Tag Archives: United States

One Man’s Hospital Bill Shows Just How Screwed Up America’s Health Care System Is

One Man’s Hospital Bill Shows Just How Screwed Up America’s Health Care System Is

The news: New Jersey man Baer Hanusz-Rajkowski recently found out the hard way that the cost of American medicine is totally out of control. Two days after slicing his finger open on the claw end of a hammer, Hanusz-Rajkowski sought medical attention at Bayonne Medical Center’s emergency room when the cut didn’t seem to be healing.

After a brisk visit in which Hanusz-Rajkowski did not see a doctor and did not receive stitches, he got a bill in the mail for $9,000. Essentially, Bayonne charged him months’ worth of pay for some gauze and a tetanus shot.

Here’s the breakdown:

– $8,200 for visiting the E.R.

– $180 for a tetanus shot

– $242 for “sterile supplies” (presumably, the bandage)

– $8 for antibacterial ointment

– Hundreds more for a few moments of the nurse practitioner’s time.

This is all after insurance…”

Advertisements

Leave a comment

Filed under Spotlights

What Happened When 3 Politicians Tried a Minimum Wage Budget

What Happened When 3 Politicians Tried a Minimum Wage Budget

By Scott Wilson

Jul 28, 2014 2:35pm

 

GTY money jef 140725 16x9 608 What Happened When 3 Politicians Tried a Minimum Wage Budget

(Getty Images)

“Have you ever seen a congressman snacking on a measly tin of sardines? Or maybe a governor ordering a McChicken off the dollar menu?

In Washington this week that scene was reality for three Democratic politicians who are taking the Live the Wage challenge.

Reps. Tim Ryan and Jan Schakowsky joined former Ohio Gov. Ted Strickland in taking the challenge–and are each living on a budget of $77 for the week–the same amount that a minimum wage worker typically has to spend on food, transportation and day-to-day expenses–after factoring out major costs such as rent and utilities.

A $77-a-week budget certainly doesn’t allow for luxuries.

“I basically had a couple bags of peanuts in the cloakroom–and there was a little fruit in the office that I ate yesterday,” Rep. Ryan told ABC News. “I spent about seven bucks last night on a couple cans of sardines and a bag of crackers from the convenience store up the street.”

The congressman began the “Live the Wage” challenge last week with hopes of bringing attention to the hardships facing minimum wage workers around the nation.

Rep. Jan Schakowsky also began the challenge Thursday–telling ABC News, “It totally changes your perspective. Even the shopping experience–I make a shopping list when I go to the store usually. I think about what I need–what I want–and I put it in the cart. I truthfully rarely think about how much it costs.”

“I’ll walk down the aisle and I’ll see something–you know, that would be great and I throw it in the cart. There’s just none of that when you’re on that kind of budget. There’s no spontaneity whatsoever,” Schakowsky added.

Strickland even took a trip to McDonald’s to try out the fast food chain’s dollar menu. Strickland posted a photograph of his $2.20 meal on Twitter noting that the workers at McDonald’s–(a company known for paying the legal minimum)–”deserve a raise.”

In a Politico op-ed, Strickland explained that he was unable to complete the week-long challenge with a budget of just $77. One particularly difficult aspect the governor discussed was eating a healthy diet while living on a $7.25 hourly wage.

“Because fresh fruits and vegetables are hard to find at a price within a minimum wage budget, I turned to bread, peanut butter, bananas and bologna more than anything else. That was what I could find when I took this budget to the grocery story last Sunday. And that’s why I ate lunch from the McDonald’s dollar menu.”

Schakowsky and Ryan have also taken to social media in recent days to share their message about the challenges facing minimum wage workers.

“There are a lot of people out there who do this for extended periods of time–years–so the idea is to get the message out and raise awareness about some of the difficulties that can happen to you,” Ryan told ABC News.

“We realize it’s not going to be exactly like the challenges that a minimum wage family faces, but the country is talking about the minimum wage right now. And I think that’s exactly what we want to do.”

