The Economic Greening of America
Dear President Obama, I am writing this letter because I feel it is time for you to change your approach to economic recovery and future prosperity.
The economy is like a large tree. If you water it and nourish its roots, it will grow and florish abundantly, with new growth and blossoms at the top. However, if you only take care of the tree's top part, and ignore the roots, the tree will wilt, perhaps become diseased, and ultimately die. You can trim the tree's branches, beautifying it, or even treat leaf diseases, but that will not keep the tree healthy. Unfortunately, I have seen that the approach your administration to this point has been to beautify the top of the tree, with relatively little attention being paid to watering and nourishing its roots. Now, bankers and financial institutions are taking their government sponsored beautification funds to the bank, which they own. The presumption of your advisors is that if the financial institutions are in good order, they will help prop up the rest of the economy. That is a false presumption, and is only true insofar as having money on hand leads the lenders to lend money. If the economy for our citizenry must rely on lent money, it is really in a desperate condition. Yet that is what I see. We are becoming a nation of persons in debt -- of renters, not owners, of borrowers, not savers. Our economy seems to be based mainly upon people playing with other people's money, the entertainment industry, the military-industrial complex -- which produces instruments of destruction rather than nourishing growth -- and people selling and buying foreign goods which they cannot really afford. This is a crazy, unsustainable economy which has been built around the conservative ideology of the past few decades.
We need to start nourishing this economy from the ground up. That means helping the average citizen. The economy builds from the bottom up, not the top down. It has always been that way, despite the efforts of the rich to justify their wealth through sophistry in their economic thinking. The idea of the so-called "trickle down economy" is just the latest in a series of self-justifications made by the wealthy elite over the centuries. All of these attempts end in failure. It is time, sir, for you to lay the notion of trickle down economics as a basis for a good economy to rest once and for all. I have been puzzled at your choice of economic advisors from previous Republican administrations, with their disproven ideas, and have been distressed that you seem to be following their advice by and large. You need to get rid of these guys! There are far better economic advisors out there, with much better economic advice. I understand the need for some bailout effort, but it should not be the basis of economic policy. I also see that some good things have been done. The cash for clunkers program has been a good and successful one. Efforts are being made toward developing alternative energy sources and alternative fuel cars, which is good. For most of us, however, there has been far too much bailout, far too little economic regulation, and far too few useful jobs programs or other efforts to create incentives and economic fairness for the great majority of Americans. In fact, it seems to us as though the culprits are being rewarded for their misdeeds! This notion of being too big to fail must stop. If you are having difficulty gathering the courage to confront the economic forces of the wealthy elite in America, which largely control and manipulate our nation, try doing what I often do when I hear of people's misdeeds. I give a stern look at the perpetrator, and in my sternest pet-owner voice, loudly say "Bad Dog!" Okay, I am kidding, sort of. But people who use the system for their own gain, and at the expense of society, the way that many in financial and corporate America have, are deserving of the Bad Dog moniker. After all, people call other people "dogs" who cause far less harm than they have.
To be sure, there are many wealthy people who are basically good people and have done more to benefit society than to hurt it in their lives. However, the real problem is in the system, a system which rewards people for operating at the lowest moral level, of the ends justifies the means, and the ends is money and wealth. (Please see my previous letter on morality for more details.) We must stop rewarding such behavior, or letting people get away with it unpunished. That is why we desperately need financial regulation. I know you have talked about doing that, but so far, it seems to be all talk. We need action now. I heard on televison recently that the number of major financial institutions, due to the current crisis, has dwindled even further, down to 7, if I recall correctly. Consolidation and the creation of monopolies is what happens when the market is unregulated, and that ends up in disaster for us all. In fact, the game Monopoly was invented to demonstrate the dangers of an unregulated market and rampant capitalism, without checks and balances. Competition is quashed, and the economy becomes a monopoly under the control of corporate and financial moguls, who have no interest in tending to the needs or welfare of the citizens. Rather, they are motivated to increase their power and wealth, sending society into a downward spiral. The way to stop this downward spiral which we are in now, is to regulate businesses of all types extensively and effectively, something which has not been done for many years. You need to enforce the Sherman Antitrust Act (PLEASE!). But furthermore, we need a variety of regulations to prevent great and unfair disparities between big business owners and other citizens, and promote economic fairness. We need stong unions, price regulations, and invest long term in education and infrastructure which will lift us all.
As a Social Psychologist and Psychology instructor, I have learned about how we process information. It turns out that how we process information is relevant to the curent topic. We can either process information bottom-up, or top-down. Bottom-up processing is dealing with the individual components of the situation we are dealing with, to build a perception. Bottom-up processing takes more effort, but it assures an accurate perception of the situation. Bottom-up processing is less used than top-down processing, however, since it is more difficult to implement. Top-down processing is using previous knowledge, theory of expectations to guide our perceptions. This often results in errors, but is usually done, anyway. The approach of government bailouts is a top down approach, using previous theory and expectations to guide policy, even though those ideas have been shown to be in error. Your administraton's approach is also top-down in a second sense, of course, of providing money to the banks and financial institutions, as well as some large corporations, which are already at the top of the financial heap (or tree if you prefer). But the top down approach I am referring to is first, in the conceptual sense, and secondly, in the financial wealth sense. As a nation, we need to go to a roots-building, bottom up approach.
