more on proportional representation

Friday 14 May 2010

So the recent British election has been a great time for me (and you, the reader) to look at think about the way democracy works here in the U.S. and possibilities for change to make the system work better.  On Monday I wrote a post called “what does it mean to be a democracy?” where I talked about two changes I saw as being beneficial, namely preferential voting and proportional representational.

The recent House of Commons elections in Britain yielded no party with a majority of seats/representatives, and thus a coalition had to be formed to create a parliament and thus bring a new prime minister.  The Conservatives elected the MPs (members of parliament), with Labour not too far behind and the Liberal Democrats the “spoilers” with a respectable third place showing — and thus the party of import for the aforementioned coalition.  Thus, both top parties courted the LDs, and ultimately a Conservative/Liberal Democrat coalition was formed (and the bedfellows are just as odd as their names suggest).

Part of what the Liberal Democrats demanded in the final coalition agreement was a referendum to see if the public would desire a voting system similar to the kinds I was proposing (which would almost definitely benefit the numbers of Liberal Democrats in parliament).  Thus, some further good information about proportional representation has become available this week I wanted to share.

First, here is an great display of different voting systems and how they can skew the representation for particular parties.  The current U.S. system obvious benefits the main two parties, as it similarly does in the U.K., and thus why it takes the third party getting involved to make any change happen.  Voting Reform: what are the options?

Also, in the mid-80s, John Cleese of Monty Python fame did an interesting 10 minute spot on the benefits of proportional representation, and it can be found embedded here: Clegg’s Prize May Be New Voting System

A few notes: first, the sizes of population and parliament in the U.K. and U.S. must be noted.

Total population # in Lower Legislature House
U.K. 62 million 650 (House of Commons)
U.S. 309 million 435 (House of Representatives)

You’ll notice that the U.K. has a much smaller population, but over 200 more representatives.  Thus, each district in the U.K. has about 95,500 people per rep, while the U.S. has a staggering 711,000 people per district — over 7 times the number of the U.K.!  Thus, for equal proportion, the U.S. would need about 3240 members in the House of Representatives!  — Obviously our districts have gotten too big, and proportional representation would better represent the views of the electorate without growing the size of our legislature.

Comments to my last blog (by my brother!) mentioned the need for regional representation, and I think distributing House seats to states based on their size, and then having proportional representation in those states would be the best way for this to happen.  And as far as I can tell, each state is on their own in determining how their state representatives are allotted, so states could make these changes individually.  And I’m sure in larger states, you’d get people from different areas in those states running, and thus still have even more locally diverse representation.

another health care post

Sunday 11 April 2010

I started reading T.R. Reid’s book “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care” this week, which I picked up at the library after talking about it in a past post, so I hope to write more on that later.  So far, it’s a pretty easy read, not too dense or technical but contains a lot of readable information (which should be true for a good journalist’s writing), so I still recommend it.

What starting that book has helped me realize is that what I care most about is health care being universal for all people.  There are many countries doing it in many different ways, but they cover everyone with some kind of basic care that allows people not to have to worry about general health care costs ruining their life.  You would think people could get behind that much and then it just be the “devil in the details,” but I still wonder if everyone believes health care coverage is a right and not a privilege.  Perhaps that’s the debate we need to be having now that a bill has been passed — winning the hearts and minds of people regarding the issue about universal health care so we can be better able to make more changes that will (almost assuredly) need to happen.

I read two articles this week that I wanted to share in relation to health care.  The first article is simply Governor Mitt Romney on Health Care, regarding his take on the health care bill and how it relates to what was passed in his state of Massachusetts, a bill he backed.  His big beef, at least how he wants to portray it, is that he thinks health care is a state issue and should be treated that way as opposed to a national mandate to carry coverage.  However, because there is so much mobility of people within the U.S., and because you’re a citizen not of a state (only a resident there), I have to disagree and say this is rather a national issue.  If the U.S. were more akin to the E.U., then maybe I could get behind that argument, but from what I can tell, all I needed was transportation to move from Ohio to Illinois to Wisconsin (and on and on, like I have), whereas  trying this from Germany to Italy to Spain, etc., would take visa upon visa upon visa, and simply living in Germany wouldn’t get me free health care any more than me showing up in Boston tomorrow would get me free health care there.  The U.S. is one country (for the foreseeable future), and health care needs to be looked at in that way.

