Health Care Reform - Freeness, Quality and Equity

It has been a long while since I have updated my blog. It’s not there haven’t been things of interest occurring in my life and the world; it’s just been that I have been a bit lazy and distracted. This post may have already been blogged to death, but here is my 2 cents worth on health care reform.

I recently watched a very interesting documentary called “Sick Around the World” on PBS. It compared the Healthcare system of the US to the developed countries of Japan, Germany, Taiwan, Switzerland and the UK. You may view the summary of findings here. The healthcare debate is raging here in the US Presidential elections as Americans clamor for a reformed system that is more affordable and responsive. Despite the broken system, most Americans abhor the idea of “socialized medicine” as practiced in Europe. The candidates have put forward their suggestion and unsurprisingly, the Republican John McCain is still advocating the continuation of a failed market based system. The democrats are somewhat better in their proposals, and despite the fear of “socialized medicine” propose plans drawing on features practiced in Europe. Hillary Clinton supports government mandated “Universal Health Care” where Americans will be required to purchase health insurance, facilitated by lower prices, with penalties that might include garnishing of wages for those who don’t. Barack Obama, supports lowering premium costs to allow more person to purchase portable insurance and access care in a system with reduced costs and improved services. He asserts that only those who don’t want to purchase health insurance would not have it. He essentially sees the issue as a problem of costs, not of will, and therefore would not institute a government mandate. In reality there is very little difference in the details between the democrats’ plans. They essentially share the same goals and strategies but seem to differ mainly on the issue of the mandate.

From the documentary I learned that US ranked highest amongst the countries in patient satisfaction but still had the most expensive system. It also appeared to have the most inequitable system of the industrialized countries. Among other things the costs are high and represent a significant and rising share of wages, patients with pre-existing conditions are routinely denied care and health insurance is not portable thus leaving or losing a job means you are without insurance. It is not uncommon for people to go bankrupt over healthcare costs. All the other countries basically found the notion of people going bankrupt to pay for health care ridiculous and alien. Starting from the point of view that health care is a fundamental human right that a government is obligated to provide to its citizens, these countries have designed various systems that guarantee affordable and access to quality care. The overarching features appear to be government set prices aimed at affordability not profitability. The ways people pay into the system vary from universal taxation managed by the government in the UK, to buying into non-profit “sickness funds” in Germany – home of socialized healthcare, and mandated health insurance purchase in Japan. In these countries those who can’t afford to pay are subsidized by the government. At the end of the day all the citizens have access to medicines, doctors and medical procedures. Additionally, the administrative costs are lower, record keeping is comprehensive and few have gate keepers in the form of doctors who must refer you to specialist before you can access those services. Gate keepers tend to raise the delivery cost and I find them to be a waste of time. In Japan you can go to any specialist as often as you like. This is good but there is no comprehensive medical history. In Britain, they reduce costs by encouraging preventative medicine. However, they are paid from the National Health System, not the individual patient as in the US. Switzerland has “frilly stuff” like massage therapy and spa treatments. But if it sounds frivolous just consider that the citizens of Switzerland and these other countries also have a longer life expectancy than the US and no doubt Jamaica.

These systems aren’t without their problems though. The doctors, highly trained specialist, do not feel adequately compensated and do not enjoy the rich lifestyles of their counterparts in the US. In Germany doctors were protesting the wages and a few in Japan complained that their businesses were unable to turn a profit because of prices being set by the government. The price of medicine, equipment and insurance were not reflective of the market situation. They are set by the government to eliminate competitive pricing and keep the system “affordable”. I wondered why doctors would continue to practice under such a system and although the documentary did not directly address this, there were references to a few individuals seeking more lucrative opportunities elsewhere. My own naïve opinion is that some people just continue out of love and duty. I couldn’t think of anything else.

Meanwhile, Jamaica has moved ahead with its plan of offering free healthcare to all its citizens. I commend Jamaica for its bold stance on providing healthcare as matter of human right and its acknowledgement of the role this plays in human development. I expect that if properly managed, this will undoubtedly contribute to our national development. However, I wonder about the efficacy of the new system. Worthy of note is that all these other developed countries commissioned studies to look at the best of the best systems around the world. They took the good, left out the bad and adopted it to their countries needs and abilities to produce a system that worked for them. I have not heard of any such thing in the Jamaican system and while I hope that this is just due to poor media reporting I seriously doubt that that is the case. The news of budget scrambling and tax increases that had to be enacted to pay for the system seems to bear this out. This does not sound like the most efficient and sustainable way to carry out of reform such a large magnitude and importance.

