication of data collected through CER result in the rationing of care? Maybe, Pho says, but that might not be such a bad thing.  

There's no reason to assume changing care will be equal to reducing care. If we know what works and what doesn’t, for whom and under what conditions, he says, change will benefit the patient, not hurt him or her. 

Pho believes advertising agencies and other media have sold patients the myth that, when it comes to health care, #1/ more is better, and  #2/ the newest care is always best.  

Not so fast, says Pho.  A number of important, large-scale recent studies (see Dartmouth Atlas 2008) have shown that sometimes more care can be harmful.

As for new drugs, don’t forget that, just because they’re on the market, there’s no guarantee they will work for you.

 “We need to break that myth,” he says. “Older, more established treatments may actually be better. It’s a difficult concept for some patients to grasp.”

Think Eastern medicine and herbal remedies. Maybe your grandmother was right about the benefits of cod liver oil. And, and OTC drug is a whole lot cheaper than some of the fancy drugs you see advertised on television. If it works, why not use it?  

Think of all the drugs that have been taken off the market in recent years because they were either ineffective or potentially harmful.  

“There’s no point paying for treatments you know won’t work,” he said, in the interview.

“Realistically, to control health care costs, the medical community will have to make some big decisions, and the best way is to make unbiased decisions with unbiased data and recommendations,” he wrote on his blog.

Is that rationing? Or, just making good use of experience?

To read more of Kevin Pho’s comments on health care, go to his blog,

If you’re like me, you thought when a drug or medical procedure is approved by the FDA, it works, right?


The FDA certifies the drug won’t hurt you, not that it will help you.    

To discover which drugs, diagnostic tests as well as surgical and therapeutic procedures work, and under what circumstances, we must rely on the people that sell them, and on the experience of the docs who use them.

Obviously, that information could be incomplete or biased. And, even if it isn’t, it might take a long time to gather, sort and distribute.

So, at the advice of all kinds of high-level medical think tanks in place for many years, the Obama administration added a provision to the American Recovery and Reinvestment Act of 2009, to set up a mechanism to fund research examining all kinds of public records, clinical trials, legal records and other information. Eventually, we should have evidence that will lead to lists of what works and what doesn’t, under a variety of circumstances.

A daunting task, to be sure.

Nobody believes such information will be available soon. But, the government will take it one step at a time. From my own research on the subject, most doctors welcome the program.

Obviously this will be a long-term research project but it’s built on a program begun in 1989 by President George H.W. Bush, to give you an idea of how long this concept has been kicked around. It’s not new, nor is it unique to the US. Other countries have had similar programs in place for years.

Although in its infancy, the very concept of comparative effectiveness research has added fuel to the fire on talk radio, giving the likes of Rush Limbaugh et al, “proof” health care reform will limit care!

When you think about it, doesn’t the word reform mean re + form, implying change?

The hundreds of health care experts (including representatives from many related industries) who wrote the legislation, as well as the Congress that passed it, must believe this particular change will be for the better.  

 For an explainer on the pros and cons of comparative effectiveness research (CER), click here to read a fairly short story I wrote recently for Progress Magazine, an ezine published by Sigma Xi, the science research society. This piece looks specifically at the concerns of minorities, who, to be sure, do not want to be left out of any studies. To make sure they’re included, Congress included a special provision into the final draft of the bill that was enacted into law on February 17, 2009. Stay tuned.


In this week’s edition, Newsweek has published Seven Falsehoods About Health Care, something put together by the good people at This is an excellent explainer that takes you right to primary sources, so you can double check everything yourself.

Why listen to opinionaters when you can go right to the source?  

This story looks at a couple of these claims:

Under health care reform, the government will decide what care I get.
The bill is paid for.
Private insurance will be illegal.
The House bill requires suicide counseling.

True or false?

See for straightforward answers. 

Young adult cancer patients have a new weapon against the insidious disease waging war on their bodies: Humor!

For a look at what they call "cancertainment," see this week's Newsweek Magazine.

Here's an excerpt from A Malignant Melanoma Walks into a Bar...:

About 70,000 people between the ages of 18 and 40 are diagnosed with cancer every year, representing about 6 percent of all new cancer cases. About 10,000 young adults die from cancer annually, more than from any other disease. This is not the best statistic to stumble on when you are looking online for hope, as I did in September 2006 after my doctor told me he found a growth in my colon. There I was—nonsmoker, athlete, young—diagnosed with colon cancer, the disease that more commonly afflicts overweight, elderly men. And all I could think was: how inconvenient. I was a travel writer and had just scheduled trips to Rome and Cologne for the following week. Bummer. I would have to reschedule those flights.

Read the entire story at

Jacqui, from Dirty Sparkle blog
Hi Paula,

We have been getting a lot of press her in the UK about the NHS here being rubbish. In fact it is wonderful.

Sure, it has it's faults, like sometimes you have to wait and sometimes you can't get the 'cure' straight away. Overall, the most beneficial thing about it is it helps those on low income, primarily. There is no charge at all for treatment or prescriptions for those who earn below a threshold. Children get ALL free treatment and so do pensioners. Everyone gets a similar level of treatment.

At the more affluent end, extra heath care insurance can be taken out so that if you want a plush room with plasma screen TV you can have that. But basically, the 'national insurance' premium is deducted at source form salaries and treatment is provided for everyone. This inspires a basic confidence that you will definitely get treatment if you get ill. The cosmetic dental and cosmetic surgery system is completely separate - all actual illness is treated
in nationally approved surgeries, clinics and hospitals.

It's a wonderful thing. I hope you soon have something similar.

Jacqueline Christodoulou, Ph.D.

Here’s a rather prophetic story I wrote for the Fall 2004 issue of the Harvard Public Health Review. It outlines health reform principles discussed in Getting Health Reform Right: A Guide to Improving Performance and Equity, a book written by four Harvard professors, presumably for developing nations. But, maybe not.


Four HSPH experts highlight the importance of social values, politics, organization, and economic considerations to health system reform in a new book, Getting Health Reform Right: A Guide to Improving Performance and Equity. Published by Oxford University Press, the uniquely multidisciplinary "repair manual" takes reformers step by step through the complexities of patching up and replacing broken systems.

"The world is littered with failed reform efforts," observes Marc J. Roberts, one of the quartet and a professor of political economy and health policy. But given the enormous needs, notes his colleague, Peter Berman, professor of population and international health economics, "We have no choice but to do better."

Despite what the United States spends to stay healthy--about $1.5 trillion a year, more than any other nation--this country ranked 37th among Western nations in one 2000 World Health Organization report that factored in quality and disparities in care among the insured and uninsured. When you consider that 2.8 billion people--more than half the population of all developing countries--live on less than $2 a day, you get an inkling of how little people in, say, Tanzania or Honduras have to spend on medical care, let alone prevention. If a wealthy, stable country like the U.S. can't provide good health services to all its citizens, what can resource-poor countries hope to accomplish?

See Getting Health Reform Right for the complete story. 

William Campbell, publisher of The Tome of the Unknown Writer, asked me to write a few words about my/our health care situation, as part of a collection of stories  he's posting from people from around this country and the world. The only stipulation he made was the piece had to be personal. 

I'm passing this along because I think you might find these stories interesting. I know I did. What a great idea, Bill!

To read more, go to: