Taiwan may provide a health care model for the U.S.

A National Public Radio profile from last year points out that Taiwan has one of the world's best health care systems and it is cost efficient too.

All Things Considered, April 15, 2008 · At the end of the 20th century, Taiwan became a rich country, almost overnight. But it still had a poor country's health care — about half the population had no coverage at all. So Taiwan set out to design a national health care system from scratch. What makes Taiwan unique is the way the country figured out how to cover everyone.

Follow the Oxcart

Hongjen Chang was one of the officials in charge back then. Walking through Taipei's imposing Chiang Kai-shek Memorial Park, he recalls how they did it.

"Taiwan is a small island," he says. "We always look abroad internationally for ideas."

Chang quotes a Chinese saying: "'The track of the previous cart is the teacher of the following cart.'"

In other words, if someone else's oxcart has found a good route to universal health coverage, follow those tracks. "If they were trapped in trouble, avoid that track. Find a new track," Chang says.

The government consulted experts from around the world, like Taiwanese American health economist Tsung-mei Cheng.

"In the end, the program that they finally set up in 1995 really is like a car that was made of different parts, imported from overseas, but manufactured domestically," Cheng says.

A Consolidated System

They wanted a system that gave everybody equal access to health care — free choice of doctors, with no waiting time — and a system that encouraged a lot of competition among medical providers.

To finance the scheme they chose a national insurance system: a single, government-run fund that forces everybody to join in and pay.

The result is a system that works a lot like Canada's, or like the U.S. Medicare system, but with more benefits.

"It has drug benefits, vision care, traditional Chinese medicine, kidney dialysis, inpatient care, outpatient care, just about everything under the sun," Cheng says.

To satisfy the patients in Taiwan, there's no gatekeeper who controls access to specialists and no waiting lines.

If you woke up in Taiwan with shoulder pain, for example, Chang says that you would be able to see an orthopedic specialist the same morning, no recommendation from a general practitioner required.

"Our people don't like the idea of gatekeepers. They want to decide by themselves," Chang says.

Don't Forget Your Smart Card

By consolidating so much — one government plan that covers everybody — Taiwan achieves remarkable efficiency.

Everybody here has to have a smart card to go to the doctor. The doctor puts it in a reader and the patient's history and medications all show up on the screen. The bill goes directly to the government insurance office and is paid automatically.

So Taiwan has the lowest administrative costs in world: less than 2 percent.

They also use that smart card to track patterns of use.

"If a patient goes to see a doctor or hospital over 20 times a month, or 50 times in a three-month period, then the IT picks that person out. The person then gets a visit from the government, the Bureau of National Health Insurance, and they have a little chat. And this works very well," Cheng says.

That may be too much like Big Brother for some people in the United States, but surveys show the Taiwanese are highly satisfied with their health care.

Plus, no one goes bankrupt because of medical bills, Chang says.

A Strained System

So the patients are safe from bankruptcy. But the system itself is under strain. Chang says that Taiwan spends 6.23 percent of its GDP on health care, compared to 16 percent in America.

So the United States spends too much on health care, and doesn't even cover everybody. But the Taiwanese don't bring in enough money to pay for all the services they offer.

"So actually, as we speak, the government is borrowing from banks to pay what there isn't enough to pay the providers," Cheng says.

Taiwan's politicians are reluctant to increase premiums: they're afraid the voters will punish them.

So that's the problem here. And frankly, the solution is fairly obvious: increase the spending a little, to maybe 8 percent of GDP.

Of course, if Taiwan did that, it would still be spending less than half of what America spends.

http://www.npr.org/templates/story/story.php?storyId=89651916

Link to Dissent Magazine article from Winter 2008, Health Care in Taiwan: Why Can’t the United States Learn Some Lessons?

http://dissentmagazine.org/article/?article=985

Lew Daly - Unjust Deserts: How the Rich Are Taking Our Common Inheritance

Here is some information from The New Press about a new book titled "Unjust Deserts" which challenges long-held assumptions about wealth and inequality.

UNJUST DESERTS
HOW THE RICH ARE TAKING OUR COMMON INHERITANCE
AND WHY WE SHOULD TAKE IT BACK
WEALTH AND INEQUALITY IN THE KNOWLEDGE ECONOMY
by Gar Alperovitz and Lew Daly
The New Press

As our financial system lurches into an unknown future, traditional views of wealth and personal rewards are being questioned. Consequently, there is no better time for a conversation about the creation of wealth today—who is entitled to it and who will control it. As our national financial crisis puts into stark relief, aren’t we are all in the economy together, whether rich or not?

With a bold salvo challenging the status quo, authors Professor Gar Alperovitz and Demos fellow Lew Daly tip the scales with the answers to these questions in what will be one of the most talked about books of the season: UNJUST DESERTS: How the Rich Are Taking Our Common Inheritance and Why We Should Take It Back.