The second article that sparked my interest was another in the NY Times “Room for Debate” series, titled “Stupak’s Abortion Deal and His Exit.”  It gives an interesting debate on how abortion policy and positions affect politics.  I’ve always been the kind of person who felt like not much would change in the political spectrum because of the views of whatever politician I was electing, so I never really even take their views on the topic into consideration.  However, many people do, and many people will not vote for someone who does not hold convictions regarding abortion they can support.  If you believe that laws banning abortion will end abortions, you need to watch Vera Drake or 4 Months, 3 Weeks, and 2 Days (or both), movies about those who have and carry out illegal abortions in various societies and time periods (1950s Britain and 1980s Romania, in particular).

Having never been a situation where I had to think about whether or not to have an abortion, I  find it very hard to think about what I might do if put in a situation where abortion might be seen by some as the best option.  And because I’m not really one to tell others what to do, I don’t want to say what is or isn’t the right decision in such situations.  I think if it came right down to it, I don’t think I could go through with an abortion, but instead of forcing others to do that themselves by law, I think we need to discuss the issue in a way that helps people first avoid as much as possible putting oneself in a situation to make that decision, and also to help people realize there are other options beyond abortion.  Perhaps that puts me in the middle ground that the article notes may be fading, but I think that instead of moving toward the edges, we all really need to be finding ways to grow closer together.

health care reform bill: day 5

Friday 2 April 2010

I’ve had some great comments about my series this week on the health care reform bill (though not directly to the blog), so I hope you, too, have enjoyed it.  In case you missed any of my previous day’s topics, here’s the recap:

Day 1 featured my main thoughts on the new health care reform bill. (If you haven’t read it yet, it’s the place to start.)
Day 2 contained multiple views and comments on the health care bill via a link to a NY Times article.
Day 3 contained links to Democracy Now! clips relating to the continuation of the for-profit system and palliative care.
Day 4 featured more of my comments in relation to the cost of health care mixed in with articles and other comments on the same topic.

I want to close out this week thinking about the ethics and morality of the United States’ health care system, especially in lieu of what goes on in other “wealthy” countries around the world.

This week I was keyed into a man named T.R. Reid.  In his article for the Washington Post, 5 Myths About Health Care Around the World, he starts out this way:

“As Americans search for the cure to what ails our health-care system, we’ve overlooked an invaluable source of ideas and solutions: the rest of the world. All the other industrialized democracies have faced problems like ours, yet they’ve found ways to cover everybody — and still spend far less than we do.

“I’ve traveled the world from Oslo to Osaka to see how other developed democracies provide health care. Instead of dismissing these models as “socialist,” we could adapt their solutions to fix our problems. To do that, we first have to dispel a few myths about health care abroad:”

He goes on to share some very interesting facts (see below).

Many other countries provide health care to everyone, though the way it is structured and paid for in each country is a little bit different.  Mr. Reid‘s article debunks some of the myths, as he did in an interview for the program Inter Compass (click and scroll down to episode #1011, Healthcare Around the World, to watch or listen) where he explained things a bit more.  He spoke about the ethics of health care, how the systems in other countries differ from that of the U.S., and many other issues I touched on in my first post.  But there was one exchange that I think is so poignant and powerful that I’ve transcribed it here to make sure you hear it (the total interview is 30 minutes, and this quote comes just at the 20 minute mark)(Thanks to Karen Saupe for sharing this):

Host, Shirley Hoogstra: Well, there’s something [referring to a previous statement] that goes against the grain of the American individualism with that, right: this idea that in Canada, well as long as the rich Canadian has to wait as long as the poor Canadian has to wait…

T.R. Reid: They’re into that, yeah.

SH: Yeah, you know, and I think in America, it’s sort of like, “Look: if I’ve earned it, if I’ve got my own wealth, I want to be able to get to the head of the line, I want to be able to buy what I want.  So would that kind’ve have to change? Would that mentality of, you know, “Look I’ve done it, I get it?”

TRR: Well, there are a lot of commodities where we say, “If you’ve worked hard and have the money or inherited the money, you get it.”  The question is whether health care is that kind of commodity, and the economist term for this is the distributional ethic.  What’s your ethic for distributing goods?  Well, we have a distributional ethic for votes: everybody get’s one.

SH: Right.

TRR: Bill Gates gets one, his chauffeur gets one.  Right? Uh, we have a different distributional ethic for yachts.

SH: That’s true.

