Politik

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Viktiga amarikanska data om den ineffektiva amerikanska privata sjukvården

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Paul Krugman, ekonomiprofessor vid Princeton i delstaten New Jersey har en utomordentligt viktig artikel i New York Times som borde ge de flesta svenskar en riktig tankeställare. Det visar sig nämligen att privatsjukvård, tvärt emot vad SvD just i dessa dagar förespråkar är ***mindre effektivt *** än den socialistiska sjukvården i bl.a. Frankrike.
Jag har inte de svenska siffrorna, men någon vänlig läsare kanske kan hitta dom.
Innan Sverige jublande inför privat sjukvård enligt amerikanskt mönster, vore det inte en bra ide att först kolla med ekonomer som Krugman? Privat sjukvård enligt amerikansk modell skulle bli förödande för Sverige. Alltså, den amerikanska privatsjukvården är mindre effektiv och alltså betydligt mer kostsam per kapita än mycket av den “socialistiska” europeiska och kanadensiska sjukvården.

Det är mycket farligt att den svenska synen på USA idags ägs av moderater och folkpartister som använder USA för att propagera för en ofta helt felaktig bild av USA.


Working Americans have two great concerns: the growing difficulty of getting health insurance, and the continuing difficulty they have in finding jobs. These concerns may have a common cause: soaring insurance premiums.

In most advanced countries, the government provides everyone with health insurance. In America, however, the government offers insurance only if you’re elderly (Medicare) or poor (Medicaid). Otherwise, you’re expected to get private health insurance, usually through your job. But insurance premiums are exploding, and the system of employment-linked insurance is falling apart.

Some employers have dropped their health plans. Others have maintained benefits for current workers, but are finding ways to avoid paying benefits to new hires – for example, by using temporary workers. And some businesses, while continuing to provide health benefits, are refusing to hire more workers.

In other words, rising health care costs aren’t just causing a rapid rise in the ranks of the uninsured (confirmed by yesterday’s Census Bureau report); they’re also, because of their link to employment, a major reason why this economic recovery has generated fewer jobs than any previous economic expansion.

Clearly, health care reform is an urgent social and economic issue. …

The fact is that the mainly private U.S. health care system spends far more than the mainly public health care systems of other advanced countries, but gets worse results. In 2001, we spent $4,887 on health care per capita, compared with $2,792 in Canada and $2,561 in France. Yet the U.S. does worse than either country by any measure of health care success you care to name – life expectancy, infant mortality, whatever. (At its best, U.S. health care is the best in the world. But the ranks of Americans who can’t afford the best, and may have no insurance at all, are large and growing.)

And the U.S. system does have very high overhead: private insurers and H.M.O.’s spend much more on administrative expenses, as opposed to actual medical treatment, than public agencies at home or abroad.

Does this mean that the American way is wrong, and that we should switch to a Canadian-style single-payer system? Well, yes. Put it this way: in Canada, respectable business executives are ardent defenders of “socialized medicine.” Two years ago the Conference Board of Canada – a who’s who of the nation’s corporate elite – issued a report urging fellow Canadians to bear in mind not just the “symbolic value” of universal health care, but its “economic contribution to the competitiveness of Canadian businesses.”

Bra Pentagon-sajt som visar USAs alla styrkor runtom i världen

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Bra Pentagonsajt som visar USAs styrkor världen över. Det här är en mycket intressant sajt som bl.a. visar att Pentagon faktiskt har tio soldater stationerade i Sverige. Antagligen knutna till ambassaden.

Vi kan också se att det fanns 211.000 amerikanska soldater i Irak den 31 mars, utav ett totalt antal av 1.4 miljoner. Däremot står det inte hur många soldater som finns i Afganistan, siffran är “inte tillgänglig” vilket visar hur känsliga operationerna där är.

Man kan också utläsa en del intressanta detaljer. Som att det finns 205 soldater i Australien, många av dem antagligen knutna till radioavlyssning, liksom de 85 i Norge och de 138 på Grönland. Diego Garcia-basens stora vikt framkommer också av att där finns hela 491 soldater. Och att fängelset i Guantanamo är viktigt framkommer av att garnisonen där är 700 mannar stark. För ett år sedan var den bara 640 man stark.

