Self Reflection After this Course

This course was very instructive for me. Some of the materials I studied in this course impacted considerably my view on environmental protection. I learned in this course how our old ideal of economic system is now one of our biggest threats. So, a new conception of economic agents behavior and system is urging to save human being. In others words we should be aware that more is not better as we were thinking all the time in economics. For instance, The Nobel Prize-winning economist Joseph Stiglitz demonstrated us that the GDP is not the best measurement of the national economic success.

Feedback on the course and its design

I have a positive attitude about this course for some reasons. First of all, this course was very informative because we learn a lot things from our own posts and from the posts of others classmates. Second, the fact that this course was focused on reading and writing was extremely important for the development of our skills. Most students consider that course is harder when it contain more writing assignments. In this course all the writing assignments were very motivating for me. I can say without doubt that this helps me to develop my writing and reading skills. However, the beginning of this course was very confusing for me even though I am used to online classes. I think this hard time was due to the fact that this course was a really new way of learning that asks to be really motivated. For the future, I think that this course could be repeated, but students need to get and understanding the methodology in the very beginning of the class.

My best Post from the 2nd half semester

I believe that Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally is my best post from the 2nd half of the semester. This post gives us the opportunity to learn some important information about the U.S. Health Care System and 10 others countries’ system. It informs us how the U.S. Health Care System quality ranks in the last position comparing to some wealthy countries. However, this post reveals that there is some good news about this crucial question. The Affordable Care Act with the implication of health care technology systems would improve considerably the health system.   Some findings stipulate that, from the outlook of both physicians and patients, the U.S. health care system could do much better in achieving worth for the colossal investment of the nation’s health care.

If you have seen this post yet, please go to this link:

My best Post from the 1st half semester

I think that The Four Asian Tigers is my best post in the 1st half semester for two reasons. First, this post shows the importance of the concept of comparative advantage. It describes us how the economic system based on the specialization in areas of competitive advantage helps Hong Kong, Singapore, South Korea, and Taiwan to develop considerably their economy (Hong Kong and Singapore have become highly competent in international finance, in contrast, Singapore and South Korea specialized in manufacturing information technology). In these economics systems the export exchange was the key of quick development. Secondly, this posting illustrate the impact of a good education system on the economic development. So, the information from this post is very necessary to understand the Comparative Economic Systems.

If you have seen this post yet, please go to this link:   

Book Review of Deep Economy: The Wealth of Communities and the Durable Future

Deep econ

Deep Economy: The Wealth of Communities and the Durable Future by Bill McKibben
Times Books, 2007
ISBN: 0805076263
272 Pages

Who is Bill Mckibben?

Bill McKibben is an author and environmentalist who in 2014 was awarded the Right Livelihood Prize, sometimes called the ‘alternative Nobel.’ His 1989 book The End of Nature is regarded as the first book for a general audience about climate change, and has appeared in 24 languages; he’s gone on to write a dozen more books. He is a founder of, the first planet-wide, grassroots climate change movement, which has organized twenty thousand rallies around the world in every country save North Korea, spearheaded the resistance to the Keystone Pipeline, and launched the fast-growing fossil fuel divestment movement.

The Schumann Distinguished Scholar in Environmental Studies at Middlebury College and a fellow of the American Academy of Arts and Sciences, he was the 2013 winner of the Gandhi Prize and the Thomas Merton Prize, and holds honorary degrees from 18 colleges and universities. Foreign Policy named him to their inaugural list of the world’s 100 most important global thinkers, and the Boston Globe said he was “probably America’s most important environmentalist.”

A former staff writer for the New Yorker, he writes frequently for a wide variety of publications around the world, including the New York Review of BooksNational Geographic, and Rolling Stone. He lives in the mountains above Lake Champlain with his wife, the writer Sue Halpern, where he spends as much time as possible outdoors . In 2014, biologists honored him by naming a new species of woodland gnat— Megophthalmidia mckibbeni–in his honor. For more information, please visit:


What is this Book about?

