Healthcare in Germany From Wikipedia

Germany has the world's oldest national social health insurance system,^[1] with origins dating back to Otto von Bismarck's social legislation, which included the Health Insurance Bill of 1883, Accident Insurance Bill of 1884, and Old Age and Disability Insurance Bill of 1889. As mandatory health insurance, it originally applied only to low-income workers and certain government employees, but has gradually expanded to cover the great majority of the population.^[8] The system is decentralized with private practice physicians providing ambulatory care, and independent, mostly non-profit hospitals providing the majority of inpatient care. Approximately 92% of the population is covered by a 'Statutory Health Insurance' plan, which provides a standardized level of coverage through any one of approximately 1,100 public or private sickness funds. Standard insurance is funded by a combination of employee contributions, employer contributions and government subsidies on a scale determined by income level. Higher income workers sometimes choose to pay a tax and opt out of the standard plan, in favor of 'private' insurance. The latter's premiums are not linked to income level but instead to health status.^[9] Historically, the level of provider reimbursement for specific services is determined through negotiations between regional physician's associations and sickness funds.

Since 1976 the government has convened an annual commission, composed of representatives of business, labor, physicians, hospitals, and insurance and pharmaceutical industries.^[10] The commission takes into account government policies and makes recommendations to regional associations with respect to overall expenditure targets. In 1986 expenditure caps were implemented and were tied to the age of the local population as well as the overall wage increases. Although reimbursement of providers is on a fee-for-service basis the amount to be reimbursed for each service is determined retrospectively to ensure that spending targets are not exceeded. Capitated care, such as that provided by U.S. health maintenance organizations, has been considered as a cost containment mechanism but would require consent of regional medical associations, and has not materialized.^[11]
Copayments were introduced in the 1980s in an attempt to prevent overutilization and control costs. The average length of hospital stay in Germany has decreased in recent years from 14 days to 9 days, still considerably longer than average stays in the U.S. (5 to 6 days).^[12][13] The difference is partly driven by the fact that hospital reimbursement is chiefly a function of the number of hospital days as opposed to procedures or the patient's diagnosis. Drug costs have increased substantially, rising nearly 60% from 1991 through 2005. Despite attempts to contain costs, overall health care expenditures rose to 10.7% of GDP in 2005, comparable to other western European nations, but substantially less than that spent in the U.S. (nearly 16% of GDP).^[14

The healthcare system is regulated by the Federal Joint Committee (Gemeinsamer Bundesausschuss), a public health organization authorized to make binding regulations growing out of health reform bills passed by lawmakers, along with routine decisions regarding healthcare in Germany.^[15]
Health insurance in Germany is split in several parts. The largest part of 85% of the population is covered by a basic health insurance plan provided by statute, formally insured under the legislation set with the Sozialgesetzbuch V (SGB V), which provides a standard level of coverage. The remainder of 15% opt for private health insurance, which frequently offers additional benefits.
The government partially reimburses the costs for low-wage workers, whose premiums are capped at a predetermined value. Higher wage workers pay a premium based on their salary. They may also opt for private insurance. This may result in substantial savings for younger individuals in good health. With age and illness, private premiums will rise and the insured will usually cancel their private insurance, turning to the government option.,^[9] however, this is not always possible, nor is it simple to accomplish.

Reimbursement is on a fee-for-service basis, but the number of physicians allowed to accept Statutory Health Insurance in a given locale is regulated by the government and professional medical societies. Co-payments were introduced in the 1980s in an attempt to prevent over-utilization.
Germany has a universal multi-payer system with two main types of health insurance. Germans are offered three mandatory health benefits, which are co-financed by employer and employee: health insurance, accident insurance, and long-term care insurance.

Accident insurance for working accidents (Arbeitsunfallversicherung) is covered by the employer and basically covers all risks for commuting to work and at the workplace.
Long-term care (Pflegeversicherung) is covered half and half by employer and employee and covers cases in which a person is not able to manage his or her daily routine (provision of food, cleaning of apartment, personal hygiene, etc.). It is about 2% of a yearly salaried income or pension, with employers matching the contribution of the employee.

