August 1, 2010
Different Escalators to and from Sanity
Did you happen to catch this in the New York Times, last week?
Even as the new coalition government [of Great Britain] said it would make enormous cuts in the public sector, it initially promised to leave health care alone. But in one of its most surprising moves so far, it has done the opposite, proposing what would be the most radical reorganization of the National Health Service, as the system is called, since its inception in 1948.Practical details of the plan are still sketchy. But its aim is clear: to shift control of England's $160 billion annual health budget from a centralized bureaucracy to doctors at the local level. Under the plan, $100 billion to $125 billion a year would be meted out to general practitioners, who would use the money to buy services from hospitals and other health care providers.
The plan would also shrink the bureaucratic apparatus, in keeping with the government’s goal to effect $30 billion in “efficiency savings” in the health budget by 2014 and to reduce administrative costs by 45 percent. Tens of thousands of jobs would be lost because layers of bureaucracy would be abolished.
Yes, the move is to doctors, but more importantly, it's toward patients. In other words, the much lauded National Health Service is decentralizing, even as the ruling class of the United States attempts to push our system in the other direction.
Note, also, the underlying justification for government bureaucracy: the employment of government bureaucrats! One wonders what is given up in the private sector in order for paper pushers to survive on plush government compensation.
In keeping with the global view- ie circular logic- you are so wrong that's why they call you the right! Great Britian should indeed be moving away from the level of government that was needed to recover after the devestation of WW11. People needed a bigger safety net, infrastructure needed more work, and government needed to be bigger. Not so for the USA. Our government in terms of size is much smaller than any of our main competitors( globally speaking). If anything, we need to look at how we can compete globally. Without increasing our government size and scope, how can we expect to compete and prosper?
Posted by: David S at August 1, 2010 6:34 PMBy decreasing the size and scope of government, thus making it more attractive to strive and do business, here. Look to Rhode Island if you wish to see the effects of large, intrusive government on such basic infrastructure needs as roads and education.
Posted by: Justin Katz at August 1, 2010 7:43 PMDavid S. writes:
"Our government in terms of size is much smaller than any of our main competitors( globally speaking). "
Nationally, 21% of working Americans draw their paycheck from the government, in RI it is more like 22$ (this data from the census).
When I hear comparisons such as David makes, I wonder if it is apples and oranges in the way the European passanger trains are compared to American.
I don't know the answer to this, but I have my suspicions. Is it the case that Germany and Japan have very "weak" states and most governmental functions are federal? The U.S. has "strong" states. If the comparison is between the size of our federal government and thiers, there is no camparison.
It is sort of like the comparison of passenger rail service in the U.S. and Europe. There is always a claim that European trains are cheap and they make a profit. This is only possible because the government owns the road beds in the way that our government owns the highways here. So all of the expenses, except direct costs for the carriage of passengers, are "off balance sheet". Think, would a trucking company make a profit if they had to pay to maintain the highways?
On the other hand, our railroad freight service is the wonder of the world. Japan and Europe can only dream of matching it. The government may sink that. The increase in "high speed rail" will require the private companies that own the rail (the government owns the trains) to improve the rails for high speed service. Freight traffic, their real business, does not require these "improvements". Many railroads will fold.
By physical size State of Hawaii is ranked 47th with 6,423 sq miles in size where State of Rhode Island is ranked 50th with 1,045 sq miles in size in the nation.
For government Hawaii has 1 state and 4 county governments with 1 school district which is run by the state. In contrast Rhode Island has 1 state and 39 cities and town governments with 37 school districts run by local cities and towns. Of note; Hawaii is ranked the 2nd most unionized state in the nation.
Rhode Island property taxes are based on 2010 39 cities/towns reported tax rates average $14.01/$1,000 and car tax 39 cities/towns average $29.53/$1,000.
Hawaii property taxes are based on 2010 4 county reported tax rates average $3.93/$1,000 with average homeowner exemption applied to first $117,000 of property value. There is no property tax in Hawaii on cars, trucks, boats or motorcycles.
Rhode Island sales tax is 7% and Hawaii is 4% except in Honolulu County where temporary ½% surcharge is added to pay for new high-speed light rail transit system.
Hawaii imposed healthcare reform over 35 years ago thereby becoming the only state in nation closest to providing universal healthcare to total state population. Hawaii has the lowest healthcare costs in the nation.
Sometimes smaller government works is what I believe Justin is implying.
Justin, I suggest you read up on what the President is actually promoting. The UK proposal is not so dissimilar to the President's initiatives in the US.
Posted by: Russ at August 2, 2010 10:14 AMhttp://insomniacmedic.blogspot.com/2010/07/cutbacks.html
I'm a little late with this, thought it might be interesting to those still following.
Posted by: michael at August 4, 2010 8:47 AM