WE ARE MOVING TOWARD A NEW KIND OF GROWTH
(From Tor Dahl & Associates – www.tordahl.com)
The industrial revolution started with James Watt’s invention of the commercially viable steam engine in 1776.
Over the roughly one million years of human development, the industrialage constitutes only 233 years. Were we to force that time span into 24hours, we would only have been industrialized for 20 seconds.
In nature, it seems that everything either grows or dies. But nature is not simple. Farmers know that for a field to regenerate, it must be allowed to fallow. For the farmer, fallowing forsakes current income in order to produce higher future yields. That is actually a definition of investment. The problem is that we confuse no-growth fallowing with lack of progress – because continuous growth has also become synonymous with progress in the public mind.
But much happens during fallowing. Farmers plow the ground so that weeds can be brought to the surface and removed and the soil structure improved so that it can better absorb water and nutrients. Earthworms enrich the soil, microorganisms flourish, and when the fallow field is planted again, rising yields more than compensate for the pause.
For 235 years, we have harvested more from the Earth than we did over the entire period prior to the industrial revolution. We have learned some important lessons from that experience:
1. Not all growth is good for us.
There used to be abundant water, abundant breathable air, abundant fisheries, and abundant energy for our daily needs. New scarcities have emerged relating to groundwater, fossil fuels, world fisheries and recently, world harvests. And in many cities, breathable air is still lacking.
2. New scarcities emerged because we have been consuming beyond our means.
Starting in 1973 growth in wages fell below our growth in consumption. Household debt between 1973 and today increased 13 times, government’s debt increased 20 times, but wages grew by only 1.86 times. We became overextended, and the only way to finance the debt was by hoping for continual increases in the prices of the assets that we had acquired at a time when we thought we could afford them. The private savings rate turned negative in 2005. Asset prices entered a free fall in 2007: Prices of housing, stocks and commodities all dropped dramatically.
3. The economy was like a field that had been exploited without pause.
To meet our needs, we even consumed part of the seed corn: What we should have invested, we consumed. A real field is restored through fallowing. So is the real economy. The pause that is now imposed on us forces the regeneration that is needed.
How does a real economy fallow?
We see it all around us: People cook at home instead of eating out. People are going to the library again. People are staying home rather than vacationing in distant and expensive places. People are repairing their shoes, mending their clothing, remodeling their homes, going for walks, shopping at local farmers’ markets, attending school at night, staying healthy, postponing cosmetic surgery – maybe canceling it altogether.
But does not all this make us poorer?
No. The Gross National Product is a poor measure of our wealth. Theearly economists measured our wealth in satisfaction, and satisfaction in the U.S. peaked in the fifties. Beyond the necessities of food, clothing, shelter, education and health, satisfaction does not increase with additional wealth accumulation. In fact, our current stress and insecurities largely stem from the very possessions we accumulated at a time when we lived beyond our means.
What is the New Growth referred to in the headline?
It will be a shift of focus from investing to meet human needs rather than human wants. There is no limit to human wants. Human needs, however, signal when they are met. Meeting these needs often doesn’t cost any money.
So – what are the human needs that also increase human capital? How can we improve our yield of life satisfaction by forsaking excessive consumption?
The first priority is to increase our ability to contribute both to the satisfaction of others and to that of ourselves. This could happen through serving as volunteers in organizations we support, learning new skills, teaching others the skills we have, and helping people in need. Then, take care of our own health so that we do not become a burden to others: A healthy diet, long walks, attending to weight and blood pressure, and dropping unhealthy habits would all do wonders for our health.
Keep in mind that the eternal scarcities are time, space and human interaction. An economist’s advice to you would be to allocate your time so that it maximizes satisfaction with life, organize your space so it is not an obstacle to what you need to live, and be with people who make you happy.
None of this is measured and included in the GDP. We have only the vaguest idea of how much human capital we add to our collective wealth each year. But we know it when we are investing in our own human capital.We know it, because we see how we can contribute more, how we can help more, and how we can build a richer community life.
One day some bright scientist will find a good way of measuring our increased capacity, our increased human capital, and make it visible to all.
In the meantime, let the economy fallow for a while. Let us bring back the sense of security of living within our means. For those who may be laid off for awhile: Rethink what you most would like to do on this Earth. Then start it. You will find a way. And for all the rest:
Find out how you can help!