The Jamaican system was, and is still, seriously broken. The abolition of the user fees benefits the poorest in the Jamaican society and, according to The Caribbean Policy Research Institute (CaPRI), because it contributed little to the overall Health budget the government can make up the shortfall elsewhere. That might be true but CaPRI, the other experts, practitioners in the field and me all agree that we need to consider is that what we need is a system that is not only “free” but efficient and of a high quality. Free access to hospitals with insufficient nurses, doctors, beds and medical supplies is not really a substantial improvement in healthcare delivery. The two, healthcare quality and access, must work together if the overall system is to improve and people are to truly benefit. Until then Jamaica will continue to have a dual system of the haves of the have-nots. Those who can afford to will continue to use the private option, and those who can’t, will endure the inefficient government system. Truly, it is better than nothing, but this duality has no place in a society where everyone is equal and should be treated as such. The least fortunate in our society should have care as good as the most fortunate. That’s how human rights work – everyone is equal.

I advocate that Jamaica does the prudent thing and examine the systems of other countries to determine what works and what doesn’t. We don’t need to reinvent a non-functioning wheel, laboring stupidly over a broken system with hodgepodge solutions instead of implementing sensible tested solutions. I haven’t heard anything of bringing more payers into the system to spread the cost burden. There is no word of using technology to reduce administrative costs through information linkage, storage and sharing systems. The shortage of doctor’s in an open market system like Jamaica’s leads to higher prices, poor care and overworked doctors. The government has plans to recruit and train more doctors, nurses and other healthcare professionals. This should increase access and reduce costs. This is a long term plan though, and the government must seriously consider training these professionals while absorbing some of the costs and compensating through bonding them to public service, somewhat like they did for nurses. Additionally, I don’t necessarily advocate price setting but a review of costs for medical services should be conducted to ensure that they are fairly priced. Generally, facilities need to be improved, machinery installed and specialized services expanded. I am no healthcare policy professional but free healthcare is just a start and Jamaica needs to seriously consider how to improve the entire system.

At the end of the documentary it was noted that the US has a disjointed system, offering “separate systems for separate classes of people”. Jamaica faces a similar dilemma. It also notes that while the plans of the US Presidential candidates represent some improvement they are not comprehensive enough, and they need to contemplate more seriously the successful examples of other countries. I agree with the documentary and believe that both countries need a system that serves everyone equally, fairly and cheaply.

Garrisons of the mind - USA and Jamaica

It’s campaign silly season again and the candidates are busy trying to do as much damage to each other as possible. I am personally fatigued by the bickering over the minutiae and the media’s perpetuation of these inconsequential matters while acting as if they are valid news stories – Hillary’s beer and whiskey shots, Obama’s bowling etc. These stories are supposed to give an insight to the soul of the candidates and help voters gain a personal understanding of these people. None of these gets us any closer to seeing how they lead. The last election all of America voted on who they wanted to “have a beer with” and got George Bush as President. Now they probably wouldn’t even want to share a table in the bar with the guy. His beer drinking facility spoke nothing about his leadership abilities. This politics of personality is petty, and can be destructive, as it distracts the focus from genuine issues. However, some of these non-issue stories reveal character traits and can give us a glimpse into how they would lead. Cindy McCain’s plagiarizing of Food Network recipes and Hillary’s lying about Bosnia is dishonest. Hillary as a Candidate did herself damage by showing she has no problem bending the truth to serve her own purposes. She appropriately paid the price by the dip in the polls of her trustworthiness ratings.

