America's crazy healthcare system

As an outsider here, one of the things that is wryly amusing to me is how many Americans are convinced by the vast superiority of their own healthcare system. I've even been told how awful the British National Health Service in Britain is and actually pitied by a grandmother at a Rick Santorum rally.

This idea, that Brits are suffering under the NHS, besides being funny, is actually part of a meme that was promoted in the US in order to attack the new healthcare laws. The British NHS, so the story goes, is awful "socialised" healthcare. I know the NHS has many flaws, but the longer I spend in the US the more I realise how utterly brilliant it is at delivering pretty universal coverage to the entire population at far less cost than in the US.

Why are healthcare costs so high? Americans will sometimes say that the quality of their healthcare is higher and they have better service. On the latter point, they are almost correct. It is easy to shop around for doctors and each doctor is far more specialised. We don't have a family GP any more, we have an internist, pediatrician, and an "obgyn" (women's things).

On the subject of quality, I am not so sure. For one thing there is the problem of "too much choice". In many ways, life would be far easier if the entire family could go and visit a local GP for everything and get referred as necessary. The family is an health ecosystem in itself. It doesn't make sense to me that if I and my son catch the same flu  that we both have to go and see different doctors. One tends to form long-term relationships with the family doctor--and this is very helpful. On top of this there is NHS Direct, a telephone  helpline that means you can speak to a nurse 24 hours a day, and if necessary be referred to a doctor or hospital.

It is also clear that in the US testing is overdone, and medical bills are greatly inflated. On the matter of tests, my son's dentist wanted to give him routine X-rays (there are no problems with his teeth). He is five. We objected and she said she wasn't sure if she could treat our son without doing routine X-rays. We said we would go elsewhere and suddenly it was possible after all. Dental X-rays are not a good thing, especially if you are a young child. I've since read more about  the link between dental X-rays and brain tumours.

On the subject of medical bills, now that I've seen the cost of the same treatment in different countries I can see that the costs doctors charge insurers are ludicrously high. We've paid privately for work on my back in the UK and received something similar under insurance in the US. The cost of 20-30 minutes of spine manipulation was about $145 at a posh private hospital in London, and $490 in a downtown corporate office.

Similarly, our pediatrician charged our insurers $1,600 to register and do a check up on two children. I can't say whether or not her time was worth this, but I can say that having the same job done on the NHS would have been a fraction of the cost. Of course the $64,000 question is whether all that extra expense was necessary--a question that is far more difficult to answer.

Updated: This blog was tidied up on 24th April.

The NRA’s star may be on the wane

Opinion from the Economist blog: Democracy in America

Apr 19th 2012, 20:25 by N.L. | ST LOUIS

 ONE of the things Europeans find incomprehensible about America is its love of guns. There are two reasons they don’t get it. One is that Europeans live in a much more urbanised, regulated and crowded part of the world. More importantly the concept of owning a gun as an essential civil liberty is entirely absent. There is no second amendment guaranteeing the right to bear arms, and there is little sense that it is up to the individual to defend one’s family and property.

The organisation most associated with America’s culture of guns is the National Rifle Association (NRA). The NRA’s lobbying arm, the Institute for Legislative Action, and the American Legislative Exchange Council (ALEC)—which drafts model legislation—have been enormously successful at pushing pro-gun laws in state legislatures. These days the debate is no longer whether assault rifles ought to be banned, but whether they should be allowed in bars, churches and schools. One group, Students for Concealed Carry, even argues that carrying concealed weapons on university campuses would be an effective means of self defence. [More...]

Arms and the man

Despite legislative victories, the NRA is under pressure 

Apr 21st 2012 | ST LOUIS | from the print edition

“TAKE a sticker,” urges the woman from Ambush Firearms. “We are giving away two free guns every day to people wearing them.” What your correspondent would do with an semi-automatic rifle, let alone one that also comes in pink, was not obvious. Welcome to the annual convention of the National Rifle Association (NRA)—this year held in St Louis, Missouri. It is a yearly celebration of freedom, the Second Amendment right to bear arms, and, above all else, a festival of guns. Seven acres, to be precise, of guns and gear.

Americans like firearms. According to a report from the Congressional Research Service there were 294m guns in the country in 2007, up from 192m in 1994. More guns might be expected to mean more influence for the NRA, except that the number of households with guns has actually declined fairly consistently since 1973. The people who buy guns, it seems, are usually those who already own them. One probable cause of this decline is a shift to urban living. Moreover, safety-conscious Americans are increasingly aware that, statistically, a gun is a far greater risk to friends and family than it is of potential use in self-defence. [More...]

Stalled in Motor City

Detroit skyline: Shawn Wilson, Wikicommons

A desperate tussle over whether the state of Michigan should take over Detroit

Apr 7th 2012 | DETROIT | from the print edition, co-written Rosemarie Ward.

APART from more money, what the city of Detroit needs most is certainty. Both are in short supply at the moment. On March 21st a state-appointed review team unanimously agreed that it is suffering a “severe financial emergency”. The day before, Moody’s had downgraded more than $2.5 billion of the city’s debt, citing its lack of cash. Amid this deepening financial crisis the state of Michigan, local unions, the mayor, the city council and the courts are battling over the future of Motor City.

The simplest solution, a state bail-out, is tricky. Both the governor of Michigan, Rick Snyder, and the head of the state’s House Appropriations Committee, Chuck Moss, argue that yet another infusion of cash will not solve Detroit’s underlying problems. To prove his point, the governor recently reminded citizens that the city has borrowed $600m since 2005 just to get by. It is also planning, with some state support, to issue $137m in bonds in order to refinance its debt and create cashflow that will allow it to totter on until the end of the financial year. [More...]

