Wayne Shorter--Deluge from Juju

Health Care in Taiwan

In the US we mostly hear news about Taiwan only in terms of their historical dispute with China, as in recent coverage of our proposed arms sales to Taiwan angering the Chinese. I'd like to look at a different aspect of Taiwan, one that ironically makes Taiwan more socialist in one respect than China when their dispute is typically characterized as capitalist Taiwan v. communist China.

I recently stumbled across an interview that the NY Times health care blog did with Harvard professor William Hsiao who led the panel devising health care reform for Taiwan in 1995, which was implemented with great success. The process is almost as impressive as the outcome.

At that time, 45% of Taiwanese had no health insurance. The country's first democratically elected president Lee Teng-hui created a panel to create a plan to cover them. After the initial panel had difficulty getting to a consensus, they invited Hsaio to head the panel and get things under control.

They proceeded to do a study of the health care systems of the US (insurance through employer or individually except government covers poor and elderly), UK (national health care system w/ government running insurance and care), Germany (universal coverage, mixed public and private ie. multi-payer), France (universal coverage, multi-payer), Canada (single-payer w/ private and public care), and Japan (universal coverage, multi-payer) to determine which system they would emulate.

In the end, they chose to emulate the Canadian system, single-payer with, unlike in the UK, both private and public health care delivery. Here's why:

Canada has a single-payer system with universal insurance coverage. It offers people free choice of doctors and hospitals, and it has competition on the delivery side between public and private hospitals. The quality of health services is very high, and people were very satisfied with the system from the 1980s through the mid-1990s.

President Teng-hui pushed the plan through, and it was implemented within 6 months of its passage. Remember how the Democrats' preferred health reform bills wouldn't really take effect until 2013 or 2014 because they said it would take time to set up the exchanges? Bullshit, especially when you add the Taiwan example to the fact that we implemented Medicare (another single-payer system) in 1966 just after it was passed in 1965.

Thus Taiwan's national health insurance plan became the sole payer for health care in the country with an excellent result. The country made the utmost effort to sign up everyone, even sending out people to sign up the homeless! Employers pay 60% of their workers' premiums, and workers pay the other 40% through a payroll tax, currently at 4.6%. Hsiao compares this to the 12-20% of wages that American workers pay for employer-based insurance, a hidden appropriation of which many Americans are not cognizant. The government covers the premiums completely for the poor and partially for veterans, the self-employed, and farmers.

Every citizen gets a "SmartCard" that contains their health care information and history. This, combined with the fact that in a single-payer system patients have total freedom to choose their provider (unlike in the US where insurance companies restrict patient choice of doctor and hospital), gives them flexibility to see whatever doctor they wish to. In addition, it cuts costs because it allows the claims system to be paperless.

The benefits are comprehensive. The national insurance system covers prevention, primary care, hospitalization, home care for the chronically ill (cheaper than hospitals), mental health, dental, eye care, and even traditional medicine like acupuncture and Chinese massage. Not only is this comprehensiveness totally awesome, but it practically guarantees better health care outcomes, and not just by traditional measures like life expectancy, which, as Hsaio notes, is on the rise.

It's important to note that this is socialized insurance. As I've written before, socialized health insurance lowers administrative costs while allowing for true universal coverage (as opposed to the 97% "universal" coverage that mandate-and-subsidies approach with a public option charging Medicare rates was projected to achieve here). It lowers costs by eliminating the costs of investor profit, exorbitant executive compensation, marketing, underwriting, and denying claims. Their administrative cost for insurance is 2.3% of premiums while ours fluctuates between 12-14%. Single-payer also lowers the cost for hospitals and doctors in dealing with claims from different payers. Currently Taiwan has universal coverage with health care costs at 6% of its GDP, while we have about 85% of our population covered and health care costs at 16% of our GDP (they actually jumped up to 17% last year, yikes).

