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Current Affairs: Single Payer Healthcare, Nov 15, 2018

Discussion leader: Charlie Goodyear

Summary :

SINGLE PAYER HEALTHCARE SYSTEMS
USA Healthcare System
-17% of GDP (was 7% in 1971) vs. 9% Canada,10% UK, 10% Germany
-Coverage :
+50% Employer (155 million people, cost $20,000/family, employee pays
$5000)
+14% Medicare (+/- 55 million people)
+12% Medicaid, Veterans, Native Americans (+/- 50 million people)
+ 7% ACA purchased (+/- 20 million people)
+ 8% Emergency Room, Other
+ 9% Uninsured (+/- 30 million people)- 80% US citizens
-Drug costs : $1000/per person/year vs. OECD $500
-Estimated 100-130 million people have “pre-exsisting conditions”
-Life expectancy below OECD countries, Infant mortality higher
-Reasons for higher costs vs OECD countries :
+ Technology and drugs ( eg more MRIs per capita, no drug price controls)
+ Obesity (35% vs 19% OECD) and chronic illnesses (32% of Medicare costs
cover the last two years of life)
+ Much higher administrative costs (4% of GDP), double the staffing vs Canada
-Healthcare costs a major factor in personal bankruptsy( !0 million have bills they can’t
pay )
Canada Healthcare System
-Single payer system covering 100% of the population -no co-pays or deductables
-Doctors and hospitals privately owned and managed within system rules
-Managed by Provincial governments who pay all doctor and hospital charges
-System funded 50/50 with Federal government
-Provinces set prices and proceedures that comply with Federal requirements
-No private insurance allowed except for drugs and dental not covered by System
-Heavy involvement in drug pricing and approval, cost benefit analysis
-Essentially no US type media drug advertising
-Doctors earn about 2/3 of what US doctors earn/year
-Lower availability of medical devices (eg. 75% fewer MRIs per capita than US)
-Open heart and transplant surgery restricted
– Major problems: waiting times for referral to specialists (+/- 16 weeks ), doctor
choice limited, long delays for elective surgery
United Kingdom Healthcare System
-Single payer system covering 100% of the population-no co-pays or deductables
-Doctors are government employees and hospitals are government owned
-Managed by major regional authorities (ie Britain, Wales,Scotland, etc)
-Drug prices controlled by the government, strict cost/benefit analysis. No US
type media drug advertising
-Drug prescriptions cost about $12/ each, free for children.

– No dental coverage for adults
– Doctors earn about 2/3 of what US doctors earn
– Individuals may purchase insurance coverage with doctors in private practice
– Major problems: Long wait times (+/- 10 weeks for general surgery), limited availabiliy
of new(expensive) or experimental treatments, cost/benefit analysis, lack of mental
health services, very long delays for elective surgery
-Per capita costs $4K/year vs US $10K/year
-Many say “Underfunded but not broken “
Germany Healthcare System ( An alternative to “single payer” ??)
-An insurance based system with non profit and for profit insurers
-Covers 90% of population- required participation for all but highest earners
-Funded by 50/50 contribution by employers and employees -15% of earnings
up to about $70K/year (2014 data)
-Private doctors and hospitals but highly regulated
-No deductables and low co-pays -children are free
-Managed by regional authorities via “sickness funds” that are used to control
total costs
– Drug prices are controlled, cost/benefit analysis, no US type public advertising
– Doctors earn about 2/3 of US doctors/year
– Per capita costs less than 1/2 of US
– Surveys indicate significantly higher public satisfaction with the system vs US,
Canada or UK
( The relationship between the insurance companies, doctors, hospitals ,employers,
employees individuals and the regional government bodies is unclear and needs
further analysis and understanding)

Comparisons of Health Care Systems in the United States, Germany and Canada

https://dpeaflcio.org/programs-publications/issue-fact-sheets/the-u-s-health-care-system-an-international-perspective/

https://theconversation.com/why-market-competition-has-not-brought-down-health-care-costs-78971

https://theconversation.com/medicare-for-all-could-be-cheaper-than-you-think-81883

Single Payer Healthcare

Universal Coverage

The article below on drug cost shows how complicated healthcare is to understand, much less manage.  Factors such as age of population, availability of new drugs, the number of insured, etc. all interact.

