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Monday, July 25, 2011

Americans don't believe we have the greatest health care system in the world | Eric Black Ink

Americans don't believe we have the greatest health care system in the world | Eric Black Ink: "

It always drives me a little nuts when, at Republican events, the U.S. health care system is routinely described as The Greatest Health Care System In The world (GHCSITW). The crowd always goes wild at the ritualized invocation of American greatness. In recent history, the invocation of the GHCSITW is, of course, always in the context of denouncing the depredations that will be visited upon the GHCSITW if Obamacare passes (before it did) or is not repealed (now that it has).

Perhaps there is a statistical torture chamber sufficiently nimble to produce some measure by which the U.S. system is the GHCSITW. It’s often pointed out by GHCSITW defenders that the unimaginably wealthy Arab royals like to come to the Mayo Clinic when they are sick, although this measure of American greatness may be difficult to wrestle into a statistic.

Still, you don’t have to be terrifically well-informed to know that by the most sensible and obvious measures of a health care system’s efficiency and effectiveness – for example, how comprehensive it is, the results it produces, how much it costs and even how it treats the less wealthy within a given society – the U.S. has pretty much the worst health care system in, at least, the developed world.

Our GHCSITW is the most expensive in the world (by far) on a per capita basis, leaves by far the biggest portion of its population without health insurance and compares very badly with Europe, Canada, Japan, etc. in life expectancy, infant mortality, death by various preventable illnesses, etc. etc.

So it’s a little hard to know why anyone other than those ignorant of the facts or who hate factuality itself are so willing to applaud the ritual invocation of the GHCSITW.

Now comes some recent evidence of what the general public thinks from a poll done by Harris for the Deloitte Center for Health Solutions. When asked what letter grade they would give to the U.S. health care system, here is how Americans graded it:

“A”: 3%

“B”: 19%

“C”: 42%

“D”: 24%

“F”: 12 %.

DeLoitte got similar results with the same question in 2009 and 2010.

When asked whether the U.S. health care system works better than most systems in the world (which is a substantially lower standard being GHCSITW), 23 percent said yes.

Hat tip to Dave Durenberger whose latest “commentary” called attention to the Deloitte survey.

A long writeup of the survey is here.

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If we want to swap polarization for moderation, we should adopt Ranked Choice Voting | Community Voices

If we want to swap polarization for moderation, we should adopt Ranked Choice Voting | Community Voices: "

If we want to swap polarization for moderation, we should adopt Ranked Choice Voting

By Cyndi Lesher | Friday, July 22, 2011

I'm a lifelong moderate and have always thought of myself as results-oriented — in work and in life. When there's a problem to solve, I'm not concerned with dogma or ideological preconceptions; I'm interested in what works.

That's how I've approached my career in corporate leadership, and it's how I've approached my public service, including my work on the U of M Board of Regents and my tenure as chair of the Governor's Workforce Development Council. My pragmatic focus on real-life solutions has served me well as an innovator and a leader.

And it's precisely why I'm such a strong believer in Ranked Choice Voting (RCV). Because, as this shutdown has so clearly underlined, politics in Minnesota is in dire need of innovation. Because, unless you have a vested interest in political polarization, mudslinging and rancor, the electoral system we've got right now is not working — and it sure isn't good for the Minnesota business community I represent.

We shouldn't accept 'politics as usual' as a fact of life. It isn't. There's a better way to run a democracy, and it's our responsibility — yours and mine — to demand it: RCV.

Father risked everything
My father was my greatest role model. He taught me, by example, the importance of integrity, and of standing up for what you believe in. When I was a teenager, he risked everything — his business, many friendships, even his neck — by discovering and reporting several cases of insurance fraud by some very prominent individuals. Indictments followed, and my father's life was threatened.

I remember asking him, 'Dad, why did you have to be the one? Why can't somebody else speak out?' His answer: 'Because it's right. And if not me, Cyndi, then who?'

I've carried that all my life and tried to apply it in all kinds of different situations. It's why I volunteer my time on the board of FairVote Minnesota — because I know that our political system is broken, and we can't just wait for others to fix it.

There was a time when it didn't matter so much who won election: Democrat or Republican, I could trust they would govern in the interests of the majority of Minnesotans. This was the Minnesota way.

Those days are now gone, and I have no illusion they'll return. Appealing to candidates and the parties to tone down the attacks, engage in civil discourse and rise above the narrow interests of their base hasn't worked — and won't work as long as the system is hard-wired to reward this political behavior.

Under our 'plurality-take-all' system, candidates win by mobilizing their party base and scaring undecided and independent voters away from their opponents. Divide-and-conquer campaigns work in a system that locks voters into a 'lesser-of-two-evils' choice.

Current process jeopardizes state's health
Our electoral process is jeopardizing the long-term health of our state.

Satisfying the party's 'base' is a winning strategy in a system where elections can be won with as little as a third of the vote. But it's a dangerous way to elect officeholders who have to govern an entire state. Elected officials who are indebted to their base enter office with their hands tied by single-issue pledges that put thoughtful deliberation and consensus out of reach.

Moreover, they can't work productively together when just weeks before they waged nasty ad campaigns belittling each others' character and reputation. As the shutdown and lose-lose budget deal have revealed, problems are simply pushed off to the future, exacerbating their size and scope and prolonging their resolution.

We must change the system if we want to swap polarization, zealousness, and deadlock for thoughtfulness, moderation, and compromise. We must put the incentives in place to compensate these outcomes. Ranked Choice Voting does this.

Under Ranked Choice Voting, voters 'rank' their preferences — 1st, 2nd, 3rd, etc. In a single-seat race (e.g. governor), if no candidate receives a majority of first choices, the least popular candidates are eliminated and their votes are reassigned to remaining candidates until one receives a majority of continuing votes. It works like a traditional runoff but happens in a single election, saving taxpayers the cost of a second election, candidates the expense of another campaign and voters another trip to the polls.

Under this kind of system, third-party candidates can run and capture votes without being labeled a 'spoiler.' Voters can rank No. 1 the candidate they think will do the best job without concern that they'll 'throw their vote away' or help toss the election to the candidate they least favor.

More choice to voters
RCV gives more choice to voters and makes third parties more competitive. In multicandidate races, candidates must reach beyond their base to appeal to voters for their second choices. It rewards candidates — and parties — who strive to represent the broad interests of the majority and penalizes those pushing ideologically extreme, single-issue agendas. Finally, it produces winners who take office with the affirmation of a majority.

RCV isn't just smart, it's doable. We know from its use in Minneapolis (and several other cities across the country and countries across the globe) that it works. St. Paul debuts RCV this year, and other Minnesota cities are working toward it. As counties across the state replace their voting equipment in the coming years, they can install machines able to tally a ranked ballot. The technology already exists.

RCV is within reach, and I hope Gov. Mark Dayton and the Legislature will put this critical reform on their list of priorities in the next session. Please join me in asking our elected leaders to enact RCV statewide.

Minnesota can't wait.

Cyndi Lesher is a retired CEO of Northern States Power, an Xcel Energy Company, and served as president of the Minneapolis-St. Paul Host Committee for the 2008 Republican National Convention.

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