Alperovitz and Daly are in good company when they write that culture has more to do with individual success than we generally acknowledge. One of the wealthiest men on the planet, Warren Buffett,with a current net worth of $60 billion, acknowledges that “society is responsible for a very significant percentage of what I’ve earned.” Bill Gates, Sr. agrees when he writes, “Success is a education and research are subsidized, where there is an orderly market, where the private sector reaps enormous benefits from public investment. For someone to assert that he or she has grown wealthy in America without the benefit of substantial public investment is pure hubris.”

Drawing on cutting-edge research as well as their knowledge of philosophy and economics, Alperovitz and Daly prove that up to 90%—or even more—of private earnings are the result not of individual ingenuity, effort or investment, but of what they describe as the “unjust” appropriation of our collective inheritance. In other words, the cumulative or aggregate knowledge that we all inherit is key to individual achievement.

The authors demonstrate that if the market rewarded people according to their contributions it would make up only 10-20% of their income. The rich don’t work harder and are not morally justified in deservingness, or “deserts” as philosophers describe it than the rest of us. We get the commonly held viewpoint that we are entitled to own whatever wealth we create from philosopher John Locke. In his
agrarian society and that of our Founding Fathers, wealth was mostly based on physical labor. In our knowledge-based society, Locke’s argument doesn’t work, since all knowledge that we receive from previous generations is a social contribution.

The individual’s role in advancing art, science and technology again is mostly based on our common heritage, too. The authors make a historically-based case for the wave of cultural and scientific knowledge that pushes a few people to the next level, the “geniuses” who create what happens next.

Alperovitz and Daly rightly conclude that the individual isn’t really important in the case of each breakthrough. Instead, the development of knowledge is society’s forward-moving catalyst. And the reader understands that there has always been this debate about what society owns and what is rightly owned by the individual.
Alperovitz and Daly suggest reforms that could begin the process of income redistribution along the lines of social justice including: income taxation for the top 1-2% should be increased, raising the current cap on Social Security taxes, increasing corporate taxes—especially on windfall gains in connection with oil industry profits, and increasing inheritance taxes on large estates would be a
beginning. Proceeds from the new taxes could be used for the common good, such as instituting universal health care or propping up decaying infrastructures like bridges and tunnels. In addition, education and research could receive additional funds. There is a promising plan put forth by Yale law professors Bruce Ackerman and Anne Abbott that suggests and “capital stake” or allocation of $80,000 to every citizen upon reaching adulthood—to be used most likely for a college education.
The capital stake would be recouped at death through an inheritance tax.

Bound to be a flashpoint of discussion and contention, UNJUST DESERTS will be the talk of the political circles this fall and to come.

About the Authors

Gar Alperovitz is the Lionel R. Bauman Professor of Political Economy at the University of Maryland and a Founding Principal of the Democracy Collaborative. His previous books include The Decision to Use the Atomic Bomb and America Beyond Capitalism. He lives in Washington, D.C.

Lew Daly is senior fellow at Demos, the New York City progressive think tank, and the author of God and the Welfare State. He lives in New York City.

UNJUST DESERTS:
How the Rich Are Taking Our Common Inheritance and Why We Should Take It Back
By Gar Alperovitz and Lew Daly
The New Press
Hardcover | $24.95 | 230 pages
ISBN: 978-1-59558-402-1

The New Effort To Steal Social Security

In Defense of the New Deal

Scott Lehigh demolishes the right-wing arguments against the New Deal in an column at Boston.Com:

The New Deal and right-wing revisionism
By Scott Lehigh
Boston Globe
February 18, 2009

ONE OF THE most diverting aspects of the debate over President Obama's stimulus plan has been the concerted conservative attack on the New Deal.

One might have thought that voters of that day had pretty much settled the question of whether the New Deal worked by enthusiastically reelecting FDR, and not once but three times. But since right-wing revisionism is really an arrow aimed at the current stimulus plan, the effort to discredit the New Deal is worth examining.

The argument that the New Deal failed is easy to make.

You start with unemployment figures that exclude those who labored in work-relief programs like the WPA or its various cousins. Yes, that's passing strange, given the many worthwhile tasks those public employees accomplished, but sophistry has its demands.

Next you present a misleading juxtaposition of that exclusionary unemployment data, noting that the 19 percent joblessness rate in 1938 wasn't all that much better than the 25 percent of 1933, FDR's first year in office.

Then you add the well-worn 1939 quote from Henry Morgenthau Jr., FDR's treasury secretary, that government spending hadn't produced a recovery, and, for professorial effect, perhaps even toss in George Santayana's observation about those who cannot learn from history.

Presto: You've got yourself a paint-by-numbers conservative polemic.

