I came across a great blog post on the NY Times about Rwanda's national health insurance system. It gives a great, succinct background of where the country was beginning from (basically, rubble) to where it is now with its VOLUNTARY (i.e., opt-in) national health insurance scheme (called mutuelle) that has had amazing health outcomes over the last 9 years, since it was launched nation-wide.
Malaria — a major killer of children — is also now treated. “People were waiting for a long time to go and access care because it was very expensive,” said Makaka. A clinic visit before was 5,000 francs — about $8.30. “By the time they accessed care malaria became so severe some lost their lives or became disabled.” Today, malaria is usually diagnosed by a community health worker. She can give the first dose of an effective medicine right away, then send the patient to a health clinic for a visit that will cost a maximum of 33 cents.
The increase in clients and the payments from Mutuelle they bring has transformed hospitals. Without income, hospitals couldn’t pay doctors or buy equipment. Now that hospitals can pay, doctors and nurses are moving from cities to the countryside. “Before there was a marked concentration in cities,” said Makaka. “Now there’s equitable distribution across the nation.”
As the President (that is still so cool!) prepares to work with Congress to fix the US' terrible health care system, we Americans abroad have begun our own work to help all our representatives (even the Republican ones... yeah, I'll own John Campbell) back home in the fight over a single-payer system at best and, at worst, at least a public option.
Below are the two email versions I sent to Senator Diane Feinstein, Senator Barbara Boxer, Representative John Campbell, and, my boy, POTUS (the letter was too long for the White House online email system, so I sent it snail mail and said a response via email was fine). I slightly altered the one I sent to my US Rep because he's a Republican and I didn't think touting my Dem street cred would do much to help me there. Please feel free to take these as inspiration for your own emails to your representatives in Congress. My only requirement is that if you use either of these letters, please let me know.
To The Democrats:
Dear [Democrat's Name],
I am writing to you to discuss the necessity of including a single-payer option in the health care debate (and, hopefully, solution), or, at the very least, a public option.
I grew up in California, but have been fortunate enough to live overseas for a short time in my childhood and for half of my adult life. Having personally experienced the health care systems in the US, France, and Japan (as an adult, responsible for my own health care programs, insurance, doctor/hospital choices, etc.), I can say without question or doubt in my mind that having a single-payer system is the best possible option for the American people. I have had surgeries and hospital stays in the US and Japan, I have visited doctors and specialists in all three countries, I have PAID for insurance in all three countries, and in each of these cases, I assure you that the United States' health insurance and health care system has come in as the least user-friendly, least wallet-friendly, and, most importantly, least available and accessible.
I currently live in Japan (but am registered to vote, and exercise that right, from overseas). Here, I have access to not only the top doctors and hospitals in the country, but these doctors also speak English and their organizations have tie-ins with several major American medical institutions (including Johns Hopkins Medicine International). So, for the cost of about $XXXX per year (an amount based on my income level), I have insurance that I know can never be rescinded; access to almost any doctor in Japan (there are a small number of doctors who cater almost exclusively to the typical expat community, most of whom have private insurance); pay only 30% co-pay (the final amount of which is usually not very much because of the negotiated rates between the government and health service providers) on doctor visits, dentist visits, hospital stays, and prescriptions; and have the comfort of knowing that, no matter how bad my medical condition might be, I won’t have to worry about it also causing debilitating debt.
My family back in the States is struggling with the costs of their individual insurance and I, myself, am afraid to let the costly individual insurance (more than twice what I pay in Japan for far inferior coverage) I have maintained back in the States lapse for fear of never being able to qualify again when I return home. For the time being, I do, in a sense, feel trapped outside the States, unable to return home because of the exorbitant costs as well as the uncertainty of American insurance coverage.
I have been a registered Democrat since the day I turned 18 and was raised in a proud Democrat household. I have voted Democrat in every election I’ve ever participated in. I am very active in Democrats Abroad in Japan—I work closely with our country committee chair, the Asia-Pacific regional chair, and as Chair of the Young Democrats Abroad Japan group. One of the reasons I have stood by the party and my elected officials all these years and worked so tirelessly to register Americans abroad to vote from overseas last year is because I care so much about the lives and well-being of my fellow citizens and I have always believed that the Democrats have the best plans to achieve the best possible quality of life for Americans. However, living overseas, I have come to learn that access to reliable, affordable, quality healthcare is not a privilege, but a right. Without a single-payer option, the United States Congress and President are letting down their constituents, their neighbors, their family members, their friends… all Americans.
The positive consequences of a single-payer system extend beyond just Americans’ every day lives and health needs. How productive could our country be if people didn’t need to choose between paying the electricity bill and paying their insurance premium? How much more could we contribute to innovation and the global economy if every man, woman, and child in American was assured of their access to a doctor without the risk of being overwhelmed by the costs of such a visit? How much more secure would we be if the people charged with overseeing our airports, seaports, and other entry points didn’t need to worry about a loved one’s illness either bankrupting their family’s coffers or, worse yet, not even being able to get their child the best care because of prohibitively costly fees?
