Every wealthy country other than the United States guarantees essential care to all its citizens. There are, however, wide variations in the specifics, with three main approaches taken.
In Britain, the government itself runs the hospitals and employs the doctors. We’ve all heard scare stories about how that works in practice; these stories are false. Like every system, the National Health Service has problems, but over all it appears to provide quite good care while spending only about 40 percent as much per person as we do. By the way, our own Veterans Health Administration, which is run somewhat like the British health service, also manages to combine quality care with low costs.
The second route to universal coverage leaves the actual delivery of health care in private hands, but the government pays most of the bills. That’s how Canada and, in a more complex fashion, France do it. It’s also a system familiar to most Americans, since even those of us not yet on Medicare have parents and relatives who are.
Again, you hear a lot of horror stories about such systems, most of them false. French health care is excellent. Canadians with chronic conditions are more satisfied with their system than their U.S. counterparts. And Medicare is highly popular, as evidenced by the tendency of town-hall protesters to demand that the government keep its hands off the program.
Finally, the third route to universal coverage relies on private insurance companies, using a combination of regulation and subsidies to ensure that everyone is covered. Switzerland offers the clearest example: everyone is required to buy insurance, insurers can’t discriminate based on medical history or pre-existing conditions, and lower-income citizens get government help in paying for their policies.
In this country, the Massachusetts health reform more or less follows the Swiss model; costs are running higher than expected, but the reform has greatly reduced the number of uninsured. And the most common form of health insurance in America, employment-based coverage, actually has some “Swiss” aspects: to avoid making benefits taxable, employers have to follow rules that effectively rule out discrimination based on medical history and subsidize care for lower-wage workers.
So where does Obamacare fit into all this? Basically, it’s a plan to Swissify America, using regulation and subsidies to ensure universal coverage.
Monday, August 17, 2009
Swiss healthcare in the US
Saturday, May 23, 2009
Chicago at the forefront of environmental design
As part of an effort to stimulate sustainable and equitable economic development in one of the more socioeconomically distressed areas of the region, the City of Chicago is sponsoring one of the largest sustainable neighborhood revitalization developments in the country. Consisting of 1,140 acres in the South Chicago neighborhood, the Leadership for Energy and Environmental Design for Neighborhood Development (LEED ND) plan will serve as a guide to the city for sustainable redevelopment on the south side for the next 25 years.
Currently responsible for the redevelopment plan is City Planner Marilyn Engwall, who has been a part of the effort for nearly a decade. Engwell stresses the comprehensive nature of the redevelopment and the necessity to engage in sustainable community building. “This is a plan—a long range plan—and not a project,” she stated, adding, “This is an area that definitely needs development.”
Developed by the U. S. Green Building Council, LEED ND projects take the building standards of LEED and many of the hallmarks of new urbanism, and apply them to an entire area. In addition to requiring new homes in the South Chicago LEED ND to be certified as LEED Silver or better, the initiative incorporates LEED ND standards of easy access to transit, close walking distance to schools and parks, and the remediation of environmentally unsuitable sites. Plans exist for the integration of the three existing Metra stops in the neighborhood with an elaborate transit network reliant on the streetcar—a system that has already gained some traction and financing among local merchants. Whether this part of the plan will happen will take years to determine.
Thursday, May 21, 2009
FT's take on Obama's car efficiency plan
Although a tax of $1 or $2 per gallon of petrol would be more effective in altering consumer behaviour and giving a clear demand signal to manufacturers to produce more fuel-efficient vehicles, it would not get through Congress.But it is an inefficient – and probably ineffective – way of meeting the twin aims Mr Obama has set out for the motor industry and the US carmakers: to curb fuel consumption and dependence on foreign oil and to help the Detroit three “once more outcompete the world”.
The corporate average fuel economy (CAFE) rules that Mr Obama wants to tighten have a history of causing unintended consequences. They were passed in 1975, following the oil crisis, to get drivers to buy smaller and more efficient cars, but instead gave Detroit an incentive to make sports utility vehicles.
The basic problem with the CAFE standards is that, rather than altering patterns of demand, they attempt to ration supply. This flaw is exacerbated by the divide in the rules between standards for “cars” and for “light trucks”, which Detroit has ingeniously exploited.
By the 1980s, petrol was cheap again and drivers did not want to buy the lighter, less powerful cars that were fuel-efficient. Instead, they switched en masse to people carriers and SUVs that were classified as light trucks, and so could be thirstier...
A petrol tax is a rare example of a policy that would be simple, let the market operate, and be likely to achieve Mr Obama’s aims. “This is a noble long-term goal, but a gas tax is an immediate incentive to change,” says David Gerard, an economist at Carnegie Mellon university.
Unfortunately, raising the federal petrol tax, which is currently 18 cents per gallon, to levels that would make it bite is not politically achievable in the US. Instead, the president has had to rally everyone around a clunky and leaky regulatory alternative. That really is extraordinary. [FT]
Saturday, April 4, 2009
Difficult Census
The quality of the US census may be undermined because of rising numbers of people living in garages, tents, basements and motels as the financial crisis deepens, key organisations working with the Census Bureau have warned.[FT]Because the census is used to distribute both representation and federal funding, the under-counting of those most in need could seriously impact the ability to help people who have fallen off the radar screen. Apparently, the stimulus bill does increase funding for the more difficult counting that goes beyond the form sent through the mail.
