| Industry | Total |
|---|---|
| Pharmaceuticals/Health Products | $1,439,270,440 |
| Insurance | $1,096,146,248 |
| Electric Utilities | $985,473,737 |
| Computers/Internet | $807,596,171 |
| Business Associations | $742,441,001 |
| Education | $710,172,651 |
| Real Estate | $684,320,914 |
| Oil & Gas | $665,862,779 |
| Hospitals/Nursing Homes | $636,486,478 |
| Misc Manufacturing & Distributing | $601,216,686 |
| Health Professionals | $595,967,644 |
| Civil Servants/Public Officials | $557,877,331 |
| Securities & Investment | $551,384,250 |
| TV/Movies/Music | $537,846,140 |
| Automotive | $517,182,511 |
| Air Transport | $516,051,886 |
| Misc Issues | $501,304,008 |
| Telecom Services & Equipment | $492,172,866 |
| Telephone Utilities | $418,847,626 |
| Defense Aerospace | $400,824,698 |
Most Patients Happy With German Health Care
Listen Now [8 min 56 sec]
Correction: In an interview, we said, "And when Germany became a nation in the 1880s, one of the first big things that the government did was to unite all of these what they call sickness funds into one system." In fact, Germany became a nation in 1871.
Chris Ertl is self-employed, so he cannot be covered under his wife's health care plan. Their two children are covered under Ertl's wife's insurance.
Compare Medical Bills
Compare Health Care Systems
The United States spends on average $6,402 per person annually on medical care. France spends about half that — while providing better maternity benefits and complete coverage for people with conditions such as diabetes and cancer. Compare the systems.
Chris Ertl owns Tip Toe Shoes, a store for children. He is one of 10 percent of German residents who has private health insurance.
As an American living in Germany, Sabina Casagrandes, seen here with her daughter Eva, has experienced health care under both systems.
Nicole Ertl says she's relatively happy with her health care coverage in Germany. But, she says, it bothers her that her husband, who has coverage through a private company, gets to go to the front of the line at the doctor's office and can see any physician he chooses.
Morning Edition, July 3, 2008 · Mention European health care to an American, and it probably conjures up a negative stereotype — high taxes, long waiting lines, rationed care.
It's not that way in Germany. Very little tax money goes into the system. The lion's share comes, as in America, from premiums paid by workers and employers to insurance companies.
German health benefits are very generous. And there's usually little or no wait to get elective surgery or diagnostic tests, such as MRIs. It's one of the world's best health care systems, visible in little ways that most Germans take for granted.
Checking In With An Old Friend
Juergen in der Schmitten was a medical student when I first met him 17 years ago. Now, he's a 42-year-old general practitioner in a suburb of Dusseldorf.
On one particular night, Juergen was the doctor on call for the region. Any German who needs after-hours care can call a central number and get connected to a doctor.
Around 11 p.m., a woman with a fever called Juergen. She wanted him to make a house call. They talked for maybe five minutes, in the end agreeing that she would come into his office in the morning.
A situation like this would be unlikely in the United States. Americans might not get through to a doctor at all, let alone have a discussion about whether the physician should make a house call in the middle of the night to treat a case of flu.
The Patients' Perspective
Sabina and Jan Casagrandes say they've had really good care from the German health system. And they've used it a lot.
Sabina is American, Jan is German. They live in a fourth-floor walkup with their two little girls in Cologne, an ancient city on the Rhine in western Germany.
"I've probably been very expensive for the health insurance system here," Sabina says. "When I was 33 years old, I had a giant lump on my neck all of a sudden, where your thyroid is. And it was a big tumor."
It took two operations to remove her cancer. Luckily it was curable with surgery and radiation. Sabina says she had the best care she could imagine.
"Then I came home to my little daughter, who I couldn't really lift up because of my neck having been cut open," Sabina says. "So I asked my doctor, 'What can I do?' And she said, 'Well, your health insurance will pay for someone to come help you in the house.'"
Sabina's health insurer paid a friend to shop, cook and even help care for the baby until Sabina was back on her feet. That's not unusual in Germany. In fact, under the country's system for long-term care, family members can choose to be paid for taking care of a frail elder at home if they want to avoid nursing home care.
Coverage For All
The health care system that took such good care of Sabina is not funded by government taxes. But it is compulsory. All German workers pay about 8 percent of their gross income to a nonprofit insurance company called a sickness fund. Their employers pay about the same amount. Workers can choose among 240 sickness funds.