I work at the research arm of the Asian Development Bank in Tokyo and so, through my job, have the opportunity to see the difference developed infrastructure systems can make for economic growth and productivity. Health care is a form of soft infrastructure that is woefully lacking in most of my organization’s member countries. The United States is one of the most developed countries in the world, if not the most developed, and, yet, when it comes to our health care system, we are sadly lagging behind other industrialized countries, putting us at an economic and political disadvantage (Because what besides our health can affect the other parts of our lives so completely?) not only vis-à-vis our developed economic competitors, but even in terms of our competitors in emerging markets.
I urge you, in this letter and with my vote, to support a single-payer health care system in the upcoming behemoth of a debate over how to right this too long-standing wrong. Please take courage, comfort, and support in knowing that there are thousands of other Californians overseas who have shared my experience and who also support a single-payer system.
If you would like to hear specific stories about the health care experiences of Americans overseas, please stop by the blog Americans Abroad Know About National Health Care (http://healthcareforamerica.blogspot.com/).
Thank you for your hard work representing Californians… wherever in the world they might be.
Very sincerely yours, XXXXXX
To The Republican:
Dear [Republican's Name],
I am writing to you to discuss the necessity of including a single-payer option in the health care debate (and, hopefully, solution), or, at the very least, a public option.
I grew up in California, but have been fortunate enough to live overseas for a short time in my childhood and for half of my adult life. Having personally experienced the health care systems in the US, France, and Japan (as an adult, responsible for my own health care programs, insurance, doctor/hospital choices, etc.), I can say without question or doubt in my mind that having a single-payer system is the best possible option for the American people. I have had surgeries and hospital stays in the US and Japan, I have visited doctors and specialists in all three countries, I have PAID for insurance in all three countries, and in each of these cases, I assure you that the United States' health insurance and health care system has come in as the least user-friendly, least wallet-friendly, and, most importantly, least available and accessible.
I currently live in Japan (but am registered to vote, and exercise that right, from overseas). Here, I have access to not only the top doctors and hospitals in the country, but these doctors also speak English and their organizations have tie-ins with several major American medical institutions (including Johns Hopkins Medicine International). So, for the cost of about $XXXX per year (an amount based on my income level), I have insurance that I know can never be rescinded; access to almost any doctor in Japan (there are a small number of doctors who cater almost exclusively to the typical expat community, most of whom have private insurance); pay only 30% co-pay (the final amount of which is usually not very much because of the negotiated rates between the government and health service providers) on doctor visits, dentist visits, hospital stays, and prescriptions; and have the comfort of knowing that, no matter how bad my medical condition might be, I won’t have to worry about it also causing debilitating debt.
My family back in the States is struggling with the costs of their individual insurance and I, myself, am afraid to let the costly individual insurance (more than twice what I pay in Japan for far inferior coverage) I have maintained back in the States lapse for fear of never being able to qualify again when I return home. For the time being, I do, in a sense, feel trapped outside the States, unable to return home because of the exorbitant costs as well as the uncertainty of American insurance coverage.
Living overseas, I have come to understand that access to reliable, affordable, quality health care is not a privilege, but a right. Without a single-payer option, the United States Congress and President are letting down their constituents, their neighbors, their family members, their friends… all Americans.
The positive consequences of a single-payer system extend beyond just Americans’ every day lives and health needs. How productive could our country be if people didn’t need to choose between paying the electricity bill and paying their insurance premium? How much more could we contribute to innovation and the global economy if every man, woman, and child in American was assured of their access to a doctor without the risk of being overwhelmed by the costs of such a visit? How much more secure would we be if the people charged with overseeing our airports, seaports, and other entry points didn’t need to worry about a loved one’s illness either bankrupting their family’s coffers or, worse yet, not even being able to get their child the best care because of prohibitively costly fees?
I work at the research arm of the Asian Development Bank in Tokyo and so, through my job, have the opportunity to see the difference developed infrastructure systems can make for economic growth and productivity. Health care is a form of soft infrastructure that is woefully lacking in most of my organization’s member countries. The United States is one of the most developed countries in the world, if not the most developed, and, yet, when it comes to our health care system, we are sadly lagging behind other industrialized countries, putting us at an economic and political disadvantage (Because what besides our health can affect the other parts of our lives so completely?) not only vis-à-vis our developed economic competitors, but even in terms of our competitors in emerging markets.
I urge you, in this letter and with my vote, to support a single-payer health care system in the upcoming behemoth of a debate over how to right this too long-standing wrong. Please take courage, comfort, and support in knowing that there are thousands of other Californians overseas who have shared my experience and who also support a single-payer system.
