Archive for June, 2010

Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update

Wednesday, June 30th, 2010

– To all my friends in America who still think that the American Health system is the best on the planet and that the moneyed corporate interests are not taking all of you for a big ride – at your expense…

= = = = = = = = = = = = =


Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. This report—an update to three earlier editions—includes data from seven countries and incorporates patients’ and physicians’ survey results on care experiences and ratings on dimensions of care. Compared with six other nations—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. Newly enacted health reform legislation in the U.S. will start to address these problems by extending coverage to those without and helping to close gaps in coverage—leading to improved disease management, care coordination, and better outcomes over time.

Executive Summary

The U.S. health system is the most expensive in the world, but comparative analyses consistently show the United States underperforms relative to other countries on most dimensions of performance. This report, which includes information from the most recent three Commonwealth Fund surveys of patients and primary care physicians about medical practices and views of their countries’ health systems (2007–2009), confirms findings discussed in previous editions of Mirror, Mirror. It also includes information on health care outcomes that were featured in the most recent (2008) U.S. health system scorecard issued by the Commonwealth Fund Commission on a High Performance Health System.

Among the seven nations studied—Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States—the U.S. ranks last overall, as it did in the 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last on dimensions of access, patient safety, coordination, efficiency, and equity. The Netherlands ranks first, followed closely by the U.K. and Australia. The 2010 edition includes data from the seven countries and incorporates patients’ and physicians’ survey results on care experiences and ratings on various dimensions of care.

The most notable way the U.S. differs from other countries is the absence of universal health insurance coverage. Health reform legislation recently signed into law by President Barack Obama should begin to improve the affordability of insurance and access to care when fully implemented in 2014. Other nations ensure the accessibility of care through universal health insurance systems and through better ties between patients and the physician practices that serve as their long-term “medical homes.” Without reform, it is not surprising that the U.S. currently underperforms relative to other countries on measures of access to care and equity in health care between populations with above-average and below-average incomes.

But even when access and equity measures are not considered, the U.S. ranks behind most of the other countries on most measures. With the inclusion of primary care physician survey data in the analysis, it is apparent that the U.S. is lagging in adoption of national policies that promote primary care, quality improvement, and information technology. Health reform legislation addresses these deficiencies; for instance, the American Recovery and Reinvestment Act signed by President Obama in February 2009 included approximately $19 billion to expand the use of health information technology. The Patient Protection and Affordable Care Act of 2010 also will work toward realigning providers’ financial incentives, encouraging more efficient organization and delivery of health care, and investing in preventive and population health.

For all countries, responses indicate room for improvement. Yet, the other six countries spend considerably less on health care per person and as a percent of gross domestic product than does the United States. These findings indicate that, from the perspectives of both physicians and patients, the U.S. health care system could do much better in achieving value for the nation’s substantial investment in health.

– To the original: 

– research thanks to Bruce S.

Maslow’s Pyramid Gets a Makeover

Saturday, June 26th, 2010

– I was very gratified to see this article.   It makes a point regarding basic human drives (see Biological Imperatives) that I have thought was central for a long time.

– I expect to see this view of things begin to inform discussions of why human behavior is so maladaptive with regard to our environment.

– At some point, I hope, a perception will grow that we cannot understand our irrational and maladaptive behaviors vis-à-vis our environment until we understand how those behaviors were shaped by evolutionary pressures.

– Then we will begin to see why we believe nearby events are more significant than remote ones; in both space and time.  Why we seek to acquire things long past any conceivable need for them.   And why concrete ideas seem more real to us than abstract ones.

– Within these, as well as other insights from Evolutionary Psychology, lie the seeds of our destruction or of our redemption.

– I suspect that the SETI Search for Extra -Terrestrial Intelligence has found the stars to be so silent because correctly responding to these understandings requires an act of transcendence so profound that most species, having just evolved into their technological adolescences, simply cannot process the insights and their implications before they’ve destroyed themselves by ruining the cradle environment under their feet.

– See this poem for another view of this idea.

– – – – – – – – – – – – –

What are the fundamental forces that drive human behavior? A group of evolutionary thinkers offer an answer by revising one of psychology’s most familiar images.

Abraham Maslow’s Pyramid of Needs is one of the iconic images of psychology. The simple diagram, first introduced in the 1940s, spells out the underlying motivations that drive our day-to-day behavior and points the way to a more meaningful life. It is elegant, approachable and uplifting.

But is it also out of date?

That’s the argument of a team of evolutionary psychologists led by Douglas Kenrick of Arizona State University. In the latest issue of the journal Perspectives on Psychological Science, they propose a revised pyramid, one informed by recent research defining our deep biological drives.

