TomLoveTexas

A Day in the Life

2019-08-23T14:29:00.001-07:00

A Day in the Life: Delusion verses Reality

I never saw anyone hunt for game with semiautomatic weapons, but far too often, they have been used to kill lots of people quickly.When I wrote this in April 2007, we had just had one of a series of events that highlighted a reason to ask why and how can we prevent the mass killings. Now we have suffered many more of the same type of events with almost no action but political theater. How many deaths will it take to achieve true awareness. Some say guns protect from gun violence, but at Fort Hood Army Base not even soldiers were immune and they indeed carry guns.

As I watched the news of the tragedy at Virginia Tech in Blacksburg, Virginia unfold, I thought of my own experiences with the mental health system in America. I have two step sons that have paranoid schizophrenia, and when they are taking their medication, they are not psychotic. The struggle to help them to lead meaningful and productive lives has encompassed the last twenty years of our existence. Once you have encountered the right of a mentally unbalanced person to not take their medicine, even though there is no possible way they can rationally make that essential decision; and then the criteria that they must actually be an immediate threat to themselves or others to get help to not be a threat, can you fully ask the question: which is more insane, the illness or the system?

I hear people debate whether to have more gun control or not despite the statistic that in gun deaths unrelated to wars, America has more gun deaths than all the rest of the world combined. In fact, we have 83% of the world’s gun non-military related deaths since 1980. But the question how an unmediated mentally unbalanced person could seemingly legally buy two guns and then kill thirty-two people is answered that Virginia does not report mentally impaired individuals to the very data Federal base that determines if someone can legally buy a weapon. Why? Simply put, it is not illegal to be psychotic, but to not treat that psychosis is also not illegal.

I hear people say that mentally unbalanced people, that really want to kill people, can use other weapons. That is undeniably true. There is the case of a young woman being shoved into an oncoming train from a passenger platform by an unmediated delusional individual that perceived her as an imaginary threat. If one wishes, one could possibly connect airline hijacking to unbalanced minds. However; that perceived threat met an immediate cry to safeguard boarding and passenger loading all across America. We have sky marshals and airline check-in procedures at all airports in every terminal, but we have averaged as many as thirty thousand gun deaths in America yearly since 1980. Why?

How many of these have been at the hands unbalanced individuals, one only can guess, but guns are not the main problem of society verses the individual on mental health. The root cause is proper treatment when that treatment is needed and the monitoring of that sick mind so that they can resume being a contributing member of society, not a potential time bomb that must explode to get the very help needed to prevent tragedy. I recently asked the question why mental health workers and social workers cannot help make sure ill and chemically imbalanced individuals take their medicine, and was met with the response that it’s not in the budget. Why? The next time a sick individual lets loose their unmediated delusions and your loved one dies, will you be satisfied with that response?

_Thomas P Love 04/17/07

Wall Street Journalreported, only 12 states account for the majority of mental health records in the FBI database. Mayors Against Illegal Guns, co-chaired by New York City Mayor Michael Bloomberg, reported that 19 states have each submitted less than 100 mental health records to the FBI database.

http://www.alternet.org/34ths-states-ignore-mental-illness-background-checks-gun-buyers?akid=9851.38024._JrUQE&rd=1&src=newsletter766339&t=2

WEDNESDAY, DECEMBER 5, 2012

The Fiscal Cliff Explained By Thomas Kenny

“Fiscal cliff” is the popular shorthand term used to describe the conundrum that the U.S. government will face at the end of 2012, when the terms of the Budget Control Act of 2011 are scheduled to go into effect.
Among the laws set to change at midnight on December 31, 2012, are the end of last year’s temporary payroll tax cuts (resulting in a 2% tax increase for workers), the end of certain tax breaks for businesses, shifts in the alternative minimum tax that would take a larger bite, the end of the tax cuts from 2001-2003, and the beginning of taxes related to President Obama’s health care law. At the same time, the spending cuts agreed upon as part of the debt ceiling deal of 2011 will begin to go into effect. According to Barron's, over 1,000 government programs - including the defense budget and Medicare are in line for "deep, automatic cuts."
In dealing with the fiscal cliff, U.S. lawmakers have a choice among three options, none of which are particularly attractive:

They can let the current policy scheduled for the beginning of 2013 – which features a number of tax increases and spending cuts that are expected to weigh heavily on growth and possibly drive the economy back into a recession – go into effect. The plus side: the deficit, as a percentage of GDP, would be cut in half.
They can cancel some or all of the scheduled tax increases and spending cuts, which would add to the deficit and increase the odds that the United States could face a crisis similar to that which is occurring in Europe. The flip side of this, of course, is that the United States' debt will continue to grow.
They could take a middle course, opting for an approach that would address the budget issues to a limited extent, but that would have a more modest impact on growth.

Can a Compromise be Reached?
The oncoming fiscal cliff is a concern for investors since the highly partisan nature of the current political environment could make a compromise difficult to reach. This problem isn’t new, after all: lawmakers have had three years to address this issue, but Congress – mired in political gridlock – has largely put off the search for a solution rather than seeking to solve the problem directly. Republicans want to cut spending and avoid raising taxes, while Democrats are looking for a combination of spending cuts and tax increases. Although both parties want to avoid the fiscal cliff, compromise is seen as being difficult to achieve – particularly in an election year. There's a strong possibility that Congress won't act until the eleventh hour. Another potential obstacle is that the next Congress won't be sworn in until January 3, after the deadline.
The most likely outcome is another set of stop-gap measures that would delay a more permanent policy change until 2013 or later. Still, the non-partisan Congressional Budget Office (CBO) estimates that if Congress takes the middle ground – extending the Bush-era tax cuts but cancelling the automatic spending cuts – the result, in the short term, would be modest growth but no major economic hit.
Possible Effects of the Fiscal Cliff
If the current laws slated for 2013 go into effect, the impact on the economy could be dramatic. While the combination of higher taxes and spending cuts would reduce the deficit by an estimated $560 billion, the CBO estimates that the policies set to go into effect would cut gross domestic product (GDP) by four percentage points in 2013, sending the economy into a recession (i.e., negative growth). At the same time, it predicts unemployment would rise by almost a full percentage point, with a loss of about two million jobs. A Wall St. Journal article from May 16, 2012 estimates the following impact in dollar terms: “In all, according to an analysis by J.P. Morgan economist Michael Feroli, $280 billion would be pulled out of the economy by the sunsetting of the Bush tax cuts; $125 billion from the expiration of the Obama payroll-tax holiday; $40 billion from the expiration of emergency unemployment benefits; and $98 billion from Budget Control Act spending cuts. In all, the tax increases and spending cuts make up about 3.5% of GDP, with the Bush tax cuts making up about half of that, according to the J.P. Morgan report.” Amid an already-fragile recovery and elevated unemployment, the economy is not in a position to avoid this type of shock.
The cost of indecision is likely to have an effect on the economy before 2013 even begins. The CBO anticipates that a lack of resolution will cause households and businesses to begin changing their spending in anticipation of the changes, possible reducing GDP before 2012 is even over.
Having said this, it's important to keep in mind that while the term “cliff” indicates an immediate disaster at the beginning of 2013, the impact of the changes - while destructive over a full year - will be gradual at first. What's more, Congress can act to change laws retroactively after the deadline. As a result, the fiscal cliff won't necessarily be an impediment to growth even if Congress doesn't address the issue until after 2013 has already begun.
The Next Crisis
Unfortunately, the fiscal cliff isn't the only problem facing the United States right now. At some point in the first quarter, the country will again hit the "debt ceiling" - the same issue that roiled the markets in the summer of 2011 and prompted the automatic spending cuts that make up a portion of the fiscal cliff.

http://bonds.about.com/od/Issues-in-the-News/a/What-Is-The-Fiscal-Cliff.htm

To learn more about this issue, see my article What is the Debt Ceiling? A Simple Explanation of the Debate and Crisis

SATURDAY, NOVEMBER 24, 2012

Henry A. Wallace from Wikipedia

Henry Agard Wallace (October 7, 1888 – November 18, 1965) was the 33rd Vice President of the United States (1941–1945), the Secretary of Agriculture (1933–1940), and the Secretary of Commerce (1945–1946). In the 1948 presidential election, Wallace was the nominee of the Progressive Party.

Henry A. Wallace, son of Henry Cantwell Wallace, a farmer, journalist, and political activist, was born on October 7, 1888, at a farm near the village of Orient, Iowa, in Adair County.^[1] Wallace attended Iowa State College at Ames, Iowa. At Iowa State he became a friend of George Washington Carver, and they spent time together collecting botanical specimens. Wallace graduated in 1910 with a bachelor's degree in animal husbandry. He worked on the editorial staff of the family-owned paper Wallaces' Farmerin Des Moines from 1910 to 1924, and he edited this publication from 1924 to 1929. Wallace experimented with breeding high-yielding hybrid corn, and he wrote a good number of publications on agriculture. In 1915, he devised the first corn-hog ratio charts indicating the probable course of markets. Wallace was also a self-taught "practicing statistician",^[2] co-authoring an influential article with George W. Snedecor on computational methods for correlations and regressions^[3] and publishing sophisticated statistical studies in the pages of Wallaces’ Farmer. Snedecor eventually invited Wallace to teach a graduate course on least squares.^[4]
With an inheritance of a few thousand dollars that had been left to his wife, the former Ilo Browne, whom he married in 1914, Wallace founded the Hi-Bred Corn Company in 1926, which later became Pioneer Hi-Bred, a major agriculture corporation, acquired in 1999 by the Dupont Corporation for approximately $10 billion.
Wallace was raised as a Presbyterian, but left that denomination early in life. He spent most of his early life exploring other religious faiths and traditions. For many years, he had been closely associated with famous Russian artist and writer Nicholas Roerich. According to Arthur Schlesinger, Jr., "Wallace's search for inner light took him to strange prophets.... It was in this search that he encountered Nicholas Roerich, a Russian emigre, painter, theosophist. Wallace did Roerich a number of favors, including sending him on an expedition to Central Asia presumably to collect drought-resistant grasses. In due course, H.A. [Wallace] became disillusioned with Roerich and turned almost viciously against him."^[5] Wallace eventually settled on Episcopalianism.
Henry Wallace was also a Freemason and attained the 32nd Degree in the Scottish Rite.
Secretary of Agriculture
In 1933, President Franklin D. Roosevelt appointed Wallace United States Secretary of Agriculture in his Cabinet, a post his father, Henry Cantwell Wallace, had occupied from 1921 to 1924. Henry A. Wallace had been a liberal Republican, but he supported Roosevelt's New Deal and soon switched to the Democratic Party. Wallace served as Secretary of Agriculture until September 1940, when he resigned, having been nominated for Vice President as Roosevelt's running mate in the 1940 presidential election. During his tenure as U.S. Secretary of Agriculture he ordered a very unpopular strategy of slaughtering pigs and plowing up cotton fields in rural America to drive the price of these commodities back up in order to improve American farmers' financial situation. He also advocated the ever-normal granary concept.

Vice President

Wallace was elected in November 1940 as Vice President on the Democratic Party ticket with President Franklin D. Roosevelt. His inauguration took place on January 20, 1941, for the term ending January 20, 1945.
Roosevelt named Wallace chairman of the Board of Economic Warfare (BEW) and of the Supply Priorities and Allocations Board (SPAB) in 1941. Both positions became important with the U.S. entry into World War II. As he began to flex his newfound political muscle in his position with SPAB, Wallace came up against the conservative wing of the Democratic party in the form of Jesse H. Jones, Secretary of Commerce, as the two differed on how to handle wartime supplies.
On May 8, 1942, Wallace delivered his most famous speech, which became known by the phrase "Century of the Common Man" to the Free World Association in New York City. This speech, grounded in Christian references, laid out a positive vision for the war beyond the simple defeat of the Nazis. The speech, and the book of the same name which appeared the following year, proved quite popular, but it earned him enemies among the Democratic leadership, among important allied leaders like Winston Churchill, and among business leaders and conservatives.
Wallace spoke out during race riots in Detroit in 1943, declaring that the nation could not "fight to crush Nazi brutality abroad and condone race riots at home."

In 1943, Wallace made a goodwill tour of Latin America, shoring up support among important allies. His trip proved a success, and helped persuade twelve countries to declare war on Germany. Regarding trade relationships with Latin America, he convinced the BEW to add "labor clauses" to contracts with Latin American producers. These clauses required producers to pay fair wages and provide safe working conditions for their employees and committed the United States to paying for up to half of the required improvements. This met opposition from the U.S. Department of Commerce.
Wallace believed that both the American and the Russian revolution were part of "the march to freedom of the past 150 years." After having met Molotov, he arranged a trip to the "Wild East" of Russia. On May 23, 1944, he started a 25-day journey accompanied by Owen Lattimore. Coming from Alaska, they landed at Magadan where they were received by Sergei Goglidze and Dalstroi director Ivan Nikishov, both NKVDgenerals. The NKVD presented a fully sanitized version of the slave labor camps in Magadan and Kolyma to their American guests, convinced them that all the work was done by volunteers, charmed them with entertainment, and left their guests impressed with the "development" of Siberia and the spirit of the "volunteers." Lattimore's film of the visit tells that "a village... in Siberia is a forum for open discussion like a town meeting in New England."^[6] The trip continued to Mongolia and then to China.
After Wallace feuded publicly with Jesse Jones and other high officials, Roosevelt stripped him of his war agency responsibilities and entertained the idea of replacing him on the presidential ticket. The Democratic Party, with concern being expressed privately about Roosevelt being able to make it through another term, chose Harry S. Truman as Roosevelt's running mate at the 1944 Democratic convention, after New Deal partisans failed to promote William O. Douglas. Wallace was succeeded as Vice President on January 20, 1945, by Truman. On April 12, 1945, Vice President Truman succeeded to the Presidency when President Franklin D. Roosevelt died. Henry A. Wallace had missed being the 33rd President of the United States by just 82 days.

Roerich controversy

From the middle 1920s, Wallace was a devoted supporter of Nicholas Roerich, a philosopher and Russian emigre.^[7] With agreement from Roosevelt, Wallace had lobbied Congress to support Roerich's Banner and Pact of Peace which was signed in Washington, D.C. in 1935 by delegates from 22 Latin American countries. Roerich and his son George were sent to Central Asia by the U.S. Department of Agriculture to search for drought-resistant grasses to prevent another Dust Bowl.
During the 1940 presidential election, a series of letters that Wallace had written in the 1930s to Roerich was in the possession of the Republicans. In the letters, Wallace addressed Roerich as "Dear Guru", and signed the letters as "G" for Galahad, the name Roerich had assigned him. Wallace assured Roerich that he awaited "the breaking of the New Day" when the people of "Northern Shambhalla" — a Buddhist term roughly equivalent to the kingdom of heaven – would create an era of peace and plenty.
With the Republicans planning to reveal the "eccentric" religious beliefs of Wallace to the public prior to the November 1940 elections, the Democrats countered by threatening to release information about Republican candidate Wendell Willkie's rumored extramarital affair with the writer Irita Van Doren.^[5]^[8] The Republicans did not publicize the "Guru" letters, and Roosevelt and Wallace won the election, overwhelmingly.
In the winter of 1947, independent columnist Westbrook Pegler published extracts from the letters. Pegler characterized Wallace as a "messianic fumbler," and "off-center mentally." There was a personal confrontation between the two men on the subject at a public meeting in Philadelphia in July 1948. Several reporters, including H.L. Mencken, joined in the increasingly aggressive questioning. Wallace declined to comment on the letters, while labeling some of the reporters "stooges" for Pegler.^[9]

Secretary of Commerce

Roosevelt placated Wallace by appointing him Secretary of Commerce. Wallace served in this post from March 1945 to September 1946, when he was fired by President Harry S. Truman because of disagreements about the policy towards the Soviet Union. He is the last former Vice President to serve in the President's cabinet.

The New Republic

Following his term as Secretary of Commerce, Wallace became the editor of The New Republic magazine, using his position to criticize vociferously Truman's foreign policy. On the declaration of the Truman Doctrine in 1947, he predicted it would mark the beginning of "a century of fear".

The 1948 Presidential election

Wallace left his editorship position in 1948 to make an unsuccessful run as a Progressive Party candidate in the 1948 U.S. presidential election. With IdahoDemocratic U.S. Senator Glen H. Taylor as his running mate, his platform advocated friendly relations with the Soviet Union, an end to the nascent Cold War, an end to segregation, full voting rights for blacks, and universal government health insurance. His campaign was unusual for his time in that it included African American candidates campaigning alongside white candidates in the American South, and that during the campaign he refused to appear before segregated audiences or eat or stay in segregated establishments.
As a further sign of the times, he was noted by Time as ostentatiously riding through various cities and towns in the South "with his Negro secretary beside him".^[10] Many eggs and tomatoes were hurled at and struck him and his campaign members during the tour, while at the same time President Truman referred to such behavior towards Wallace as very un-American. Wallace commented that "there is a long chain that links unknown young hoodlums in North Carolina or Alabama with men in finely tailored business suits in the great financial centers of New York or Boston, men who make a dollars-&-cents profit by setting race against race in the far away South."^[10] State authorities in Virginia sidestepped enforcing its own segregation laws by declaring Wallace's campaign gatherings as private parties.^[11]
Wallace's campaign to advance progressive causes inspired several activists and organizations. One short-lived effort was an attempt by Harry Hay, an active Communist teacher in Southern California, to create an organization of homosexuals, to be called Bachelors for Wallace, which would lobby for the inclusion in Wallace's platform of a call for the reform of sodomy and other laws that were the basis of widespread anti-gay discrimination and persecution. Hay was unsuccessful in his efforts to find other homosexual men willing to join such a risky venture, and the idea was never realized. Two years later, however, Hay and other leftists successfully founded the Mattachine Society, now recognized as the first significant grassroots organization for LGBT rights in the United States.^[12] Wallace had not made any official statements in support of gay rights and it is unclear how much support this group gave to the campaign. Yet, in the tenor of the times, such an organization would have been highly controversial. The fact that group generated almost no notice by the press or even the campaign itself, may be because of other controversies facing the campaign.
The "Dear Guru" letters reappeared now and were published, seriously hampering his campaign.^[5] Even more damage was done to Wallace's campaign when several prominent journalists, including H.L. Mencken and Dorothy Thompson, publicly charged that Wallace and the Progressives were under the covert control of Communists. Wallace was endorsed by the Communist Party (USA), and his subsequent refusal to publicly disavow any Communist support cost him the backing of many anti-Communist

The Methanol Economy By Kevin Bullis

2015-03-14T13:35:00.001-07:00

Forget about the hydrogen economy. Methanol is the key to weaning the world off oil. George Olah tells us how to do it.

The hydrogen economy – with its vision of gas-guzzling engines replaced by hydrogen fuel cells that produce water instead of smog and greenhouse gases – is a big mistake, according to George Olah, winner of the 1994 Nobel Prize in chemistry.

Olah, whose research in the chemistry of hydrocarbons has led to high-octane fuels and more easily degradable hydrocarbons, is now director of the Loker Hydrocarbon Research Institute at the University of Southern California. He argues that storing energy in the form of methanol, not hydrogen, could end our dependence on fossil fuels and transform carbon dioxide from a global-warming liability into an essential raw material for a methanol-based economy. Olah lays out his plan in a new book, Beyond Oil and Gas: The Methanol Economy, published last week by Wiley-VCH.

Technology Review: Why methanol?

George Olah: Methanol in its own right is an excellent fuel. You can mix it into gasoline – it’s a much better fuel than ethanol. And we have developed a methanol fuel cell.

Methanol is a very simple chemical that can be made in a very efficient way. It is just one oxygen atom inserted into methane, the basal component of natural gas; but methanol is a liquid material which is easily stored, transported, and used.

TR: What’s wrong with hydrogen fuel cells?

GO: Even today you could put a pump dispensing methanol at every gasoline station. You can dispense it very well without any [new] infrastructure. For hydrogen, there is no infrastructure. To establish a hydrogen infrastructure is an enormously costly and questionable thing. Hydrogen is a very volatile gas, and there is no way to store or handle it in any significant amount without going to high pressure.

TR: But methanol is a way of storing energy, not a source of energy like gasoline. Where will the energy come from?

GO: The beauty is we can take any source of energy. Whether it’s from burning fossil fuels, from atomic plants, from wind, solar, or whatever. What we are saying is it makes a lot better sense, instead of trying to store and transport energy as very volatile hydrogen gas, to convert it into a convenient liquid. And there’s a fringe benefit: you really mitigate carbon dioxide in the atmosphere.

TR: How do you make methanol?

GO: One approach is to produce methanol by converting still-existing huge reserves of natural gas, but in entirely different, new ways. Today, methanol is made exclusively from natural gas. Natural gas is incompletely burned, or converted, to synthesis gas, which can then be put together into methanol. Now we have developed ways to completely eliminate the use of synthesis gas.

The second approach involves carbon dioxide. We were co-inventors of the direct methanol fuel cell. This fuel cell uses methanol and produces CO2 and water. It occurred to us that maybe you could reverse the process. And, indeed, you can take carbon dioxide and water, and if you have electric power, you can chemically reduce it into methanol.

So the second leg of our methanol economy approach is to regenerate or recycle carbon dioxide initially from sources where it is present in high concentrations, like flue gases from a power plant burning natural gas. But eventually, and this won’t come overnight, we could just take out carbon dioxide from air.

TR: This would help address the problem of carbon dioxide as a greenhouse gas, wouldn’t it?

GO: Sequestration [of carbon dioxide] is our [government’s] official policy and this is what everybody is swearing by. They say that you stick carbon dioxide down into the earth and at the bottom of the sea, and you solve the problem. [But] how long will it stay down there? Carbon dioxide is a very volatile material. Under the best of conditions it eventually will seep up. Our approach is very different: we simply say that if we need to dispose of carbon dioxide, we need to capture it – why not use it as a chemical raw material? In other words, recycle it.

TR: We’ve heard a lot lately about replacing gasoline with ethanol from biological sources and developing better batteries for super-efficient hybrid cars. Do these have a place in a methanol economy?

GO: I think we should explore all possibilities. There is no silver bullet. There is no single solution. I sincerely believe, however, that if you look really impartially, but hard-nosed, at the figures, the needs are so enormous that biological sources per se won’t solve them. The president mentioned making ethanol from cellulosic materials. In principle it’s possible, but it’s a very difficult, undeveloped, and, in my mind, unrealistic technology. Batteries, sure, we should try to find better batteries. But realistically today, fuel cells are a lot more convenient than any battery.

TR: What steps need to be taken now to move toward a methanol economy?

GO: I’m a great believer that technological development is done by major companies. ExxonMobil certainly has some means to do it. The only trouble is that so far they are not coming up with any reasonable solution. Basically, I don’t think they like [the methanol economy] very much. If you sit on a large supply of oil and gas, on which you make enormous profits, or if you are an Arab country that has great supplies and great wealth, you wouldn’t welcome some crazy guy who comes up and says that mankind can have an ultimate solution which would not be dependent, anymore, on what nature put under your soil.

If this methanol economy makes sense, and I think it does, there is not necessarily a monopoly any more for oil companies. Big chemical companies could equally well do this, or even better. But there is also a need for politicians and the public to say that they want to explore reasonable solutions.

TR: How urgent is the problem?

GO: Man began to use coal on a massive scale during the Industrial Revolution, which was, what, 250 years ago. And we are already, to a very significant degree, depleting what nature gave us. Now, I’m not saying we’ll run out of it overnight, but we need to think about how we manage our problems now and how we will manage in the future.

You see natural gas getting in short supply, and we import liquefied natural gas. There are many natural gas sources – Nigeria, the United Arab Emirates, the North Sea, and so on. The energy content of a single LNG tanker is equivalent to a medium-sized hydrogen bomb. Bad guys are trying to blow up refineries now, and a big tanker is a very inviting target. Who can guarantee that some crazy terrorist won’t blow up an LNG tanker? I think a realistic solution is, again, to convert natural gas, as efficiently as we can, into a safe liquid product, like methanol.

All people believe that what they are doing has some importance; but this [methanol research] is, in my mind, the most important thing I ever did in my career, and it has serious implications for society.

http://www.technologyreview.com/news/405436/the-methanol-economy/page/2/

Ethanol Vs. Methanol by Patrick Takahashi

2015-03-14T12:55:00.001-07:00

Ethanol and biodiesel are dead, long live methanol! Methanol is the simplest alcohol, with one carbon atom; ethanol has two. Thus, given biomass, it should be cheaper to produce methanol than ethanol. Surely enough, in a comprehensive assessment Stone & Webster performed for the U.S. Department of Energy two decades ago, with the Hawaii Natural Energy Institute as an associate, this fact was confirmed.
However, methanol has a few flaws. First, if drunk, you can go blind. But, who drinks gasoline? Second, there was a time when methanol was used as the feedstock to produce MTBE as a gasoline additive. MTBE is carcinogenic. Methanol is not, just don't drink it. Third, methanol can dissolve certain plastics and embrittle a some metals. So change the plastic and metals to avoid this problem.
Methanol has only half the energy content per gallon of gasoline. Ethanol is two-thirds the intensity of gasoline. However, a fuel cell powered vehicle is at least twice the efficiency of an internal combustion engine, so the tank storage problem would be solved with a direct methanol fuel cell. The DMFC for portable electronics is said to soon replace batteries, so the technology is real. Methanol is the only biofuel capable of being directly fed to a fuel cell. Ethanol and gasoline need to first be passed through an expensive reformer.
Plus, and this is difficult to accept, but true: one gallon of methanol has more hydrogen than one gallon of liquid hydrogen. Thus, the infrastructure is already largely in place for a methanol economy. George Olah in his book, Beyond Oil and Gas: The Methanol Economy, provides all the science and speculation you need.
So why is our country and rest of world enamored over ethanol and biodiesel? In two words, the Farm Lobby. They came up with a politically brilliant scheme to use corn as an answer to imported oil. By so doing, the price of farm commodities recently doubled and more. Farmers are ecstatic! The poor around the world are suffering.
Global food riots occurred, so the Farm Lobby thought, oh, no problem, we'll now, more and more, begin to convert the cellulose into ethanol, for, after all, those tax incentives are already in place. Well, if you have biomass and want a biofuel, you either hydrolyze and ferment it to produce ethanol, or gasify and catalyze it to make methanol. But the current mentality is stuck in an ethanol mode. Before farmers and their partners build fermented ethanol from biomass factories, they need to totally re-think the long term and just change the congressional language to say: ethanol, biodiesel and other renewable biofuels. Methanol does not even need to be mentioned. Otherwise, they will be creating a second herd of white elephants.
With all this logic, won't methanol soon displace ethanol? No. Why? The Farm Lobby is so dominant that they will continue to insure for the continued use of ethanol for another decade because those facilities are already built, and they don't want them to suddenly become obsolete. Okay, fair enough, let those plants profitably phase out. But don't compound the problem by adding that second elephant herd.
I might add that there has been a sudden surge of interest in biofuels from algae. Certainly, as algae can be from two to ten times more efficient in converting sunlight into biomass than any terrestrial crop; grown in the ocean where there is no irrigation problem (and Peak Freshwater looms on the horizon); if fed the cold water effluent from the ocean thermal energy conversion process there will not be a need for fertilizers (deep ocean effluents are high in just the right nutrients--farm fertilizers are manufactured from fossil fuels); and with genetic engineering, who knows where this option can go--this has been my dream for a third of a century. However, the eventual costs are unknown. Yes, do the R&D, but don't expect a magic solution within a decade. Biomethanol is real and immediately available for commercial prospecting.
As no one I know is commercially jumping unto the methanol bandwagon, I will tomorrow publish a hypothetical letter to colleagues to inspire some enterprise. The strategies, then, become available to the readers of the Huffington Post. Also, too, perhaps some partnerships can be stimulated to come up to a better solution than ethanol and biodiesel. Let's do more than share ideas. Let's take action!
http://www.huffingtonpost.com/patrick-takahashi/ethanol-vs-methanol_b_106380.html

Methanol Biofuels Sustainable Transportation Fuel Future of Fuel Marine Algae The Future of Fuel Ethanol Biodiesel

Healthcare in Germany From Wikipedia

2013-11-09T07:12:00.002-08:00

Germany has the world's oldest national social health insurance system,^[1] with origins dating back to Otto von Bismarck's social legislation, which included the Health Insurance Bill of 1883, Accident Insurance Bill of 1884, and Old Age and Disability Insurance Bill of 1889. As mandatory health insurance, it originally applied only to low-income workers and certain government employees, but has gradually expanded to cover the great majority of the population.^[8] The system is decentralized with private practice physicians providing ambulatory care, and independent, mostly non-profit hospitals providing the majority of inpatient care. Approximately 92% of the population is covered by a 'Statutory Health Insurance' plan, which provides a standardized level of coverage through any one of approximately 1,100 public or private sickness funds. Standard insurance is funded by a combination of employee contributions, employer contributions and government subsidies on a scale determined by income level. Higher income workers sometimes choose to pay a tax and opt out of the standard plan, in favor of 'private' insurance. The latter's premiums are not linked to income level but instead to health status.^[9] Historically, the level of provider reimbursement for specific services is determined through negotiations between regional physician's associations and sickness funds.