There are two separate types of health insurance: public health insurance (Gesetzliche Krankenversicherung) and private insurance (Private Krankenversicherung). Both systems struggle with the increasing cost of medical treatment and the changing demography. About 87.5% of the persons with health insurance are members of the public system, while 12.5% are covered by private insurance (as of 2006).^[16]
In the Private system the premium

• is based on an individual agreement between the insurance company and the insured person defining the set of covered services and the percentage of coverage
• depends on the amount of services chosen and the person's risk and age of entry into the private system
• is used to build up savings for the rising health costs at higher age (required by law)

For persons who have opted out of the public health insurance system to get private health insurance, it can prove difficult to subsequently go back to the public system, since this is only possible under certain circumstances, for example if they are not yet 55 years of age and their income drops below the level required for private selection. Since private health insurance is usually more expensive than public health insurance, the higher premiums must then be paid out of a lower income. During the last twenty years private health insurance became more and more expensive and less efficient compared with the public insurance.^[17
http://en.wikipedia.org/wiki/Healthcare_in_Germany

Fourteenth Amendment to the United States Constitution by Wikipedia

The Fourteenth Amendment (Amendment XIV) to the United States Constitution was adopted on July 9, 1868, as one of the Reconstruction Amendments.
Its Citizenship Clause provides a broad definition of citizenship that overruled the Supreme Court's ruling in Dred Scott v. Sandford (1857) that had held that black people could not be citizens of the United States.^[1]
Its Due Process Clause prohibits state and local governments from depriving persons of life, liberty, or property without certain steps being taken to ensure fairness. This clause has been used to make most of the Bill of Rights applicable to the states, as well as to recognize substantive and procedural rights.
Its Equal Protection Clause requires each state to provide equal protection under the law to all people within its jurisdiction. This clause was the basis for Brown v. Board of Education (1954), the Supreme Court decision which precipitated the dismantling of racial segregation in United States education. In Reed v. Reed (1971), the Supreme Court ruled that laws arbitrarily requiring sex discrimination violated the Equal Protection Clause.

Text

Section 1. All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.Section 2. Representatives shall be apportioned among the several States according to their respective numbers, counting the whole number of persons in each State, excluding Indians not taxed. But when the right to vote at any election for the choice of electors for President and Vice President of the United States, Representatives in Congress, the Executive and Judicial officers of a State, or the members of the Legislature thereof, is denied to any of the male inhabitants of such State, being twenty-one years of age, and citizens of the United States, or in any way abridged, except for participation in rebellion, or other crime, the basis of representation therein shall be reduced in the proportion which the number of such male citizens shall bear to the whole number of male citizens twenty-one years of age in such State.
Section 3. No person shall be a Senator or Representative in Congress, or elector of President and Vice President, or hold any office, civil or military, under the United States, or under any State, who, having previously taken an oath, as a member of Congress, or as an officer of the United States, or as a member of any State legislature, or as an executive or judicial officer of any State, to support the Constitution of the United States, shall have engaged in insurrection or rebellion against the same, or given aid or comfort to the enemies thereof. But Congress may, by a vote of two-thirds of each House, remove such disability.
Section 4. The validity of the public debt of the United States, authorized by law, including debts incurred for payment of pensions and bounties for services in suppressing insurrection or rebellion, shall not be questioned. But neither the United States nor any State shall assume or pay any debt or obligation incurred in aid of insurrection or rebellion against the United States, or any claim for the loss or emancipation of any slave; but all such debts, obligations and claims shall be held illegal and void.
Section 5. The Congress shall have power to enforce, by appropriate legislation, the provisions of this article.

Validity of public debtSection 4 confirmed the legitimacy of all United States public debt appropriated by the Congress. It also confirmed that neither the United States nor any state would pay for the loss of slaves or debts that had been incurred by the Confederacy. For example, during the Civil War several British and French banks had lent large sums of money to the Confederacy to support its war against the Union.^[47] In Perry v. United States (1935), the Supreme Court ruled that under Section 4 voiding a United States government bond "went beyond the congressional power."^[48]The United States debt-ceiling crisis in 2011 raised the question of what powers Section 4 gives to the President. Under the current law, the executive branch of the government (which includes the Treasury and the President) is obligated to carry out all appropriations authorized by the Congress. It has been argued that, in the presence of conflicting statutes (a federal budget statute, which instructs the Treasury to spend a certain amount of money, and a debt ceiling statute, which limits the amount of money that the Treasury is allowed to borrow in process), the statute that was passed more recently "wins"; therefore, in this situation, the President may simply instruct the Treasury to continue issuing bonds beyond the ceiling. Furthermore, such an instruction may be difficult to challenge in court, because it would take a joint resolution of both chambers of Congress to get standing to challenge it.^[49] In addition, it has been observed by many, such as legal scholar Garrett Epps, fiscal expert Bruce Bartlett and Treasury Secretary Timothy Geithner, that the debt ceiling itself may be unconstitutional and therefore void as long as it interferes with the duty of the government to pay interest on outstanding bonds and to make payments owed to pensioners (that is, Social Security recipients).^[50][51]
The issue of what effect Section 4 has regarding the debt ceiling remains unsettled.^[52] Legal analyst Jeffrey Rosen has argued that Section 4 gives the President unilateral authority to raise or ignore the national debt ceiling, and that if challenged the Supreme Court would likely rule in favor of expanded executive power or dismiss the case altogether for lack of standing.^[53] Erwin Chemerinsky, professor and dean at University of California, Irvine School of Law, has argued that not even in a "dire financial emergency" could the President raise the debt ceiling as "there is no reasonable way to interpret the Constitution that [allows him to do so]".^[54]

