從美國人反對健保制度來看：我們身為公民該有的責任--值得一讀的好文章

[newshine]

從美國人反對健保制度來看：我們身為公民該有的責任
商業週刊的文章


節錄一小段

有時候，在一個現代民主國家中，公民的水準和跟他們政府的關係，不只是由國家能提供它的人民多好的服務和福利來決定，同時也要看，是否它的人民夠理性且成熟地故意對他們自身福利說不，如果，他們認為長期而言，這對國家而言是錯誤的方向。」

[李誠民]

Newshine 先生請參考!!!
The ACA and High-Deductible Insurance — Strategies for Sharpening a Blunt Instrument
J. Frank Wharam, M.B., B.Ch., B.A.O., M.P.H., Dennis Ross-Degnan, Sc.D., and Meredith B. Rosenthal, Ph.D.
N Engl J Med 2013; 369:1481-1484October 17, 2013DOI: 10.1056/NEJMp1309490
The Affordable Care Act (ACA) will cause a major expansion of high-deductible health insurance, a fact that has received little attention but has substantial implications for patients, health care pro-viders, and employers. High-deductible health plans (HDHPs…
…In the ACA, Congress chose market-based cost controls over measures that are common internationally, such as global budgets……. Larger employers might adopt HDHPs to achieve ACA-regulated premium levels and avoid the 2018 “Cadillac tax……台灣健保卻不是, 連中國大陸去年開始的醫療保險(三級制醫療!!!)都不是!!

.. For individuals without employer-based insurance options, ACA-instituted health insurance exchanges will provide coverage at four levels of generosity (bronze, silver, gold, and platinum) to 5 to 10% of Americans younger than 65. In Massachusetts, where an exchange began operating in 2006, 84% of enrollees opted for bronze or silver plans, according to the Blue Cross Blue Shield of Massachusetts Foundation….美國健保有銅, 銀, 金, 白金卡(bronze, silver, gold, and platinum)…..

the resulting protections may be robust only for persons with incomes below 200% of the poverty level; Cover Oregon, for example, estimates that cost sharing for Oregon families with incomes between 200 and 399% of the poverty level will include $5,000 deductibles, 30% coinsurance for many services even after reaching the deductible, and out-of-pocket spending maximums of $8,500 to $12,700.
In general, a family of four with annual income at 200% of the poverty level ($47,100) and the highest allowable deductible could face out-of-pocket payments of 8 to 27% of its income, depending on the coverage vehicle (see table). Sentier Research has estimated that the median U.S. household income in February 2013 was $51,404, so the aggregate financial burden on middle-income Americans will be substantial……..請自行閱讀!!!

[gary]

國力強弱
由此可見

[blanka1231]

美國強是有原因的

人民強 國家強

[李誠民]

美國強嗎?....去年G8 歐巴馬在會前與普丁會談, 搞得不歡而散--G8沒開成!!!.......
美國不是要重返亞洲嗎?!.....去年APEC歐巴馬沒出席, 風光都是習近平主席!!!.......
印度 義大利 最高法院都判決美國Big Pharmacy Co.賠償巨款!!!......
美國只要有"霸權心態", 就只有經濟衰退, 國立不振!!!!

[Khadgar]

美國雖然國內問題很多，國力較過去衰弱，但我認為依然會是這個世紀最強盛的國家。
雖然仍有歧視問題，但美國仍然是世界上最能包容移民的國家。
不論是二戰、冷戰、伊斯蘭衝突或中國崛起，即使美國對國安監控不假辭色，
但依然歡迎各國出身，願意在美國貢獻心力的優秀腦力。

世界上哪裡找得到第二個能夠如此廣納人才的國家？

[cwhung]

柴契爾夫人有一句話非常有名：
「社會主義的問題是，遲早有一天，你會花光別人的錢。」
．．．．．．．．．．．．．．．．．．．．．．．．．．．．．．．．．．．
鬼島賤寶鼠：
「台灣健保的沒問題是，我早就已經花光別人的錢。不過，我可以繼續從醫生那邊撈錢過來用。這就叫永續經營！」

[min]

這是劫富濟貧的政策！？

[polo]

柴契爾夫人有一句話非常有名：
「社會主義的問題是，遲早有一天，你會花光別人的錢。」
．．．．．．．．．．．．．．．．．．．．．．．．．．．．．．．．．．．
鬼島賤寶鼠：
「台灣健保的沒問題是，我早就已經花光別人的錢。不過，我可以繼續從醫生那邊撈錢過來用。這就叫永續經營！」

[Nicholas]

許多州抗拒Obamacare 但無效
而且
保費甚至高過商業保險
美國正在傾向財團化的社會主義

[李誠民]

這就是此次"反服貿學運--暴民運動"之所在; 代價太高了!!!.....在立法前, 公共議題就要充分討論, 但是就有許多學者是等著當官,政治人物要摩取利益!!!.....怎麼能不沾鍋!!!!--政治就是要協商 妥協?......