During World War II, Norwegians were healthier than ever. They could not buy tobacco, and sugar was in short supply. Refined flour was severely rationed. But the ocean teemed with fish, vegetable gardens flourished on city lots, and people picked fruit and berries to preserve them for the long winters.
We certainly had become poorer measured in money. But I cannot recall a time when the community was more united, friendships and will to sacrifice were stronger, and ingenuity in making do with what we had was more prevalent.
Now Norway is one of the richest countries in the world in per capita income. Norway also has no government debt and owns the third largest sovereign fund in the world. What could they work on now in that beautiful and well-run country? Well, Norway ranks No.27 in freedom, No.9 in safety, No.12 in justice, No.13 in competitiveness, and No.19 in happiness compared to other nations.
It is a challenging agenda to make every citizen freer, safer, more justly treated, more competitive, and happier. Economists can estimate the wealth increase that will follow from moving forward all these areas, except maybe happiness.
Happiness is elusive. It is summoned by reaching out rather than turning inward. What we do for others is more strongly satisfying than what we do for ourselves. From an evolutionary perspective, that is what helps us survive as a species – whether it is barn raising on the North Dakota prairie or fighting disease in Africa.
In our final hours we are not likely to focus on our possessions – we shall probably think about what made our lives richer and more fulfilling. We shall remember those moments when we experienced what Thomas Hood described as ‘a happiness that made the heart afraid’. We shall visit memories of both happiness and sorrow, both victories and defeats, and we might ponder how we could have lived an even better life.
But if we have learned, and grown, and loved, and contributed, I know the feeling we would all have: What a splendid ride! What a glorious life!
But why did life put us through all these tests before we had learned life’s lessons? And could we not have learned those lessons before we faced the tests?
I think we could have. That is precisely what would have changed our lives, and the world, for the better.
How about acting on life’s lessons now? Before it is too late?
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HEALTH CARE REFORM/DENTAL CARE REFORM?
We have been hearing and reading about health care reform. I was talking to a ‘wise old man’ the other day and he stated that dental care is critically important to overall physical health care but it appears costs are escalating to the point that people cannot afford to ‘pay upfront’ for dental services so dental care is ignored.
Over 47 million are without health care insurance so over 47 million are without dental insurance. Millions more have health care insurance but do not have dental insurance.
Do we need to begin to think about DENTAL CARE REFORM ?
(you will hear more from the ‘wise old man’ in the near future-an engaging thought provoking individual)
MN Requirements for Electronic Health Care Remittance effective December 15, 2009
| New state requirements for standard, electronic health care remittance advices effective Dec. 15 |
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(from Minnesota Medical Group Management Association) Exchanges between Minnesota health care payers and providers must be done electronically; reforms are part of effort to save $60 million annually
As of Dec. 15, health care group purchasers (payers) and providers in Minnesota must exchange remittance advices electronically, using a single, standard data content and format. The requirement is part of a first-in-the-nation law that state officials say will help save millions of dollars in health care administrative costs each year.
The requirement focuses on the electronic exchange of remittance advices, or RAs, which payers send to providers to explain the payment, adjustment or denial of billings. Earlier this year, Minnesota implemented similar requirements for the electronic exchange of other information between payers and providers, including health care billing claims and queries to confirm patients’ health coverage and benefit levels.
The Minnesota Department of Health (MDH) estimates that when fully implemented, Minnesota’s law requiring the standard, electronic exchange of these three types of routine health care business transactions will save the state’s health care system more than $60 million per year.
The requirements are part of Minnesota’s Vision, a set of broader statewide health reforms that aim to improve the health of all Minnesotans, the individual patient experience and the affordability of health care. “Electronic RAs will reduce the amount of paper flowing in the system and speed up millions of routine transactions to help reduce overall health care administrative costs and burdens,” said James Golden, MDH Health Policy Division director and the state’s health information technology coordinator.
The law applies to insurance carriers, including workers’ compensation, auto and property-casualty carriers, as well as third-party administrators that are licensed or doing business in Minnesota. The regulations also apply to HMOs, the Minnesota Department of Human Services, which administers the state’s Medical Assistance and MinnesotaCare programs, and other payers.