Since 1976 the government has convened an annual commission, composed of representatives of business, labor, physicians, hospitals, and insurance and pharmaceutical industries.^[10] The commission takes into account government policies and makes recommendations to regional associations with respect to overall expenditure targets. In 1986 expenditure caps were implemented and were tied to the age of the local population as well as the overall wage increases. Although reimbursement of providers is on a fee-for-service basis the amount to be reimbursed for each service is determined retrospectively to ensure that spending targets are not exceeded. Capitated care, such as that provided by U.S. health maintenance organizations, has been considered as a cost containment mechanism but would require consent of regional medical associations, and has not materialized.^[11]
Copayments were introduced in the 1980s in an attempt to prevent overutilization and control costs. The average length of hospital stay in Germany has decreased in recent years from 14 days to 9 days, still considerably longer than average stays in the U.S. (5 to 6 days).^[12]^[13] The difference is partly driven by the fact that hospital reimbursement is chiefly a function of the number of hospital days as opposed to procedures or the patient's diagnosis. Drug costs have increased substantially, rising nearly 60% from 1991 through 2005. Despite attempts to contain costs, overall health care expenditures rose to 10.7% of GDP in 2005, comparable to other western European nations, but substantially less than that spent in the U.S. (nearly 16% of GDP).^[14

The healthcare system is regulated by the Federal Joint Committee (Gemeinsamer Bundesausschuss), a public health organization authorized to make binding regulations growing out of health reform bills passed by lawmakers, along with routine decisions regarding healthcare in Germany.^[15]
Health insurance in Germany is split in several parts. The largest part of 85% of the population is covered by a basic health insurance plan provided by statute, formally insured under the legislation set with the Sozialgesetzbuch V (SGB V), which provides a standard level of coverage. The remainder of 15% opt for private health insurance, which frequently offers additional benefits.
The government partially reimburses the costs for low-wage workers, whose premiums are capped at a predetermined value. Higher wage workers pay a premium based on their salary. They may also opt for private insurance. This may result in substantial savings for younger individuals in good health. With age and illness, private premiums will rise and the insured will usually cancel their private insurance, turning to the government option.,^[9] however, this is not always possible, nor is it simple to accomplish.

Reimbursement is on a fee-for-service basis, but the number of physicians allowed to accept Statutory Health Insurance in a given locale is regulated by the government and professional medical societies. Co-payments were introduced in the 1980s in an attempt to prevent over-utilization.
Germany has a universal multi-payer system with two main types of health insurance. Germans are offered three mandatory health benefits, which are co-financed by employer and employee: health insurance, accident insurance, and long-term care insurance.

Accident insurance for working accidents (Arbeitsunfallversicherung) is covered by the employer and basically covers all risks for commuting to work and at the workplace.
Long-term care (Pflegeversicherung) is covered half and half by employer and employee and covers cases in which a person is not able to manage his or her daily routine (provision of food, cleaning of apartment, personal hygiene, etc.). It is about 2% of a yearly salaried income or pension, with employers matching the contribution of the employee.

There are two separate types of health insurance: public health insurance (Gesetzliche Krankenversicherung) and private insurance (Private Krankenversicherung). Both systems struggle with the increasing cost of medical treatment and the changing demography. About 87.5% of the persons with health insurance are members of the public system, while 12.5% are covered by private insurance (as of 2006).^[16]
In the Private system the premium

is based on an individual agreement between the insurance company and the insured person defining the set of covered services and the percentage of coverage
depends on the amount of services chosen and the person's risk and age of entry into the private system
is used to build up savings for the rising health costs at higher age (required by law)

For persons who have opted out of the public health insurance system to get private health insurance, it can prove difficult to subsequently go back to the public system, since this is only possible under certain circumstances, for example if they are not yet 55 years of age and their income drops below the level required for private selection. Since private health insurance is usually more expensive than public health insurance, the higher premiums must then be paid out of a lower income. During the last twenty years private health insurance became more and more expensive and less efficient compared with the public insurance.^[17
http://en.wikipedia.org/wiki/Healthcare_in_Germany

Fourteenth Amendment to the United States Constitution by Wikipedia

2013-09-29T07:19:00.001-07:00

The Fourteenth Amendment (Amendment XIV) to the United States Constitution was adopted on July 9, 1868, as one of the Reconstruction Amendments.
Its Citizenship Clause provides a broad definition of citizenship that overruled the Supreme Court's ruling in Dred Scott v. Sandford (1857) that had held that black people could not be citizens of the United States.^[1]
Its Due Process Clause prohibits state and local governments from depriving persons of life, liberty, or property without certain steps being taken to ensure fairness. This clause has been used to make most of the Bill of Rights applicable to the states, as well as to recognize substantive and procedural rights.
Its Equal Protection Clause requires each state to provide equal protection under the law to all people within its jurisdiction. This clause was the basis for Brown v. Board of Education (1954), the Supreme Court decision which precipitated the dismantling of racial segregation in United States education. In Reed v. Reed (1971), the Supreme Court ruled that laws arbitrarily requiring sex discrimination violated the Equal Protection Clause.

Text

Section 1. All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.Section 2. Representatives shall be apportioned among the several States according to their respective numbers, counting the whole number of persons in each State, excluding Indians not taxed. But when the right to vote at any election for the choice of electors for President and Vice President of the United States, Representatives in Congress, the Executive and Judicial officers of a State, or the members of the Legislature thereof, is denied to any of the male inhabitants of such State, being twenty-one years of age, and citizens of the United States, or in any way abridged, except for participation in rebellion, or other crime, the basis of representation therein shall be reduced in the proportion which the number of such male citizens shall bear to the whole number of male citizens twenty-one years of age in such State.
Section 3. No person shall be a Senator or Representative in Congress, or elector of President and Vice President, or hold any office, civil or military, under the United States, or under any State, who, having previously taken an oath, as a member of Congress, or as an officer of the United States, or as a member of any State legislature, or as an executive or judicial officer of any State, to support the Constitution of the United States, shall have engaged in insurrection or rebellion against the same, or given aid or comfort to the enemies thereof. But Congress may, by a vote of two-thirds of each House, remove such disability.
Section 4. The validity of the public debt of the United States, authorized by law, including debts incurred for payment of pensions and bounties for services in suppressing insurrection or rebellion, shall not be questioned. But neither the United States nor any State shall assume or pay any debt or obligation incurred in aid of insurrection or rebellion against the United States, or any claim for the loss or emancipation of any slave; but all such debts, obligations and claims shall be held illegal and void.
Section 5. The Congress shall have power to enforce, by appropriate legislation, the provisions of this article.

Validity of public debtSection 4 confirmed the legitimacy of all United States public debt appropriated by the Congress. It also confirmed that neither the United States nor any state would pay for the loss of slaves or debts that had been incurred by the Confederacy. For example, during the Civil War several British and French banks had lent large sums of money to the Confederacy to support its war against the Union.^[47] In Perry v. United States (1935), the Supreme Court ruled that under Section 4 voiding a United States government bond "went beyond the congressional power."^[^48]The United States debt-ceiling crisis in 2011 raised the question of what powers Section 4 gives to the President. Under the current law, the executive branch of the government (which includes the Treasury and the President) is obligated to carry out all appropriations authorized by the Congress. It has been argued that, in the presence of conflicting statutes (a federal budget statute, which instructs the Treasury to spend a certain amount of money, and a debt ceiling statute, which limits the amount of money that the Treasury is allowed to borrow in process), the statute that was passed more recently "wins"; therefore, in this situation, the President may simply instruct the Treasury to continue issuing bonds beyond the ceiling. Furthermore, such an instruction may be difficult to challenge in court, because it would take a joint resolution of both chambers of Congress to get standing to challenge it.^[49] In addition, it has been observed by many, such as legal scholar Garrett Epps, fiscal expert Bruce Bartlett and Treasury Secretary Timothy Geithner, that the debt ceiling itself may be unconstitutional and therefore void as long as it interferes with the duty of the government to pay interest on outstanding bonds and to make payments owed to pensioners (that is, Social Security recipients).^[50]^[51]
The issue of what effect Section 4 has regarding the debt ceiling remains unsettled.^[52] Legal analyst Jeffrey Rosen has argued that Section 4 gives the President unilateral authority to raise or ignore the national debt ceiling, and that if challenged the Supreme Court would likely rule in favor of expanded executive power or dismiss the case altogether for lack of standing.^[53] Erwin Chemerinsky, professor and dean at University of California, Irvine School of Law, has argued that not even in a "dire financial emergency" could the President raise the debt ceiling as "there is no reasonable way to interpret the Constitution that [allows him to do so]".^[54]

Power of enforcement

Main article: Congressional power of enforcement
Section 5, the last section, was construed broadly by the Supreme Court in Katzenbach v. Morgan (1966).^[55] However, the Court, in City of Boerne v. Flores (1997), said:

Any suggestion that Congress has a substantive, non-remedial power under the Fourteenth Amendment is not supported by our case law.^[56]

Proposal and ratification
The 39th United States Congress proposed the Fourteenth Amendment on June 13, 1866.
Ratification of the Fourteenth Amendment was bitterly contested: all the Southern state legislatures, with the exception of Tennessee, refused to ratify the amendment. This refusal led to the passage of the Reconstruction Acts. Ignoring the existing state governments, military government was imposed until new civil governments were established and the Fourteenth Amendment was ratified.^[57]
By July 9, 1868, three-fourths of the states (28 of 37) ratified the amendment:^[58

http://en.wikipedia.org/wiki/Fourteenth_Amendment_to_the_United_States_Constitution#Validity_of_public_debt

What You Need to Know About the Chained CPI from AARP

2013-06-02T07:11:00.000-07:00

5 Reasons Chained CPI Is Bad For Social Security

1. Chained CPI compounds over time.
As a result of a chained CPI, there will be a 0.3% annual cut in Social Security cost of living adjustments (COLAs). Since this compounds over time, it would end up cutting the equivalent of one full month of benefits each year from a 92-year-old beneficiary. And it’s not a small cut overall – Social Security loses $112 billion over the next 10 years.

2. The greatest impact will be on the most vulnerable older Americans.
As retirees age, they have less income, fewer financial assets, and are more dependent on Social Security. Specifically, women tend to live longer than men and tend to have lower incomes, so women and poorer households are more at risk of falling into poverty with any cuts to Social Security.

3. Benefits for disabled and retired veterans would be cut.
3.2 million disabled veterans and another 2 million military retirees would see their benefits cut if chained CPI is adopted. Permanently disabled veterans who started receiving disability benefits at age 30 would see their benefits cut by more than $1,400 a year at age 45, $2,300 a year at age 55 and $3,200 a year at age 65.

4. Chained CPI is a less accurate measure of inflation
Since retirees spend much more on medical care than working-age Americans, the current CPI calculations already underreport the rapidly increasing health care costs experienced by seniors. Moving to a chained CPI would exacerbate the gap between formula and actual costs.

5. Social Security does not drive deficits, and should not be cut as part of a budget deal.
Social Security is a separately financed, off-budget program – it is not a driver of deficits in the rest of the budget. Any changes to Social Security should be handled separately, not as part of a budget deal that focuses on near-term savings that harm current retirees.
====================================================================
Here's how the budget proposal now being considered by Congress and the president could cut the value of your Social Security benefit

Most everyone has heard of the Consumer Price Index, or CPI. It's used to make the annual cost-of-living adjustments in Social Security and other federal programs that help millions of seniors keep up with inflation. But do you know about the chained CPI?

It Is Time

2013-05-12T08:33:00.001-07:00

It is time to reestablish that culture that our Forefathers lived and died to create, not in merely the words, but the deeds. It is time.

On the Statue of Liberty are inscriptions about giving Americans the tired, the poor, and the huddled masses yearning to breathe free. It is time to actually fulfill that promise and give our Latino brothers and Latina sisters that promised freedom. It would appear we, like some Madison Avenue advertising agency have shown the slogans, yet denied the reality to much of Latin America. We seem to say you cannot attempt to cross the border illegally, and have children in the United States, and you cannot become a citizen. Many have lived here for over twenty years and have as many as three generations in America, but are still considered illegal and must constantly be on constant vigil against reprisal.

Every one knows that conditions south of our borders have long been devoid of the opportunity to allow families to grow and prosper with a life style that rewards ability and enlarges the middle class. They have struggled to get here and died in closed freight trailers on some lonely desert or fallen prey to rings exploiting them into prostitution and economic slavery. They must keep watching with a constant eye for immigration and threats to be deported should they try to get better wages or living conditions. Mexicans in particular have migrated in large numbers to America to provide for their families in land that once was in fact theirs. Additionally Latinos from Latin and Central America have come here to escape political and economic hardships. Their children have grown up here and seen the hypocrisy between what we do and what we say we do.

America should be the literal shining beacon of hope and justice for immigrants, but most with the exception of the first Europeans who crossed the ocean shores, have had to suffer until they were assimilated and accepted into a kinder, gentler society. There were Irish, Italian, Jewish, Black, and Oriental slums and repressions. And so, there are now Latinos marching, shouting, and asking for justice in the American mosaic that is our culture.

People that have been here ten years should be on a fast track toward citizenship. Those that have lived in America and have two or more generations that are native born and lived here have earned that right. People that have lived here and been gainfully employed for five years should have that right as well. We should reform the hiring laws to penalize those that hire illegal workers and have degrees of legal work status for those that desperately seek jobs and enrich, not detract from our culture. Parents of children born here need to be able to remain and provide for their families. An Amnesty Day must be set and adhered to that is fair and real. We must retain the heritage to the claim of the Land of Opportunity and Freedom.

From Liberty Enlightening the World is its inscription by Emma Lazarus:

Not like the brazen giant of Greek fame,
With conquering limbs astride from land to land;
Here at our sea-washed, sunset gates shall stand
A mighty woman with a torch, whose flame
Is the imprisoned lightning, and her name
Mother of Exiles. From her beacon-hand
Glows world-wide welcome; her mild eyes command
The air-bridged harbor that twin cities frame.
"Keep, ancient lands, your storied pomp!" cries she
' With silent lips. "Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tossed to me,
I lift my lamp beside the golden door!"

It is time to reestablish that culture that our Forefathers lived and died to create, not in merely the words, but the deeds. It is time.

by Thomas P Love

http://tomlovetexas.blogspot.com/2007/10/it-is-time.html

Fourteenth Amendment to the United States Constitution by Wikipedia

2013-01-12T09:50:00.000-08:00

Section 1. All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.Section 2. Representatives shall be apportioned among the several States according to their respective numbers, counting the whole number of persons in each State, excluding Indians not taxed. But when the right to vote at any election for the choice of electors for President and Vice President of the United States, Representatives in Congress, the Executive and Judicial officers of a State, or the members of the Legislature thereof, is denied to any of the male inhabitants of such State, being twenty-one years of age, and citizens of the United States, or in any way abridged, except for participation in rebellion, or other crime, the basis of representation therein shall be reduced in the proportion which the number of such male citizens shall bear to the whole number of male citizens twenty-one years of age in such State.
Section 3. No person shall be a Senator or Representative in Congress, or elector of President and Vice President, or hold any office, civil or military, under the United States, or under any State, who, having previously taken an oath, as a member of Congress, or as an officer of the United States, or as a member of any State legislature, or as an executive or judicial officer of any State, to support the Constitution of the United States, shall have engaged in insurrection or rebellion against the same, or given aid or comfort to the enemies thereof. But Congress may, by a vote of two-thirds of each House, remove such disability.
Section 4. The validity of the public debt of the United States, authorized by law, including debts incurred for payment of pensions and bounties for services in suppressing insurrection or rebellion, shall not be questioned. But neither the United States nor any State shall assume or pay any debt or obligation incurred in aid of insurrection or rebellion against the United States, or any claim for the loss or emancipation of any slave; but all such debts, obligations and claims shall be held illegal and void.
Section 5. The Congress shall have power to enforce, by appropriate legislation, the provisions of this article.

Validity of public debtSection 4 confirmed the legitimacy of all United States public debt appropriated by the Congress. It also confirmed that neither the United States nor any state would pay for the loss of slaves or debts that had been incurred by the Confederacy. For example, during the Civil War several British and French banks had lent large sums of money to the Confederacy to support its war against the Union.^[47] In Perry v. United States (1935), the Supreme Court ruled that under Section 4 voiding a United States government bond "went beyond the congressional power."^[^48]

The United States debt-ceiling crisis in 2011 raised the question of what powers Section 4 gives to the President. Under the current law, the executive branch of the government (which includes the Treasury and the President) is obligated to carry out all appropriations authorized by the Congress. It has been argued that, in the presence of conflicting statutes (a federal budget statute, which instructs the Treasury to spend a certain amount of money, and a debt ceiling statute, which limits the amount of money that the Treasury is allowed to borrow in process), the statute that was passed more recently "wins"; therefore, in this situation, the President may simply instruct the Treasury to continue issuing bonds beyond the ceiling. Furthermore, such an instruction may be difficult to challenge in court, because it would take a joint resolution of both chambers of Congress to get standing to challenge it.^[49] In addition, it has been observed by many, such as legal scholar Garrett Epps, fiscal expert Bruce Bartlett and Treasury Secretary Timothy Geithner, that the debt ceiling itself may be unconstitutional and therefore void as long as it interferes with the duty of the government to pay interest on outstanding bonds and to make payments owed to pensioners (that is, Social Security recipients).^[50]^[51]
The issue of what effect Section 4 has regarding the debt ceiling remains unsettled.^[52] Legal analyst Jeffrey Rosen has argued that Section 4 gives the President unilateral authority to raise or ignore the national debt ceiling, and that if challenged the Supreme Court would likely rule in favor of expanded executive power or dismiss the case altogether for lack of standing.^[53] Erwin Chemerinsky, professor and dean at University of California, Irvine School of Law, has argued that not even in a "dire financial emergency" could the President raise the debt ceiling as "there is no reasonable way to interpret the Constitution that [allows him to do so]".^[54]

Power of enforcement

Main article: Congressional power of enforcement
Section 5, the last section, was construed broadly by the Supreme Court in Katzenbach v. Morgan (1966).^[55] However, the Court, in City of Boerne v. Flores (1997), said:

Any suggestion that Congress has a substantive, non-remedial power under the Fourteenth Amendment is not supported by our case law.^[56]

Proposal and ratification
The 39th United States Congress proposed the Fourteenth Amendment on June 13, 1866.
Ratification of the Fourteenth Amendment was bitterly contested: all the Southern state legislatures, with the exception of Tennessee, refused to ratify the amendment. This refusal led to the passage of the Reconstruction Acts. Ignoring the existing state governments, military government was imposed until new civil governments were established and the Fourteenth Amendment was ratified.^[57]
By July 9, 1868, three-fourths of the states (28 of 37) ratified the amendment:^[58

http://en.wikipedia.org/wiki/Fourteenth_Amendment_to_the_United_States_Constitution#Validity_of_public_debt

A Day in the Life: Delusion verses Reality

2012-12-15T09:44:00.001-08:00

As I watched the news of the tragedy at Virginia Tech in Blacksburg, Virginia unfold, I thought of my own experiences with the mental health system in America. I have two step sons that have paranoid schizophrenia, and when they are taking their medication, they are not psychotic. The struggle to help them to lead meaningful and productive lives has encompassed the last twenty years of our existence. Once you have encountered the right of a mentally unbalanced person to not take their medicine, even though there is no possible way they can rationally make that essential decision; and then the criteria that they must actually be an immediate threat to themselves or others to get help to not be a threat, can you fully ask the question: which is more insane, the illness or the system?

I hear people debate whether to have more gun control or not despite the statistic that in gun deaths unrelated to wars, America has more gun deaths than all the rest of the world combined. In fact, we have 83% of the world’s gun non-military related deaths since 1980. But the question how an unmedicated mentally unbalanced person could seemingly legally buy two guns and then kill thirty-two people is answered that Virginia does not report mentally impaired individuals to the very data Federal base that determines if someone can legally buy a weapon. Why? Simply put, it is not illegal to be psychotic, but to not treat that psychosis is also not illegal.

I hear people say that mentally unbalanced people, that really want to kill people, can use other weapons. That is undeniably true. There is the case of a young woman being shoved into an oncoming train from a passenger platform by an unmedicated delusional individual that perceived her as an imaginary threat. If one wishes, one could possibly connect airline hijacking to unbalanced minds. However; that perceived threat met an immediate cry to safeguard boarding and passenger loading all across America. We have sky marshals and airline check-in procedures at all airports in every terminal, but we have averaged as many as thirty thousand gun deaths in America yearly since 1980. Why?

How many of these have been at the hands unbalanced individuals, one only can guess, but guns are not the main problem of society verses the individual on mental health. The root cause is proper treatment when that treatment is needed and the monitoring of that sick mind so that they can resume being a contributing member of society, not a potential time bomb that must explode to get the very help needed to prevent tragedy. I recently asked the question why mental health workers and social workers cannot help make sure ill and chemically imbalanced individuals take their medicine, and was met with the response that it’s not in the budget. Why? The next time a sick individual lets loose their unmedicated delusions and your loved one dies, will you be satisfied with that response?

_Thomas P Love 04/17/07

The Fiscal Cliff Explained By Thomas Kenny

2012-12-05T15:20:00.001-08:00

They can let the current policy scheduled for the beginning of 2013 – which features a number of tax increases and spending cuts that are expected to weigh heavily on growth and possibly drive the economy back into a recession – go into effect. The plus side: the deficit, as a percentage of GDP, would be cut in half.
They can cancel some or all of the scheduled tax increases and spending cuts, which would add to the deficit and increase the odds that the United States could face a crisis similar to that which is occurring in Europe. The flip side of this, of course, is that the United States' debt will continue to grow.
They could take a middle course, opting for an approach that would address the budget issues to a limited extent, but that would have a more modest impact on growth.

Henry A. Wallace from Wikipedia

2012-11-24T07:47:00.002-08:00

Henry Agard Wallace (October 7, 1888 – November 18, 1965) was the 33rd Vice President of the United States (1941–1945), the Secretary of Agriculture (1933–1940), and the Secretary of Commerce (1945–1946). In the 1948 presidential election, Wallace was the nominee of the Progressive Party.

Henry A. Wallace, son of Henry Cantwell Wallace, a farmer, journalist, and political activist, was born on October 7, 1888, at a farm near the village of Orient, Iowa, in Adair County.^[1] Wallace attended Iowa State College at Ames, Iowa. At Iowa State he became a friend of George Washington Carver, and they spent time together collecting botanical specimens. Wallace graduated in 1910 with a bachelor's degree in animal husbandry. He worked on the editorial staff of the family-owned paper Wallaces' Farmer in Des Moines from 1910 to 1924, and he edited this publication from 1924 to 1929. Wallace experimented with breeding high-yielding hybrid corn, and he wrote a good number of publications on agriculture. In 1915, he devised the first corn-hog ratio charts indicating the probable course of markets. Wallace was also a self-taught "practicing statistician",^[2] co-authoring an influential article with George W. Snedecor on computational methods for correlations and regressions^[3] and publishing sophisticated statistical studies in the pages of Wallaces’ Farmer. Snedecor eventually invited Wallace to teach a graduate course on least squares.^[4]
With an inheritance of a few thousand dollars that had been left to his wife, the former Ilo Browne, whom he married in 1914, Wallace founded the Hi-Bred Corn Company in 1926, which later became Pioneer Hi-Bred, a major agriculture corporation, acquired in 1999 by the Dupont Corporation for approximately $10 billion.
Wallace was raised as a Presbyterian, but left that denomination early in life. He spent most of his early life exploring other religious faiths and traditions. For many years, he had been closely associated with famous Russian artist and writer Nicholas Roerich. According to Arthur Schlesinger, Jr., "Wallace's search for inner light took him to strange prophets.... It was in this search that he encountered Nicholas Roerich, a Russian emigre, painter, theosophist. Wallace did Roerich a number of favors, including sending him on an expedition to Central Asia presumably to collect drought-resistant grasses. In due course, H.A. [Wallace] became disillusioned with Roerich and turned almost viciously against him."^[5] Wallace eventually settled on Episcopalianism.
Henry Wallace was also a Freemason and attained the 32nd Degree in the Scottish Rite.
Secretary of Agriculture
In 1933, President Franklin D. Roosevelt appointed Wallace United States Secretary of Agriculture in his Cabinet, a post his father, Henry Cantwell Wallace, had occupied from 1921 to 1924. Henry A. Wallace had been a liberal Republican, but he supported Roosevelt's New Deal and soon switched to the Democratic Party. Wallace served as Secretary of Agriculture until September 1940, when he resigned, having been nominated for Vice President as Roosevelt's running mate in the 1940 presidential election. During his tenure as U.S. Secretary of Agriculture he ordered a very unpopular strategy of slaughtering pigs and plowing up cotton fields in rural America to drive the price of these commodities back up in order to improve American farmers' financial situation. He also advocated the ever-normal granary concept.

Vice President

In 1943, Wallace made a goodwill tour of Latin America, shoring up support among important allies. His trip proved a success, and helped persuade twelve countries to declare war on Germany. Regarding trade relationships with Latin America, he convinced the BEW to add "labor clauses" to contracts with Latin American producers. These clauses required producers to pay fair wages and provide safe working conditions for their employees and committed the United States to paying for up to half of the required improvements. This met opposition from the U.S. Department of Commerce.
Wallace believed that both the American and the Russian revolution were part of "the march to freedom of the past 150 years." After having met Molotov, he arranged a trip to the "Wild East" of Russia. On May 23, 1944, he started a 25-day journey accompanied by Owen Lattimore. Coming from Alaska, they landed at Magadan where they were received by Sergei Goglidze and Dalstroi director Ivan Nikishov, both NKVD generals. The NKVD presented a fully sanitized version of the slave labor camps in Magadan and Kolyma to their American guests, convinced them that all the work was done by volunteers, charmed them with entertainment, and left their guests impressed with the "development" of Siberia and the spirit of the "volunteers." Lattimore's film of the visit tells that "a village... in Siberia is a forum for open discussion like a town meeting in New England."^[6] The trip continued to Mongolia and then to China.
After Wallace feuded publicly with Jesse Jones and other high officials, Roosevelt stripped him of his war agency responsibilities and entertained the idea of replacing him on the presidential ticket. The Democratic Party, with concern being expressed privately about Roosevelt being able to make it through another term, chose Harry S. Truman as Roosevelt's running mate at the 1944 Democratic convention, after New Deal partisans failed to promote William O. Douglas. Wallace was succeeded as Vice President on January 20, 1945, by Truman. On April 12, 1945, Vice President Truman succeeded to the Presidency when President Franklin D. Roosevelt died. Henry A. Wallace had missed being the 33rd President of the United States by just 82 days.

Roerich controversy

Secretary of Commerce

The New Republic

The 1948 Presidential election

Wallace left his editorship position in 1948 to make an unsuccessful run as a Progressive Party candidate in the 1948 U.S. presidential election. With Idaho Democratic U.S. Senator Glen H. Taylor as his running mate, his platform advocated friendly relations with the Soviet Union, an end to the nascent Cold War, an end to segregation, full voting rights for blacks, and universal government health insurance. His campaign was unusual for his time in that it included African American candidates campaigning alongside white candidates in the American South, and that during the campaign he refused to appear before segregated audiences or eat or stay in segregated establishments.
As a further sign of the times, he was noted by Time as ostentatiously riding through various cities and towns in the South "with his Negro secretary beside him".^[10] Many eggs and tomatoes were hurled at and struck him and his campaign members during the tour, while at the same time President Truman referred to such behavior towards Wallace as very un-American. Wallace commented that "there is a long chain that links unknown young hoodlums in North Carolina or Alabama with men in finely tailored business suits in the great financial centers of New York or Boston, men who make a dollars-&-cents profit by setting race against race in the far away South."^[10] State authorities in Virginia sidestepped enforcing its own segregation laws by declaring Wallace's campaign gatherings as private parties.^[11]
Wallace's campaign to advance progressive causes inspired several activists and organizations. One short-lived effort was an attempt by Harry Hay, an active Communist teacher in Southern California, to create an organization of homosexuals, to be called Bachelors for Wallace, which would lobby for the inclusion in Wallace's platform of a call for the reform of sodomy and other laws that were the basis of widespread anti-gay discrimination and persecution. Hay was unsuccessful in his efforts to find other homosexual men willing to join such a risky venture, and the idea was never realized. Two years later, however, Hay and other leftists successfully founded the Mattachine Society, now recognized as the first significant grassroots organization for LGBT rights in the United States.^[12] Wallace had not made any official statements in support of gay rights and it is unclear how much support this group gave to the campaign. Yet, in the tenor of the times, such an organization would have been highly controversial. The fact that group generated almost no notice by the press or even the campaign itself, may be because of other controversies facing the campaign.
The "Dear Guru" letters reappeared now and were published, seriously hampering his campaign.^[5] Even more damage was done to Wallace's campaign when several prominent journalists, including H.L. Mencken and Dorothy Thompson, publicly charged that Wallace and the Progressives were under the covert control of Communists. Wallace was endorsed by the Communist Party (USA), and his subsequent refusal to publicly disavow any Communist support cost him the backing of many anti-Communist liberals and socialists, such as Norman Thomas. Christopher Andrew, a University of Cambridge historian working with evidence in the famed Mitrokhin Archive, has stated publicly^[13] that he believed Wallace was a confirmed KGB agent, though evidence for this was never produced.
Wallace suffered a decisive defeat in the election to the Democratic incumbent Harry S. Truman. He finished in fourth place with 2.4% of the popular vote. Dixiecrat presidential candidate Strom Thurmond outstripped Wallace in the popular vote. Thurmond managed to carry several states in the Deep South, gaining 39 electoral votes to Wallace's electoral total of zero.

Later career

Wallace resumed his farming interests, and resided in South Salem, New York. During his later years he made a number of advances in the field of agricultural science. His many accomplishments included a breed of chicken that at one point accounted for the overwhelming majority of all egg-laying chickens sold across the globe. The Henry A. Wallace Beltsville Agricultural Research Center, the largest agricultural research complex in the world, is named for him.
In 1950, when North Korea invaded South Korea, Wallace broke with the Progressives and backed the U.S.-led war effort in the Korean War.^[5] In 1952, Wallace published Where I Was Wrong, in which he explained that his seemingly-trusting stance toward the Soviet Union and Joseph Stalin stemmed from inadequate information about Stalin's crimes and that he, too, now considered himself an anti-Communist. He wrote various letters to "people who he thought had traduced (maligned) him" and advocated the re-election of President Dwight D. Eisenhower in 1956.^[5]
In 1961, President-elect John F. Kennedy invited him to his inauguration ceremony, though he had supported Kennedy's opponent Richard Nixon. A touched Wallace wrote to Kennedy: "At no time in our history have so many tens of millions of people been so completely enthusiastic about an Inaugural Address as about yours."^[5]
Wallace first experienced the onsets of Lou Gehrig's disease on one of his frequent trips to South America in 1964.^[14] He died in Danbury, Connecticut, in 1965.^[5]^[15] His remains were cremated at Grace Cemetery in Bridgeport, Connecticut, and the ashes interred in Glendale Cemetery, Des Moines, Iowa.

http://en.wikipedia.org/wiki/Henry_A._Wallace

Know Nothing, Do Nothing Congress by Harry Truman

2012-09-22T09:46:00.002-07:00

You are here because you are interested in the issues of this campaign. You know, as all the citizens of this great country know, that the election is not all over nothing but shouting. That is what they would like to have you believe, but it isn't so--it isn't so at all.