If you have already read many books about the dangers facing human beings, but this book is not amount them, I would recommend you to get it as soon as possible. Why did I choose to read The Wealth of Communities and the Durable Future by Bill McKibben? I have never heard about this book before, so the only thing that attracted me to read it is the title. In the title there are two important words or concepts: “community” and “future”. These two concepts are very connected to human beings. Since human question should be treated with more thoughtfulness, this book exposed in a intelligible way how we can solve the problem of climate change. The matter in question discussed in this book is centered on the concept of indefinite growth which is seen as the most by economic system. In most culture and historically, more have been considered as equal to better. The individual behaviors in trying to get their own interest have made others people opulent. The author ideas are first that that the growth is a danger for humanity because it will create insecure condition in the future. The author pointed the environment degradation out caused by this growth as a negative effect on human life. He discussed the concept of the happiness and showed that the growth is not positively link to it. Our desire to get always more and to think that being able to produce a huge quantity of good in the economy is questioned in this book. We are unconsciously our planet by our greedy. The author argued that to save humanity we should reduce the effect of the globalization and the endless economic growth impacting negatively the environment. He supported that we should localize our economy. He thinks that it we must act now consciously in managing the good of our economy in a community.

What is my thought about this book?

This book is one the best that discuss the outcome of some our economic rationality behaviors. It appeals us to start thinking about the community’s economic goals achievement. It explains why our individualism behavior should be abandoned. As you see, the matter in question in this book is very controversial. The author goal in this book is really challenging.  It is not easy at all to argue that “more is not better” and to convince people to change their individualism behavior to the community wellbeing. The author supports his argument with some remarkable personal experiences. All of the arguments used are well supported by this author. I think that this book is very intelligible. As I said, I chose to read this book because of the title. After my reading I learned how our world is dramatically worsen by the old conception of economic development.  The author recommendation appealing a deep change in the mass production and consumption without control (global) to a small size (local) is very convincing. I am proud of the job done by Bill in treating this challenging question. I especially like his reasoning in the chapter 4. where he discussed the Wealth of the Communities. This passage is from this chapter “Radio is, like food, a large part of most people’s lives: 77 percent of the population listens to radio an average of at least three and a half hours a day, making it very nearly ubiquitous. And like food, radio used to be mostly local, hemmed in by mountains, limited by signal strength”. (pp.211-212).

What is The Mindful World said about this book?

In Deep Economy, McKibben argues against the current neoliberal social order while creating a very approachable prescription for a sustainable society. To McKibben, sustainability rests in a resurgence of community, exemplified by locavorism and public radio movements, which he believes offer true alternatives to the malaise of endless hyper-individualist consumerism. If, in McKibben’s words, the “two birds named ‘More’ and ‘Better’” can no longer perch on the branch they have for centuries, society must slow down and put more energy into our local communities to revitalize the important, immediate bonds that make up a fulfilling, sustainable life. But is depth enough?

A mainstream understanding of economy is rooted in individual choice—we have sustainable “alternatives” rather than a system that is simply sustainable. The dominant logic is that before the Arctic becomes beachfront property, consumers will become enlightened and invest in a sustainable world. But who gets to define “sustainability” in the first place?

McKibben touches on the economic exploitation of global workers while arguing that the world’s poor cannot use the same industrial capitalism used since the 1700s by North America and Europe to achieve a higher standard of living. But he fails to bridge the Western, white, bourgeois understanding of sustainable society to the globally and locally disenfranchised experience, which is based around material lack. As the UN Climate Change Conference in Copenhagen has recently demonstrated, privileged nations have a fundamental inability to understand the experiences of poor nations. Our current global infrastructure, proudly built in the West, is a veritable blueprint for exploitation and unsustainable accumulation. Yet the West’s solutions to climate change ignore a history of Western global exploitation while admonishing poorer nations for attempting to follow in our footsteps. Locally, farmer’s markets and many other supposedly sustainable practices occur within an individualist system with a history of exploitation. Within such systems sustainable goods become luxury goods that are not economically attainable for many. So long as sustainability is defined in a public arena where malls speak louder than parks, sustainability will fail to address the experiences of marginalized people. What is a community where sustainability is for those who can afford it as a lifestyle product? It is unsustainable.

Despite the disjuncture between equity and sustainability, Deep Economy can open eyes to an alternative way of understanding society. It diagnoses our energy use, eating and purchasing habits, and the underlying way that we value things as terminal, but goes well past the gloom and doom. McKibben weaves together the disparate threads of community-driven alternatives to mainstream consumer society into a thoughtful prescription of how we might start to reorganize our lives so that they are less economically, but more socially valuable. Perhaps in time, McKibben’s work will help bring the many experiences of “sustainability” out of the marketplace and into a society-driven discourse.


