Why I Support Healthcare Reform | healthcare

After months of discussion and negotiation, the US Senate voted on its healthcare reform bill on Christmas Eve. The US House of Representatives passed its version of healthcare reform in November which means it is likely that a bill will be on President Obama’s desk in early 2010. This legislation would mark the first major expansion of healthcare coverage in the United States since Medicare and Medicaid were created in 1965.I worked on the last healthcare reform effort as a member of the Clinton Healthcare Reform Task Force and Legislative Director to Congressman Eliot Engel (D-NY). I believe this legislation is important and will be an improvement over our current healthcare system which does not work and cannot be sustained in its current form.Helping the UninsuredThere are current 47 million Americans who have no health insurance. The uninsured are both an economic and social problem. They are an economic problem because the uninsured raise the cost of health insurance by over $1,000 per year for every family. Most uninsured people get care through emergency rooms which are required to treat everyone regardless of their ability to pay. These are hidden costs which are passed along to everyone in the form of higher insurance premiums.The uninsured are a social problem because people die when they do not have health coverage and cannot get the medical services they need. A recent study by Harvard Medical School found that 45,000 per year die because they don’t have health insurance. That is unconscionable in a country as wealthy as the United StatesThe bills being discussed in Congress will provide a substantial expansion of healthcare coverage. By 2019, the House bill would provide coverage to an addition 37 million Americans while the Senate bill would provide insurance for an additional 31 million. The bills would ensure that approximately 95% of Americans have health insurance.Cost ControlThe US spends more for healthcare than any of its major competitors and gets less for it than any other industrialized country. In 2007, the US spent $2.2 trillion dollars on healthcare which represents 16.2 percent of our economy. Healthcare costs have been increasing sharply in the past decade and the current trends are unsustainable.Both the House and Senate bills have cost containment measures in them. It is expected that the House bill will reduce the federal deficit by $104 billion over ten years while the Senate bill reduce the federal deficit by $127 billion over ten years. Additionally, the bills are expected to lower insurance premiums for most Americans including a reduction of almost 50% in the individual insurance market.Consumer Protections Both the House and Senate bills provide important consumer protections to help ensure that people get the coverage they purchase and deserve. Some of the most important include:

Elimination of “pre-existing conditions” a practice used to deny coverage for chronic conditions including diabetes, high blood pressure and arthritis?
Providing a yearly limit on consumer out of pocket medical expenses.?
Removing dollar caps on how much medical treatment insurers will pay for.?
Preventing the use of medical underwriting, a practice that allows insurers to charge more to people who are sick or suffer from chronic conditions.
Requiring insurers to spend a minimum amount of insurance premiums on medical care. The target is expected to be set around 85% of premiums.
The bills would also establish federal regulation of health insurance instead of the uneven state by state system which exists today. This will help ensure that consumers get strong protections regardless of where they live.Why The Senate Bill Is an Improvement Over the Current SystemFew people are arguing in favor of maintaining the status quo in our current healthcare system so most of the debate has centered on which direction reform should take. In many ways I prefer the House bill because it provides coverage to a larger number of people and establishes a public insurance option which will provide more competition in the private insurance market.The Senate bill does not include a public option but is still a major improvement over our current healthcare system. It aggressively tackles the problem of the uninsured, helps control medical costs, and provides important consumer protections regardless of what state a person lives in.History shows the chance to enact major changes to our healthcare system comes along every 15-20 years. There is a tendency to run away from healthcare reform after it has failed. We cannot afford to wait a decade or two to address this issue again. I support passing the Senate bill and working to improve it because enacting a flawed healthcare reform bill now is far better than to trying to pass the perfect bill and ending up with nothing.

How to Design a Long Narrow Garden | gardening

The main problem with long narrow gardens is that they can feel like you’re standing in a corridor. In a long, narrow garden your eye is drawn straight to the boundaries making the space seem small and claustrophobic. This type of garden does not invite exploration and the furthest parts of the garden often remain dark, dank and unused. Counteracting the claustrophobic feeling and giving the impression of greater space and depth are the main challenges when designing a long, narrow garden.There are three main ways to deal with the problems of a long-narrow space. One strategy involves changing the perceived shape of the garden and tricking the eye into focusing away from the garden boundaries. Another method is to introduce drama by creating a more complex journey around the garden. The third way is to draw the eye upwards by introducing vertical elements that open up the garden by giving the appearance of more height.Although it seems counter-intuitive to close off a garden that is already feeling cramped, dividing the garden into separate areas is a very effective way to design a long-narrow garden. Creating separate garden rooms each with its own distinct character makes people want to use the whole garden and explore the next room. The garden will become more useable because each room has its own purpose. Breaking up the space is a great way of stopping the eye from immediately alighting on the rear boundary. This strategy creates a more stimulating journey and encourages exploration of the garden.Walls work well for creating garden rooms, especially if they have a window offering a tantalizing glimpse through to the next room. However, brick and block walls are expensive to build and other methods of dividing the space can be just as effective. Clipped hedges, pergolas, or a simple screen of posts and trellis with an archway through all make good partitions and may be more appropriate for the style and setting of the garden. Railway sleepers set on end like a huge vertical blind create a dramatic garden screen.The transitions between the garden rooms provide another opportunity to add visual and vertical interest. Circular moon gates add striking architectural detail, they also give height and their shape is excellent for focusing attention inside the garden. An arched doorway cut through a clipped hedge creates a dark outline that cries out to be explored.Circles and curves are a great for directing attention where it is desired. Using circular shapes for lawns and seating areas focuses the eye into the centre of the garden. An ‘S’ shaped path will draw attention away from the boundaries and give a more interesting journey through the garden. Placing some taller plants or trees in the deep curves of the ‘S’ creates informal divisions and stops the eye.Another design strategy that tricks the eye and creates a more exciting, indirect route around the garden is to set the plan on the diagonal. The lines of paths, lawns and borders set at 45 degrees to the boundaries draws the eye across the garden and gives the impression of greater width. Using zig-zag paths will provide a meandering walk around the garden.There are many different ways to create height in a garden, it can be done simply by including trees and taller plants. Pergolas are useful for creating instant vertical focus, they can be used as room dividers and give extra space for planting which is especially useful in a small garden. Clipped, formal hedges are also excellent for creating height, as a backdrop for planting and as walls for outdoor rooms.Long narrow sites can make fabulous gardens, but like any tricky space they need a good design that addresses all the practical issues, and includes a bit of wizardry to make them comfortable and inviting spaces to spend time in.


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