The Republicans are trying to hide the truth from you in a great many ways. They don't want you to know the truth about the issues in this campaign. The big fundamental issue in this campaign is the people against the special interests.

The Democratic party stands for the people.

The Republican party stands, and always has stood, for special interests. They have proved that conclusively in the record that they made in this "do-nothing" Congress.

The Republican party candidates are going around talking to you in high-sounding platitudes, trying to make you believe that they themselves are the best people to run the government. Well now, you have had experience with them running the government. In 1920 to 1932, they had complete control of the government. Look what they did to it!

This country is enjoying the greatest prosperity it has ever known because we have been following, for sixteen years, the policies inaugurated by Franklin D. Roosevelt. Everybody benefited from these policies--labor, the farmer, businessmen, and white-collar workers.

We want to keep that prosperity. We cannot keep that if we don't lick the biggest problem facing us today, and that is high prices.

I have been trying to get the Republicans to do something about high prices and housing ever since they came to Washington. They are responsible for that situation, because they killed price control, and they killed the housing bill. That Republican, 80th "do-nothing" Congress absolutely refused to give any relief whatever in either one of those categories.

What do you suppose the Republicans think you ought to do about high prices?

Senator Taft, one of the leaders in the Republican Congress, said, "If consumers think the price is too high today, they will wait until the price is lower. I feel that in time, the law of supply and demand will bring prices into line. "

There is the Republican answer to the high cost of living.

If it costs too much, just wait.

If you think fifteen cents is too much for a loaf of bread, just do without it and wait until you can afford to pay fifteen cents for it.

If you don't want to pay sixty cents a-pound for hamburger, just wait. That is what the Republican Congress thought you ought to do, and that is the same Congress that the Republican candidate for president said did a good job.

Some people say I ought not to talk so much about the Republican 80th "do-nothing" Congress in this campaign. I will tell you why I will talk about it. If two-thirds of the people stay at home again on election day as they did in 1946, and if we get another Republican Congress like the 80th Congress, it will be controlled by the same men who controlled that 80th Congress--the Tabers and the Tafts, the Martins and the Hallecks--would be the bosses. The same men would be the bosses, the same as those who passed the Taft-Hartley Act, and passed the rich man's tax bill, and took Social Security away from a million workers.

Do you want that kind of administration? I don't believe you do--I don't believe you do.

I don't believe you would be out here, interested in listening to my outline of what the Republicans are trying to do to you, if you intended to put them back in there.

When a bunch of Republican reactionaries are in control of the Congress, then the people get reactionary laws. The only way you can get the kind of government you need is by going to the polls and voting the straight Democratic ticket on November 2. Then you will get a Democratic Congress, and I will get a Congress that will work with me. Then we will get good housing at prices we can afford to pay; and repeal of that vicious Taft-Hartley Act; and more Social Security coverage; and prices that will be fair to everybody; and we can go on and keep sixty-one million people at work; we can have an income of more than $217 billion, and that income will be distributed so that the farmer, the workingman, the white collar worker, and the businessman get their fair share of that income.

That is what I stand for.

That is what the Democratic party stands for.

Vote for that, and you will be safe.

Elizabeth, New Jersey, October 7, 1948 by President Harry S Truman

http://www.speeches-usa.com/Transcripts/053_truman.html

Former GOP Fla. Gov. Crist Says Romney, Ryan 'Aren't Up to the Task'

2012-09-09T13:01:00.002-07:00

By Marc Caputo, The Miami Herald

he biggest Florida speaker at the Democratic National Convention wasn't a Democrat.

Yet.

After former Republican Gov. Charlie Crist's speech Thursday night, it's only a matter of time before he officially joins the party's ranks in a slow march to running for governor in two years.

Crist's high-profile role disturbed many Florida delegates, but it furthered President Obama's campaign message - that the Republican Party is too extreme.

"As a former lifelong Republican, it pains me to tell you that today's Republicans - and their standard-bearers, Mitt Romney and Paul Ryan - just aren't up to the task," Crist said. "They're beholden to ‘my way or the highway' bullies, indebted to billionaires who bankroll ads and allergic to the very idea of compromise."

Crist's speech was as much a condemnation of today's Republican Party as it was an explanation of why he's officially moving toward the Democratic Party and away from the conservative positions he once espoused.

Republicans and many Democrats alike won't let Crist forget he campaigned for years as a pro-life, anti-gay marriage, gun-touting "Reagan Republican" and "Jeb Bush Republican." In 2010, in his unsuccessful Senate bid, he bashed Obama's agenda and ran as a "true conservative."

"Is he here, and in this for his principles?" asked Democratic delegate Bob Hartnett of Orlando. "I've got a long time to think about that. But there are many others in this party qualified to lead and be onstage representing our people."

Crist said Thursday that he was addressing the convention "not as a Republican, not as a Democrat, but as an optimist." Crist referred to Bush in his speech as "my friend" - a comment sure to irk conservatives as well as Bush, who has described Crist as an opportunist.

Crist ran as a conservative in his first statewide race in 1998, when he unsuccessfully ran for U.S. Senate. With Bush's help, Crist was elected education commissioner, attorney general and, in 2006, governor where he governed as a centrist.

"Half a century ago, Ronald Reagan, the man whose relentless optimism inspired me to enter politics, famously said that he didn't leave the Democratic Party; the party left him," Crist said. "I can certainly relate. I didn't leave the Republican Party; it left me."

But the timing of Crist's departure from the Republican Party suggests a colder political calculation. He officially left the party just before a candidate-qualifying deadline in the 2010 Senate race.

Crist was running against fellow Republican Marco Rubio, and Crist would have handily lost the GOP primary. So he left the GOP and ran as an independent, though he ultimately lost the general election.

Crist's undoing in the GOP: The infamous "hug," his decision to appear onstage with Obama in 2009 in Fort Myers, where he literally embraced the president and the $787 billion stimulus program.

"That hug caused me more grief from my former party than you can ever imagine," Crist said. "But even as the Republican Party fought tooth and nail to stop him, this president showed his courage, invested in America - and saved Florida."

Crist was the only Republican governor to break ranks with his party to talk up the stimulus, which every GOP governor and Legislature wound up using to patch holes in their budget.

As the primary race intensified, Crist then flip-flopped on the stimulus, alternately bashing it and talking it up depending on the day or the media outlet he was addressing. Crist released a radio ad that bashed Obama for spending. The Florida Democratic Party later released a TV spot that questioned Crist's authenticity.

Crist brushed aside those differences Thursday night.

"I'll be honest with you, I don't agree with President Obama about everything.," Crist said. "But I've gotten to know him, I've worked with him, and the choice is crystal clear."

Crist credited Obama with not only saving the economy in Florida, but for fighting to ensure that BP cleaned up the Gulf Coast after the oil spill. Crist said nothing Thursday about the president's Affordable Care Act, which Crist once described as scary.

Crist's role at the Democratic National Convention underscores the weakness of the party in Florida, where only Sen. Bill Nelson holds a statewide seat. The Legislature is overwhelmingly Republican, even though registered Democrats outnumber Republicans in the state.

Democrats want a winner. They note that, as an independent, he garnered 1.6 million votes in 2010 to Rubio's 2.6 million. Democratic Rep. Kendrick Meek came in third, with just over 1 million votes, the overwhelming majority of which would likely have gone to Crist had there not been a three-way race.

Meek won't rule out running for governor against Crist. Florida Senate Democratic leader Nan Rich, of Weston, is running. And former state Chief Financial Officer Alex Sink might want a rematch against Republican Gov. Rick Scott, who narrowly beat her in 2010.

"If by some miracle Charlie Crist makes it out of the gauntlet of a Democratic primary even though he called himself a staunch conservative, he then has to run on his dismal record," said Scott's political advisor and pollster Tony Fabrizio, who ticked off the dismal economic indicators that unfolded on Crist's watch.

Former Miami Beach Democratic state Sen. Dan Gelber recently penned a column welcoming Crist to the party, and he chuckled at Republicans painting the former governor out as a flip flopper.

"Just a week ago," Gelber said, "Republicans nominated Mitt Romney, a former pro-choice, pro-gay marriage, anti-Reagan economic, self-described progressive who used to be concerned about global warming."

Crist steered clear of mentioning Romney's reversals, but he did echo the Democratic talking point that the Republicans "would break the fundamental promise of Medicare and Social Security" - a line of attack that could prove devastating in must-win Florida, a state with a disproportionate share of elderly residents.

Crist's speech was brief. Accustomed to having a fan at his side to keep cool, Crist didn't have the luxury on Thursday night and was on the cusp of breaking into a sweat on stage.

But he ended quickly and smoothly as he started to win the home crowd, noting "I used to play quarterback just down the road from here at Wake Forest University. My dad always told me, ‘Charlie, it takes a cool head to win a hot game.'"

Crist said Obama had the "cool head" the nation needs.

"That's the leader Florida needs. That's the leader America needs," he said, as the crowd rose to its feet. "And that's the reason I'm here tonight."

http://www.mcclatchydc.com/2012/09/07/167436/former-fla-gov-crist-says-romney.html

Labor Day From Wikipedia

2012-09-03T07:37:00.002-07:00

History

In 1882, Matthew Maguire, a machinist, first proposed the holiday while serving as secretary of the CLU (Central Labor Union) of New York.^[1] Others argue that it was first proposed by Peter J. McGuire of the American Federation of Labor in May 1882,^[2] after witnessing the annual labor festival held in Toronto, Canada.^[3]
Oregon was the first state to make it a holiday in 1887. By the time it became a federal holiday in 1894, thirty states officially celebrated Labor Day.^[2] Following the deaths of a number of workers at the hands of the U.S. military and U.S. Marshals during the Pullman Strike, President Grover Cleveland reconciled with Reyes, leader of the labor movement. Fearing further conflict, the United States Congress unanimously voted to approve rush legislation that made Labor Day a national holiday; Cleveland signed it into law a mere six days after the end of the strike.^[4] The September date originally chosen by the CLU of New York and observed by many of the nation's trade unions for the past several years was selected rather than the more widespread International Workers' Day because Cleveland was concerned that observance of the latter would be associated with the nascent Communist, Syndicalist and Anarchist movements that, though distinct from one another, had rallied to commemorate the Haymarket Affair in International Workers' Day.^[5] All U.S. states, the District of Columbia, and the territories have made it a statutory holiday.

Pattern of celebration

The form for the celebration of Labor Day was outlined in the first proposal of the holiday: A street parade to exhibit to the public "the strength and esprit de corps of the trade and labor organizations",^[1] followed by a festival for the workers and their families. This became the pattern for Labor Day celebrations. Speeches by prominent men and women were introduced later, as more emphasis was placed upon the civil significance of the holiday. Still later, by a resolution of the American Federation of Labor convention of 1909, the Sunday preceding Labor Day was adopted as Labor Sunday and dedicated to the spiritual and educational aspects of the labor movement.^[1]
The holiday is often regarded as a day of rest and parties. Speeches or political demonstrations are more low-key than May 1 Labor Day celebrations in most countries, although events held by labor organizations often feature political themes and appearances by candidates for office, especially in election years.^[6] Forms of celebration include picnics, barbecues, fireworks displays, water sports, and public art events. Families with school-age children take it as the last chance to travel before the end of summer recess. Similarly, some teenagers and young adults view it as the last weekend for parties before returning to school, although school starting times now vary.End of summer
Labor Day has come to be celebrated by most Americans as the symbolic end of the summer. In high society, Labor Day is (or was) considered the last day of the year when it is fashionable to wear white^[8] or seersucker.^[9]^[10]
In U.S. sports, Labor Day marks the beginning of the NFL and college football seasons. NCAA teams usually play their first games the week before Labor Day, with the NFL traditionally playing their first game the Thursday following Labor Day. The Southern 500 NASCAR auto race was held that day from 1950 to 1983 in Darlington, South Carolina. At Indianapolis Raceway Park, the National Hot Rod Association hold their finals to the U.S. Nationals drag race.
In the U.S., most school districts that started summer vacation in early June will resume school the day after this day (see First Day of School), while schools that had summer vacation begin on the Saturday before Memorial Day in late May will have already been in session since late August. However this tradition is changing as many school districts end in early June and begin mid-August.^[11]

http://en.wikipedia.org/wiki/Labor_Day

Labor Day Numbers

(CNN) -- Labor Day is a holiday many American workers eagerly anticipate -- a three-day weekend, and a respite from work to relax and celebrate with friends and family. As you're calculating how many bags of buns you need to go with that jumbo pack of hot dogs at your barbecue (they never seem to match up), here are some other Labor Day numbers to contemplate.

33 million: Americans who plan to travel at least 50 miles over Labor Day weekend this year, according to AAA.

14 cents: Average increase in the price of a gallon of gas since AAA's 2011 Labor Day forecast.

155.2 million: Number of people 16 years and older who are in the labor force.

85: Percentage of full-time workers 18 to 64 covered by health care insurance during all or part of 2010.

39.7 million: Number of people who the Department of Labor helped through the Employment and Training Administration programs.

58: Percent who think it's OK to wear white after Labor Day according to a nonscientific poll.

685,000: Number of workers who were placed into new jobs through the Workforce Investment Act Adult and Dislocated Worker programs.

1.674 million: Veterans who were helped by the Department's Veterans' Employment and Training Service (VETS) in 2010.

473,700: Number of veteran workers entering into employment.

25.3 minutes: Average commute time in 2010. Maryland has the longest commute in the country, with an average time of 31.8 minutes. (Source: U.S. Census Bureau, 2010 American Community Survey, Table R0801)

3.2 million: Number of workers whose commutes were 90 or more minutes each day in 2010.

$47,715: 2010 real median full-time earnings for males.

$36,931: 2010 real median full-time earnings for females.

29.2: Percent difference in men's and women's earnings.

11.8: Percentage of workers who were members of a union in 2011.

30: Percentage reduction of overall family summer travel from May through September.

http://www.cnn.com/2012/09/01/living/labor-day-numbers/index.html

It Is Time

2012-09-01T12:44:00.000-07:00

On the Statue of Liberty are inscriptions about giving Americans the tired, the poor, and the huddled masses yearning to breathe free. It is time to actually fulfill that promise and give our Latino brothers and Latina sisters that promised freedom. It would appear we, like some Madison Avenue advertising agency have shown the slogans, yet denied the reality to much of Latin America. We seem to say you can attempt to cross the border illegally, and have children in the United States, but you cannot become a citizen. Many have lived here for over twenty years and have as many as three generations in America, but are still considered illegal and must constantly be on constant vigil against reprisal.

Every one knows that conditions south of our borders have long been devoid of the opportunity to allow families to grow and prosper with a life style that rewards ability and enlarges the middle class. They have struggled to get here and died in closed freight trailers on some lonely desert or fallen prey to rings exploiting them into prostitution and economic slavery. They must keep watching with a constant eye for immigration and threats to be deported should they try to get better wages or living conditions. Mexicans in particular have migrated in large numbers to America to provide for their families in land that once was in fact theirs. Additionally Latinos from Latin and Central America have come here to escape political and economic hardships. Their children the Dreamers have grown up here and seen the hypocrisy between what we do and what we say we do. They must have a pathway for citizenship.

America should be the literal shining beacon of hope and justice for immigrants, but most with the exception of the first Europeans who crossed the ocean shores, have had to suffer until they were assimilated and accepted into a kinder, gentler society. There were Irish, Italian, Jewish, Black, and Oriental slums and repressions. And so, there are now Latinos marching, shouting, and asking for justice in the American mosaic that is our culture.

People that have been here ten years should be on a fast track toward citizenship. Those that have lived in America and have two or more generations that are native born and lived here have earned that right. People that have lived here and been gainfully employed for five years should have that right as well. We should reform the hiring laws to penalize those that hire illegal workers and have degrees of legal work status for those that desperately seek jobs and enrich, not detract from our culture. Parents of children born here need to be able to remain and provide for their families. An Amnesty Day must be set and adhered to that is fair and real. We must retain the heritage to the claim of the Land of Opportunity and Freedom.

From Liberty Enlightening the World is its inscription by Emma Lazarus:

Not like the brazen giant of Greek fame,
With conquering limbs astride from land to land;
Here at our sea-washed, sunset gates shall stand
A mighty woman with a torch, whose flame
Is the imprisoned lightning, and her name
Mother of Exiles. From her beacon-hand
Glows world-wide welcome; her mild eyes command
The air-bridged harbor that twin cities frame.
"Keep, ancient lands, your storied pomp!" cries she
' With silent lips. "Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tossed to me,
I lift my lamp beside the golden door!"

It is time to reestablish that culture that our Forefathers lived and died to create, not in merely the words, but the deeds. It is time.

by Thomas P Love

The Medicare Killers by Paul Krugman

2012-09-01T12:35:00.000-07:00

Paul Ryan’s speech Wednesday night may have accomplished one good thing: It finally may have dispelled the myth that he is a Serious, Honest Conservative. Indeed, Mr. Ryan’s brazen dishonesty left even his critics breathless.

Some of his fibs were trivial but telling, like his suggestion that President Obama is responsible for a closed auto plant in his hometown, even though the plant closed before Mr. Obama took office. Others were infuriating, like his sanctimonious declaration that “the truest measure of any society is how it treats those who cannot defend or care for themselves.” This from a man proposing savage cuts in Medicaid, which would cause tens of millions of vulnerable Americans to lose health coverage.

And Mr. Ryan — who has proposed $4.3 trillion in tax cuts over the next decade, versus only about $1.7 trillion in specific spending cuts — is still posing as a deficit hawk.

But Mr. Ryan’s big lie — and, yes, it deserves that designation — was his claim that “a Romney-Ryan administration will protect and strengthen Medicare.” Actually, it would kill the program.

Before I get there, let me just mention that Mr. Ryan has now gone all-in on the party line that the president’s plan to trim Medicare expenses by around $700 billion over the next decade — savings achieved by paying less to insurance companies and hospitals, not by reducing benefits — is a terrible, terrible thing. Yet, just a few days ago, Mr. Ryan was still touting his own budget plan, which included those very same savings.

But back to the big lie. The Republican Party is now firmly committed to replacing Medicare with what we might call Vouchercare. The government would no longer pay your major medical bills; instead, it would give you a voucher that could be applied to the purchase of private insurance. And, if the voucher proved insufficient to buy decent coverage, hey, that would be your problem.

Moreover, the vouchers almost certainly would be inadequate; their value would be set by a formula taking no account of likely increases in health care costs.

Why would anyone think that this was a good idea? The G.O.P. platform says that it “will empower millions of seniors to control their personal health care decisions.” Indeed. Because those of us too young for Medicare just feel so personally empowered, you know, when dealing with insurance companies.

Still, wouldn’t private insurers reduce costs through the magic of the marketplace? No. All, and I mean all, the evidence says that public systems like Medicare and Medicaid, which have less bureaucracy than private insurers (if you can’t believe this, you’ve never had to deal with an insurance company) and greater bargaining power, are better than the private sector at controlling costs.

I know this flies in the face of free-market dogma, but it’s just a fact. You can see this fact in the history of Medicare Advantage, which is run through private insurers and has consistently had higher costs than traditional Medicare. You can see it from comparisons between Medicaid and private insurance: Medicaid costs much less. And you can see it in international comparisons: The United States has the most privatized health system in the advanced world and, by far, the highest health costs.

So Vouchercare would mean higher costs and lower benefits for seniors. Over time, the Republican plan wouldn’t just end Medicare as we know it, it would kill the thing Medicare is supposed to provide: universal access to essential care. Seniors who couldn’t afford to top up their vouchers with a lot of additional money would just be out of luck.

Still, the G.O.P. promises to maintain Medicare as we know it for those currently over 55. Should everyone born before 1957 feel safe? Again, no.

For one thing, repeal of Obamacare would cause older Americans to lose a number of significant benefits that the law provides, including the way it closes the “doughnut hole” in drug coverage and the way it protects early retirees.

Beyond that, the promise of unchanged benefits for Americans of a certain age just isn’t credible. Think about the political dynamics that would arise once someone born in 1956 still received full Medicare while someone born in 1959 couldn’t afford decent coverage. Do you really think that would be a stable situation? For sure, it would unleash political warfare between the cohorts — and the odds are high that older cohorts would soon find their alleged guarantees snatched away.

The question now is whether voters will understand what’s really going on (which depends to a large extent on whether the news media do their jobs). Mr. Ryan and his party are betting that they can bluster their way through this, pretending that they are the real defenders of Medicare even as they work to kill it. Will they get away with it?

http://www.nytimes.com/2012/08/31/opinion/Krugman.html?src=me&ref=general

I'm not backing down by Harry Reid

2012-08-03T14:35:00.000-07:00

Dear Taxpayer,

The other day, I said that I’d been told by a very credible source that Mitt Romney hadn’t paid taxes for ten years. Governor Romney got upset. But, you know what? I’m not backing down.

I’m not backing down because, when you run for President, you should be an open book. I’m not backing down because Mitt Romney is hiding something — and the American people deserve to know what it is.

Governor Romney told me to “put up or shut up” — but he’s the one who’s shut up when people asked legitimate questions about his finances, and it’s up to him to put up his taxes so we can see the answers.

We can’t let Mitt Romney get away with this — not with hiding his taxes, and not with a tax plan that would reach into the pockets of the middle class to help multi-millionaires like himself.

Will you stand with me? Click here to help me tell Mitt Romney we’re not going to shut up until he comes clean — and make a contribution to prove you're not backing down.

It’s well-known that wealthy individuals like Mitt Romney have all sorts of creative tricks to dodge taxes — offshore accounts, hidden loopholes, questionable deductions, and the like.

And it’s clear that the Romney campaign knows they have something to hide. After Governor Romney promised to tell the nation whether he’d ever paid a lower tax rate than the 13.9% he paid in the one year of taxes he partially released, his campaign quickly walked it back.

So instead of attacking me for raising questions, Governor Romney needs to start answering them. And if he thinks I’m about to back down, he’s got another thing coming.

Mitt Romney is waiting for us to apologize and stop asking questions. Click here to help build our strength and show him that’s not going to happen.

In the end, Mitt Romney could end all the controversy by releasing his taxes. He can tell us exactly what shady tricks he’s used to avoid paying his fair share, or he can prove that he had nothing to hide all along.

What he can’t do — what I won’t let him do — is keep hiding. He’s running for President, for Pete’s sake. And it’s up to us to make Mitt Romney come clean with the American people.

Click here to take a stand with me.

Thanks for proving that Democrats aren’t about to back down on this.

Harry

Why is Mitt Romney Afraid to Release His Tax Returns?

2012-07-29T10:20:00.002-07:00

A. He Registered his Companies as Foreign Businesses

B. He Paid less than 10% While Earning Multi Millions of Dollars

C. He Did NOT Pay Taxes AT ALL in most years at Bain Capital

D. He Claimed Negative Earnings and GOT Paid from the US Government Tax Credits

E. All the Above

F. None of the Above

John McCain saw 23 years of Mitt Ronmey's Tax Returns and chose Sarah Palin

2012-07-15T07:06:00.001-07:00

Health Care in the US from Wikipedia

2012-07-01T06:37:00.002-07:00

Health care in the United States is provided by many separate legal entities. Health care facilities are largely owned and operated by the private sector. Health insurance is now primarily provided by the government in the public sector, with 60-65% of healthcare provision and spending coming from programs such as Medicare, Medicaid, TRICARE, the Children's Health Insurance Program, and the Veterans Health Administration. Most of the population under 65 is insured by an employer, some buy health insurance on their own, and the remainder are uninsured.

The U.S. Census Bureau reported that 49.9 million residents, 16.3% of the population, were uninsured in 2010 (up from 49.0 million residents, 16.1% of the population, in 2009).[1][2] According to the World Health Organization (WHO), the United States spent more on health care per capita ($7,146), and more on health care as percentage of its GDP (15.2%), than any other nation in 2008.[3] The United States had the fourth highest level of government health care spending per capita ($3,426), behind three countries with higher levels of GDP per capita: Monaco, Luxembourg, and Norway.[3] A 2001 study in five states found that medical debt contributed to 46.2% of all personal bankruptcies and in 2007, 62.1% of filers for bankruptcies claimed high medical expenses.[4] Since then, health costs and the numbers of uninsured and underinsured have increased.[5]

Active debate about health care reform in the United States concerns questions of a right to health care, access, fairness, efficiency, cost, choice, value, and quality. Some have argued that the system does not deliver equivalent value for the money spent. The USA pays twice as much yet lags behind other wealthy nations in such measures as infant mortality and life expectancy. Currently, the USA has a higher infant mortality rate than most of the world's industrialized nations.[nb 1][6] In the United States life expectancy is 42nd in the world, after some other industrialized nations, lagging the other nations of the G5 (Japan, France, Germany, UK, USA) and just after Chile (35th) and Cuba (37th).[7]

Life expectancy at birth in the USA, 78.49, is 50th in the world, below most developed nations and some developing nations. Monaco is first with 89.68. Angola is last with 31.88. US statistics are below the average life expectancy for the European Union.[8][9] The World Health Organization (WHO), in 2000, ranked the U.S. health care system as the highest in cost, first in responsiveness, 37th in overall performance, and 72nd by overall level of health (among 191 member nations included in the study).[10][11] The Commonwealth Fund ranked the United States last in the quality of health care among similar countries,[12] and notes U.S. care costs the most.[13]

A 2004 Institute of Medicine (IOM) report said: "The United States is among the few industrialized nations in the world that does not guarantee access to health care for its population."[14] A 2004 OECD report said: "With the exception of Mexico, Turkey, and the United States, all OECD countries had achieved universal or near-universal (at least 98.4% insured) coverage of their populations by 1990.[15] The 2004 IOM report observed "lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States."[14] while a 2009 Harvard study estimated that 44,800 excess deaths occurred annually due to lack of health insurance.[16]

On March 23, 2010, the Patient Protection and Affordable Care Act (PPACA) became law, providing for major changes in health insurance.[17]

ProvidersHealth care providers in the United States encompass individual health care personnel, health care facilities and medical products.

FacilitiesMain article: Medical centers in the United States

In the United States, ownership of the health care system is mainly in private hands, though federal, state, county, and city governments also own certain facilities.

The non-profit hospitals share of total hospital capacity has remained relatively stable (about 70%) for decades.[18] There are also privately owned for-profit hospitals as well as government hospitals in some locations, mainly owned by county and city governments.

There is no nationwide system of government-owned medical facilities open to the general public but there are local government-owned medical facilities open to the general public. The federal Department of Defense operates field hospitals as well as permanent hospitals (the Military Health System), to provide military-funded care to active military personnel.

The federal Veterans Health Administration operates VA hospitals open only to veterans, though veterans who seek medical care for conditions they did not receive while serving in the military are charged for services. The Indian Health Service operates facilities open only to Native Americans from recognized tribes. These facilities, plus tribal facilities and privately contracted services funded by IHS to increase system capacity and capabilities, provide medical care to tribespeople beyond what can be paid for by any private insurance or other government programs.[19]

Hospitals provide some outpatient care in their emergency rooms and specialty clinics, but primarily exist to provide inpatient care. Hospital emergency departments and urgent care centers are sources of sporadic problem-focused care. "Surgicenters" are examples of specialty clinics. Hospice services for the terminally ill who are expected to live six months or less are most commonly subsidized by charities and government. Prenatal, family planning, and "dysplasia" clinics are government-funded obstetric and gynecologic specialty clinics respectively, and are usually staffed by nurse practitioners.

PhysiciansMain article: Physician in the United States

Physicians in the United States include those trained by the US medical education system, and those that are international medical graduates who have progressed through the necessary steps to acquire a medical license to practice in a state.

The American College of Physicians, uses the term physician to describe all medical practitioners holding a professional medical degree. The American Medical Association as well as the American Osteopathic Association both currently use the term physician to describe members.

Medical products, research and developmentAs in most other countries, the manufacture and production of pharmaceuticals and medical devices is carried out by private companies. The research and development of medical devices and pharmaceuticals is supported by both public and private sources of funding. In 2003, research and development expenditures were approximately $95 billion with $40 billion coming from public sources and $55 billion coming from private sources.[20][21] These investments into medical research have made the United States the leader in medical innovation, measured either in terms of revenue or the number of new drugs and devices introduced.[22][23] In 2006, the United States accounted for three quarters of the world’s biotechnology revenues and 82% of world R&D spending in biotechnology.[22][23] According to multiple international pharmaceutical trade groups, the high cost of patented drugs in the U.S. has encouraged substantial reinvestment in such research and development.[22][23][24]

Spending

U.S. healthcare costs exceed those of other countries, relative to the size of the economy or GDP.

Total U.S. healthcare spending as a percent of U.S. GDP (gross domestic product).[25] Click on chart for data.According to the World Health Organization (WHO), total health care spending in the U.S. was 15.2% of its GDP in 2008, the highest in the world.[3] The Health and Human Services Department expects that the health share of GDP will continue its historical upward trend, reaching 19.5% of GDP by 2017.[26][27] Of each dollar spent on health care in the United States, 31% goes to hospital care, 21% goes to physician/clinical services, 10% to pharmaceuticals, 4% to dental, 6% to nursing homes and 3% to home health care, 3% for other retail products, 3% for government public health activities, 7% to administrative costs, 7% to investment, and 6% to other professional services (physical therapists, optometrists, etc).[28]

Office of the Actuary (OACT) of the Centers for Medicare and Medicaid Services publishes data on total health care spending in the United States, including both historical levels and future projections.[29] In 2007, the U.S. spent $2.26 trillion on health care, or $7,439 per person, up from $2.1 trillion, or $7,026 per capita, the previous year.[30] Spending in 2006 represented 16% of GDP, an increase of 6.7% over 2004 spending. Growth in spending is projected to average 6.7% annually over the period 2007 through 2017.