Schakowsky echoed Rep. Ryan’s sentiments.

“I’m not going to pretend that now I understand what it’s like to live on the minimum wage. I think it’s a taste of it. But for anyone who thinks it’s a gimmick, my suggestion would be–try it,” Schakowsky said.

“You will get a small sense of what it’s like to be constantly thinking about how much you’re spending.”

Ryan and Schakowsky were co-sponsors of the Fair Minimum Wage Act of 2013. Their goal is to increase the federal minimum wage from $7.25 to $10.10.

The push to increase the national minimum has steadily intensified in the past year–as the minimum wage has remained unchanged since 2009.

Last week marked the five-year anniversary since Congress last passed an increase to the national minimum, while the wage for tipped workers has remained at $2.13 an hour since 1991.

According to the Bureau of Labor Statistics, the minimum wage doesn’t get you very far. “On average, a single-parent household (One parent, at least one child under 18) will spend $5,457 per year on food, or about $105 per week.”

That’s $28 above what a minimum wage worker has to live on for a week.

When asked about plans for reintroducing minimum wage legislation, Schakowsky was optimistic, but expressed concerns over whether Speaker of the House John Boehner would bring the bill to a vote.

“We’re hoping that we’re going to see another vote on it in the Senate and that there will be more pressure,” Schakowsky said.

“I fully believe that if Speaker Boehner were to call an increase on the minimum wage–that it would pass. It’s a matter of making sure that we just get more Republicans over this recess to ask the speaker to just call the bill.”

Ryan, however, was not as optimistic about the bill’s prospects before the midterm elections.

“I doubt it. The speaker’s holding the line on this. And I hope it’s a rallying call for the 65,000 minimum wage workers in my district–and the million and a half across the country,” Ryan said.

“Let’s increase the minimum wage and get people to work and make sure work pays. That’s ultimately the conversation we want to have.””

Leave a comment

Filed under Spotlights

One Country Will Replace America as the ‘Land of Opportunity’ by Doing What the U.S. Refuses To

One Country Will Replace America as the ‘Land of Opportunity’ by Doing What the U.S. Refuses To

“Germany.

Yes, Germany is now considered a blossoming land of opportunity for immigrants. It is the top immigrant destination in Europe and only second to the U.S. in number of immigrants welcomed in 2012.

The country has radically simplified the immigration process for educated E.U. citizens and foreigners and has developed special programs to encourage unemployed Europeans to migrate, with Germany footing the bill.

Jordi Colombi, a 36-year-old Spaniard profiled by the Washington Post, exemplifies this migratory pattern. Colombi’s journey from unemployment in Spain to flourishing architect in Germany is symbolic of a functional immigration system.

Germany, who the Economist calls “a bastion of strength in the fragile euro zone,” is experiencing a surge in jobs and an employment peak for the first time in 2014 since 1990. And it is growing and thriving in part because the country has laid out welcome mats for people wanting the “German dream.” Meanwhile, America’s stale immigration system that is indefinitely locked in limbo could learn a thing or two from Germany’s success.

Image Credit: AP

Germany Immigration Policy 101: In 2013, a record high of 437,000 immigrants flooded onto Germany’s border, Deutsche Bank reported. That influx has aided a shrinking pool of German workers, where the country “has Europe’s oldest population and second-lowest birthrate after Monaco,” according toBloomberg Businessweek.

Specific policies are tempting foreign individuals to seek out Germany’s employment opportunities and transition programs. E.U. nationals can easily migrate between the 28 nations. But Germany went beyond that measure by instituting a “Blue Card” system in 2013 where anyone “with a university degree and a job offer with a minimum salary of $50,000 to $64,000 a year, depending on the field” can immigrate, theWashington Post reported.

Additionally, Germany invested $609 million in a program targeting unemployed European 18- to 35-year-olds. The country pays for almost all of their assimilation including travel, language classes and accommodations during job training (though the program had to stop taking new applicants in April).

