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11.15  The long read:  The plastic backlash: what's behind our sudden rage – and will it make a difference? [the world wants to throw-up...]

11.15 Claws out: crab fishermen sue 30 oil firms over climate change [workers are waking-up...]

11.15 Trump administration to cut air pollution from heavy-duty trucks [behaving ignorantly again...]

11.14 Backed by Ocasio-Cortez, Youth Climate Activists Arrested in Pelosi's Office Demanding Democrats Embrace 'Green New Deal'

11.13 What would a smog-free city look like?

11.13 Global report highlights Australia’s renewables potential amid mixed signals for coal

11.13 Interior department whistleblower: Ryan Zinke hollowed out the agency

11.12  This Land is Your Land:  The Zinke effect: how the US interior department became a tool of industry [behaving ignorantly again...]

11.12 Planned Parenthood's new president warns of 'state of emergency' for women's health

11.11 Trump responds to worst fires in California’s history by threatening to withhold federal aid [behaving ignorantly again...]

11.11 Interior department sued for ‘secretive process’ in at-risk species assessment [behaving ignorantly again...]

11.11 Keystone XL pipeline: judge rules government 'jumped the gun' and orders halt [behaving ignorantly again...]

11.09 Rainforest destruction from gold mining hits all-time high in Peru

11.09 A new way to make steel could cut 5% of CO2 emissions at a stroke

11.08 Medicaid’s stunning victory

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11.15 Democrats Won Big. Can They Go Bold, Too? [it's about suppressing the influence and leadership by Republican-like Democrats who counsel 'íncremental' (no) change, such as Nancy Pelosi, Steny Hoyer, Hillary Clinton, Chuck Shumer and Joe Biden]

11.15 Pentagon Officials Forced to Make Fewer Public Appearances to Avoid Provoking Trump [...by revealing Trump's huuuge ignorance]

11.15 REPUBLICANS USED A BILL ABOUT WOLVES TO AVOID A VOTE ON YEMEN WAR [if there are 'defense industry' profits to be made—including congress-critter insider-trading—and political 'donations' to be had, we mustn't stop killing innocent civilians!]

11.15 Big Oil v the planet is the fight of our lives. Democrats must choose a side

11.14 The Real Florida Recount Fraud

11.14 Telling NRA #ThisIsOurLane, Doctors' Photos Show Blood-Soaked Reality of America's Gun Madness

11.14 At Freshman Orientation, Young and Growing Progressive Caucus Makes Clear It Will 'Fight Like Hell' for Bold Democratic Agenda

11.13 'You Sound Nervous': Gillum Mocks Trump as President Demands End to Florida Recount

11.13 Kyrsten Sinema wins Arizona Senate race in breakthrough for Democrats

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11.09 Trump administration blocks asylum claims by those crossing border illegally [Making America Less Great Again...]

High Crimes?

11.14 The Guardian view on Yemen’s misery: the west is complicit [WAR CRIMES]

11.10 US stops refuelling of Saudi-led coalition aircraft in Yemen war [But there are a few children still alive. It's too soon!]

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11.15 The Earth is in a death spiral. It will take radical action to save us [fossil fuel burning, un-recyclable plastic production/use and methane gas release must cease ASAP.]

11.14 Brexit: May tells her cabinet, this is the deal – now back me

11.11 Tax reform: down with the ‘stepped-up basis’

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11.15 Cuba to pull doctors out of Brazil after President-elect Bolsonaro comments [terms must be negotiated for fairness to Cuba's health professionals without disruption of healthcare for Brazil's poor]

11.14 'Appalling' Khashoggi audio shocked Saudi intelligence – Erdogan [Exposing a psychopath?]

11.14 Israel and Hamas launch hundreds of attacks in Gaza clash

11.14 Mueller seeking more details on Nigel Farage, key Russia inquiry target says

11.13 Austin's Fix for Homelessness: Tiny Houses, and Lots of Neighbors

11.13 Portugal Dared to Cast Aside Austerity. It’s Having a Major Revival.

11.13 Caravan marks one month on the road: ‘We keep on going, laughing or crying’

11.13 Letter Shows Einstein’s Prescient Concerns About ‘Dark Times’ in Germany

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  Japan's Low-Cost, High Quality Health Care System
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COMMENTARY:

Japan’s Low-Cost, High Quality Health Care System

The issue is not whether a health care system is public or private, but whether costs are rigorously controlled or not.

by James Ridgeway
First published in his blog Unsilent Generation yesterday, 28 October 2009

Japan’s health system provides health care to its citizens as a matter of right. It earns some of the highest marks on various measures of quality, and costs far less per capita than the U.S. system–and less, even, than most European systems. Frontline examined how the system works as part of its “Sick Around the World” series.

