Now, Russia has received the ultimate ISIS danger warning with the probable bomb attack on a passenger airliner flying over the Egyptian Sinai . Yahoo News reports, "No matter what caused the fatal crash of a Russian airliner in Egypt, the answer will almost certainly hit Russia hard." Although Russia's President Putin seems nonplused by the downing of the innocent Malaysian jet shot down over the Ukraine, the destruction of the Metrojet lands right on Putin's lap. Russians may respond to the probable airliner attack by calling for a check on Vladimir Putin's unmitigated leadership and a challenge to his Syrian military intervention. Obviously, evil ISIS made the effort to attack the Russian Metrojet because they had the chance to sabbotatge in retaliation for the intervention in Syria. In fact, the Russian reponse in Syria is doing more to protect the dictator President Assad than to remove evil ISIS. As a matter of fact, Putin would love to be the leader who destroyed ISIS in Syria but the end result would be an expansion of Russia's influence in the Middle East. Metrojet's tragic end is a warning from evil ISIS to the entire world. This terrorism network is clearly not impacted by the carnage the barbaric followers create. They are immune to intellectual enlightenment, humanitarian values or diplomatic negotiations. Their motivation is fueled by raising the bar on terrorism. By bringing down the Metrojet with an on board explosive device, as evil ISIS claims to have done, they have proven how their network of followers are lurking nearly anywhere and perhaps everywhere. Consequently, the Metrojet disaster has proven on thing to the world. That is, current strategies to destroy the evil ISIS movement and the terrorism momentum are just not working. In past blogs, I stated my uninformed instincts to call for destroying the evil ISIS leadership. Well, that has happened. Airsrikes and drone attacks have removed many ISIS leaders. Nevertheless, the poisinious snake, obviously, has several rengenerative heads. Additonally, attempts have been made to destroy the revenue evil ISIS obtained from selling oil. Now, evil ISIS, instead, is illegally retailing valuable ancient cultural treasures. Metrojet is a tragic sea turn on ISIS offensive strategies. Clearly, nothing is stopping these barbarians from achieving their horrifically ambitious goals to terrorize the world. Universal and collective strategies haven't penetrated the root cause of the evil ISIS growth and its ability to attract suicidal followers. As a result, the next level of strategies must involve something the world has been hesitant to address or to discredit. There's an overt zealous philosophical attraction to ISIS. Therefore, to dismantle the terrorism network will involve vilification of its destructive motivation. In other words, the innocents of the world must somehow motivate the Muslims of the world to remove evil ISIS off the face of the earth.
Russia's economy can't sustain war and economic sanctions -but real estate might be a bargain
Russia's President Putin is reported to be planning a trip to visit Egypt, but his nation's credit card might want to check the balance on his account before he leaves the country.
In fact, maybe the Egyptians will even ask for advance payment for the cost of his visit. In other words, Russia's economic woes are worsening even while President Putin continues to support military operations in the Eastern Ukraine as well as in Syria.It's impossible to figure out how Russia pays the military as well as the cost of operations, while the ruble currency is in a free fall.
As a matter of fact, the cost of world oil continues to slide as well. Therefore, the financial security Putin once believed would come from Russia's oil reserves is bringing in less revenue. Nevertheless, according to a report in The New York Times, real estate may be a bargain in Moscow, because vacancy rates for high rise office space are climbing.Apparently, the luxury office space in Moscow's financial district is being utilized by low rent occupants. Sounds like a nice place to hang out, on the cheap. Commercial Real Estate: In Moscow, a Financial District in Name Only NOV. 25, 2014 by Andrew E. Kramer MOSCOW — In the coveted corner office, a bearded man in sweatpants scrambled eggs at a kitchenette, all the while taking in the serene beauty of the city lights twinkling far below.
Moscow’s skyscraper district, formally the Moscow
International Business Center, reflects the broader problems in the
Russian economy. The country, facing broad-ranging financial sanctions
and largely dominated by state-run companies, simply has no need for
vast office spaces for stock traders, auditors and bankers.
Vacancy
rates in the newly built financial district have become acute. The
entire site, some 148 acres that now includes the tallest building in Europe,
Mercury City Tower, had a vacancy rate of 32 percent at the end of
October, according to Cushman & Wakefield, the real estate
consultancy. The rate is projected to rise above 50 percent next year
when new buildings open. In the conference room, or as the company prefers to call it, the “common area,” two other men lounged about playing video games on an Xbox. In place of cubicles, there are bunk beds.
High Level Hostel, one of the newest tenants in the financial district here known as Moscow City, sits on prime real estate on the 43rd floor of a multimillion-dollar glass-and-steel tower. It is not a youth-hostel-themed work space, but an actual youth hostel — dirty socks and all.
“We thought, ‘why not open a hostel in a skyscraper?’ ” said Roman Drozdenko, the 25-year-old owner. “Nobody’s done that before.”
The tower, with its marble veneer foyer, banks of elevators and breathtaking views, was clearly built for lawyers, accountants or stock traders. But “there were no questions regarding our guests” from the building management when he opened in September, Mr. Drozdenko said. “In fact, there were no questions at all.”
Moscow’s skyscraper district, formally the Moscow International Business Center, reflects the broader problems in the Russian economy. The country, facing broad-ranging financial sanctions and largely dominated by state-run companies, simply has no need for vast office spaces for stock traders, auditors and bankers.