Other than occasional xenophobic incidents, the country has seen nothing but positive results of these policies. Deutsche Bank estimated that in recent years, 10% of Germany’s economic growth “can be attributed to an increase in employment of citizens from [Greece, Ireland, Portugal, Spain] and Eastern European partners.”

Meanwhile in America: On the other side of the spectrum, the U.S. continues to display an aggressive and degrading approach to the immigration issue. Particularly as the country faces what President Barack Obama has declared “an urgent humanitarian situation,” with more than 47,000 unaccompanied children that have been detained crossing the U.S.-Mexico border since October 2013.

This is how Governor Rick Perry (R-Texas) decided to respond to the flood of children fleeing their poverty-ridden and violence-laden countries in Central and South America.

And Perry, holding an automatic weapon to “protect our borders,” isn’t even the half of it. In early July, misinformed protesters — demonstrating against so-called illegals who threaten their jobs and apparently spread diseases — blocked three busloads of the detained children from going to detention centers in Murrieta, Calif.

Image Credit: ABC-10 News

It doesn’t have to be this way. In Bloomberg Businessweek, Harold Silkin outlines how a more nuanced approach to immigration reform could end up being a tremendous boon to the U.S. economy:

Filling America’s workplace needs is a huge challenge. On one end, U.S. agriculture and the food and hospitality industries seem to have an insatiable need for unskilled labor—mostly to do jobs Americans don’t want to do. This should not panic anyone. Unskilled laborers with inadequate (or nonexistent) English-language skills are not infiltrating U.S. factories, taking skilled manufacturing jobs away from American workers. Claims to the contrary are a fiction.

At the other end of the labor market are the thousands of computer, science, engineering, and other high-skill jobs U.S. employers also are having difficulty filling. This is not a new problem. It’s one of the reasons we have the H-1B visa program, which authorizes the annual hiring of up to 85,000 highly skilled (mostly technology) workers per year from overseas. In a country of 310 million, that does not an invasion make.


Final tally:
Germany’s immigration system bodes well for the country’s economy. If Germany were to tutor the U.S., they would likely point to their own policies that embrace foreigners and produce a skilled workforce that propels the economy forward. They would also highlight anti-immigrant fanaticism that consistently paralyzes immigration reform.

In late 2013, German Chancellor Angela Merkel said, “Germany today is a country that is indeed very open to immigration.” With so much success under their belts, Germany is the best model right now for immigration. The U.S. better start scheduling those tutoring sessions … we have a lot to catch up on.”

Leave a comment

Filed under Spotlights

An Idiot’s Guide to Inequality

An Idiot’s Guide to Inequality

JULY 23, 2014

Nicholas Kristof

“We may now have a new “most unread best seller of all time.”

Data from Amazon Kindles suggests that that honor may go to Thomas Piketty’s “Capital in the Twenty-First Century,” which reached No. 1 on the best-seller list this year. Jordan Ellenberg, a professor of mathematics at the University of Wisconsin, Madison, wrote in The Wall Street Journal that Piketty’s book seems to eclipse its rivals in losing readers: All five of the passages that readers on Kindle have highlighted most are in the first 26 pages of a tome that runs 685 pages.

The rush to purchase Piketty’s book suggested that Americans must have wanted to understand inequality. The apparent rush to put it down suggests that, well, we’re human.

So let me satisfy this demand with my own “Idiot’s Guide to Inequality.” Here are five points:

First, economic inequality has worsened significantly in the United States and some other countries. The richest 1 percent in the United States now own more wealth than the bottom 90 percent. Oxfam estimates that the richest 85 people in the world own half of all wealth.

The situation might be tolerable if a rising tide were lifting all boats. But it’s lifting mostly the yachts. In 2010, 93 percent of the additional income created in America went to the top 1 percent.

Second, inequality in America is destabilizing. Some inequality is essential to create incentives, but we seem to have reached the point where inequality actually becomes an impediment to economic growth.