The Taiwan case shows that is possible to implement single-payer and achieve universal coverage at a reasonable cost in a short time. The claim of those like President Obama that switching to single-payer would be too disruptive is total bullshit intended to avoid explaining why they don't support single-payer when it makes so much sense. Considering our problem with health care costs (the worst in the world I might add), we need structural change in our insurance system. Hsaio concludes that this is true for just about any country:

You can have universal coverage and good quality health care while still managing to control costs. But you have to have a single-payer system to do it.

So next time a liberal or leftist friend of yours threatens to move to Europe out of frustration with our government, tell them to consider Taiwan!

PS. There's much more to be gleaned from this brief interview, so watch out for a Part 2 and maybe 3.

Media Distortion of New Jobs Numbers

Here's the headline in today's NY Times: "Labor Market Shows Signs of Reawakening in New Data". True, the Labor Department's report for January says that the rate of unemployment dropped from 10% to 9.7%.

Yet in the second paragraph: "The economy shed another 20,000 net jobs during the course of month." That's a lot better than losing hundreds of thousands of jobs a month like we were at the peak of recession, but it's still a net loss of jobs. Not exactly a "reawakening."

You might ask, how did the unemployment rate drop if the economy lost jobs on the whole? Well, it turns out that the Labor Department changed how they estimate the overall population.

The report also featured a new way in which the government estimates the population, which is used to calculate the unemployment rate. That prompted some economists to dismiss the drop in joblessness as a statistical quirk.

“The message is, you can’t believe what they tell you,” said Joshua Shapiro, chief United States economist at MFR Inc. in New York. “Everyone goes crazy over today’s number, but history has been rewritten. Things are not comparable from month to month.”

So we'll see when next month's numbers out, but it's clear that the labor market isn't exactly reawakening if we're still losing jobs.

Meanwhile, my daily Financial Times email summary of the day's global news remarked that "the number of US workers claiming jobless benefits unexpectedly rose last week." Didn't see that in the Times article. Obviously a monthly time scale is a better indicator of overall trends than a weekly one, but it is another strike against the supposed reawakening. That weekly data combined with fears of sovereign debt default in Greece and elsewhere in Europe "rocked global markets" according to the FT, suggesting that investors take that data more seriously than the monthly report.

The NYT article concludes oddly enough with a quote from the great liberal economist (actually probably more of a leftist than a liberal, pretty cool that he's getting such coverage, probably has to do with the fact that he called the housing bubble), Dean Baker, that is at odds with their optimistic headline.

Things are getting bad less rapidly,” said Dean Baker, co-director of the liberal Center for Economic and Policy Research in Washington. “We’re sort of hitting bottom, but there is no evidence of a robust turnaround.”

If the media and politicians continue to trumpet about a recovery in the labor market when it's clearly not there, it lessens the chance of a serious jobs program to deal with the millions of people left semi-permanently unemployed (as the article notes, 6.3 million out of work for 6 months or more), financed through debt or taxes on the wealthy and financial sector. We need to be on the alert for a jobless recovery that will benefit capital much more than working families. Plus, given that so much of our economy is reliant on consumer spending, a jobless recovery might not end up being a recovery at all.

RIP Howard Zinn

Frankly I haven't read much by Zinn outside of a few articles and book excerpts, but he is certainly a luminary of the American left. He taught thousands of Americans our history from the perspective of the working classes and oppressed elements of our society. I hope to be one of them soon (once I finish my simultaneous projects of Marx's Capital and Dante's Divine Comedy and the next 10 books in my queue, ha).

Normally I wouldn't post about a person who I know little about, but I read a moving eulogy to Zinn by the leftist sports writer Dave Zirin on The Nation's website here that I think people will enjoy. To the end, Zinn promoted independent organizing to move our country in a more progressive direction regardless of who currently holds the reins of power. Here's Zinn on the Age of Obama:

At our event in Madison, Wisconsin, Howard issued a challenge to the audience. He said, "Our job as citizens is to honestly assess what Obama is doing. Not measured just against Bush, because against Bush, everybody looks good. But look honestly at what Obama's doing and act as engaged and vigorous citizens."

