Imod dødsstraf i USA

Det er, når livet viser sig så usikkert og tilfældigt, at vi må foretage et valg. Enten løfter vi os ud over hævngerrigheden og holder fast i vores medmenneskelighed, eller vi daler ned hvor der er angst og frygt. For mig er det ikke et svært valg.

Læs mere i min kronik om Vilkårlighed og dødens alt for menneskelige ansigt i Kristeligt Dagblad.

Hvordan oplever man ligestilling i USA og Danmark?

Læs mit debatindlæg i Dagbladet Information om “Positiv særbehandling kan fuldende ligestillingen.” Et citat om USA: “Mens vores mødre kæmpede for retten til at være mere end nogens sekretær, fik min generation retten til at arbejde så meget, at der aldrig blev tid til at stifte familie…Her kan Danmark stå som rollemodel.”

Affordable Care Act’s Survival Depends on Reducing Costs

An Opinion by Andreas Lauritzen

It is no secret that Americans are spending more money on health care than they can afford. According to the OECD, Americans are less healthy than people in countries spending half their gross domestic product on health care. Yet only a single measure of President Barack Obama’s signature program, the Patient Protection and Affordable Care Act, is dedicated to curbing the increase in health care costs on a national scale: the establishment of Accountable Care Organizations (ACOs).

The Affordable Care Act contains many mechanisms aimed at lowering insurance costs, such as offering health insurance through state exchanges and widening the insurance pool through the individual mandate. But these provisions do not decrease the rate at which health care costs are rising in relation to gross domestic product. They only make it more affordable to buy health care insurance. Thus, it is more appropriate to call President Obama’s new law insurance reform rather than health care reform.

The purpose of an Accountable Care Organization is to provide better care for patients without augmenting costs. Studies have shown that improving the transparency of communication and increasing cooperation among different health care actors can significantly drive down costs and increase health care quality. Often doctors’ offices cannot communicate with hospitals. The standardization of electronic health records by ACOs helps to solve this problem.

The Mayo Clinic in Minnesota is an example of an ACO which has driven down costs to unparalleled levels while simultaneously providing some of the best care for patients in the world. It has achieved this by, among other things, promoting better communication and cooperation between health care agents.

Currently, there are about 1,400 independent ACOs across America. The Center for Medicare and Medicaid Services is the federal entity allocating and overseeing funds to create and develop ACOs. Many of those already existing are small practices at decidedly different stages in their ability to change incentives that drive down costs. Thus, the Center is charged with grouping and transforming these smaller practices into larger units in order to more effectively manage care.

The success of Accountable Care Organizations rests on three highly critical points:

First, the current political reality creates pressure on the government to create ACOs at a fast pace.The danger is that these organizations will not significantly effect rising health care costs in the near future. If there is a lack of progress in curbing costs, then not only will it mean cuts in health care, but it will also hand the Republicans vital political capital to overturn the health care law.

Second, Congress has the power to perform draconian cuts in 2017 through the Independent Payment Advisory Board. If there is a lack of progress or if the political climate changes to oppose the Accountable Care Act in national elections, then these cuts are likely to occur. Removing funds will be a serious blow to the facilitation of affordable care.

Third, there is a danger that ACOs become Health Maintenance Organizations (HMOs) in disguise. In the 1990’s, managed care stood for everything that is bad about the American health care system. Helen Hunt expressed America’s frustration in her 1997 Oscar winning performance in: “As Good as it Gets,” when she exclaimed: “Those [bleep] HMOs pieces of [bleep]!”

Managed care is not a public favorite. In 1981, the Reagan Administration removed the requirement that HMOs be non-profit organizations. The idea was that if someone could make a profit and save money, it should be allowed.

Today, all HMOs are for-profit, except for Kaiser Permanente in California. The result is devastating. These organizations went from caring about their patients to caring more for their shareholders by, among other things, ensuring that patients not overuse the system.

In most HMOs, every dollar spent on actual care is deemed a loss because it does not go to shareholders. Much is lost, such as the freedom to see any doctor one wants and the ability to visit any specialist without prior authorization. Even if a patient is in desperate need of a specialist, he or she will not receive further treatment if the insurance company decides not to pay.

While HMOs restrict patient choice, ACOs are designed to preserve them. A significant difference is that patients are not forced to choose a network of doctors. Instead, they can choose any provider they wish.

But if accountable care begins to resemble the failed model of HMOs, it will prove devastating for President Obama’s signature legislation and for the Democratic Party. While it is unlikely that health care providers will want to relive the 90’s, it is a fact that accountable care shares some of the same cost-effective measures of managed care; namely, capitated payment.

Capitated payment allocates a fixed budget per patient. In capitation, the doctor’s incentive is to provide the care needed until the patient is cured. But because of the fixed budget, any unnecessary care is eliminated and costs are kept down to a minimum. This is in contrast to traditional fee-for-service in which the physician is paid for every single service and procedure performed, and costs are high because there is no incentive to refuse to provide unnecessary treatment.

ACOs have to work fast and show significant results in reducing health care costs. Any failure can place significant political capital in the hands of Republicans in the next presidential campaign. Surely, Hilary Clinton, for one, will not stand a chance if the 2016 election is all about the failure of health care reform.

Twitter Is More Than A Couch Sport @CaliforniaRobin

A dilemma for viewers in Denmark waiting for daredevil Felix Baumgartner to break the sound barrier was whether to switch to the international TV hit, The Killing (Forbrydelsen).  Ten minutes before the show, sportscaster Ulla Essendrop voiced Denmark’s frustration by tweeting: “JUUUUUUUUUUUUMP.”

Two days later, Washington Post journalist Erza Klein tweeted “My sources say Obama will enter tonight’s town hall by space jumping from approximately 130,000 feet…” The President’s successful comeback that evening was dissected by 7.2 million tweets.