Now Obama has gone and messed up his sweet ride by lumping together bitterness, God, guns, anti-immigration sentiment etc. The media is making a big hoopla over the story but has once again missed the point. The statement was made in response to a question of how race factors into his difficulty getting working class whites to vote for him. He was in essence defending these people by saying it was not race related but due to the fact that people don’t always vote their economic interests. They instead vote on issues where they feel they will get some results like religious and gun issues as opposed to one’s where they would be neglected – economic issues. This is nothing new. I learned of this phenomenon watching shows like Chris Matthews Hardball and Joe Scarborough’s Morning Joe. They have often referred to poor people voting against their economic issues to support republicans because of these other issues – God and guns. It’s a well known phenomenon. Obama stated it inarticulately and he has apologized but defends his sentiment. The media pretends to have no clue of what he meant and his rivals call him elitist. They do not mention that he was denying accusations of racism in his inability to get white voters and that he was trying to get people to realize that poor people are angry over a lack of government responsiveness on economic issues over the last 25 years.

The upshot of all of this is that both Clinton and McCain have said that they do not believe he is an elitist but is statement is. His defense is that he and his wife has working class roots, dragged themselves up from the circumstances of their birth and fought hard to acquire the things they now have. Now all the candidates vie to prove the same record of working class roots and I believe they all have validity. Some, like Obama, stayed in this class longer than others, while other like McCain and the Clinton’s moved up a while ago. All of them did this through hard work and sacrifice. However, elitism is not only an affliction of the wealthy, because as a philosophy on government and social organization, anyone holding those views, even with middle class or working class status, can be elitist. So this “I am rich, but once was poor defense” is inconsequential.

According to www.dictionary.com elitism is:

1. Practice of or belief in rule by an elite.
2. Consciousness of or pride in belonging to a select or favored group.
and
1. The belief that certain persons or members of certain classes or groups deserve favored treatment by virtue of their perceived superiority, as in intellect, social status, or financial resources.
2.
a. The sense of entitlement enjoyed by such a group or class.
b. Control, rule, or domination by such a group or class.

Is Obama an elitist? No. Was his statement elitist? No. I do not see, based on these definitions, how such conclusions can be drawn from Obama’s statement or subsequent explanation. How can a statement defending working class poor that encourages them to consider their economic interests in choosing a leader be seen as elitist? I really don’t know. If Clinton and McCain don’t believe he is elitist why accuse him of this then. The simple answer - political expediency. They cater to the simplest base instincts of people, telling them what to feel, what to think and how to interpret these “complex” issues. They do not trust the electorate to consider these issues and draw their own conclusions. They make sure they know they should be outraged. Even if they do not believe the charges, they will make them because they know they can gain political mileage.

This theory of winning by all means is even more disturbing to me coming from Hillary Clinton because as it stands she has no real path to winning the nomination except through the super delegates. She is willing to tear down Obama and damage her party to acquire power. She trails in elected delegates and says these party officials have no obligation to follow the will of the voters. The super delegates, on whom she is banking to hand her the nomination despite the popular vote, know better than the ordinary voter what is best for the country, and that is her. She is behind in number of states won, and calls the small ones she hasn’t won “boutique” states. What does that mean? The people in these states are mere decorative trinkets in the democratic process. She has a lead, albeit dwindling, among the super delegates, the true party elites, whom she has an inside track to because of her years in Washington. Her supporter James Carville was so upset at Bill Richardson’s support for Obama he called the Governor “Judas”. How dare he go against the Clinton’s who had given him so much? Doesn’t he owe his allegiance to this dynasty? He had no right as an elected official and servant of the people to think in the interest of those he represents only to give loyalty to the former and aspiring dynastic rulers. These things are by definition elitist. They reflect a belief that she is part of the ruling class and that the will of the people can be ignored as necessary to get her to the seat of her power, the White House.

Someone should call her on this, but the media has abdicated its role as an unbiased provider of information to the masses and is now an entertainment source providing “witty” sound bites taken out context and the shallowest most sensationalized analysis. The 24 hour news channels are perhaps the worst things to happen to democracy, they crave ratings so much that they dare not do their job for fear of upsetting their advertisers and losing their economic lifeline viewers. They underestimate their viewer’s intelligence and pander, like the politicians, to the lowest instincts. It is this failure which allowed the government to go unchallenged into Iraq. No one dared asked the hard questions. At the onset of the Iraq war they focused on “Shock and Awe” and put up eye-catching graphics while reporting from the dessert, excited about the sensationalism of being on the battles frontlines. No one asked where were the WMDs or how the country could prove they didn’t have it (How can you prove a negative?). In 2000 they all wanted to know who would Americans most like to have a beer with. Now they act all outraged over the Iraq war and amazed at Bush’s failures but still refuse to make real probing news. Now the media is more concerned about Obama’s “bitter” comments, how they are being interpreted, and how they affect his ratings instead of putting the comment in the appropriate context and discussing the validity, or invalidity, of his assertion. In this election can we move beyond the bar shots, bowling alleys and cow farm bottle feedings please?