In addition, the law covers over 60,000 health care providers, including doctors, hospitals, dentists, chiropractors, pharmacies and others providing services for a fee in Minnesota and who are also otherwise eligible for reimbursement under the state’s Medical Assistance program.
For further information about Minnesota’s statewide health care e-billing initiative please go to www.health.state.mn.us/asa or contact the Minnesota Health Information Clearinghouse at 1-800-657-3793, or health.clearinghouse@state.mn.us. |
A SUMMARY OF HEALTH CARE IN OTHER COUNTIES
Belgium: Has a compulsory health care system based on the social insurance model. Patients have free choice of provider, hospital, and sickness fund. A comprehensive benefit package is available to 99% of the population. The federal government regulates and supervises all sectors of the program. It is financed through employer and employee contributions.
Canada: Known as the Canada Health Act, it is Canada’s federal legislation for publicly funded health care insurance. Its aim is to ensure that all eligible residents of Canada have reasonable access to health services on a prepaid basis, without direct charges at the point of services. It is comprehensive in its coverage, insisting that a province or territory must cover all insured health services provided.
Japan: Has a system of universal health coverage, however, there are criteria to how it is applied to any given individual. The factors are whether or not the person is working, visiting or a student, and age. There are two main systems and both have different subcategories. Basically, there is the National Health Insurance or there is the Employees’ Health Insurance. One must belong to one plan or the other.
France: Health system is an important aspect of the French social security program. As a result, everyone received protection through the program, regardless of age, gender, income, or state of health. In some cases, the person pays a part of the charges out of their pocket, but in the case of the needy, they pay nothing. The program is financed by employer and employee contributions.
Italy: Has a governmental medical service, which encompasses all citizens. There are three tiers to the program: national, regional and local. The program if financed through public resources (37.5%), employer (48.8%), and the balance from private payments.
Austria: Guarantees medical treatment in case of illness or accidents, if not covered by the accident insurance. While there are 94 insurers, they are not allowed to strive for profit. Every person has to be insured. It is based on the American system of managed care.
Britain: Put in place more than 50 years ago (after WWII), all citizens are entitled to have access to health care. Medical treatment by a doctor is free, with no co-pays or deductibles. Citizens can also choose a private insurance plan. More that 70% of the financing is paid through taxes.
Denmark: State-run health system. All financing, planning and management are fully subject to the authorities. The services area financed through taxes, and there is only one legal state-run insurance.
Germany: Has a system of compulsory health insurance companies that are responsible for compulsory health insurance, and are considered public corporations. Decisions are made by legislation. Everyone gets the same benefit.
Switzerland: Guarantees medical treatment for illness or accident, unless covered through accident insurance. Program is similar to Austria.
PLEASE COMMENT IF YOU HAVE VALUE-ADDED RESPONSE TO INFORMATION LISTED FOR A SPECIFIC COUNTRY
HEALTH CARE REFORM? NOT REALLY
FDR wanted health care reform but decided social security was a more important issue. Since the time of the FDR administration, multiple attempts have been considered related to health care reform resulting in many ‘minor’ adjustments to address issues (DRG’s anyone?). Unfortunately, no substantial beneficial change occurred that would benefit the citizens of the United States of America.
We are now in a position, decades later, to see substantial change regarding America’s ability to provide access to health care for all citizens – or perhaps we were in a position to see positive change. Suddenly we are reading about issues that are not focused on health care reform or reform of the insurance industry. We are now reading not about a ’public option’ to allow all citizens to be covered, but a watered down ‘public plan,’ but private insurers – not the government – would offer coverage. We are now reading not about coverage for pre-existing conditions, but an amendment to restrict insurance coverage of abortion. We are now reading not about coverage for elderly, but reductions in medicare/medicaid services. We have lost our focus.
Perhaps it is the hope of some to get ’something’ passed and begin cleaning it up in future years. Perhaps it is the greed and ethical lapse in corporate American that has been transferred like a virus to the leadership in the United States Congress to place party ideology before the concerns of citizens of the United States. Former Vice-President Hubert H. Humphrey noted that the moral test of a government is how it treats those who are in the dawn of their life, its children; those who are in the twilight of life, its aged; and those who are in the shadow of life, its sick, needy, and handicapped. For a government that can neither educate its children, care for and sustain its elderly, nor provide hope and meet the needs of its infirmed, sick, poor, and disabled, is a government without compassion and a nation without a soul.