Born to be wild

Buffalo about to be released. Credit: NL

Buffalo are coming back to the American prairie 

Mar 17th 2012 | BLAINE COUNTY, MONTANA | from the print edition

IN A quiet spot in eastern Montana, on rolling golden prairies and under vast skies, 71 buffalo calves charge out of a corral. Kicking up dust as they run, they quickly join a herd of several hundred American buffalo of all ages. The calves had arrived by road from Elk Island reserve in Canada; they are pure descendants of the buffalo that once lived in this area. At the end of the 19th century just a few were saved from American hunters and bred, in peace, on the other side of the border.

Before Europeans arrived in North America as many as 60m buffalo are estimated to have ranged across the Great Plains. From around 1830, however, they were systematically killed until only a handful remained. Buffalo were taken for their hides, or simply because they were getting in the way of settlers. Men like Buffalo Bill slaughtered thousands.

At the end there was also a deliberate policy of wiping out the lumbering giants in order to remove the staple food source of Native Americans and to force them on to reservations. Last week’s buffalo “homecoming” was an emotional event for the Gros Ventre and Salish-Kootenai tribes who witnessed it.

Ultimately it is logic and enormous ambition that lie behind the return of the buffalo to Montana. The idea, says Sean Gerrity, president of the American Prairie Reserve (APR), a charity, is to create the largest wildlife reserve anywhere in the contiguous 48 states. Mr Gerrity wants to rebuild a vast native prairie of 3.6m acres (1.46m hectares) where an enormous herd of wild buffalo can roam free once again.

Recreating America’s version of Africa’s Serengeti means thinking big. A sustainable ecosystem needs to be able to cope with fires, disease and icing over of parts of the ground in the winter. But such a reserve would be of international significance. Grasslands, which are economically valuable as farmland, are enormously underrepresented in nature reserves in America and worldwide. Temperate grasslands have the lowest level of protection of the world’s 14 recognised “biomes”, or habitats.

APR is currently spending about $6m a year, largely on land. By autumn it will own or lease 270,000 acres. One of the first jobs APR has to do when it obtains land is to remove the fences. A single ranch can easily have more than 800 miles of barriers. APR will ultimately be able to stitch together a network of private and public land to create its reserve. But even though the land is cheap, at around $450 an acre, APR will need $330m to set up the reserve and a further $120m for an endowment to maintain it and pay for grazing rights.

Buying land in eastern Montana is not difficult. Thanks to its lack of water, ranching in the area is hard work, often marginal and increasingly unpopular with the children of ranchers. Those ranches that are still in business are in effect subsidised by the government, which charges grazing fees of just $1.35 a month for each cow on federal land.

In only 14 years from now, thanks largely to the buffalo’s natural fecundity, APR will have over 5,000 buffalo, the largest conservation herd on the planet. Significantly, this herd will be entirely free of cattle genes—unlike most existing buffalo herds in America, which have interbred with domestic cattle. Officially, the American buffalo is now a type of livestock. But one day, if Mr Gerrity gets his way, his buffalo will be declared wild animals again.

Part of the restoration project requires the return of another crucial species: the prairie dog. This “dog” is actually a small ground squirrel that forms large underground colonies. More important, it is the Chicken McNugget of the prairie—a convenient snack food for almost every creature, from burrowing owls and ferruginous hawks to foxes and even wolves.

Prairie dogs are hated by ranchers, who say their burrows pose a danger to cattle. So they are poisoned on a large scale. APR is in the early stages of developing a wildlife-friendly label for beef produced on ranches that are friendly to such prairie wildlife. In many parts of the world, such labels allow producers to command premiums for their produce.

Mr Gerrity says that the reserve will take decades to complete. But one day, he says, Americans will be able to come on safari in their own country and roam across the prairies, unencumbered by fences, to view abundance rather than emptiness.

When the explorers Lewis and Clark arrived in Montana in 1805 they found more wildlife than they had seen in any other part of their journey; elk, antelope, deer, beavers and grizzly bears. The buffalo came in “gangues” of tens of thousands. Restoring the abundance seen by early explorers, and with nothing more than private money, is a worthy gift to any nation.

[More...]

Cuyahoga Falls, Ohio, March 2012

Protester at Rick Santorum campaign event, Cuyahoga Falls, Ohio. Credit: NL

No end in sight

Minor contribution to this lead in the US section.

There was something for all the contestants to hang on to on Super Tuesday. But Mitt Romney still looks like the eventual winner 

Mar 10th 2012 | ATLANTA, WASHINGTON, DC, AND YOUNGSTOWN, OHIO | from the print edition

“WE’RE counting up the delegates for the convention, and it looks good,” declared Mitt Romney on March 6th—“Super Tuesday”—the biggest single day in the race for the Republican presidential nomination. And so, up to a point, it did: Mr Romney, the front-runner, won six of the ten states holding primaries or caucuses, including a narrow victory in Ohio, the most fiercely contested. He performed just as well in terms of delegates to the Republican convention in August, where the nominee is formally selected, securing over half of those on offer. He now has well over twice as many delegates as his closest rival, Rick Santorum, and is over a third of the way towards the 1,144 needed to prevail. And yet it was still a lacklustre night, in many ways, for the presumed but unloved nominee. [More...]