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The worst health care reform ever?
Perhaps Turkmenistan takes the prize:
In 2003, "President for Life" Saparmurat Niyazov decided that poor, landlocked Turkmenistan's medical costs were too high and that its healthcare system urgently needed reform. The country had already suffered from a shortage of doctors, and the only qualified ones were in cities, Niyazov said on a public radio address.
So, in a frankly insane healthcare reform effort, he restricted the public's access to care by replacing up to 15,000 doctors and nurses with unqualified military conscripts. The next year, he ordered hospitals and clinics outside of the capital, Ashgabat, to close -- even though the vast proportion of Turkmenistan's population lives in rural areas. The BBC quoted him as saying, "Why do we need such hospitals? If people are ill, they can come to Ashgabat." He also implemented fees and created an "unofficial" ban on the diagnosis of certain communicable diseases, like hepatitis.
As a result, an epidemic of the bubonic plague reportedly broke out (Turkmenistan's highly secretive government does not allow in organizations like the WHO) and existing rashes of AIDS, hepatitis, and tuberculosis worsened. At the time of Niyazov's death from a cardiac infarction in 2006, Turkmenistan had one of the lowest life expectancies in Asia -- less than 60 years.
The full story is here and it lists some other very bad health care reforms.
Posted by Tyler Cowen on August 15, 2009 at 04:49 AM in Medicine | Permalink
Comments
Sounds like a perfect storm of Hope & Change, Turkmenistan style. ;-)
Posted by: Speedmaster at Aug 15, 2009 8:12:55 AM
Thank god we're not in these socialized systems. We ought to stick with our current homegrown American system, best in the world!
Posted by: Zephyrus at Aug 15, 2009 1:30:53 PM
Well, Speedmaster and Zephyrus, it looks like you did not finish reading the linked article. It lists United States as having one of the "least-functional" health care systems, in part because our insurance market is "under-regulated".
It repeats oft-heard nonsense about per-capita deaths by lung cancer, bemoans the fate of HillaryCare (which would have fixed everything), etc.
Frankly, I don't see why this was even blogged. The fact that the U.S. was lumped in with China, Russia, and Turkmenistan (the first two received criticism for partial privatization) leads me to doubt the accuracy of the article. The agenda was to disparage the U.S. system.
Posted by: Peter K. at Aug 15, 2009 2:09:05 PM
For those not reading the article, the fourth example given is
But for the most part, the history of health reform in the United States has been a history of failure. The last attempt at comprehensive reform -- the 1993 bill derided as "HillaryCare," during the administration of Bill Clinton -- floundered in Congress. Since then, costs and premiums have doubled, a lower percentage of employers offer coverage, and millions more are uninsured.
And I think this event staged by a group that has been working for years taking health care to "third world nations" and areas struck by major disasters says a lot about the United States health care system: http://www.nytimes.com/2009/08/13/health/13clinic.html?hp
When Remote Area Medical, the Tennessee-based organization running the event, decided to try its hand at large urban medical services, its principals thought Los Angeles would be a good place to start. But they were far from prepared for the outpouring of need. Set up for eight days of care, the group was already overwhelmed on the first day after allowing 1,500 people through the door, nearly 500 of whom had still not been served by day’s end and had to return in the wee hours Wednesday morning.
Posted by: mulp at Aug 15, 2009 2:19:30 PM
People in the United States are as likely to die from diseases like lung cancer as citizens in all OECD countries -
And they're even more likely to die of cancer than people in Turkmenistan!
Posted by: Careless at Aug 15, 2009 3:27:57 PM
Turkmenistan is clearly better at preventing Hepatitis than the U.S.
We should look into that....
Posted by: Steve at Aug 15, 2009 3:48:16 PM
Sarcasm apparently doesn't translate well over the interwebs.
And Peter K, even though our health care system obviously gets significantly better results than Turkmenistan, that doesn't mean it's good or even average. You've got to look at the value we get for it. Which, if you do, comes out making us look like a train wreck. If Canada spent the money we do on health care, it wouldn't know what to do with it all.
This is an indisputable fact. It doesn't mean that we need single payer, or Wyden-Bennett, or Obamacare (though I think all of them would be a significant improvement over the status quo, in decreasing order); I'd be quite happy even if we simply dismantled employer-based healthcare and had a Milton Friedman-esque universal catastrophic health insurance system. But something simply must be done.
