Zhang

From, bcn dot boulder dot co dot us slash  health slash healthwatch slash canada dot html

In contrast, the single payer system that Canada has used for the last 25 years has drastically simplified their administration costs. For instance, it takes more people to administer Blue Cross Blue Shield of Massachusetts that it does to administer the entire health care system of Canada. Before Canada implemented their national health program, their health costs were the same portion of their economy as in the U.S. After they implemented their program, their costs stabilized at 9% while U.S. costs have increased to 14%. They spend one tenth of what U.S. health care providers spend on overhead.

Amartya Sen’s model

Pg 3

“Growth of GNP or of individual incomes can, of course, be very important as means to expanding the freedoms enjoyed by the members of the society. But freedoms depend also on other determinants, such as social and economic arrangements (for example, facilities for education and health care) as well as political and civil rights (for example, the liberty to participate in public discussion and scrutiny).

Pg 4

“Freedom is central to the process of development for two distinct reasons.

1. The evaluative reason: assessment of progress has to be done primarily in terms of whether the freedoms that people have are enhanced;
2. the effectiveness reason: achievement of development is thoroughly dependent on the free agency of people.

Pg 10

“Five distinct types of freedom, seen in an “instrumental” perspective, are particularly investigated in the empirical studies that follow. These include (1) political freedoms, (2) economic facilities, (3) social opportunities, (4) transparency guarantees and (5) protective security.

Pg 10

A CONCLUDING REMARK

“Freedoms are not only the primary ends of development, they are also among its principal means.”

Pg 11

“political freedoms help to promote economic security. Social opportunities facilitate economic participation. Economic facilities can help to generate personal abundance as well as public resources for social facilities.

Pg 14

“The ends and means of development require examination and scrutiny for a fuller understanding of the development process; it is simply not adequate to take as our basic objective just the maximization of income or wealth, ….

Pg 15

“It is sometimes claimed that the denial of these rights helps to stimulate economic growth and is “good” for rapid economic development. … Indeed, the empirical evidence very strongly suggests that economic growth is more a matter of a friendlier economic climate than of a harsher political system.”

Pg 19

“this is not to deny that deprivation of individual capabilities can have close links with the lowness of income, which connects in both directions: (1) low income can be a major reason for illiteracy and ill health as well as hunger and undernourishment, and (2) conversely, better education and health help in the earning of higher incomes.

Pg 25

“The relation of the market mechanism to freedom and thus to economic development raises questions of at least two quite distinct types, which nee to be clearly distinguished. First, a denial of opportunities of transaction, through arbitrary controls, can be a source of unfreedom in itself.

…

second… markets typically work to expand income and wealth and economic opportunities that people have.

Pg 27

“The shift in the focus of attention of pro-market economics from freedom to utility has been achieved at some cost: the neglect of the central value of freedom itself.

Pg 31

“Individual freedom is quintessentially a social product, and there is a two-way relation between (1) social arrangements to expand individual freedoms and (2) the use of individual freedoms not only to improve the respective lives but also to make the social arrangements more appropriate and effective.

Pg 31-32

“The real conflict is between

1) the basic value that the people must be allowed to decide freely what traditions they wish or not wish to follow; and

2) the insistence that established traditions be followed (no matter what), or, alternatively, people must obey the decisions by religious or secular authorities who enforce traditions – real or imagined.

Pg 33

“The motivation underlying the approach of “development as freedom” is not so much to order all states – or all alternative scenarios – into one “complete ordering,” but to draw attention to important aspects of the process of development, each of which deserves attention.”

Pg 38

“Political freedoms, broadly conceived (including what are called civil rights), refer to the opportunities that people have to determine who should govern and on what principles, and also include the possibility to scrutinize and criticize authorities, to have freedom of political expression and an uncensored press, to enjoy the freedom to choose between different political parties, and so on.

…

Economic facilities refer to the opportunities that individuals respectively enjoy to utilize economic resources for the purpose of consumption, or production, or exchange.

…

Social opportunities refer to the arrangements that society makes for education, health care and so on, which influence the individual’s substantive freedom to live better.

…

Transparency guarantees deal with the need for openness that people can expect: the freedom to deal with one another under guarantees of disclosure and lucidity.

…

Protective security is needed to provide a social safety net for preventing the affected population from being reduced to abject misery, and in some cases even starvation and death.”

Social Justice Research, Vol. 1, No. 3, 1987

Equity and the allocation of Health Care Resources: proposition or Oxymoron?

Rosemary R. Lichtman

Pg 253

“However, in other circumstances, as individuals possess the ability to make choices about their health , it is necessary to take into account the historical health-related choices made by them in order to make statements relative to any alleged inequities.”

“Any policy decisions concerning changes in the financing of health care should, in their view, be guided by several goals: to induce socially efficient health care utilization, to spread the risk across the population, to spread the risk across a person’s lifetime, and to distribute the resources equitably by need (both in terms of income and health status). Health care revenues generally arise from four different sources: income tax, payroll tax, direct payments (user fees), and insurance premiums.”