In 2009, the United States federal, state and local governments, corporations and individuals, together spent $2.5 trillion, $8,047 per person, on health care. This amount represented 17.3% of the GDP, up from 16.2% in 2008.[31] Health insurance costs are rising faster than wages or inflation,[32] and medical causes were cited by about half of bankruptcy filers in the United States in 2001.[33]

The Congressional Budget Office has found that "about half of all growth in health care spending in the past several decades was associated with changes in medical care made possible by advances in technology." Other factors included higher income levels, changes in insurance coverage, and rising prices.[34] Hospitals and physician spending take the largest share of the health care dollar, while prescription drugs take about 10%.[35] The use of prescription drugs is increasing among adults who have drug coverage.[36]

One analysis of international spending levels in the year 2000 found that while the U.S. spends more on health care than other countries in the Organisation for Economic Co-operation and Development (OECD), the use of health care services in the U.S. is below the OECD median by most measures. The authors of the study concluded that the prices paid for health care services are much higher in the U.S.[37] Economist Hans Sennholz has argued that the Medicare and Medicaid programs may be the main reason for rising health care costs in the U.S.[38]

Health care spending in the United States is concentrated. An analysis of the 1996 Medical Expenditure Panel Survey found that the 1% of the population with the highest spending accounted for 27% of aggregate health care spending. The highest-spending 5% of the population accounted for more than half of all spending. This reflects spending in 2009, as well.[39] These patterns were stable through the 1970s and 1980s, and some data suggest that they may have been typical of the mid-to-early 20th century as well.[40]

One study by the Agency for Healthcare Research and Quality (AHRQ) found significant persistence in the level of health care spending from year to year. Of the 1% of the population with the highest health care spending in 2002, 24.3% maintained their ranking in the top 1% in 2003. Of the 5% with the highest spending in 2002, 34% maintained that ranking in 2003. Individuals over age 45 were disproportionately represented among those who were in the top decile of spending for both years.[41]

Health care cost rise based on total expenditure on health as % of GDP. Countries are USA, Germany, Austria, Switzerland, United Kingdom and Canada.Seniors spend, on average, far more on health care costs than either working-age adults or children. The pattern of spending by age was stable for most ages from 1987 through 2004, with the exception of spending for seniors age 85 and over. Spending for this group grew less rapidly than that of other groups over this period.[42]

The 2008 edition of the Dartmouth Atlas of Health Care[43] found that providing Medicare beneficiaries with severe chronic illnesses with more intense health care in the last two years of life—increased spending, more tests, more procedures and longer hospital stays—is not associated with better patient outcomes. There are significant geographic variations in the level of care provided to chronically ill patients, only 4% of which are explained by differences in the number of severely ill people in an area. Most of the differences are explained by differences in the amount of "supply-sensitive" care available in an area. Acute hospital care accounts for over half (55%) of the spending for Medicare beneficiaries in the last two years of life, and differences in the volume of services provided is more significant than differences in price. The researchers found no evidence of "substitution" of care, where increased use of hospital care would reduce outpatient spending (or vice versa).[43][44]

Increased spending on disease prevention is often suggested as a way of reducing health care spending.[45] Whether prevention saves or costs money depends on the intervention. Childhood vaccinations,[45] or contraceptives[46] save much more than they cost. Research suggests that in many cases prevention does not produce significant long-term cost savings.[45] Some interventions may be cost-effective by providing health benefits, while others are not cost-effective.[45] Preventive care is typically provided to many people who would never become ill, and for those who would have become ill is partially offset by the health care costs during additional years of life.[45]

In September 2008 The Wall Street Journal reported that consumers were reducing their health care spending in response to the current economic slow-down. Both the number of prescriptions filled and the number of office visits dropped between 2007 and 2008. In one survey, 22% of consumers reported going to the doctor less often, and 11% reported buying fewer prescription drugs.[47]

In 2009, the average private room in a nursing home cost $219 daily. Assisted living costs averaged $3,131 monthly. Home health aides averaged $21 per hour. Adult day care services averaged $67 daily.[48]

Impact on U.S. economic productivityOn March 1, 2010, billionaire investor Warren Buffett said that the high costs paid by U.S. companies for their employees’ health care put them at a competitive disadvantage. He compared the roughly 17% of GDP spent by the U.S. on health care with the 9% of GDP spent by much of the rest of the world, noted that the U.S. has fewer doctors and nurses per person, and said, “[t]hat kind of a cost, compared with the rest of the world, is like a tapeworm eating at our economic body.”[49]

Allegations of wasteIn December 2011, the outgoing Administrator of the Centers for Medicare & Medicaid Services, Dr. Donald Berwick, asserted that 20% to 30% of health care spending is waste. He listed five causes for the waste: (1) overtreatment of patients, (2) the failure to coordinate care, (3) the administrative complexity of the health care system, (4) burdensome rules and (5) fraud.[50]

Payment (See also: Bundled payment, Capitation (healthcare), and Fee-for-service

Doctors and hospitals are generally funded by payments from patients and insurance plans in return for services rendered (fee-for-service or FFS).

Around 84.7% of Americans have some form of health insurance; either through their employer or the employer of their spouse or parent (59.3%), purchased individually (8.9%), or provided by government programs (27.8%; there is some overlap in these figures).[51] All government health care programs have restricted eligibility, and there is no government health insurance company which covers all Americans. Americans without health insurance coverage in 2007 totaled 15.3% of the population, or 45.7 million people.[51]

Amomg those whose employer pays for health insurance, the employee may be required to contribute part of the cost of this insurance, while the employer usually chooses the insurance company and, for large groups, negotiates with the insurance company.

2004, private insurance paid for 36% of personal health expenditures, private out-of-pocket 15%, federal government 34%, state and local governments 11%, and other private funds 4%.[52] Due to "a dishonest and inefficient system" that sometimes inflates bills to ten times the actual cost, even insured patients can be billed more than the real cost of their care.[53]

Insurance for dental and vision care (except for visits to ophthalmologists, which are covered by regular health insurance) is usually sold separately. Prescription drugs are often handled differently than medical services, including by the government programs. Major federal laws regulating the insurance industry include COBRA and HIPAA.

Individuals with private or government insurance are limited to medical facilities which accept the particular type of medical insurance they carry. Visits to facilities outside the insurance program's "network" are usually either not covered or the patient must bear more of the cost. Hospitals negotiate with insurance programs to set reimbursement rates; some rates for government insurance programs are set by law. The sum paid to a doctor for a service rendered to an insured patient is generally less than that paid "out of pocket" by an uninsured patient. In return for this discount, the insurance company includes the doctor as part of their "network", which means more patients are eligible for lowest-cost treatment there. The negotiated rate may not cover the cost of the service, but providers (hospitals and doctors) can refuse to accept a given type of insurance, including Medicare and Medicaid. Low reimbursement rates have generated complaints from providers, and some patients with government insurance have difficulty finding nearby providers for certain types of medical services.

Charity care for those who cannot pay is sometimes available, and is usually funded by non-profit foundations, religious orders, government subsidies, or services donated by the employees. Massachusetts and New Jersey have programs where the state will pay for health care when the patient cannot afford to do so.[54] The City and County of San Francisco is also implementing a citywide health care program for all uninsured residents, limited to those whose incomes and net worth are below an eligibility threshold. Some cities and counties operate or provide subsidies to private facilities open to all regardless of the ability to pay. Means testing is applied, and some patients of limited means may be charged for the services they use.

The Emergency Medical Treatment and Active Labor Act requires virtually all hospitals to accept all patients, regardless of the ability to pay, for emergency room care. The act does not provide access to non-emergency room care for patients who cannot afford to pay for health care, nor does it provide the benefit of preventive care and the continuity of a primary care physician. Emergency health care is generally more expensive than an urgent care clinic or a doctor's office visit, especially if a condition has worsened due to putting off needed care. Emergency rooms are typically at, near, or over capacity. Long wait times have become a problem nationally, and in urban areas some ERs are put on "diversion" on a regular basis, meaning that ambulances are directed to bring patients elsewhere.[55]

Most Americans under age 65 (59.3%) receive their health insurance coverage through an employer (which includes both private as well as civilian public-sector employers) under group coverage, although this percentage is declining. Costs for employer-paid health insurance are rising rapidly: since 2001, premiums for family coverage have increased 78%, while wages have risen 19% and inflation has risen 17%, according to a 2007 study by the Kaiser Family Foundation.[32] Workers with employer-sponsored insurance also contribute; in 2007, the average percentage of premium paid by covered workers is 16% for single coverage and 28% for family coverage.[32] In addition to their premium contributions, most covered workers face additional payments when they use health care services, in the form of deductibles and copayments.

Just less than 9% of the population purchases individual health care insurance.[51] Insurance payments are a form of cost-sharing and risk management where each individual or their employer pays predictable monthly premiums. This cost-spreading mechanism often picks up much of the cost of health care, but individuals must often pay up-front a minimum part of the total cost (a ‘’deductible’’), or a small part of the cost of every procedure (a copayment). Private insurance accounts for 35% of total health spending in the United States, by far the largest share among OECD countries. Beside the United States, Canada and France are the two other OECD countries where private insurance represents more than 10% of total health spending.[56]

Provider networks can be used to reduce costs by negotiating favorable fees from providers, selecting cost effective providers, and creating financial incentives for providers to practice more efficiently.[57] A survey issued in 2009 by America's Health Insurance Plans found that patients going to out-of-network providers are sometimes charged extremely high fees.[58][59]

Defying many analysts' expectations, PPOs have gained market share at the expense of HMOs over the past decade.[60]

Just as the more loosely managed PPOs have edged out HMOs, HMOs themselves have also evolved towards less tightly managed models. The first HMOs in the U.S., such as Kaiser Permanente in Oakland, California, and the Health Insurance Plan (HIP) in New York, were "staff-model" HMOs, which owned their own health care facilities and employed the doctors and other health care professionals who staffed them. The name health maintenance organization stems from the idea that the HMO would make it its job to maintain the enrollee's health, rather than merely to treat illnesses. In accordance with this mission, managed care organizations typically cover preventive health care. Within the tightly integrated staff-model HMO, the HMO can develop and disseminate guidelines on cost-effective care, while the enrollee's primary care doctor can act as patient advocate and care coordinator, helping the patient negotiate the complex health care system. Despite a substantial body of research demonstrating that many staff-model HMOs deliver high-quality and cost-effective care, they have steadily lost market share. They have been replaced by more loosely managed networks of providers with whom health plans have negotiated discounted fees. It is common today for a physician or hospital to have contracts with a dozen or more health plans, each with different referral networks, contracts with different diagnostic facilities, and different practice guidelines.

[edit] PublicGovernment programs directly cover 27.8% of the population (83 million),[51] including the elderly, disabled, children, veterans, and some of the poor, and federal law mandates public access to emergency services regardless of ability to pay. Public spending accounts for between 45% and 56.1% of U.S. health care spending.[61] Per-capita spending on health care by the U.S. government placed it among the top ten highest spenders among United Nations member countries in 2004.[62]

Government funded programs include:

Medicare, generally covering citizens and long-term residents 65 years and older and the disabled.

Medicaid, generally covering low income people in certain categories, including children, pregnant women, and the disabled. (Administered by the states.)

State Children's Health Insurance Program, which provides health insurance for low-income children who do not qualify for Medicaid. (Administered by the states, with matching state funds.)

Various programs for federal employees, including TRICARE for military personnel (for use in civilian facilities)

The Veterans Administration, which provides care to veterans, their families, and survivors through medical centers and clinics.[63]

Title X which funds reproductive health care

State and local health department clinics

Indian health service

National Institutes of Health treats patients who enroll in research for free.

Medical Corps of various branches of the military.

Certain county and state hospitals

Government run community clinics

The exemption of employer-sponsored health benefits from federal income and payroll taxes distorts the health care market.[64] The U.S. government, unlike some other countries, does not treat employer funded health care benefits as a taxable benefit in kind to the employee. The value of the lost tax revenue from a benefits in kind tax is an estimated $150 billion a year.[65] Some regard this as being disadvantageous to people who have to buy insurance in the individual market which must be paid from income received after tax.[66]

ealth insurance benefits are an attractive way for employers to increase the salary of employees as they are nontaxable. As a result, 65% of the non-elderly population and over 90% of the privately insured non-elderly population receives health insurance at the workplace.[67] Additionally, most economists agree that this tax shelter increases individual demand for health insurance, leading some to claim that it is largely responsible for the rise in health care spending.[67]

In addition the government allows full tax shelter at the highest marginal rate to investors in health savings accounts (HSAs). Some have argued that this tax incentive adds little value to national health care as a whole because the most wealthy in society tend also to be the most healthy. Also it has been argued, HSAs segregate the insurance pools into those for the wealthy and those for the less wealthy which thereby makes equivalent insurance cheaper for the rich and more expensive for the poor.[68] However, one advantage of health insurance accounts is that funds can only be used towards certain HSA qualified expenses, including medicine, doctor's fees, and Medicare Parts A and B. Funds cannot be used towards expenses such as cosmetic surgery.[69]

There are also various state and local programs for the poor. In 2007, Medicaid provided health care coverage for 39.6 million low-income Americans (although Medicaid covers approximately 40% of America's poor),[70] and Medicare provided health care coverage for 41.4 million elderly and disabled Americans.[51] Enrollment in Medicare is expected to reach 77 million by 2031, when the baby boom generation is fully enrolled.[71]

It has been reported that the number of physicians accepting Medicaid has decreased in recent years due to relatively high administrative costs and low reimbursements.[72] In 1997, the federal government also created the State Children's Health Insurance Program (SCHIP), a joint federal-state program to insure children in families that earn too much to qualify for Medicaid but cannot afford health insurance.[73] SCHIP covered 6.6 million children in 2006,[74] but the program is already facing funding shortfalls in many states.[75] The government has also mandated access to emergency care regardless of insurance status and ability to pay through the Emergency Medical Treatment and Labor Act (EMTALA), passed in 1986,[76] but EMTALA is an unfunded mandate.[77]

The uninsured: Main article: Health insurance coverage in the United States

Some Americans do not qualify for government-provided health insurance, are not provided health insurance by an employer, and are unable to afford, cannot qualify for, or choose not to purchase, private health insurance. When charity or "uncompensated" care is not available, they sometimes simply go without needed medical treatment. This problem has become a source of considerable political controversy on a national level.

According to the US Census Bureau, in 2007, 45.7 million people in the U.S. (15.3% of the population) were without health insurance for at least part of the year. This number was down slightly from the previous year, with nearly 3 million more people receiving government coverage and a slightly lower percentage covered under private plans than the year previous.[51] Other studies have placed the number of uninsured in the years 2007–2008 as high as 86.7 million, about 29% of the US population.[78][79]

Among the uninsured population, the Census Bureau says, nearly 37 million were employment-age adults (ages 18 to 64), and more than 27 million worked at least part time. About 38% of the uninsured live in households with incomes of $50,000 or more.[51] According to the Census Bureau, nearly 36 million of the uninsured are legal U.S citizens. Another 9.7 million are non-citizens, but the Census Bureau does not distinguish in its estimate between legal non-citizens and illegal immigrants.[51] Nearly one fifth of the uninsured population is able to afford insurance, almost one quarter is eligible for public coverage, and the remaining 56% need financial assistance (8.9% of all Americans).[80] Extending coverage to all who are eligible remains a fiscal challenge.[81]

A 2003 study in Health Affairs estimated that uninsured people in the U.S. received approximately $35 billion in uncompensated care in 2001.[82] The study noted that this amount per capita was half what the average insured person received. The study found that various levels of government finance most uncompensated care, spending about $30.6 billion on payments and programs to serve the uninsured and covering as much as 80–85% of uncompensated care costs through grants and other direct payments, tax appropriations, and Medicare and Medicaid payment add-ons. Most of this money comes from the federal government, followed by state and local tax appropriations for hospitals. Another study by the same authors in the same year estimated the additional annual cost of covering the uninsured (in 2001 dollars) at $34 billion (for public coverage) and $69 billion (for private coverage). These estimates represent an increase in total health care spending of 3–6% and would raise health care’s share of GDP by less than one percentage point, the study concluded.[83] Another study published in the same journal in 2004 estimated that the value of health forgone each year because of uninsurance was $65–$130 billion and concluded that this figure constituted "a lower-bound estimate of economic losses resulting from the present level of uninsurance nationally."[84]

The health insurance system in America, in contrast with health insurance in almost all other developed nations, is fundamentally a voluntary one. There are many perspectives on the purpose of health insurance in the United States. For consumers, health insurance serves two main purposes: it provides access to affordable health care through preferential pricing and it offers financial protection from unexpected health care costs. For clinicians and other health care providers, insurance ensures financial stability of the practice/office. Health insurance was first developed by Baylor University Hospital for exactly that purpose.[85]

From 2000 to 2004, the Institute of Medicine's Committee on the Consequences of Uninsurance issued a series of six reports that reviewed and reported on the evidence on the effects of the lack of health insurance coverage.[14]

The reports concluded that the committee recommended that the nation should implement a strategy to achieve universal health insurance coverage. As of 2011, a comprehensive national plan to address what universal health plan supporters terms "America’s uninsured crisis", has yet to be enacted. A few states have achieved progress towards the goal of universal health insurance coverage, such as Maine, Massachusetts, and Vermont, but other states including California, have failed attempts of reforms.[86]

The six reports created by the Institute of Medicine (IOM) found that the principle consequences of uninsurance were the following: Children and Adults without health insurance did not receive needed medical care; they typically live in poorer health and die earlier than children or adults who have insurance. The financial stability of a whole family can be put at risk if only one person is uninsured and needs treatment for unexpected health care costs. The overall health status of a community can be adversely affected by a higher percentage of uninsured people within the community. The coverage gap between the insured and the uninsured has not decreased even after the recent federal initiatives to extend health insurance coverage.[86]

The last report was published in 2004 and was named Insuring America’s Health: Principles and Recommendations. This report recommended the following: The President and Congress need to develop a strategy to achieve universal insurance coverage and establish a firm schedule to reach this goal by the year 2010. The committee also recommended that the federal and state governments provide sufficient resources for Medicaid and the State Children’s Health Insurance Program (SCHIP) to cover all persons currently eligible until the universal coverage takes effect. They also warned that the federal and state governments should prevent the erosion of outreach efforts, eligibility, enrollment, and coverage of these specific programs.[86]

Some people think that not having health insurance will have adverse consequences for the health of the uninsured.[87]On the other hand, some people believe that children and adults without health insurance have access to needed health care services at hospital emergency rooms, community health centers, or other safety net facilities offering charity care.[88] Some observers note that there is a solid body of evidence showing that a substantial proportion of U.S. health care expenditures is directed toward care that is not effective and may sometimes even be harmful.[89] At least for the insured population, spending more and using more health care services does not always yield better health outcomes or increase life expectancy.[90]

Children in America are typically perceived as in good health relative to adults, due to the fact that most serious health problems occur later in one’s life. Certain conditions including asthma, diabetes, and obesity have become much more prevalent among children in the past few decades.[86] There is also a growing population of vulnerable children with special health care needs that require ongoing medical attention, which would not be accessible without health insurance. More than 10 million children in the United States meet the federal definition of children with special health care needs “who have or are at increased risk for a chronic physical, development, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally”.[91] These children require health related services of an amount beyond that required by the average children in America. Typically when children acquire health insurance, they are much less likely to experience previously unmet health care needs, this includes the average child in America and children with special health care needs.[86] The Committee on Health Insurance Status and Its Consequences concluded that the effects of health insurance on children’s health outcomes: Children with health insurance receive more timely diagnosis of serious health conditions, experience fewer hospitalizations, and miss fewer days of school.

The same committee analyzed the effects of health insurance on adult’s health outcomes: adults who do not have health insurance coverage who acquire Medicare coverage at age 65, experience substantially improved health and functional status, particularly those who have cardiovascular disease or diabetes. Adults who have cardiovascular disease or other cardiac risk factors that are uninsured are less likely to be aware of their condition, which leads to worse health outcomes for those individuals. Without health insurance, adults are more likely to be diagnosed with certain cancers that would have been detectable earlier by screening by a clinician if they had regularly visited a doctor. As a consequence, these adults are more likely to die from their diagnosed cancer or suffer poorer health outcomes.[86]

Many towns and cities in the United States have high concentrations of people under the age of 65 who lack health insurance.[92] There are implications of high rates of uninsurance for communities and for insured people in those communities. Institute of Medicine committee warned of the potential problems of high rates of uninsurance for local health care, including reduced access to clinic-based primary care, specialty services, and hospital-based emergency services.[93]

Estimates for 2008 reported that the uninsured would spend $30 billion for healthcare and receive $56 billion in uncompensated care, and that if everyone were covered by insurance then overall costs would increase by $123 billion.[94] A 2003 Institute of Medicine (IOM) report estimated total cost of health care provided to the uninsured at $98.9 billion in 2001, including $26.4 billion in out-of-pocket spending by the uninsured, with $34.5 billion in "free" "uncompensated" care covered by government subsidies of $30.6 billion to hospitals and clinics and $5.1 billion in donated services by physicians.[95]

Role of government in health care market

Numerous publicly funded health care programs help to provide for the elderly, disabled, military service families and veterans, children, and the poor,[96] and federal law ensures public access to emergency services regardless of ability to pay;[97] however, a system of universal health care has not been implemented nation-wide. However, as the OECD has pointed out, the total U.S. public expenditure for this limited population would, in most other OECD countries, be enough for the government to provide primary health insurance for the entire population.[56] Although the federal Medicare program and the federal-state Medicaid programs possess some monopsonistic purchasing power, the highly fragmented buy side of the U.S. health system is relatively weak by international standards, and in some areas, some suppliers such as large hospital groups have a virtual monopoly on the supply side.[98] In most OECD countries, there is a high degree of public ownership and public finance.[99] The resulting economy of scale in providing health care services appears to enable a much tighter grip on costs.[100] The U.S., as a matter of oft-stated public policy, largely does not regulate prices of services from private providers, assuming the private sector to do it better.[101]

Massachusetts has adopted a universal health care system through the Massachusetts 2006 Health Reform Statute. It mandates that all residents who can afford to do so purchase health insurance, provides subsidized insurance plans so that nearly everyone can afford health insurance, and provides a "Health Safety Net Fund" to pay for necessary treatment for those who cannot find affordable health insurance or are not eligible.[102]

In July 2009, Connecticut passed into law a plan called SustiNet, with the goal of achieving health-care coverage of 98% of its residents by 2014.[103]

Regulation and oversight

Further information: American Board of Medical Specialties, United States Medical Licensing Examination, and National Association of Insurance Commissioners

Involved organizations and institutions

Healthcare is subject to extensive regulation at both the federal and the state level, much of which "arose haphazardly".[104] Under this system, the federal government cedes primary responsibility to the states under the McCarran-Ferguson Act. Essential regulation includes the licensure of health care providers at the state level and the testing and approval of pharmaceuticals and medical devices by the Food and Drug Administration, and laboratory testing. These regulations are designed to protect consumers from ineffective or fraudulent healthcare. Additionally, states regulate the health insurance market and they often have laws which require that health insurance companies cover certain procedures,[105] although state mandates generally do not apply to the self-funded health care plans offered by large employers, which exempt from state laws under preemption clause of the Employee Retirement Income Security Act. In 2010, the Patient Protection and Affordable Care Act (PPACA) was passed, and includes various new regulations, with one of the most notable being a health insurance mandate which requires all citizens to purchase health insurance. While not regulation per se, the federal government also has a major influence on the healthcare market through its payments to providers under Medicare and Medicaid, which in some cases are used as a reference point in the negotiations between medical providers and insurance companies.[104]

At the federal level, United States Department of Health and Human Services oversees the various federal agencies involved in health care. The health agencies are a part of the United States Public Health Service, and include the Food and Drug Administration, which certifies the safety of food, effectiveness of drugs and medical products, the Centers for Disease Prevention, which prevents disease, premature death, and disability, the Agency of Health Care Research and Quality, the Agency Toxic Substances and Disease Registry, which regulates hazardous spills of toxic substances, and the National Institutes of Health, which conducts medical research.

State governments maintain state health departments, and local governments (counties and municipalities) often have their own health departments, usually branches of the state health department. Regulations of a state board may have executive and police strength to enforce state health laws. In some states, all members of state boards must be health care professionals. Members of state boards may be assigned by the governor or elected by the state committee. Members of local boards may be elected by the mayor council. The McCarran–Ferguson Act, which cedes regulation to the states, does not itself regulate insurance, nor does it mandate that states regulate insurance. "Acts of Congress" that do not expressly purport to regulate the "business of insurance" will not preempt state laws or regulations that regulate the "business of insurance." The Act also provides that federal anti-trust laws will not apply to the "business of insurance" as long as the state regulates in that area, but federal anti-trust laws will apply in cases of boycott, coercion, and intimidation. By contrast, most other federal laws will not apply to insurance whether the states regulate in that area or not.

Self-policing of providers by providers is a major part of oversight. Many health care organizations also voluntarily submit to inspection and certification by the Joint Commission on Accreditation of Hospital Organizations, JCAHO. Providers also undergo testing to obtain board certification attesting to their skills. A report issued by Public Citizen in April 2008 found that, for the third year in a row, the number of serious disciplinary actions against physicians by state medical boards declined from 2006 to 2007, and called for more oversight of the boards.[106]

The Centers for Medicare and Medicaid Services (CMS) publishes an on-line searchable database of performance data on nursing homes.[107]

The regulation is controversial. In 2004, conservative think tank Cato Institute published a study which concluded that regulation provides benefits in the amount of $170 billion but costs the public up to $340 billion.[108] The study concluded that the majority of the cost differential arises from medical malpractice, U.S. Food and Drug Administration (FDA) regulations, and facilities regulations.[108]

"Certificates of need" for hospitals

In 1978, the federal government required that all states implement Certificate of Need (CON) programs for cardiac care, meaning that hospitals had to apply and receive certificates prior to implementing the program; the intent was to reduce cost by reducing duplicate investments in facilities.[109] It has been observed that these certificates could be used to increase costs through weakened competition.[104] Many states removed the CON programs after the federal requirement expired in 1986, but some states still have these programs.[109] Empirical research looking at the costs in areas where these programs have been discontinued have not found a clear effect on costs, and the CON programs could decrease costs because of reduced facility construction or increase costs due to reduced competition.[109]

Licensing of providers

American Medical Association (AMA) has lobbied the government to highly limit physician education since 1910, currently at 100,000 doctors per year,[110] which has led to a shortage of doctors[111] and physicians' wages in the U.S. are double those in the Europe, which is a major reason for the more expensive health care.[112]

An even bigger problem may be that the doctors are paid for procedures instead of results.[112]

AMA has also aggressively lobbied for many restrictions that require doctors to carry out operations that might be carried out by cheaper workforce. For example, in 1995, 36 states banned or restricted midwifery even though it delivers equally safe care to that by doctors, according to studies. The regulation lobbied by AMA has decreased the amount and quality of health care, according to the consensus of economist: the restrictions do not add to quality, they decrease the supply of care.[110][113] Moreover, psychologists, nurses and pharmacologists are not allowed to prescribe medicines.[clarification needed] Previously nurses were not even allowed to vaccinate the patients without direct supervision by doctors.

36 states require that health care workers undergo criminal background checks.[114]

Emergency Medical Treatment and Active Labor Act (EMTALA)Main article: Emergency Medical Treatment and Active Labor Act

EMTALA, enacted by the federal government in 1986, requires that hospital emergency departments treat emergency conditions of all patients regardless of their ability to pay and is considered a critical element in the "safety net" for the uninsured, but established no direct payment mechanism for such care. Indirect payments and reimbursements through federal and state government programs have never fully compensated public and private hospitals for the full cost of care mandated by EMTALA. In fact, more than half of all emergency care in the U.S. now goes uncompensated.[115] According to some analyses, EMTALA is an unfunded mandate that has contributed to financial pressures on hospitals in the last 20 years, causing them to consolidate and close facilities, and contributing to emergency room overcrowding. According to the Institute of Medicine, between 1993 and 2003, emergency room visits in the U.S. grew by 26%, while in the same period, the number of emergency departments declined by 425.[116]

Mentally ill patients present a unique challenge for emergency departments and hospitals. In accordance with EMTALA, mentally ill patients who enter emergency rooms are evaluated for emergency medical conditions. Once mentally ill patients are medically stable, regional mental health agencies are contacted to evaluate them. Patients are evaluated as to whether they are a danger to themselves or others. Those meeting this criterion are admitted to a mental health facility to be further evaluated by a psychiatrist. Typically, mentally ill patients can be held for up to 72 hours, after which a court order is required.[citation needed]

Quality assurance

Health care quality assurance consists of the "activities and programs intended to assure or improve the quality of care in either a defined medical setting or a program. The concept includes the assessment or evaluation of the quality of care; identification of problems or shortcomings in the delivery of care; designing activities to overcome these deficiencies; and follow-up monitoring to ensure effectiveness of corrective steps."[117]

One innovation in encouraging quality of health care is the public reporting of the performance of hospitals, health professionals or providers, and healthcare organizations. However, there is "no consistent evidence that the public release of performance data changes consumer behaviour or improves care."[118]

Overall system effectiveness compared to other countries

The U.S. stands 50th in the world with a life expectancy of 78.49.[119] The CIA World Factbook ranked the United States 174th worst (out of 222) in the world for infant mortality rate (5.98/1,000 live births).[120]

A study found that between 1997 and 2003, preventable deaths declined more slowly in the United States than in 18 other industrialized nations.[121] A 2008 study found that 101,000 people a year die in the U.S. that would not if the health care system were as effective as that of France, Japan, or Australia.[122]

The Organisation for Economic Co-operation and Development (OECD) found that the United States ranked poorly in terms of Years of potential life lost (YPLL), a statistical measure of years of life lost under the age of 70 that were amenable to being saved by health care. Among OECD nations for which data are available, the United States ranked third last for the health care of women (after Mexico and Hungary) and fifth last for men (Slovakia and Poland were also worse). See the table and source at YPLL for details.