Vacancy rates in the newly built financial district have become acute. The entire site, some 148 acres that now includes the Mercury City Tower, the tallest in Europe, had a vacancy rate of 32 percent at the end of October, according to Cushman & Wakefield, the real estate consultancy. The rate is projected to rise above 50 percent next year when new buildings open.
“Russians have a great tradition of building things they don’t need,” Sergei Petrov, an office worker in Naberezhnaya tower, said of the emptiness behind the glass facades, a veritable Potemkin Wall Street.
Moscow City was envisioned as a hub of emerging market finance, a shiny skyscraper-dotted testament to Russia’s growing international influence. For a time, the idea was not improbable: From 2000 to 2007, the Russian economy grew on average 7 percent a year.
This herculean undertaking on a bank of the Moskva River was to be Moscow’s answer to the City of London or Manhattan.
One tower, called Evolution, twists in a DNA-evoking double helix. The spires of Federation Towers resemble billowing sails, evoking Russia sailing into a capitalist future. Federation Tower East, when finished, will rise 95 stories to a height of 1,224 feet, surpassing its still mostly empty neighbor Mercury City Tower as the tallest building in Europe. Eight skyscrapers are finished, including the gold-tinted Mercury tower. Eight others are under construction, and two more are planned. The entire site is scheduled to be finished by 2018.
But Russia’s tanks are now getting more international attention than its banks, leaving Moscow City as a $12 billion reminder of the nation’s economic woes.
Western sanctions, for example, have taken aim at Russia’s largest state financial institutions, Sberbank and VTB, which both own towers or floor space in Moscow City. The two banks now have a limited ability to issue debt on global markets, thus limiting their growth options.
Sanctions by the United States and the European Union are expected to trim about 1 percentage point of growth from Russia’s gross domestic product this year, and slightly more next year if they remain in place. Even without sanctions, problems have been stacking up. Rising inflation, falling oil prices, and a tumbling ruble have left Russia near recession.
The government also accounts for an outsize proportion of the economy, leaving scant jobs for the grunt workers of private enterprise, the bankers, lawyers and traders for whom Moscow City was built. In Russia, 81 percent of the shares of the top 10 companies are owned by the same entity, the state, compared with 11 in Germany, according to a study by Organization for Economic Cooperation and Development economists.
Rather than turning to banks, Russia’s largest company, the sanctioned state oil company Rosneft is now appealing directly to state funds for loans. And the Kremlin this year again delayed shifting pensions into the private sector, dealing another blow to financial sector jobs.
“Somebody had the idea that if you build a lot of skyscrapers in one spot you have an international financial center,” Darrell Stanaford, a real estate analyst in Moscow with Romanov Dvor, said in an interview. “But it doesn’t work. You need other things, too.”
Moscow City, which has taken a direct hit from these policies, is now shifting tactics to fill the glut of premier office space.
City, the management company for the development in the neighborhood, says financial services companies are no longer the majority of its new tenants. Of the new Russian occupants signing leases this year, 58 percent were nonfinancial companies as well as local small and midsize businesses, like High Level Hostel, according to the management company.
New buildings are also being repurposed at the development stage. One low-rise will become a 6,000-seat movie theater. (!!!)
In finished towers, various nonfinancial ventures are renting space. One company sells Cambodian citizenship to Russians wanting a second passport. A culinary school and restaurant are opening.
Many multinationals have rented space. IBM, General Electric, KPMG, General Motors, Hyundai, Energizer and Japan Tobacco International are all tenants, as is a major Russian investment bank, Renaissance Capital.
Prices, too, are falling. Mr. Drozdenko, the hostel owner, said a real estate agent offered him the space for about $8,000 a month for 1,600 square feet, or about $5 a square foot.
In Moscow City, office space currently averages $6.90 a square foot each month. That’s below the average of $7.75 for high-grade office space elsewhere in the capital, according to Denis T. Sokolov, senior analyst and a partner at Cushman & Wakefield in Moscow.
“We have to do this,” Dmitry Granov, the director of City management, said in an interview of the effort to broaden the range of tenants, because of the dearth of financial sector jobs in Russia.
“If before we were looking for international corporations, today we are looking for Russian companies, and small and medium businesses,” he said. He said dropping rents would attract technology start-ups.
City management company contested the vacancy estimate by Cushman & Wakefield. Cushman & Wakefield counts vacant sublease space in its total, while the management company does not. City says current vacancies are about 20 percent.
Meshing the various constituencies is also creating challenges.
“The cafes, amenities and dress code you need is different for clients of a youth hostel and for investment bankers,” said Mr. Stanaford, the real estate analyst, of settling tenants like High Level Hostel in their high-level location. “What image-conscious business is going to buy office space in the same skyscraper with a youth hostel?”
Empire Tower, the skyscraper where High Level hostel sits, is still largely empty two years after opening. In the foyer, an oval marble sculpture echoes the oval motif of the 60-story tower, designed for a more professional clientele.
Forty-three stories up, High Level Hostel opened in September with 24 beds, with prices starting at $25.50 in a six-person room, including a breakfast of toast, porridge or muesli. The hostel manager, Leonid L. Fedotov, 19, who goes by the nickname the Beard, recalled backpacking guests from Holland named Ron and Eve.