What you need to know about Obamacare’s cost-cutting measures

October 6, 2014

When we talk about the Affordable Care Act, we talk about the millions of Americans newly insured under the law. Or the state marketplaces, the Medicaid expansions. Or the Web site kinks.

But a host of cost-cutting initiatives are built into the legislation, and partnerships with health providers nationwide — big and small, urban and rural — reduce government spending. 

Stephen Zuckerman, co-director of Urban Institute’s Health Policy Center who has studied the economics of health care for three decades, said care quality is particularly emphasized in the ACA. He co-wrote this paper to answer critics who said the law didn’t do anything to cut health-care spending. This conversation has been edited for clarity and length.

“I got into health care 30 years ago. This has long been the case: Many people don’t have health insurance, and health care is expensive.

The Affordable Care Act caused a major shift in the country’s ability to provide people with health-care coverage. But cost-containing remains a challenge: When you give people insurance, they’re likely to go out and get the care they weren’t getting when they were uninsured. That’s a good thing — but it’s going to add cost to the program.

There was a lot of criticism of the ACA not addressing cost containment. But the law built on money-saving devices that have been around for a long time — such as managed competition in creating the marketplaces, so that health plans would have incentive to compete with one another and keep premiums low. In the first year, and going into the second year, you’re seeing lower premiums and slower growth in premiums.

You also have explicit controls on Medicare payments. The feeling was: You’re going to finance this coverage expansion, and providers were going to have a lot fewer uninsured patients. So, the law focuses on reducing payments for one of the major public programs, Medicare.

Under the Affordable Care Act, hospitals, home-care programs and skilled nursing facilities are going to be seeing lower Medicare payments. A range of policy ideas address this. Many are related to hospital readmissions, which are costly. Incentives were put in place for hospitals to reduce readmissions for pneumonia, congestive heart failure and heart attacks. If they didn’t, they’d pay a penalty.

People are working under the assumption that, in a system where prices are not well controlled, providers don’t necessarily have the incentive to organize in the most efficient ways possible. Hospitals may be overstaffed, for example. They may not be taking advantage of electronic health records that allow for a better flow of information.

The ACA recognized that — and it introduced the notion of an Accountable Care Organization. The ACOs are set up to manage, specifically, the costs of the populations they’re treating. If they’re successful in providing services at lower costs while maintaining quality, hospitals earn bonuses. They get a share of the savings.

Before the ACA, quality wasn’t always the first thing considered.

One of my first projects at the Urban Institute, in the 1980s, was an evaluation of a change in hospitals getting paid on a cost-based system — they were essentially reimbursed for all costs incurred. Hospitals, more recently, have been paid a fixed price per patient. They didn’t have an incentive to keep patients in the hospital for a long time — which means they had an incentive to get patients out of hospitals.

That’s not always a good thing for a sick person. Or the system. Patients get discharged too quickly and get readmitted somewhere else. Or they end up in a nursing facility for expensive rehabilitation.

You can’t compromise quality if you’re going to save costs.

Nowadays, we know how to expand insurance coverage. Policymakers have done that effectively. We know much less about cost containment, and how to make that happen in a way that preserves quality. A lot of experimentation is taking place under the ACA.

It’s early. The jury is still out on how it’ll all work.”

Here are some of the Affordable Care Act’s cost-cutting creations:

  • The Patient-Centered Outcomes Research Institute conductscomparative-effectiveness research, which aims to uncover the positives and negatives of different treatment options. The institute’s objective: Help doctors, patients and policymakers make informed choices amid an ever-shifting health climate.
  • Hospitals can apply to become Accountable Care Organizations. That means doctors, nurses and social workers band together to deliver continuous, coordinated care to patients. If they slash government spending, they get to keep a share of the savings.
  • The Readmissions Reduction Program penalizes hospitals when patients return too frequently with, for example, heart problems or pneumonia. The idea: Doctors should prevent these maladies after a patient’s first stay. Readmissions result in Medicare payment cuts.
  • Starting next year, the Independent Payment Advisory Board will recommend changes to Medicare if costs exceed a certain target (GDP plus 0.5 percent). The 15-member agency, comprised of experts across the health-care industry, will focus on curbing costs without affecting coverage or quality.
  • Pilot programs for “bundled” Medicare payments give health-care providers a lump sum for certain treatments. The idea: Hospitals gain flexibility to better allocate resources — and save money through reduced complications and readmissions.