Their new formulation is intellectually stimulating, but emotionally deflating. “Self-actualization,” the noble-sounding top layer of Maslow’s hierarchy, in their model has not only been dethroned, it has been relegated to footnote status. It has been replaced at the top with a more mundane motivation Maslow didn’t even mention: “Parenting.”

The new pyramid is based on the premise that our strongest and most fundamental impulse, which shapes our day-to-day desires on an unconscious level, is to survive long enough to pass our genes to the next generation. According to this school of thought, backed by considerable — though not irrefutable — evidence, all our achievements are linked in one way or another to the urge to reproduce.

In other words, aside from our powerful brains, we’re pretty much like every other living creature.

Given that we humans like to think of ourselves as special, this new pyramid will surely encounter strong resistance. But it could also become a shorthand way to clarify the often-misunderstood concepts of evolutionary psychology, which, its advocates insist, are not as meaning-denying and ego-deflating as we might think.

– More…

– Research thanks to Kael

Millions of cancer survivors putting off care because they cannot afford it

Monday, June 21st, 2010

– For me, the purpose of national governments should be to make the quality of life for their citizens of the highest quality possible consistent with not depriving future generations of those same benefits.

– And it should not be to allow Corporations the widest latitude of action in their monomaniacal pursuit of profits.

– Unfortunately, humanity in the large has not absorbed this lesson and we are all much the worse for it.

– Witness this story from the U.S. – home of unbridled Capitalism.

– – – – – – –

(NATIONAL) — A new study suggests America’s challenged and stressed employer based health care/health insurance system has come home to roost for millions of cancer survivors who are putting off medical care they need because they can no longer afford it.

The results, released online Monday by an American Cancer Society medical journal, shows that millions of cancer survivors are forgoing needed medical care because of concerns about cost or because they can no longer afford the care.

The new study, led by a Wake Forest University Baptist Medical Center researcher, estimates that more than 2 million of 12 million U.S. adult cancer survivors – or about 8% of the total – did not get one or more needed medical services because of the costs involved.

And about 10 percent also said they had to forgo filling prescriptions.

The study is being called the first to estimate how often current and former patients have skipped getting care because of money worries.

Survey participants were asked if they had needed medical care in the previous year but didn’t get it because they couldn’t afford it. Cancer survivors younger than 65 were between 1.5 and 2 times more likely to have said yes to that question than those who hadn’t had cancer.

The study showed that among cancer survivors, the prevalence of forgoing care in the past year due to concerns about cost was 7.8 percent for medical care, 9.9 percent for prescription medications, 11.3 percent for dental care, and 2.7 percent for mental health care.


Kiwi cities rank among world’s best

Sunday, June 20th, 2010

Auckland has the world’s fourth-best quality of living, according to a new ranking dominated by European cities.

But in another ranking for eco-cities, Wellington beats out Auckland, ranking fifth worldwide.

In both categories, New Zealand cities sit at the top of the Asia Pacific, ahead of Australian contenders.

The 2010 Mercer Worldwide Quality of Living Survey was released today, ranking cities for overall quality of living based on political, socio-economic and environmental criteria as well as sanitisation, education and transport. The company also compiled a list of top eco-cities.

Spokeswoman Georgina Harley said in a statement to media that New Zealand cities had been recognised for having “quality housing close to the city”, “political stability” and “transport”.

Ms Harley also praised New Zealand cities’ “wide selection of restaurants”.

Auckland ranked fourth while Wellington was judged 12th worldwide for quality

Among eco-cities, Wellington was fifth while Auckland was deemed 13th.

– More…

New Zealand most peaceful nation

Sunday, June 20th, 2010

New Zealand has been named the most peaceful nation for the second year running, smashing Australia which barely managed to scrape into the top 20.

The fourth annual Global Peace Index (GPI), compiled by global think tank Institute for Economics and Peace, looked at the relationship between economic development, business and peace.

The report examines key areas of conflict, safety, security and military factors in 149 countries.

Their latest index, presented on Tuesday, suggested the world has become slightly less peaceful in the past 12 months.

New Zealand took out the top spot because of its political stability, safety and harmonious relations with neighbouring countries like Australia, which came in at number 19 in the poll.

The “peace indicators” which the Kiwis outshone their trans-Tasman neighbours in were the number of conflicts fought, the likelihood of violent demonstrations, the level of security required per capita and a number of military factors.

The Kiwis were followed by Iceland and Japan in the poll, while Austria and Norway rounded out the top five.

– More:

U.S. sits at #85 in 2010 Global Peace Index

Sunday, June 20th, 2010

Say it ain’t so.