“It was really cool because Ron and I played guitar in the evening,” he said, as they gazed out at the twirling facade of Evolution Tower and the sea of lights of Moscow below. +++++++++++++++ It's hard to imagine how Russia can sustain economic growth, when the posh office buildings in the nation's highest rent business district are essentially being lent out to kids in a youth hostel. In other words, some of the world's homeless people are benefiting from the low rents while residing in a high rent neighborhood.
Meanwhile, the Russian ruble continues to be worth less than the paper it's printed on. It's only a matter of time before Putin will be on the ropes. Consequently, maybe Egypt will be a good hiding place for Putin, as long as his line of credit can cover living costs.
"How sick are the world's healthcare systems" is deserving of a journalism award.
In the best of health? Photograph: Getty/Guardian
China - long lines; access to care is bureaucratic. A soaring demand for quality medical care by Jonathan Kaiman
In Lewis Carroll’s Through the Looking Glass, Alice finds herself facing a difficult conundrum. She’s running towards a distant hill; yet no matter how quickly she runs, her surroundings move with her, effectively stranding her. She meets the enigmatic Red Queen. “Now, here, you see, it takes all the running you can do, to keep in the same place,” the Queen explains. “If you want to get somewhere else, you must run at least twice as fast as that!”
China’s healthcare system suffers from the same problem – despite running at full speed over the past few decades, it can’t possibly move fast enough to keep up with the country’s social and economic changes. China’s per capita GDP grew more than 25-fold from 1980 to 2011; its life expectancy rose by nine years; its infant mortality rate quartered. Yet as Chinese citizens grow older and wealthier, they are also burdened by a rise in pollution, smoking, obesity and other public-health hazards, creating a soaring demand for quality medical care.
During the Mao era, in the 1940s through to the mid-70s, the country’s healthcare system was rudimentary but egalitarian, entirely supported by the state. Yet in the 80s, reformer Deng Xiaoping dismantled the system, leaving hospitals suddenly responsible for their own economic wellbeing. The result has been rampant profit-seeking: overprescription of medications, excessive testing and shocking efforts to cut corners. Many Chinese hospitals don’t keep soap in their public bathrooms. Physicians are so underpaid that they often must supplement their salaries with kickbacks from drug companies and patient bribes.
The system is also deeply stratified. A typical villager, upon falling ill, will first visit a local clinic – usually a concrete-floored, one- to two-room facility, equipped with little more than intravenous drips and a small pharmacy. If his malady requires further attention, he will be forced to ascend through a hierarchy of institutions – to a county hospital, then a provincial hospital, then a specialised clinic in a metropolis such as Beijing or Shanghai. Major institutions, inundated with patients from afar, suffer from chronic overcrowding. It is common to see families sleeping overnight on hospital lawns to avoid early-morning queues.
With the stakes so high, tempers run hot when treatments fail. Patient-on-doctor violence has become startlingly common – stabbings and mob-style attacks have risen 23% a year on average since 2002, according to the China Hospital Management Association. A typical hospital suffers one such incident every two weeks.
The Chinese government has poured billions of pounds into healthcare reform in recent years, and the system has improved accordingly. At present, 99% of the rural population gets some kind of insurance, up from 21% a decade ago; the country plans to roll out universal coverage by 2020. Yet the price of basic medical services has also risen, and many insured patients are paying as much as they once were. As of last year, the government gives each rural resident 280 yuan (£28.34) in annual healthcare subsidies. Yet elaborate procedures can cost many times that, and patients must pay the difference out of pocket. China has one of the highest savings rates in the world – about 50% – largely because families fear catastrophic healthcare costs.
Chinese authorities have been embracing other, more innovative ideas to improve the system: new technologies, private investment, new training regimens for doctors – in short, redoubling their speed just to keep up the pace.
South Africa: ‘Labouring under a two-tier system’ With the world’s biggest HIV caseload by David Smith
HIV with rampant tuberculosis (TB) and rising obesity, South Africa's healthcare is under strain.
The government spent more than 8.5% of GDP on healthcare in 2012, higher than the 5% recommended by the World Health Organisation (WHO) for a country of its socioeconomic status, yet performed worse than comparable nations.
The historical legacy of colonialism and apartheid is still manifest in one of the most unequal societies in the world. Health care is not exempt from this culture, so South Africa continues to labour under a two-tier system.
The private sector consumes 60% of total health spending yet caters to only about 15% of the population. The facilities are world class and less expensive than in Britain, the US or Australia – fertility treatment, for example, attracts foreigners at a fraction of the cost – but are beyond the financial means of most South Africans.
Public healthcare struggles to meet the needs of the other 85%, with often overcrowded facilities, poor equipment and shortages of drugs. Less than 30% of doctors, dentists, pharmacists, physiotherapists and psychologists, and just 40% of professional nurses, work in the public sector.
Some essential services are provided free by the state. TB treatment, for example, is not available in private clinics. After diagnosing a patient with TB, private doctors refer the patient to the public sector, where everyone receives TB medicine free of charge.
The most striking success in free provision is the antiretroviral treatment programme for people with HIV, initiated 10 years ago after the government, accused of “Aids denialism”, lost a landmark court case. Today, South Africa has the world’s biggest public-sector HIV programme, with 2.5 million people receiving treatment (!). The country’s life expectancy has consequently increased from 53 in 2002 to 60 in 2013.
