Sunday, October 25, 2009
Sunday, October 18, 2009
Behavioral economists have established that we feel pain of losses more than we enjoy the pleasure of gains. So when we think about change we focus more on what we might lose rather than on what we might get. Even people who aren't all that happy with the current (health care) system, then, are still likely to feel anxious about whatever will replace it......After all, although people tend to feel that they own their health insurance, their entitlement is distinctly tenuous.
- 750,000 homeless
- 131,000 homeless veterans
- 37 million people living below the poverty line (larger than the entire population of California)
- Approximately 45 million people without health insurance
- 20 percent of all of its children currently receiving welfare
- The top 1 percent of households owning 57 percent of all corporate wealth
- An infant mortality rate that holds at 6.7 per 1,000 births (45th in the world)
- An average life expectancy that ranks 50th in the world
- Approximately 700,000 of its citizens file for medical bankruptcy each year. (In France, Britain, Germany, the Netherlands, Switzerland, Canada and Japan combined the number is zero.)
Whenever the French talk about health care, they invoke the concept of solidarite, the notion that all French citizens must stick solidly together to help one another in time of need. "The solidarity principle," explains Professor Rodwin, "requires mutual aid and cooperation among the sick and the well, the inactive and the active, the poor and the wealthy, and insists on financing health insurance on the basis of ability to pay, not actuarial risk."
With the truly poor, the free-riders turn up at emergency rooms. This is hugely inefficient, because pricey late interventions and operations could very often have been avoided with a much smaller investment in preventive care. Insured people and taxpayers are forced to cross-subsidies such "uncompensated" and wasteful treatments to the tune of tens of billions of dollars per year.
People without insurance tend to delay seeking medical care until their diseases, like diabetes and incipient cancer, become so severe that they require emergency attention and often cannot be treated effectively. The rest of us pay for their charitable care through taxes or higher premiums on private insurance.
It's revealing that, in the lingo of the U.S. health insurance industry, the money paid to doctors, hospitals, and pharmacies for treatment of insured patients is referred to as "medical loss." That is, when health insurance actually pays for somebody's health care, the industry considers it a loss.
In the real world, nothing except a single-payer system makes any sense. There are currently more than 1,300 private insurers in this country, forcing doctors to fill out different forms and follow different reimbursement procedures for each and every one. This drowns medical facilities in idiotic paperwork and jacks up prices: Nearly a third of all health care costs in America are associated with wasteful administration. Fully $35o billion a year could be saved on paperwork alone if the U.S. went to a single-payer system - more than enough to pay for the whole goddamned thing, if anyone had the balls to stand up and say so.
But Senator Charles E. Grassley of Iowa, the senior Republican on the committee, said a government insurance plan would have inherent advantages over private insurers "Government is not a fair competitor," Mr. Grassley said. "It's a predator." He predicted that "a government plan will ultimately force private insurers out of business," reducing choices for consumers.
To compete, private insurance companies would be forced to change the way they do business. They would have to end all of those practices that American consumers have grown to hate, cut administrative costs - maybe even cut CEO pay. Of course since the CEO of Cigna makes $26 million -- 65 times the salary of the President of the United States -- he could afford several million dollars in belt-tightening.They could compete - but they would have to change the way they compete. That's what they are fighting tooth and nail to avoid - and that's also the whole point of health care reform: to change the incentives that determine how the players in the health insurance market do business day to day.
Friday, October 16, 2009
Sunday, October 4, 2009
Most of us have seen the poster.
Saturday, October 3, 2009
Say what you will about the Republicans, but they sure as hell know how to stay on message, irrespective of whether that message is quasi-rational or bordering on the maniacally insane. You see, West Virginia Senator Jay Rockefeller had a proposal this week that would've offered a fiscally responsible public option to compete with health insurance companies, which would inevitably temper their current stranglehold on the health care system.
Mr. Rockefeller said the Congressional Budget Office had estimated that a government insurance plan could slice $50 billion from the cost of Mr. Baucus's bill, originally put at $774 billion over 10 years......"The public plan will be optional, "Mr. Rockefeller insisted. "It will be voluntary. It will be affordable to people who are now helpless before their insurance companies."
Mr. Schumer said the public option would hold down costs because it would not have to generate profits, answer to shareholders or incur marketing expenses.
Locally dominant insurers often pay providers excessive reimbursement rates to discourage them from participating in rival insurance plans. That dissuades other insurers from entering the market, which, in turn, frees the leading insurer to raise its premiums to cover the inflated reimbursements."The only people who lose in that," Nichols says dryly, "are the patients."
But Senator Charles E. Grassley of Iowa, the senior Republican on the committee, said a government insurance plan would have inherent advantages over private insurers. "Government is not a fair competitor," Mr. Grassley said. "It's a predator." He predicted that "a government plan will ultimately force private insurers out of business," reducing choices for consumers.
Getting movement on a public option - or any other meaningful reform - will now require the support of one of the three Republicans in the group: Grassley (who has received $2,034,000 from the health sector), [Olympia] Snowe ($756,000) or [Mike] Enzi ($627,000).This is what the prospects for real health care reform come down to - whether one of three Republicans from tiny states with no major urban populations decides, out of the goodness of his or her cash-fattened heart, to forsake forever any contributions from the health-insurance industry.
Friday, October 2, 2009
In the age of the iPhone, Kindle and YouTube, the notion of the book is becoming increasingly elastic as publishers mash together text, video and Web features in a scramble to keep readers interested in an archaic form of entertainment.
On Thursday, for instance, Simon & Schuster, the publisher of Ernest Hemingway and Stephen King, is working with a multimedia partner to release four "vooks," which intersperse videos throughout electronic text that can be read - and viewed - online or an iPhone or iPod touch.
The debasement of the nation's speech is evident in virtually everything broadcast and podcast on radio, television, and the internet. In this true, all-encompassing public square, homogenized language and homogenized thought reinforce each other in circular fashion. As George Orwell noted in 1946, "A man may take a drink because he feels himself a failure, and then fail all the more completely because he drinks." It is rather the same thing that is happening to the English language. It becomes ugly and inaccurate because our thoughts are foolish, but the slovenliness of our language makes it easier for us to have foolish thoughts.
There is no question that these new media are going to be superb at engaging and interesting the reader.
Learning to read is an almost miraculous story filled with many developmental processes that come together to give the child entry into the teeming underlife of a word usable by the child. Socrates and the ancient Indian scholars feared that reading words, rather than hearing and speaking them, would prevent our ability to know their many layers of meaning, sound, function, and possibility. In fact, early reading exposes - during the moment of acquisition - how many of the multiple, older structures contribute to each layer as they come together to form the brain's new circuitry for reading.
The more a child is exposed to written words, the greater his or her implicit and explicit understanding of all language.
Can you any longer read Henry James or George Eliot? Do you have the patience?