Monday, July 6, 2009
Friday, June 26, 2009
Health care reform
If we are going to be deprived of a single payer health care system as most of the civilized world enjoys, we must at least have a public option to widen the range of our choices. President Obama said it well the other day: “If private insurers say that the marketplace provides the best quality health care, if they tell us that they are offering a good deal, then why is it that the government, which they say cannot run anything, suddenly is going to drive them out of business? That is not logical.”
If only he would not swerve from that line of thought.
The USA’s healthcare system (if you can call it that) is actually a patchwork of heterogeneous systems: First is Medicare, covering our elderly, and until the Bush administration started messing around with it, a model of efficient delivery of services to the population it serves, at a cost unrivaled by any privately run system, inspite of the large amount of fraud private initiative commits against it. Then there is the Government run health care system for Congress (House and Senate); none of these clients complains of its quality, and cost is not even a consideration here. There is also the huge Veteran’s administration running a good, if stodgy, health provision for its clients, and doing some cutting edge research in many medical fields.
These huge systems cover close to 50% of the US population, leaving the insurance companies sharking around to make a buck from the rest of us. The first disfunction of what they offer is the health care plans offered through employers. In a world of frequent and numerous layoffs, the churning of clients adds a large administrative cost to this model, on top of the officialdom required to verify customer eligibility to receive service. The underlying prevailing attitude is denial of service to as many people as possible in order to safeguard shareholder return.
The more insidious effect of employer-provided health care is, in my view, the competitive burden it imposes on manufacturing companies. It may very well be the main reason driving manufacturing, the making of stuff, from this country. Thurow, the MIT economist, said long ago that we would not be able to survive as an economic power of the first order if we were reduced to doing brain surgery on each other, instead of employing the variegated skills of our population in the most productive ways possible. The wage stagnation of the middle class in the USA over the last fifty years is the result of the exodus of manufacturing, and the decline of union power.
The Obama administration talks a good game along these lines, but it may very well be that a democratic system such as ours is unable to summon the political will to undertake a radical rethinking of the underlying economic realities. When Congress talks about the costs of reform, it tends not to look at the possible economies of a different system. Yes, I know, outlays are a certainty, and income tends to vanish into the mists of the future.
The insurance industry, meanwhile, lies and spouts platitudes to consumers warning of bureaucratic meddling in healthcare decisions, as if we did not have that in their normal course of business; of long waits for surgery, omitting the word “elective”; of lack of all the technical, cutting edge gadgets in a public healthcare system…..as if the proliferation of MIR machines and CAT scanners on every corner were any more efficient.
The populations of countries where the provision of health services is a right of the citizen administered by the government, such as most in Europe, are well served. The costs are one third to one half of the costs of healthcare provision in the USA. You can always find horror stories “pour épater le bourgeois” in any of those countries, but nobody is driven to bankruptcy by pending medical bills.
As educational reading I would recommend http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-the-cost-conundrum-redux.html, or the full article posted in my blog Listen-up www.midnightepiphanies.blogspot.com/
If only he would not swerve from that line of thought.
The USA’s healthcare system (if you can call it that) is actually a patchwork of heterogeneous systems: First is Medicare, covering our elderly, and until the Bush administration started messing around with it, a model of efficient delivery of services to the population it serves, at a cost unrivaled by any privately run system, inspite of the large amount of fraud private initiative commits against it. Then there is the Government run health care system for Congress (House and Senate); none of these clients complains of its quality, and cost is not even a consideration here. There is also the huge Veteran’s administration running a good, if stodgy, health provision for its clients, and doing some cutting edge research in many medical fields.
These huge systems cover close to 50% of the US population, leaving the insurance companies sharking around to make a buck from the rest of us. The first disfunction of what they offer is the health care plans offered through employers. In a world of frequent and numerous layoffs, the churning of clients adds a large administrative cost to this model, on top of the officialdom required to verify customer eligibility to receive service. The underlying prevailing attitude is denial of service to as many people as possible in order to safeguard shareholder return.