Power of enforcement

Main article: Congressional power of enforcement

Section 5, the last section, was construed broadly by the Supreme Court in Katzenbach v. Morgan (1966).^[55] However, the Court, in City of Boerne v. Flores (1997), said:

Any suggestion that Congress has a substantive, non-remedial power under the Fourteenth Amendment is not supported by our case law.^[56]

Proposal and ratification

The 39th United States Congress proposed the Fourteenth Amendment on June 13, 1866.
Ratification of the Fourteenth Amendment was bitterly contested: all the Southern state legislatures, with the exception of Tennessee, refused to ratify the amendment. This refusal led to the passage of the Reconstruction Acts. Ignoring the existing state governments, military government was imposed until new civil governments were established and the Fourteenth Amendment was ratified.^[57]
By July 9, 1868, three-fourths of the states (28 of 37) ratified the amendment:^[58

http://en.wikipedia.org/wiki/Fourteenth_Amendment_to_the_United_States_Constitution#Validity_of_public_debt

What You Need to Know About the Chained CPI from AARP

5 Reasons Chained CPI Is Bad For Social Security 

1. Chained CPI compounds over time. 
As a result of a chained CPI, there will be a 0.3% annual cut in Social Security cost of living adjustments (COLAs). Since this compounds over time, it would end up cutting the equivalent of one full month of benefits each year from a 92-year-old beneficiary. And it’s not a small cut overall – Social Security loses $112 billion over the next 10 years.

2. The greatest impact will be on the most vulnerable older Americans.
As retirees age, they have less income, fewer financial assets, and are more dependent on Social Security. Specifically, women tend to live longer than men and tend to have lower incomes, so women and poorer households are more at risk of falling into poverty with any cuts to Social Security.

3. Benefits for disabled and retired veterans would be cut.
3.2 million disabled veterans and another 2 million military retirees would see their benefits cut if chained CPI is adopted. Permanently disabled veterans who started receiving disability benefits at age 30 would see their benefits cut by more than $1,400 a year at age 45, $2,300 a year at age 55 and $3,200 a year at age 65.

4. Chained CPI is a less accurate measure of inflation
Since retirees spend much more on medical care than working-age Americans, the current CPI calculations already underreport the rapidly increasing health care costs experienced by seniors. Moving to a chained CPI would exacerbate the gap between formula and actual costs.

5. Social Security does not drive deficits, and should not be cut as part of a budget deal.
Social Security is a separately financed, off-budget program – it is not a driver of deficits in the rest of the budget. Any changes to Social Security should be handled separately, not as part of a budget deal that focuses on near-term savings that harm current retirees.
====================================================================
Here's how the budget proposal now being considered by Congress and the president could cut the value of your Social Security benefit

Most everyone has heard of the Consumer Price Index, or CPI. It's used to make the annual cost-of-living adjustments in Social Security and other federal programs that help millions of seniors keep up with inflation. But do you know about the chained CPI?

See also: Chained CPI Calculator: How much would your benefit be cut?

In an AARP whiteboard video, David Certner, AARP director of legislative policy, explains why a proposal that some politicians in Washington are pushing to cut federal spending may seem like a little thing, but in truth it could have a big impact on Social Security and veterans benefits.

http://action.aarp.org/site/PageNavigator/SocialSecurityCalculator.html

http://blog.aarp.org/2013/02/11/5-reasons-chained-cpi-is-bad-for-social-security/

http://www.aarp.org/politics-society/advocacy/info-03-2013/what-you-need-to-know-about-chained-cpi.html

It Is Time

It is time to reestablish that culture that our Forefathers lived and died to create, not in merely the words, but the deeds. It is time.

