Which Country Has the Best Health Care – Ezekiel J. Emanuel

Ezekiel Emanuel is an American oncologist, bioethicist and senior fellow at the Center for American Progress. He is the current Vice Provost for Global Initiatives at the University of Pennsylvania and chair of the Department of Medical Ethics and Health Policy.

Dr, Emanuel sets out to profile the healthcare systems in 11 wealthy developed countries in an effort to identify the best, or at least where excellence exists. His assessment includes the United States, Australia, Canada, China, France, Germany, the Netherlands, Norway, Switzerland, Taiwan, and the United Kingdom. He evaluates each system on 22 different dimensions in 5 categories: Coverage; Financing; Payment; Delivery; Pharmacy Prices. The information is presented in substantial detail including graphical representations. And he discusses the challenges each country is going to face in the coming decade.

Once the author presented the individual analysis of each country’s system he then compared the systems with each other. He makes the point the each system has its strengths but also has its weaknesses. He chooses not to identify the best country because all have challenges. So he identifies those countries he calls “top tier”; they include Germany, the Netherlands, Norway, and Taiwan. He also identifies the “best performing countries” in each of his 22 dimensions as well as those that are “notably poor performers”. Sadly, the US is identified as one of the poor performers in 12 of the 22 dimensions.

Finally, the author identifies 6 lessons for improving the US healthcare system, They are:

• Ensure universal coverage with auto-enrollment and larger subsidies;

• Cover children at no additional cost to their parents and families;

• Simplify the American health care system;

• Emphasize and increase the reimbursement for primary care;

• Adopt and implement best practices for the care of patients with chronic and mental health conditions;

• The United States needs to join the rest of the world in regulating drug prices.

I found this book vastly more authoritative and in depth on healthcare than I am qualified to address. Generally though I was pleased to find that it is mostly in agreement with a piece that I wrote some time ago on the subject of the US healthcare system. If you want to read what I wrote you can find it on my blog in the category “My Credo”.

Rise of the Warrior Cop – Radley Balko

Radley Balko is an American journalist, author, blogger, and lecturer who writes about criminal justice, the drug war, and civil liberties. Balko has written other books on these same subjects. The central theme of this volume is a close look at the rapid militarization of domestic law enforcement agencies and its associated dangers to civil rights and freedom.

The author points out that American revolutionaries toward the end of the colonial period in America saw soldiers in the streets as bringing conflict and tyranny. As a result, from its founding our country has worked to keep the military out of domestic law enforcement. However, he traces the history of domestic law enforcement over the past several decades and how police forces have begun to resemble and behave like military ground assault troops.

Mr. Balko says the consequences of this transition has been dire: a citizen’s home is no longer a sanctuary; the Castle Doctrine is substantially dead for all intents and purposes. Today the Fourth Amendment is being ignored by law enforcement and has been gutted by conservative court decisions upholding abusive behavior by police. With this increased militarization police have been conditioned to see the citizens they are sworn to serve as the enemy.

The author demonstrates that today’s armed police forces are a far cry from peace officers of earlier decades walking the beat in local neighborhoods where they knew the people and were a part of the community. The unrest of the 1960s gave rise to the Special Weapons and Tactics (SWAT) team concept where a unit of officers were specially trained to handle violent criminal situations – bank robbers, hostage takers, snipers, and rioters. Then with Nixon’s War on Drugs followed by Reagan’s War on Poverty, and the post 9/11 security state, police powers were gradually expanded and empowered, always at the expense of civil liberties.

Federal grants to acquire military grade weapons as well as military training for local police forces have helped the number of SWAT teams to explode nationwide. Suddenly every city of 25,000 or more had to have a SWAT team. But there wasn’t enough violent crime to fight. Also as part of the War on Drugs the federal government initiated a policy of confiscating property in drug raids and then sharing the proceeds with participating local law enforcement agencies. That prompted local SWAT teams to shift their aggressive fear inducing tactics to serving arrest or search warrants on non-violent drug users, local poker games, and other non-violent but technically illegal activities. They typically use their aggressive tactics during the night dressed as assault troops with little regard for individual citizens’ rights. In most cases their tactics are unwarranted and the warrants could be better executed in the daytime with other safer non-confrontational approaches. Further because of inadequate investigation up front the error rate of raiding the wrong house is very high. While the author says we are not yet a police state, or close to it, the trend in policing is clearly going in the wrong direction.

The author sites multiple cases of abuse of power, mistakes, unnecessary deaths and destruction to prove his point. This is a sobering look at where we are in domestic policing. I think this book is worthwhile reading for every American. We should be alert for and recognize the signs of police abuse of power. When we see or suspect it we must challenge our elected leader to exercise more control and accountability in aggressive police tactics.