I am not an expert on economics, but it seems to me that our current situation offers a unique opportunity to build a more sustainable economy. As time goes on, it is becoming more and more clear that economy and environment are linked. In order to have a sustainable economy, we must have a sustainable, healthy environment. The recycling industry, for one, is a vital and growing one. Businesses which work to reduce the pollution generated by other industries are as well. Of course, the need for environment-friendly, sustainable forms of energy is made absolutely necessary in the long run by the limited amount of fossil fuel present on this planet. Now that technologies are developing, or already developed, which can produce goods in far more sustainable, environmentally sound ways, we are in a position to implement these technologies, with help from the government and business both. Furthermore, we can provide an example of which we can be proud, and other nations may follow. At the same time, there are other nations which are already increasingly going down the path of environmentally friendly practices. We can also follow their lead. Even relatively cloudy, unsunny Germany now generates much of its energy using Solar Power. China is now beginning to undertake a major project to develop it Solar Power resources. Iceland generates most of its energy needs from Geothermal Power. Wind power is extensively used in parts of Europe. We can do such things in the United States. In fact, all over the world, there are abundant sources of natural energy. One nation need no longer depend upon another for fulfilling its energy needs. This seems to me a great potential boon to world peace and international relations. By the way, environmentalism is yet another reason to do our part to reduce militarism around the world and avoid conflict. No human activity is more environmentally destructive than war or wasteful of resources than military activities. I see a future in which the United States, and indeed the entire world, becomes a "green" one economically, as a result of which citizens in general will be able to put more "green" in their pockets, to be used to buy environmentally safe products, or saved in well-regulated banks. The tree of the world's economy will be in full bloom.
If we continue to let businesses submit to short-term profit motives, however, we face future economic, political and environmental disaster. As global warming continues, sea levels will rise, displacing millions of people, and even submerging certain low lying nations, as well as a few low lying states in the United States. Conflicts between nations, or even between displaced persons and non-displaced persons within a nation, will likely result. Extinctions will continue to decrease biodiversity, moving us closer to environmental collapse. These problems will all be exacerbated if we do not find a way to peacefully stabilize the number of human beings living in this world at a sustainable level, using methods such as birth control, sex education, and the empowerment of women around the world. But I am an optimist, and I think you are, too. I believe that we can meet all of these challenges and create a greener future.
Thanks again for your diligent efforts. Yours, M. Robert Warden, Jr.
Dear Mr. President, Please Be Our Moral Leader
Barack, I heard from the news that last week, you went to view the bodies of 18 U.S. military personnel who had recently been killed in Afghanistan. I know there must be a tremendous burden placed upon you from making decisions which may lead to promising lives being cut short. From what I have observed of you, I am confident that you are a person of good moral character. Hopefully, your outstanding moral character can have an impact upon the moral character of this nation. It is my hope that you reconsider, not only our military misadventures throughout the world, but also, the role of the United States in the world, and even, the morality of our actions at home. You see, I have been thinking a great deal about morality recently, myself. I realize that you cannot do everything you wish, even as President. I know that you need help in order for us to accomplish what we must attempt. Please know that I, and I believe the majority of Americans, are here to help, if you do the right thing. If you lead us toward progress, we will help you get there. But you are our leader. You set the tone of our nation. I want to see that tone be a moral one, not only in inspiring speeches, but in actions as well. Without translating our aspirations into action, after all, all of the talk in the world is only pie-in-the-sky fantasizing. With you as our leader, we feel that there is a chance of making our aspirations of having a better, more moral nation a reality.
As a Social Psychologist and Psychology instructor, I have been exposed to a considerable amount of information about morality -- both theories and research regarding morality. Morality can be conceived of as having cognitive, emotional and behavioral components. From whichever of these 3 perspectives one looks at it, our nation has been a miserable moral failure in recent years. At the same time, it has been the world leader militarily, and in terms of "power" and "influence." I submit here that our nation has placed far too much emphasis on military, power, and coercive influence, and far too little on being a moral leader, role model, and gentle persuader. The cognitive perspective of morality, as described by Psychologist Lawrence Kohlberg, views moral development as manifested by the sophistication of a person's moral reasoning. The most naive form of moral judgment bases morality on whether the results are favorable or unfavorable for the individual doing the judment. In other words, it is a selfish and self-centered approach to life, which does not really qualify as true morality. Most distressingly, this resembles the point of view taken by corporate America in the pursuit of profit, as well as the pursuit of international power and influence using our military might. The second level of morality is based on social conventions, such as getting along, the Golden Rule, "being nice" and following the law. This is good, but does not allow for individual conscience or creative thinking. The highest level is when morality is fully internalized and based upon individual conscience, when universal ethical principles or the greater good prevail in one's thinking. We create a social contract to guide our actions, which defines our rights and obligations. I was actually heartened to hear that Bill Moyers understands this, when I heard him say a few days ago that our government "has broken its social contract with the public" in regard to health care. It needs to have a social contract with the public, not only in regard to healthcare, but in regard to all matters involving the relation of government to public.