Obamacare士它競選支票,自2009年(?)就在參院討論 協商 立法, 最後美國試辦的許多州都浮現反對聲音,但是已經立法了, 除非修法!!!.....我們前衛生部長還去美國參院作證, 不是很奇怪嗎?!

台灣怎麼能不從美國健保改革中,學習到經驗?!....當健保(台灣)成為問題...--而不是公共議題時,慘況可能比這次暴民運動更慘!!!

[李誠民]

Newshine 先生::轉仔的文章太長了!!!
The Atlantic March 25, 2014 -------America's Workers: Stressed Out, Overwhelmed, Totally Exhausted
Why do so many people—particularly women—seem to have so much on their plates?
REBECCA J. ROSENMAR 25 2014, 7:55 AM ET……………..
America's Workers: Stressed Out, Overwhelmed, Totally Exhausted

America's Workers: Stressed Out, Overwhelmed, Totally Exhausted


April 10, 2014 | 3,091 views---Mercola com.

Story at-a-glance
• Workplace policies in the US still overwhelmingly favor a “male breadwinner-homemaker” family model, even though many households have two earners or women as the primary breadwinners
• The antiquated 1938 Fair Labor Standards Act only protects hourly workers (who must be paid overtime once they hit 40 hours a week). There is no such protection for salaried workers, who presumably can be worked until they drop
• The US lags far beyond most other developed countries in terms of work-life balance; the European Union, for instance, limits work hours by laws, while others require paid leave when children are born, fostered, or adopted
• Companies can help relieve employee burnout by offering flexible hours, telecommute options, and wellness options in the workplace

April 10, 2014 | 2,192 views—“”Mercola com.
WHO估計美國每年要企業花費三千億(300billion)精神科學會說::許多美國人罹患慢性工作有關的壓力”(chronic work-related stress.)))

The World Health Organization (WHO) estimates that stress costs American businesses $300 billion a year; and a Workplace Survey done by the American Psychological Association reported that many Americans suffer from chronic work-related stress.1

……The effects of our increasingly 24/7 work environments have gotten so bad that 38 percent of employees in one survey said they can’t stop thinking about problems related to emotional, health, financial, and job concerns……..

Why Are US Workers So Overwhelmed?
In an interview with the Atlantic, writer Brigid Schulte, author of Overwhelmed: Work, Love, and Play When No One Has the Time, explained that birth rates are actually declining in the US, as young people simply don’t see how they can juggle both work and family life, with the latter being ultimately sacrificed.
Busyness and “living a fast-paced life” are increasingly being viewed as signs of status. The more e-mails you have to check in a day, the more important you are. The more meetings you attend, phone calls you receive, and lessons your child attends, the better. On the work front, especially, extreme hours are valued and overwork has become the norm.

…….Workplace Expectations and Laws Are Stuck in the 1950s – and Earlier
Workplace policies in the US still overwhelmingly favor a “breadwinner-homemaker” family model, with the man still typically viewed as the primary earner. Working mothers, in particular, are bearing the brunt of this often-unconscious bias, as there are no national policies in place (nor many supportive workplace cultures) to help women juggle both work and home. ………..
………In fact, in 40 percent of US households with children under 18, women are the single or primary breadwinners. The workforce is changing, as are the needs of modern families, but few workplaces have followed suit. According to Schulte:
“All you have to do is look at some fascinating work done by consulting companies, when they ask CEOs and top managers at companies around the world who they think the best employees are, more than three-fourths have said: the worker without any family or caregiving responsibilities. In other words, the distant father provider of the 1950s. I say father because social science has found that married men with kids actually earn more money—what they call a ‘fatherhood bonus’—because the workplace culture assumes this man will now work harder because he has a family to support.
…That same social science finds a motherhood penalty—a pay gap that can’t be explained by anything other than the fact that the woman has children, another sign of the consequences of our society’s ambivalence about working mothers… Even the way we pose our questions is stuck in the 1950s.
I say father because social science has found that married men with kids actually earn more money—what they call a ‘fatherhood bonus’—because the workplace culture assumes this man will now work harder because he has a family to support.
…That same social science finds a motherhood penalty—a pay gap that can’t be explained by anything other than the fact that the woman has children, another sign of the consequences of our society’s ambivalence about working mothers… Even the way we pose our questions is stuck in the 1950s.
Our family lives, family structures and the workforce has changed utterly in the last half century, and yet our workplaces, the policies everyone knows look nice on the books but are the kiss of death to take, our laws, and our attitudes have yet to catch up with our reality. That’s where the swirl of ‘the overwhelm’ begins..