On the Statue of Liberty are inscriptions about giving Americans the tired, the poor, and the huddled masses yearning to breathe free. It is time to actually fulfill that promise and give our Latino brothers and Latina sisters that promised freedom. It would appear we, like some Madison Avenue advertising agency have shown the slogans, yet denied the reality to much of Latin America. We seem to say you cannot attempt to cross the border illegally, and have children in the United States, and you cannot become a citizen. Many have lived here for over twenty years and have as many as three generations in America, but are still considered illegal and must constantly be on constant vigil against reprisal.

Every one knows that conditions south of our borders have long been devoid of the opportunity to allow families to grow and prosper with a life style that rewards ability and enlarges the middle class. They have struggled to get here and died in closed freight trailers on some lonely desert or fallen prey to rings exploiting them into prostitution and economic slavery. They must keep watching with a constant eye for immigration and threats to be deported should they try to get better wages or living conditions. Mexicans in particular have migrated in large numbers to America to provide for their families in land that once was in fact theirs. Additionally Latinos from Latin and Central America have come here to escape political and economic hardships. Their children have grown up here and seen the hypocrisy between what we do and what we say we do.

America should be the literal shining beacon of hope and justice for immigrants, but most with the exception of the first Europeans who crossed the ocean shores, have had to suffer until they were assimilated and accepted into a kinder, gentler society. There were Irish, Italian, Jewish, Black, and Oriental slums and repressions. And so, there are now Latinos marching, shouting, and asking for justice in the American mosaic that is our culture.

People that have been here ten years should be on a fast track toward citizenship. Those that have lived in America and have two or more generations that are native born and lived here have earned that right. People that have lived here and been gainfully employed for five years should have that right as well. We should reform the hiring laws to penalize those that hire illegal workers and have degrees of legal work status for those that desperately seek jobs and enrich, not detract from our culture. Parents of children born here need to be able to remain and provide for their families. An Amnesty Day must be set and adhered to that is fair and real. We must retain the heritage to the claim of the Land of Opportunity and Freedom.

From Liberty Enlightening the World is its inscription by Emma Lazarus:

Not like the brazen giant of Greek fame,
With conquering limbs astride from land to land;
Here at our sea-washed, sunset gates shall stand
A mighty woman with a torch, whose flame
Is the imprisoned lightning, and her name
Mother of Exiles. From her beacon-hand
Glows world-wide welcome; her mild eyes command
The air-bridged harbor that twin cities frame.
"Keep, ancient lands, your storied pomp!" cries she
' With silent lips. "Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tossed to me,
I lift my lamp beside the golden door!"

It is time to reestablish that culture that our Forefathers lived and died to create, not in merely the words, but the deeds. It is time.

by Thomas P Love

http://tomlovetexas.blogspot.com/2007/10/it-is-time.html

Fourteenth Amendment to the United States Constitution by Wikipedia

The Fourteenth Amendment (Amendment XIV) to the United States Constitution was adopted on July 9, 1868, as one of the Reconstruction Amendments.
Its Citizenship Clause provides a broad definition of citizenship that overruled the Supreme Court's ruling in Dred Scott v. Sandford (1857) that had held that black people could not be citizens of the United States.^[1]
Its Due Process Clause prohibits state and local governments from depriving persons of life, liberty, or property without certain steps being taken to ensure fairness. This clause has been used to make most of the Bill of Rights applicable to the states, as well as to recognize substantive and procedural rights.
Its Equal Protection Clause requires each state to provide equal protection under the law to all people within its jurisdiction. This clause was the basis for Brown v. Board of Education (1954), the Supreme Court decision which precipitated the dismantling of racial segregation in United States education. In Reed v. Reed (1971), the Supreme Court ruled that laws arbitrarily requiring sex discrimination violated the Equal Protection Clause.