The emotional perspective of morality, as described by Harvard Professor Carol Gilligan (not the one from the island), views the most naive form of morality as the feeling that whatever makes one happy must be good. There is also far too much of this going on in corporate America, and in our government, and this translates into some very maladaptive foreign policy. If it feels good to conquer and occupy another, weaker nation, which we don't like, it must be the right thing to do, according to this type of thinking. That type of attitude seemed to prevail in the Bush Administration. The next level of morality according to Gilligan, is based on self-sacrifice, which once again, is admirable, but ultimately self-destructive. The highest level of morality from the emotional perspective, is similar to the social contract concept, but with more emphasis on the emotional well-being of the public. Gilligan calls this "The Psychology of Nonviolence," which properly places peacefulness, love and tolerance as paramount to true morality. Behavioral morality is what should follow from a person's cognitive and emotional moral conscience. Behavior should reflect moral thoughts and feelings, but this does not always happen. Morals need to be so important to us that we make sure to follow our own moral conscience. Behavior which leads to unhappiness, misery and so forth, to self or others, is morally maladaptive. One look at our current situation, socially, economically and militarily, makes it clear that we currently have a morally disordered nation.
We need to rethink our place in the world. The United States is not unique, but rather, a member of the family of nations. What works for other nations, should work for us, and what doesn't work for other nations should not work for us. We are subject to the same human nature, and rules of nature, which influence outcomes and well-being of peoples throughout the world. The United States may be a world leader, but as citizens of these states, we should never forget that, nor should we forget that we are part of the human family. If we aspire to be true world leaders, it must be in a moral sense, as role models and facilitators. The use of military force to accomplish influence in the world is antithetical to our aspirations as moral and lasting leaders. As a winner of the Nobel Peace Prize, I hope you understand this. We need to build bridges, not bombs. We need to build schools, roads, infrastructure, friendships, all of which can be done much more cheaply, and more effectively, than sending soldiers to foreign lands to exert our will.
I did a long series of blog posts earlier this year about war, from a Psychological perspective, so I consider myself to be something of an authority on this topic. I will not go into all of the gory details of what I discovered, but let me say this. I will be brutally honest here. Wars, and military occupations -- which are what the operations in Afghanistan and Iraq really are, regardless of how our media or government labels them -- are started to serve the short-term interests of politicians and generals. They generally do not serve the interests of the public, except in cases of true self-defense, which is not the case in our nation's current situation. However, media and government form a coalition which promotes war and serves their own interests by taking advantage of human nature. They are usually successful in convincing the majority of the public to support a war, or an occupation, at least in the beginning, by heaping adulation (or perhaps sympathy) upon the warriors -- we have more holidays to honor soldiers than for any other reason, for example -- and using cognitive dissonance to make people carry through on their commitment to the war. Cognitive dissonance is a feeling of mental discomfort which occurs when a person becomes aware of conflicting cognitions, and thus is avoided or negated in some way. In the case of war, any notion that the sacrifices made by the people were not worth the effort, creates great cognitive dissonance. As a consequence, people convince themselves that the sacrifices of war must be worthwhile, and that can only happen with ultimate victory. To quit would be anathema. Meanwhile, pro-war messages (as I am sure you are aware of from stations such as FOX news), continuously bombard people with a barrage of propaganda, like a military campaign of words. Even worse, as yesterday's tragic shootings at Fort Hood remind us, the violence comes home. I did a study as part of my blog series this year, of international murder rates, which found that military spending across the world correlates with murder rates. We cannot be a moral leader in the world until we learn how to build a peaceful, moral society.
We elected you in large part to do so -- to bring our troops home from Iraq and Afghanistan. I am frankly very disappointed that you are considering an increase in troop strength in Afghanistan. We need to get our military out of there, too. Perhaps a temporary strategic increase in troops there to quell violence and stabilize the nation might be successful, but it must not be a long term strategy. Long term occupation is a losing proposition, extremely costly in human, moral, and financial terms. Yet I see our government seeming to slide down this slippery path. For that matter, I don't even see much evidence of us divesting our military from Iraq. Please, please change our national foreign policy strategy. Feeding people, building schools, roads, electrical supplies, sewers, and other infrastructure is far more effective in changing people's hearts and minds than military actions can ever be! It is also far cheaper. This is the path we must take in order to be a moral nation and a moral leader. It costs our government an extravagant 1 million dollars to keep one soldier on foreign soil for 1 year, and it ends up being counterproductive. We not only need to stop the occupations in the Middle East, but we also need to remove most of our military bases on foreign lands. There is no real threat in most of these places, and even were something to happen which called for military action, distance does not prevent quick action from occuring. There is no real need for these bases, unless our purpose as a nation is to be an empire, an international warlord. I think we can agree that this is neither a practical, sustainable, nor moral approach to international relations. Our international military presence, I believe, drains us morally and financially. As progressives, we must have faith in human nature, and not live a life of fear and paranoia. We must realize that there are some things which peoples of the world must do for themselves, and given the opportunity, they will.