……….Fair Labor Standards Act, which only protects hourly workers (who must be paid overtime once they hit 40 hours a week). There is no such protection for salaried workers, who presumably can be worked until they drop. Even the 40-hour workweek is in drastic need of a 21st century overhaul……….
…“…the 40-hour workweek is an artifact of the manufacturing age; it was the amount of time Henry Ford discovered he could push his manual laborers on his assembly lines before they’d get so tired they’d make costly mistakes,” Schulte said. ………..
Bright Spots on the Horizon
Baby Boomers are staying on longer in the workforce as well, but many are growing tired with 90-hour workweeks, which means “there’s pressure from the top end to change as well.” There are other potential changes as well that are far more human-friendly:
• Some states, including California, New Jersey, and Rhode Island, now have state-paid parental leave policies
• Certain cities are passing tax incentives to companies that promote telework and flexible work hours
• Other cities are exploring “right to request” flexible work laws, a program that has already been successfully implemented in the UK (it gives employees the right to put together a plan to get their work done in a flexible way that an employer must accept as long as it won’t hurt the business)
………..Wellness in the Workplace Matters
• This overwork comes at a price to US companies as workers suffer from increasing stress- and overwork-related health problems. Private companies spend close to $45 billion a year in employee-related medical expenses.4 It’s a financial burden many companies can no longer bear. Chronically sick employees can be crippling to businesses, both large and small, and can even lead to layoffs, company closures, and bankruptcy……….