May we hope our nation finds it’s soul.
A DOC’S PERSPECTIVE OF HEALTH CARE
a link to The Sun Magazine.
http://www.thesunmagazine.org/issues/407/who_will_heal_the_healers
The Sun Magazine
THE HEALTH CARE BUBBLE IN THE U.S.
FROM TOR DAHL AND ASSOCIATES
Newsletter Volume 6, Issue 9:
For health care premiums for 2010 price increases are now estimated to be in the range of nine to eleven percent – about five times higher than inflation. Outcomes will be about the same – we’ll still be 41st in life expectancy, 33rd in infant mortality, and 37th in health system effectiveness.
And the productivity improvement in the health sector will be a negative two percent.
Americans apparently don’t want this to change. Why? Because about 70% of the US population get their health insurance from their employers or through self-paid plans, and they are more afraid of losing it than paying 10% more. The 15% who are uninsured have no voting power, and the remaining who are insured are mostly people on Medicare, Medicaid and other government-sponsored plans (military, VA, federal employer), so most people fear that proposed changes may put them in a worse position than they are now. And this fear has produced the most emotion-laded debates that we have ever witnessed.
Yet almost all Americans are just one step away from losing their health insurance. That insurance may disappear if the employer lays off people or goes broke. If may disappear if you have a pre-existing condition, or you have a ceiling on how much the insurer will pay, or you have co-payments that you cannot afford, or the insurance company drops you because you are considered a poor risk.
So the average American is only two steps away from bankruptcy. If you lose your health insurance, you enter a twilight zone where 62% of all personal bankruptcies are caused by staggering health care bills.
This is what people prefer over a change in our system of health care financing? A change that promises to remove the pre-existing condition problem, makes your insurance non-cancelable and insures everybody? The reason, they say, is that it will cost too much.
Give me a break!
Is the 62% of bankruptcies not costly enough? The shift from going to your own doctor to waiting six hours in an emergency room? A system that will consume the entire Gross National Product of the US in 2060 if cost increases continue on the same path as they have since 2000? This is, without a doubt, the largest and most dangerous economic bubble we have ever encountered.
Here is the solution, and I cannot imagine why no one has advocated it during the entire debate that now has raged over nearly 5 years. The solution is to raise the productivity level of the health sector to be comparable with that of the average American worker.
That’s it.
That’s the solution.
If we do that, we do not have to hire even one additional healthcare worker over the next ten years. Over that period, everyone in the health sector will be paid the same pay increases as they received in the past decade. All Americans will be treated, whether insured or not, and the cost will not increase in total -–it will be offset by higher productivity.
And ten years from now, health care costs will be 10% less than they are today, in real dollars.
This is what the productivity of the average American can do for the rest of the economy.
If the health sector does as well, we shall have solved the cost problem, and the problem of the uninsured, all while continuing to provide the newly effective health care workers with the same high annual pay increases they received in the past.
Now, tell me again: Why don’t we do this? And now?
WOMAN OF WISDOM
We are fortunate when we have the chance to listen and learn from someone who possesses the strength of wisdom. A recent conversation with a woman taught me that wisdom is a scarce commodity in our society today. The wisdom possessed by this woman was not developed through formal education but through first hand life experiences.
The woman of wisdom expressed her concern to me about what is happening in society today and specifically her observation that America is “imploding” – referring to internal self-destruction. The woman of wisdom talked about the depression and the “acceptance” of children not finishing their high school education because they were needed to work on the farm or find work to help support the families. “Families” referred to not only to the immediate and extended families, but neighbors and people and individuals in the small rural communities they supported. The woman of wisdom explained how people would butcher farm animals and share the meat with others in the community. The depression was a difficult time, but people did not blame each other or their neighbors or their leaders. The people came together and supported each other.
The woman of wisdom married and bore eight children. It was a new era but not without hardships. World War II produced anxiety, a call to duty, shortages, and rationing. Again, people came together, supported each other to the extent that ration books and tokens were issued to each American family, dictating how much gasoline, tires, sugar, meat, silk, shoes, nylon and other items any one person could buy. The point of the woman of wisdom was rationing (sugar is an example) provided equal shares of a single commodity to ALL CONSUMERS. If another family had an issue or emergency, commodities were shared or given to them by other families.
