Insist on intelligent health care change
In a recent study for the Progressive Club, I uncovered numerous facts about our American medical culture that may be of interest.  I present it here in brief, hoping this will further inform public discussion.
Health care is complex, a $3 trillion expenditure of our $18 trillion annual GDP, or about 17 percent of all goods and services in this country as of 2015. Warren Buffett called medical costs “the tapeworm of American economic competitiveness.” That averages about $9,000 per capita annually, more than twice the $3,600 spent in the average OECD countries (Western-oriented industrial economies; Canada $4,608, France $4,407, all in equivalent purchasing power).  Yet we don’t live as long, have more chronic conditions, and have poorer health outcomes despite spending so much more.

The Legatum Institute in London developed a prosperity index – a composite measure of wealth, education, economic growth and personal wellbeing. In 2016 the U.S. ranked 32nd, just below Thailand and Kuwait, and far below most European countries.  Japan ranked fourth, Sweden sixth, and Canada 16th.  So despite our wealth, our wellbeing is lower than many “almost peer” countries, with our average age at death being 73 years, a ranking of 43rd.

Importantly, we can learn from other countries that are doing better at lower cost. The numbers prove it. Our health care system is wasteful, unfair, inefficient, and unethical, and denies resources to other national priorities.  The Peterson Foundation reports costs result from greater use of technology and unwarrantedly high prices, not the number of doctor visits or hospital admissions. Others add uncompetitive pricing, multiple payers (federal, state, private, public, insurance companies, employers and out-of-pocket sources), and unneeded services as causes.

Here are some partial solutions:

  • Incentivize healthier living.
  • Implement a single payer system, like Medicare, the VA and Tricare now, with income-based co-payments. Private insurance could “top-up” coverage, maintaining individual choice.
  • Compare other countries’ systems, adopting best practices.
  • Reduce Medicare costs by establishing mean-based premiums.
  • Mandate competitive bidding for all medical services.

Buffett’s tapeworm is “eating our lunch,” making us less healthy and less competitive nationally in a highly competitive world.  Insistence on intelligent change is our obligation.

Jeff James
Progressive Club

Amendments more effective than Emancipation Proclamation
I realize that everyone is not a history buff, but it is wrong to change the facts of history to suit our political agenda. That is called historical revisionism and it takes place all too often.

Contrary to the discussion in the May 3 Board of Supervisors meeting, the Emancipation Proclamation was not “an outcome” of the Civil War. It was an executive order by President Lincoln to take effect Jan. 1, 1863 – long before the war ended – that purported to free slaves only in the 10 Confederate states in rebellion, where he knew he could not enforce it. It also decreed that freed slaves could be enlisted in the Union army which would then make more manpower available to Union forces. Clever political move on his part.

Exempted from the Emancipation Proclamation were the border and slave states of Maryland, Missouri, Tennessee, West Virginia, Delaware and Kentucky. Lincoln allowed these states to remain slave states. It was a political move by Lincoln. He only applied his order to the Confederate states with no real enforcement capabilities.

Lincoln was a great president but also a consummate politician. Why would he not extend freedom to slaves in all states? Maybe he would have lost political support in those states. Maybe slavery was not the only issue of the Civil War. By the way, Delaware and Kentucky did not free their slaves until the 13th amendment did it for them in December 1865.

On Dec. 14, 1865 (eight months after Lincoln’s assassination), the 13th amendment was ratified and effectively abolished slavery in the United States. The even more important 14th amendment followed in 1868, guaranteeing African Americans citizenship rights and promised federal enforcement of equal protection under the law. The 15th amendment did not pass until 1870 and guaranteed the right to vote to all citizens.

These three amendments accomplished much more than the politician Lincoln pretended with the Emancipation Proclamation. The ideals of the 13th, 14th and 15th amendments are the ones we should celebrate and they took years and more than one politician to accomplish.

Monuments come and go for some but our constitution and its ideals are living monuments that we should honor.

Sharon Rateau
Lake Monticello