As I am sure you are aware, this nation has always fallen short of its idealistic aspirations. Over time, it has for the most part gotten closer. However, these past few decades, I feel we have slid into a moral morass of capitalistic greed, might makes right, ends justifies the means, lower end of the moral spectrum thinking and action. This needs to stop. Ultimately, morality is practical. It might not be the expedient thing to do, and may not yield much short term gain, but morals are manifestations of practical, long-term philosophy, which if followed, result in long-term well-being. The morality of the greater good, of the social contract, is the course we must follow as a nation. This is something that progessives, and increasingly, the majority of the American public, understands. We also understand that a democratic government is meant to represent the people, and is our best hope of following this course. The choice, we understand, is not between stand alone individualism, versus the government, as conservatives frame the issue. The choice, which conservatives fail to understand, is between people power as manifested by the actions of our government, versus corporate power. For too long, corporate power has won, so that it feels to most of us as though we have become peons of corporate America, and the military-industrial complex which Eisenhower warned us about. Please help us, the people, take this nation back. Help America become the moral nation it was meant to be, as envisioned by the founders of this great nation.
Morality ties all of our problems together -- our economy, economic and social fairness, the optimization of freedom and democracy, social policies of our government such as health care. Originally, I was going to refer to foreign policy only in this letter, but as I wrote it, this fact became more and more clear to me. These problems are linked, and that needs to be recognized. Proper moral action will help us on all fronts. Proper foreign policy which focuses on peace-building through non-military means, will greatly help both world peace and our economy. Proper regulation of corporate America, will increase economic and social fairness, and help to build our middle class, as well as that of other nations, since major corporations are international. (As Senator Bernie Sanders says of big business: "Too big to fail is too big to exist." ) Joining the rest of the world in considering health care as a basic human right, as creating a proper and moral national health care policy, will make us a happier and more productive nation. And building a green economy will be moral, necessary for sustainable future development, and provide a framework for long-term economic prosperity both here and around the world.
Dear Mr. President, I saw Charlie Rose interviewing Al Gore a couple days ago, on the anniversary of your election. He was talking about climate change, and also the problems of rampant corporate power and the entrenchment of lobbying power in government. I could not help but feel that the world would now be a much better place had he become President in 2001, as he should have. But I thank God that you have come along, and are now our President. I am a true supporter of your administration. I lobbied for your election on the internet, and donated to your campaign. I still believe in you and your administration. But I feel you must be reminded that the world looks to you, and us, for moral leadership. The way to do this is the way of peace, progress, and a free and fair society for all.
Respectfully yours, M. Robert Warden, Jr.
Okay, here we go. This week, I started a group on Facebook (using Eunice's account), which I named The Thom Hartmann Bloggers Group. We already have several members who are bloggers or potnetial bloggers at Thom Hartmann's website, and several topics of discussion. For me, it's a big development, and the group members are people whom I consider to be good friends (although I just met a couple of them). I plan to address three major topics facing the Obama administration, perhaps with some input from the group, and submit our conclusions to the Obama website (Change.org). The first issue is health care.
When I Get Sick, I Hope I'm In Taiwan
Fortunately for me, I have been relatively healthy, at least since my nasty encounter with pneumonia about 2 years ago. But if I were sick, I think I would pray to be magically transported to a nation which has a truly good health care system which does not cost an "arm and a leg" metaphorically speaking. Meanwhile, let us do what we can to bring the health care system of the United States into the public sphere.
There has been much debate about how to reform the health care system of the United States. Mostly, it has focused on mere modifications of the current system, rather than creating a new system, much to my chagrin. Tweaking, or modifying, our current system in the "least painful" possible way to the health insurance system, drug industry and to health care providers, frankly, it is clear to me, will not get the job done. The usual egocentric American position of American exceptionalism seems to hold sway over the American public, by and large. Consideration of other nations' health care systems has been minimized; either they are thought not to be applicable to the United States, or somehow inferior, as foreign products. However, I suspect that the real reasons behind the unwillingness to learn from other nations are that for one, legislators consider the changes necessary to incorporate crucial elements of other nations' health care systems would hurt the health insurance and pharmeceutical industries too much, combined with the lobbying and financing power of these industries. When other systems are considered, it is usually that of various European countries or Canada. However, I and others with whom I am close have experience with, or knowledge of, a number of other health care systems which work well. In particular, the health care systems of Taiwan and of Australia have relevance to people I have spoken with. In addition to interviewing people and studying the health care systems of these two nations, I have also studied that of Japan, which has the highest life expectancy in the world.
My wife is from Taiwan, so I have learned much about Taiwan's health care system through her. Ten years or so ago, my wife's stepson in Taiwan was afflicted with colon cancer. Doctors and nurses in Kaohsiung City, Taiwan, where my wife's family is from, effectively treated his condition, performing surgery to remove the cancer and taking care of his recovery needs, all for very little cost. That treatment probably saved his life. Now, he is healthy. In fact, a few years ago, he was married, and now has two young sons. Another of my wife's relatives in Taiwan had a bad kidney stone problem, which was treated for free. Now his kidneys function well. Yet another one of my wife's relatives, less than a year ago, had a serious stroke at a rather young age (around 40). His treatment also was inexpensive and effective. He spent about 1 month in the hospital, during which time he was given physical therapy and mental exercises to do every day twice per day, one hour each time. When he went home from the hospital, he was given a healthy lifestyle regimen to help prevent another stroke, including diet changes and more exercises to do. Now, he is back at work as a construction supervisor.