But there are practical barriers. Patients’ first point of contact are primary healthcare clinics where, in serious cases, nurses and community health workers can refer them to hospital. These clinics are concentrated in cities and towns, often inaccessible to people in rural areas who cannot afford transport. Some 47% of children live in rural areas where only 12% of doctors and 19% of nurses work. Some villagers rely on an informal network of traditional healers and medicines.
Not everything in public hospitals is free, and only an estimated 17% of South Africans are part of a medical aid scheme to cover the costs. In addition, staff shortages translate into long waiting times. Critics say treatable conditions are not treated on time and preventable diseases are not prevented. The government has admitted the need for a “radical improvement” in the quality of services and “massive investment” in buildings and equipment, as well as fundamental changes in management.
The health minister, Dr Aaron Motsoaledi, has been known to roll up his sleeves and work a night shift at the Chris Hani Baragwanath hospital in Soweto, the biggest hospital in the southern hemisphere. He and his family use public hospitals and in 2011 he told the Mail & Guardian newspaper: “It’s a self-defeating prophecy to keep on saying we don’t have the means. There are good services in countries with fewer facilities and staff than us.” Nevertheless, Motsoaledi has a big plan for healthcare reform: a national health insurance scheme. The aim is to provide essential healthcare for all, irrespective of employment status and ability to pay, as enshrined in the post-apartheid constitution. Anyone earning above a certain income will be required to contribute to the NHI Fund.
The plan has met resistance from the private sector. But the government insists: “It will actually make the sector more sustainable by making it levy reasonable fees. The intention of NHI is rather to make sure that citizens are able to use both the public and private sectors in such a way that they complement each other rather than one undermining the other. At the moment, private healthcare is only for the rich. NHI is trying to blend the two in a more sustainable manner that benefits the population.”
India: ‘Public or private, India’s health care system is largely unregulated’ by Anu Anand
When Ria, 12, an illiterate maid’s daughter, suddenly developed a giant lump in her abdomen, her mother knew better than to trust India’s publicly run hospital system. Mazes of dingy corridors, outdated equipment and filthy wards where linens are absent and rats run freely greet the desperately poor and sick patients seeking care.
India spends just 1.3% of GDP on healthcare, one of the lowest in the world. Every day, patients from around the country, some who have travelled for days, can be seen queueing outside India’s biggest public teaching hospital, the All India Institute of Medical Sciences (AIIMS) in New Delhi. Hundreds jostle to see erratically available specialists. Others push their way to the counters of crowded roadside medical shops to purchase not just bandages and surgical equipment, but even life-saving drugs and the pints of blood patients are often expected to provide. At night, dozens of patients and their relatives sleep under the bright lights of the closest bus shelter, unable to afford accommodation.
The other option, equally inaccessible for poor Indians, lies a few miles away. In the lobby of one of New Delhi’s swanky corporate hospitals, wealthy patients from around the world sip lattes as they wait for doctors in brightly lit waiting rooms, complete with cleaners, attendants and stacks of glossy magazines.
Here, by global standards, the best diagnostic tests and procedures can be had for a fraction of western prices, a fact that fuels medical tourism to the tune of an estimated $78.6bn in India. But public or private, India’s health care system is largely unregulated.
In May, David Berger, a visiting Australian doctor writing in the British Medical Journal of his experiences in a small Indian hospital, blew the lid off the widespread practice of doctors receiving kickbacks for referring patients for medical tests, scans and even surgery. Subsequently, a group of doctors at AIIMS formed the Society for Less Investigative Medicine to counter corruption, which is deemed widespread by many.
India’s new health minister has also vowed to clean up corruption. And the new prime minister, Narendra Modi, has further spoken of his vision for universal healthcare. Partially inspired by Obamacare, it would potentially be the largest scheme in the world and tackle such daunting silent epidemics as tuberculosis, which claims 300,000 Indian lives annually.
But critics argue that such a private sector-led scheme will further marginalise the state system and leave India’s poorest citizens increasingly vulnerable to exploitation and substandard treatment, especially in rural areas.
Ria successfully had a grapefruit-sized tumour removed from her ovary. Her mother’s employer led the search for credible doctors, interpreting their advice and helping to cover the roughly £600 in diagnostic and surgical costs. Thankfully, her tumour was benign.
Brazil ‘A huge gap between standards of private and public care’ by John Watts
When more than a million protesters took to the Brazil streets last year, the woeful condition of the public healthcare system was high among their list of grievances.
Inequality and vast distances are the main problem. According to the World Bank, the country has 1.8 doctors for every 1,000 people – well below the 3.2 ratio in neighbouring Argentina, and significantly below those of Mexico, the US and the UK.
On paper, however, Brazil has one of the most comprehensive and generous public health networks in the world. The Unified Health System, or SUS as it is widely known, is universal and free for everyone. It has notched up impressive achievements. Since the turn of the century, life expectancy is up from 68.8 to 74.5, infant mortality is estimated to have fallen to 14.4 per 1,000 live births from 17.6, and the government says 95% of children are now fully vaccinated. Brazil’s healthcare spending was 9.3% of GDP in 2012.
But, reflecting this very unequal society, there is a huge gap between standards of private and public care. In state capitals, the one in four of the population who can afford private services benefits from almost double the doctor-patient ratio. For those in the SUS, there are insufficient beds, and waiting times for basic diagnosis and treatment are long.
