With US Health Law Debate at Supreme Court, A Look at the State Of Global Health Care (REPORT)

(Video BNBalenda)

(HN, March 27, 2012) - As the US Supreme Court takes up a controversial healthcare reform bill - the signature campaign issue of President Barack Obama's 2008 election promises - the fate of US citizens healthcare system remains in the hands of just 9 people.  

After two days of hearings at the high court where lawyers on both sides are presenting arguments, the Justices appear closely divided along ideological lines with the majority of questions to the Obama administration's lawyer being about whether Congress had the power to require people to buy medical insurance; the main sticking point of the law.

The court will hear a third and final day of arguments on Wednesday. 26 of the 50 states and a small-business trade group are challenging a law they say would essentially define where the limits would be on US federal power if people opposed to insurance were forced to buy coverage.

The court's ruling on the insurance requirement, which takes effect in 2014 according to current law passed by the US Congress in 2010, could decide the fate of the massive multi-part healthcare overhaul meant to improve access to medical care and extend insurance to more than 30 million Americans.

Outside the venerable Washington, DC courthouse, thousands of people demonstrated for and against the law which many in US politics call "Obamacare".  After the three day presentations, the Court is scheduled to take some time, and release its decision on whether or not the law is constitutional sometime in late summer; making the healthcare issue a central campaign theme again in November 2012 US presidential election. 

A hard fought US Republican candidate race has been playing out for months between former US state of Massachusetts Governor Mitt Romney, former US House of Representatives Speaker Newt Gingrich, former US Senator Rick Santorum, and US Congressman Ron Paul - all of whom have significant professional experience with the healthcare issue.

But for the US public, the physicians community, and the American insurance industry the delay in deciding where the healthcare system is going is troubling and for many, means the - expensive - difference between life and death. 

(GRAPH: NatGeo 2007 table showing relationship between health care costs, life expectancy) The United States spends more on medical care per person than any country, yet life expectancy is shorter than in most other developed nations and many developing ones. Annual U.S. healthcare spending totals $2.6 trillion, about 18% of the annual GDP, or $8,402 per person according to the US Department of Health and Human Services.

A New York Times/CBS News poll showed that a narrow majority of Americans oppose the individual mandate, 51% to 45%, but strongly supported other provisions of the law covering pre-existing medical conditions and allowing young adults to stay on their parents' health insurance plans. Roughly 15% of Americans lack insurance coverage, a factor in life span which contributes to an estimated 45,000 deaths a year.

HEALTHCARE IN OTHER COUNTRIES

In other countries, the decision to create a universal or government supported health care system has been an easier one, long decided upon.

32 of the 33 developed nations of the world have universal health care, with the United States being the lone exception. The following list, compiled from World Health Organization sources, shows the start date and type of  system used to implement universal health care in each developed country; and a `universal health care plan' can mean having both public and private insurance and medical providers.

(GRAPH: Blue countries have a government health system, green going there, orange 2-tier/WHO)These are in order of date of system:  Norway, 1912, Single Payer; New Zealand, 1938, Two Tier; Japan, 1938, Single Payer; Germany, 1941, Insurance Mandate; Belgium, 1945, Insurance Mandate; United Kingdom, 1948, Single Payer; Kuwait, 1950, Single Payer; Sweden, 1955, Single Payer; Bahrain, 1957, Single Payer;  Brunei, 1958, Single Payer; Canada, 1966, Single Payer; Netherlands, 1966, Two-Tier; Austria, 1967, Insurance Mandate; United Arab Emirates, 1971, Single Payer; Finland, 1972, Single Payer; Slovenia, 1972, Single Payer; Denmark, 1973, Two-Tier; Luxembourg, 1973, Insurance Mandate; France, 1974, Two-Tier; Australia, 1975, Two Tier; Ireland, 1977, Two-Tier; Italy, 1978, Single Payer; Portugal, 1979, Single Payer; Cyprus, 1980, Single Payer; Greece, 1983, Insurance Mandate; Spain, 1986, Single Payer; South Korea, 1988, Insurance Mandate; Iceland, 1990, Single Payer; Hong Kong, 1993, Two-Tier; Singapore, 1993, Two-Tier; Switzerland, 1994, Insurance Mandate; Israel, 1995, Two-Tier.

System Types:

Single Payer: The government provides insurance for all residents (or citizens) and pays all health care expenses except for copays and coinsurance. Providers may be public, private, or a combination of both.