Recent studies find growing gaps in life expectancy based on income and geography. In 2008, a government-sponsored study found that life expectancy declined from 1983 to 1999 for women in 180 counties, and for men in 11 counties, with most of the life expectancy declines occurring the Deep South, Appalachia, along the Mississippi River, in the Southern Plains and in Texas. The gap is growing between rich and poor and by educational level, but narrowing between men and women and by race.[123] Another study found that the mortality gap between the well-educated and the poorly educated widened significantly between 1993 and 2001 for adults ages 25 through 64; the authors speculated that risk factors such as smoking, obesity and high blood pressure may lie behind these disparities.[124] In 2011 the United States National Research Council forecasted that deaths attributed to smoking, on the decline in the US, will drop dramatically, improving life expectancy; it also suggested that 1/5 to 1/3 of the life expectancy difference can be attributed to obesity which is the worst in the world and has been increasing.[125] In an analysis of breast cancer, colorectal cancer, and prostate cancer diagnosed during 1990–1994 in 31 countries, the United States had the highest five-year relative survival rate for breast cancer and prostate cancer, although survival was systematically and substantially lower in black U.S. men and women.[126]

The debate about U.S. health care concerns questions of access, efficiency, and quality purchased by the high sums spent. The World Health Organization (WHO) in 2000 ranked the U.S. health care system first in responsiveness, but 37th in overall performance and 72nd by overall level of health (among 191 member nations included in the study).[10][11] The WHO study has been criticized by the free market advocate David Gratzer because "fairness in financial contribution" was used as an assessment factor, marking down countries with high per-capita private or fee-paying health treatment.[127] The WHO study has been criticized, in an article published in Health Affairs, for its failure to include the satisfaction ratings of the general public.[128] The study found that there was little correlation between the WHO rankings for health systems and the stated satisfaction of citizens using those systems.[129] Some countries, such as Italy and Spain, which were given the highest ratings by WHO were ranked poorly by their citizens while other countries, such as Denmark and Finland, were given low scores by WHO but had the highest percentages of citizens reporting satisfaction with their health care systems.[129] WHO staff, however, say that the WHO analysis does reflect system "responsiveness" and argue that this is a superior measure to consumer satisfaction, which is influenced by expectations.[130]

A report released in April 2008 by the Foundation for Child Development, which studied the period from 1994 through 2006, found mixed results for the health of children in the U.S. Mortality rates for children ages 1 through 4 dropped by a third, and the percentage of children with elevated blood lead levels dropped by 84%. The percentage of mothers who smoked during pregnancy also declined. On the other hand, both obesity and the percentage of low-birth weight babies increased. The authors note that the increase in babies born with low birth weights can be attributed to women delaying childbearing and the increased use of fertility drugs.[131][132]

[edit] System efficiency and equityVariations in the efficiency of health care delivery can cause variations in outcomes. The Dartmouth Atlas Project, for instance, reported that, for over 20 years, marked variations in how medical resources are distributed and used in the United States were accompanied by marked variations in outcomes.[133]

Efficiency

Value for moneyA study of international health care spending levels published in the health policy journal Health Affairs in the year 2000 found that the U.S. spends substantially more on health care than any other country in the Organization for Economic Co-operation and Development (OECD), and that the use of health care services in the U.S. is below the OECD median by most measures. The authors of the study conclude that the prices paid for health care services are much higher in the U.S. than elsewhere.[37]

Delays in seeking care and increased use of emergency care

Uninsured Americans are less likely to have regular health care and use preventive services. They are more likely to delay seeking care, resulting in more medical crises, which are more expensive than ongoing treatment for such conditions as diabetes and high blood pressure. A 2007 study published in JAMA concluded that uninsured people were less likely than the insured to receive any medical care after an accidental injury or the onset of a new chronic condition. The uninsured with an injury were also twice as likely as those with insurance to have received none of the recommended follow-up care, and a similar pattern held for those with a new chronic condition.[134] Uninsured patients are twice as likely to visit hospital emergency rooms as those with insurance; burdening a system meant for true emergencies with less-urgent care needs.[135]

In 2008 researchers with the American Cancer Society found that individuals who lacked private insurance (including those covered by Medicaid) were more likely to be diagnosed with late-stage cancer than those who had such insurance.[136]

Shared costs of the uninsured : Main article: Uninsured in the United States

The costs of treating the uninsured must often be absorbed by providers as charity care, passed on to the insured via cost shifting and higher health insurance premiums, or paid by taxpayers through higher taxes.[137] However, hospitals and other providers are reimbursed for the cost of providing uncompensated care via a federal matching fund program. Each state enacts legislation governing the reimbursement of funds to providers. In Missouri, for example, providers assessments totaling $800 million are matched — $2 for each assessed $1 — to create a pool of approximately $2 billion. By federal law these funds are transferred to the Missouri Hospital Association for disbursement to hospitals for the costs incurred providing uncompenstated care including Disproportionate Share Payments (to hospitals with high quantities of uninsured patients), Medicaid shortfalls, Medicaid managed care payments to insurance companies and other costs incurred by hospitals.[138] In New Hampshire, by statute, reimbursable uncompensated care costs shall include: charity care costs, any portion of Medicaid patient care costs that are unreimbursed by Medicaid payments, and any portion of bad debt costs that the commissioner determines would meet the criteria under 42 U.S.C. section 1396r-4(g) governing hospital-specific limits on disproportionate share hospital payments under Title XIX of the Social Security Act.[139]

A report published by the Kaiser Family Foundation in April 2008 found that economic downturns place a significant strain on state Medicaid and SCHIP programs. The authors estimated that a 1% increase in the unemployment rate would increase Medicaid and SCHIP enrollment by 1 million, and increase the number uninsured by 1.1 million. State spending on Medicaid and SCHIP would increase by $1.4 billion (total spending on these programs would increase by $3.4 billion). This increased spending would occur at the same time state government revenues were declining. During the last downturn, the Jobs and Growth Tax Relief Reconciliation Act of 2003 (JGTRRA) included federal assistance to states, which helped states avoid tightening their Medicaid and SCHIP eligibility rules. The authors conclude that Congress should consider similar relief for the current economic downturn.[140]

[edit] Variations in provider practicesThe treatment given to a patient can vary significantly depending on which health care providers they use. Research suggests that some cost-effective treatments are not used as often as they should be, while overutilization occurs with other health care services. Unnecessary treatments increase costs and can cause patients unnecessary anxiety.[141] The use of prescription drugs varies significantly by geographic region.[142] The overuse of medical benefits is known as moral hazard -individuals who are insured are then more inclined to consume health care. The way the Health care system tries to eliminate this problem is through cost sharing tactics like co-pays and deductibles. If patients face more of the economic burden they will then only consume health care when it is necessary. According to the RAND health insurance experiment, individuals with higher Coinsurance rates consumed less health care than those with lower rates. The experiment concluded that with less consumption of care there was generally no loss in societal welfare but, for the poorer and sicker groups of people there were definitely negative effects. These patients were forced to forgo necessary preventative care measures in order to save money leading to late diagnosis of easily treated diseases and more expensive procedures later. With less preventative care, the patient is hurt financially with an increase in expensive visits to the ER.The Health Care costs in the U.S will also rise with these procedures as well. More expensive procedures leads to greater costs.[143][144]

One study has found significant geographic variations in Medicare spending for patients in the last two years of life. These spending levels are associated with the amount of hospital capacity available in each area. Higher spending did not result in patients living longer.[43][145]

Care coordination

Primary care doctors are often the point of entry for most patients needing care, but in the fragmented health care system of the U.S., many patients and their providers experience problems with care coordination. For example, a Harris Interactive survey of California physicians found that:

Four of every ten physicians report that their patients have had problems with coordination of their care in the last 12 months.

More than 60% of doctors report that their patients "sometimes" or "often" experience long wait times for diagnostic tests.

Some 20% of doctors report having their patients repeat tests because of an inability to locate the results during a scheduled visit.[146]

According to an article in The New York Times, the relationship between doctors and patients is deteriorating.[147] A study from Johns Hopkins University found that roughly one in four patients believe their doctors have exposed them to unnecessary risks, and anecdotal evidence such as self-help books and web postings suggest increasing patient frustration. Possible factors behind the deteriorating doctor/patient relationship include the current system for training physicians and differences in how doctors and patients view the practice of medicine. Doctors may focus on diagnosis and treatment, while patients may be more interested in wellness and being listened to by their doctors.[147]

Many primary care physicians no longer see their patients while they are in the hospital. Instead, hospitalists are used, which fragments care because hospitalists usually have had no previous relationship with the patient they are treating and do not have a personal knowledge of the patient's medical history.[148][149] The use of hospitalists is sometimes mandated by health insurance companies as a cost-saving measure which is resented by some primary care physicians.[150]

Administrative costs

The health care system in the U.S. has a vast number of players. There are hundreds, if not thousands, of insurance companies in the U.S.[65][151] This system has considerable administrative overhead, far greater than in nationalized, single-payer systems, such as Canada's. An oft-cited study by Harvard Medical School and the Canadian Institute for Health Information determined that some 31% of U.S. health care dollars, or more than $1,000 per person per year, went to health care administrative costs, nearly double the administrative overhead in Canada, on a percentage basis.[152]

According to the insurance industry group America's Health Insurance Plans, administrative costs for private health insurance plans have averaged approximately 12% of premiums over the last 40 years. There has been a shift in the type and distribution of administrative expenses over that period. The cost of adjudicating claims has fallen, while insurers are spending more on other administrative activities, such as medical management, nurse help lines, and negotiating discounted fees with health care providers.[153]

A 2003 study published by the Blue Cross and Blue Shield Association also found that health insurer administrative costs were approximately 11% to 12% of premiums, with Blue Cross and Blue Shield plans reporting slightly lower administrative costs, on average, than commercial insurers.[154] For the period 1998 through 2003, average insurer administrative costs declined from 12.9% to 11.6% of premiums. The largest increases in administrative costs were in customer service and information technology, and the largest decreases were in provider services and contracting and in general administration.[155] The McKinsey Global Institute estimated that excess spending on "health administration and insurance" accounted for as much as 21% of the estimated total excess spending ($477 billion in 2003).[156]

According to a report published by the CBO in 2008, administrative costs for private insurance represent approximately 12% of premiums. Variations in administrative costs between private plans are largely attributable to economies of scale. Coverage for large employers has the lowest administrative costs. The percentage of premium attributable to administration increases for smaller firms, and is highest for individually purchased coverage.[157] A 2009 study published by the Blue Cross and Blue Shield Association found that the average administrative expense cost for all commercial health insurance products was represented 9.18% of premiums in 2008.[158] Administrative costs were 11.12% of premiums for small group products and 16.35% in the individual market.[158]

One study of the billing and insurance-related (BIR) costs borne not only by insurers but also by physicians and hospitals found that BIR among insurers, physicians, and hospitals in California represented 20-22% of privately insured spending in California acute care settings.[159]

Third-party payment problem and consumer-driven insurance

Most Americans pay for medical services largely through insurance, and this can distort the incentives of consumers since the consumer pays only a portion of the ultimate cost.[104] The lack of price information on medical services can also distort incentives.[104] The insurance which pays on behalf of insureds negotiate with medical providers, sometimes using government-established prices such as Medicaid billing rates as a reference point.[104] This reasoning has led for calls to reform the insurance system to create a consumer-driven health care system whereby consumers pay more out-of-pocket.[160] In 2003, the Medicare Prescription Drug, Improvement, and Modernization Act was passed, which encourages consumers to have a high-deductible health plan and a health savings account.

Overall costs

The cost impact of the existing mixed public-private system is subject to debate. The United States spends more as a percentage of GDP than similar countries, and this can be explained either through higher prices for services themselves, higher costs to administer the system, or more utilization of these services (for example, due to the United States having a more sickly population), or to a combination of these elements.[161]

Free-market advocates claim that the health care system is "dysfunctional" because the system of third-party payments from insurers removes the patient as a major participant in the financial and medical choices that affect costs. Because government intervention has expanded insurance availability through programs such as Medicare and Medicaid, this has exacerbated the problem.[162] According to a study paid for by America's Health Insurance Plans (a Washington lobbyist for the health insurance industry) and carried out by PriceWaterhouseCoopers, increased utilization is the primary driver of rising health care costs in the U.S.[163] The study cites numerous causes of increased utilization, including rising consumer demand, new treatments, more intensive diagnostic testing, lifestyle factors, the movement to broader-access plans, and higher-priced technologies.[163] The study also mentions cost-shifting from government programs to private payers. Low reimbursement rates for Medicare and Medicaid have increased cost-shifting pressures on hospitals and doctors, who charge higher rates for the same services to private payers, which eventually affects health insurance rates.[164]

Health care costs rising far faster than inflation have been a major driver for health care reform in the United States.

In March 2010, Massachusetts released a report on the cost drivers which it called "unique in the nation".[165] The report noted that providers and insurers negotiate privately, and therefore the prices can vary between providers and insurers for the same services, and it found that the variation in prices did not vary based on quality of care but rather on market leverage; the report also found that price increases rather than increased utilization explained the spending increases in the past several years.[165]

Equity

CoverageEnrollment rules in private and governmental programs result in millions of Americans going without health care coverage, including children. The U.S. Census Bureau estimated that 45.7 million Americans (15.3% of the total population) had no health insurance coverage in 2007.[51] However, statistics regarding the insured population are difficult to pinpoint for a number of factors, with the Census Bureau writing that "health insurance coverage is likely to be underreported".[5] Further, such statistics do not provide insight into the reason a given person might be uninsured. For example, studies have shown that approximately one third of this 45.7 million person population of uninsured persons is actually eligible for government insurance programmes such as Medicaid/Medicare, but has elected not to enroll. The largest proportion of the population of uninsured Americans is persons earning in excess of $50,000 per annum, with those earning over $75,000 p.a. comprising the fastest-growing segment of the uninsured population. US Citizens who earn too much money to qualify for government assistance with insurance programs but who do not earn enough to purchase a private health insurance plan make up approxmiately 2.7% percent of the total US population (8.2 million of approximately 300 million total population, by 2003 figures).[6]

Some states (like California) do offer insurance coverage for children of low income families, but not for adults; other states do not offer such coverage at all, and so, both parent and child are caught in the notorious coverage "gap." Although EMTALA[166] certainly keeps alive many working-class people who are badly injured, the 1986 law neither requires the provision of preventive or rehabilitative care, nor subsidizes such care, and it does nothing about the difficulties in the American mental health system.

Coverage gaps also occur among the insured population. Johns Hopkins University professor Vicente Navarro stated in 2003, "the problem does not end here, with the uninsured. An even larger problem is the underinsured" and "The most credible estimate of the number of people in the United States who have died because of lack of medical care was provided by a study carried out by Harvard Medical School Professors Himmelstein and Woolhandler (New England Journal of Medicine 336, no. 11, 1997). They concluded that almost 100,000 people died in the United States each year because of lack of needed care."[167] Another study by the Commonwealth Fund published in Health Affairs estimated that 16 million U.S. adults were underinsured in 2003. The study defined underinsurance as characterized by at least one of the following conditions: annual out-of-pocket medical expenses totaling 10% or more of income, or 5% or more among adults with incomes below 200% of the federal poverty level; or health plan deductibles equaling or exceeding 5% of income. The underinsured were significantly more likely than those with adequate insurance to forgo health care, report financial stress because of medical bills, and experience coverage gaps for such items as prescription drugs. The study found that underinsurance disproportionately affects those with lower incomes—73% of the underinsured in the study population had annual incomes below 200% of the federal poverty level.[168] Another study focusing on the effect of being uninsured found that individuals with private insurance were less likely to be diagnosed with late-stage cancer than either the uninsured or Medicaid beneficiaries.[136] A study examining the effects of health insurance cost-sharing more generally found that chronically ill patients with higher co-payments sought less care for both minor and serious symptoms while no effect on self-reported health status was observed. The authors concluded that the effect of cost sharing should be carefully monitored.[169]

Coverage gaps and affordability also surfaced in a 2007 international comparison by the Commonwealth Fund. Among adults surveyed in the U.S., 37% reported that they had foregone needed medical care in the previous year because of cost; either skipping medications, avoiding seeing a doctor when sick, or avoiding other recommended care. The rate was even higher— 42%—among those with chronic conditions. The study reported that these rates were well above those found in the other six countries surveyed: Australia, Canada, Germany, the Netherlands, New Zealand, and the UK.[170] The study also found that 19% of U.S. adults surveyed reported serious problems paying medical bills, more than double the rate in the next highest country.

Mental health

A lack of mental health coverage for Americans bears significant ramifications to the U.S. economy and social system. A report by the U.S. Surgeon General found that mental illnesses are the second leading cause of disability in the nation and affect 20% of all Americans.[171] It is estimated that less than half of all people with mental illnesses receive treatment (or specifically, an ongoing, much needed, and managed care; where meds alone, can not easily remove mental conditions, but may only help) due to factors such as stigma and lack of access to care.[172]

The Paul Wellstone Mental Health and Addiction Equity Act of 2008 mandates that group health plans provide mental health and substance-related disorder benefits that are at least equivalent to benefits offered for medical and surgical procedures. The legislation renews and expands provisions of the Mental Health Parity Act of 1996. The law requires financial equity for annual and lifetime mental health benefits, and compels parity in treatment limits and expands all equity provisions to addiction services. Up to 2008 insurance companies used loopholes and, though providing financial equity, they often worked around the law by applying unequal co-payments or setting limits on the number of days spent in in-patient or out-patient treatment facilities.[173]

Medical underwriting and the uninsurable

In most states in the U.S., people seeking to purchase health insurance directly must undergo medical underwriting. Insurance companies seeking to mitigate the problem of adverse selection and manage their risk pools screen applicants for pre-existing conditions. Insurers reject many applicants or quote increased rates for those with pre-existing conditions. Diseases that can make an individual uninsurable include serious conditions, such as arthritis, cancer, and heart disease, but also such common ailments as acne, being 20 pounds over or under weight, and old sports injuries.[174] An estimated 5 million of those without health insurance are considered "uninsurable" because of pre-existing conditions.[175]

Proponents of medical underwriting argue that it ensures that individual health insurance premiums are kept as low as possible.[176] Critics of medical underwriting believe that it unfairly prevents people with relatively minor and treatable pre-existing conditions from obtaining health insurance.[177]

One large industry survey found that 13% of applicants for individual health insurance who went through medical underwriting were denied coverage in 2004. Declination rates increased significantly with age, rising from 5% for those under 18 to just under one-third for those aged 60 to 64.[178] Among those who were offered coverage, the study found that 76% received offers at standard premium rates, and 22% were offered higher rates.[179] The frequency of increased premiums also increased with age, so for applicants over 40, roughly half were affected by medical underwriting, either in the form of denial or increased premiums. In contrast, almost 90% of applicants in their 20s were offered coverage, and three-quarters of those were offered standard rates. Seventy percent of applicants age 60–64 were offered coverage, but almost half the time (40%) it was at an increased premium. The study did not address how many applicants who were offered coverage at increased rates chose to decline the policy. A study conducted by the Commonwealth Fund in 2001 found that, among those aged 19 to 64 who sought individual health insurance during the previous three years, the majority found it unaffordable, and less than a third ended up purchasing insurance. This study did not distinguish between consumers who were quoted increased rates due to medical underwriting and those who qualified for standard or preferred premiums.[180] Some states have outlawed medical underwriting as a prerequisite for individually purchased health coverage.[181] These states tend to have the highest premiums for individual health insurance.[182]

Demographic differencesMain articles: Health disparities and Race and health

In the United States, health disparities are well documented in ethnic minorities such as African Americans, Native Americans, and Hispanics.[183] When compared to whites, these minority groups have higher incidence of chronic diseases, higher mortality, and poorer health outcomes. Among the disease-specific examples of racial and ethnic disparities in the United States is the cancer incidence rate among African Americans, which is 25% higher than among whites.[184] In addition, adult African Americans and Hispanics have approximately twice the risk as whites of developing diabetes. Minorities also have higher rates of cardiovascular disease and HIV/AIDS than whites.[184] Caucasian Americans have much lower life expectancy than Asian Americans.[185] A 2001 study found large racial differences exist in healthy life expectancy at lower levels of education.[186]

Public spending is highly correlated with age; average per capita public spending for seniors was more than five times that for children ($6,921 versus $1,225). Average public spending for non-Hispanic blacks ($2,973) was slightly higher than that for whites ($2,675), while spending for Hispanics ($1,967) was significantly lower than the population average ($2,612). Total public spending is also strongly correlated with self-reported health status ($13,770 for those reporting "poor" health versus $1,279 for those reporting "excellent" health).[61] Seniors comprise 13% of the population but take 1/3 of all prescription drugs. The average senior fills 38 prescriptions annually.[187]

There is a great deal of research into inequalities in health care. In some cases these inequalities are caused by income disparities that result in lack of health insurance and other barriers to receiving services.[188] According to the 2009 National Healthcare Disparities Report, uninsured Americans are less likely to receive preventive services in health care.[189] For example, minorities are not regularly screened for colon cancer and the death rate for colon cancer has increased among African Americans and Hispanic people. In other cases, inequalities in health care reflect a systemic bias in the way medical procedures and treatments are prescribed for different ethnic groups. Raj Bhopal writes that the history of racism in science and medicine shows that people and institutions behave according to the ethos of their times.[190] Nancy Krieger wrote that racism underlies unexplained inequities in health care, including treatment for heart disease,[191] renal failure,[192] bladder cancer,[193] and pneumonia.[194] Raj Bhopal writes that these inequalities have been documented in numerous studies. The consistent and repeated findings were that black Americans received less health care than white Americans —particularly when the care involved expensive new technology.[195] One recent study has found that when minority and white patients use the same hospital, they are given the same standard of care.[196][197]

Drug efficacy and safety/See also: Regulation of therapeutic goods in the United States

The Food and Drug Administration (FDA)[198] is the primary institution tasked with the safety and effectiveness of human and veterinary drugs. It also is responsible for making sure drug information is accurately and informatively presented to the public. The FDA reviews and approves products and establishes drug labeling, drug standards, and medical device manufacturing standards. It sets performance standards for radiation and ultrasonic equipment.

One of the more contentious issues related to drug safety is immunity from prosecution. In 2004, the FDA reversed a federal policy, arguing that FDA premarket approval overrides most claims for damages under state law for medical devices. In 2008 this was confirmed by the Supreme Court in Riegel v. Medtronic.[199]

On 30 June 2006, an FDA ruling went into effect extending protection from lawsuits to pharmaceutical manufacturers, even if it was found that they submitted fraudulent clinical trial data to the FDA in their quest for approval. This left consumers who experience serious health consequences from drug use with little recourse. In 2007, opposition was raised in the Congressional House to the FDA ruling, but the Senate upheld the status quo. On 4 March 2009, an important U.S. Supreme Court decision was handed down. In Wyeth v. Levine, the court asserted that state-level rights of action could not be pre-empted by federal immunity and could provide "appropriate relief for injured consumers."[200] In June 2009, under the Public Readiness and Emergency Preparedness Act, Secretary of Health and Human Services Kathleen Sebelius signed an order extending protection to vaccine makers and federal officials from prosecution during a declared health emergency related to the administration of the swine flu vaccine.[201][202]

Impact of drug companies

The United States is one of two countries in the world that allows direct-to-consumer advertising of prescription drugs. Critics note that drug ads costs money which they believe have raised the overall price of drugs.[203]

When health care legislation was being written in 2009, the drug companies were asked to support the legislation in return for not allowing importation of drugs from foreign countries.[204]

Main article: Prescription drug prices in the United States

During the 1990s, the price of prescription drugs became a major issue in American politics as the prices of many new drugs increased exponentially, and many citizens discovered that neither the government nor their insurer would cover the cost of such drugs. Per capita, the U.S. spends more on pharmaceuticals than any other country. National expenditures on pharmaceuticals accounted for 12.9% of total health care costs, compared to an OECD average of 17.7% (2003 figures).[205] Some 25% of out-of-pocket spending by individuals is for prescription drugs.[206]

The U.S. government has taken the position (through the Office of the United States Trade Representative) that U.S. drug prices are rising because U.S. consumers are effectively subsidizing costs which drug companies cannot recover from consumers in other countries (because many other countries use their bulk-purchasing power to aggressively negotiate drug prices).[207] The U.S. position (consistent with the primary lobbying position of the Pharmaceutical Research and Manufacturers of America) is that the governments of such countries are free riding on the backs of U.S. consumers. Such governments should either deregulate their markets, or raise their domestic taxes in order to fairly compensate U.S. consumers by directly remitting the difference (between what the companies would earn in an open market versus what they are earning now) to drug companies or to the U.S. government. In turn, pharmaceutical companies would be able to continue to produce innovative pharmaceuticals while lowering prices for U.S. consumers. Currently, the U.S., as a purchaser of pharmaceuticals, negotiates some drug prices but is forbidden by law from negotiating drug prices for the Medicare program due to the Medicare Prescription Drug, Improvement, and Modernization Act passed in 2003. Democrats have charged that the purpose of this provision is merely to allow the pharmaceutical industry to profiteer off of the Medicare program, which is already in imminent danger of becoming financially insolvent.[208]

[edit] DebateMain article: Health care reform in the United States

A poll released in March 2008 by the Harvard School of Public Health and Harris Interactive found that Americans are divided in their views of the U.S. health system, and that there are significant differences by political affiliation. When asked whether the U.S. has the best health care system or if other countries have better systems, 45% said that the U.S. system was best and 39% said that other countries' systems are better. Belief that the U.S. system is best was highest among Republicans (68%), lower among independents (40%), and lowest among Democrats (32%). Over half of Democrats (56%) said they would be more likely to support a presidential candidate who advocates making the U.S. system more like those of other countries; 37% of independents and 19% of Republicans said they would be more likely to support such a candidate. 45% of Republicans said that they would be less likely to support such a candidate, compared to 17% of independents and 7% of Democrats.[209][210]

A 2004 Institute of Medicine (IOM) report said: "The United States is among the few industrialized nations in the world that does not guarantee access to health care for its population."[14] There is currently an ongoing political debate centering around questions of access, efficiency, quality, and sustainability. Whether a government-mandated system of universal health care should be implemented in the U.S. remains a hotly debated political topic, with Americans divided along party lines in their views of the U.S. health system and what should be done to improve it. Those in favor of universal health care argue that the large number of uninsured Americans creates direct and hidden costs shared by all, and that extending coverage to all would lower costs and improve quality.[211] Cato Institute Senior Fellow Alan Reynolds argues that people should be free to opt out of health insurance, citing a study by Economists Craig Perry and Harvey Rosen that found "the lack of health insurance among the self-employed does not affect their health. For virtually every subjective and objective measure of their health status, the self-employed and wage-earners are statistically indistinguishable for each other."[212] Both sides of the political spectrum have also looked to more philosophical arguments,[citation needed] debating whether people have a fundamental right to have health care provided to them by their government.[213][214]

An impediment to implementing any US healthcare reform that does not benefit insurance companies or the private health care industry is the power of insurance company and health care industry lobbyists.[215][216] Possibly as a consequence of the power of lobbyists, key politicians such as Senator Max Baucus have taken the option of single payer health care off the table entirely.[217] In a June 2009 NBC News/Wall Street Journal survey, 76% said it was either "extremely" or "quite" important to "give people a choice of both a public plan administered by the federal government and a private plan for their health insurance."[218]

Advocates for single-payer health care often point to other countries, where national government-funded systems produce better health outcomes at lower cost. Opponents deride this type of system as "socialized medicine", and it has not been one of the favored reform options by Congress or the President in both the Clinton and Obama reform efforts.[219][220] It has been pointed out that socialized medicine is a system in which the government owns the means of providing medicine. Britain is an example of socialized system, as, in America, is the Veterans Health Administration. Medicare is an example of a mostly single-payer system, as is France. Both of these systems have private insurers to choose from, but the government is the dominant purchaser.[221]

As an example of how government intervention has had unintended consequences, in 1973, the federal government passed the Health Maintenance Organization Act, which heavily subsidized the HMO business model — a model that was in decline prior to such legislative intervention. The law was intended to create market incentives that would lower health care costs, but HMOs have never achieved their cost-reduction potential.[222]

Piecemeal market-based reform efforts are complex. One study evaluating current popular market-based reform policy packages concluded that if market-oriented reforms are not implemented on a systematic basis with appropriate safeguards, they have the potential to cause more problems than they solve.[223]

According to economist and former US Secretary of Labor, Robert Reich, only a "big, national, public option" can force insurance companies to cooperate, share information, and reduce costs. Scattered, localized, "insurance cooperatives" are too small to do that and are "designed to fail" by the moneyed forces opposing Democratic health care reform.[224][225] The Patient Protection and Affordable Care Act, signed into law in March, 2010, did not include such an option.

Reform

Main articles: Health care reform in the United States and Patient Protection and Affordable Care Act

Health care reform in the United States

Healthcare reform in the US

Debate over reform

History

Latest enacted legislation

Patient Protection and Affordable Care Act (Senate bill - H.R. 3590)

Health Care and Education Reconciliation Act of 2010 (H.R. 4872)

preceding legislation

Social Security Act of 1965

Emergency Medical Treatment and Active Labor Act (1986)

Health Insurance Portability and Accountability Act (1996)

Medicare Prescription Drug, Improvement, and Modernization Act (2003)

Patient Safety and Quality Improvement Act (2005)

[show]More information

Health care reforms in US

Recent legislative proposals

Public opinion

Reform advocacy groups

Rationing

Insurance coverage

Systems

Free-market health care

Health insurance exchange

National health insurance

Publicly-funded health care

Single-payer health care

Comparison of Canadian and American health care systems

Two-tier health care

Universal health care

Third-party payment models

Capitation

Fee-for-service

Global payment

Other legislation

Superseded

Affordable Health Care for America Act (House bill - H.R. 3962)

America's Affordable Health Choices Act of 2009 (H.R. 3200)

America's Healthy Future Act (Baucus bill - S. 1796)

Healthy Americans Act (Wyden-Bennett Bill - S. 391)

Proposed

United States National Health Care Act (H.R. 676)

Health care in the United States

--------------------------------------------------------------------------------

The Patient Protection and Affordable Care Act (Public Law 111-148) is a health care reform bill that was signed into law in the United States by President Barack Obama on March 23, 2010. Along with the Health Care and Education Reconciliation Act of 2010 (passed March 25), the Act is a product of the health care reform agenda of the Democratic 111th Congress and the Obama administration.

