Taking Note

Health Care in Singapore

It’s always worth exploring how health care works in other countries, if for no other reason than that models in other countries give us the chance to see how some of the approaches discussed by American reformers might pan out. What do the experiences of Germany and Netherlands tell us about the possibility of a better mixed public-private system in the United States? How is China’s health care system a cautionary tale of market forces gone wild? The answer to these questions can add to—or detract from—the appeal of certain health care strategies in the U.S.

It’s hard to imagine a country that could provide a more valuable example than Singapore. The Southeast Asian city-state is widely regarded as a health care superstar, especially when compared to the United States. Life expectancy at birth in the U.S. is 78 years; in Singapore, it’s 82 years. The Singaporean infant mortality rate is a mere 2.3 deaths per 1,000 live births, versus 6.4 in the U.S. As some have noted, these trends persist despite the fact that the U.S. has far more caregivers: 2.6 physicians per 1,000 people, compared with 1.4 physicians in Singapore. The United States has 9.4 nurses per 1,000 people; Singapore, just 4.2. Last—but certainly not least—is the issue of spending: the U.S. spends almost 16 percent of its GDP on health care, while Singapore spends a mere 3.7 percent. 

Is It About the Money?

Continuing our series of video highlights from the "Billionaires and Their Impact" conference held  at The Century Foundation offices earlier this summer, today we bring you comments from Gary Rivlin. Gary is a long-time contributor to The New York Times and has done a lot of work, both through the Times and in books like The Godfather of Silicon Valley, on Silicon Valley's wealth boom.

Speaking on our "Envy Economy" panel, which looked at the anxieties and insecurities of today's millionaires and billionaires, Rivlin spoke a little about how he discovered such a thing as "the working class millionaire"--and about how, sometimes, money's just not enough to buy happiness. Click the image below to see more from Gary.

Rating Health Care Performance

The ever-insightful Commonwealth Fund has just released its 2008 National Scorecard on Health System Performance, and reports that “the U.S. health system continues to fall far short of what is attainable, especially given the resources invested. Across 37 core indicators of performance, the U.S. achieves an overall score of 65 out of a possible 100 when comparing national averages with U.S. and international performance benchmarks.” According to Commonwealth’s metrics, overall performance has not improved since 2006.

A Note About Images

The splashy political images of mid-summer came from Barack Obama’s triumphal trip to Afghanistan, Iraq, Israel, and Europe, beamed back to us to be viewed on television, in news photographs, and in various formats on the Internet. But last week I was taken by different imagery, from Europe, echoes of another time.

The arrest of Radovan Karadzic, the hirsute former leader of the Bosnian Serbs, revived memories of the 1990s Balkan wars, especially the massacres of 8,000 men and boys at Srebrenica in 1995, for which Karadizic has been charged with murder by the International Criminal Tribunal for the former Yugoslavia in The Hague. The cruelty again being displayed from those wars is appalling and yet one of the most striking aspects of the video clips and photographs is how faded the period and its imagery now feels. After all, these were brutal conflicts on the European mainland in which vast numbers of civilians—as many as 250,000 by some accounts—were killed and millions of people were displaced. These were wars, which ended barely more than a decade ago, on a scale comparable to Iraq and Afghanistan.

Pitiful Bounty

Oil Survey Says Arctic Has Riches headlines the New York Times. No less an authority than the U.S. Geological Survey estimates that as much as a fifth of the world’s yet-to-be-discovered oil and natural gas reserves lie north of the Arctic Circle.

So maybe Bush and McCain are right. Maybe we are nuts not to go after this bounty. Can we afford to let 90 billion barrels of oil and 1,670 trillion cubic feet of gas just lie there under the tundra and the sea while we suffer an energy price explosion?

Well, certainly we can let them lie. In fact, it makes every kind of sense to choose to let them lie as we turn our attention to other options.

The Envy Economy, Part II

In my last post on our June "Billionaires and Their Impact" conference, I touched on the mindset of today's richest Americans: namely, their anxiety and envy. Robert Frank, a reporter for the Wall Street Journal and author of  Richistan: A Journey Through the American Wealth Boom, spoke about these sentiments--which he observed first-hand by immersing himself in the world of today's mega-rich--at last month's conference.

The big questions that Frank tackles are: When do the rich feel rich enough? And, perhaps more importantly, what does the reality of being rich teach us about the fantasy of being rich? Maybe being rich isn't all it's cracked up to be...

Part II of his comments follows below.

Can School Integration Work in the Cities?

Emily Bazelon's terrific New York Times Magazine article on the benefits of economically and racially integrated schools in Jefferson County (Louisville), Kentucky and Wake County (Raleigh), North Carolina, has led some liberal bloggers to bemoan the fact that this type of policy "won't work" in urban areas.  Kevin Drum at the Washington Monthly argues "there is no plausible way to reduce concentrated poverty in our biggest school districts" while Matthew Yglesias at The Atlantic says "an extremely large proportion of poor and minority students live in places where you couldn't possibly make this work."

In fact, however, the picture is hardly so grim.  A couple of facts:

The Platform: Saving the Neighborhood Bookstore

In the early morning of July 4, a fire broke out in the basement of Café Moxie, a popular restaurant in Vineyard Haven, Massachusetts, on Martha’s Vineyard, destroying the building and severely damaging the adjoining Bunch of Grapes bookstore next door. The store, owned by the Nelson family for almost thirty years, was piled high with inventory in anticipation of the summer season. Nearly everything was ruined, and it will be months before insurance, construction, and recovered spirits get the store back in shape. A week later, the acrid smell had finally cleared and the rest of Main Street—the galleries, movie theater, an inn, and some shops—seemed ready again for comers, yet the street was nonetheless forlorn. Bunch of Grapes was much more than a commercial anchor. It was, by all accounts, the soul of the thoroughfare.    

Are They Ever Rich Enough?

There's no shortage of statistics and data points you can point to in order to highlight the New Gilded Age in which we live: the top one percent almost doubling their share of the national income since the 1970s, for example, or the near flat-lining of wage growth for the average worker during this same period.

But perhaps just as telling as economic data is psychological data: just what do people think about wealth nowadays? More to the point, how do the rich view being rich? In times of relative equality, you'd expect rich folk and average Joes to have a similar set of worries. But as most of us increasingly worry about unstable incomes, high gas prices, and soaring health care expenses, America's super-rich--those who make about $10 million a year--are worried about...buying golf courses?

It’s Time to Go

Conservatives insist that winning the war in Iraq is central to achieving success in the fight against terrorism and that we must therefore stay in Iraq as long as necessary to win the war. On this, as with so many other policies advocated by today’s conservatives, the public has a completely different viewpoint.

Take how winning the war fits into the fight against terrorism. In the just released ABC News/Washington Post poll, only about a third of Americans think the United States needs to win the Iraq war “in order for the broader war against terrorism to be a success,” compared to 60 percent who think the war against terrorism can succeed without victory in Iraq.