Regional disparities are even more glaring. Residents Maranhão, the country's poorest state, have barely a quarter of the spend per head as the inhabitants of wealthy Rio de Janeiro.
To address this problem, President Dilma Rousseff last year launched a crash programme to fill the gap with thousands of primarily foreign medics. The “Mais Medicos” (More Doctors) programme offers incentives to those go to medical schools in remote and poor areas, such as the Amazon, so that in the long term they can train a new generation of professionals. So far, 4,199 doctors have been dispatched and the plan is to increase this to 11,500 doctors by the end of 2017.
The vast majority have come from Cuba. This is politically controversial because the Cuban government pockets about a quarter of their salaries. When they arrived, Brazilian doctors booed and chanted “slave” at the newcomers and accused them of lacking the necessary qualification and language skills needed to do a good job.
While it is true that the normal diploma requirement has been waived for the Cubans, the government says this is justified because they are only expected to provide primary care, not surgery. “Mais Medicos is a success because it is serving the public with quality and because it is greatly improving health indicators throughout Brazil,” says health minister Arthur Chioro. “Fifty million people who did not previously have primary care now have exactly what they need most of all.”
Egypt ‘A system that doesn’t know how to manage itself’ by Patrick Kinsley
A few weeks ago, a woman gave birth in a street outside of a public hospital in northern Egypt. Depending on who you believe, the hospital either didn’t have enough medics to tend to her – or they demanded money that she couldn’t pay.
Hers was an extreme example of the problems with Egypt’s public health service, particularly in provincial areas. Thanks to a decree issued earlier this year, all Egyptians should get free access to emergency hospital care for at least 48 hours. But in practice some state facilities, particularly in the countryside, either cannot provide instant healthcare – or have to charge for it. Due to a shortfall in government funding, they have no other way of paying their staff.
And the problem goes beyond A&E. A state-run insurance scheme nominally provides subsidised non-emergency healthcare to children, government workers and the families of those workers – a group that the government says totals 54% of the population. But by the government’s own count, only 8% of those covered by the scheme actually use state facilities. “This in itself denounces the problem,” says Ayman Sabae, a doctor and campaigner for healthcare reform at the Egyptian Initiative for Personal Rights, a prominent watchdog. “Both the service quality and access to the services are so limited that only 8% use them.”
A government clinic that Sabae visited in rural Qena province last month exemplifies the problem. Like about half of Egypt’s 4,000 state clinics, this one is well-equipped, and newly refurbished. But according to Sabae, there has not been a doctor here for the past four years. Clinicians assigned here might only earn around 1,200 Egyptian pounds a month – about £100, or little more than Egypt’s average monthly wage – whereas they can earn around five times as much in the private sector. So they opt for the latter.
“There’s a couple of finance employees, maybe a nurse,” says Sabae of the clinic. “But no doctors. And that’s very typical – you have a system that doesn’t know how to manage itself. You have the money to renovate the clinic, but not the human resources to manage it.”
As a result, the half of the population who are eligible for free healthcare are often no better off than the half who aren’t. Most end up paying for their care themselves – in fact, 71.8% of healthcare spending in Egypt comes from people’s pockets. NGOs, charities and religious groups pick up some of the slack (the now-banned Muslim Brotherhood part-built their influence on their network of clinics).
Those who aren’t covered by the state healthcare plan can apply for another of state-paid treatment – the Program for Treatment at the Expense of the State. But this is only for those with life-threatening diseases who can show they are incapable of paying through other means.
As a last resort, any patient can get free treatment at university training clinics and hospitals. On the plus side, the doctors here are often the best in the country. On the downside, students observe every operation, the facilities are often unhygienic, and the cost of basic supplies is frequently covered by the patients or the doctors themselves.
“When I worked there as a doctor, I was paid 200 Egyptian pounds [about £20] a month, and I would spend more per month from my own pocket to buy blood from other hospitals,” says Sally Toma, another doctor who campaigns for healthcare reform. “Otherwise, I was told, I would have to choose who should get blood, and who should not.”
Italy ‘A persistent complaint is unfairness’ by John Hooper
Italians by and large regard health as a priority. And it shows up in one of the highest life expectancies in the world. In 2012, according to the World Bank, the average newborn Italian could expect to live to the age of 83 – the same as in Switzerland or Japan.
But, like many things in a country of contrasts and disparities, the provision of health services varies widely from one part of Italy to another. Last year, a report was published by the parliamentary committee that scrutinises what Italians callmalasanita (literally “bad health”): cases of extreme negligence on the part of doctors or hospital staff. Out of 400 deaths attributable to malasanita between April 2009 and December 2012, more than 40% occurred in just two of Italy’s 20 regions, Calabria and Sicily.
Italy’s Servizio Sanitario Nazionale was founded in 1978 and modelled in large part on the NHS. But right from the outset it was only to a limited extent national.
The central government fixes the overall budget, determines minimum levels of care and, for example, negotiates drug prices with the big pharmaceutical companies. But it is the regional governments that administer the system, and there are huge discrepancies between them in levels of efficiency and integrity.
In parts of northern Italy, patients receive attention as good as anywhere in Europe. “Customer satisfaction”, however, falls off rapidly in the southern half of the country. And the drop goes hand in hand with a fall in measures of efficiency.