TRR: If you have money, you can have ten of ’em; if you don’t have money, tough, and we don’t mind that. So here’s the question: do you think health care is more like voting or is it more like yachting.  Well, what I found in my book is all the other countries have said, “No, this is, this is like voting. This is like education.  This is like equal treatment.  Everybody should have the same.” But the U.S. hasn’t made that commitment.

Isn’t it time the U.S. made that commitment?  Should health care be more like education, where the U.S. provides a basic service to all people, or do we want to keep our current system where only those with certain money or connections obtain basic, life-giving health care?  This reform bill claims to accord everyone care while still letting people make money from it, but I think we’re going to see that you can’t do both, and then we’ll have to choose how we want to more forward.

As Mr. Reid notes in his interview, universal health care — which comes in many shapes and forms around the world — would take a massive overhaul of the system, not just attempts to tweak the system that this health care bill tries to accomplish meaningful change with.  Perhaps this is a good first step, but hopefully more and more people will begin to recognize the moral imperative of universal health care and call for a system that no longer discriminates and kills in the way our current system does.  I encourage you to be someone who does just that.

(Reid also has a book, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, which I think I’m going to look for myself.)

Some of the more interesting facts I found in Reid’s column:

As for those notorious waiting lists, some countries are indeed plagued by them. Canada makes patients wait weeks or months for nonemergency care, as a way to keep costs down. But studies by the Commonwealth Fund and others report that many nations — Germany, Britain, Austria — outperform the United States on measures such as waiting times for appointments and for elective surgeries.  In Japan, waiting times are so short that most patients don’t bother to make an appointment.

U.S. health insurance companies have the highest administrative costs in the world; they spend roughly 20 cents of every dollar for nonmedical costs, such as paperwork, reviewing claims and marketing. France’s health insurance industry, in contrast, covers everybody and spends about 4 percent on administration. Canada’s universal insurance system, run by government bureaucrats, spends 6 percent on administration. In Taiwan, a leaner version of the Canadian model has administrative costs of 1.5 percent; one year, this figure ballooned to 2 percent, and the opposition parties savaged the government for wasting money.
The world champion at controlling medical costs is Japan, even though its aging population is a profligate consumer of medical care. On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3,400 per person annually on health care; the United States spends more than $7,000.

Overseas, strict cost controls actually drive innovation. In the United States, an MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98. Under the pressure of cost controls, Japanese researchers found ways to perform the same diagnostic technique for one-fifteenth the American price. (And Japanese labs still make a profit.)

The key difference is that foreign health insurance plans exist only to pay people’s medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage.

health care reform bill: day 4

Thursday 1 April 2010

So here we are Day 4 of my week-long focus on the health care reform bill.

On Day 1, I shared with you my thoughts on the new health care reform bill (I’ve heard people say they liked this, but no comments on the blog — I love it when you comment on the blog!)  If you haven’t read it yet, it’s the place to start.
Day 2 contained multiple takes on the health care bill from prominent politicians and such, via a link to a NY Times article.
Yesterday (Day 3) contained links relating to the continuation of the for-profit system and on palliative care.

Today, I wanted touch on the headlines discussing the cost of health care in general, taking special note of the recent headlines related to new costs for businesses.

First, a New York Times article from January, written by David M. Herszenhorn and titled “Why Does Health Care Cost So Much?” (a great article on health costs in itself) started this way:

“People like to live too much.

“This is my favorite, only half-kidding, response when people ask why health care in America is so expensive.”

As I talked about in my original entry, as medical procedures become more advanced, they’re going to cost more overall, especially if we believe we can give everything to everyone.  Without some kind of rationing, costs will continue to skyrocket.  And it must be noted, too, that whatever care is given, someone has to pay for — be it insurance companies, the patient, employers, the providrs, or the government (and probably others).  The question we then need to ask is, “Who’s going to pay?”

As the bill rolled out, we heard news of companies taking financial hits because of new tax structures in the bill:
ObamaCare Day One
(Wall Street Journal)
AT&T Plans $1 Billion Charge For Health Care
(Huffington Post)
Healthcare Reform will “cost” AT&T and friends WHUT? A Liberal vs. Conservative Debate (Really!) (contains quotes from the articles Companies Push to Repeal Provision of Health Law (NY Times) and Henry Waxman’s War on Accounting (The Atlantic))

But there are other voices, too:
Ben Arnon: On Measuring the Cost of Health Care Reform (The Huffington Post)

“So how do we measure the cost of health care reform? The cost of health care reform cannot be measured solely based on absolute monetary cost. Opportunity cost must be factored into the equation. The opportunity cost of remaining with the status quo and avoiding health care reform involved significant costs both in terms of monetary value as well as emotional costs that tear at the human psyche and that ultimately affect macroeconomic factors such as overall work output and productivity.”