The Atlantic March 25, 2014 -------America's Workers: Stressed Out, Overwhelmed, Totally Exhausted
Why do so many people—particularly women—seem to have so much on their plates?
REBECCA J. ROSENMAR 25 2014, 7:55 AM ET
Perhaps the most poignant detail from Anne-Marie Slaughter's Atlantic cover story, "Why Women Still Can't Have It All," was also one of the smallest: an overworked mother of three who "organized her time so ruthlessly that she always keyed in 1:11 or 2:22 or 3:33 on the microwave rather than 1:00, 2:00, or 3:00, because hitting the same number three times took less time."
That may be extreme, but it illustrated a familiar feeling, one the writer Brigid Schulte calls "the overwhelm." In her new book, Overwhelmed: Work, Love, and Play When No One Has the Time, Schulte scrutinizes this state of affairs: Why do we all feel so overworked? How is that feeling different for men than for women? Is a better, less harried life possible? I spoke with Schulte about her research, and a lightly edited transcript of the conversation follows.
Can you start by telling us about what "the overwhelm" is, how you see it now after years of research and writing on the topic, and how you think that your understanding differs from the conventional one?................
…………
………..How much of the overwhelm would you say can be chalked up to a sort of shared mental state—in which we are all constantly in a frenzy and talking about that frenzy, and that elevates our feeling of being overwhelmed? And how much of this feeling is justified by reality—Americans, particularly women, doing more, having such high standards for themselves, the endless chores it takes just to maintain a household, etc. etc. etc.? Also, how much of this is due to our choices—I’m thinking of this recent Onion article “Unambitious Loser With Happy, Fulfilling Life Still Lives In Hometown.” Is it just that we are all striving too hard to achieve too much?...........
………….
To tack back for a moment to one thing you mentioned earlier ... on the griping ritual we all take part in: Do you think that sort of reciprocated venting can contribute to our stress, rather than have the, I suppose, "normal" effect of venting—that is, to let off steam?
YES! I can’t tell you how many years I bitched and moaned about how much I did at home and how unfair that felt. I always had so many people willing to chime in about how they felt the same. Then we all went back to our lives, bitching and moaning, and picking up the dirty socks and mumbling under our breaths and seething. It never changed. Maybe I felt a little better because I wasn’t alone, but all it did was reinforce this notion that men were getting away with murder and my life sucked and I was justified in being so pissed off all the time………….
…………..
Yes! I notice this a lot—from men too—often framed around “I get XYZ million emails per day.” Beneath the superficial complaint, the subtext frequently seems to be an assertion of that person's importance. It drives me nuts.
Ha! So true. I notice it all the time, particularly in workplaces where face time, extreme hours, and 24/7 total work devotion are prized (did I say media?). I worked through the night on a killer breaking story a few months ago, and I came into the office really grumpy the next day. When someone asked why, I snapped that I’d been up all night. “Oh yeah,” the person said, “Well I’ve been up for two nights!” It’s funny. I truly was complaining—after all the research I’ve done for the book about peak human performance science, how to get the best, most creative work out of motivated workers—I knew that staying up all night may be necessary sometimes, but as a general rule, is nuts. And the other person was still very much in the grips of the one upmanship busy-petition. At that point, I stopped, and thought: So I want to talk a bit more about this work culture we have— “where face time, extreme hours, and 24/7 total work devotion are prized,” as you put it. And you note that that is characteristic of media but it’s certainly not limited to media. Is this sort of cut-throat, competitive worklife a new phenomenon? Do you see it as being driven at least in part by inequality, as Monika Bauerlein and Clara Jeffrey have written in Mother Jones? And, regardless of what’s causing it, what can be done?
Their piece was right on in so many ways. It’s not just media companies; overwork has really become pervasive. I’m not talking about hard work. I’m all for hard work that we find meaning in. But overwork leaves us burned out and disengaged butts in chairs at work and fried at home without the energy to do much more than flop down in front of the boob tube—not quite the leisure the ancient Greek philosophers had in mind when they said pure leisure was that place where we both refreshed the soul and become most fully human.
Economists have noted how work hours for white collar, college-educated workers began to become extreme in about the 1980s, and at the same time, social surveys were picking up a heightened sense of economic insecurity in this same group. Some people say we’re working more because we want more stuff (like that stupid Cadillac commercial that made me so angry I wrote a piece about it). While it’s true that household debt and spending on “luxury” items have gone up at the same time, it’s also true that wages have been stagnating and the costs of basic things like health care, housing, and education have gone through the roof—the cost of college has blown up nearly 900 percent in recent decades. When was the last time anyone outside hedge fund managers and the 1 percent got a 900 percent raise?
Against that backdrop comes technology and the ability to be connected 24/7 - which leads to a feeling of constantly being “on call,” that you can never quite get away from work, that the boundaries that used to keep work more contained have bled and spilled over into the hours of the day that used to be for family, for self, for leisure, for sleep.
Okay, you win. But I’m going home at a decent hour tonight………..
………….
• Bright spots. I went looking for innovative "bright spots" at work, love, and play and found a host of really hopeful and cool things happening in companies large and small. For example, I have a profile of an innovative software company in Ann Arbor, Menlo Innovations, LLC, that was founded based on one principle: joy. Workers do intense, creative work, and are expected NOT to answer work phone and emails after hours or on weekends. If you come back refreshed—and maybe you’ve met someone, had a new experience, expanded your horizons—you’ll bring that freshness to work, perhaps make new connections, figure out how to solve an old problem in new ways.The more we shine a spotlight on how work can be done differently and well, the more companies and the middle managers who are the ones who implement policy changes, can follow new role models of success.
• Millennials. They may have been raised as precious and entitled, but many are coming into workplaces assuming that they can have it all—work and life—and are showing that they can do excellent work in their own way and in their own time. Creaky, rigid, old-fashioned cultures are beginning to adapt.
• Baby Boomers. They’re living longer and are healthier and aren’t ready or can’t afford to sail off into the sunset at 62. But neither do they want to work 90 hours a week anymore. There’s pressure from the top end to change as well.----嬰兒潮不但延長了退休年齡,也增加了老人負擔---全世界已開發工業發達國家的問題!!!!---台灣呢?!只有一個葉金川還有臉去美國參院作證!!.....就如美牛進口案(2008年)幫美國政府解套, 卻沒有換得甚麼?!(不如韓國!!!)........
• Technology. Technology is a double-edged sword right now. It’s freeing us up to work differently, but it’s also showing that it’s extending our work hours. I’m hoping that the more we use it, the smarter we’ll get about how to adapt to it. And all this recent extreme weather is showing managers how much good work can be done on snow days, etc. even when you’re not sitting at your desk under their nose.
• Human performance science and the creative class. In a knowledge economy, what do we value? Innovation, new ideas, creativity. How do we foster that? The brain is wired for the “A Ha” moment to come, not when our noses are pressed firmly into the grindstone, but in a break in the action. When we let our mind wander. In the shower. On a walk. When we are idle, neuroscience is showing that our brains are most active.
• Changes on the state level. While our national politics has been frozen for so long on issues of work and life, I was heartened to find states stepping in and looking for common sense policies and solutions to help people better manage the now conflicting demands and work and life. California, New Jersey, and Rhode Island have state paid parental leave policies—paid for by employees a few cents out of every paycheck that is pooled into a Temporary Disability Insurance fund. Cities are passing tax incentives to companies that promote telework and flexible work, as well as exploring their own “right to request” flexible work laws.
• Health. NIH is in the middle of a giant, multi-year study of how our high-stress, long hours work cultures are making us sick—and that costs employers a lot of money. And the Yale Stress Center is finding in their functional MRI studies that stress—the WHO has rated us the most anxious country on the planet—is actually shrinking our brains. Sick and stupid and overworked and overtired does not make for the most creative and productive workforce.