Pg 254

“In order to achieve justice with respect to health care, there must be equality of the burdens of health care as well as equal access to care both in terms of the existing supply and the preallocative sphere.”

“…because the social trends of medicalization, social inclusion, biomedical transcendence, and health absolutism have crated a high demand for medical care, it is becoming more and more difficult to provide for all of the increasing health-related needs as perceived by society.

Pg 255

“Our society is in the midst of establishing various innovative programs to bring about the equality to which we have committed ourselves, but with little thought about objectively evaluating the outcome of the programs. If they compromise the quality of care we have been able to achieve to date, that outcome should weigh heavily in the efficiency-efficacy-equity equation.”

The following points is presented from a talk by Tim Murphy

Local aid, education, criminal spending increases, which brings the deficit, so we need the innovative policy to deal with the issue.

No.1 guiding

Heritage foundation play a vital rule of providing the data with the department.

We need to pay cares for certain people, so we need to start a momentum, do not take money way, we will done something innovatively.

All the healthcare money or universal health insurance money will come from the tax, reimbursement, or federal aid. How does it contribute.

The reason of so many uninsured, which are qualified for some program? Bad intake, follow-up, hospital tracing system.

{{{{All the model the law maker had used was the efficiency model and the cost/benefit analysis. He did not use the rest of the model to test whether there might be a better solution for the universal healthcare or there might be some universal insurance coverage.

35% of people under 30 do not have the insurance, even the employers offer, those people would take risk.

Now we are socializing the healthcare and thus everyone need to contribute at least part of the cost.

Now the incentive for the hospital is that the hospital would not get paid if the hospital did not provide the proof of not enrolling in one of the health program. By using this virtual gateway hospital has the incentive to help enroll the uninsured people.

(((poverty level is fro the federal data

He 100% or 300 is compromise from the data analysis and the common sense. Someone says 400%,but it is insane to set that high. At last it is set 300

(((LPF coverage including kids, which is really cheap and much cheaper than the adult.

(((No solutions to the extent that how the gov is going to fund this universal health insurance, the law makers even did not know.

Why health care reform in Mass?

1. Double-digit, annual increases in insurance premiums and the highest per capita health care spending in the nation.
2. 500, 000 uninsured in latest state survey
3. Small businesses and individuals facing significant barriers to entry for coverage
4. Limited availability of information to consumers and businesses precludes informed health insurance purchases decisions.
5. Potential loss of at least $ 385 million in federal government Medicaid funding
6. $1 billion and growing of “free-care” forcing all stakeholders to deal with costs for uninsured and under-insured.
7. Two “universal” health care ballot initiatives.

The uninsured in Mass: 2004

Total Commonwealth population: 6,200,000

Currently insured 93%

Employer, Individual, Medicare or Medicaid 5,740,000

Currently uninsured (7%) ~460, 000

100% FPL Medicaid eligible but unenrolled 100,000

100-300% FDL Low Income 150,000

>300% Middle Income 204,000

The law changed eligibility for certain populations and raised enrollment caps:

1. Children: expanded to 300% FPL
2. Insurance Partnership: expanded to 300% FPL
3. MassHealth Essential: raised cap to 60,000 people
4. HIV Family Assistance: raised to 1300 people

Massachusetts Health Care Reform

medicaid

cost/quality improvements

Insurance Reforms

ßShared Responsibility

contractor authority

commonwealth care

By McKinsey Research

Benefits and challenges of the US health system

Benefits:

1. Focus on quality of life
2. convenience
3. patience choice
4. innovation
5. access to new treatments and technologies

Challenges:

1. Highest per capita expenditure (16% of GDP)
2. access for uninsured (16% of the population)
3. compared to OECD, lower life expectancy and higher infant mortality.

Talisse On Rawls

Pg 6

“What is ‘justice as fairness,’ and why has it stirred so much controversy?

Pg 19

“Of course, the term “justice” is used in many different ways; for example, we often hear the word “just” used to describe entities as diverse as governments, laws, court decisions, and individual actions. However, Rawls is concerned primarily with social justice, the justice of what he calls the “basic structure” of a society.”

(.. the primary subject of justice is the basic structure of society, or more exactly, the way in which the major social institutions distribute fundamental rights and duties and determine the division of advantages from social cooperation. From Theory of Justice )

Pg 24

“…individuals enter into social arrangements for the purpose of attaining benefits unavailable to them singularly; accordingly, a society is a “cooperative venture” aimed at the “mutual advantage” of the individuals that comprise it.

At the time Rawls wrote A Theory of Justice, the dominant liberal theory of justice was utilitarianism.

John Rawls model of justice

Pg. XI.

Editor’s Foreword,

“A political conception of justice is justified by reference to political values and should not be presented as part of a more “comprehensive” moral, religious, or philosophical doctrine.”

Pg. 2

“One is that political philosophy may contribute to how a people think of their political and social institutions as a whole, and their basic aims and purposes as a society with a history — a nation – as opposed to their aims and purposes as individuals, or as members of families and associations.”