Basing premiums on a percentage-of-salary means that the less people make, the less they have to pay. The more money they make, the more they pay. This principle is at the heart of the system. Germans call it "solidarity." The idea is that everybody's in it together, and nobody should be without health insurance.
"If I don't make a lot of money, I don't have to pay a lot of money for health insurance," Sabina says. "But I have the same access to health care that someone who makes more money has."
But she acknowledges that nearly 8 percent of her salary is a sizable bite.
"Yes, it's expensive. You know, it's a big chunk of your monthly income," Sabina says. "But considering what you can get for it, it's worth it."
Actually, it's about the same proportion of income that American workers pay, on average, if they get their health insurance through their job. The big difference is that U.S. employers pay far more, on average, than German employers do — 18 percent of each employee's gross income versus around 8 percent in Germany.
More Added Benefits In Germany
Moreover, German health insurance has more generous benefits than U.S. policies cover. There are never any deductibles, for instance, before coverage kicks in. And all Germans get the same coverage.
For instance, the Casagrandes' insurance covers an expensive medicine Jan needs for a chronic intestinal problem. He says if they moved to America, they might not be able to buy insurance at all because of their pre-existing conditions — a nonproblem in Germany.
"He says for himself — or for us — the health care system in the United States is the major reason why we have never moved there, and never will move there. Because both of us have chronic illnesses that have to have a lot of medical attention, and we would go broke," Sabina says, translating for Jan.
Jan adds something else. "It's also the No. 1 reason in the United States that people personally go bankrupt," Sabina translates, "which would never happen here ... never!"
Coverage For The Family
On the other side of Germany, in Berlin, we meet another couple who know both the American and German health systems.
Nicole and Chris Ertl own Tip Toe Shoes, a children's shoe shop in a well-off area of the German capital. The Ertls sell high-quality European shoes — tiny Italian sandals, French and Danish boots and clogs in wonderful colors.
Chris is from San Diego, Nicole is German. She also works part time as a physician therapist and gets her health care through her job like the great majority of Germans. Like the Casagrandes, she's happy with her coverage.
"It's a good deal!" she says. "It's really good because it's a package."
It's a package many Americans might envy. Nicole pays a premium of $270 a month for insurance that covers her children, too. Nicole pays a single $15 copayment once every three months to see her primary-care doctor — and another $15 a quarter to see each specialist, as often as she wants. She pays no copayments for her children's care —-and her insurance even covers her daughter's orthodontia bill.
"They always have good care," Nicole says, "because for kids, everything is free. The drugs, it's always free" until they turn 18.
Different Rules For The Self-Employed
But even though her insurance covers the kids, it doesn't cover her husband. Because Chris Ertl is self-employed, he has to buy insurance on his own, from a for-profit insurance company.
About one in 10 Germans buy this so-called "private" coverage. It's not just for people who are self-employed. Civil servants and anyone who makes more than $72,000 a year can opt out of the main system. It's a kind of safety valve for people who want more and can pay for it.
But most people don't opt out. Chris says that's because there's a fundamental difference in the way Germans view health care and the government's role — which, in Germany, means refereeing the system and making sure it's fair and affordable.
"The general opinion in Germany is always that the government will do it for us, everything will be OK," Chris says. "In the States, I think you grow up knowing that no one's going to help you do anything. If you want health care, go get it."
It's important to remember that the German government doesn't provide health care or finance it directly. It does regulate insurance companies closely — the nonprofits in the main system and the for-profits where Chris gets his coverage. So Chris' insurer can't raise his rates if he gets sick or jack up his premiums too much as he gets older. The government also requires insurers to keep costs down so things don't get too expensive.
"Where am I better off medically?" Chris says. "I would probably say Germany."
In some ways, Chis Ertl's coverage is better than his wife's. He gets his choice of top doctors — the chief of medicine, if he wants. If he goes into the hospital, he gets a private room. When he goes to the doctor, he gets a free cup of coffee and goes to the head of the line. All this embarrasses him — and annoys Nicole.
"When he goes to the doctor, he has a lot more service," she complains.
Germans really hate any hint of unfairness in health care. The fundamental idea is that everybody must be covered and, preferably, everybody should get equal treatment. So the fact that 10 percent or so can buy some perks is an irritant — something Germans complain about but manage to put up with.
But it's unthinkable that 48 million people wouldn't have health insurance at all — the situation in America. As an American, Chris thinks that's shameful. "It's terrible," he says. "It's unbelievable. It shouldn't happen."