Healthcare costs burden more Americans: study (Reuters)

“The percentage of Americans with a “high financial burden for healthcare” rose to 19 percent in 2006 from 14 percent in 2001, according to the Washington-based Center for Studying Health System Change.

“The think tank defines a high out-of-pocket burden for healthcare as spending more than 10 percent of before-tax income on insurance premiums and medical care.”

Ezra Klein: The five most promising cost controls in the health-care bill (The Washington Post – read for more details)

(1) Create a competitive insurance market
(2) The Medicare Commission
(3) A tax on “Cadillac plans”
(4) Medicare “bundling” programs
(5) Changing the politics of reform

So we come back to the question again, “Who’s going to pay?”  As I stated on Day 1, I believe we all need to take care of each other.  I don’t believe there should be profiteering on people’s health, or lack thereof, but the current health care reform bill continues the for-profit system.  How much individuals vs. corporations are left on the hook might be an interesting topic, but that just would end with everyone crying, “Not Me!”  (And we already know insurance companies have been known to find ways to drop coverage to avoid paying for medical costs when people get sick.)

So “Who’s going to pay?” Let’s agree that we all need to take care of each other and thatwe can share the costs of our another’s health based on our economic abilities.  Who’s in?

health care reform bill: day 3

Wednesday 31 March 2010

Day 1’s post contained a lot of my thoughts on the new health care reform bill.
Day 2, I  linked to a NY Times article with multiple reactions from prominent politicians, historians, and others.

Here on day 3, I wanted to share some videos taken from a radio (and TV some places) program called Democracy Now! that I’ve connected with at different times.  It’s decidedly “progressive,” to be sure, but so is my position, so it works well c:  In addition to the effect of the bill in general, they particularly touch on my comment about the bill “further entrenching the for-profit healthcare system that rations care based on wealth,” as well as how we relate and care for those nearing death or with terminal illnesses.

The links contain video clips along with transcripts of the videos (faster to digest, but you have to read them), so feel free to pick and choose.

Tuesday, 23 March: Michael Moore: Healthcare Bill “A Victory for Capitalism” (27 minute video/audio)

Wednesday, 24 March: Palliative Care Pioneer Dr. Diane Meier on How People Struggle with Serious, Sometimes Terminal, Illness (19 minute video/audio)

Monday, 22 March: In Historic Vote, House Approves Landmark Healthcare Reform Bill (15 minute video/audio)

Friday, 26 March: Congress OKs Final Changes to Healthcare Overhaul (9 minute video/audio)

And from before the bill actually passed, Thursday, 18 March: Dennis Kucinich and Ralph Nader: A Discussion on Healthcare, Politics and Reform (complete video/audio 50 minutes, but Healthcare discussion only about half of that)

health care reform bill: day 2

Tuesday 30 March 2010

So if you haven’t yet read my take on the new health care reform bill, please click and do that now.  Otherwise, thus continues a week of blogs devoted to the health care reform bill.

Here is a collection of thoughts and comments by many notable thinkers the NY Times posted last week: A Historic Moment for Health Care?

Those featured:

the health care reform bill: a week later

Sunday 28 March 2010

One week ago, the House of Representatives approved a health care/insurance reform bill that had been passed last November by the Senate.  Since then, President Obama has signed that bill into law, issued an executive order related to abortions and government spending, and a bill to make some “fixes” to the original has passed both houses of Congress.  With all that, the topic of the past year or more, health care reform, has been adopted.

Since then, I’m sure you’ve been able to read, listen to, and watch a lot of coverage on this topic (not to mention all of the coverage that happened the months leading up to this).  You’ve likely heard complaints of those who seeks its repeal, those who are pretty happy with the results, and those who don’t think it went far enough — and any combination of those views.

In my writing on this blog, I try to be pretty balanced and pragmatic, and I hope I will hold true to that even today.  However, I also want to share with you my personal thoughts on the topic as best I can in a succinct way.  I don’t claim to know all the ins and outs of the bills passed, and I’ll probably not touch on all the topics you might be interested in.  However, I invite you to leave comments, short and long, and if you’d be interested in writing a guest blog this week, please let me know and we can be in touch.