But what do unemployment figures from the era actually show? The best regarded data excluding public-works employees traces a steady decline in joblessness through the first five years of the New Deal, from 25 percent when FDR took office to 14.3 percent in 1937. Then, however, joblessness rose, hitting 19.1 percent in 1938 before dropping back to 14.6 percent in 1940 and 9.9 percent in 1941.

Include work-relief employees, and unemployment declined more steeply, falling to 9.2 percent in 1937. It then rose to 12.5 percent in 1938 before dropping back to 6 percent in 1941.

Given that pattern, comparing 1938 with 1932 to argue that the New Deal didn't work is akin to claiming that the economy scarcely recovered under Ronald Reagan because unemployment, which hit 9.7 percent in 1982, was at 7.5 percent in 1992 under George H.W. Bush. It ignores the larger drop in joblessness in between.

Still, the New Deal debate does raise an interesting question: Why did Roosevelt's recovery falter?

Unfortunately for conservatives, the evidence cuts against their conclusions. The rise in unemployment followed FDR's cutback in government spending in 1937. The resulting spike in unemployment prompted him to shift courses and expand spending again, whereupon unemployment again fell.

Gross Domestic Product tracks the same way, notes economist Dean Baker, who has matched the increase in federal spending during each Depression year with the following year's growth in GDP. A 23.7 percent increase in federal spending in 1933 was followed by a 10.8 percent increase in GDP in 1934, for example, while a 34.2 percent increase in 1934 was followed by an 8.9 percent GDP increase in 1935. But when FDR retrenched and spending fell by 10 percent in 1937, the next year's GDP shrank by 3.4 percent.

Interestingly, one scholarly criticism of the New Deal is that federal spending wasn't expansionary enough at a time when other levels of government were slashing budgets. "[I]f we take the seven years from 1933 on, in only two was the federal share significantly more than enough to offset state and local shrinkages," MIT economist E. Cary Brown wrote in his well-regarded study of the era.

There's virtually no disagreement that World War II gave the country the strong final tug out of the Depression. Yet that reality also argues for the efficacy of Keynesian remedies; economically, the war constituted a huge government stimulus, financed by massive deficit spending.

In sum, determined efforts at revisionism notwithstanding, the New Deal was hardly a failure. It's more accurate to say that it was a success, but a limited one - and that there are important lessons to be learned from its shortcomings.

But those lessons would be hard for conservatives to square with their beliefs.

And where ideology's amiss, 'tis jolly to revise.

http://www.boston.com/bostonglobe/editorial_opinion/oped/articles/2009/02/18/the_new_deal_and_right_wing_revisionism/

Employee Free Choice Act Rally

AFL-CIO: Buy American Will Create Jobs

Tula Connell defends Buy American in AFL-CIO's NOW Blog:

The Buy America provision in the economic recovery package Congress now is finalizing has some rich and powerful voices against it.

AT&T, Dow Chemical, Cisco Systems, IBM, Intel, Microsoft, the Computer and Communications Industry Association and the Consumer Electronics Association sent a letter last week to Senate Majority Leader Harry Reid (D-Nev.) and Senate Minority Leader Mitch McConnell (R-Ky.) saying the provision “will harm American workers and companies across the entire U.S. economy, undermine U.S. global engagement, and result in mirror-image trade restrictions abroad that would put at risk huge amounts of American exports.”

Wrong. Such cries of protectionism are red herrings for the corporate search for the lowest-wage labor possible—at the expense of America’s workers and the U.S. economy.

United Steelworkers (USW) President Leo Gerard sums up Buy America this way:

This isn’t about a trade war. It’s about making sure we’re not putting our jobs out to bid for China.

Buy America would help ensure that our tax dollars funding the economic recovery package are spent on products that are made in America—to the maximum extent possible. When we buy products made in the United States, that creates jobs. And with 3.6 million jobs lost in this country since the recession started in December 2007, job creation is fundamental.

But if the big corporations can’t understand how that works, they can take a lesson from the president. The inauguration of President Obama was not just American-made, but union-made from start to finish. Here are just a few examples from the AFL-CIO Union Label & Service Trades Department about the inauguration:

Members of the International Alliance of Theatrical Stage Employees (IATSE) employed by the all-union Hargrove Co., along with electricians, carpen­ters, Teamsters and assorted skilled building trades workers worked for weeks crafting parade floats, and designing and executing décor for 10 official inaugural balls, a prayer breakfast, dozens of formal dinners and 30 other “unofficial” inaugural events.

All official inauguration printed materials—programs, schedules, tickets—carried a union “bug,” indicating members of the Communications Workers of America (CWA), Teamsters Graphic Communications Conference or both produced them.

Except for the military bands, musi­cians performing on the official inaugural stand were members of the American Federation of Musicians. Performers entertaining at the various balls were union members as well, as were the sound and lighting engineers and backstage personnel.