Germans, he says, would never tolerate that. And their system has been working pretty well for 125 years.
Radio piece produced by Jane Greenhalgh.
Obama Tax Proposals Historically Sound
Steven McDevitt
Posted August 15, 2008I've been thinking about this Wall Street Journal article ("Their
Fair Share") since I read it. It seems to be very convincing. However, when you view economic policy through a Keynesian vs. Chicago School paradigm you find that Barack Obama's tax proposals contain historically heavyweight arguments.
The article led me to do some quick, light reading on the whole Keynesian-Chicago economic split and I found some interesting things. Granted, I know the danger of laying history on top of contemporary events and saying, "Eureka!" But, I will say there are some interesting parallels. And, of course, much of the argument between the two schools is on theory, not on practical policy issues, but much of what they were discussing is still applicable to the current campaign and/or larger scope of US Economic Policy.
The Keynesians enjoyed heavy influence in the United States Government, post World War II, particularly under President Franklin D. Roosevelt. They advocated heavy government spending with a decrease in tax rates across the board. Their idea was that government needed to incur heavy deficits in order to prop up economic institutions that would spur economic growth (i.e., Public Works Projects, Fannie and Freddie, etc., as well as War Production).
The cut in taxes was necessary so that once the public works programs began to run soundly and provided jobs for people they would have that income in-pocket and would then have the purchasing power necessary to drive new investing. The increase in personal income would make up for the deficit in the long run because, although the government would be taxing at a lower rate, the increased domestic wealth spread out amongst many individuals would generate more revenue than the previous taxing structure.
I found this long quote from Marriner Eccles, FDR's Chairman of the Fed:
"As mass production has to be accompanied by mass consumption; mass consumption, in turn, implies a distribution of wealth -- not of existing wealth, but of wealth as it is currently produced -- to provide men with buying power equal to the amount of goods and services offered by the nation's economic machinery. Instead of achieving that kind of distribution, a giant suction pump had by 1929-30 drawn into a few hands an increasing portion of currently produced wealth. This served them as capital accumulations. But by taking purchasing power out of the hands of mass consumers, the savers denied to themselves the kind of effective demand for their products that would justify a reinvestment of their capital accumulations in new plants. In consequence, as in a poker game where the chips were concentrated in fewer and fewer hands, the other fellows could stay in the game only by borrowing. When their credit ran out, the game stopped.
That is what happened to us in the twenties. We sustained high levels of employment in that period with the aid of an exceptional expansion of debt outside of the banking system. This debt was provided by the large growth of business savings as well as savings by individuals, particularly in the upper-income groups where taxes were relatively low. Private debt outside of the banking system increased about fifty per cent. This debt, which was at high interest rates, largely took the form of mortgage debt on housing, office, and hotel structures, consumer installment debt, brokers' loans and foreign debt.
The stimulation to spending by debt-creation of this sort was short lived and could not be counted on to sustain high levels of employment for long periods of time. Had there been a better distribution of the current income from the national product -- in other words, had there been less savings by business and the higher-income groups and more income in the lower groups -- we should have had far greater stability in our economy. Had the six billion dollars, for instance, that were loaned by corporations and wealthy individuals for stock-market speculation been distributed to the public as lower prices or higher wages and with less profits to the corporations and the well-to-do, it would have prevented or greatly moderated the economic collapse that began at the end of 1929.
The time came when there were no more poker chips to be loaned on credit. Debtors were forced to curtail their consumption in an effort to create a margin that could be applied to the reduction of outstanding debts. This naturally reduced the demand for goods of all kinds and brought on what seemed to be overproduction, but what was in reality under-consumption when judged in terms of the real world instead of the money world. This, in turn, brought about a fall in prices and employment.
Unemployment further decreased the consumption of goods, which further increased unemployment, thus closing the circle in a continuing decline of prices. Earnings began to disappear which required economies of all kinds in the wages, salaries, and time of those employed. And, thus again, the vicious circle of deflation was closed until one third of the entire working population was unemployed with our national income reduced by fifty percent. The aggregate debt burden was greater than ever before, not in dollars but measured by current values and income that represented the ability to pay. Fixed charges such as taxes, railroad and other utility rates, and insurance and interest charges clung close to the 1929 level and required such a portion of the national income to meet them that the amount left for consumption of goods was not sufficient to support the population.
This then, was my reading of what brought on the depression."