In Sicily, for example, there are roughly 10 hospital doctors for every hospital bed. In the north-eastern region of Friuli-Venezia Giulia, the ratio is half that.
Discernible in the statistics are variations in the degree of corruption and the use of public services to distribute jobs and patronage. Last year’s parliamentary commission report noted that in Campania, the region around Naples, 383 health officials had been taken on to the payroll without having to go through the bother of a selection process.
A persistent complaint among patients is of unfairness. In the southern half of Italy especially, they often move up waiting lists, not according to the date on which their names were first entered, nor by virtue of the seriousness of their condition, but according to whether they can secure a raccomandazione(reference) from someone with influence over the relevant surgeon.
By and large, the state has been open-handed in allocating resources to health. In 2012, Italy spent 7.2% of its gross domestic product on the public health system. That was less than was spent by the UK, Germany or France. But then Italy’s economy has scarcely grown since the turn of the century and is under growing pressure from European institutions to trim its spending.
Cuts have been made in recent years. But the overall budget for this year, of almost €111bn (£88bn), was still almost 4% higher than it had been in 2011.
The United States ‘More than 13% of Americans still have no health insurance’ by Nicki Woolf
When he announced the news that a doctor returning from Guinea to Harlem, in New York, had been diagnosed with Ebola in October, mayor Bill de Blasio said that New York’s had the “world’s strongest healthcare system”.
But the fact that he referred to the city’s system, rather than the nation’s, is telling. In fact, while the US can boast some of the best doctors and most advanced medical technology in the world, it doesn’t really have a coherent healthcare system at all. Healthcare in the US is private insurance-based and decentralised, with most care providers owned locally by private companies, and local and state governments controlling access to federal programs.
The private and public systems that overlap in some areas, and leave gaps in others, make the US the country that spends the most per capita and as a percentage of GDP of any country in the world, but paradoxically consistently last among comparable nations in measures of quality of coverage such as infant mortality.
Because their cost is decided by private companies, individual procedures can be extraordinarily expensive. A single MRI scan in some parts of the country can cost as much as $2,871 (£1,780); an appendectomy as much as $29,426 (£18,000), and a caesarean-section delivery as much as $26,305 (£16,000), according to a report by the International Federation of Health Plans. Some procedures can be as much as eight times the price of the equivalent operation in the UK, and a 2013 study by NerdWallet Health showed that medical bills are the biggest cause of bankruptcy in the US.
Some of the gaps are filled by government operations. One of these is Medicare, which guarantees health insurance for the elderly. Another is Medicaid, a low-income program which the Obama administration has recently expanded – but state governments, especially those controlled by rightwing Republican governors, have consistently rejected the expansion, leaving many poor residents without healthcare. Yet another is the Veterans Health Administration, which was hit by scandal in April 2014 when it was revealed that at least 40 US military veterans had died while waiting for medical care.
Perhaps the core struggle of Barack Obama’s presidency has been to pass his Affordable Care Act (ACA), which would aim to use state online insurance exchanges to reduce the number of people without coverage. But the bill has become a political football for the far-right Tea Party, who see any attempt to close the gaping holes in coverage as unacceptable government overreach.
The result has been that as of the beginning of 2014, more than 13% of Americans still have no health insurance coverage at all.
Germany ‘It gives patients a lot of choice’ by Philip Oltermann
Germany’s healthcare system is best understood as a middle option between the British state-run and the American market-led model. In principle, healthcare cover is universal, as in Britain: treatment of the unemployed is covered by the state, and ordinary patients rarely get presented with a bill after seeing a doctor.
Unlike in Britain, however, this universal care is not funded by a centrally collected tax, but by so-called Krankenkassen or sickness funds – a system that goes back all the way to Otto von Bismarck’s health insurance bill of 1883. Signing up with a sickness fund is compulsory for every German citizen. Once you have joined, you pay a premium calculated according to your income: half of it is paid by you, the other half by your employer. If you make less money, you pay less.
If you are lucky enough to have a career that makes you a lot of money – and this is where Germany veers towards the US model – you can choose to ignore one of the 131 public, non-profit sickness funds, and go with a private insurer instead. One advantage in comparison with the British system is that you don’t end up having to pay double – say, for Bupa and the NHS. In Germany, about 89% of the population is covered by public sickness funds, the remaining 11% are private.
One of the big plus points of the German system is that it gives patients a lot of choice: you are not restricted to the nearest general practitioner in your postcode but can sign up with any GP you like. GPs also have less of a gatekeeper function: if you know you have a back problem, you can go straight to see an osteopath.
Because the system is less centralised, doctors and nurses don’t have to stick to behavioural guidelines: for foreigners, some German doctors can come across as shockingly informal. “Practitioners enjoy a lot of freedom in Germany,” says Stefan Etgeton, a senior expert of the Bertelsmann Foundation. “But therein can also lie a problem: forcing through new medical standards can be arduous, because some doctors are convinced that their way of doing things is still best.”
In Germany, the healthcare system does not attract the same unholy combination of vitriol and affection that the NHS does – it just about works so that both the left and the free-marketeers can see in the system what they want. But that’s not to say that there aren’t problems eating away at the system.