The law includes a large number of health-related provisions to take effect over the next four years, including expanding Medicaid eligibility for people making up to 133% of FPL,[226] subsidizing insurance premiums for peoples making up to 400% of FPL ($88,000 for family of 4) so their maximum "out-of-pocket" pay will be from 2% to 9.8% of income for annual premium,[227][228] providing incentives for businesses to provide health care benefits, prohibiting denial of coverage and denial of claims based on pre-existing conditions, establishing health insurance exchanges, prohibiting insurers from establishing annual spending caps and support for medical research. The costs of these provisions are offset by a variety of taxes, fees, and cost-saving measures, such as new Medicare taxes for high-income brackets, taxes on indoor tanning, cuts to the Medicare Advantage program in favor of traditional Medicare, and fees on medical devices and pharmaceutical companies;[229] there is also a tax penalty for citizens who do not obtain health insurance (unless they are exempt due to low income or other reasons).[230] The Congressional Budget Office estimates that the net effect (including the reconciliation act) will be a reduction in the federal deficit by $143 billion over the first decade.[231]

In May of 2011, the state of Vermont became the first state to pass legislation establishing a Single-Payer health care system. The legislation, known as Act 48, establishes health care in the state as a "human right" and lays the responsibility on the state to provide a health care system which best meets the needs of the citizens of Vermont. The state is currently in the studying phase of how best to implement this system.[citation needed]

[edit] Health Insurance Coverage of ImmigrantsOf the 26.2 million foreign immigrants living in the US in 1998, 62.9% were non-citizens. In 1997, 34.3% of non-citizens living in America did not have health insurance coverage opposed to the 14.2% of native-born Americans who do not have health insurance coverage. Among those immigrants who became citizens, 18.5% were uninsured as opposed to non citizens who are 43.6% uninsured. In each age and income group, immigrants are less likely to have health insurance.[232]

See alsoCanadian and American health care systems compared

Centers for Disease Control and Prevention timeline

Key person insurance

Health care compared - tabular comparisons of the US, Canada, and other countries not shown above.

Health care industry

Health care politics

Health care systems (including comparisons)

Health insurance cooperative

Healthy people

HIV/AIDS in the United States

List of healthcare accreditation organizations in the United States

List of countries by health care expenditures

Medical cannabis in the United States

Medical centers in the United States

Medical debt

Medicare Rights Center

Medicare Sustainable Growth Rate

Military Health System

School health services

United States National Health Care Act

Universal Health Care Foundation of Connecticut

Water fluoridation in the United States

Notes^ Falling from 12th in 1960 to 23d in 1990 to 29th in 2004

References Constructs such as ibid., loc. cit. and idem are discouraged by Wikipedia's style guide for footnotes, as they are easily broken. Please improve this article by replacing them with named references (quick guide), or an abbreviated title. (July 2010)

^ DeNavas-Walt, Carmen; Proctor, Bernadette D.; Smith, Jessica C. (September 13, 2011). Income, poverty, and health insurance coverage in the United States: 2010. U.S. Census Bureau: Current Population Reports, P60-239. Washington, DC: U.S. Government Printing Office. http://www.census.gov/prod/2011pubs/p60-239.pdf.

^ Johnson, Avery (September 17, 2010). "Recession swells number of uninsured to 50.7 million". The Wall Street Journal: p. A4. http://online.wsj.com/article/SB10001424052748704394704575496093363948142.html. Retrieved 2010-11-21.

Wolf, Richard (September 17, 2010). "Number of uninsured Americans rises to 50.7 million". USA Today: p. 8A. http://www.usatoday.com/news/nation/2010-09-17-uninsured17_ST_N.htm. Retrieved 2010-11-21.

DeNavas-Walt, Carmen; Proctor, Bernadette D.; Smith, Jessica C. (September 16, 2010). "Income, poverty, and health insurance coverage in the United States: 2009". Washington, D.C.: U.S. Census Bureau. http://www.census.gov/prod/2010pubs/p60-238.pdf. Retrieved 2010-11-21.

Roberts, Michelle; Rhoades, Jeffrey A. (August 19, 2010). "The uninsured in America, first half of 2009: estimates for the U.S. civilian noninstituionalized population under age 65. Medical Expenditure Panel Survey, Statistical Brief #291". Rockville, Md.: Agency for Healthcare Research and Quality (AHRQ). http://meps.ahrq.gov/mepsweb/data_files/publications/st291/stat291.pdf. Retrieved 2010-11-21.

Cohen, Robin A.; Martinez, Michael A. (September 22, 2010). "Health insurance coverage: early release of estimates from the National Health Interview Survey, January–March 2010". Hyattsville, Md.: National Center for Health Statistics (NCHS). http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201009.pdf. Retrieved 2010-11-21.

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^ a b c WHO (2011). World health statistics 2011. Geneva: World Health Organization. ISBN 978-92-4-156419-9. http://www.who.int/gho/publications/world_health_statistics/2011/en/index.html.

^ "Medical Debt Huge Bankruptcy Culprit - Study: It's Behind Six-In-Ten Personal Filings". CBS. 2009-06-05. http://www.cbsnews.com/stories/2009/06/05/earlyshow/health/main5064981.shtml. Retrieved 2009-06-22.

^ CNN. http://money.cnn.com/2009/03/05/news/economy/under-insured/. [dead link]

^ Marian F MacDorman, Ph.D., and T.J. Mathews, M.S.. "Recent Trends in Infant Mortality in the United States" (pdf). National Center for Health Statistics, Centers for Disease Control. http://www.cdc.gov/nchs/data/databriefs/db09.pdf. Retrieved 2009-08-25.

^ File:Life Expectancy 2005-2010 UN WPP 2006.PNG using: United Nations World Population Prospects: 2006 revision -Table A.17 United Nations Department of Economic and Social Affairs "World Population Prospects: The 2006 Revision, Life expectancy at p80 ff,; infant mortality at p85 ff. Life expectancy at birth (years) 2005-2010. All data from the ranking is included, except for Martinique and Guadeloupe (due to imaging difficulties). See also US Slipping in Life Expectancy Rankings, Washington Post.

^ https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html CIA Factbook, Life expectancy by country.

^ https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html CIA Factbook, Infant mortality rate by country.

^ a b World Health Organization assesses the world's health system. Press Release WHO/44 21 June 2000.

^ a b Health system attainment and performance in all Member States, ranked by eight measures, estimates for 1997

^ Roehr, Bob (2008). "Health care in US ranks lowest among developed countries". BMJ 337 (jul21 1): a889. DOI:10.1136/bmj.a889. PMID 18644774.

^ Davis, Karen, Schoen, Cathy, and Stremikis, Kristof (June 2010). "Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update". The Commonwealth Fund. http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx?page=all. Retrieved June 23, 2010.

^ a b c d Institute of Medicine. Committee on the Consequences of Uninsurance (January 13, 2004). Insuring America's health: principles and recommendations. Washington, DC: National Academies Press. p. 25. ISBN 978-0-309-52826-9. http://www.iom.edu/Reports/2004/Insuring-Americas-Health-Principles-and-Recommendations.aspx.

^ Docteur, Elizabeth; Oxley, Howard (October 19, 2004). "Health-system reform: lessons from experience". Towards high-performing health systems: policy studies. The OECD health project. Paris: OECD. pp. 25, 74. ISBN 978-92-64-01559-3. http://books.google.com/books?id=r6MLakbHnEQC&pg=PA74.

^ Wilper, Andrew P.; Woolhandler, Steffie; Lasser, Karen E.; McCormick, Danny; Bor, David H.; Himmelstein, David U. (December 2009). "Health insurance and mortality in US adults". American Journal of Public Health 99 (12): 2289–2295. DOI:10.2105/AJPH.2008.157685. PMC 2775760. PMID 19762659. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2775760.

^ http://healthcare.change.org/

^ http://www.aeaweb.org/annual_mtg_papers/2006/0106_0800_0204.pdf

^ The Indian Health Service Fact Sheets

^ EMRC WHITE PAPER: Present Status and Future Strategy for Medical Research in Europe http://www.csic.es/vri/otros-programas/esf/EMRC_Whitepaper.pdf (Open using Adobe reader) Page 16

^ Medical Research Spending Doubled Over Past Decade, Neil Osterweil, MedPage Today, September 20, 2005

^ a b c Accessed August 25, 2009

^ a b c Stats from 2007 Europ.Fed.of Pharm.Indust.and Assoc. Retrieved June 17, 2009, from [1]

^ "2008 Annual Report" (pdf). PHRMA. http://www.phrma.org/files/PhRMA_annualreportFianl.pdf. Retrieved 2009-06-20. [dead link]

^ OECD Health Data 2009 - Frequently Requested Data. OECD.

^ "National Health Expenditure Data: NHE Fact Sheet," Centers for Medicare and Medicaid Services, referenced February 26, 2008

^ Sean Keehan, Andrea Sisko, Christopher Truffer, Sheila Smith, Cathy Cowan, John Poisal, M. Kent Clemens, and the National Health Expenditure Accounts Projections Team, "Health Spending Projections Through 2017: The Baby-Boom Generation Is Coming To Medicare", Health Affairs Web Exclusive, February 26, 2008. Retrieved February 27, 2008.

^ U.S. Healthcare Costs: Background Brief. KaiserEDU.org. See also Trends in Health Care Costs and Spending, March 2009 - Fact Sheet. Kaiser Permanente.

^ "National Health Expenditure Data: Overview," Centers for Medicare and Medicaid Services

^ "National Health Expenditures, Forecast summary and selected tables", Office of the Actuary in the Centers for Medicare & Medicaid Services, 2008. Retrieved March 20, 2008.

^ Jones, Brent (2010-02-04). "Medical expenses have 'very steep rate of growth'". USA Today. http://www.usatoday.com/news/health/2010-02-04-health-care-costs_N.htm. Retrieved 2010-02-07.

^ a b c "Health Insurance Premiums Rise 6.1 Percent In 2007, Less Rapidly Than In Recent Years But Still Faster Than Wages And Inflation" (Press release). Kaiser Family Foundation. 2007-09-11. http://www.kff.org/insurance/ehbs091107nr.cfm. Retrieved 2007-09-13.

^ "Illness And Injury As Contributors To Bankruptcy", by David U. Himmelstein, Elizabeth Warren, Deborah Thorne, and Steffie Woolhandler, published at Health Affairs journal in 2005, Accessed 10 May 2006.

^ U.S. Congressional Budget Office, "Technological Change and the Growth of Health Care Spending," January 2008

^ California HealthCare Foundation. http://www.chcf.org/documents/insurance/HealthCareCosts07.pdf "Health Care Costs 101" 2007 Edition. Katherine B. Wilson. April 2007.

^ Emily Cox, Doug Mager, Ed Weisbart, "Geographic Variation Trends in Prescription Use: 2000 to 2006"[dead link], Express Scripts, January 2008

^ a b Gerard F. Anderson, Uwe E. Reinhardt, Peter S. Hussey and Varduhi Petrosyan, "It's The Prices, Stupid: Why The United States Is So Different From Other Countries", Health Affairs, Volume 22, Number 3, May/June 2003. Retrieved February 27, 2008.

^ Sennholz, Hans. Why is Medical Care so Expensive?. August 22, 2006.

^ "Most Popular E-mail Newsletter". USA Today. January 11, 2012. http://www.usatoday.com/news/washington/story/2012-01-11/health-care-costs-11/52505562/1.

^ Marc L. Berk and Alan C. Monheit, "The Concentration Of Health Care Expenditures, Revisited", Health Affairs, Volume 20, Number 2, March/April 2001. Retrieved February 27, 2008.

^ Steven B. Cohen and William Yu, "The Persistence in the Level of Health Expenditures over Time: Estimates for the U.S. Population, 2002–2003," MEPS Statistical Brief #124, Agency for Healthcare Research and Quality, May 2006

^ Micah Hartman, Aaron Catlin, David Lassman, Jonathan Cylus and Stephen Heffler, "U.S. Health Spending By Age, Selected Years Through 2004", Health Affairs web exclusive, November 6, 2007. Retrieved February 27, 2008.

^ a b c John E. Wennberg, Elliott S. Fisher, David C. Goodman, and Jonathan S. Skinner, "Tracking the Care of Patients with Severe Chronic Illness: the Dartmouth Atlas of Health Care 2008." The Dartmouth Institute for Health Policy and Clinical Practice, May 2008, ISBN 978-0-9815862-0-5 (Executive Summary)

^ "Coverage & Access
More Aggressive Hospital Care Does Not Lead to Improved Patient Outcomes in All Cases, Study Finds," Kaiser Daily Health Policy Report, Kaiser Family Foundation, May 30, 2008

^ a b c d e David Brown, "In the Balance: Some Candidates Disagree, but Studies Show It's Often Cheaper To Let People Get Sick," The Washington Post, April 8, 2008

^ Tsui AO, McDonald-Mosley R, Burke AE (April 2010). "Family planning and the burden of unintended pregnancies". Epidemiol Rev 32 (1): 152–74. DOI:10.1093/epirev/mxq012. PMC 3115338. PMID 20570955. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=3115338.

^ Vanessa Fuhrmans, "Consumers Cut Health Spending, As Economic Downturn Takes Toll," The Wall Street Journal, September 22, 2008

^ "Long term care costs rise across the board from 2008 to 2009". metlife.com. 27 October 2009. http://www.metlife.com/assets/cao/mmi/publications/mmi-pressroom/mmi-market-survey-nursing-home-pr-final.pdf.

^ Funk, Josh (March 1, 2010). "Buffett says economy recovering but at slow rate". San Francisco Chronicle (SFGate.com). http://articles.sfgate.com/2010-03-01/business/18371919_1_berkshire-hathaway-billionaire-warren-buffett-health-care. Retrieved Apr. 3, 2010. [dead link]

^ Pear, Robert (Dec. 3, 2011). "Health Official Takes Parting Shot at ‘Waste’". New York Times. http://www.nytimes.com/2011/12/04/health/policy/parting-shot-at-waste-by-key-obama-health-official.html?_r=1&emc=eta1. Retrieved Dec. 20, 2011.

^ a b c d e f g h i "Income, Poverty, and Health Insurance Coverage in the United States: 2007." U.S. Census Bureau. Issued August 2008.

^ Health, United States, 2007. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.

^ Lopez, Steve (November 22, 2009). "The emergency room bill is enough to make you sick". Los Angeles Times. http://www.latimes.com/news/local/la-me-lopez22-2009nov22,0,7367540.column?page=1. Retrieved May 4, 2010.

^ See Massachusetts health care reform for Massachusetts and charity care for New Jersey.

^ See emergency department for details.

^ a b "OECD Health Data 2009" (pdf). How Does the United States Compare. OECD. http://www.oecd.org/dataoecd/43/23/40905066.pdf. Retrieved 2009-10-02.

^ Managed Care: Integrating the Delivery and Financing of Health Care - Part A, Health Insurance Association of America, 1995, p. 9 ISBN 1-879143-26-1

^ THE VALUE OF PROVIDER NETWORKS AND THE ROLE OF OUT-OF-NETWORK CHARGES IN RISING HEALTH CARE COSTS: A SURVEY OF CHARGES BILLED BY OUT-OF-NETWORK PHYSICIANS, America's Health Insurance Plans, August 2009

^ Gina Kolata, "Survey Finds High Fees Common in Medical Care", The New York Times, August 11, 2009

^ Hurley RE, Strunk BC, White JS (2004). "The puzzling popularity of the PPO". Health Aff (Millwood) 23 (2): 56–68. DOI:10.1377/hlthaff.23.2.56. PMID 15046131. http://content.healthaffairs.org/cgi/pmidlookup?view=long&pmid=15046131.

^ a b Thomas M. Selden and Merrile Sing, "The Distribution Of Public Spending For Health Care In The United States, 2002," Health Affairs 27, no. 5 (2008): w349-w359 (published online 29 July 2008)

^ Core Health Indicators: Per capita government expenditure on health at average exchange rate World Health Organization. Retrieved 2007-10-05.

^ Centers for Medicare & Medicaid Services: Medicare

^ How the Tax Code Distorts Health Care Cato Institute

^ a b "The Health Care Crisis and What to Do About It" By Paul Krugman, Robin Wells, New York Review of Books, March 23, 2006

^ http://www.setaxequity.org/ Equity for Our Nation’s Self-Employed

^ a b Employer-Sponsored Health Insurance: Past, Present and Future Journal of Forensic Economics

^ LATEST ENROLLMENT DATA STILL FAIL TO DISPEL CONCERNS ABOUT HEALTH SAVINGS ACCOUNTS: The Center on Budget and Policy Priorities

^ "Health Savings Accounts FAQ". Health 401k. http://www.health401k.com/2011/09/health-savings-accounts-faq/. Retrieved 19 December 2010.

^ Unsettling Scores: A Ranking of State Medicaid Programs, P. 15

^ "Health and Human Services Statistics 2006" (PDF). U.S. Department of Health and Human Services. Archived from the original on 2007-06-28. http://web.archive.org/web/20070628214810/http://www.cms.hhs.gov/CapMarketUpdates/Downloads/2006CMSstat.pdf. Retrieved 2007-07-03.

^ Cunningham P, May J (August 2006). "Medicaid patients increasingly concentrated among physicians". Track Rep (16): 1–5. PMID 16918046.

^ "SCHIP Overview". U.S. Department of Health & Human Services, Centers for Medicare and Medicaid Services. http://www.cms.hhs.gov/LowCostHealthInsFamChild/. Retrieved 2007-07-03.

^ "SCHIP Ever Enrolled in Year" (PDF). U.S. Centers for Medicare and Medicaid Services. http://www.cms.hhs.gov/NationalSCHIPPolicy/downloads/SCHIPEverEnrolledYearGraph.pdf. Retrieved 2007-09-02.

^ "President's FY 2008 Budget and the State Children's Health Insurance Program (SCHIP)" (PDF). Henry J. Kaiser Family Foundation. http://www.kff.org/medicaid/upload/7635.pdf. Retrieved 2007-07-03.

^ Centers for Medicare & Medicaid Services: Emergency Medical Treatment and Active Labor Act

^ Rowes, Jeffrey (2000). "EMTALA: OIG/HCFA Special Advisory Bulletin Clarifies EMTALA, American College of Emergency Physicians Criticizes It". Journal of Law, Medicine & Ethics 28 (1): 9092. Archived from the original on 2008-01-29. http://web.archive.org/web/20080129005052/http://www.aslme.org/news/jlme/28.1e.html. Retrieved 2008-01-02.

^ Families USA (2009) press release summarizing a Lewin Group (wholly owned by United Healthcare insurance company) study: "New Report Finds 86.7 Million Americans Were Uninsured at Some Point in 2007-2008" [2]

^ http://www.familiesusa.org/assets/pdfs/americans-at-risk.pdf

^ Dubay L, Holahan J and Cook A.,The Uninsured and the Affordability of Health Insurance Coverage, Health Affairs (Web Exclusive), November 2006. Retrieved February 4, 2007.

^ "Characteristics of the Uninsured: Who is Eligible for Public Coverage and Who Needs Help Affording Coverage?" (PDF). Kaiser Commission on Medicaid and the Uninsured. http://www.kff.org/uninsured/upload/7613.pdf. Retrieved 2007-07-19.

^ Jack Hadley and John Holahan,How Much Medical Care Do the Uninsured Use and Who Pays for It?, Health Affairs Web Exclusive, 2003-02-13. Retrieved 2007-10-05.

^ Jack Hadley and John Holahan, Covering The Uninsured: How Much Would It Cost?, Health Affairs Web Exclusive, 2003-06-04. Retrieved 2007-10-05.

^ Wilhelmine Miller, Elizabeth Richardson Vigdor, and Willard G. Manning, Covering The Uninsured: What Is It Worth?, Health Affairs Web Exclusive, 2004-03-31. Retrieved 2007-10-05.

^ Porter, M.E., and E.O. Teisberg. 2006. Redefining health care: Creating value-based competition on results. Cambridge, Ma: Harvard Business Press.

^ a b c d e f Committee on Health Insurance Status and Its Consequences (Author). America's Uninsured Crisis : Consequences for Health and Health Care. Washington, DC, USA: National Academies Press, 2009

^ Fisher E. S., Wennberg D. E., Stukel T. A., Gottlieb D. J., Lucas F. L., Pinder E. L. (2003). "The implications of regional variations in Medicare spending. Part 1: The content, quality, and accessibility of care". Annals of Internal Medicine 138 (4): 273–287.

^ Fuchs, V. R. 2004. Perspective: More variation in use of case, more flat-of-the-curve medicine. Health Affairs 104.

^ Wennberg, D. E., and J. E. Wennberg. 2003. Perspective: Addressing variations: Is there hope for the future? Health Affairs w3.614-w3.617

^ Wennberg, J. E., and E. S. Fisher, and S. M. Sharp. 2006. The care of patients with severe chronic illness. Lebanon, NH: The Dartmouth Atlas of Health Care.

^ American Academy of Pediatrics. 2008. Definition of children with special health care needs (CSHCN), http://www.medicalhomeinfo.org/about/def_cshcn.html (accessed December 4, 2011).

^ DeNavas-Walt, C., B. D. Proctor, and J. Smith. 2008. Income, poverty, and health insurance coverage in the United State: 2007. Washington, DC. U.S Census Bureau.

^ Institute of Medicine. Committee on the Consequences of Uninsurance (March 3, 2003). A shared destiny: community effects of uninsurance. Washington, DC: National Academies Press. ISBN 978-0-309-08726-1. http://www.nap.edu/catalog.php?record_id=10602.

^ http://www.kff.org/uninsured/kcmu082508pkg.cfm

^ Institute of Medicine. Committee on the Consequences of Uninsurance (June 17, 2003). Hidden costs, value lost: uninsurance in America. Washington, DC: National Academies Press. pp. 47–55. ISBN 978-0-309-08931-9. http://www.nap.edu/catalog.php?record_id=10719.

^ Centers for Medicare & Medicaid Services. CMS Programs & Information.. Retrieved August 30, 2006.

^ Centers for Medicare & Medicaid Services. Emergency Medical Treatment & Labor Act.. Retrieved August 30, 2006.

^ Anderson, Gerard F.; Uwe E. Reinhardt, Peter S. Hussey, Varduhi Petrosyan (2009). "It's the prices Stupid: Why the United States is so different from other countries" (pdf). Health Affairs Volume 22, Number 3. http://content.healthaffairs.org/cgi/reprint/22/3/89.pdf. Retrieved 2009-10-02.

^ Organisation for Economic Co-operation and Development. "OECD Health Data 2008: How Does Canada Compare" (pdf). http://www.oecd.org/dataoecd/46/33/38979719.pdf. Retrieved 2009-01-09. .

^ Ibid.

^ Wangsness, Lisa (June 21, 2009). "Health debate shifting to public vs. private". The Boston Globe. http://www.boston.com/news/nation/washington/articles/2009/06/21/healthcare_debate_shifting_to_public_vs_private/?page=full. Retrieved September 21, 2009.

^ Fahrenthold DA. "Mass. Bill Requires Health Coverage."

^ http://www.aarp.org/states/ct/advocacy/articles/in_historic_vote_legislature_overrides_sustinet_veto.html

^ a b c d e f Improving Health Care: A Dose of Competition, Report by the Federal Trade Commission and the Department of Justice, 2004

^ Victoria Craig Bunce and JP Wieske, "Health Insurance Mandates in the States 2008", The Council for Affordable Health Insurance, 2008

^ "Coverage & Access: Disciplinary Action Against Physicians Dropped 6% From 2006 to 2007, Report Finds," Kaiser Daily Health Policy Report, Kaiser Family Foundation, April 23, 2008. Original report: Sidney M. Wolfe and Kate Resnevic, "Public Citizen’s Health Research Group Ranking of the Rate of State Medical Boards’ Serious Disciplinary Actions, 2005-2007," Public Citizen, April 22, 2008

^ Nursing Home Compare, Centers for Medicare and Medicaid Services (accessed 4/24/2008). Note, CMS also publishes a list of Special Focus Facilities - nursing homes with "a history of serious quality issues" at Special Focus Facility (“SFF”) Initiative.

^ a b Christopher J. Conover (4–10–2004). "Health Care Regulation: A $169 Billion Hidden Tax" (PDF). Cato Policy Analysis 527: 1–32. http://www.cato.org/pubs/pas/pa527.pdf.

^ a b c Ho V, Ku-Goto MH, Jollis JG (2009). "Certificate of Need (CON) for cardiac care: controversy over the contributions of CON". Health Serv Res 44 (2 Pt 1): 483–500. DOI:10.1111/j.1475-6773.2008.00933.x. PMC 2677050. PMID 19207590. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2677050.

^ a b The Evil-Mongering of the American Medical Association, Shikha Dalmia, Aug 27, 2009

^ Medical miscalculation creates doctor shortage, USA Today, March 2, 2005

^ a b Sending Back the Doctor’s Bill, The New York Times July 29, 2007

^ Licensing Doctors: Do Economists Agree?

^ Data from 2006, presented in: Criminal Background Checks for Entering Medical Students by James Kleshinski, MD; Steven T. Case, PhD; Dwight Davis, MD; George F. Heinrich, MD; Robert A. Witzburg, MD. Posted: 08/02/2011; Academic Medicine. 2011;86(7):795-798.

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^ https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html?countryName=United%20States&countryCode=us®ionCode=noa&rank=50#us

^ https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html

^ Ellen Nolte and C. Martin McKee, "Measuring the Health of Nations: Updating an Earlier Analysis,", Health Affairs, January 8, 2008, Volume 98

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^ Ezzati M, Friedman AB, Kulkarni SC, Murray CJ (2008). Novotny, Thomas. ed. "The reversal of fortunes: trends in county mortality and cross-county mortality disparities in the United States". PLoS Med 5 (4): e66. DOI:10.1371/journal.pmed.0050066. PMC 2323303. PMID 18433290. //www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2323303. Lay summary.

^ Jemal A, Ward E, Anderson RN, Murray T, Thun MJ (2008). "Widening of Socioeconomic Inequalities in U.S. Death Rates, 1993–2001". PLoS ONE 3 (5): e2181. DOI:10.1371/journal.pone.0002181.

^ Smoking, Obesity Blamed for U.S. Lag in Life Expectancy

^ Doheny, Kathleen (July 16, 2008). "Cancer survival rates vary by country. Study shows U.S., Japan, and France have highest cancer survival rates". WebMD. http://www.webmd.com/cancer/news/20080716/cancer-survival-rates-vary-by-country.

Coleman, Michael P.; Quaresma, Manuela et al. (August 2008). "Cancer survival in five continents: a worldwide population-based study (CONCORD)". Lancet Oncol 9 (8): 730–756. DOI:10.1016/S1470-2045(08)70179-7. PMID 18639491.

In the CONCORD study, Cuba had the highest five-year relative survival rates for breast cancer and for colorectal cancer in women, but problems with data quality might have led to over-estimations.

^ David Gratzer, Why Isn't Government Health Care The Answer?, Free Market Cure, 16 July 2007

^ Robert J. Blendon, Minah Kim and John M. Benson, "The Public Versus The World Health Organization On Health System Performance," Health Affairs, May/June 2001

^ a b Robert J. Blendon, Minah Kim and John M. Benson, "The Public Versus The World Health Organization On Health System Performance", Health Affairs, May/June 2001

^ Christopher J.L. Murray, Kei Kawabata, and Nicole Valentine, "People’s Experience Versus People’s Expectations", Health Affairs, May/June 2001

^ Donna St. George, "For Children, a Better Beginning," The Washington Post, April 24, 2008

^ Kenneth C. Land, Project Coordinator, "2008 Special Focus Report: Trends in Infancy/Early Childhood and Middle Childhood Well-Being, 1994-2006," The Foundation for Child Development Child and Youth Well-Being Index (CWI) Project, Foundation for Child Development (FCD), April 24, 2008

^ Dartmouth Atlas review of regional disparities.

^ Hadley, Jack, "Insurance Coverage, Medical Care Use, and Short-term Health Changes Following an Unintentional Injury or the Onset of a Chronic Condition", JAMA, March 14, 2007; 297: 1073–1084.

^ National Hospital Ambulatory Care Survey

^ a b Halpern MT, Ward EM, Pavluck AL, Schrag NM, Bian J, Chen AY (2008). "Association of insurance status and ethnicity with cancer stage at diagnosis for 12 cancer sites: a retrospective analysis". Lancet Oncol 9 (3): 222–31. DOI:10.1016/S1470-2045(08)70032-9. PMID 18282806. Lay summary: Study Finds Cancer Diagnosis Linked to Insurance, New York Times.

^ The Cost of Lack of Health Insurance, American College of Physicians

^ http://web.mhanet.com/UserDocs/articles/FRA.pdf

^ http://www.gencourt.state.nh.us/rsa/html/xii/167/167-64.htm

^ Stan Dorn, Bowen Garrett, John Holahan, and Aimee Williams, "Medicaid, SCHIP and Economic Downturn:Policy Challenges and Policy Responses," Kaiser Family Foundation, April 2008

^ Valerie Ulene, "Costs of overtreating patients," Los Angeles Times, May 5, 2008

^ Emily Cox, Doug Mager, Ed Weisbart, "Geographic Variation Trends in Prescription Use: 2000 to 2006,"[dead link] Express Scripts, January 2008

^ "Effective Care," The Dartmouth Atlas of Health Care, January 15, 2007

^ Laurence C. Baker, Elliott S. Fisher, and John E. Wennberg, "Variations In Hospital Resource Use For Medicare And Privately Insured Populations In California," Health Affairs web exclusive, February 2008

^ "Medicare: End-of-Life Hospital Spending for Medicare Beneficiaries With Chronic Health Conditions Varies Widely, Study Finds," Kaiser Daily Health Policy Report, Kaiser Family Foundation, April 7, 2008

^ California HealthCare Foundation, [3] "Uncoordinated Care: A Survey of Physician and Patient Experience"], Harris Interactive. 2007. Retrieved March 20, 2008.

^ a b Tare Parker-Pople, "Well: Doctor and Patient, Now at Odds," The New York Times, July 29, 2008

^ Hospitalists and the family physician [4] by Bruce Bagley, M.D.; American Family Physician

^ Hospitalist concept: another dangerous trend[dead link] by Robert G. Brown, M.D.; American Family Physician

^ Use of mandatory hospitalists blasted, American College of Physicians

^ The trade association America's Health Insurance Plans, has some 1,300 members.