DN om Stonewall Jackson och religiös fanatism

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Det är inte var dag som man möter den gamle sydstatsgeneralen Stonewall Jackson i dagens svenska press. Men DN drar i alla fall fram honom på ledarplats som ett exempel på hur religion kan motivera till stordåd. Att Jacksons förmenta stordåd utfördes för att de svarta i sydstaterna skulle hållas som slavar nämns inte i ledaren. Jackson var en man av sin tid, och hans religion var av ett helt annat slag än den som dagens amerikanska officerare tror på. Jag tror själv inte alls att hans framgångar på slagfältet hade mycket med hans religion att göra. Jackson var en skicklig general, punkt och slut. Ulysses S. Grant var en betydligt mer framgångrik general i samma krig som inte alls var religiös. Och att nordstatsarmen var mindre motiverad än sydstatsarmen finns det vad jag vet inget som helst belägg för.

Hitlers arme var betydligt mer motiverad än den franska i andra världskrigets startskede. Knappast ett tecken på att den tyska armen var religïös. 1945 var situationen den omvända

Men visst kan religion motivera till våldsdåd. Bättre exempel i dag vore kanske om DN drog fram bin Laden och Nord Irland.

Det vore intressant att se om DN också skulle kalla bin Laden eller varför inte Muqtada el Sadr “dristig” , se nedan:


Den dristige sydstatsgeneralen Stonewall Jackson anses allmänt ha spelat en stor roll i det amerikanska inbördeskriget på 1860-talet. I slag efter slag överlistade han numerärt och materiellt överlägsna nordstatsarméer.

Vad var hemligheten bakom hans framgångar? Frans G Bengtsson kommer sannolikt nära i sin klassiska essäsamling “Litteratörer och militärer”:

“I sin bergfasta förvissning att leva omedelbart under Guds hand var han alltid i stånd att med fullkomligaste sinneslugn ta på sig ansvar av vilken art och vilken storlek som helst; han tvekade aldrig, misströstade aldrig, tvivlade inte ett ögonblick på att planerade företag kunde genomföras, hur desperat situationen än kunde te sig…”

Stonewall Jackson är bara ett av många exempel i historien på att tron i sig själv kan vara lika viktig som vad man tror på. Även om sydstaternas sak var dömd på sikt lyckades Stonewall Jackson inspirera sig själv och sina soldater till militära stordåd gentemot de mindre motiverade unionsarméerna.

Washington Post om de allvarliga tekniska problemen i USAs valsystem

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Dagens Washington Post har en artikel om de mycket allvarliga tekniska problem som existerar i USAs valsystem. En avsevärd del av de som röstar på valdagen får helt enkelt inte sina valsedlar räknade, trots att de har lämnat in helt giltiga röstsedlar:

washingtonpost.com
Lost Votes in N.M. a Cautionary Tale
As Election Day Nears, a Look at Problems in 2000 Shows Fallibility of Machines

By Dan Keating
Washington Post Staff Writer
Sunday, August 22, 2004; Page A05

ESPAÑOLA, N.M. — Four years ago, about 2,300 voters traveled the winding roads through this remote county to cast their ballots before Election Day on state-of-the-art, push-button electronic voting machines. For 678 of them, their votes were never recorded.

Vice President Al Gore won this state by 366 votes. Even if the missing votes had gone for George W. Bush and given him New Mexico’s five electoral votes, it would not have changed the outcome of the presidential race.

But the missing votes in Rio Arriba County show that even in the finest electronic voting systems — New Mexico holds itself out as a leader after a decade of experience — serious miscounts that could sway elections can occur if the computerized machines are not correctly programmed.

With many states making moves to electronic voting machines this year, critics of the new technology say it is fraught with the potential for fraud. But what happened in Rio Arriba County shows what some computer experts say is a far more pressing concern: mistakes in computer programming by inexperienced local election staffs.

The Washington Post examined the voting results here because New Mexico had the narrowest winning margin in the presidential contest, and Rio Arriba County had the largest percentage of voters who had no presidential vote. The review discovered that 203 voters turned out in one of Rio Arriba’s voting districts, but the state’s certified results show “0” votes were recorded for Gore or Bush. The same was true for the U.S. Senate and House candidates. In another district, two-thirds of those who voted in the month before Election Day — early voting is allowed in New Mexico — had no votes recorded in any races. Steve Fresquez, a state computer technician who oversaw vote counts for Rio Arriba County, said the electronic machines had been programmed incorrectly for early voters, but it was not discovered until days after the election.