For a start, the per-capita cost of healthcare has been much higher in Germany than in Britain for years. Most recent figures, from 2012, show the country spending 11.3% of its GDP on healthcare – 2% above the OECD average. “As a whole, the German system encourages overspending,” says Edzard Ernst, Exeter University’s German-born professor of complementary medicine. Doctors, who get charged per item, are incentivised to oversubscribe, and patients are incentivised to use the system more than in other countries.
There are also concerns about the long-term effects of the dual private-public system. One of the problems is that it provides an incentive for the best doctors to move to urban areas where there are more high earners who can afford private sickness funds. As a result, rural regions struggle. A public survey in 2012 showed 58% of the population supports scrapping private health insurance altogether.
What's happening in North Carolina is called "Moral Mondays" and those who are challenging the extraordinary right wing agenda, being forced through the state legislature, are taking pride in participating in civil disobedience.
I met a nurse educator in Washington DC who was delighted to tell me how she was arrested by the police the week before, because she participated in "Moral Monday".
Time Magazine reports July 1, 2013: By Elizabeth Dias@elizabethjdias Moral Mondays: Religious Progressives Protest North Carolina Policies
Almost every Monday since late April, hundreds of protestors have gathered at the North Carolina General Assembly in Raleigh to oppose the state’s budget cuts to unemployment benefits, healthcare funding, education, and other social benefits. Today, July 1, the “Moral Mondays” protest may break records: Thousands of people are expected, as it is the first Monday since the U.S. Supreme Court overturned parts of the Voting Rights Act and the day that some of the most severe state cuts go into effect.
Nearly 600 people have been arrested for civil disobedience in the Moral Mondays protests since they started on April 29. Last week’s protest alone drew 3,000 people, and 120 people were arrested. The protesters range from ministers to a 60-year-old seventh-grade teacher to college students to a Duke University historian (including my nurse educator).
Baptist churches host worship and prayer services before the protests begin, and regional Christian radio stations are starting to cover the protests.
Moral Monday protesters are liberal in bent, unhappy with the conservative policies their Republican-controlled legislature has enacted so far this year. A new law goes into effect Monday that pulls extended unemployment benefits from over 70,000 North Carolinians. The legislature opted out of the Affordable Care Act’s Medicaid expansion provision that would have covered an additional 500,000 people, and repealed the state’s earned income tax credit, which will now expire at the end of this year. It also appealed the Racial Justice Act, which allowed people on death row to argue that racial bias influenced their trial.
State Republican leaders have largely dismissed the Moral Mondays. Governor Pat McCrory waited five weeks before commenting about them, and then stated that he is not interested in meeting with the group, whom he called “outsiders” who were trying “to do to us what they did to Scott Walker in Wisconsin.” Republican State Senator Thom Goolsby dubbed the protests “Moron Mondays” in an op-ed for the Chatham Journal. He later said he was just joking. Police records indicate that 98% of people arrested are actually from North Carolina.
The man behind the Moral Mondays movement, Rev. William Barber II, president of the North Carolina NAACP and a Disciples of Christ minister, says he is undeterred. The Moral Mondays are the result of seven years of progressive organizing for a new Southern ‘fusion politics’—a new multi-ethnic, multi-religious coalition with an anti-racist, anti-poverty agenda. Their goal, he continues, is “to directly attack the old divisions of the white southern strategy and what we believe were the shortcomings of the so-called Christian evangelical right that limits issues in the public square to things like prayer in school, abortion, and gender issues.”
His goals are bigger than just changing policies and looking toward the 2014 election. Barber believes the South is in the middle of what he calls the “third reconstruction.” Changing demographics in America, and state battles over voting rights laws, he claims, echo both the first reconstruction, which was voting rights for African Americans after the civil war, and the second reconstruction, which was the Civil Rights movement. A new southern strategy must, he says, be “rooted in the idea of the deep moral issues about faith, our constitution, anti-racism, anti-poverty, that can break open the solid south and put holes in it so that we expand the electorate, we expand the discourse, we destroy the myth that when you hurt entitlements you only hurt certain folk.”
Barber, 49, sees North Carolina as a necessary test case. Republicans won both houses of the General Assembly in 2010 for the first time in more than a century, and the state that swung from President Obama in 2008 to Mitt Romney in 2012. “[Republicans] believe if they can get away with this in a progressive, southern state, then it pours water on the aspirations of the rest of the southern states,” Barber says. Barber has a masters degree from Duke Divinity School and a doctorate in Public Policy and Pastoral Care from Drew University, and he worked on Jesse Jackson’s 1984 presidential campaign.
Local Catholic, Episcopal, Lutheran, Presbyterian, and United Methodist leaders issued a joint statement in early June supporting the Moral Mondays purpose, if not their means of civil disobedience. Their concern, the faith leaders explain, is “not an act of political partisanship”—instead “it is a matter of faith with respect to our understanding of the biblical teachings and imperatives to protect the poor, respect the stranger, care for widows and children and love our neighbors (Isaiah 10:1‐2, Hebrews 13:2, James 1:27, Matthew 22:39, Galatians 5:14).”
Look at what's happening at home in North Carolina!
Many Americans are justifiably mesmerized by the scope of the massive street demonstrations broadcast out of Cairo, Egypt; but we haven't paid enough attention to the important civil disobedience happening in North Carolina.
Let's turn those television cameras from Cairo on ourselves. We can show the world how Americans are engaged in our own civil disobedience, trying to overturn a growing right wing movement that's intent on turning our nation into a self righteous theocracy, run by a group of elite right wing neo-conservatives (neocons).