Still, negotiation is an important factor.  The article states that many western countries (all government run healthcare) will only pay for improved outcomes.
But it’s not purely rational.  If some exotic drug will save your life, it’s worth a lot to you but maybe not so much to society if it starves other healthcare services.  The payers are subject to political pressure from interest groups.  Not simple.

The False Promise of ‘Medicare for All’

Cost is only part of the problem. Single-payer systems create long waits and delays on new drugs.

 

 

 

Barksdale, Ed W. Jr.

Little Rock Ed Barksdale was born in Little Rock, Ark., in 1945 and grew up in Atlanta, Ga. He graduated from W.F. Dykes High School in 1963, where he was active in student government. Ed graduated from Duke University in 1966 with a B.A. in economics and from the Wharton School at the University of Pennsylvania in 1968 with an M.B.A. in finance. Upon graduation, Ed joined General Dynamics in New York as a pension officer; in 1969, he joined Mitchum, Jones and Templeton, which later became Callan Associates, in San Francisco, as performance measurement and investment manager, tracking staff and systems. He returned to New York as a pension and investment consultant to institutional investors with Dreher Rogers. In 1976, Ed joined Rogers, Casey and Barksdale in Stamford, working with institutional clients and managing technical staff and systems. His division was purchased by Northern Trust of Chicago in 1995, and Ed became president and CEO of Northern Trust Global Advisors and Northern Trust of Connecticut. In 2000, Ed was co-founder of Federal Street Partners in Stamford, where he created pooled vehicles focused on alternatives, primarily hedge funds. In 2018, the firm downsized, focusing on partner capital and advice to a few long-time clients. Ed and his wife Joan have three children (living in Tokyo; Freeport, Maine; and Missoula, Mo.). He belongs to the Tokeneke Club, Wee Burn Country Club, Noroton Yacht Club, Campfire Club and Lost Tree Club. He enjoys boating in the summer and skiing in the winter. Sponsored by Gene Markowski.

Loomis, Donald E. Jr.

Don Loomis was born in Miami, Fla., in 1946. He grew up at the Wentworth Club in Surrey, United Kingdom. He graduated from Fairfield Prep in 1964, where he was active on the cross-country team. He graduated from Georgetown University School of Foreign Service in 1968, where he rowed lightweight crew. He served in the U.S. Navy from 1968 to 1974 aboard a destroyer escort based in Naples, Italy (where he met his wife). In 1971, he became sports editor of the English language daily paper The Rome Daily American. Upon returning to the States, he worked at Fisher International, located in Norwalk, Conn., in consulting and market research on the paper industry. He assisted in constructing the company’s worldwide database covering 3,560 mills on all five continents. Ron and his wife Daniela live in Darien and have one daughter (Navy JAG officer stationed in Washington, D.C.) and three grandchildren. He belongs to the Norwalk River Rowing Association and St. John’s Choir. For leisure, he enjoys rowing, skiing, travel and languages. Sponsored by Dieter Bruhn.

Gilliam, George

George Gilliam was born on August 14, 1944 in Brooklyn, NY, though his time as a Brooklynite was short-lived: his family moved to New Hyde Park, NY, when his father returned from WWII in 1946.

 

George graduated from the University of Dayton (Go Flyers!) with a bachelor’s degree in business in 1966, and began his sales career with U.S. Plywood in Albany, NY.  In the mid 80’s, George established his own sales agency, representing numerous building material manufacturers in Pennsylvania, Delaware, New Jersey, New York, and Connecticut. He retired from a long and satisfying career in December 2014.