^ "Costs of Health Administration in the U.S. and Canada", Woolhandler, et al., NEJM 349(8) Sept. 21, 2003

^ Jeff Lemieux, "Perspective: Administrative Costs of Private Health Insurance Plans", America’s Health Insurance Plans, 2005

^ "Understanding Health Plan Administrative Costs"[dead link], Blue Cross Blue Shield Association, 2003

^ Kent J. Sacia and Robert H. Dobson, "Health Plan Administrative Cost Trends," Prepared for the BlueCross BlueShield Association by Milliman USA, February 20, 2003

^ Reinhardt, Uwe E. (November 21, 2008). "Why Does U.S. Health Care Cost So Much? (Part II: Indefensible Administrative Costs)". The New York Times. http://economix.blogs.nytimes.com/2008/11/21/why-does-us-health-care-cost-so-much-part-ii-indefensible-administrative-costs/. Retrieved May 4, 2010.

^ U.S. Congressional Budget Office, Key Issues in Analyzing Major Health Insurance Proposals, December 2008

^ a b Douglas B. Sherlock, "Administrative Expenses of Health Plans", Blue Cross Blue Shield Association, 2009

^ Kahn JG, Kronick R, Kreger M, Gans DN (2005). "The cost of health insurance administration in California: estimates for insurers, physicians, and hospitals". Health Aff (Millwood) 24 (6): 1629–39. DOI:10.1377/hlthaff.24.6.1629. PMID 16284038. http://content.healthaffairs.org/cgi/pmidlookup?view=long&pmid=16284038. Retrieved 2008-01-22.

^ Scandlen G (2005). "Consumer-driven health care: just a tweak or a revolution?". Health Aff (Millwood) 24 (6): 1554–8. DOI:10.1377/hlthaff.24.6.1554. PMID 16284028. http://content.healthaffairs.org/content/24/6/1554.full.

^ Marmor T, Oberlander J, White J (2009). "The Obama administration's options for health care cost control: hope versus reality". Ann Intern Med 150 (7): 485–9. PMID 19258549. Free full-text.

^ Liebowitz, Stan Policy Analysis: Why Health Care Costs So Much, Cato Institute, June 23, 1994

^ a b The Factors Fueling Rising Healthcare Costs 2006, PriceWaterhouseCoopers for America's Health Insurance Plans, 2006. Retrieved 2007-10-08.

^ "Confronting The Medicare Cost Shift". Managed Care Magazine. http://www.managedcaremag.com/archives/0612/0612.costshift.html. Retrieved 2007-06-28.

^ a b Health Care Cost Trends. Massachusetts Office of Health and Human Services. See Appendix B: Preliminary Report of the Massachusetts Attorney General (PDF), pp. 1-2, for quote and summary.

^ Text of EMTALA on FindLaw

^ The Inhuman State of U.S. Health Care, Monthly Review, Vicente Navarro, September 2003. Retrieved 2009-09-10

^ Schoen, C.; Cathy Schoen, M.S., Michelle M. Doty, Ph.D., Sara R. Collins, Ph.D., and Alyssa L. Holmgren (2005-06-14). "Insured But Not Protected: How Many Adults Are Underinsured?". Health Affairs Web Exclusive Suppl Web Exclusives: W5–289–W5–302. DOI:10.1377/hlthaff.w5.289. PMID 15956055. http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.289?ijkey=1hR6oh4Hhh2jc&keytype=ref&siteid=healthaff. Retrieved 2007-08-11.

^ Mitchell D. Wong, Ronald Andersen, Cathy D. Sherbourne, Ron D. Hays, and Martin F. Shapiro "Effects of Cost Sharing on Care Seeking and Health Status: Results From the Medical Outcomes Study," American Journal of Public Health, Vol 91, No. 11, November 2001

^ Schoen, C; Cathy Schoen, Robin Osborn, Michelle M. Doty, Meghan Bishop, Jordon Peugh and Nandita Murukutla (2007-11-01). "Toward Higher-Performance Health Systems: Adults' Health Care Experiences in Seven Countries, 2007". Health Affairs Web Exclusive 26 (6): w717–34. DOI:10.1377/hlthaff.26.6.w717. PMID 17978360. http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=568237. Retrieved 2007-11-06.

^ "The Carter Center Mental Health Program: Combating the Stigma of Mental Illness". The Carter Center. http://www.cartercenter.org/health/mental_health/index.html. Retrieved 2008-07-30.

^ Weiss, Rick (2005-06-07). "Study: U.S. Leads In Mental Illness, Lags in Treatment". The Washington Post. http://www.washingtonpost.com/wp-dyn/content/article/2005/06/06/AR2005060601651.html. Retrieved 2008-07-30.

^ Pear, Robert (March 6, 2008). "House Approves Bill on Mental Health Parity". The New York Times. http://www.nytimes.com/2008/03/06/washington/06health.html?_r=1. Retrieved 2009-07-29.

^ Andrews, Michelle (2007-08-07). "The Untouchables". Health. U.S. News and World Report. http://health.usnews.com/usnews/health/articles/070820/20preconditions.b1.htm. Retrieved 2007-10-27.

^ Marcus, Aliza (2008-05-07). "Baby Kendra's $300,000 Bill Pains Insurers, Inspires Candidates". Bloomberg News. http://www.bloomberg.com/apps/news?pid=newsarchive&sid=a4BEIIi_OauQ. Retrieved 2008-05-10.

^ "Risk Classification in Individually Purchased Voluntary Medical Expense Insurance", American Academy of Actuaries, (February 1999)

^ "The "Uninsurables"". CBS News. May 23, 2007. http://www.cbsnews.com/stories/2007/05/23/cbsnews_investigates/main2843007.shtml. Retrieved 2007-06-27.

^ Teresa Chovan, Hannah Yoo and Tom Wildsmith, "Individual Health Insurance: A Comprehensive Survey of Affordability, Access, and Benefits", America’s Health Insurance Plans, August 2005

^ Teresa Chovan, Hannah Yoo and Tom Wildsmith "Individual Health Insurance: A Comprehensive Survey of Affordability, Access, and Benefits", America’s Health Insurance Plans, August 2005. See Table 7, page 11 (Note that the remainder, roughly 2%, received other types of offers, such as policies with condition waivers).

^ "Experiences of Working-Age Adults in the Individual Insurance Market". Issue Brief. Commonweath Fund. 2001-12-01. http://www.commonwealthfund.org/Content/Publications/Issue-Briefs/2001/Dec/Experiences-of-Working-Age-Adults-in-the-Individual-Insurance-Market.aspx. Retrieved 2007-10-27.

^ States include New York, New Jersey, Maine, Massachusetts, and Vermont.

^ Teresa Chovan, Hannah Yoo and Tom Wildsmith, "Individual Health Insurance: a Comprehensive Survey of Affordability, Access, and Benefits", America’s Health Insurance Plans, August 2005. See Tables 2 and 3.

^ Goldberg, J., Hayes, W., and Huntley, J. "Understanding Health Disparities." Health Policy Institute of Ohio (November 2004), page 3.

^ a b American Public Health Association (APHA), Eliminating Health Disparities: Toolkit (2004).

^ Study: Race, Location Affects Longevity

^ Trends in healthy life expectancy in the united states, 1970-1990 : gender, racial, and educational differences

^ Tronetti, Pamela (11 January 2011). "Senior consult:Check drugs supplements to avoid interactions". Melbourne, Florida: Florida Today. pp. 1D. http://www.floridatoday.com/article/20110111/LIFE01/101110310/Dr-Pamela-TronettiI-Check-drugs-supplements-to-avoid-interactions.

^ "How Trends in the Health Care System Affect Low-Income Adults: Identifying Access Problems and Financial Burdens", Issue Brief: Kaiser Commission on Medicaid and the Uninsured, December 21, 2007. Retrieved February 26, 2008.

^ Habib JL (2010). "Progress lags in infection prevention and health disparities". Drug Benefit Trends 22 (4): 112. http://dbt.consultantlive.com/display/article/1145628/1582744.

^ Spectre of racism in health and health care: lessons from history and the United States

^ Oberman A, Cutter G. Issues in the natural history and treatment of coronary heart disease in black populations: surgical treatment. Am Heart J. 1984;108:688–694.

^ Kjellstrand C. Age, sex, and race inequality in renal transplantation. Arch Intern Med. 1988;148:1305–1309.

^ Mayer W, McWhorter WP. Black/white differences in non-treatment of bladder cancer patients and implications for survival. Am J Public Health. 1989;79:772–774.

^ Yergan J, Flood AB, LoGerfo JP, Diehr P. Relationship between patient race and the intensity of hospital services. Med Care. 1987;25:592–603.

^ Council on ethical and judicial affairs. Black-white disparities in health care. JAMA. 1990;263:2344–2346.

^ Darrell J. Gaskin, Christine S. Spencer, Patrick Richard, Gerard F. Anderson, Neil R. Powe, and Thomas A. LaVeist, "Do Hospitals Provide Lower-Quality Care To Minorities Than To Whites?," Health Affairs, March/April 2008

^ "In the Literature: Do Hospitals Provide Lower-Quality Care To Minorities Than To Whites?," The Commonwealth Fund, March 11, 2008

^ http://www.fda.gov/AboutFDA/WhatWeDo/WhatFDARegulates/default.htm

^ http://www.nejm.org/doi/full/10.1056/NEJMp0802108

^ http://www.oyez.org/cases/2000-2009/2008/2008_06_1249/

^ 74 F.R. 30294, Federal Register: June 25, 2009 (Volume 74, Number 121), pp. 30294–30297.

^ Coverage Under the Public Readiness and Emergency Preparedness (PREP) Act for H1N1 Vaccination Flu.gov, retrieved 11 November 2009

^ http://www.bmj.com/cgi/content/full/330/7481/5

^ Hook, Janet; Levey, Noam N. (December 16, 2009). "Senate healthcare bill advances with rejection of imported drugs". Los Angeles Times. http://articles.latimes.com/2009/dec/16/nation/la-na-health-senate16-2009dec16. Retrieved May 4, 2010.

^ "OECD Health Data, How Does the United States Compare" (PDF). Organisation for Economic Co-operation and Development. http://www.oecd.org/dataoecd/15/23/34970246.pdf. Retrieved 2007-04-14.

^ Heffler S, Smith S, Keehan S, Clemens MK, Zezza M, Truffer C (2004). "Health spending projections through 2013". Health Aff (Millwood) Suppl Web Exclusives: W4–79–93, See especially exhibit 5. DOI:10.1377/hlthaff.w4.79. PMID 15451969. http://content.healthaffairs.org/cgi/pmidlookup?view=long&pmid=15451969.

^ See the summary of the official U.S. position in the "Pharmaceutical Research and Manufacturers of America (PhRMA) Special 301 Submission of 2008"[dead link], 11 February 2008, 10–20.

^ Berenson, Alex (November 6, 2006). "As Drug Prices Climb, Democrats Find Fault With Medicare Plan". The New York Times. http://www.nytimes.com/2006/11/06/business/06drug.html?pagewanted=all. Retrieved May 4, 2010.

^ "Most Republicans Think the U.S. Health Care System is the Best in the World. Democrats Disagree.," Press Release, Harvard School of Public Health and Harris Interactive, March 20, 2008

^ "Americans’ Views on the U.S. Health Care System Compared to Other Countries," Harvard School of Public Health and Harris Interactive, March 20, 2008

^ "Insuring America's Health: Principles and Recommendations". Institute of Medicine of the National Academies. http://www.iom.edu/Reports/2004/Insuring-Americas-Health-Principles-and-Recommendations.aspx. Retrieved 2007-10-27.

^ Reynolds, Alan (2002-10-03). "No Health Insurance? So What?". The Cato Institute. http://www.cato.org/research/articles/reynolds-021003.html. Retrieved 2007-10-27.

^ Center for Economic and Social Rights. "The Right to Health in the United States of America: What Does it Mean?"[dead link] October 29, 2004.

^ Sade RM (December 1971). "Medical care as a right: a refutation". N. Engl. J. Med. 285 (23): 1288–92. DOI:10.1056/NEJM197112022852304. PMID 5113728. http://www.aapsonline.org/brochures/sademcr.htm.

^ Seabrook, Andrea & Overby, Peter (July 23, 2009). "Drug Firms Pour $40 Million Into Health Care Debate." NPR. Retrieved on July 23, 2009.

^ Lorber, Jennie (July 21, 2009)."Lobbying Increases as Health Care Debate Intensifies." The New York Times. Retrieved on July 23, 2009.

^ Eggen, Dan (July 21, 2009). "Industry Cash Flowed To Drafters of Reform; Key Senator Baucus Is a Leading Recipient." Washington Post. Retrieved on July 22, 2009.

^ HART/McINTURFF, NBC News/Wall Street Journal Survey, Study #6095, Jun 12-15, 2009

^ http://spectator.org/archives/2009/04/20/socialized-medicine-on-modern

^ Reinhardt, Uwe E. (May 8, 2009). "What Is ‘Socialized Medicine'?: A Taxonomy of Health Care Systems". The New York Times. http://economix.blogs.nytimes.com/2009/05/08/what-is-socialized-medicine-a-taxonomy-of-health-care-systems/. Retrieved May 4, 2010.

^ "Health Reform for Beginners: The Difference Between Socialized Medicine, Single-Payer Health Care, and What We'll Be Getting". The Washington Post. http://voices.washingtonpost.com/ezra-klein/2009/06/health_reform_for_beginners_th_1.html. Retrieved May 4, 2010.

^ Ronald Bailey. "Mandatory Health Insurance Now! It will save private medicine -- and spur medical innovation.". Reason Magazine. Archived from the original on 2006-06-18. http://web.archive.org/web/20060618023609/http://www.reason.com/0411/fe.rb.mandatory.shtml. Retrieved 2006-06-21.

^ Linda J. Blumberg and Len Nichols, "Health Insurance Market Reforms: What They Can and Cannot Do," Urban Institute, November 1, 1995

^ Robert Reich Public Option Video

^ How Pharma and Insurance Intend to Kill the Public Option, And What Obama and the Rest of Us Must Do

^ "5 key things to remember about health care reform". CNN. March 25, 2010. http://www.cnn.com/2010/HEALTH/03/25/health.care.law.basics/index.html.

^ "Policies to Improve Affordability and Accountability". The White House. http://www.whitehouse.gov/health-care-meeting/proposal/whatsnew/affordability.

^ "Health Care Reform Bill 101". The Christian Science Monitor. http://www.csmonitor.com/USA/Politics/2010/0320/Health-care-reform-bill-101-Who-gets-subsidized-insurance.

^ Peter Grier, Health care reform bill 101: Who will pay for reform?, Christian Science Monitor (March 21, 2010).

^ Grier, Peter (March 19, 2010). "Health care reform bill 101: Who must buy insurance?". Christian Science Monitor (Washington, D.C.). http://www.csmonitor.com/USA/Politics/2010/0319/Health-care-reform-bill-101-Who-must-buy-insurance. Retrieved 2010-04-07.

^ Congressional Budget Office, Cost Estimates for H.R. 4872, Reconciliation Act of 2010 (Final Health Care Legislation) (March 20, 2010).

^ http://ajph.aphapublications.org/cgi/reprint/90/6/917.pdf

[edit] Further readingChristensen, Clayton Hwang MD, Jason, Grossman MD, Jerome, The Innovator's Prescription, McGraw Hill, 2009. ISBN 978-0-07-159208-6

Gutkind, Lee, One Children's Place: Inside a Children's Hospital, Penguin, 1992. ISBN 978-0-452-26687-2

Gutkind, Lee, Stuck in Time: The Tragedy of Childhood Mental Illness, Henry Holt & Company, 1994. ISBN 0-8050-1469-1

Mahar, Maggie, Money-Driven Medicine: The Real Reason Health Care Costs So Much, Harper/Collins, 2006. ISBN 978-0-06-076533-0

Reid, T.R., "U.S. Health Care: The Good News", PBS, February 16, 2012

Starr, Paul, The Social Transformation of American Medicine, Basic Books, 1982. ISBN 0-465-07934-2

President Obama REMARKS BY THE PRESIDENT TO A JOINT SESSION OF CONGRESS ON HEALTH CARE September 9, 2009

[edit] External linksNational Center for Health Statistics from Centers for Disease Control and Prevention (CDC)

National Health Expenditure Data (U.S.) from United States Department of Health and Human Services (CMS)

United States profile from the World Health Organization *

Health Care in the United States at the Open Directory Project

FamiliesUSA contains links to numerous studies and literature about various aspects of health care in the US].

http://en.wikipedia.org/wiki/Health_care_in_the_United_States

The Power to Make Metaphor Into Law

2012-06-26T06:41:00.000-07:00

by George Lakoff and Elisabeth Wehling, Reader Supported News

Perhaps as early as today, the conservative-dominated Roberts Court will choose a metaphor that will affect millions of people and perhaps change the history of our country very much for the worse.
Back in 1978, linguists Michael Reddy and me (George Lakoff), working independently, demonstrated that metaphor is fundamentally a matter of thought, and that metaphorical language is secondary. Conceptual metaphors shape our understanding and can determine how we reason. Consequently, metaphor is central to law, as Citizens United showed by making the metaphor Corporations Are Persons into a law, with vast political consequences.
This week's likely judgment was prefigured in the 2008 Republican presidential race when Rudolph Giuliani likened health care to a flat screen TV. If you want a flat screen TV, buy one; and if you don't have the money, go earn it. If you can't, too bad, you don't deserve it. The same with health care, he argued, imposing the metaphor that Health Care Is a Product.
This was a sign that conservative strategists were looking for a way to impose this metaphor.
Barack Obama helped them. He bought into that metaphor when he chose the Interstate Commerce clause as the constitutional basis of his health care act. He had an alternative - Medicare for All - since Congress has the duty to provide for the general welfare.
But Obama accepted the Health Care as Product metaphor because he wanted to regulate the insurance industry, and Congress has the power to regulate interstate commerce. In doing so he fell into a conservative trap. The Interstate Commerce clause rests on the metaphor that Health Care is Product. That led to Supreme Court justices arguing that the individual mandate is forcing people to buy a product, and that, they hinted, is unconstitutional - at least 5-4 unconstitutional. The argument is that if the government can force you to buy one product, it can force you to buy any product - even broccoli.
There is another metaphor trying to get onstage - that the individual mandate levies a health care tax on all citizens, with exemptions for those with health care. The mandate wasn't called a tax, but because money is fungible, it is economically equivalent to a tax, and so it could be metaphorically considered a tax - but only if the Supreme Decided.
Where the first metaphor would effectively kill the Affordable Care Act, the second could save it. Since Congress has the power to levy taxes, the second metaphor would clearly be constitutional.
But adopting such a metaphor would open the door to other disasters, since then all fees or fines can be argued to be taxes. Conservatives are already making such arguments.
The Supreme Court is a remarkable institution. By a 5-4 vote, it can decide what metaphors we will live - or die - by. It is time recognize, and speak regularly of, the Metaphor Power of the Court, the power to make metaphors legally binding. It is an awesome power. This is a something the press should be reporting on, legal theorists should be writing about, and all of us should be discussing. Should the Court have such a power? And if so, should there be any limits on it?
Indeed, could the Court decide whether the Metaphor Power of the Court itself is constitutional?

http://readersupportednews.org/opinion2/272-39/12092-focus-the-power-to-make-metaphor-into-law

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At Look at Koch Industries From Wikipedia

2012-06-23T08:20:00.000-07:00

Koch Industries, Inc. is an American multinational corporation based in Wichita, Kansas, United States, with subsidiaries involved in manufacturing, trading and investments. Koch also owns Invista, Georgia-Pacific, Flint Hills Resources, Koch Pipeline, Koch Fertilizer, Koch Minerals and Matador Cattle Company. Koch companies are involved in core industries such as the manufacturing, refining and distribution[1] of petroleum, chemicals, energy, fiber, intermediates and polymers, minerals, fertilizers, pulp and paper, chemical technology equipment, ranching,[3] finance, commodities trading, as well as other ventures and investments. The firm employs 50,000 people in the United States and another 20,000 in 59 other countries.[4]
In 2011, Forbes called it the second largest privately held company in the United States (after Cargill), with an annual revenue of about $98 billion,[5][6][7] down from the largest in 2006. If Koch Industries were a public company in 2007, it would rank about 16 in the Fortune 500.[8]
Fred C. Koch, for whom Koch Industries, Inc. is named, co-founded the company in 1940 and developed an innovative crude oil refining process.[9] His sons, Charles G. Koch, chairman of the board and chief executive officer, and David H. Koch, executive vice president, are principal owners of the company after they bought out their brothers, Frederick and William, for $1.1 billion in 1983.[10] Charles and David H. Koch each own 42% of Koch Industries, and Charles has stated that the company will publicly offer shares "literally over my dead body".[5]
Predecessor companies
In 1925, Fred C. Koch joined MIT classmate Lewis E. Winkler at an engineering firm in Wichita, Kansas, which was renamed the Winkler-Koch Engineering Company. In 1927 they developed a more efficient thermal cracking process for turning crude oil into gasoline. This process threatened the competitive advantage of established oil companies, which sued for patent infringement. Temporarily forced out of business in the United States, they turned to other markets, including the Soviet Union, where Winkler-Koch built 15 cracking units between 1929 and 1932. During this time, Koch came to despise communism and Joseph Stalin's regime.[11][12] In his 1960 book, A Business Man Looks at Communism, Koch wrote that he found the USSR to be "a land of hunger, misery, and terror."[13] According to Charles G. Koch, "Virtually every engineer he worked with [there] was purged."[12]
In 1940, Koch joined new partners to create a new firm, the Wood River Oil and Refining Company, which is today known as Koch Industries. In 1946 the firm acquired the Rock Island refinery and crude oil gathering system near Duncan, Oklahoma. Wood River was later renamed the Rock Island Oil & Refining Company.[14] Charles G. Koch joined Rock Island in 1961, having started his career at the management consulting firm Arthur D. Little. He became president in 1966 and chairman at age 32, upon his father's death the following year.[9][15]
Koch Industries
The company was renamed Koch Industries in honor of Fred Koch, the year after his death. At that time, it was primarily an engineering firm with part interest in a Minnesota refinery, a crude oil-gathering system in Oklahoma,[12] and some cattle ranches.[16] In 1968, Charles approached Union Oil of California about buying their interest in Great Northern Oil Company and its Pine Bend Refinery but the discussions quickly stalled after Union asked for a large premium.[11] In 1969, Union Oil began trying to market their interest in Great Northern by telling potential buyers that Koch's controlling interest could be thwarted by currying favor with another owner, J. Howard Marshall II. When Marshall discovered this he threw his lot in with Koch, they together acquired a majority interest in the company and ultimately bought Union's interest.[14] Ownership of Pine Bend refinery led to several new businesses and capabilities, including chemicals, fibers, polymers, asphalt and other commodities such as petroleum coke and sulfur. These were followed by global commodity trading, gas liquids processing, real estate, pulp and paper, risk management and finance.[11]
In 1970, Charles was joined at the family firm by his brother David H. Koch. Having started as a technical services manager, David became president of Koch Engineering in 1979.
Subsidiaries
Among Koch Industries' subsidiaries across various industries[17] are:
Georgia-Pacific
Georgia-Pacific is a paper and pulp company that produces "Brawny" paper towels, "Angel Soft" toilet paper, "Mardi Gras" napkins and towels, "Quilted Northern" toilet paper and paper towels, "Dixie" paper plates, bowls, napkins and cups, "Sparkle" paper towels, and "Vanity Fair" paper napkins, bowls, plates and tablecloths. The Atlanta-based company has operations in 27 states.[18]
INVISTA
INVISTA is a polymer and fibers company that makes "Stainmaster" carpet, and "Lycra" fiber, among other products.
Koch Pipeline Company LP
Koch Pipeline Company LP, which owns and operates 4,000 miles (6,400 km) of pipeline used to transport oil, natural gas liquids and chemicals. Its pipelines are located across Wisconsin, Minnesota, Texas, Missouri, Iowa, Oklahoma, Louisiana, and Alberta, Canada. The firm operates offices in Wichita, Kansas, St. Paul, Minnesota and Corpus Christi, Texas.
In 1946 Wood River Oil Co. (a precursor company to Koch Industries) purchased Rock Island Oil and Refining Co. As a part of the transaction, it acquired a crude-oil pipeline in Oklahoma. As a result of construction and investments, Wood River acquired other pipelines in the U.S. and Canada. “In the ensuing years,” according to Koch Pipeline's website, “the company bought, sold and built pipeline systems transporting crude oil and refined products, as well as natural gas, natural gas liquids and anhydrous ammonia (for fertilizer).”[19] Koch Pipeline and its affiliates currently maintain a 4,000-mile network of pipelines.
In January 2000, Koch Pipeline agreed to a $35 million settlement with the U.S. Justice Department and the State of Texas. This settlement, including a $30 million civil fine, represented compensation for three hundred oil spills in Texas and five other states dating back to 1990.[20][21][22]
Pipeline accident
Koch's Sterling butane pipeline had a leak in Lively, Texas, on August 24, 1996. Two teenagers were killed when the gas exploded and burned. The National Transportation Safety Board concluded that severe external pipeline corrosion was the cause of the failure, and recommended to Koch to improve corrosion evaluation procedures.[23] Although Koch distributed pamphlets about safety around the pipelines, they failed to maintain an up-to-date mailing list. Only 5 out of 45 residences in the area of the accident had received pamphlets. The families of the dead had not.[24]
In 1999, a Texas jury found that negligence had led to the rupture of the Koch pipeline and awarded the victims' families $296 million — "the largest compensatory damages judgment in a wrongful death case against a corporation in U.S. history".[25]
In a statement released in 2010, Koch Industries offered this comment:
The August, 1996 pipeline accident in Texas was a tragedy. Koch accepted responsibility immediately for the incident, which is the only event of its kind in the company’s history. The thorough review conducted of this pipeline the year before the accident did not uncover any issues that posed a foreseeable threat to public safety. The bacteria-induced corrosion that caused the accident acted more quickly to damage this pipeline than had ever been documented by any industry expert. Koch’s cooperative efforts to identify the source and cause of this problem so that this knowledge could be shared throughout industry were praised by the National Transportation Safety Board, which did a two-year investigation into this incident.[26]
Flint Hill Resources LP
Flint Hill Resources LP, originally called Koch Petroleum Group, is a major refining and chemicals company based in Wichita, Kansas. It sells products such as gasoline, diesel, jet fuel, ethanol, polymers, intermediate chemicals, base oils and asphalt. It operates oil refineries in six states. Flint Hill has chemical plants in Illinois, Texas and Michigan. The firm is also a major manufacturer of asphalt used for paving and roofing applications. It operates 13 asphalt terminals located in six states including Alaska (2 terminals), Wisconsin (2), Iowa (3), Minnesota (4), Nebraska (1), and North Dakota(1).[27] The firm manages the purchasing of domestic crude oil from Texas and Colorado offices, has four ethanol plants across Iowa, operates three refineries in Alaska, Texas, and Minnesota, and has a refinery terminal in Alaska. The Minnesota refinery can process 320,000 barrels (51,000 m3) of crude a day, most of which comes from from Alberta, Canada, and handles one quarter of all Canadian oil sands crude entering the U.S.[28] It also operates fuel terminals in Wisconsin (4 locations), Texas (6), and one each in Iowa and Minnesota.[29]
In March 1999, Koch Petroleum Group acknowledged that it had negligently dumped hundreds of thousands of gallons of aviation fuel into wetlands from its refinery in Rosemount, Minnesota, and that it had illegally dumped a million gallons of high-ammonia wastewater onto the ground and into the Mississippi River. Koch Petroleum paid a $6 million fine and $2 million in remediation costs, and was ordered to serve three years of probation.[30]
In April 2001, the company reached a $20 million settlement in exchange for admitting to covering up environmental violations at its refinery in Corpus Christi, Texas.[31][32]
In June 2003, the US Commerce Department fined Flint Hill Resources a $200,000 civil penalty. The fine settled charges that the company exported crude petroleum from the US to Canada without proper US government authorization. The Commerce Department’s Bureau of Industry and Security said from July 1997 to March 1999, Koch Petroleum (later called Flint Hill Resources) committed 40 violations of Export Administration Regulations.[33]
In 2005, Koch's Flint Hills Resources refinery was recognized by the Environmental Protection Agency's Clean Air Awards program for reducing air emissions by 50 percent while expanding operations.[34] The EPA has worked with Flint Hills Resources to develop "strategies for curtailing so-called 'upset' emissions, in what agency and company sources say could lead to guidance to minimize such emissions from petroleum refineries and other industrial facilities."[35] The EPA described the process as a "model for other companies."[36]
In 2006, Flint Hill Resources was fined nearly $16,000 by the EPA for 10 separate violations of the Clean Air Act at its Alaska oil refinery facilities, and required to spend another $60,000 on safety equipment needed to help prevent future violations.[37]
Koch Fertilizer, LLC
Koch Fertilizer, LLC, which is one of the world’s largest makers of nitrogen fertilizers.[38] Koch Fertilizer owns or has interests in fertilizer plants the United States, Canada, Trinidad and Tobago, Venezuela, and Italy, among others.[39][40] Koch Fertilizer was formed in 1988 when the Koch companies purchased the Gulf Central Pipeline and ammonia terminals connected to the pipeline. The next year, the Koch Nitrogen Company was formed in order to market ammonia. The next few years saw purchases of various ammonia facilities in Louisiana, Canada, and elsewhere, and ammonia sales agreements with firms in Australia, the U.K., and other countries. The year 2010 saw the founding of Koch Methanol, LLC, and Koch Agronomic Services, LLC. In October 2010, a plant in Venezuela was nationalized by the government.[41] In 2011, the firm acquired the British fertilizer firm J&H Bunn Limited.
Koch Agricultural Company
Koch Agricultural Company's Matador Cattle Company division operates three ranches totaling 425,000 acres (1,720 km2) located in Beaverhead, Montana, Matador, Texas and the Flint Hills of eastern Kansas. There are more than 15,000 head of cattle raised on the ranches.[42]
The Matador Land and Cattle Company was founded in 1882 by Scottish investors, whose acquisition included 2.5 million acres in four Texas counties. In 1951, the company was sold to Lazard Freres and Company, which in turn sold some of the Texas land to Fred C. Koch. In 1952 Koch formed Matador Cattle Company, and later one of his companies purchased part of Matador Ranch, which was brought together with other Koch ranches in Montana and Kansas. Today, according to the ranch's website, it “is owned and operated by Matador Cattle Company, a division of Koch Agriculture Company, which is an indirect, wholly-owned subsidiary of Koch Industries.”[43]
Koch's Matador Ranch in Texas earned the Lone Star Land Steward award for outstanding natural resource management in 2010.[44] The Montana ranch has earned several environmental stewardship awards, including the EPA Regional Administrator's award.[45]
Environmental and safety record
From 1999 to 2003, Koch Industries was assessed "more than $400 million in fines, penalties and judgments."[25] Another source points out that Koch has had only "eight instances of alleged misconduct ... over the span of 63 years" despite being a giant multinational, and that this compares favorably to the fines, penalties and judgments accrued by the similarly large General Electric corporation.[46]
Pollution and resource fines
In May 2001, Koch Industries paid $25 million to the federal government to settle a federal lawsuit that found the company had improperly taken more oil than it had paid for from federal and Indian land.[47]
In 2007, Koch Nitrogen's plant in Enid, Oklahoma, was listed as the third highest company releasing toxic chemicals in Oklahoma, according to the EPA, ranking behind Perma-Fix Environmental Services in Tulsa and Weyerhaeuser Co. in Valliant.[48] The facility produces about 10% of the US national production of anhydrous ammonia, as well as urea and UAN.[49]
In 2010, Koch Industries was ranked 10th on the list of top US corporate air polluters, the "Toxic 100 Air Polluters", by the Political Economic Research Institute at the University of Massachusetts Amherst Amherst.[50]
Awards and certifications
According to its website, Koch Industries and its subsidiaries received 289 stewardship awards over the two years ending January 2011.[51]
Koch Industries' headquarters in Wichita has been certified for meeting the Energy Star standards for superior energy efficiency and environmental protection. As of 2010 it is the only Wichita office building to be so recognized.[52][53] A Tulsa, Oklahoma site of the Koch-owned John Zink Company site was part of the EPA's National Environmental Performance Track program from 2003 until 2009 when the program was suspended.[54][55]
In 2011, the Midway-Kansas Chapter of the American Red Cross awarded Koch Industries with a Corporate Excellence Award for its long-standing commitment to the humanitarian mission of Red Cross.[56]
Legal activity
In 2008, Koch Industries discovered that the French affiliate Koch-Glitsch had violated bribery laws allegedly securing contracts in Algeria, Egypt, India, Morocco, Nigeria and Saudi Arabia after an investigation by Ethics Compliance officer, Egorova-Farines.[25] After Koch Industries' investigative team looked into her findings, the four employees involved were terminated. A Bloomberg article states that Egorova-Farines’ reported her findings immediately, and even after Koch’s investigators substantiated the findings, her “superiors removed her from the inquiry in August 2008 and fired her in June 2009, calling her incompetent.”[25] Koch Industries’ general counsel, Mark Holden, gave a different account of the events to Jennifer Rubin of the Washington Post.[57] Holden stated that Egorova-Farines failed to promptly share the findings, choosing instead to give the information to a manager at Koch-Glitsch who was later fired for bribery. Rubin writes that, according to Holden, “Egorova-Farines was not fired but instead ran into performance problems, left the company to go on leave and never returned.” Egorova-Farines sued Koch-Glitsch for wrongful termination in France. Rubin writes that she lost and “was ordered to pay costs for bringing a frivolous case.”[57]
In May 2011, a Utah judge dismissed a Koch Industries lawsuit alleging that Youth For Climate Truth, in releasing a fake Koch Industries press release, had infringed on Koch Industries' trademark.[58]
Political activity
Koch Industries has spent more than $50 million to lobby in Washington since 2006, according to the Center for Responsive Politics.[25]
The company has opposed the regulation of financial derivatives and limits on greenhouse gases.[25] It sponsors free market foundations and causes.[59][60] According to the Center for Responsive Politics, many of Koch Industries' contributions have gone toward achieving legislation on energy issues, defense appropriations and financial regulatory reform.[61] According to Greenpeace, the company has "had a quiet but dominant role in a high-profile national policy debate on global warming," and has out-spent ExxonMobil (another corporation active in fighting climate change science and legislation) in giving money to organizations fighting legislation related to climate change. "From 2005 to 2008, ExxonMobil spent $8.9 million while the Koch Industries-controlled foundations contributed $24.9 million in funding."[62][63] Another Greenpeace study states that between 1997 and 2008 Koch Industries donated nearly $48 million to groups which doubt or oppose the theory of anthropogenic global warming.[64][65] Koch Industries replied saying the Greenpeace report "distorts the environmental record of our companies."[63][context?]
One policy proposal to control global warming that Koch Industries has come out against is Low Carbon Fuel Standards, such as were passed in 2007 in California.[28] According to Koch Industries, "LCFS would cripple refiners that rely on heavy crude feedstocks to provide the transportation fuels that keep America moving."[66]
Koch Industries have also been active in supporting and opposing politicians, including presidents. The Koch Industries website includes an opinion piece from the Wall Street Journal by Charles Koch, one of the company's owners, "Why Koch Industries is Speaking Out"[67] The article states:
Because of our activism, we've been vilified by various groups. Despite this criticism, we're determined to keep contributing and standing up for those politicians, like Wisconsin Gov. Scott Walker, who are taking these challenges [deficit spending by governments] seriously