Of course, many still view Twitter as a fleeting pastime. But there are 140 million active users monthly and the company is valued at billions of dollars.  To prove once again that tweeting is more than an official couch sport, here are four reasons why Twitter is important.

First, it provides up-to-the-second snapshots of events. Live blogging can only stream information through one channel.  But with Twitter, users can tap into endless channels for instant fact checking, expert commentary and belly-aching humor. The result is a deeper, more sophisticated understanding.

This is illustrated by the Twitter reaction during the second presidential face-off. One debate question concerned the doubling of gas prices since Obama took office.  Resembling two fighting bighorn sheep, the candidates clashed horns repeatedly, but generally avoided answering the question. The confusion was settled when experts tweeted that prices plummeted because of the global financial crisis and that gas prices are largely controlled internationally, with little help from the President.

Second, while breaking news used to be captured through photos or quotes, now it is tweeted.  Similar to interpreting intelligence data, the trick is to find the gem. Last summer, many were convinced that America’s near-universal health care program, ObamaCare, was stillborn.  This was because it was assumed that the U.S. Supreme Court’s conservative majority would overturn it.  But according to legal journalist Jeffrey Toobin, conservative Chief Justice Roberts’ switch to save the program was leaked via Twitter two months before the Court upheld it.

Third, Twitter further breaks down the barriers between average Janes and the famous. Michael Moore, the director of the film Bowling for Columbine, dedicated his day to getting Americans to vote on November 6.  He provided his cell phone number, tweeting: “If u know someone who isn’t going to vote but might if I called or texted them, text me their cell # …”  Five hours later, he tweeted his 1.2 million followers, “Thx for sending numbers of your loved ones who weren’t gonna vote. Have been on the phone or texting with scads of them for the past 4 hrs!”

Moore’s example provides direct evidence of a final advantage: Twitter’s potential to spur democratic participation. Admittedly, it can be difficult to measure just how effective Twitter is.  But Lady Gaga tweeted and retweeted her 31 million followers 13 times on Election Day. One tweet read, “If you’re old enough to vote for the first time, exercise your right today! It matters & can change the world.”  If anyone could convince a young American to vote, it is she.

Football and Danish National Pride: A Convert’s Perspective

Danish Football Fans, EURO2012, Lviv, Ukraine

Danish Football Fans, EURO2012
photo by Kathrin Pelgröm

Painting the flag on the faces of football fans on the way to the game against Portugal made me nervous.  Was I getting the proportions right?  After all, I am American.  Luckily, I was sitting on a train with over 400 Danes covered in a celebration of red and white, including flags. By the end of the tour in Lviv, Ukraine, I could draw this cherished symbol and had become a convert of Danish national pride.

Call it arrogance, but Americans are used to relaxing and waiting for success.  Of course this perception is unrealistic.  The U.S. never made it past stage two of the 2010 World Cup, losing 1-2 to Ghana.  Still, the feeling of being unbeatable persists because we say that football doesn’t really count.

In contrast, I found cheering for Denmark stressful, yet rewarding.  The train nearly danced on the rails on the way to the Fan Zone and the game against Portugal. Having already won the Netherlands 1-0, we were euphorically jumping up and down, continuing at the stadium: “Dem som ikke hopper, de elsker Portugal,” (Those who aren’t jumping, they love Portugal).

Our high spirits burst like a punctured balloon when the Portuguese scored in the 24th and 36th minutes. We were flying again before the first half ended, when Michael Krohn-Dehli headed the ball in for a goal. “Ole, vi er Danskerne, vi er Danskerne!”  (Ole’, we are the Danes, we are the Danes!). Hope peaked to new levels when Nicklas Bendtner headed the ball in to make it 2-2. With only 10 minutes left of the game, we waited out the tense atmosphere, but were again disappointed when the Portuguese scored with 3 minutes to go.

There was no party that night. Yet hope sprung eternal because Denmark won the European Championships in 1992.  Marching into the Fan Zone before the game against Germany, there was a feeling that it could happen again. “Deutschland, Deutschland alles ist vorbei!” (It’s all over Germany!).

When our red and white force of over 400 was met by Ukrainians smiling from the sidewalks and waving from the balconies, I was surprised to find that I felt like crying.  Although we lost the game to Germany 1-2, I had become a convert to Danish national pride.  Here success doesn’t come by default and we run into walls most of the time.  Instead, success requires an unwavering collective belief and a stubborn tenacity to hold on for the ride.  Because we know, one day, it will be like 1992 again.

Fodbold og dansk, national stolthed: fra en konvertits synspunkt

Dansk Roligans, EM 2012

Dansk Roligans, EM 2012
foto af Kathrin Pelgröm

Det gjorde mig nervøs at male flag i ansigtet på fodboldfans på vej til kampen mod Portugal. Var proportionerne rigtige? Jeg er trods alt amerikaner. Heldigvis sad jeg i et tog med over 400 danskere, der var dækket af de rød-hvide farver, deriblandt flag. Imod slutningen af turen til Lviv, Ukraine kunne jeg male det elskede symbol og var konverteret til dansk, national stolthed. Continue reading

A Decision Against ObamaCare Could Foment A Revolution

Judge's Gavel on U.S. flagFollowing oral arguments at the Supreme Court, a consensus has emerged that the individual mandate is in jeopardy.  Before this rush to judgment becomes a tsunami, let us consider the legal consequences.  After all, the justices are not rock stars, but public servants.

If politics win, the results will be more troubling than the unrealistic parade of horribles that dominate today. Though not as colorful a soundbite as being forced to buy broccoli, a decision against the mandate could foment a revolution.

Continue reading