Tuesday, August 5, 2008
Obama's Energy Plan
- There are ample federal lands where oil companies already have concessions and are doing nothing with them
- We only have so much wilderness - leave it alone!
- We should be spending that money, yes THAT MUCH money, on conservation technologies and alternative energy technology
Monday, June 23, 2008
Friedman on Energy
Now, just as he's preparing to leave office, he's trying to give his oil buddies two last gifts: he wants congress to allow drilling off-shore and in the Arctic National Wildlife Refuge, which will do nothing to bring down oil prices before 2030, and he wants the Saudis to give us more oil in the short term to lower prices, increasing our dependence on foreign oil, which would help to kill alternative energy development at home.
Bush has never had an energy policy, except for the completely shady one drawn up behind closed doors with no names attached, early in his first term. Once again, no leadership, just crony-ism.
Monday, May 5, 2008
Lifting an 18 cent tax for 3 months is an Energy Policy?
I wish I'd written this article. It pretty much says what I was thinking. When Obama was getting pressure to also lift the gas tax for the summer, he made the point that this would save the average person $30, and take away valuable funding for transportation infrastructure.
It is great to see that we Americans finally have some national unity on energy policy. Unfortunately, the unifying idea is so ridiculous, so unworthy of the people aspiring to lead the United States, it takes your breath away.
Hillary Clinton has decided to line up with John McCain in pushing to suspend the federal excise tax on gasoline, 18.4 cents a gallon, for this summer's travel season. This is not an energy policy. This is money laundering: We Americans borrow money from China and ship it to Saudi Arabia and take a little cut for ourselves as it goes through our gas tanks. What a way to build the country.
When the summer is over, we will have increased our debt to China, increased our transfer of wealth to Saudi Arabia and increased our contribution to global warming for our kids to inherit.
No, no, no, we'll just get the money by taxing Big Oil, says Clinton. Even if you could do that, what a terrible way to spend precious tax dollars - burning it up on the way to the beach rather than on innovation?
The McCain-Clinton gas holiday proposal is a perfect example of what energy expert Peter Schwartz of Global Business Network describes as the true American energy policy today: "Maximize demand, minimize supply and buy the rest from the people who hate us the most."
Good for Barack Obama for resisting this shameful pandering.
But here's what's scary: America's problem is so much worse than you think. We have no energy strategy. If you are going to use tax policy to shape energy strategy then you would want to raise taxes on the things you want to discourage - gasoline consumption and gas-guzzling cars - and you would want to lower taxes on the things you want to encourage - new, renewable energy technologies. We are doing just the opposite.
Are you sitting down?
Few people know it, but for almost a year now, Congress has been bickering over whether and how to renew the investment tax credit to stimulate investment in solar energy and the production tax credit to encourage investment in wind energy. The bickering has been so poisonous that when Congress passed the 2007 energy bill last December, it failed to extend any stimulus for wind and solar energy production. Oil and gas kept all their credits, but those for wind and solar have been left to expire this December. I am not making this up.
At a time when we should be throwing everything into clean power innovation, we are squabbling over pennies.
These credits are critical because they ensure that if oil prices slip back down again - which often happens - investments in wind and solar would still be profitable. That's how you launch a new energy technology and help it achieve scale, so it can compete without subsidies.
The Democrats wanted the wind and solar credits to be paid for by taking away tax credits from the oil industry. President George W. Bush said he would veto that. Neither side would back down, and Bush - showing not one iota of leadership - refused to get all the adults together in a room and work out a compromise. Stalemate. Meanwhile, Germany has a 20-year solar incentive program; Japan 12 years. Ours, at best, run two years.
"It's a disaster," says Michael Polsky, founder of Invenergy, one of the biggest wind-power developers in America. "Wind is a very capital-intensive industry, and financial institutions are not ready to take 'congressional risk.' They say if you don't get the [production tax credit] we will not lend you the money to buy more turbines and build projects."
It is also alarming, says Rhone Resch, the president of the Solar Energy Industries Association, that the U.S. has reached a point "where the priorities of Congress could become so distorted by politics" that it would turn its back on the next great global industry - clean power - "but that's exactly what is happening." If the wind and solar credits expire, said Resch, the impact in just 2009 would be more than 100,000 jobs either lost or not created in these industries, and $20-billion worth of investments that won't be made.
While all the presidential candidates were railing about lost manufacturing jobs in Ohio, no one noticed that America's premier solar company, First Solar, from Toledo, Ohio, was opening its newest factory in the former East Germany - 540 high-paying engineering jobs - because Germany has created a booming solar market and America has not.
In 1997, said Resch, America was the leader in solar energy technology, with 40 percent of global solar production. "Last year, we were less than 8 percent, and even most of that was manufacturing for overseas markets."
The McCain-Clinton proposal is a reminder to me that the biggest energy crisis we have in our country today is the energy to be serious - the energy to do big things in a sustained, focused and intelligent way. We are in the midst of a national political brownout.