Hundreds of thousands of spectators who opted for public transportation to the formal inauguration ceremony were served by members of the Amalgam­ated Transit Union who operate the city’s Metrorail and Metrobus systems.
So rather than yelling “trade wars,” Big Business should repeat the following: “Investing in America makes the nation stronger. Investing in America makes the nation stronger…”

It’s really not a hard concept.

http://blog.aflcio.org/2009/02/09/buy-america-will-create-us-jobs-we-need-lots-of-jobs/

Loudon Wainwright III - Times Is Hard

From NPR's All Things Considered

Songwriter and actor Loudon Wainwright III has composed numerous musical commentaries for NPR over the past two decades. He's sung about everything from the World Series to Christmas in besieged Sarajevo.

This time — like many people around the world — he's feeling hammered by all of the bad economic news. So he wrote "Times Is Hard." It's not intended to cheer us up. Read the lyrics below:

Times Is Hard

Times is hard. Times is tough.
Nothin's easy. It's all rough.
There's not much right; so much gone wrong.
All I can do is play this song.

You're watchin' the news. It all looks bad.
The worst half-hour you ever had.
What in God's name is goin' on?
All I can do is play this song.

You're losin' your job, your house and your car.
Hittin' rock bottom don't feel that far.
Nothin' good is gonna come along.
All I can do is play this song.

Folks are scared watchin' that news.
Folks feel bad. They're gettin' the blues.
My poor stomach, it ain't that strong.
All I can do is play this song.

Times is rough. Times is hard.
Take a pair of scissors to your credit card.
Circuit City just said, 'So long.'
All I can do is play this song.

Who's at fault? Who gets the blame?
Let's string up Bernie what's-his-name.
And ask Alan Greenspan to come along.
All I can do is play this song.

They want your gold, and they'll pay cash.
The only silver lining is the price of gas.
Money's short and the odds are long.
All I can do is play this song.

The factory's closed. The bank is bust.
On the money it says, 'In God We Trust.'
So pray for all your stocks and bonds.
All I can do is play this song.

Outta luck. Outta hope.
I'm wonderin' why I even cast that vote.
I took that sign offa my front lawn.
All I can do is play this song.

There's a new man down there in D.C.
They say he's gonna help you and me.
They sure know how to bang the gong.
All I can do is play this song.

Last man in D.C., he had eight years.
Now the whole damn country is in arrears.
We got two, three, four wars goin' on.
All I can do is play this song.

Times is hard. Times is rough.
I guess you folks need some cheerin' up.
Well it ain't me babe. You got that wrong.
All I can do is play this song.

You heard it here. I sang it first.
Don't feel so bad; things are gonna get worse.
Consider yourselves all strung along.
All I can do is play this song.

All I can do is ...

http://www.npr.org/templates/story/story.php?storyId=100261261

Listen at:
http://www.npr.org/templates/player/mediaPlayer.html?action=1&t=1&islist=false&id=100261261&m=100256269

Democrats Discuss January Jobs Report

Washington, DC—Democratic Senators Robert Menendez and Bob Casey joined Congresswoman Carolyn Maloney at a press conference this morning to discuss the Labor Department’s release of its monthly jobs report and unemployment rate. This morning, the Labor Department reported that employers cut 598,000 jobs in January, the most since 1974, bringing the unemployment rate to 7.6 percent. Facing the most severe economic crisis in generations, Democrats are working quickly and responsibly to enact a bold plan that creates jobs and cuts taxes for the middle class.

“There is nothing more indicative of the economic condition of America’s families than how we are doing with respect to job creation and job losses,” Menendez said. “Today, the latest snapshot of our economic condition shows that more and more American families are falling on harder and harder times, plain and simple. We have to act on the economic recovery plan quickly because we are in a crisis, and we have a responsibility to the American people. It is our responsibility to enact a plan that is bold, fast-acting and effective enough that it gets people back to work, and does so in short order.”

Said Casey: "Today's report is the latest in a string of bad news for American workers. Years of bad policy during the Bush Administration has driven our economy off a cliff. We don't have time for endless debate and must act swiftly to enact a recovery package to create jobs and move our economy in the right direction."

“Today’s grim job loss numbers underscore the human toll of our economic crisis and add to the overwhelming evidence for getting a recovery package to the President’s desk fast,” Maloney said. “Even the bright spots are dim. The 3.6 million jobs erased since the recession started, including 598,000 last month, is why President Obama and Congressional Democrats are dedicated to acting in a bold and targeted way to revitalize the economy. We have a plan to create and save up to 4 million jobs while cutting taxes for middle class Americans. Democrats have tried to work with Republicans to find middle ground, but so far House Republicans seem intent on letting the economy slide off a cliff for political gain. Democrats must and will ensure that they don't take our country with them.”

American Worker Ad: It's Time to Protect American Jobs