Danielle Paquette is a reporter covering the intersection of people and policy. She’s from Indianapolis and previously worked for the Tampa Bay Times. Follow her on Twitter: @Dpaqreport.

Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally

Executive Summary

The United States health care system is the most expensive in the world, but this report and prior editions consistently show the U.S. underperforms relative to other countries on most dimensions of performance. Among the 11 nations studied in this report—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity. In this edition of Mirror, Mirror, the United Kingdom ranks first, followed closely by Switzerland (Exhibit ES-1).

Expanding from the seven countries included in 2010, the 2014 edition includes data from 11 countries. It incorporates patients’ and physicians’ survey results on care experiences and ratings on various dimensions of care. It includes information from the most recent three Commonwealth Fund international surveys of patients and primary care physicians about medical practices and views of their countries’ health systems (2011–2013). It also includes information on health care outcomes featured in The Commonwealth Fund’s most recent (2011) national health system scorecard, and from the World Health Organization (WHO) and the Organization for Economic Cooperation and Development (OECD).

Overall health care ranking

Click to download Powerpoint chart.

The most notable way the U.S. differs from other industrialized countries is the absence of universal health insurance coverage.5 Other nations ensure the accessibility of care through universal health systems and through better ties between patients and the physician practices that serve as their medical homes. The Affordable Care Act is increasing the number of Americans with coverage and improving access to care, though the data in this report are from years prior to the full implementation of the law. Thus, it is not surprising that the U.S. underperforms on measures of access and equity between populations with above- average and below-average incomes.

The U.S. also ranks behind most countries on many measures of health outcomes, quality, and efficiency. U.S. physicians face particular difficulties receiving timely information, coordinating care, and dealing with administrative hassles. Other countries have led in the adoption of modern health information systems, but U.S. physicians and hospitals are catching up as they respond to significant financial incentives to adopt and make meaningful use of health information technology systems. Additional provisions in the Affordable Care Act will further encourage the efficient organization and delivery of health care, as well as investment in important preventive and population health measures.

For all countries, responses indicate room for improvement. Yet, the other 10 countries spend considerably less on health care per person and as a percent of gross domestic product than does the United States. These findings indicate that, from the perspectives of both physicians and patients, the U.S. health care system could do much better in achieving value for the nation’s substantial investment in health.

Major Findings

  • Quality: The indicators of quality were grouped into four categories: effective care, safe care, coordinated care, and patient-centered care. Compared with the other 10 countries, the U.S. fares best on provision and receipt of preventive and patient-centered care. While there has been some improvement in recent years, lower scores on safe and coordinated care pull the overall U.S. quality score down. Continued adoption of health information technology should enhance the ability of U.S. physicians to identify, monitor, and coordinate care for their patients, particularly those with chronic conditions.
  • Access: Not surprisingly—given the absence of universal coverage—people in the U.S. go without needed health care because of cost more often than people do in the other countries. Americans were the most likely to say they had access problems related to cost. Patients in the U.S. have rapid access to specialized health care services; however, they are less likely to report rapid access to primary care than people in leading countries in the study. In other countries, like Canada, patients have little to no financial burden, but experience wait times for such specialized services. There is a frequent misperception that trade-offs between universal coverage and timely access to specialized services are inevitable; however, the Netherlands, U.K., and Germany provide universal coverage with low out-of-pocket costs while maintaining quick access to specialty services.
  • Efficiency: On indicators of efficiency, the U.S. ranks last among the 11 countries, with the U.K. and Sweden ranking first and second, respectively. The U.S. has poor performance on measures of national health expenditures and administrative costs as well as on measures of administrative hassles, avoidable emergency room use, and duplicative medical testing. Sicker survey respondents in the U.K. and France are less likely to visit the emergency room for a condition that could have been treated by a regular doctor, had one been available.
  • Equity: The U.S. ranks a clear last on measures of equity. Americans with below-average incomes were much more likely than their counterparts in other countries to report not visiting a physician when sick; not getting a recommended test, treatment, or follow-up care; or not filling a prescription or skipping doses when needed because of costs. On each of these indicators, one-third or more lower-income adults in the U.S. said they went without needed care because of costs in the past year.
  • Healthy lives: The U.S. ranks last overall with poor scores on all three indicators of healthy lives—mortality amenable to medical care, infant mortality, and healthy life expectancy at age 60. The U.S. and U.K. had much higher death rates in 2007 from conditions amenable to medical care than some of the other countries, e.g., rates 25 percent to 50 percent higher than Australia and Sweden. Overall, France, Sweden, and Switzerland rank highest on healthy lives.