So let’s get on with it.

From what I can tell, I first have to say that the changes that were passed are better than nothing.  If this bill will truly allow 30 million more people to receive health insurance, then it’s a step in the right direction.  However, by my calculations, that apparently still leaves about 15 million people without insurance, so obviously it didn’t go far enough.  And we’ve often heard that the goal of controlling costs only works when everyone is covered, so what’s the deal there.

That being said, another issue I have with the bill is that, using a phrase I’ve also heard a bit this week, it “further entrenches the state of a for-profit private insurance industry.”  As someone who ultimately believes in universal health care provided by tax dollars, continuing on with privatized insurance companies that seek to make money off of people receiving (or not receiving) health care is a sham.  Obviously to continue on making money, insurance companies are going to pass their rising costs of coverage on to customers in the form of higher premiums and co-pays, and with no public option that is not-for-profit (they left that out, you know), what is there to truly control rising costs?  I’d really love an answer, because I don’t have one.

I personally can’t get behind a system where people are making money from health-related issues, which is why I totally disagree with the for-profit model.  I think health care is a basic right that we as a society need to get behind.  This structure and system seems unlikely to give universal coverage while keeping costs down — though I hope it will — so unless the plan is to show that the private, for-profit system doesn’t work and we truly need a nationalized system, I’m worried this will simply be an experiment costing thousands of lives in the process.

Some other generalized concerns I’ve been thinking about, in no particular order:

I heard this week that Switzerland has a highly regulated, privately run and universal health care system where profits are capped and the government doesn’t run the system directly but holds extremely powerful oversight abilities.  If we’re so worried about government f-ing things up and straying from our capitalist roots, perhaps this would be a compromise?

We must recognize the interconnectedness of health and other aspects of our lives, such as the food we eat and the lives we lead.  If we had a system where we all were in the same pool, then ultimately those with healthy habits would be subsidizing those with unhealthy habits (smoking/over drinking/poor diet/no exercise/etc.).  How do we change the fabric of society to deal with all these issues?

Our food system is built most calories for your $ is unhealthy foods that lead to diabetes and other such diseases, so changes can’t just come in the health care system itself. No one says having a beer is bad, but we need more support for other who use it excessively and in harmful ways. Also, I’ve heard that many people smoke because it works on the brain similarly to the ways anti-depression drugs work, but will all the extra complications we all know so well.  The question becomes how to deal with things like this that do affect a person’s health and would affect a system where we are all supporting one another. I certainly can’t claim to have all the answers, but it’s going to take more than this bill to change some large structures that are contributing to health issues in this country.

Another issue I have is that we (in the U.S.) have become accustomed to thinking that money can buy anything and failing to accept that we’re all mortal and will thus get sick and die. Unfortunately, until we accept that, we will continue to clamor for more medicine and medical service to keep us going, and if we have money we’ll think that should mean we can thus use it to buy more services and stay healthier longer.  Unfortunately, all the talk of “death panels” incited fear instead of a positive discussion about death itself. Should there be people “playing god” and deciding who should live and die? Well, maybe not to that extent, but we need to find a general consensus of what a good life lived looks like so we can better make decisions about how we’re using our limited health care resources.  Should we be giving a 95-year-old a hip and knee replacement if that takes away resources from a 10-year-old in some way?  I don’t think so, but we’ve failed to have open discussions on this topic because we feel entitled to certain privileges in relation to health care, especially if we have money to pay for it.

My biggest desire is that all people have access to a certain level of health care that doesn’t burden them financially. Will that ultimately mean some kind of rationing? Probably, and I’m fine with that as long as it’s happening to everyone equally. My biggest problem is that discrimination is happening in the health care system. Sometimes it’s in the form of people not being able to purchase insurance. Sometimes it’s that, with or without insurance, people are driven to bankruptcy or huge financial burdens because of medical costs.

For all these reasons I’ve listed above, I believe we need a system that treats all and is paid for by all.  In my mind, people would contribute in proportion to their wealth for the betterment of all.  Some people call this socialized health care, others call it a collective.  No matter the name, until we unite against those who continue to profit from the current system, inequality in relation to health care will continue, with some on the outside looking in.  I hope people will recognize that the fight needs to continue until this type of system is achieved.