Certainly, the nation grew more quickly in periods when we were more equal, including in the golden decades after World War II when growth was strong and inequality actually diminished. Likewise, a major research paperfrom the International Monetary Fund in April found that more equitable societies tend to enjoy more rapid economic growth.

Indeed, even Lloyd Blankfein, the chief executive of Goldman Sachs, warns that “too much … has gone to too few” and that inequality in America is now “very destabilizing.”

Inequality causes problems by creating fissures in societies, leaving those at the bottom feeling marginalized or disenfranchised. That has been a classic problem in “banana republic” countries in Latin America, and the United States now has a Gini coefficient (a standard measure of inequality) approaching some traditionally poor and dysfunctional Latin countries.

Third, disparities reflect not just the invisible hand of the market but also manipulation of markets. Joseph Stiglitz, the Nobel Prize-winning economist, wrote a terrific book two years ago, “The Price of Inequality,” which is a shorter and easier read than Piketty’s book. In it, he notes: “Much of America’s inequality is the result of market distortions, with incentives directed not at creating new wealth but at taking it from others.”

For example, financiers are wealthy partly because they’re highly educated and hardworking — and also because they’ve successfully lobbied for the carried interest tax loophole that lets their pay be taxed at much lower rates than other people’s.

Likewise, if you’re a pharmaceutical executive, one way to create profits is to generate new products. Another is to lobby Congress to bar the government’s Medicare program from bargaining for drug prices. That amounts to a $50 billion annual gift to pharmaceutical companies.

Fourth, inequality doesn’t necessarily even benefit the rich as much as we think. At some point, extra incomes don’t go to sate desires but to attempt to buy status through “positional goods” — like the hottest car on the block.

The problem is that there can only be one hottest car on the block. So the lawyer who buys a Porsche is foiled by the C.E.O. who buys a Ferrari, who in turn is foiled by the hedge fund manager who buys a Lamborghini. This arms race leaves these desires unsated; there’s still only one at the top of the heap.

Fifth, progressives probably talk too much about “inequality” and not enough about “opportunity.” Some voters are turned off by tirades about inequality because they say it connotes envy of the rich; there is more consensus on bringing everyone to the same starting line.

Unfortunately, equal opportunity is now a mirage. Indeed, researchers find that there is less economic mobility in America than in class-conscious Europe.

We know some of the tools, including job incentives and better schools, that can reduce this opportunity gap. But the United States is one of the few advanced countries that spends less educating the average poor child than the average rich one. As an escalator of mobility, the American education system is broken.

There’s still a great deal we don’t understand about inequality. But whether or not you read Piketty, there’s one overwhelming lesson you should be aware of: Inequality and lack of opportunity today constitute a national infirmity and vulnerability — and there are policy tools that can make a difference.”

1 Comment

Filed under Spotlights

Why Do Other Rich Nations Spend So Much Less on Healthcare?

Why Do Other Rich Nations Spend So Much Less on Healthcare?

 JUL 23 2014, 9:57 AM ET

“Despite the news last week that America’s healthcare spending will not be rising at the sky-high rate that was once predicted, the fact remains that the U.S. far outspends its peer nations when it comes to healthcare costs per capita. This year the United States will spend almost 18 percent of the gross domestic product (GDP) on healthcare—six percentage points more than the Netherlands, the next highest spender. Because the U.S. GDP in 2014 will be approximately 17 trillion dollars, those six percentage points over the Netherlands amount to one trillion dollars in additional spending. The burden to the average household through lost wages, insurance premiums, taxes, out-of-pocket care, and other costs will be more than $8,000.

Why does the United States spend so much more? The biggest reason is that U.S. healthcare delivers a more expensive mix of services. For example, a much larger proportion of physician visits in the U.S. are to specialists who get higher fees and usually order more high-tech diagnostic and therapeutic procedures than primary care physicians.