George met Diane Tapley, the love of his life, while working at the New York World’s Fair during the summer of 1964. She was – and still is – the prettiest woman he’d ever seen, and he was somehow able to sweep her off her feet and convince her to marry him.

Fifty-two years later, George and Diane have two children: Drew, who works for Ring’s End in Darien, and Katy, who is a New York Times bestselling author. Katy is also the mother of Henry and Callie, George’s two terrific grandchildren, whom Katy and her husband are raising in nearby Ridgefield.

After spending 35 years in Darien, George moved to Norwalk, where he enjoys spending time with his grandchildren, in addition to playing golf, bridge, bowling and taking long walks with Diane.

George became a proud member of the DMA in 2014, and is currently the chairman of DMA Cares, which makes the weekly announcements regarding the well-being of our members.

 

 

Book Club: Destined for War : Can America and China Escape Thucydides’s Trap? by Graham T Allison, Nov 14, 2018

CHINA AND THE UNITED STATES ARE HEADING TOWARD A WAR NEITHER WANTS. The reason is Thucydides’s Trap, a deadly pattern of structural stress that results when a rising power challenges a ruling one. This phenomenon is as old as history itself. About the Peloponnesian War that devastated ancient Greece, the historian Thucydides explained: “It was the rise of Athens and the fear that this instilled in Sparta that made war inevitable.” Over the past 500 years, these conditions have occurred sixteen times. War broke out in twelve of them. Today, as an unstoppable China approaches an immovable America and both Xi Jinping and Donald Trump promise to make their countries “great again,” the seventeenth case looks grim. Unless China is willing to scale back its ambitions or Washington can accept becoming number two in the Pacific, a trade conflict, cyberattack, or accident at sea could soon escalate into all-out war. In Destined for War, the eminent Harvard scholar Graham Allison explains why Thucydides’s Trap is the best lens for understanding U.S.-China relations in the twenty-first century. Through uncanny historical parallels and war scenarios, he shows how close we are to the unthinkable. Yet, stressing that war is not inevitable, Allison also reveals how clashing powers have kept the peace in the past — and what painful steps the United States and China must take to avoid disaster today.

 

See entry about Thucydides Thucydides

 

Two pieces shared by Tom Igoe

Graham-Allison-Opinion-in-Weekend-Financial-Times

The-Crisis-in-U.S.-China-Relations-WSJ.pdf

The Myth of the Liberal Order

The Truth About the Liberal Order

 

Dynamic growth of China’s GDP.

 

 

Filmer, Chris

Born (1937and Educated in South Africa with a BA Business degree.
Lived in England for five years then returned to Cape Town SA before moving to Darien with PepsiCo International in 1977. Extensive world travel focused on Marketing and later Executive Training.
Wife Sandy and he live in Darien and have a vacation house in
the British Virgin Islands. They have six children between
them, three now living in England and three in either
Washington DC or Boulder CO.
Chris competed in US Senior Olympics Track and Field events
for seven years at a state and national level. He enjoys golf,
tennis and painting in oils.
Since retiring in 2001 –
-He has written a world history book for 12 year olds,
“Famous Lives” which includes 300 illustrations by him.
-Been very active in local nature conservation with the Darien
Land Trust and Friends of Selleck’s Woods, both of which he
headed as President.
– Other board positions have been with A Better Chance in
Darien, Creative Connections , The Darien Community
Association (and its Bird Sanctuary) and DMA