Whenever my wife, Eunice, or stepdaughter, Isabella, want any involved medical care, such as dental care, they prefer to delay it until they go to Taiwan for a "visit." Despite the fact that both of them are naturalized U.S. citizens, they receive very inexpensive and very effective health care in Taiwan. The medical staff are very competent, well trained, and able to use the most modern medical techniques, and unlike the United States, people in Taiwan are not scared away by the likely cost of the medical care. In fact, both of them are in Taiwan now, and both have had dental work done while there, opting to have it done in Taiwan rather than the U.S. So reluctant are we in the United States to seek health care, that I never even went to the doctor when I had a bad case of pneumonia and was sick for about two months. This was almost 2 years ago. I had the good fortune to have well-trained health care professionals in my family -- my nursing-trained wife and retired physician father -- who took good care of me while I was sick, but most people are not so lucky. In any case, we were scared of having to pay the $2000 deductable on the life insurance policy which my parents bought for us. Were my parents not paying for our life insurance, I am not sure what we would do about health care; most likely, we would just forego life insurance altogether, since it would be very difficult for me to pay in addition to our other expenses, using my meager salary as a half-time professor. We would just have to cross our fingers and pray that neither of us gets sick or injured, as so many millions of Americans are currently doing in the absence of health insurance.
I actually interviewed my wife about the health care system in Taiwan recently -- a little bit of a strange experience, but the best way to attain the necessary information. The following is what I was able to gather from her. The health care system in Taiwan has been modified very recently. Before -- dating back to 1996 -- people could go to treat any medical problem for only a $100 NT processing fee. That is the equivalent of about 3 to 4 U.S. dollars. Now, due to the debt the system was invoking, the $100 NT processing fee only applies to serious medical problems, not routine ones. For optional care, the patient has to pay more, but not very much, relatively speaking. Even special care in Taiwan, however, is very inexpensive compared to care in the United States. For example, a hospital room costs about $1,500 NT, which is about 50 U.S. dollars, far cheaper than such care in the U.S. The most a person in Taiwan may pay for medical care is around 70 to 80 U.S. dollars per day. This is even without medical insurance. Also, a person in Taiwan can purchase cheap health insurance for serious medical disorders such as cancer or stroke. The purchaser pays a few dollars per month, and if the person does not get cancer, a stroke or heart attack, the money is returned to the person after 20 years. If the person does get such a medical condition, the treatment is free, other than the price of the policy, and includes better hospital care such as private rooms which are considered "special care" -- those rooms which cost $50 per day which were mentioned previously. In addition to medical treatment, the government of Taiwan sponsors free health care classes to educate people about health care, including teaching good health habits, and proper use of the health care system.
I also asked a health care professional whom I know about his ideas for what should be done with our health care system. Here are his suggestions, paraphrased from a letter he wrote to me except for the quote:
1. Expand Medi-Care; however, this may be difficult to finance as Part A (Hospital) and Part B (Doctor and outpatient) are currently financed by different means. The premiums for Part B come out of Social Security checks.
2. Expand Medic-Aid eligibility. The problem with this is that each state has slightly different coverage, although they all have to meet certain minimum Federal standards.
3. Tax deductions up to a certain amount with adjustment for inflation and vouchers for purchase of Health Insurance for lower income people. The vouchers should only be valid for purchasing Health Insurance and not for food or clothing, etc. "This would not disrupt the current system as much as some other ideas, but would probably be stongly opposed by some. It would probably result in almost everyone being covered after a period of time. It's hard to figure out what Congress will do with their bills."
In addition, he mentioned to me that he thought Australia had a good health care system.
Three Alternative Health Care Systems
An internet search revealed the following information about Taiwan's healthcare system. According to Wikipedia (Healthcare in Taiwan), the current health care system in Taiwan, which is called National Health Insurance, began in 1995. "NHI is a single-payer compulsory social insurance plan which centralizes the disbursement of health-care funds. The system promises equal access to health care for all citizens, and the population coverage had reached 99% by the end of 2004. NHI is mainly financed through premiums, which are based on the payroll tax, and is supplemented with out-of-pocket payments and direct government funding. In the initial stage, fee-for-service predominated for both public and private providers. Most health providers operate in the private sector and form a competitive market on the health delivery side. However, many health care providers took advantage of the system by offering unnecessary services to a larger number of patients and then billing the government. In the face of increasing loss and the need for cost containment , NHI changed the payment system from fee-for-service to a global budget, a kind of prospective payment system, in 2002." This does not reflect the most recent changes in the system, which have been instituted within the last year or two, as described previously.