The Chicago School, in opposition to the Keynesians, gained influence in the 1950s and 60s under neoliberalism and then changed their mode in the 1980s to monetarism. They generally advocated laissez-faire economics. Milton Friedman is perhaps the most famous of the Chicago schoolers. He argued that less government intrusion in economic policy was best because active monetarism (easy credit) and fiscal (tax and spend, i.e. PAYGO) policy was detrimental to the money supply. A naturally expanding money supply, to Friedman, was the most important thing. If a country's money supply was to grow organically it theoretically would reduce the causes of inflation and devaluation of currencies.
Now how do I get all of the above information into an argument about tax policy? First, I find great wisdom in what Mr. Eccles says to initiate his quote, "As mass production has to be accompanied by mass consumption; mass consumption, in turn, implies a distribution of wealth...to provide men with buying power equal to the amount of goods and services offered by the nation's economic machinery."
I think we are seeing the negative of this statement playing out now. Much has been written not only of the housing crisis and a credit crunch for investment banks but also much has been written about the increasing level of credit usage by average consumers. I think Eccles' reference to a poker game is very apt -- only right now there are very few additional chips to buy for the average American. (There will be fewer and fewer "chips" as the government continues to borrow at the ridiculous rate it has under the Bush tax policy. Record deficits and debt leaves less and less available financing for private borrowing.--java BTW: printing more money has simply reduced the value of our currency.) Not only that, but while credit is running out and average Americans are more indebted (therefore have very limited discretionary funds) their dollars are being devalued by a previous era of active monetarism by the Federal Government (i.e., their focus was on how to make credit easily available).
Now, the arguments against tax hikes is that increased tax rates on high-net individuals -- through income tax rates and capital gains -- will lower re-investment. And that may be true but I think it may be good to stop and consider what those people would be investing in. Is there enough buying power in the middle class for these investments to be successful, profitable, and contributing towards an overall growth of the economy? I believe this is a serious question investors must ask themselves. (The obvious must be stated here. The money will find it's way to the top eventually as consumers spend on goods and services. There will be profit. This can only happen if the American consumer is healthy and has discretionary income with which to purchase and save. Give money to the poor and they have no choice but to spend it on essentials. Give money to the rich and, without tax incentives, it will be invested or spent without regard to economic growth or employment.--java)
As for the taxation part, currently the income gap is the widest it has been since 1928 right before the Great Depression. Under the Obama plan, the Bush tax cuts for those in the middle class will actually be extended and actually offer a further cut while the Bush tax cuts for those in the top income bracket (the top 1% of earners) would expire. Those same folks, the top 1%, will also see a rise in terms of capital gains.
The point here is that taxes for the middle and lower class, the consumer class if you would, will decrease -- putting more discretionary funds in-pocket. Those in the highest tax bracket will be asked to endure a slight increase in rates (no higher than they were under Clinton) in order to make up the revenue lost in giving the middle class cuts. The argument here is that more Americans will have money to spend and will increase the dividend yields on stocks because the stock index will rise due to rising corporate sales and profits. This, Obama argues, is the best way to incentivize investing -- make it more profitable than the current conditions.
Essentially, this is government run wealth redistribution. Many people may disagree with that but it is important to know why Obama would attempt wealth redistribution especially in the manner he is proposing. He seems to have an underlying agreement with the Keynesians in saying that purchasing power needs to increase in line with investments.
But underlying all of this is an agreement with the Chicago school of thought. Consider the fact that a good deal of Obama's Economic team is University of Chicago schooled -- his head Economic advisor is Austen Goolsbee, economics professor at the University Of Chicago Graduate School Of Business. The Chicago school's line of thought is that governments need to have a neutral monetary policy.
Following this line of reasoning Obama would be opposed to more adjustment of the interest rate by the Fed. This would be a move that seeks to make credit more available to consumers or investors. Instead, Obama seems to be advocating what I would consider the more sound policy of organically growing both purchasing power and investment capital (the grassroots mentality apparently filters through to his governing style as well). The way he seems to be doing this without the federal government engaging in active monetary or fiscal policy (as opposed to laissez-fair monetary and fiscal policy) is through wealth redistribution by tax restructuring.
While some may disagree with these conclusions there is no doubt that there is heavy intellectual and rational thought going into the formation of Democratic economic and tax policy. It is not just populist rhetoric, as some Republicans claim. Here is a list of Obama's economic advisors with links to their profiles and other articles just in case you'd like to see what their theoretical backgrounds are.
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