The woman of wisdom expressed gratitude that out of the depression and the experiences of WW II, she felt blessed that social security became available for her generation, especially since her husband died at an early age. The woman of wisdom also expressed gratitude that she had Medicare and Medicaid in her ‘twilight’ years. The woman of wisdom expressed disappointment that the lessons of her generation appears to be lost in current discussions of helping people, and especially children, have access to “medical” insurance. The woman of wisdom said she was confused why people verbally attack each other on difference of opinions regarding “medical” insurance, and wanted to know why “these people” cannot work together for the good of the people, and for the good of each other .
The woman of wisdom passed away at the age of 92. I love you Mom.
THE COST OF FAILURE TO ENACT HEALTH CARE REFORM
FROM THE ROBERT WOOD JOHNSON FOUNDATION
September 30, 2009
By: Garrett B, Holahan J, Doan L and Headen I
Researchers from the Urban Institute used their Health Insurance Policy Simulation Model to estimate how coverage and cost trends would change between now and 2019 if the health system is not reformed. The report shows that under the worst-case scenario, within 10 years:
- The number of people without insurance would increase by more than 30 percent in 29 states.
In every state, the number of uninsured would increase by at least 10 percent. - Businesses would see their premiums increase—more than doubling in 27 states.
Even in the best case scenario, employers in 46 states would see premiums increase by more than 60 percent. - Every state would see a smaller share of its population getting health care through their job.
Half of the states would see the number of people with ESI fall by more than 10 percent. - Every state would see spending for Medicaid/Children’s Health Insurance Program (CHIP) rise by more than 75 percent.
- The amount of uncompensated care in the health system would more than double in 45 states.
http://www.rwjf.org/files/research/49148.pdf
FIVE BIGGEST LIES IN THE HEALTH CARE DEBATE
By Sharon Begley NEWSWEEK
Published Aug 29, 2009
From the magazine issue dated Sep 7, 2009
To the credit of opponents of health-care reform, the lies and exaggerations they’re spreading are not made up out of whole cloth—which makes the misinformation that much more credible. Instead, because opponents demand that everyone within earshot (or e-mail range) look, say, “at page 425 of the House bill!,” the lies take on a patina of credibility. Take the claim in one chain e-mail that the government will have electronic access to everyone’s bank account, implying that the Feds will rob you blind. The 1,017-page bill passed by the House Ways and Means Committee does call for electronic fund transfers—but from insurers to doctors and other providers. There is zero provision to include patients in any such system.
Five other myths that won’t die:
You’ll have no choice in what health benefits you receive.The myth that a “health choices commissioner” will decide what benefits you get seems to have originated in a july 19 post at blog.flecksoflife.com, whose homepage features an image of Obama looking like heath ledger’s joker. In fact, the house bill sets up a health-care exchange—essentially a list of private insurers and one government plan—where people who do not have health insurance through their employer or some other source (including small businesses) can shop for a plan, much as seniors shop for a drug plan under medicare part d. The government will indeed require that participating plans not refuse people with preexisting conditions and offer at least minimum coverage, just as it does now with employer-provided insurance plans and part d. The requirements will be floors, not ceilings, however, in that the feds will have no say in how generous private insurance can be.
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No chemo for older medicare patients.The threat that medicare will give cancer patients over 70 only end-of-life counseling and not chemotherapy—as a nurse at a hospital told a roomful of chemo patients, including the uncle of a NEWSWEEK reporter—has zero basis in fact. It’s just a vicious form of the rationing scare. The house bill does not use the word “ration.” Nor does it call for cost-effectiveness research, much less implementation—the idea that “it isn’t cost-effective to give a 90-year-old a hip replacement.”
The general claim that care will be rationed under health-care reform is less a lie and more of a non-disprovable projection (as is Howard Dean’s assertion that health-care reform will not lead to rationing, ever). What we can say is that there is de facto rationing under the current system, by both medicare and private insurance. No plan covers everything, but coverage decisions “are now made in opaque ways by insurance companies,” says dr. Donald Berwick of the institute for healthcare improvement.