Plunkett, Robert

Bob Plunkett was born in Milwaukee, Wis., in 1962 and grew up in River Hills, Wis. He graduated from University School of Milwaukee in 1980, where he was active in track and field, cross country and the chess club. He graduated from Cornell University with a B.A. in economics in 1984, where he was on the cross-country team and participated in some marathon running. Bob continued his studies at Cornell, where he received his M.B.A. from the Johnson Graduate School of Management in 1988 while also working with the Old Ezra Investment Club and the hockey team. His work history began in 1988 with Metropolitan Life in New York City in investments. In 1995, he relocated to Stamford with GE Asset Management and in 2016 joined JPMorgan Chase in Fairfield in relationship banking. Bob and his wife Karen live in Darien and have four children, two living nearby, one in college and one in high school. He is a member of the CFA Institute and CFA Society of Stamford, served on the board and was vice president of investments on the executive board of the Darien Nature Center. He is a former member of the Noroton Yacht Club and Middlesex Club, and served as tribal chief of the Darien YMCA Guides. For leisure, Bob enjoys travel, reading, investments and hiking. Sponsored by Bryan Hooper.

DeLeo, Frank

Frank DeLeo was born in Mt. Vernon, N.Y., in 1952 and grew up in Greenwich. He graduated from Greenwich High School in 1970, where he was active in baseball, student government, the service club, chorus and the youth church organization. He graduated from the University of Connecticut in 1974 with a B.A. in psychology. He was a University Scholar, invited to Phi Beta Kappa and Phi Kappa Phi, and was active in intramural sports. He graduated from the Wharton School, University of Pennsylvania, in 1976 with an M.B.A. in marketing and was awarded the Colgate-Palmolive Fellow Degree with Distinction. In 1976, he began working at General Foods in White Plains involved with product management. He continued in product and brand management marketing and product development for companies in consumer provider businesses such as Clairol, Cadbury Schweppes, Bath & Body Works, Eddie Bauer and Hallmark Cards until retiring in 2018. Frank and his wife Patti of 44 years live in West Norwalk and have three children and six grandchildren living nearby. He is an enthusiastic supporter of the Yankees, Giants, Knicks and Rangers, as well as both the UConn men’s and women’s basketball teams. His hobbies include golf, tennis, reading, crossword puzzles, guitar playing, water sports, skiing, and family water destinations for vacations (Nantucket, the Caribbean and Florida). Sponsored by Gerrit Lydecker.

Kelly, Jim

Born September 1935 in Chicago, Jim grew up in Highland Park, IL. He graduated from DePauw University in 1957 with a BA in Economics-including a semester @ American U. seeing the government in action.  He was on the Golf Team and was a member of Phi Gamma Delta fraternity.

His work experience began with Union Carbide selling their consumer products in TX and Midwest, followed by a stint as a Media Buyer and Account Exec at Leo Burnett, ad agency in Chicago.

He spent the next 32 years in Broadcasting Advertising sales with Katz and Blair Television in their Chicago offices transferring to Blair’s New York office in 1971.  He held various sales management positions at Blair retiring in 1995 as Sr. VP new business.  During those years he had major interaction with most every major US network and television station group that provided an opportunity to be successfully involved in the TV station brokerage business as President-Television of Kepper, Tupper and Company of CT from 1995-2017.  He also is managing trustee of a family farm in Sullivan Co. IN since 2004.

Jim married his wife Elizabeth (Betsy) Phelps, also from Highland Park IL, in October 1958-they are looking forward to celebrating their 65th anniversary next month.

The family moved to Darien in 1971 and he and Betsy have remained in town since then.  Their two daughters and their families now reside in Cohasset, MA and Cumberland Foreside, ME.  Their son and his wife live in Manhattan.  All 3 went to Darien schools thru High school.  They have 5 grandchildren-2 boys and 3 girls and a 1-1/2 year old great grandson.  The 3 eldest are through college and working, the youngest granddaughter is a junior in college.  Their other grandson is successfully involved in a special needs program in the Portland ME area.

Besides enjoying the golf, special events, investment group and other programs DMA offers, Jim is a member of Noroton Presbyterian Church, Woodway Country Club, various area senior golf, tennis and paddle groups.  Other interests include volunteering, fitness, jazz and being an ardent sports fan-still heavily tilted to rooting for his favorite Chicago teams.