The history of the NHI traces back to a committee which actually studied various health care systems around the world to create the best possible one. "Taiwan started its health reform in the 1980s after experiencing two decades of economic growth. In 1987, the government did away with the martial law which mobilized the governmental departments. The government set up a planning commission and looked abroad to study other countries health care systems. Taiwan looked at more than ten countries and combined their best qualities to form their own unique system. In 1995, Taiwan formed the National Health Insurance (NHI) model. In a 2009 interview, Dr. Michael Chen, Vice President and CFO of Taiwan's National Health Insurance Bureau explained that one of the models investigated was the United States and that fundamentally, NHI 'is modeled after (U.S.) Medicare. And there are so many similarities - other than that our program covers all of the population, and Medicare covers only the elderly. It seems the way to go to have social insurance.' NHI delivers universal coverage offered by a government-run insurer. The working population pays premiums split with their employers, others pay a flat rate with government help and the poor or veterans are fully subsidized. Taiwans citizens no longer have to worry about going bankrupt due to medical bills.
Under this model, citizens have free range to choose hospitals and physicians without using a gatekeeper and do not have to worry about waiting lists. NHI offers a comprehensive benefit package that covers preventive medical services, prescription drugs, dental services, Chinese medicine, home nurse visits and many more. Working people do not have to worry about losing their jobs or changing jobs because they will not lose their insurance. Since NHI, the previously uninsured have increased their usage of medical services. Most preventive services are free such as annual checkups and maternal and child care. Regular office visits have co-payments as low as US $5 per visit. Co-payments are fixed and unvaried by the persons income."
In other words, Taiwan's health care system is similar to a "Medicare for all" system, which has been called "Medicare, Part E" (E for everyone) by some advocates in the United States, including Representative Dennis Kucinich, Senator Bernie Sanders, and talk show host Thom Hartmann.
According to author Ian Williams (deadlinepundit), in Taiwan "the premiums at the maximum are less than $20 (U.S.) per month (the annual per capita GDP is $16,500 U.S.). Taiwan has done this for proportionately, less than half the cost of the United States, with costs running at 6.2 percent of gross domestic product in 2005, compared with the following for other countries: United States, 15.2 percent; France, 10.1 percent; Canada, 9.9 percent; United Kingdom, 7.7 percent; Japan, 7.9 percent; South Korea, 5.2 percent (World Health Organization figures for 2003 published in 2006)." In other words, it is medicare for all which does not cost much. Since it is government subsidized, it has been somewhat of an economic strain on Taiwan's government. However, the financing shortfall could be easily made up by increasing government revenue modestly, as changes in recent years have been intended to do.
Australia: According to theAustralian
Department of Health and Aging "The aim of the national health care
funding system is to give universal access to health care while allowing choice
for individuals through a substantial private sector involvement in delivery
The major part of the national health care system is called 'Medicare'. Medicare provides high quality health care which is both affordable and accessible to all Australians, often provided free of charge at the point of care. It is financed largely from general taxation revenue, which includes a Medicare levy based on a persons taxable income. Commonwealth funding for Medicare is mainly provided as:
subsidies for prescribed medicines (with a safety net providing
free medicines for the chronically ill) and free or subsidised treatment by
practitioners such as doctors, participating optometrists or dentists (specified
substantial grants to State and Territory governments to contribute to the costs of providing access to public hospitals at no cost to patients; and
specific purpose grants to State/Territory governments and other bodies.
In addition, Commonwealth general-purpose funding grants to State and Territory governments flow partly to health services. State and Territory governments supplement Medicare funding with their own revenues, mainly for funding public hospitals."
Additionally, an overview of the Australian health care system found in Wikipedia (Health Care in Australia) provides the following information: "Health care in Australia is provided by both private and government institutions. The Minister for Health and Ageing, currently the Hon. Nicola Roxon MP, administers national health policy. Primary health care remains the responsibility of the federal government, elements of which (such as the operation of hospitals) are overseen by individual states.
In Australia the current system, known as Medicare, was instituted in 1984. It coexists with a private health system. Medicare is funded partly by a 1.5% income tax levy (with exceptions for low-income earners), but mostly out of general revenue. An additional levy of 1% is imposed on high-income earners without private health insurance. As well as Medicare, there is a separate Pharmaceutical Benefits Scheme that heavily subsidises prescription medications. In 2005, Australia spent 8.8% of GDP on health care, or US$3,181 per capita. Of that, approximately 67% was government expenditure."
Thus, similar to Taiwan, Australia also seems to have a "Medicare for all" system, combined with supplemental private health care and insurance. Health care costs are paid using several sources including income tax, a levy on high income learners, and private insurance.
Japan: The health care system of Japan (like many aspects of Japanese culture) is quite complex. According to the website Asian Pacific Americans for Progress (APAP), "In the strictest terminology, Japan does not employ a single-payer healthcare system. In fact, Japan has a multi-payer system where the citizens, employers, and the Japanese government all share the costs of healthcare. Private insurance companies are alive and do very well in Japan.
In Japan, like in Obama's proposed plan, employers are mandated to provide coverage. Premiums are set to about 8% of an employee's salary regardless of the amount be it US 30,000 or US 150,000 (Average Income in Japan is US 30,000). The employer pitches in an equal amount. The same goes for seniors and the self-employed, except the government picks up the tab in place of the employer much like in our Medicare program (which, incidentally, is a single-payer system).