While peace and stability aren’t easy to come by, this year the world fared slightly worse, partly due to the global recession, according to the fourth annual Global Peace Index.

The survey, which aims to objectively measure security and violence among nations while illustrating drivers of peace, ranked 149 countries this year.

Based on 23 factors, including military expenditures, participation in United Nations peacekeeping, social unrest and jail population, the U.S. placed somewhere in the middle, falling behind China (#80) and Cuba (#72).

Its mediocre spot is due to a combination of factors. While receiving low marks for its domestic murder rate, military expenses and role in international conflicts, it received a boost for respecting human rights and strengthening international relations.

Not surprisingly, Iraq was where it was last year — in the bottom spot.

And New Zealand snagged the top spot, earning the title of most peaceful nation in the world.

– More…

Rising costs hit EU’s nuclear dream

Tuesday, June 8th, 2010

– A sad business this.   Fusion is one of the few possibilities out that that is almost all benefit and little downside.   Imagine a world with nearly unlimited power.

– But, the problem with short-term and long-term thinking, in which humans are so poorly balanced, has led us away from this goal again and again.   And, now that we’re reaching the limits of the current petroleum-based energy systems, we’re going to find out the hard way what this lack of long-term focus is going to cost us.

= = = = = = = = = = = = = = =

The cost of an ambitious international nuclear fusion project has trebled in three years, scientists say, prompting fears the work may be scrapped.

At the same time, financial crises have beset all the nations involved in the project.

As a result, construction of the International Thermonuclear Experiment Reactor (Iter) at Cadarache in France has been pushed back from 2015 to 2019, and more delays are likely.

Some scientists say there is a risk that the entire project could be cancelled. The original price tag was €6 billion. ($11 billion). The latest estimate is €18 billion.

Because it is hoped that fusion plants could one day supply the world with cheap, non-polluting power, the crisis facing Iter is a substantial threat to plans to tackle world energy and climate problems.

– More…

Venting Online, Consumers Can Find Themselves in Court

Thursday, June 3rd, 2010

– Just lovely – as if we don’t have enough reasons to think that powerful and uncontrolled corporations are a bad idea.

– – – – – – – – – –

After a towing company hauled Justin Kurtz’s car from his apartment complex parking lot, despite his permit to park there, Mr. Kurtz, 21, a college student in Kalamazoo, Mich., went to the Internet for revenge.

Outraged at having to pay $118 to get his car back, Mr. Kurtz created a Facebook page called “Kalamazoo Residents against T&J Towing.” Within two days, 800 people had joined the group, some posting comments about their own maddening experiences with the company.

T&J filed a defamation suit against Mr. Kurtz, claiming the site was hurting business and seeking $750,000 in damages.

Web sites like Facebook, Twitter and Yelp have given individuals a global platform on which to air their grievances with companies. But legal experts say the soaring popularity of such sites has also given rise to more cases like Mr. Kurtz’s, in which a business sues an individual for posting critical comments online.

The towing company’s lawyer said that it was justified in removing Mr. Kurtz’s car because the permit was not visible, and that the Facebook page was costing it business and had unfairly damaged its reputation.

Some First Amendment lawyers see the case differently. They consider the lawsuit an example of the latest incarnation of a decades-old legal maneuver known as a strategic lawsuit against public participation, or Slapp.

The label has traditionally referred to meritless defamation suits filed by businesses or government officials against citizens who speak out against them. The plaintiffs are not necessarily expecting to succeed — most do not — but rather to intimidate critics who are inclined to back down when faced with the prospect of a long, expensive court battle.

– more…

– This article is from the NY Times and they insist that folks have an ID and a PW in order to read their stuff. You can get these for free just by signing up. However, a friend of mine suggests the website :arrow: as an alternative to having to do these annoying sign ups. Check it out. Thx Bruce S. for the tip.

Government review to examine threat of world resources shortage

Thursday, June 3rd, 2010

Study commissioned following sharp rises in commodity prices on world markets and food riots in some countries

[British] Ministers have ordered a review of looming global shortages of resources, from fish and timber to water and precious metals, amid mounting concern that the problem could hit every sector of the economy.

The study has been commissioned following sharp rises in many commodity prices on the world markets and recent riots in some countries over food shortages.

There is also evidence that some nations are stockpiling important materials, buying up key producers and land and restricting exports in an attempt to protect their own businesses from increasingly fierce global competition.

Several research projects have also warned of a pending crisis in natural resources, such as water and wildlife, which have suffered dramatic losses due to over-use, pollution, habitat loss, and, increasingly, changes caused by global warming.

– more…

– research thanks to Tony H.