The more insidious effect of employer-provided health care is, in my view, the competitive burden it imposes on manufacturing companies. It may very well be the main reason driving manufacturing, the making of stuff, from this country. Thurow, the MIT economist, said long ago that we would not be able to survive as an economic power of the first order if we were reduced to doing brain surgery on each other, instead of employing the variegated skills of our population in the most productive ways possible. The wage stagnation of the middle class in the USA over the last fifty years is the result of the exodus of manufacturing, and the decline of union power.
The Obama administration talks a good game along these lines, but it may very well be that a democratic system such as ours is unable to summon the political will to undertake a radical rethinking of the underlying economic realities. When Congress talks about the costs of reform, it tends not to look at the possible economies of a different system. Yes, I know, outlays are a certainty, and income tends to vanish into the mists of the future.
The insurance industry, meanwhile, lies and spouts platitudes to consumers warning of bureaucratic meddling in healthcare decisions, as if we did not have that in their normal course of business; of long waits for surgery, omitting the word “elective”; of lack of all the technical, cutting edge gadgets in a public healthcare system…..as if the proliferation of MIR machines and CAT scanners on every corner were any more efficient.
The populations of countries where the provision of health services is a right of the citizen administered by the government, such as most in Europe, are well served. The costs are one third to one half of the costs of healthcare provision in the USA. You can always find horror stories “pour épater le bourgeois” in any of those countries, but nobody is driven to bankruptcy by pending medical bills.
As educational reading I would recommend http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-the-cost-conundrum-redux.html, or the full article posted in my blog Listen-up www.midnightepiphanies.blogspot.com/
Wednesday, June 17, 2009
Equal law for all
We talk a lot, and always about the same stuff. So a couple of days ago, in the Library Community Room, The Saratoga Citizen retreaded the road to change towards a different kind of City Government.
Saratoga Springs, for those who have lived on Mars for the last generation, adopted way back when a form of civic organization that embodies two functions into its elected officials: they are supposed both to manage and to legislate. A Board of five people handles the functions that are considered essential to the good administration of the “res publica”, the matters of the public: Finance (tax collection, bookkeeping, and budgets), Public Works (everything from snow removal to road maintenance), Public Safety (keeping the populace in line and providing fire protection), and Accounts (mostly assessing the taxes on the stock of houses within the city boundaries and city clerk duties). Then, of course, there is the Mayor, to head up City planning, human resources, legal matters, and, of course, cut ribbons..
These five people are supposed to be part-timers, and are paid as such (today they receive the princely sum of $14,000 per year, $7.00 an hour, calculated on 2,000 hours per year). Each is supposed to administer her/his area of responsibility, and also establish the rules by which this administration runs: they are both administrators and legislators.
Therefore we have five co-equal votes on the City Council. It is customary to keep any deliberative body to an uneven number of votes, to prevent ties.
I am no expert on Municipal administration, and I have not memorized the City Charter, but a few problems jump out of this arrangement:
1- Each ship on its own bottom, as they like to say at Harvard, means that each department determines the level of employment and of expenditures, and then sets out to fight for the share of funds available according to its own lights and goals. There is no unified fiscal authority that establishes overall priorities, and/or oversees the administration of funds. By definition this hampers long-term planning and sets up a scenario similar to a food fight in the school cafeteria.
2- Each commissioner will be under the temptation to propose municipal legislation that furthers his/her pet projects, regardless of the broader interests of the community. Personal rivalries between the Commissioners tend to result in stalemates, inaction, or, worse, shouting matches.
3- Democracy is not served, despite loud protestations by the Commissioners: “Any taxpayer (they say) can pick up the phone and talk to me about his/her concerns. No need of procedures or intermediaries.” But what happens when the citizen steps into one of those food-fights, or the Commissioner, for whatever reason, dislikes the caller? There is no recourse, no legal procedure short of suing the City, for getting redress. The principle of equal law for all is denied.
When we talk of open, transparent government we are not talking of a theoretical construct to run up the mast, admire and forget. Each citizen is entitled to know where to address his wishes or complaints, to be assured that his words, petitions and actions will be subject to the same constraints and administrative steps as everybody else’s. And to know that his suit will be in full view at all times, at every turn. Above all the reasons for the denial of his aspirations will be clear, pre-established and uniformly applied, ensuring the orderly transformation of the particular aspiration into the common good.