The intent of the plans is to cover all grounds of basic healthcare and preventative medicine. And when co-pay amounts are predictable (the maximum a Japanese citizen pays for an operation/procedure is 10% ~ 30% in some cases), the Japanese go get medical check ups much more frequently than Americans. Not only is the co-pay predictable, the price of your total operation/procedure is equally predictable as those prices are set by the Japanese Ministry of Health. Guess what happens then? Life expectancy shoots up to No. 1 in the world."
Japan also has private health care insurance, but these organizations are required to be non-profit organizations. Also, the price of various medical treatments is set by the government, so that it is standard, predictable and relatively inexpensive, and cannot be raised by doctors. There is an effective ceiling on co-payments of approximately 15% of the cost of the health care. Patients in Japan can go to any doctor they want to, since all doctors are part of the same system. Also, every resident of Japan must be enrolled in one of three insurance programs: Employees health insurance (63% of the population), national health insurance (37% of the population), or, for people with chronic health problems, long-term health insurance (a fraction of 1% of the population). Employees health insurance takes an average of 8.5% of the employee's pay for the purpose of health insurance, with the employer also contributing an equal amount. The so-called national health insurance is actually delivered through about 3,400 regional plans. Persons in the national health insurance program have to pay premiums if they are employed, based on income, assests and benefit payments from the previous year. However, unemployed or low-income persons do not have to pay premiums in this system. Basically, it is sponsored by regional governments.
According to the Medhunters Medical Community website (Medhunters), "Year 2000 Organisation for Economic Co-operation and Development (OECD) figures show that Japan spends 7.6% of its GDP on health, compared to 9.2% for Canada and 13.1% for the US. In 1998, Japan spent ¥29.8 trillion (US$280 billion) on healthcare, of which 53% was covered by insurance, 32.3% by the government, and 14.8% by patients' co-payments."
Unlike the single-payer, Medicare-type health care systems of Taiwan and Australia, Japan's health care system basically asks all involved parties to pitch in and absorb their share of the burden of health care costs. It is a complex and effective system, which spreads the costs of health care maximally. Nonetheless, it also shares much in common with other socialized or partially socialized health care systems. In particular, health care is viewed as a human right, not a privilege, in Japan's system. Health care is also viewed as a not-for-profit system. Thus, even private insurance is required to be not-for-profit. Of course, governments, which bear much of the costs of health care in such systems, are also non-profit organizations! Given the complexities of the debate going on in Congress over health care, and the complex issues involved, I could see the United States adopting a health care system much like that of Japan, although making Medicare available to everyone seems more straightforward, understandable, and perhaps easier to implement.
The fact is, concerning the United States of America, it is alone in the world in viewing health care as a for profit enterprise, one which is basically a privilege for those who can afford it. In the ill-conceived system that is the United States' health care system, we pay for insurance at inflated rates as we can, pay as we go, and pray we never get sick, for it is a "pay or die" system. As a result, we have the least effective health care system among all the world's industrialized nations.
My Plea for Change
Barack, I am a loyal supporter of you and your administration, who contributed to your campaign. However, I have been concerned at the tone of your administration at times regarding the issue of health care reform. Your party has a commanding majority! Please stop bending over backward to please the conservatives among us. We desperately need health care reform in this nation. Otherwise, we will continue to slide as a nation and as individuals into debt, and unhealthy, third world status as we continue to increasingly become a nation of a few "haves" and a great many "have nots." Health care should be viewed as a basic human right, not a privilege for those who can afford it! It is a fundamental part of the basic welfare of a society. Nothing could be more obvious than that. Without healthy citizens, it is difficult for them to be productive workers, effective parents, or happy people.
Recently, I received a letter (addressed to my wife, Mrs. Zunliang Warden) from your administration. It is addressed "Dear Friend" and goes on to describe a Democratic Party initiative called Organizing for America. It presents a good, progressive agenda, and asks the question: "What can I do to lift America up?" My friends and I who are members of The Thom Hartmann Bloggers Group are doing something to lift America up now. If we pass a good health care insurance plan for all of America, with a public option for everyone, we collectively will have lifted all of America up. For the sake of my 82 year old father, a retired physician and longtime Medical employee here in California, who has generally been healthy throughout his life, but now is in the hospital for around a month with various problems, and for the sake of us all, my friend, do everything in your power to make health care (health care, not health insurance) reform a reality. Now is the time to use the so-called "bully pulpit" of the Presidency. Thank You, and keep up your diligent work on behalf of the people not only of the United States, but all over the world!
Humbly yours, M. Robert Warden, Jr.
When I think of George W. Bush and Barack Obama at the same time, I find it striking how great the contrast between the two is. I suspect that the public was so disgusted with the George W. Bush presidency that the system worked to choose his polar opposite to replace him.
Part of the process rested with Barack Obama, who realized that he was the antidote to Bushism. Once he recognized this, and saw his growing popularity, he realized that he had a genuine chance to win the 2008 election, made the leap and declared his candidacy. After that, it was a relentless, consistent, above-board campaign which kept to the moral high ground and contrasted his policy ideas with those of the Bushies.