Posted by: Zephyrus at Aug 15, 2009 7:20:22 PM
As bad as this sounds, it can't be as bad as the Khmer Rouge health care reform, which was to close the hospitals and kill all the people that wore glasses.
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Posted by: sevda sohbet at Aug 17, 2009 2:30:21 AM
After reading this report fully as well as all the others, the reality of the debate is whether you as a patient want your treatment to be more and more removed from the decisions of doctors and placed into the hands of bureaucrats and politicians. The example of lung cancer is clearly flawed namely because lung cancer is difficult to cure no matter what country one lives in. But, in my experience, the drugs, treatment, and prognosis for cancer patients in the US is certainly greater than in all other developed countries. Before jumping on the band wagon of US health care hate perhaps we should look at all the advancements that have been achieved by US doctors and researchers. This advancement, was and continues to lead the world. Wonder where the research and development comes from...it is the US, but helps EVERYONE in the world and has for decades.
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Posted by: Peter at Aug 26, 2009 6:30:53 AM
Below are the Court of Veterans Appeals, Chief Judge's "Constitution, Statutes and Regulations" "policy freely ignored" remarks,i.e., PARAGRAPHS 1, 8 & 9. It is now 15 years later without his advised Congressional oversight and accountability for veterans health care repair!
Please hold your Congressional Representatives responsible.
The complete 16 paragraph "STATE OF COURT" transcript is available on request.
STATE OF COURT
CHIEF JUDGE FRANK Q. NEBEKER
STATE OF THE COURT
FOR PRESENTATION TO THE
UNITED STATES COURT OF VETERANS APPEALS
THIRD JUDICIAL CONFERENCE
OCTOBER 17-18, 1994
{as it appears in Veterans Appeals Reporter}
PARAGRAPH NO. 1:
I will speak to you today about my view of the state of the Court and the scope and chain of authority within the veterans' benefits system. Let us remember that Board mistakes and inconsistent results were deemed to warrant review and oversight on a case-by-case basis where the results were adverse to the claimant. Hence, the Court was created and began its operation five years ago today. Before the advent of judicial review, that system, as now, functioned in a two-tiered operation-agencies of original jurisdiction and the Board of Veterans' Appeals. Whether the former were within the direct chain of authority under the Board, or acted as a separate surrogate of the Secretary seemed of no concern for many years.
--------------------PARAGRAPHS 2 through 7 in TRANSCRIPT.------------------------------------------
PARAGRAPH NO. 8:
Imagine, if you will, the creation of a government of a new state in our union, or one in the world of emerging nations. In that state, there is an Executive and a Supreme court and a Court of Appeals. At the local level, however, there are adjudicative bodies which initially resolve disputes. But, the Constitution leaves the Supreme Court and the Court of Appeals with direct authority over the local adjudicators. It is only when the Executive can be persuaded to issue the proper order that these local adjudicators must obey. Thus, the locals determine, quite independently of the courts, when, and how they will decide matters before them. I dare say, you know of no viable republican form of government with such a system, and it is not hard to see that it would not work well.
PARAGRAPH NO. 9:
I believe my message is clear. There is, I suggest, no system with judicial review which has within it a component part free to function in its own way, in its own time and with one message to those it disappoints -- take an appeal. That is, I am afraid, what we have today in many of the Department's Agencies of Original Jurisdiction -- that is AOJs -- around the country. Neither the Court, through the Board, the Board, nor the General Counsel has direct and meaningful control over the Agencies of Original Jurisdiction. Indeed, it is also clear that the VHA -- the Veterans Health Administration -- ignores specific directives to provide medical opinions as directed. And this is resulting in unconscionable delays. Let us examine judicial review. Remember, the Court and the Board do not make policy, the Secretary and Congress do. The Court simply identifies error made below by a failure to adhere, in individual cases, to the Constitution, statutes, and regulations which themselves reflect policy -- policy freely ignored by many initial adjudicators whose attitude is, "I haven't been told by my boss to change. If you don't like it -- appeal it." (Emphasis added)
--------------------PARAGRAPHS 10 through 16 in TRANSCRIPT.------------------------------------------
- - - End - - -
Posted by: David Marshall at Sep 1, 2009 10:16:39 AM