North Carolinians are being politically run roughshod over by a right wing legislature who are voted into office because they control who votes and who can't. Residents are in living in a polarized political situation, especially Democrats and women, who dare to be seen challenging the bullies in the state's General Assembly. Moral Mondays are slowly providing some relief to those who disagree with the right wing agenda by drawing attention to the political posturing of the state's right wing extremists.
Egyptians might provide inspiration to North Carolinians who could declare a coup against their legislature, because they are overstepping their political power. By ramming a right wing agenda through the legislature, often without public input, they are, in fact, only representing a small group of extremists while ignoring the will of the people. Moral Mondays, like the Arab Spring street revolutions, should grow into a coup. Indeed, if that really happens, the impact will reverberate to other right wing minded states - Ohio, Wisconsin and Texas could be next.
Egypt's brave people showed extraordinary resilience during their facebook revolution, rising up against 30 years of governmental tyranny. Therefore, I hope the Egyptians will kindly accept my Zen advice knowing it is offered with extreme admiration. Zen Buddhism is not my specialty, but having watched the movie Charlie Wilson's War recently, the character played by the actor Philip Seymour Hoffman tells a story worth repeating here. His character warns Congressman Wilson about the Zen of winning a war.
I'm adapting the story to Egypt and it goes like this: "A young Egyptian boy gets a pony for his birthday. His village is so happy, they say 'isn't this good?'. But, the father says, 'We'll see'. So, later, the boy badly damages his leg when he falls off the pony. The village people say, 'this is not a good thing'. But the father says 'We'll see'. Then, Egypt goes to war with Israel in 1972, but the boy cannot serve because of his injured leg, so the village says 'this is a good thing'. But the father says, "We'll see". At the end of the story, the outcome of Charlie Wilson's War was not what he intended when he began his Congressional deal making. His victory was short lived. .....Moral of the story being ...."we'll see".
In other words, although the Egyptian people are justifiably exalted about their recent revolution to overturn a dictator, the unintended consequences and benefits are yet to be determined. To coin a sometimes overused cliche: "Freedom is Not Free". There may be a price yet to be paid for the people's victory....
Now, fast forward to June 2013:
Huge protests across Egypt calling for the resignation of President Mohammed Morsi have continued through the night, with sporadic outbreaks of violence.
In the capital, Cairo, tens of thousands of people have been massed in Tahrir Square and outside the presidential palace. They have vowed to stay on until Mr Morsi steps down.
At least one person was killed in clashes at Cairo's headquarters of the governing Muslim Brotherhood movement.
Four others died in clashes elsewhere.
Millions of protesters across the country accuse the country's first Islamist president of failing to tackle economic and security problems since taking power a year ago.
Cairo's Tahrir Square on Sunday saw the biggest demonstration since the 2011 revolution which ousted President Hosni Mubarak.
Egyptians, Syrians and other Middle East countries struggling with their Pandora's Box of issues, unleashed by the Arab Spring, have yet to embrace an inspired leader who can move them forward.
Therefore, these Arab Spring nations will remain in a perpetual state of "Egyptian Zen" until they can see their way forward.
There seems no end to the street violence and revolution now flooding through the Middle East like a tsunami.
Inspired leadership is urgent. Egypt needs leaders like the strong and iconic Pharaohs. Otherwise, the nation where the roots of Western Civilization began, risks being absorbed by a massive dust storm and the Arab Spring will be as arid as the Sahara Desert.
Egypt's brave people showed extraordinary resilience during their facebook revolution, rising up against 30 years of governmental tyranny. Therefore, I hope the Egyptians will kindly accept my Zen advice knowing it is offered with extreme admiration.
Zen Buddhism is not my specialty, but having watched the movie Charlie Wilson's War recently, the character played by the actor Philip Seymour Hoffman tells a story worth repeating here. His character warns Congressman Wilson about the Zen of winning a war. I'm adapting the story to Egypt and it goes something like this:
"A young Egyptian boy gets a pony for his birthday. His village is so happy, they say 'isn't this good?'. But, the father says, 'We'll see'. So, later, the boy badly damages his leg when he falls off the pony. The village people say, 'this is not a good thing'. But the father says 'We'll see'. Then, Egypt goes to war with Israel in 1972, but the boy cannot serve because of his injured leg, so the village says 'this is a good thing'. But the father says, "We'll see". At the end of the story, the outcome of Charlie Wilson's War was not what he intended when he began his Congressional deal making. His victory was short lived.
In other words, although the Egyptian people are justifiably exalted about their recent revolution to overturn a dictator, the unintended consequences and benefits are yet to be determined. To coin a sometimes overused cliche: "Freedom is Not Free". There may be a price yet to be paid for the people's victory.
Facebook gets credit for providing the matrix to fuel the people's demonstrations against President Hosni Mubarak; but it was the dictator himself and his autocratic rule that caused the Egyptian revolution.
The Middle East is now a tinder box as a result of two back to back revolutions fueled by the power of social networking media - Tunesia and then Egypt. Two revolutions will cause a physics-lab type of equal and opposite reaction on the part of other Middle Eastern dictators, of which there are apparantly several.
In the Zen philosophy, facts are not necessarily what they seem.
Egypt's euphoria may be short lived. "We'll see".