References/ Footnotes

1.↑ 1.0 1.1 1.2 "Koch Industries Welcomes 2009 Leadership Kansas Class" (PDF). http://www.kochind.com/files/070709KIILeadershipKansas.pdf. Retrieved 2011-07-23.

2.↑ "Forbes Magazine Profile for America's Top 100 Private Companies". Forbes.com. 3 November 2010. http://www.forbes.com/lists/2010/21/private-companies-10_Koch-Industries_VMZQ.html. Retrieved 2011-07-23.

3.↑ "Koch Industries, Inc - Industry Areas". Kochind.com. http://www.kochind.com/IndustryAreas/default.asp. Retrieved 2011-07-23.

4.↑ Continetti, Matthew (April 4, 2011). "The Paranoid Style in Liberal Politics". The Weekly Standard. http://www.weeklystandard.com/articles/paranoid-style-liberal-politics_555525.html?nopager=1.

5.↑ 5.0 5.1 Fisher, Daniel (Mar. 13, 2006). "Mr. Big", pp. 24–26. Forbes. Online summary for calendar year 2005 at [1].

6.↑ "America's Largest Private Companies". Forbes. 8 November 2007. http://www.forbes.com/lists/2007/21/biz_privates07_Americas-Largest-Private-Companies_Rank.html?boxes=custom. Retrieved 2011-07-23.

7.↑ "Forbes rankings for 2009". Forbes.com. 2009-10-28. http://www.forbes.com/2009/10/28/largest-private-companies-business-private-companies-09_land.html. Retrieved 2011-07-23.

8.↑ "The Principled Entrepreneur". The American. July–August 2007. http://www.american.com/archive/2007/july-august-magazine-contents/the-principled-entrepreneur. Retrieved 23 February 2010.

9.↑ 9.0 9.1 "Summary of Koch Industries History". sec.gov. U.S. Securities and Exchange Commission. 14 November 2005. http://www.sec.gov/Archives/edgar/data/41077/000119312505225697/dex993.htm. Retrieved 18 February 2010.

10.↑ The Top 10 Forbes Asia October 19, 2009

11.↑ 11.0 11.1 11.2 Koch, Charles C. (2007). The Science of Success: How Market-Based Management Built the World's Largest Private Company. John Wiley & Sons, Inc.. p. 6. ISBN 978-0-470-13988-2.

12.↑ 12.0 12.1 12.2 Daniel Fisher (13 March 2006). "Mr. Big". Forbes. http://www.forbes.com/global/2006/0313/024.html.

13.↑ Koch, Fred C. (1960). A Business Man Looks at Communism. Wichita, Kansas.

14.↑ 14.0 14.1 J. Howard, Marshall II (1994). Done in Oil: An Autobiography. College Station: Texas A&M University Press. p. 254. ISBN 0-89096-533-1.

15.↑ Bruce Upbin; Brandon Copple (14 December 1998). "Creative destruction 101". Forbes.

16.↑ John, Lincoln (1989). Rich Grass and Sweet Water. College Station: Texas A&M University Press. ISBN 0-89096-387-8.

17.↑ Koch Industries website, Industry Areas, accessed Aug 25 2010,

18.↑ Georgia Pacific website, accessed March 11, 2011, Georgia-Pacific Company Overview

19.↑ "History". Koch Pipeline Company, L.P.. http://www.kochpipeline.com/AboutUs/history.asp. Retrieved 12 April 2012.

20.↑ "Koch Pipeline Company L.P. - Newsroom". Kochpipeline.com. 2000-01-13. http://www.kochpipeline.com/news/printable.asp?id=270. Retrieved 2011-07-23.

21.↑ By Ralph K.M. Haurwitz and Jeff Nesmith (2001-07-23). "Austin news, sports, weather, Longhorns, business". Statesman.com. http://www.statesman.com/specialreports/content/specialreports/pipelines/23pipegathering.html. Retrieved 2011-07-23.

22.↑ "Koch Agrees to $35 Million Settlement in Two Environmental Cases". Safety Online. 17 January 2000. http://www.safetyonline.com/article.mvc/Koch-Agrees-to-35-million-Settlement-in-Two-E-0001?VNETCOOKIE=NO.

23.↑ Pipeline Rupture, Liquid Butane Release, and Fire, Lively, Texas, August 24, 1996

24.↑ "Austin news, sports, weather, Longhorns, business". Statesman.com. http://www.statesman.com/specialreports/content/specialreports/pipelines/23pipelively3.html. Retrieved 2011-07-23.

25.↑ 25.0 25.1 25.2 25.3 25.4 25.5 Loder, Asjylyn; David Evans (3 October 2011). "Koch Brothers Flout Law With Secret Iran Sales". Bloomberg Markets Magazine. http://www.bloomberg.com/news/2011-10-02/koch-brothers-flout-law-getting-richer-with-secret-iran-sales.html. Retrieved 5 October 2011.

26.↑ "Koch Industries Responds to New Yorker Claims". Newsmax Media. http://www.newsmax.com/InsideCover/koch-industries-new-yorker/2010/08/26/id/368519. Retrieved 23 April 2011.

27.↑ Flint Hill Resources website, accessed March 11, 2011, FHR Asphalt

28.↑ 28.0 28.1 Dembicki, Geoff (March 22, 2011). "The Kochs: Oil Sands Billionaires Bankrolling US Right". The Tyee (Vancouver, B.C.). http://thetyee.ca/News/2011/03/22/KochBrothers/index.html. Retrieved 2011-08-21.

29.↑ Koch Industries website, accessed March 11, 2011, http://www.fhr.com/newsroom/contact.aspx?ID=9

30.↑ "Koch Petroleum Group Sentenced for Minnesota Pollution" (Press release). Environmental Protection Agency. 9 March 2000. http://yosemite.epa.gov/opa/admpress.nsf/d0cf6618525a9efb85257359003fb69d/eae2020401d0bf098525689d00713ea5!OpenDocument. Retrieved 2010-06-14.

31.↑ "Koch Pleads Guilty to Covering up Environmental Violations at Texas Oil Refinery". justice.gov. U.S. Department of Justice. 9 April 2001. http://www.justice.gov/opa/pr/2001/April/153enrd.htm. Retrieved 30 May 2010.

32.↑ Don Richards (22 January 2001). "DOJ Reduces Indictments Against Koch Industries". ICIS. http://www.icis.com/Articles/2001/01/22/130888/doj-reduces-indictments-against-koch-industries.html.

33.↑ US Dept of Commerce, Commerce Dept Fines Kansas Firm, June 3, 2003 press release, http://www.bis.doc.gov/news/2003/kansasfirmfined.htm

34.↑ Jessica Harper (18 November 2009). "Flint Hills is coming out of murky waters". Dakota County Tribune. http://www.thisweeklive.com/2009/11/18/flint-hills-is-coming-out-of-murky-waters/.

35.↑ "Inside EPA's Clean Air Report". InsideEPA. http://docs.google.com/viewer?a=v&q=cache:7eiXKq7LLHkJ:www.flinthillsresources.info/upload/InsideEPA9-09Pactwithoil.pdf+Flint+Hills+Resources+epa&hl=en&gl=us&pid=bl&srcid=ADGEESjlfx6q_Ri64N7NdqA3rho-Amf6W1nzG7_PkmPqn7Z9eJiGxEsQN9ph1qqI7EjuAUdIwNaS1l1voou3gXceHm_zhgBmQidSNdEp44PfgvYdxXP_u1PTXKeTbv4SM4bGwfZZ_7S2&sig=AHIEtbQgO5KZzY5H1tGz7XGieXnNJakdqQ. Retrieved 23 April 2011.

36.↑ "Flint Hills Resources, LP Agrees to Transition Its Texas Flexible Permits to Federally Approved Clean Air Act Permits - Transition affects facilities in Corpus Christi, Port Arthur and Longview". EPA. http://yosemite.epa.gov/opa/admpress.nsf/0/6F25BD791C4B21CB852577C400552339. Retrieved 27 April 2011.

37.↑ EPA Press Release, EPA Fines Flint Hill Resources Alaska, Dec 13 2006, accessed Aug 25 2010, http://yosemite.epa.gov/opa/admpress.nsf/b0789fb70f8ff03285257029006e3880/6b191200b3ce87e2852572430062f987!OpenDocument

38.↑ Koch Fertilizer website, accessed March 11, 2011, http://www.kochfertilizer.com/

39.↑ Yasha Levine (1 September 2010). "7 Ways the Koch Bros. Benefit from Corporate Welfare". The New York Observer. http://www.observer.com/2010/daily-transom/how-libertarian-koch-bros-benefit-corporate-welfare.

40.↑ "Fertilizers". http://www.kochind.com/IndustryAreas/fertilizers.aspx.

41.↑ "Koch Industries says no word on Venezuela takeover". Reuters. 11 October 2010. http://www.reuters.com/article/idUSN1112262420101011.

42.↑ Koch Industries website, accessed March 11, 2011, Ranching

43.↑ "The History of Matador Ranch". Matador Ranch. http://www.matadorranch.com/matadorranchhistory.php. Retrieved 12 April 2012.

44.↑ "Lone Star Land Steward Awards Winners Announced" (Press release). Texas Parks & Wildlife. 6 May 2010. http://archive.tpwd.state.tx.us/newsmedia/releases/text.phtml?req=20100506. Retrieved 2010-06-14.

45.↑ "EPA Honors Koch Ranch for Environmental Excellence; Award is Ranch's Fourth Major Environmental Honor in 1999" (Press release). Koch Industries. 7 June 1999. http://findarticles.com/p/articles/mi_m0EIN/is_1999_June_7/ai_54811290/. Retrieved 2010-06-14.

46.↑ Bloomberg's Exposé on Koch Industries Reveals ... What Exactly? Daniel Indiviglio
4 October 2011

47.↑ Russell Ray (20 June 2001). "Tribe Likely to Get Piece of Settlement in Osage County, Okla., Oil Squabble". Tulsa World.

48.↑ "EPA Reports Toxic Releases to Air, Water and Land in Oklahoma in 2007". Environmental Protection Agency. 2009-03-19. http://yosemite.epa.gov/opa/admpress.nsf/6427a6b7538955c585257359003f0230/0c43e41531a2f7848525757e00664797!OpenDocument.

49.↑ Voorhis, Dan (2010-12-16). "Fertilizer Helps Koch Grow". Wichita Eagle. http://www.kansas.com/2010/12/16/1635564/fertilizer-helps-koch-grow.html.

50.↑ "Toxic 100 Air Polluters" (Press release). March 31, 2010. http://www.peri.umass.edu/toxic_press/.

51.↑ "Koch Companies Recognized with 289 Stewardship Awards since 2009" press release, January 24, 2011.

52.↑ "Koch Industries Inc., Earns Prestigious Energy Star for Efficiencies at Wichita Complex" (Press release). Koch Industries. 17 June 2008. http://www.kochind.com/newsroom/news_releases_details.aspx?id=994. Retrieved 2010-05-31.

53.↑ "ENERGY STAR Labeled Offices in Kansas". energystar.gov. U.S. Environmental Protection Agency. http://www.energystar.gov/index.cfm?fuseaction=labeled_buildings.showMap&SEARCH_OWNER_ID=&S_CODE=KS&PROFILES=&YEAR=&BUILDING_TYPE_ID=700&SEARCH_SPP_ID=&CITY=&ZIP=&SEARCH_PROP_MANAGER_ID=&FILTER_B_ID=#. Retrieved 30 May 2010.

54.↑ "Process and Pollution Control". kochenergy.com. Koch Industries. http://kochenergy.com/EHS/processandpollutioncontrol.aspx. Retrieved 30 May 2010.

55.↑ "Performance Track Final Progress Report". epa.gov. U.S. Environmental Protection Agency. May 2009. http://www.epa.gov/performancetrack/downloads/PT_ProgRprt_2009_web.pdf. Retrieved 30 May 2010.

56.↑ Heck, Josh (18 May 2011). "Red Cross Recognizes three fundraisers". Wichita Business Journal. http://www.bizjournals.com/wichita/news/2011/05/18/red-cross-recognizes-three-fundraisers.html. Retrieved 19 May 2011.

57.↑ 57.0 57.1 Rubin, Jennifer. "Koch responds to Bloomberg". The Washington Post. http://www.washingtonpost.com/blogs/right-turn/post/koch-responds-to-bloomberg/2011/03/29/gIQA3KzNIL_blog.html. Retrieved 5 October 2011.

58.↑ "SUMMARY JUDGMENTS: Our daily legal-news aggregator for May 11, 2011" Thompson Reuters News and Insight

59.↑ Secretive Republican Donors Are Planning Ahead by Kate Zernike published October 19, 2010, New York Times

60.↑ Pulling the Wraps Off Koch Industries By LESLIE WAYNE; Published: November 20, 1994; New York Times; " Their donations reflect their belief in libertarian and free market philosophies or their personal interests."

61.↑ OpenSecrets, Summary of Koch Industries

62.↑ Koch Industries: Secretly Funding the Climate Denial Machine . greenpeace.org . 30 March 2010]

63.↑ 63.0 63.1 Covert Operations The billionaire brothers who are waging a war against Obama. by Jane Mayer . newyorker.com . August 30, 2010

64.↑ Vidal, John (30 March 2010). "US oil company donated millions to climate skeptic groups, says Greenpeace". The Guardian (London). http://www.guardian.co.uk/environment/2010/mar/30/us-oil-donated-millions-climate-sceptics.

65.↑ "Secretly Funding the Climate Denial Machine". Global Warming. Washington: Greenpeace. 2010-03-29. http://www.greenpeace.org/usa/campaigns/global-warming-and-energy/polluterwatch/koch-industries. Retrieved 2010-04-01.

66.↑ http://www.kochind.com/ViewPoint/lowCarbon.aspx Low Carbon Fuel Standards

67.↑ Why Koch Industries is Speaking Out, Wall Street Journal, March 1, 2011

ttp://www.ask.com/wiki/Koch_Industries

The Future of Social Security: 12 Proposals You Should Know About

2012-06-09T07:05:00.002-07:00

What are the pros and cons of options on the table in Washington?

You’ve paid into Social Security, and you deserve to know what changes are being proposed and how each might affect you and your family.
With more people living longer, Social Security faces increasing financial challenges. Estimates indicate the program will be able to pay full benefits for the next 20 years, but only 75 percent after that.

Here are summaries of 12 options being talked about in Washington. Each summary is accompanied by two opinions that AARP commissioned from experts whose views typically represent different sides of the issues.
(The calculations in these options are based on the 2011 Social Security Trustees’ report.)

Experts and policymakers in Washington are considering a broad range of proposals for reforming Medicare. Below, we present perspectives from leading experts on some of the more frequently mentioned policy options. Henry Aaron is a Senior Fellow in Economic Studies at The Brookings Institution, Stuart Butler is the Director of the Heritage Foundation’s Center for Policy Innovation, and Avalere Health is a leading health care policy consulting firm

In just 21 years, Social Security will be able to pay only three-fourths of its promised benefits, an outlook that guarantees debate about the future of — and the meaning of — Social Security in American life. Yet the projected shortfall is not the only challenge facing the program and those who depend on it. Changes in lifestyle, demographics and the economy are bringing insecurity to many older Americans.
See also: Social Security and older women.
Experts have put forth a number of proposals that in some combination could sustain Social Security for the long haul, while making it more helpful and fair. Here are 10 options now on the policy table in Washington:

1. Increase the cap
You make payroll tax contributions to Social Security on your earnings up to a limit ($110,100 in 2012). If you're like most workers, you earn less than the cap. Increasing the cap to $215,400 — so that 90 percent of U.S. earnings are covered — would reduce Social Security's shortfall by about 36 percent. Eliminating it altogether would end almost all of the shortfall in one stroke. Supporters say that raising the cap would be fair and that the amount would not be onerous. The main argument against such a rise is that high earners already get less of a return on contributions than lower-income workers, because benefits are progressive by design. Also, raising the earnings base would amount to a big tax hike on high earners.

2. Raise the payroll tax rate
In recent years, wage earners have paid a Social Security tax of 6.2 percent on earnings up to the income cap, as have their employers. (Congress temporarily cut the employee share to 4.2 percent in 2011 and 2012 as a way to boost the economy.)
Raising the tax rate to 6.45 percent for both employees and employers would eliminate 22 percent of the shortfall and could be phased in. Critics voice concerns about the economic impact and say employers might respond by cutting other payroll costs, such as jobs.
Other ways to raise revenues include increasing income taxes on benefits. Taxing the money that goes into "salary reduction plans," which let you divert pretax income to health care, transit and other uses, could reduce the shortfall by 10 percent. But such a move would hit consumers who may rely on such accounts.

3. Consider women's work patterns
Women workers — single or married — tend to get lower benefits because they're paid less over the course of their careers and because they are more likely than men to take time off from paid employment for caregiving or child-rearing. One proposal would give workers credit for at least some of the time spent caregiving or child-rearing. At the same time, a non-married woman potentially gets a much smaller benefit (depending on her earnings history) than a nonworking wife because she can't rely on a higher-earning spouse for benefits. Measures addressing these issues would be gender-neutral, so they could also help some men. The cost of such a proposal would have to be offset, however, or it could increase the shortfall.

4. Adjust benefits
Benefit cuts are nothing to cheer about, but they would save money. They could be structured in a way that doesn't hurt current or near-retirees and low-income individuals. Any changes could be phased in after a long lead time, giving younger workers years to adjust their financial plans.
Still, reducing benefits for modest-income people could affect their standard of living in retirement. Reducing benefits for higher earners could undermine the broad public support for Social Security as a program in which everyone pays in and everyone gets benefits.

5. Set a minimum benefit
People who had low incomes during their working lives — perhaps one in five earners — now may end up with benefits that are still below the poverty line. A minimum benefit might be set at 125 percent of the poverty line, indexed to wage increases to keep it adequate over time.
6. Modify the COLA formula
Social Security benefits generally rise to keep up with the cost of living. This cost-of-living adjustment, known as the COLA, is currently based on the Consumer Price Index for Urban Wage Earners and Clerical Workers (known as CPI-W).
One proposal would switch to a different measure, the "chained CPI," which assumes consumers alter their buying patterns if a price goes up too much. Say the price of beef soars — people may switch to chicken. The chained CPI rises about 0.3 percentage point more slowly each year than the CPI-W, meaning benefits would grow more slowly, too — about 6 percent less over the course of 20 years. Adopting a chained CPI would reduce the shortfall by about 23 percent.
Another approach would substitute a formula known as CPI-E. It takes into special account the type of spending that is more common among people 62 and older, such as medical care, which continues to rise faster than other costs. This could increase benefits, expanding the shortfall by about 16 percent.

7. Raise the full retirement age
The age at which you can get full Social Security benefits is gradually rising to 67 for people born in 1960 and later. Pushing it up even further would save money and provide an incentive for people to keep working.
A full retirement age of 68 could reduce the shortfall by about 18 percent. Raising it to 70 would close 44 percent. Such increases could be phased in, and proponents say this approach makes sense in an era of increased life expectancy. A healthy 65-year-old man, for example, is expected to live beyond 82. But not everyone has benefited equally from increases in longevity — lower-income, less educated workers have not gained as much as their more affluent, more educated counterparts. And a later full retirement age could be onerous for workers with health problems or physically demanding jobs. A related proposal — longevity indexing — would link benefits to increased life expectancy.
8. Give the oldest a boost
Americans are living longer, and the oldest often are the poorest. They may have little savings left; usually they no longer work and any pensions they have are likely eroded by inflation. A longevity bonus, for example, a 5 percent benefit increase for people above a certain age, say 85, could help them.
9. Establish private accounts
Free-market advocates have long pushed to make Social Security more of a private program, in which some of your payroll taxes would go into a personal account that would rise and fall with the financial markets. Supporters believe that stock market returns could make up for benefit cuts. You would own the assets in your personal account and could pass them on to your heirs. Personal accounts could be introduced gradually and become a choice for younger workers, while retirees and near retirees could remain in the current system. Opponents worry that they would replace a guaranteed, inflation-protected benefit for workers and, potentially, family members, with more limited protections. Private accounts only pay out the amount in the account. Also, diverting money to private accounts means additional funding could be needed to pay currently promised benefits.

10. Cover more workers
Not all workers take part in Social Security. The largest uncovered group is about 25 percent of state and local government employees who rely on state pension systems. Bringing new hires into Social Security would raise enough new revenue to trim about 8 percent of the long-term shortfall (though down the road, when these people claim benefits, costs would rise). State and local governments may oppose such a measure because it would divert dollars from public pensions that are already underfunded.
You may also like: How to maximize your check.
Jonathan Peterson wrote Social Security for Dummies © 2012 by AARP/John Wiley & Sons Inc. He is an executive communications director at AARP and a former correspondent at the Los Angeles Times

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http://www.aarp.org/work/social-security/info-05-2012/future-of-social-security-proposals.html?cmp=NLC-WBLTR-MPCTRL-060812-F3-13&USEG_ID

Theodore Truman Perry

2012-06-02T07:39:00.002-07:00

Theodore Truman Perry followed Horace Greeley's advice and went West. With his cousin, either Loren Edwards or Loen Witherall, he sold subscriptions to Horrace Greeley's newspaper to pay expenses. Following his brother Anthony's advise, he studied law and with Loren they boarded 2 blocks from Lombard College with the widow of Lorenzo Chapin. Mary Ann Chapin was a step daughter of Lorenzo's widow and was studying Literature and Art at Lombard College. During the summer, Theodore worked on surrounding farms around Galesburg, Illinois and hoped to have his own farm some day.
Theodore and Mary Ann Chapin becamer sweethearts while they were atteding college and married an hour after she graduated on the lawn of her home near the college. Rev. Parker, the President of Lombard College married them on June 15, 1870. They moved to Girard, Kansas where Theodore had established a Real Estate office for the Frisco Rail Road and was running excursions from Illinois and Iowa in order to sell land to farmers.
They had 6 children:
Nellie Augusta Perry -Born in 1871 and died in 1871 in Girard Kansas
Roxanna Perry - Born in 1872 and died in 1872 in Girard Kansas
Minnie Izah Perry born 12/23/1873 and married Walter Lee Burkett, Dec 1910
Herbert Harvey Perry born 12/23/1873 and married Clara Ann Depuy, Dec 1907
Grace Adfelia Perry born 01/22/1879 and married Gavid Emanual Gustafson 6/15/1909
Theodore Thruman Perry -Born 2/1/1881 and died 02/1888 in Girard Kansas
Mary Ann Chapin died of pneumonia in Girard, Kansas in 1883 and in July 1885, Theodore Truman Perry married her cousin Sarah E Chapin who died Februaruy 2, 1913 in Girard, Kansas of a long illness.
In January 13, 1916 Theodore T Perry had a stroke and died within a few hours.

From Donaldson - Perry Geneology writtern by Abigail Perry Richards from Lamar, Missouri 1/15/1909 & amended by Evelyn Perry Love in 1948

The Early History of Cape Girardeau, MO:1798 to 1803

2012-06-02T07:36:00.000-07:00

George Frederick Bollinger who came from Lincoln County, NC established a settlement from a Spanish Land Grant in 1796 at which time Louis Lormier, Spanish Commandant appears to have promised a large grant of land on the provision that he would bring additional colonolists to the district. Bollinger returned to North Carolina in 1798 and brought back about 20 families to farm the land. Lands had been established by treaty between the US and Spain from 1795 and land grants were given only with the survey expense owed. History of Southeast Missouri in recanting the immigration:
"The journey was made in wagons. The company crossed the Missouri River at St. Genevieve on the first of January 1800, and proceeded to the Whitewater along which stream the made their settlements. In this colony were Mathias Bollinger, William Bollinger, Henry Bollinger, Phillip Bollinger, Peter and Conrad Statler, Joseph Neyswanger, Peter and George Grount, John and Isaac Miller, Frederick Limbaugh, Leonard Walker, and Frederick Slinkard. All were either German or Swiss and all spoke fluent German. "
The first listing on the Millers in district land records is from a hearing before the Board of Land Commissioners appointed to adjust the claims in the Louisiana Territory. According to the testimonies of Isaac Miller (son of John Miller) George Frederick Bollinger, and Joseph Neyswanger Bollinger all were settled in Cape Girdeau County by October of 1803.
Although the rest of the community was Swiss-Germans (the Millers were friends of Hans Peter Eaker) and were of Scotch-Irish ancestory. A monument erecterd to his memory in the Millerville Cemetary lists his birth as 1763, and by the Revolutinary War, he was listed in his early twenties. Lincoln County, NC was site of one of the most decisive battles of the War at King's Mountain fought just twenty miles fropm the Miller home. A deed from 1790 lists the property belonging to the"4th Company" and listing several Millers.
John Miller's wife was Martha Clay, the third child of Edward Clay, the brother of Reverand John Clay and Madalena Trabue. She bore him twelve children, eight boys and four girls.

Millersville and the Miller Family by Helen Miller Penzel Ritgerod & Henry Ritgerod. Published in Fayetteville, AR, August 1939 with special acknowledgement to Miss Hunter Miller who began collecting data in 1926.

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