Text

Section 1. All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.Section 2. Representatives shall be apportioned among the several States according to their respective numbers, counting the whole number of persons in each State, excluding Indians not taxed. But when the right to vote at any election for the choice of electors for President and Vice President of the United States, Representatives in Congress, the Executive and Judicial officers of a State, or the members of the Legislature thereof, is denied to any of the male inhabitants of such State, being twenty-one years of age, and citizens of the United States, or in any way abridged, except for participation in rebellion, or other crime, the basis of representation therein shall be reduced in the proportion which the number of such male citizens shall bear to the whole number of male citizens twenty-one years of age in such State.
Section 3. No person shall be a Senator or Representative in Congress, or elector of President and Vice President, or hold any office, civil or military, under the United States, or under any State, who, having previously taken an oath, as a member of Congress, or as an officer of the United States, or as a member of any State legislature, or as an executive or judicial officer of any State, to support the Constitution of the United States, shall have engaged in insurrection or rebellion against the same, or given aid or comfort to the enemies thereof. But Congress may, by a vote of two-thirds of each House, remove such disability.
Section 4. The validity of the public debt of the United States, authorized by law, including debts incurred for payment of pensions and bounties for services in suppressing insurrection or rebellion, shall not be questioned. But neither the United States nor any State shall assume or pay any debt or obligation incurred in aid of insurrection or rebellion against the United States, or any claim for the loss or emancipation of any slave; but all such debts, obligations and claims shall be held illegal and void.
Section 5. The Congress shall have power to enforce, by appropriate legislation, the provisions of this article.
 

Validity of public debtSection 4 confirmed the legitimacy of all United States public debt appropriated by the Congress. It also confirmed that neither the United States nor any state would pay for the loss of slaves or debts that had been incurred by the Confederacy. For example, during the Civil War several British and French banks had lent large sums of money to the Confederacy to support its war against the Union.^[47] In Perry v. United States (1935), the Supreme Court ruled that under Section 4 voiding a United States government bond "went beyond the congressional power."^[48]

The United States debt-ceiling crisis in 2011 raised the question of what powers Section 4 gives to the President. Under the current law, the executive branch of the government (which includes the Treasury and the President) is obligated to carry out all appropriations authorized by the Congress. It has been argued that, in the presence of conflicting statutes (a federal budget statute, which instructs the Treasury to spend a certain amount of money, and a debt ceiling statute, which limits the amount of money that the Treasury is allowed to borrow in process), the statute that was passed more recently "wins"; therefore, in this situation, the President may simply instruct the Treasury to continue issuing bonds beyond the ceiling. Furthermore, such an instruction may be difficult to challenge in court, because it would take a joint resolution of both chambers of Congress to get standing to challenge it.^[49] In addition, it has been observed by many, such as legal scholar Garrett Epps, fiscal expert Bruce Bartlett and Treasury Secretary Timothy Geithner, that the debt ceiling itself may be unconstitutional and therefore void as long as it interferes with the duty of the government to pay interest on outstanding bonds and to make payments owed to pensioners (that is, Social Security recipients).^[50][51]
The issue of what effect Section 4 has regarding the debt ceiling remains unsettled.^[52] Legal analyst Jeffrey Rosen has argued that Section 4 gives the President unilateral authority to raise or ignore the national debt ceiling, and that if challenged the Supreme Court would likely rule in favor of expanded executive power or dismiss the case altogether for lack of standing.^[53] Erwin Chemerinsky, professor and dean at University of California, Irvine School of Law, has argued that not even in a "dire financial emergency" could the President raise the debt ceiling as "there is no reasonable way to interpret the Constitution that [allows him to do so]".^[54]

Power of enforcement

Main article: Congressional power of enforcement

Section 5, the last section, was construed broadly by the Supreme Court in Katzenbach v. Morgan (1966).^[55] However, the Court, in City of Boerne v. Flores (1997), said:

Any suggestion that Congress has a substantive, non-remedial power under the Fourteenth Amendment is not supported by our case law.^[56]

Proposal and ratification

The 39th United States Congress proposed the Fourteenth Amendment on June 13, 1866.
Ratification of the Fourteenth Amendment was bitterly contested: all the Southern state legislatures, with the exception of Tennessee, refused to ratify the amendment. This refusal led to the passage of the Reconstruction Acts. Ignoring the existing state governments, military government was imposed until new civil governments were established and the Fourteenth Amendment was ratified.^[57]
By July 9, 1868, three-fourths of the states (28 of 37) ratified the amendment:^[58

http://en.wikipedia.org/wiki/Fourteenth_Amendment_to_the_United_States_Constitution#Validity_of_public_debt