The other part of the process rested with the electorate. The majority of American voters were looking for an antidote to the venomous policies of the neocons which have so damaged our nation, what I call Bushism, which is really just the culmination of Reaganism. Voters found that antidote in Obama, more than any other candidate. While Bush was born rich, Obama's family was poor when he was a child. In fact, his mother was on welfare at times. While Bush's father was a recent President, Obama was completely politically unconnected when he got into politics, and his father was in fact, a Kenyan national. While Bush was an upper-crust Anglo-American, Obama was a self-described "mutt," half Kenyan, half Anglo-American, who obviously, looks nothing like Bush. While Bush was the embodiment of the alliance between the big business, especially oil, the military, evangelistic Christianity, and politics, Obama gives us the embodiment of populism, the middle class, the power of education, and the Jesus-as-role model form of Christianity as opposed to the everyone-else-is-going-to-hell evangelistic form of Christianity. He has no real ties to big business or the military, and no apparent special fondness of big business or the military. While Bush endorsed fear-based, regressive policies which favored his rich buddies, Obama favors hope and optimism based, progressive policies which favor the public of all socioecnomic statuses, as a whole. Also, while Bush represents the rise of intellectual mediocrity and the idea that it is best to have a leader who has no greater an intellect than the average citizen, Obama represents the rise of enormous intellectual talent and the realization that the job of President of the United States is so complex and such an enormous challenge, that it compels us to choose the smartest person we can find. Finally, while Bush is impulsive, unquestioning, and lacking self-insight, Obama is thoughtful, intellectually curious, deliberate, knowledgable and has great self-understanding. In fact, he has written two best-selling books analysing his past. Bush thought that God told him to become President, which would make God a masochist if true. In contrast, Obama, as a deliberate, relatively young and new Senator, had to be encouraged by political allies to join the presidential race.
With so many people desiring to the highest status job around, it is my belief that no matter how talented, anyone who becomes president is enormously lucky. That holds true for Obama just as well as it does for his predecessors. Obama is indeed enormously talented, and progessive-minded, and for that, I am grateful. However, in order for him to become President, he had to have all the circumstances and breaks go his way, and they did. He was the antidote to the toxic neo-conservative world view, whose bill has just recently come due. He was the right lefty to come along, just when it became apparent to the public how wrong the right has been.
Barring any unforeseen circumstances, I expect Obama to serve
eight years in the White House, eight years that for once, I am looking forward
to. In those years, I expect our society, and the world as a whole, to make
great progress. After that, I expect the general progressive trend to continue,
most likely with a much more demographically diverse assortment of mostly progressive
Presidents compared to what we have seen in the past -- women, Hispanics, Asians,
perhaps more African-Americans, more mixed-race politicians, as well as some
White guys. Along with the United States, I expect the world as a whole to make
social, moral and technological progress as well, as people demand more responsive
government and governments learn to employ more effective policies which serve
the public. Let the Obama era begin.
A New Morning For America
As I write (left) this post, I am listening to the festivities just prior to the inauguration of Barack Obama as the 44th President of the United States. Last night, I realized that fewer than 44 people have actually been elected President of the United States. Gerald Ford was President but was never elected. Neither was Andrew Johnson. There may have been one or two others as well who were never actually elected, due to the deaths of sitting Presidents. In any event, the election and inauguration of a new President is not an event which occurs very often.
I feel privileged to have been a part of this election, and am satisfied that I did my part to help elect Barack Obama, who is about to take the oath of office now. As mentioned in a previous post, I had a premonitional vision of Barack Obama becoming President last February, a premonition which came true, although at times I had my doubts. The actual vision I saw was, I am sure, his acceptance speech on the night of the election. When I saw that speech, I knew that was what I had seen.
Usually, I do not get excited by events such as inaugurations of Presidents, but this time is much more compelling than previous inaugurations for me. Most inaugurations in the past have been cause for me to hold my nose, while Presidents I heartily disapproved of such as Nixon, Reagan, and the two George Bushes took the oath of office. Even when a more acceptable President was inaugurated, it was not an event to get excited about. This inauguration, however, has generated a great deal of excitement across our nation. There is a feeling that we have turned things around politically, and a new and better morning is dawning. Although it is noontime in Washington D.C., it feels as though it is 9 in the morning, as it is here in California. We can feel peace and good government coming at last.
Peter Yarrow of the folk music group Peter, Paul, and Mary said that he was so used to not getting his way politically, that it feels really strange now that he finally has. I feel the same way. In some ways, it is difficult to believe. Who would have thought, when Barack Obama gave his speech at the Democratic National Convention in 2004, that he would be elected our next President in 2008? Certainly, there are many who will oppose Obama's Presidency, but the majority of us are all heading in the same direction, and working together.
We must continue to work together as a nation in the coming years. For that matter, we must work together as a world in the coming years. We know it is not going to be easy, but our success depends upon that. We are all -- all of humanity -- in this together. While I have been writing this post, Obama has taken the oath of office and has begun his inaugural address. Now, I will finish this post while I listen to this historic speech. It's a new morning in America, and we have a long day ahead of us.