Pgs 2-3

“… the members of any civilized society need a conception that enables themselves as members having a certain political status – in a democracy, that of equal citizenship – and how this status affects their relation to their social world.”

Pg. 5

“Society as a fair system of cooperation.”

Pg 6

“The central organizing idea of social cooperation has at least three essential features:

(a) Social cooperation is distinct from merely socially coordinated activity – for example, activity coordinated by orders issued by an absolute central authority. Rather, social cooperation is guided by publicly recognized rules and proceduresaccept as appropriate to regulate their conduct. which those cooperating

(b) The idea of cooperation includes the idea of fair terms of cooperation: these are terms each participant may reasonably accept, and sometimes should accept, provided that everyone else likewise accepts them. Fair terms of cooperation specify an idea of reciprocity, or mutuality: all who do their part as the recognized rules require are to benefit as specified by a public and agreed-upon standard.

(c) The idea of cooperation also includes the idea of each participant’s rational advantage, or good. The idea of rational advantage specifies what it is that those engaged in cooperation are seeking to advance from the standpoint of their own good.”

Pg. 12

“We view justice as fairness not as a comprehensive moral doctrine but as a political conception to apply to that structure of political and social institutions.”

Pg 13

“In justice as fairness the question of justice between peoples is postponed until we have an account of political justice for a well-ordered democratic society.”

Pg 14 (back to editor’s Foreword)

“Finally, I stress a point implicit in what we have said: namely, that justice as fairness is not a comprehensive religious, philosophical, or moral doctrine – one that applies to all subjects and covers all values. Nor is it to be regarded as the application of such a doctrine to the basic structure of society, as if this structure were merely another subject to which that comprehensive view is to be applied. Neither political philosophy nor justice as fairness is, in that way, applied moral philosophy. Political philosophy has its own distinctive features and problems. Justice as fairness is a political conception of justice for the special case of the basic structure of a modern democratic society. I this respect it is much narrower in scope than comprehensive philosophical moral doctrines such as utilitarianism, perfectionism, and intuitionism, among others. It focuses on the political (in the form of the basic structure), which is but a part of the domain of the moral.”

Pg 15

“Justice as fairness adopts … the fair terms of social cooperation are to be given by an agreement entered into by those engaged in it. One reason it does this is that, given the assumption of reasonable pluralism, citizens cannot agree on any moral authority, say a sacred order of values or the dictates of what some view as natural law. So what better alternative is there than an agreement between citizens themselves reached under conditions that are fair for all?”

“The difficulty is this: we must specify a point of view from which a fair agreement between free and equal persons can be reached; but this point of view must be removed from and not distorted by the particular features and circumstances of the existing basic structure.”

My own words, the just society should have the following features: respect, diversity, tolerance.

Diversity includes a ray of different elements, such as white and black, rich and poor, English and Spanish. There is no fairer society than one with diverse elements of one society.

Pg 18

“Justice as fairness regards citizens as engaged in social cooperation, and hence as fully capable of doing so, and this over a complete life. Persons so regarded have what we may call ‘the two moral powers,’ explained as follows:

i. One such power is the capacity for a sense of justice: it is the capacity to understand, to apply, and to act from (and not merely in accordance with) the principles of political justice that specify the fair terms of social cooperation.

ii. The other moral power is a capacity for a conception of the good: it is the capacity to have, to revise, and rationally to pursue a conception of the good. Such a conception is an ordered family of final ends and aims which specifics a person’s conception of what is of value in human life or, alternatively, of what is regarded as a fully worthwhile life.

Pg 19

“Here it is important to keep in mind that justice as fairness is a political conception of justice: that is, it is designed for the special case of the basic structure of society and is not intended as a comprehensive moral doctrine. Therefore, the idea of the person, when specified into a conception of the person, belongs to a political conception.

… the conception of the person itself is meant as both normative and political, not metaphysical or psychological.”

Pg 21

“The relevant meaning of free persons is to be drawn from the political culture of such a society and may have little or no connection, for example, with freedom of the will as discussed in the philosophy of mind. Following up this idea, we say that citizens are regarded as free persons in tow respects.

First, citizens are free in that they conceive of themselves and of one another as having the moral per to have a conception of the good.

…

A second respect in which citizens view themselves as free is that they regard themselves as self-authenticating sources of valid claims.”

Pg 25

“We cannot tell in advance whether the idea of social cooperation, and its tow companion ideas, will provide the organizing ideas, will provide the organizing ideas we need for a workable political conception of justice. … All we need claim is that the idea of society as a fair system of cooperation is deeply embedded in that culture, and so it is not unreasonable to examine its merits as a central organizing idea. The point is that whatever idea we select as the central organizing idea cannot be fully justified by its own intrinsic reasonableness, as its intrinsic reasonableness cannot suffice for that. Such an idea can be fully justified (if at all) only by the conception of political justice to which it eventually leads when worked out, and by how well that conception coheres with our considered convictions of political justice at all levels of generality in what we may call wide (and general) reflective equilibrium (§10).”