Compared with the average OECD country, the U.S. delivers (population adjusted) almost three times as many mammograms, two-and-a-half times the number of MRI scans, and 31 percent more C-sections. Also, the U.S. has more stand-by equipment, for example, 1.66 MRI machines per 6,000 annual scans vs. 1.06 machines. The extra machines provide easier access for Americans, but add to cost. Similarly, occupancy rates in U.S. acute care hospitals are much lower than in OECD countries, reducing the likelihood of delays in admissions, but building that extra capacity adds to cost. Aggressive treatment of very sick elderly also makes the mix expensive. In the U.S. many elderly patients are treated in intensive care units (ICUs), but in other countries they would receive only palliative care. More amenities such as privacy and space in hospitals and more attractive clinics also add to U.S. costs.

While the U.S. mix of services is disproportionately tilted toward more expensive interventions, the other OECD countries emphasize a “plain vanilla” mix. Compared with the U.S., the average OECD country has 30 percent more physician visits and more than 30 percent more hospital days per capita.

One reason for the more expensive mix in the U.S. is it produces more income for drug manufacturers, specialist physicians, and others who have considerable influence on policy. Second, some patients prefer the more expensive mix, just as some prefer to shop at Whole Foods rather than Walmart. Third, some workers mistakenly believe that employers pay for their healthcare and that more expensive means better care. Health economists believe that the premiums for employer-sponsored insurance come out of potential wages. Similarly, the extra money the government spends for health could be used for education, infrastructure, the environment, and other public investment, but these alternatives are not readily apparent or agreed upon. Does the more expensive mix result in better health outcomes? There are no definitive studies to answer this question. Superficially, it appears that the systems in the other countries are more effective because their life expectancy is higher. But their advantage may be attributable to non-medical factors such as significantly lower poverty rates.

A second important reason for higher healthcare spending in the U.S. is higher prices for inputs such as drugs and the services of specialist physicians. The prices of branded prescription drugs in the U.S. are, on average, about double those in other countries. The fees of specialist physicians are typically two to three times as high as in other countries. The lower prices and fees abroad are achieved by negotiation and controls by governments who typically pay for about 75 percent of all medical care. Government in the U.S. pays about 50 percent, which would still confer considerable bargaining power, but the government is kept from exerting it by legislation and a Congress sensitive to interest-group lobbying.

The third and last important reason for higher spending in the U.S. is high administrative costs of insurance. This includes private insurance which covers more than half the insured population. Each year scores of insurance companies must estimate appropriate premiums for plans they wish to sell to several million employers plus 20 to 30 million individuals. In addition, hospitals, clinics, and individual physicians incur substantial costs in billing for each test, visit, and procedure regardless of whether they are covered by private or public insurance or self-pay. Many of our peer countries have lower administrative costs through more coordination, standardization, and in some countries a single national system or several regional healthcare-insurance systems, even when the provision of care is primarily a private-sector responsibility.

The complexity of private-sector insurance is not in the public interest. Each company offers many plans that differ in coverage, deductibles, co-pays, premiums, and other features that make it difficult for buyers to compare the prices of different policies. For most goods and services, wider choice for consumers is assumed to contribute to well-being. In the case of health insurance, however, the fact that the customer knows more than the insurance company about his or her likely use of care results in adverse selection. If the company sets a premium based on average utilization, the company will lose money on the high users and will lose as customers those who expect to use less than the average. It is not efficient or fair to allow a family to choose a plan with generous maternity benefits when they are planning to have a baby and then switch to a plan with no maternity benefits when they are not.

If we turn the question around and ask why healthcare costs so much less in other high-income countries, the answer nearly always points to a larger, stronger role for government. Governments usually eliminate much of the high administrative costs of insurance, obtain lower prices for inputs, and influence the mix of healthcare outputs by arranging for large supplies of primary-care physicians and hospital beds while keeping tight control on the number of specialist physicians and expensive technology. In the United States, the political system creates many “choke points” for diverse interest groups to block or modify government’s role in these areas.

