MOWING YOUR ROOF

There are several fascinating, encouraging items on the Climate Crisis Coalition news blog this month. Click here to see them (thanks, Stephanie) . . . especially the one about putting a lawn on your roof (can a putting green be far behind?), which would obviously not work for most homes – a house with seven gables, for example, or the house in Psycho – but could be terrific for the roof of the local Jiffy Lube, and hundreds of millions of other square feet.

Environment Canada found that a typical one-storey building with a grass roof and 10 centimetres [4 inches] of growing medium [soil] would cut summer cooling needs by 25 percent. Other studies have found that a 15-centimetre green roof reduced heat gains by 95 percent and heat losses by 26 percent compared to a traditional roof.

In Germany, which has apparently been pushing this concept for decades, 12% of the flat roofs are already ‘green’ – 3 billion square feet worth, which is a thousand times what have been installed in North America.

PEDALING YOUR HOOF

And in Paris, they launch this month an ambitious bike rental scheme that, it is hoped, will gain more in traffic and CO2 reduction than it costs in increased emergency room visits.

Of course, in France, medical care is free . . .

SiCKO

Sam R. Linder: ‘In SiCKO, Moore tries to skirt the issue of rationing by going to a Canadian emergency room and finding that people have only had to wait there for 20 minutes. I don’t know what city Mr. Moore was in, nor what hospital, as I haven’t seen his movie yet. However, the Royal Inland Hospital in Kamloops, Canada, was a place where I waited in their emergency room for 6 hours without being seen by a doctor. If I had, I would have been charged $250 because I was a visiting American. The waiting room was full and people were lined up on gurneys in the halls waiting to be seen. It had to have been one of the worst examples of ‘socialized medicine’ I have ever seen. This country would do well to be careful of radically changing our system before considering ALL the implications. As a side note, I’m fortunate enough to be a member/patient of Kaiser Permanente in Oregon and have always received excellent and timely care.’

☞ Radical change may or may not be an option in the U.S., but it seems to me a few big-picture ideas should help guide the discussion:

  • One is that our system employs something vaguely on the order of a million people to sell and administer health insurance policies – not counting all the time doctors and nurses and employers and patients and hospital employees spend trying to comply. Could those million employees provide an even greater health care benefit if they were, say, nurses? Or do you sometimes find yourself writhing in your hospital bed thinking you have too much nursing care, too few people selling you insurance and denying your claims?
  • Medicare spends about 3% administering itself; Kaiser Permanente, more like 17%; for-profit insurers, more still.

  • Two is that we spend almost twice as much on health care as the French and the Canadians (although we live less long), so for all the flaws we may rightly find in the Canadian system, or the French, there may be some financial wiggle room to correct them. If the Canadians or the French spent more, as we do, their care might be even better than it is.
  • Three is that it is complete madness that Medicare is prohibited – by law! – from using its purchasing power to negotiate low drug prices. (This is, of course, a Republican law that the Democratic Congress is now trying to change.) Yes, big drug companies need big profit incentives. But they don’t need taxpayer subsidies, which is what this mandatory ‘pay-top-dollar’ law effectively is.
  • Four is that not everyone can go to the best doctor in town (what would all the other doctors do?) or have access to the very latest medical equipment (it takes time to build and install enough of a new device to serve the entire population). The two ways I can think of to ration health care are, first, on the basis of need; and second, on a ‘highest-bidder’ basis. In Canada, as I understand it, it is only the former that is used. Those wanting even better or faster care come down to the United States for treatment – if they can afford it. And in that sense, Canada has a two-tiered system without having to admit it. Realistically, America should probably have a two-tiered system, too. We should have outstanding care available to all, especially for acute health needs and preventive care. But we should allow those who want it to pay more to ‘fly first class.’ Private rooms? Private 24-hour nursing? No wait for elective surgery? On one level, it is undemocratic. On another, it is quintessentially American and can be a win-win. If I want to pay five times as much as you to fly to Chicago in the front of the plane (I don’t, by the way; I use frequent-flier upgrades), this is good for both of us. It makes me happy; and it makes the flight cheaper for you. (What it does to my carbon footprint is another issue for another day. Upgrades or no, I drip with guilt.)
  • Five is that there are tremendous inefficiencies in the system which we, of all people, should be able to make more progress wringing out. It’s 2007, people.

So I would like to see something like the Canadian system, but more amply funded for even better standard care – and the escape valve of being able to ‘go to America,’ as the Canadians now do, for private care.

The two principal challenges, it seems to me, are, first: finding ways to be sure the universal ‘standard’ care is really good (which would include the simple pride and humanity of doctors, nurses, and hospital administrators, but also outcome-based incentives that reward improved results); second, and more difficult: finding a politically feasible way to get from here to there.

Finding a way gradually to redirect a million people from clerking to nursing could be part of it. Licensing more med schools (and fewer law schools?) could be another.

You really should see SiCKO and join the conversation. Your health – and the competitiveness of our economy – are at stake.

Scott Nicol: ‘Haven’t seen it yet, but having lived in both Canada and the US, I can see problems in both systems. A few years ago, complaining of back pain, my doctor determined I had a pinched nerve. He called his secretary to arrange for me to get an MRI. As I was leaving the office, the secretary was on the phone with the MRI clinic, and stopped me to ask if I’d prefer tomorrow morning or afternoon. Can you take a wild guess at which country this took place in? The U.S., of course. In Ottawa, Canada’s capital, the wait for a non-emergency MRI is around five months. BTW, I think both next day and five months ridiculous. Both show poor planning, but in opposite directions.’

☞ ‘Next day’ is fine with me if someone is willing to pay through the nose for that luxury, making MRIs a little cheaper for the rest of us. Just as long as that never blocks someone who really needs an MRI right now from getting it.

Larry: ‘The Slate article referenced by Jim Hannah is refuted here.’

☞ And very well.

 

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