[rollei_list] Re: OT - Taxes (was: Cost of LF (was: Aust...)
- From: Ardeshir Mehta <ardeshir@xxxxxxxxxxxx>
- To: rollei_list@xxxxxxxxxxxxx
- Date: Thu, 21 Apr 2005 15:31:29 -0400
Ruben,
I agree that government-provided services could be provided more
EFFICIENTLY.
However, they ARE provided more efficiently in many cases than
PRIVATELY-provided services. Take for instance medical care. There was
an article recently - which I have copied at the end of this post -
showing that privately-provided medical services such as those in the
US cost much MORE than those provided by the government - so much more,
in fact, that there's no comparison.
Likewise consider the cost of sending a letter via privately-owned
couriers compared with sending one via the government-owned and
operated post office.
And then consider the costs of privately-run schools. They are MUCH
higher than average people can afford to pay. So what is better: a
nation with a few highly educated people and lots and lots of totally
UNeducated people, or one full of people with more-or-less average
education?
As for welfare, yes, SOME people would rather be on welfare than work.
But if they were NOT on welfare they would not necessarily work,
either! They would be out on the streets, breeding crime and disease.
That is MORE expensive for society as a whole, innit.
As our NDP ("New Democratic Party") leader said a while back in our
parliament, poverty is MORE, not LESS, expensive than the lack of it -
even when one has to pay to eliminate it out of the public purse.
The cure is, as you say, more EFFICIENT running of government-provided
services. (I could help there! I used to work for quite a few years for
a consulting firm which was engaged in showing ways to increase
efficiency in both private and public organisations.)
AND, in my opinion, what is also needed is the introduction of
incentives which are NOT monetary - such as increased pleasure and
enjoyment from work. (Just give the employees a voice, and allow them
to provide solutions, and implement their solutions, and that itself
would make a big difference.)
Best of all would be DIRECT democracy. Get rid of all politicians, and
let the country be run democratically and DIRECTLY by ALL its citizens.
But that requires a high level of commitment and involvement by the
citizens.
All the same, I think Scandinavian people at least are ready for that.
(I dunno about us Canadians! Maybe not.)
Cheers.
+++++
On Thursday, April 21, 2005, at 01:28 PM, Ruben wrote:
> It is not entirely right or wrong Ardeshir
>
> we have the worlds most expensive public school in what the state use
> to pay for running it and yet it ranges like on a 75 place in results!
>
> We have one of the most expensive medical sector and yet the service
> and higenic standrs are very low while the skills of doctors etc is
> not impresive
>
> We are in a process of changin some of this because untill a few years
> back it was a better deal to be on welfare then to have a work!
>
> I am not kidding.
>
> I am interested in keeping a high standard and solidarity towards
> those who is misfortuned but I like there to be an inticamant to work.
>
> We are getting there now but it is always hard to go backwards and
> avoid people to yell WOLF
>
> Fortunatly our big labour political party has seen the writings on the
> wall - (in 20 years we will be 40% more senior citizens and 40 % less
> young people to work and pay for the welfare) so things are getting
> adjusted.
Ardeshir <http://homepage.mac.com/ardeshir>
And now, the article I was telling you about:
[QUOTE]
The Medical Money Pit
By PAUL KRUGMAN
Published: April 15, 2005
Fred R. Conrad/The New York Times
A dozen years ago, everyone was talking about a health care crisis. But
then the issue faded from view: a few years of good data led many
people to conclude that H.M.O.'s and other innovations had ended the
historic trend of rising medical costs.
But the pause in the growth of health care costs in the 1990's proved
temporary. Medical costs are once again rising rapidly, and our health
care system is once again in crisis. So now is a good time to ask why
other advanced countries manage to spend so much less than we do, while
getting better results.
Before I get to the numbers, let me deal with the usual problem one
encounters when trying to draw lessons from foreign experience:
somebody is sure to bring up the supposed horrors of Britain's
government-run system, which historically had long waiting lists for
elective surgery.
In fact, Britain's system isn't as bad as its reputation - especially
for lower-paid workers, whose counterparts in the United States often
have no health insurance at all. And the waiting lists have gotten
shorter.
But in any case, Britain isn't the country we want to look at, because
its health care system is run on the cheap, with total spending per
person only 40 percent as high as ours.
The countries that have something to teach us are the nations that
don't pinch pennies to the same extent - like France, Germany or Canada
- but still spend far less than we do. (Yes, Canada also has waiting
lists, but they're much shorter than Britain's - and Canadians
overwhelmingly prefer their system to ours. France and Germany don't
have a waiting list problem.)
Let me rattle off some numbers.
In 2002, the latest year for which comparable data are available, the
United States spent $5,267 on health care for each man, woman and child
in the population. Of this, $2,364, or 45 percent, was government
spending, mainly on Medicare and Medicaid. Canada spent $2,931 per
person, of which $2,048 came from the government. France spent $2,736
per person, of which $2,080 was government spending.
Amazing, isn't it? U.S. health care is so expensive that our government
spends more on health care than the governments of other advanced
countries, even though the private sector pays a far higher share of
the bills than anywhere else.
What do we get for all that money? Not much.
Most Americans probably don't know that we have substantially lower
life-expectancy and higher infant-mortality figures than other advanced
countries. It would be wrong to jump to the conclusion that this poor
performance is entirely the result of a defective health care system;
social factors, notably America's high poverty rate, surely play a
role. Still, it seems puzzling that we spend so much, with so little
return.
A 2003 study published in Health Affairs (one of whose authors is my
Princeton colleague Uwe Reinhardt) tried to resolve that puzzle by
comparing a number of measures of health services across the advanced
world. What the authors found was that the United States scores high on
high-tech services - we have lots of M.R.I.'s - but on more prosaic
measures, like the number of doctors' visits and number of days spent
in hospitals, America is only average, or even below average. There's
also direct evidence that identical procedures cost far more in the
U.S. than in other advanced countries.
The authors concluded that Americans spend far more on health care than
their counterparts abroad - but they don't actually receive more care.
The title of their article? "It's the Prices, Stupid."
Why is the price of U.S. health care so high? One answer is doctors'
salaries: although average wages in France and the United States are
similar, American doctors are paid much more than their French
counterparts. Another answer is that America's health care system
drives a poor bargain with the pharmaceutical industry.
Above all, a large part of America's health care spending goes into
paperwork. A 2003 study in The New England Journal of Medicine
estimated that administrative costs took 31 cents out of every dollar
the United States spent on health care, compared with only 17 cents in
Canada.
[END QUOTE]
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