A related myth is that health-care reform will be financed through $500 billion in medicare cuts. This refers to proposed decreases in medicare increases. That is, spending is on track to reach $803 billion in 2019 from today’s $422 billion, and that would be dialed back. Even the $560 billion in reductions (which would be spread over 10 years and come from reducing payments to private medicare advantage plans, reducing annual increases in payments to hospitals and other providers, and improving care so seniors are not readmitted to a hospital) is misleading: the house bill also gives medicare $340 billion more over a decade. The money would pay docs more for office visits, eliminate copays and deductibles for preventive care, and help close the “doughnut hole” in the medicare drug benefit, explains medicare expert Tricia Neuman of the Kaiser Family Foundation.
Illegal immigrants will get free health insuranceThe house bill doesn’t give anyone free health care (though under a 1986 law illegals who can’t pay do get free emergency care now, courtesy of all us premiumpaying customers or of hospitals that have to eat the cost). Will they be eligible for subsidies to buy health insurance? The house bill says that “individuals who are not lawfully present in the United States” will not be allowed to receive subsidies.
The claim that taxpayers will wind up subsidizing health insurance for illegal immigrants has its origins in the defeat of an amendment, offered in July by republican rep. Dean Heller of Nevada, to require those enrolling in a public plan or seeking subsidies to purchase private insurance to have their citizenship verified. Flecksoflife.com claimed on july 19 that “hc [health care] will be provided 2 all non us citizens, illegal or otherwise.” Rep. Steve king of Iowa spread the claim in a usa today op-ed on aug. 20, calling the explicit prohibition on such coverage “functionally meaningless” absent mandatory citizenship checks, and it’s now gone viral. Can we say that none of the estimated 11.9 million illegal immigrants will ever wangle insurance subsidies through identity fraud, pretending to be a citizen? You can’t prove a negative, but experts say that medicare—the closest thing to the proposals in the house bill—has no such problem.
Death panels will decide who lives.On July 16 Betsy Mccaughey, a former lieutenant governor of New York and darling of the right, said on Fred Thompson’s radio show that “on page 425,” “congress would make it mandatory … That every five years, people in medicare have a required counseling session that will tell them how to end their life sooner, how to decline nutrition.” Sarah Palin coined “death panels” in an Aug. 7 facebook post.
This lie springs from a provision in the house bill to have medicare cover optional counseling on end-of-life care for any senior who requests it. This means that any patient, terminally ill or not, can request a special consultation with his or her physician about ventilators, feeding tubes, and other measures. Thus the house bill expands medicare coverage, but without forcing anyone into end-of-life counseling.
The death-panels claim nevertheless got a new lease on life when Jim Towey, director of the White House office of faith-based initiatives under George W. Bush, claimed in an Aug. 18 Wall Street Journal op-ed that a 1997 workbook from the department of veterans affairs pushes vets to “hurry up and die.” In fact, the thrust of the 51-page book, which the va pulled from circulation in 2007, is letting “loved ones” and “health care providers” “know your wishes.” Readers are asked to decide what they believe, including that “life is sacred and has meaning, no matter what its quality,” and that “my life should be prolonged as long as it can…using any means possible.” But the workbook also asks if readers “believe there are some situations in which I would not want treatments to keep me alive.” Opponents of health-care reform have selectively cited this passage as evidence the government wants to kill the old and the sick.
The government will set doctors’ wages.This, too, seems to have originated on the Flecksoflife blog on July 19. But while page 127 of the House bill says that physicians who choose to accept patients in the public insurance plan would receive 5 percent more than Medicare pays for a given service, doctors can refuse to accept such patients, and, even if they participate in a public plan, they are not salaried employees of it any more than your doctor today is an employee of, say, Aetna. “Nobody is saying we want the doctors working for the government; that’s completely false,” says Amitabh Chandra, professor of public policy at Harvard’s Kennedy School of Government.
To be sure, there are also honest and principled objections to health-care reform. Some oppose a requirement that everyone have health insurance as an erosion of individual liberty. That’s a debatable position, but an honest one. And many are simply scared out of their wits about what health-care reform will mean for them. But when fear and loathing hijack the brain, anything becomes believable—even that health-care reform is unconstitutional. To disprove that, check the commerce clause: Article I, Section 8.
With Katie Connolly, Claudia Kalb, and Ian Yarett
Find this article at http://www.newsweek.com/id/214254