Finally, here's a Zinn quote from the article on what he sees as the need to revive the concept of democratic socialism in our country, of which, as he would know more than almost anyone, we have a beautiful tradition:

"Let's talk about socialism. … I think it's very important to bring back the idea of socialism into the national discussion to where it was at the turn of the [last] century before the Soviet Union gave it a bad name. Socialism had a good name in this country. Socialism had Eugene Debs. It had Clarence Darrow. It had Mother Jones. It had Emma Goldman. It had several million people reading socialist newspapers around the country… Socialism basically said, hey, let's have a kinder, gentler society. Let's share things. Let's have an economic system that produces things not because they're profitable for some corporation, but produces things that people need. People should not be retreating from the word socialism because you have to go beyond capitalism."

PS. Dave Zirin writes some great stuff on the intersection of sports and politics. If you are a left sports fan like myself, look for his stuff in The Nation and The Progressive among other publications.

Amy Goodman from Haiti

I know, I know, I go on streaks where I love one journalist. But Amy is at it again, on the ground in Haiti going where the mainstream media will not and raising issues that they deliberately do not.

Here's the thing about the Haiti crisis. Every mainstream media outlet talks about "instability" and potential for violence, which is supposed to justify the massive presence of more than 10,000 US soldiers. This is eerily reminiscent of the media's racist description of the Hurricane Katrina aftermath in New Orleans. The MSM always concludes that people of color who go through a natural disaster resort to looting and violence. Even so-called liberal commentators like Keith Olbermann have expressed fear that aid workers will be at risk in Haiti.

In Haiti, this racist misperception has convinced the US and the UN that soldiers must precede aid workers to ensure their "security." Of course this delays the arrival and scaling up of aid to 3 million people who desperately need it.

Pretty much everybody that Amy speaks with, from a doctor with Partners in Health, to a journalist who's worked in the country for years, to Haitians themselves, describes a rather non-violent scene. In fact, there's some fears there among Haitians and aid workers that the soldiers will provoke violence rather than quell it. All the effort that went into building up a military presence was basically unnecessary.

Meanwhile, the American military, so intent on building up its presence to create the "protection" supposedly required for aid delivery, is turning away aid coming in through the Port-au-Prince airport that it controls. Doctors Without Borders reported having a plane diverted to Santo Domingo in the Dominican Republic, from which it will take a very long time to get to Port-au-Prince over land. A representative of one Haitian aid group has stated that the US military is directly "blocking aid."

The result of militarization of the aid process in Haiti has been delays in the arrival of aid. It has directly cost Haitian lives. Unfortunately it's too late to scale back the military's presence there. Still, at this late hour our military can stop sending away aid planes in favor of continually building up the security presence.

For Haitians, the militarization of aid is even more ominous than the thousands of lives it is costing. They remember the long history of US imperialism in their country and the disastrous consequences. This includes a Marine occupation from 1915 to 1934, support for brutal rightist military dictatorships from the 1950's to the 1980's, CIA-backed coup against elected President Aristide in 1991, the re-installation of Aristide by President Clinton with the condition that he liberalize Haiti's economy, and the CIA-backed coup #2 against Aristide in 2004. These interventions have crushed resurgent democracy and impoverished the country while shunting wealth to the upper classes. Amy interview with journalist Kim Ives excellently delves into this history here, particularly the privatization of the crucial flour, cement, and telecom industries. I also highly suggest the interview with Robert Fatton that I linked to in my last post on Haiti.

My Picks for the NFL Divisional Round

I didn't have any portentous dreams last night regarding football, perhaps fortunately so. I'm left with mere logic and intuition.

Cardinals v. Saints: Cardinals

My sole upset pick. This is going to be a shootout with two of the best offenses in the league and two mediocre defenses. The Saints were so lackluster the last couple games, and I think that will carry over to this one, while old man Kurt Warner and the Cards are flying high after last week's thrilling win over the Packers (that I got wrong).

Ravens v. Colts: Colts

I'm rooting for the Ravens, but Peyton Manning is so good.