No rule of law is possible without the consent, or at least acquiescence, of the governed. Only transparency will ensure respect of the laws that we are expected to obey every day of our lives.
Saratoga Springs, for those who have lived on Mars for the last generation, adopted way back when a form of civic organization that embodies two functions into its elected officials: they are supposed both to manage and to legislate. A Board of five people handles the functions that are considered essential to the good administration of the “res publica”, the matters of the public: Finance (tax collection, bookkeeping, and budgets), Public Works (everything from snow removal to road maintenance), Public Safety (keeping the populace in line and providing fire protection), and Accounts (mostly assessing the taxes on the stock of houses within the city boundaries and city clerk duties). Then, of course, there is the Mayor, to head up City planning, human resources, legal matters, and, of course, cut ribbons..
These five people are supposed to be part-timers, and are paid as such (today they receive the princely sum of $14,000 per year, $7.00 an hour, calculated on 2,000 hours per year). Each is supposed to administer her/his area of responsibility, and also establish the rules by which this administration runs: they are both administrators and legislators.
Therefore we have five co-equal votes on the City Council. It is customary to keep any deliberative body to an uneven number of votes, to prevent ties.
I am no expert on Municipal administration, and I have not memorized the City Charter, but a few problems jump out of this arrangement:
1- Each ship on its own bottom, as they like to say at Harvard, means that each department determines the level of employment and of expenditures, and then sets out to fight for the share of funds available according to its own lights and goals. There is no unified fiscal authority that establishes overall priorities, and/or oversees the administration of funds. By definition this hampers long-term planning and sets up a scenario similar to a food fight in the school cafeteria.
2- Each commissioner will be under the temptation to propose municipal legislation that furthers his/her pet projects, regardless of the broader interests of the community. Personal rivalries between the Commissioners tend to result in stalemates, inaction, or, worse, shouting matches.
3- Democracy is not served, despite loud protestations by the Commissioners: “Any taxpayer (they say) can pick up the phone and talk to me about his/her concerns. No need of procedures or intermediaries.” But what happens when the citizen steps into one of those food-fights, or the Commissioner, for whatever reason, dislikes the caller? There is no recourse, no legal procedure short of suing the City, for getting redress. The principle of equal law for all is denied.
When we talk of open, transparent government we are not talking of a theoretical construct to run up the mast, admire and forget. Each citizen is entitled to know where to address his wishes or complaints, to be assured that his words, petitions and actions will be subject to the same constraints and administrative steps as everybody else’s. And to know that his suit will be in full view at all times, at every turn. Above all the reasons for the denial of his aspirations will be clear, pre-established and uniformly applied, ensuring the orderly transformation of the particular aspiration into the common good.
No rule of law is possible without the consent, or at least acquiescence, of the governed. Only transparency will ensure respect of the laws that we are expected to obey every day of our lives.
Tuesday, June 9, 2009
Monday, June 1, 2009
Hudson River Clean-up: Sludge going to Texas
The PCB laced sludge from the upper Hudson River clean-up is going all the way to Texas, five mills across the border from eunice, New Mexico.
According to the NYT, "The landfill... belongs to Harold C. Simmons, a Dallas billionaire who was a large campaign contributor to former President George W. Bush and Gov. Rick Perry. (He also helped finance the Swift Boat Veterans for Truth campaign against Senator John Kerry in the 2004 presidential race and the advertisements linking President Obama to William Ayers in 2008.)
Not only has Mr. Simmons’s company, Waste Control Specialists, landed a lucrative contract to take the Hudson River sludge to Texas, but this spring it won a permit from the state to store low-level radioactive waste as well. Read more.
Kathryn H. Starbuck Awards 2009
Saratogian (June 1, 2009): Within the fields of education, politics and technology, three local residents have left an indelible mark on the city through their community service contributions.
Laura Chodos, Elliott Masie and Shawn C. Thompson were honored Sunday with the Kathryn H. Starbuck Lifetime Achievement Award, sponsored by the Saratoga Springs Democratic Committee. Read more.
Laura Chodos, Elliott Masie and Shawn C. Thompson were honored Sunday with the Kathryn H. Starbuck Lifetime Achievement Award, sponsored by the Saratoga Springs Democratic Committee. Read more.
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