I hate when politicians and media speak condescendingly and patronizingly to people. When we are not properly informed we are unable to make decisions in our best interest. Knowledge is power and perhaps some of these characters enjoy keeping us in the dark, distracted, and upset over trivialities so we don’t have enough time to focus on the real issues affecting us. I use to think America had no garrisons, but apparently I was wrong. If you are trapped into a purely politically biased stream of thought so that you cannot rationally consider other alternatives then you are in a mental garrison. It is as much a state of mind here as it is for the people in Rema and Tivoli. No one kills each other over the politics but they operate on the same narrow minded levels. Apparently politicians and media are the same the world over.

I really hope one day to be able to start a Political and Economic think tank in Jamaica that caters to Jamaican people, particularly those in garrison communities and other ghetto areas. It would be non-political but educational, giving people information in an unbiased way to be able to assess economic, political and social issues independently. I know many people have the foundations of this through life experiences but people with formal education they are better equipped through wider and deeper exposure. I hope to give more people the tools to be able to do this. How they vote after that is their business. I just wish they would think.

P.S. – This was written before the last debate in Pennsylvania. That debate raised new distractions and resurrected some old ones. However, the constants of questionable media behavior and inordinate focus on issues of no value to voters remain. I’m so over it and apparently so is most of America.

Citizens of Humanity vs Race, War and Peace

Growing up in Jamaica I never experienced racial discrimination. That was easy considering that Jamaica, though out of many one people, is a majority black/ African descendant population and is very racially intermixed. Nonetheless, there were always those incidents where race and class intersected to give rise to a form of discrimination based more on social standing. As Jamaicans we are familiar with the refrain that ghetto youths are discriminated against, that the big power broker families – Issa, Azan, Mahfood etc. control the reins of society and that “black” people are oppressed and discriminated against in their social aspirations by this built in structure of the rich versus poor and uptown versus downtown. Race and class are closely linked in Jamaica because of our history of slavery and subsequent development. The historical race based socio-economic organization led to a system where a few powerful families of “high colour” owned the majority of the wealth in Jamaica. This is changing.

When I was growing up my family called me “Reds” because I had a likkle colour to me (I have since lost that colour). I was poor and could not really be mistaken for anything but poor. Yet, my family have sworn up and down the place that I received favoritism because of my colour. I can’t say that that was ever true. I worked hard to overcome every obstacle placed before me and always thought that with this effort I could place myself in a better position than the one in which I was born. I never experienced racial discrimination/ benefit but I did experience social discrimination. A poor little girl like me with no connections to the well to do power brokers could hardly get a fair shake. There were serious life changing incidents of discrimination and with no one to advocate on my behalf, and not knowing any better, I had to suck it up.

My Jamaican experiences have influenced my interpretation of race and class in America. Here you are indistinguishable among the masses, and unless you make the effort to deliberately stand out, you are anonymous. Of course, the well to do and well connected still get ahead but because of the openness of the society upward mobility is very possible. I am sometimes amazed at the entrepreneurial spirit of the society and how the successful can change their lives’ and move beyond the circumstances of their birth. But to tell you the truth I am also amazed at how you can never really move beyond your race in America. This has been brought home to me by this recent presidential election in the US.

Barack Obama is a well educated and successful man by any measure. He has achieved what many will never achieve. Among his many accomplishments is the fact that he is only the 3rd “black” senator in US history, and I use the term “black” loosely considering that he is as white as he is black. Now that the issue of Reverend Wright has surfaced people are saying that they always expected the issue of race to come up. They speak about him becoming the candidate of race and how he had skillfully avoided that label. I am conflicted because, while I expected the issue of race to come along I hate that he has to re-assure voters that his blackness is not a threat. His speech on race relations in recent weeks has been hailed as historical and congratulated for its candidness. But I think to myself, “Did people really not know this?” Are Americans really so ignorant of the feelings of their racially different neighbours?