If you would like to hear specific stories about the health care experiences of Americans overseas, please stop by the blog Americans Abroad Know About National Health Care (http://healthcareforamerica.blogspot.com/).
Thank you for your hard work representing Californians… wherever in the world they might be.
Very sincerely yours, XXXXXX Image source originally Air America.
Editor's note: Yeah, um, same problem with this post as with the last. Sorry, I think my brain took an unauthorized leave of absence from February 'til now.
I so agree with the ideas expressed in this Op-Ed in the New York Times that I'm going to just reproduce the piece in it's entirety here. And add this: Ditto.
Please Raise My Taxes
By REED HASTINGS
Published: February 5, 2009
Los Gatos, Calif.
I’M the chief executive of a publicly traded company and, like my peers, I’m very highly paid. The difference between salaries like mine and those of average Americans creates a lot of tension, and I’d like to offer a suggestion. President Obama should celebrate our success, rather than trying to shame us or cap our pay. But he should also take half of our huge earnings in taxes, instead of the current one-third.
Then, the next time a chief executive earns an eye-popping amount of money, we can cheer that half of it is going to pay for our soldiers, schools and security. Higher taxes on huge pay days can finance opportunity for the next generation of Americans.
Clearly, the efforts over the past few decades to control executive compensation haven’t accomplished much. Improved public disclosure was supposed to shame companies into lowering salaries, and it obviously hasn’t worked. In 1993, President Bill Clinton changed the tax law to effectively cap executives’ salaries at $1 million a year, but that simply drove corporate boards to offer larger bonuses and stock options to attract and keep talent. More recently, “say on pay” proposals would have shareholders opine on their boards’ compensation decisions, but “say and pay” won’t change the fact that luring a top executive away from another company is never easy or cheap.
The reality is that the boards of public companies hate overpaying for anything, including executives. But picking the wrong chief executive is an enormous disaster, so boards are willing to pay an arm and a leg for already proven talent. Putting limits on the salaries at public companies, or trying to shame them into coming down, won’t stop this costly competition for talent.
Of course, it’s galling when a chief executive fails and is still handsomely rewarded. But with the concept of “tax, not shame,” a shocking $20 million severance package would generate $10 million for the government. That’s a far better solution than what we have today, not least because it works with the market rather than against it.
Another advantage is that it would also cover the sometimes huge earnings of hedge fund managers, star athletes, stunning movie stars, venture capitalists and the chief executives of private companies. Surely there is no reason to focus only on executives at publicly traded companies.
This week, President Obama proposed imposing a $500,000 compensation cap on companies seeking a bailout. It’s a terrible idea. We all want the taxpayers’ money returned, and capping compensation at bailout recipients will just make it that much harder for those boards to hire and hold on to the executives who can lead their companies to compete and thrive.
Perhaps a starting place for “tax, not shame” would be creating a top federal marginal tax rate of 50 percent on all income above $1 million per year. Some will tell you that would reduce the incentive to earn but I don’t see that as likely. Besides, half of a giant compensation package is still pretty huge, and most of our motivation is the sheer challenge of the job anyway.
Instead of trying to shame companies and executives, the president should take advantage of our success by using our outsized earnings to pay for the needs of our nation.
National health care is gearing up to be a big issue in the coming election. As someone who has experienced the health care systems in the States, France, and Japan, I can tell you without hesitation nor exaggeration that the Universal, Nationalized health care system is the best option. How that program is structured varies country to country, but ultimately the sense of security that guaranteed access to affordable health care that comes with nationalized health care is something whose value cannot be over-emphasized.
To get a more thorough (and more interesting) idea of what I'm talking about, check out PBS Frontline's series "Sick Around the World," which explores universal health care systems in five different countries (including Japan). Props to PBS for making the whole series available to watch online for free. Thanks, PBS!
Also, you've probably at least heard of Michael Moore's "Sicko." If you haven't seen it (and I was reluctant to - as much as I love his movies, they can a be a bit much), you absolutely must. The final part of the movie that takes place in Cuba is heart-wrenching and should put all Americans to shame. I cried tears of shame, sadness, and despair mixed with hope: Is there nothing that can help to change America's system for the better? Do so many Americans care so little for others that they don't see the value in providing sufficient basic health care for all of us? What about just covering the basics of those who need and/or deserve coverage the most: kids, veterans, and the elderly. What hope is there for any progress?
I know it's depressing, but it doesn't have to be. It can be a call to action and for change. Support universal health care measures.
And if you're a Californian, vote for any ballot initiative the Governator puts forward that will give people a taste of the benefits of universal coverage, even if it's just for kids. Once people have got a taste for it, they'll see the benefits.
Finally, Democrats Abroad Japan Secretary Linda Gould is in the process of organizing an information campaign that lets us Americans abroad share our real-life experiences with national health care with the Americans back home. Here's a video she did recently that will give you an idea of why I'm such a supporter of universal health care.