For those who would like to limit government control, there is an alternative route to more efficient healthcare through “managed competition,” proposed by Alain Enthoven, a Stanford University Business School Professor, more than 25 years ago. It is based on integrated group practice, which brings the insurance function, physicians, hospital, drugs, and other elements of care into a single organization that takes responsibility for the health of a defined population for an annual risk-adjusted per capita payment. Examples include the Group Health Cooperative of Puget Sound in Seattle and the Kaiser Permanente organizations in California.

Such organizations deliver high-quality care at lower costs, and some employers offer such a plan as one option, but most don’t. And even those employers that do offer a low-cost integrated group practice as an option typically pay the same percentage subsidy of premium regardless of whether the employee chooses an expensive plan or the low-cost plan. For managed competition to be most effective, employees should be required to pay the marginal excess of a high-cost plan over the low-cost plan. For one large employer who did follow this approach, 71 percent of the hourly paid men chose the low-cost integrated group practice while 63 percent of the salaried men chose one of the more expensive plans.(This statistic comes from a study in progress by Enthoven and myself.)

With regard to healthcare, the United States is at a crossroads. Whether the Affordable Care Act will significantly control costs is uncertain; its main thrust is to reduce the number of uninsured. The alternatives seem to be a larger role for government or a larger role for managed competition in the private sector. Even if the latter route is pursued, government is the only logical choice if the country wants to have universal coverage. There are two necessary and sufficient conditions to cover everyone for health insurance: Subsidies for the poor and the sick and compulsory participation by everyone. Only government can create those conditions.”

Leave a comment

Filed under Spotlights

One of the Most Brilliant AIDS Researchers in the World Died on Malaysia Airlines Flight MH17

One of the Most Brilliant AIDS Researchers in the World Died on Malaysia Airlines Flight MH17

I hurt deeply when I think of all the thoughtless violence that is happening around the world in Syria, in Russia, in Ukraine, in Israel, in Gaza, in Nigeria, in Afghanistan, in China, in North Korea, and even in the United States. All these deaths were people who could’ve made a difference in the world, who would’ve innovated and created and grown beyond their immediate surroundings. My heart goes out to the world.

Leave a comment

Filed under Spotlights

74% of Obamacare’s Biggest Haters Now Say They Actually Love It

74% of Obamacare’s Biggest Haters Now Say They Actually Love It

“Republicans love it. Three-quarters of self-identified conservatives who purchased a health insurance plan under the Affordable Care Act say they are more than pleased with their new care.

In short, Obamacare is working — even for those who railed against it.

How it’s working: Among young adults (the new law’s most important benefactors), the rate of uninsured people declined by 28%, according to a new Commonwealth Fund study. Of all of those who signed up for Obamacare (either using Medicaid or private insurance) 58% said they were better off than they were before they got their new coverage. Those with Medicaid showed their new plans the most love — 67% said they were doing better with Obamacare.

Image Credit: Commonwealth Fund

Luckily for Republicans, the new health care plans are party-blind: Less than a year after launching an all-out war against Obamacare, Republicans have turned out to be some of its biggest benefactors — at least the ones who don’t live in states where conservative leaders have blocked the law. Along a strip of the Midwest and throughout most of the South where the law is not in effect, more than a third of the lowest-income residents remain uninsured. That number has remained virtually unchanged from last year, even as millions of people in surrounding states gained coverage (many of whom for the first time). Meanwhile, in states that did participate in the expansion, the cost of Medicare has plummeted, saving the U.S. government a cool $50 billion.

Image Credit: Kaiser Family Health Foundation

Despite a rocky roll-out, 8 million Americans signed up for Obamacare since it became available in January, decreasing the number of adults without insurance from 20% to 15%.

Image Credit: Commonwealth Fund

Most adults with new coverage have used it to go to the doctor. Overall, about 80% have said they are satisfied with their purchase.

“This is yet another datapoint showing that the Affordable Care Act is basically doing what it’s supposed to do,” The Kaiser Foundation’s Larry Levitt told the New York Times.”

Leave a comment

Filed under Spotlights