Mace, David

David Mace was born in Springfield, Massachusetts, and is a graduate of Amherst College, 1960 and the University of Virginia Law School, 1964.  He began practicing law in New York City with the firm of Cadwalader, Wickersham and Taft.  In 1966 he joined Irving Trust Company as General Counsel.  Mr. Mace was elected President of Irving Trust in 1984 and retired from the bank in 1990 following the merger with Bank of New York.

After retiring from Irving, Mr. Mace became Chairman of Pacific Fruit, Inc., a holding company for the Luis Noboa family (Guayaquil, Ecuador) companies, which include shipping, banking, insurance and the banana export business under the Bonita label. Mr. Mace left Pacific Fruit in 1996 to join Northern Trust Company of Connecticut.  He retired from Northern in 2003 as Chairman and CEO.

Mr. Mace is an Emeritus Trustee of Princeton Theological Seminary where he served as Chairman of the Board from 2001-2005.  He was a director of the Overseas Ministries Study Center in New Haven, Ct. from 2005-2010. He is Founder and Chairman of the Fairfield County Microinvestors Council, a group of Christian families in Connecticut who have worked in collaboration with World Vision and Vision Fund International on microlending projects in Ecuador, Chile, Dominican Republic, El Salvador and Senegal. Mr. Mace was one of the original directors of Vision Fund beginning in 2004 and was elected Chairman of VFI in 2010.  He retired as a Vision Fund Director in November 2013.

Mr. Mace is married to Rosemary Hull. They are the parents of three adult children and six grandchildren living in London, England, Wilton, CT and New York City. The Maces belong to the Noroton Presbyterian Church in Darien, CT where they were married in 1961.

 

Hooper, Bryan

Bryan Hooper was born in 1941 in Newcastle-upon-Tyne and brought up in London, England.  He attended Christ’s Hospital school and then the Royal College of Science at Imperial College of Science and Technology, London University, graduating in 1963 with BSc and ARCS degrees.

He joined Imperial Chemical Industries in Harrogate, Yorkshire, in the fibres marketing department and was transferred to Celanese Corporation in Charlotte, North Carolina, in 1974 as a strategic planning director for Fiber Industries Inc.  In 1978 Bryan moved to New York to become planning director for Celanese Fibers Marketing and then director of International Marketing before leaving in 1986.  He established his own strategic planning and development consultancy before joining McAlinden Associates in New York in 1997 to coach and consult in communication skills, a job which involved him in programs with clients around the world.  He retired at the end of 2015.

Bryan and his wife were married in 1964 after Carol also graduated from Imperial College.  They have lived in Rowayton since 1997 and have two daughters, three grandchildren and two grand-dogs.  Bryan’s interests include theater, film, crosswords and the hopeless cause of supporting Newcastle United of the UK soccer Premier League.

Lom, Tom

Tom was born and raised in Philadelphia where he attended the William Penn Charter School.

After graduating from Trinity College in Hartford and Columbia Business School, he embarked on a 35 year career in the advertising business.  He spent 28 of those years with Saatchi & Saatchi including stints as a Managing Partner at Saatchi & Saatchi New York and as President of Saatchi & Saatchi Consumer Healthcare.  For five years he was President of William Douglas McAdams, an independent healthcare ad agency.  He was also an EVP at BBDO in New York.  Among the highlights of his career, Tom led the communications team that helped Tylenol recover from the tampering incidents in the 1980s which recovery became a paradigm “crisis management” case history at the Harvard Business School.  He served on the Board of CHPA (Consumer Healthcare Products Association) and was a Director of the National Center for Health Education.

Tom and his wife, Winifred, moved to Darien in 1978 where they raised three great kids (a son and two daughters).  He has one granddaughter and one grandson.  He is a member of the Country Club of Darien where he served on its Board and Executive Committee for six years.

Tom is an avid golfer and enthusiastic sports fan who maintains his life-long allegiances to those Philadelphia teams.  He and Winifred love to travel and have taken many trips both in the U.S. and abroad.

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