Summary and Implications

The U.S. ranks last of 11 nations overall. Findings in this report confirm many of those in the earlier four editions of Mirror, Mirror, with the U.S. still ranking last on indicators of efficiency, equity, and outcomes. The U.K. continues to demonstrate strong performance and ranked first overall, though lagging notably on health outcomes. Switzerland, which was included for the first time in this edition, ranked second overall. In the subcategories, the U.S. ranks higher on preventive care, and is strong on waiting times for specialist care, but weak on access to needed services and ability to obtain prompt attention from primary care physicians. Any attempt to assess the relative performance of countries has inherent limitations. These rankings summarize evidence on measures of high performance based on national mortality data and the perceptions and experiences of patients and physicians. They do not capture important dimensions of effectiveness or efficiency that might be obtained from medical records or administrative data. Patients’ and physicians’ assessments might be affected by their experiences and expectations, which could differ by country and culture.

Disparities in access to services signal the need to expand insurance to cover the uninsured and to ensure that all Americans have an accessible medical home. Under the Affordable Care Act, low- to moderate-income families are now eligible for financial assistance in obtaining coverage. Meanwhile, the U.S. has significantly accelerated the adoption of health information technology following the enactment of the American Recovery and Reinvestment Act, and is beginning to close the gap with other countries that have led on adoption of health information technology. Significant incentives now encourage U.S. providers to utilize integrated medical records and information systems that are accessible to providers and patients. Those efforts will likely help clinicians deliver more effective and efficient care.

Many U.S. hospitals and health systems are dedicated to improving the process of care to achieve better safety and quality, but the U.S. can also learn from innovations in other countries—including public reporting of quality data, payment systems that reward high-quality care, and a team approach to management of chronic conditions. Based on these patient and physician reports, and with the enactment of health reform, the United States should be able to make significant strides in improving the delivery, coordination, and equity of the health care system in coming years.

us health care ranks last

Macroeconomics and Health

Macrohealth montage

Health is an intrinsic human right as well as a central input to poverty reduction and socioeconomic development. Cost-effective interventions for controlling major diseases exist, but a serious lack of money for health and a range of system constraints hamper global and national efforts to expand health services to the poor. The high burden of preventable diseases in poor countries and communities calls for strategic planning of investments across health and health-related sectors to improve the lives of poor people and promote development.

Responding to this urgent need, a macroeconomics and health process helps place health at the centre of the broader development agenda in countries. It engages Ministries of Finance, Planning and Health to act in tandem with development agencies, civil society, philanthropic organizations, academia, and the private sector. Together, they can take forward a shared agenda for addressing financial and systemic constraints to the equitable and timely delivery of quality health and social services. This work will contribute toward achievement of the Millennium Development Goals, global objectives such as “3 by 5”, and national health targets.

Countries are driving the macroeconomics and health process, which takes into account countries’ unique health and macroeconomic variables. WHO, working closely with governments and their partners, advocates for a more prominent role for health within countries’ macroeconomic agendas. It also offers technical expertise to support country efforts for developing long-term multisectoral investment plans. The work is carried out in line with three themes:

  • Achieving better health for the poor
  • Increasing investments in health
  • Progressively eliminating non-financial constraints.

In support of ongoing country macroeconomics and health activities, the Second Consultation on Macroeconomics and Health, “Increasing Investments in Health Outcomes for the Poor” took place from 28-30 October 2003 at WHO Headquarters in Geneva. Ministers of Health, Finance and Planning from forty low- and middle-income countries came together with development partners to discuss issues related to improving the effectiveness of health delivery systems and increasing domestic and external resources to health. Following the Consultation, participants endorsed a Declaration incorporating major outcomes from Consultation and working group discussions.