Now the media is getting all hopped up over Obama’s Minister’s, Rev. Wright, sermons. Wright, is a former Marine who served his country in war and fought for the rights of Americans to say whatever they want to say at a time when it would have been perfectly OK and socially acceptable to call him nigga, and deny him the freedom to associate with the whites of the society he defended. He also served by the bedside of President Johnson. His ministry and his work in the community is more than these cherry picked snapshots. He has earned and defended the right of freedeom of speech. I don't think he is unpatriotic even in his calls for damnation of America. Religion and patriotism are two different matters. Nonetheless, I can never agree with, even with freedom of speech, the damnation of one’s country. You can say it but you shouldn’t say it.

I read the sermons in their entirety and found in them some of the uncomfortable truths which people seem to be amazed by in Obama’s speech. I never heard him advocate a taking up of arms in revolution only a revolution in thinking. He correctly asserts that the process of changing governments to become more responsive to the needs of all its citizens can only occur when the status quo is challenged. America loves to call itself a Christian nation, where convenient, and acts though only Christians have the right to be considered for the highest office in the land. All these leaders have to out Christian and out conservative each other, with sometimes ridiculous consequences and stances which are politically convenient but I feel not truly believed. Well, faith without works is dead and Christians should always be the first to speak against unjust governments and systems.

I also never heard him say anything patently racist but people will call it racist I believe because 1) a black man said it and 2) they do not like to hear black people/ minorities defend themselves. They prefer when we speak all the while as we do in polite company that all is well and we are happy for the all the mercies that we have gained from government and society. These “mercies’ were earned in blood, sweat and tears. So yeah there’s a chip on the oppressed racial minority shoulder. Also, I cannot believe the sermon was racist when it only spoke of the abuses meted out on the poor, weak historical minorities by the majority. Again, why does this offend white (and some other) people? Why does it offend Christian people? Yes, it was over 300 years ago and we have come a long way but the oppressive historical majority power holders continue to reap the benefit of this historical order while the minorities continue to reap the woes. Yes things have changed, like Obama reminds us, by all the races working together. But the effects linger for both sides and unless we can truthfully acknowledge these issues we will not be able to unite to fix them. We can’t retreat, as he says, to our corners and expect a solution to our common problems.

The sermons have their faults, like asserting that AIDS is a white man’s plot to destroy black people. I don’t believe this, but I know this is an idea out there, and it is not such an eccentric thing to believe when you consider how white America experimented on black men using syphillis. Wright reminds us that oppression comes in all kinds of packages, not just race, and even spoke out on the rights of women. America is a great and influential country in world history, but it also has the history of abusing its powers, oppressing and mistreating people. Thousands of innocents died in the bombing of Japan. Vaporized where they stood. America acted slowly to stop Aparatheid in South Africa even where poor powerless Jamaica made a defiant stand. Today, hundreds of thousands of Iraqi's are dying and millions more are displaced as collateral damage of a war whose legitimacy is well questioned. These are difficult things for much of mainstream America to swallow and so we rarely hear of these people. His delivery was abrasive but on the majority of points he spoke the uncomfortable truth. This was not “hate speech”.

The sermons may even be viewed as messages of hope because ultimately Wright reminds us that where principalities, family and communities may change, fail and fall, God is the same God he was yesterday and will always continue to be today and tomorrow. Even while the truth of man changes God is enduring. America, a Christian nation would do well to remember this as it seeks to create a more perfect union. He says that Christians should look to God for hope and deliverance instead of looking to government, community or family. I’ve heard this in my own church before and never thought it radical, racist, anti-country or anti-government. But then again I always remember that Jesus in his Ministry was also viewed as a radical, social justice preacher who was anti oppressive, racist, segregationist government. Jesus spoke of the just Kingdom of God prevailing against anything man creates to idolize and act unjustly against his fellow man.