In October 2007, Frontline interviewed Ikegami, the program chair of the Department of Health Policy and Management at the Keio University School of Medicine, and widely regarded as Japan’s top health economist. As he explains it:

[T]he government is able to control the flow of money....[W]e have multiple payers and multiple providers, but there’s a single-payment system — not a single payer but a single-payment system — so that all payers must abide by the payment system, and all providers must be paid by the system...[T]his is done on a procedure-by-procedure basis and by a drug-by-drug basis, and the way that is done is that a survey is made of the financial situation of the providers.

Each year, the government publishes a directory of what each procedure should cost. Here’s how that plays out when it comes to just one of the drivers of U.S. health care costs: high-priced imaging technology.

Q: Let’s take an example of how these low costs work. In Denver, where I live, if you get an MRI of your neck region it’s $1,200, and the doctor we visited in Japan says he gets $98 for an MRI. So how do you do that?

A: Well, in 2002 the government says that the MRIs, we are paying too much, so in order to be within the total budget, we will cut them by 35 percent.

Q: If I’m a doctor, why don’t I say, “I’m not going to do them; it’s not enough money”?

A: You forgot that we have only one payment system. So if you want to do your MRIs, unless you can get private-pay patients, which is almost impossible in Japan, you go out of business. ...

Q:... The price of that MRI is so much cheaper in Japan. Doesn’t he have to pay the same price, $5,000, for an MRI machine like the man in America?

A: Well, it depends on what kind of image density the radiologist wants. And the MRIs that are available in Japan are much less expensive than those that are typically found in the United States.

Q: So the imaging machine is cheaper? ... To me that’s another advantage of negotiating low prices: Then the supplying industry has to cut its prices, and the MRI makers met this need.

A: Right. And MRIs have now become very big in [the] export industry.

Q: So the health ministry set a low price, the MRI makers make cheaper machines to help the doctors meet that price, and now Japan is exporting these around the world?

A: Right. ... This is a situation where the market does work in health care. ...

Here are some other excerpts, which shows how far we are from most other developed countries when it comes to our thinking on health care. The Japanese are charged co-pays for their services, but there is a ceiling on these out-of-pocket expenses, which is not only extremely low (by our standards), but also adjusted according to income. Keep in mind, as you read this, that some 60 percent of U.S. bankruptcies are related to medical bills, according to a recent study.

Q: [T]hey’ve got a system that makes sure people don’t go broke paying medical bills.

A: Right. I think the main goal of a public health insurance system is to prevent people [from] going broke.

Q: How many people in Japan go bankrupt because of medical bills?

A: None, or at least there should be none, because first of all, they should be covered, and if they’re not covered, then they can get covered by paying back one year’s premiums. And if they can’t pay back the one year’s premium, then they will be on public assistance....

Q: Do you think the Japanese people feel that everyone in this country should all have a basic package of medical coverage?

A: According to opinion polls, I would not only say basic but egalitarian coverage [for] all. Over 70 percent of the Japanese, when they’re asked that question, say they’re not only in favor of basic coverage, they are in favor of egalitarian coverage.

Videos of more health care systems...


Born in 1936, James Ridgeway has been reporting on politics for more than 45 years. He is currently Senior Washington Correspondent for Mother Jones, and recently wrote a blog on the 2008 presidential election for the Guardian online. He previously served as Washington Correspondent for the Village Voice; wrote for Ramparts and The New Republic; and founded and edited two independent newsletters, Hard Times and The Elements.

Ridgeway is the author of 16 books, including The Five Unanswered Questions About 9/11, It’s All for Sale: The Control of Global Resources, and Blood in the Face: The Ku Klux Klan, Aryan Nations, Nazi Skinheads, and the Rise of a New White Culture. He co-directed a companion film to Blood in the Face and a second documentary film, Feed, and has co-produced web videos for GuardianFilms.

Additional information and samples of James Ridgeway’s work can be found on his web site, http://jamesridgeway.net.

This article is republished in the Baltimore Chronicle with permission of the author.



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This story was published on October 29, 2009.
 



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