Cowboys v. Vikings: Vikings

Everybody's loving the Cowboys now, but I'm betting on the genius of Brett Favre and Jared Allen getting in Tony Romo's face a few times.

Jets v. Chargers: Chargers

The Jets have the potential to go far with their excellent running game and defense, but they've been pretty inconsistent over the season while the Chargers have been rocksteady running up to the playoffs.

Janet Napolitano Reads Arob's View

Actually probably not, but she did grant Temporary Protected Status to Haitian immigrants yesterday as I called for a few days ago. Now we'll have to see how long that lasts. As I wrote earlier this week, they should've been granted TPS after the 4 hurricanes the country suffered last year but both Bush and Obama rejected the pleas of the Haitian government. It will take years for Haiti to recover from this earthquake much less to recover to its still-desperate situation prior to the hurricanes and food crisis of 2008. In addition, the remittances that Haitian immigrants send home account for more than 25% of the country's GDP and will be crucial for recovery. The deportation of any Haitian would be injurious to the future of that country. TPS must not be rescinded for Haitian immigrants for at least several years. We who support immigrant rights and just Global South development need to be vigilant and watch out for the anti-immigrant Department of Homeland Security rescinding TPS status for Haitians too soon.

So Haitian immigrants are secure from deportation, but there's another hitch. TransAfrica Forum has called out DHS for requiring Haitians to pay $340 for a work permit, which will hamper the ability of immigrants to get a permit and start working to send money back him. Join their call to President Obama to waive that stiff fee here as well as to thank him for granting TPS.

In other Haiti news, the International Monetary Fund has offered a loan of $100 million to Haiti, a move decried by development justice groups like Jubilee USA. How the hell does the IMF expect a country as poor as Haiti to pay that money back when 30-40% of its budget is comprised of foreign aid? Any disaster aid should come in the form of grants not loans. The IMF doesn't do grants, but, fresh from its resurrection in wake of the global financial crisis, it would love to stick its ugly head in every crisis.

Haiti still has $641 million in outstanding debt to foreign nations and international financial institutions like the IMF. Every dollar that goes to servicing the debt is a dollar that could go to education, police, health care, infrastructure, etc. Instead of adding to that debt, these institutions should be canceling it so that the Haitian government can get back on its feet. Robert Naiman of Just Foreign Policy has noted that President Obama can push for that through his prestige as well as the US's voting seats on the IMF's Board of Directors. As he writes, the IMF mostly defers to the US Treasury, so Obama can manhandle them into canceling Haiti's debt if he so chooses.

Naomi Klein has been warning that the Haiti earthquake crisis is going to be an example of "disaster capitalism" a la the title of her recent book. I think this is somewhat overblown. True, much of the disaster aid will benefit non-profit and for-profit entities even as it goes to help the Haitian people. But that's unavoidable because Haiti's government is so weak and privatized already. Scant basic services were already performed mostly by aid groups before the disaster, so there is very little left to privatize. Professor Robert Fatton, an expert on Haiti at the University of Virginia, characterized Haiti back in 2004 as "probably the most open economy in the world" after US intervention and austerity programs forced by the IMF (check out the whole interview with him, great recent history of Haiti, including events running up to the CIA removing President Aristide in 2004). So even if the IMF convinces Haiti to take its loan, there's not many economic changes it can force on Haiti. I think the biggest thing to worry about is more debt getting in the way of Haiti re-building its government institutions and economy.

There are a couple things we need to watch out for in the coming months. Aid needs to take the form of grants and direct help and not loans. Initially these grants need to go to basics like food, shelter, emergency medical care, etc. Over time the focus must shift to building up the Haitian government. Also aid needs to go to agriculture or the country will persist in a permanent food crisis. As Haiti's markets were forcibly opened up by US and IMF mandate, subsidized US rice put most of Haiti's ag sector out of business. For the past two decades, US policy towards Haiti has been aimed at making it a home for multinational corporation export factories and little else. This is an opportunity to change that policy and help Haiti work for a more balanced and sustainable economy that benefits the broader populace instead of just the elite factory owners and landholders.