On a final I have not heard mention from anyone that Rev. Wright did ask his congregation for forgiveness immediately after uttering the “God damn America” line. From the transcript on CNN he said, “Tell your neighbor he’s (going to) help us one last time. Turn back and say forgive him for the God Damn, that’s in the Bible though. Blessings and curses is in the Bible. It’s in the Bible.” He recognizes he spoke harshly and immediately sought forgiveness. Why has no one of the offended Christians ever mentioned that he sought forgiveness for speaking this?

I am now learning to deal with the race issue as a Jamaican in America and I am happy that I have a broader, more informed and open minded view with which to analyze these issues. I just know now for a fact that no matter what you do in America you will always be black. I am happy I never had to deal with this in Jamaica; it would have made me too bitter. On the other hand I am bitter about the social injustices based on class prejudices I experienced in Jamaica. I guess we all must continue to fight for more equal societies.

A Personal Story of Race

Eustis is small semi-rural city located in Central Florida. I lived there for one year. The majority of the population is white and the blacks are typically poor. They still sell the Dixie flags all over the main mall and quite a few people fly them from their vehicles. On an ordinary day I walked to the store and was enjoying my leisurely stroll home. A jeep full of white girls whizzed by and I heard what seemed to be “nigga” shouted out at me. I looked back in disbelief. I couldn’t believe it. I just had no prior experience with which to process this assault and so thought to myself, “No, I didn’t just hear that”. But no amount of denying could change that I was called “nigga” by a bunch of white girls. I didn’t know them and never did anything to offend them. In that same period some KKK were demonstrating in Orlando against all the people and things that offend them.

Yes We Can! Si, Se Puede!

It was a creed written into the founding documents that declared the destiny of a nation.

Yes we can.

It was whispered by slaves and abolitionists as they blazed a trail toward freedom.

Yes we can.

It was sung by immigrants as they struck out from distant shores and pioneers who pushed westward against an unforgiving wilderness.

Yes we can.

It was the call of workers who organized; women who reached for the ballots; a President who chose the moon as our new frontier; and a King who took us to the mountaintop and pointed the way to the Promised Land.

Yes we can to justice and equality.

Yes we can to opportunity and prosperity.

Yes we can heal this nation.

Yes we can repair this world.

Yes we can.

We know the battle ahead will be long, but always remember that no matter what obstacles stand in our way, nothing can stand in the way of the power of millions of voices calling for change.

We have been told we cannot do this by a chorus of cynics...they will only grow louder and more dissonant ........... We've been asked to pause for a reality check. We've been warned against offering the people of this nation false hope.

But in the unlikely story that is America, there has never been anything false about hope.

Now the hopes of the little girl who goes to a crumbling school in Dillon are the same as the dreams of the boy who learns on the streets of LA; we will remember that there is something happening in America; that we are not as divided as our politics suggests; that we are one people; we are one nation; and together, we will begin the next great chapter in the American story with three words that will ring from coast to coast; from sea to shining sea --

Yes. We. Can.


I am loving the US Presidential elections right now and I am rooting for Obama. I love what his campaign stands for and the change that his Presidency could represent. I know there are naysayers who worry about his lack of experience but I think good judgment, leadership, and management qualities can overcome those obstacles. I follow the campaigns closely and I am now officially addicted to CNN and MSNBC political coverage. I won’t go into all my political opinions here but thought I would post this video below because I find it inspirational. I think it is one of the best speeches I have heard in the modern era and believe, if he becomes President, it will be a landmark of a moment in history. I even emailed it to my little sister because I feel so convinced of its importance to history.

My support for Obama is not racially motivated but at the same time I think he could provide inspiration and leadership by example. I've always thought inspirational black leadership is sorely missing in America, the Caribbean and African countries. The days of great leaders who really stood for something revolutionary and united people to act around that have passed. I hope we can come to that point of revolution in spirit and thought again and create a serious movement for change.

However, inspiration and leadership is just that, inspiration and leadership. The action needs to be done to achieve the results...the American/ Caribbean/ African dream. So action is what is really needed by the leaders and the followers. People can be provided with the tools but it is always their responsibility to choose how to use it. I hope people temper this hoopla over Obama by this realism.