“It was such a mess, but there was nothing we could do about it because it was over. It was too late. The election had already gone through,” Fresquez said. When it came to reporting the results, “we allowed the county to do the best they could and, as you can see, it wasn’t too good.”

In the months after the disputed 2000 presidential vote in Florida, which was marred by “hanging chads” and other problems with paper ballots, advocates of electronic voting machines said computerized systems would end concerns about the accuracy of ballots.

A number of states, including Maryland and Georgia, have moved to such systems, spending tens of millions of dollars.

Critics have said the machines are not perfect and are subject to deliberate tampering, but the experience in Rio Arriba County shows that simple, benign mistakes in programming can lead to results being wildly off.

Mistakes are likely to arise when thousands of small counties nationwide program ballots for multiple districts with dozens of races in each election, said Steve Ansolabehere, a political scientist at the Massachusetts Institute of Technology who is participating in the CalTech-MIT Voting Technology Project. “That is the Number 1 problem with electronic voting: the programming for each election,” he said. “These offices in rural areas do not have the staff with the kind of technical expertise necessary to do electronic voting.”

The need for better training of local workers and volunteers is one point on which supporters and opponents of electronic voting agree. Several states, the federal government and think tanks all say that undertrained workers are the weakest link.

“You can spend all the money you want to spend on technology and you’re still not going to get better elections,” said William F. Welsh, board member and former chairman of Election Systems & Software, one of the industry’s biggest companies.

About 90 percent of New Mexico’s voters cast their ballots electronically. Rio Arriba County sits on the state’s northern border and features a mile-high valley between two plateaus, with purple mountains in the distance. It has a population of just more than 40,000 spread across an area almost half the size of Maryland. It takes 2 1/2 hours to drive from one end of the county to another — from some pueblos, driving to a polling place requires following a road into Colorado and back.

Because of those distances, County Clerk Fred Vigil encourages voting during the month before the election on the push-button electronic voting equipment used here for a decade.

Neither Vigil nor state elections director Denise Lamb remembered problems in Rio Arriba when asked about them for The Post’s review. They referred questions to Fresquez, who said he remembered the problem well.

Rio Arriba County has three voting districts — the candidates for state legislature in each are different — but for early voters the county used just one ballot listing the names of all the candidates.

“There was no way we could get the correct votes because that was how they programmed the machine,” Fresquez said.

Fresquez said the county had only two early-voting locations. Rather than programming separate machines at each location for the county’s different voting districts, Rio Arriba tried to program one machine to cover all the districts. “They were trying to use less machines,” he said. “They thought they could put it all on one ballot. They were not aware of” any problem.

Still, he and Lamb said they thought the error did not mean votes were really lost. Rather, they said it was likely the votes in one or two districts were credited to the totals of another district.

That outcome does not appear to square with tallies from the county’s three election districts. In one district, none of the 203 ballots cast were recorded for Bush or Gore. In another, 188 of the 569 voters cast a presidential vote. The third district had a more typical pattern, with 1,500 of the 1,594 voters recording a presidential choice.

New Mexico is the only state to have an elaborate, three-step audit process of voting results. Precinct results are checked by the county and state and then by a certified public accounting firm. The federal Election Assistance Commission, established after the 2000 Florida recount to help states establish new voting systems, has cited the audit as a “best practice” to be used elsewhere.

Lamb testified to the commission that the “triple audit” would alert the state to problems with the electronic voting machines. Fresquez’s work on Rio Arriba’s results did uncover the programming error. But it was never publicized.

In fact, the audit could show only that the programming error occurred. There was no way to recount the missed votes. They were simply gone.

Mistakes with new computer technology leave election officials with no recourse, said electronic voting critic Avi Ruben of Johns Hopkins University.

The outcome of a close presidential election could hinge on votes that cannot be reconstructed. “What are we going to do?” he asked. “Do we throw our hands up on a national scale and say ‘We messed up’?”

© 2004 The Washington Post Company