Two-Tier: The government provides or mandates catastrophic or minimum insurance coverage for all residents (or citizens), while allowing the purchase of additional voluntary insurance or fee-for service care when desired. In Singapore all residents receive a catastrophic policy from the government coupled with a health savings account that they use to pay for routine care. In other countries like Ireland and Israel, the government provides a core policy which the majority of the population supplement with private insurance.

Insurance Mandate: The government mandates that all citizens purchase insurance, whether from private, public, or non-profit insurers. In some cases the insurer list is quite restrictive, while in others a healthy private market for insurance is simply regulated and standardized by the government. In this kind of system insurers are barred from rejecting sick individuals, and individuals are required to purchase insurance, in order to prevent typical health care market failures from arising.

---HUMNEWS, with research from WHO, Wikipedia, NatGeo.

Hillary, Stoves Won’t Save the World (PERSPECTIVE)

By Jennifer Lentfer

(HN, Novermber 12, 2011) - "Hillary Clinton unveils initiative on clean cooking stoves," was among last year’s highlights at the Millennium Development Goals Summit. But what has become of The Global Alliance for Clean Cookstoves a year later? A system of cooking typical in many African villages. Credit: CETRUD

Climate change, deforestation, global health, and women’s empowerment remain extremely important issues to address. And I remain extremely wary of any products manufactured in the developed world that are touted, marketed, or delivered to “make life better” for poor people in the developing world.

I have worked for many years supporting a local, community-based organization operating in Kasese, Uganda, The Center for Environment Technology and Rural Development. They have been helping women build safer and more environmentally sound stoves with locally available materials in the Rwenzori region for years.

In their own words,

“Cooking with three stones has been common in rural areas of Uganda. But in the villages where our programs are located, CETRUD has helped women who cook the meals for their families through the building of appropriate and safer cooking stoves. This saves wood and provides relief to women, and often their small children, who suffer constant smoke inhalation. Cooking stoves improve general health, save time, and reduce the amount of wood used.”

The New Yorker featured the Aprovecho Research Center’s 10^th annual Stove Camp in Oregon, which they described as a “kind of hippie Manhattan Project” of the “small but fanatical world of stovemakers.” Despite recent publicity among policy wonks and donors, several designs for improved cook stoves have been developed and successfully utilized in the developing world using locally available materials such as clay, mud, concrete, sheet metal, or tile. Local efforts also have the flexibility and responsiveness to address environmental conditions and community needs more directly than any global alliance can.

This is why the United States’ $50 million commitment was met by me with a deep sigh, disappointment, and skepticism, Julia Roberts-endorsed or not. Taking exception to newly-hyped technological ideas that will “save the world” can be unpopular. In fact, a fellow international do-gooder once criticized my view as an “a priori xenophobic dismissal of the intentions and products of rich-world technological intelligence.”

Rather, my concerns are based on wanting to ensure that any efforts to improve people’s lives in the developing world are first based on the locally available resources, before creating additional dependency on outside “expertise,” supplies, or technology. My concerns also include wanting to avoid undermining local economies and local organizations, especially if products such as these are delivered through traditional funding mechanisms, with each layer of bureaucracy taking its share.

On this World Pneumonia Day and beyond, Clinton and other thought leaders in the international aid sector need to take a more responsible approach to throwing their support behind “solutions” such as these. The media must also stop portraying foreign assistance as a kind of ever-elusive, arrogant search for a single, magic "silver bullet” to solve poverty. Instead, let us all focus on putting real resources behind local initiatives and means of overcoming obstacles in the developing world.

Despite whatever trend comes next from the policymakers, development experts, and donors, skilled and experienced people working on the ground know that no technological initiative in and of itself can offer the full answer to complex problems in the developing world. As former Clinton crony, Al Gore, reminds us in his movement to stop global warning, “It’s not a silver bullet, it’s silver buckshot."

Lentfer is a blogger at how-matters.org, a blogsite aimed at raising the level of human dignity within development assistance and putting real resources behind local means of overcoming obstacles. Serving with various international organizations over the past decade, she has worked with over 300 grassroots groups in sub-Saharan Africa. This post was based on one that originally appeared at: http://www.how-matters.org/2010/09/21/hillary-stoves-won’t-save-the-world/   

Watch this video on cookstoves by the Global Aliance for Clean Cookstoves: