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The Prisoner Visitation and Support (PVS) Volunteer Organization has been visiting prisoners all over the United States in both federal and ilitary Prisoners. Currently, PVS has over 400 volunteers.

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Prisoner Visitation and Support (PVS) is a volunteer visitation program to federal and military prisoners throughout the United States.

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Switzerland’s healthcare is one of the most effective in the world as it spends very little of its GDP on healthcare and maintains a basic standard for every private insurance company in the country (the government does not provide public healthcare). In addition, the Swiss government offers subsidized healthcare to low-income citizens such that they do not spend too much of their income on health insurance. All in all, almost every Swiss citizen has health insurance.

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Long-time readers of this blog will know that my favorite health policy topic is the Swiss health care system. So I was glad to see Megan McArdle, Tyler Cowen, and Ezra Klein devote some space to the topic on Monday, provoked by Paul Krugman's fact-free claim that "consumer-based medicine has been a bust everywhere it has been tried." (Indeed, as Tyler and Ezra point out, Krugman once praised Obamacare as a "plan to Swissify America," arguing that "a Swiss-style system of universal coverage would be a vast improvement on what we have now.")

Megan's piece is especially worth reading, as she tackles the question I have been spending a lot of time on-whether or not it is better for individuals or governments to be in control of health spending:

It's all very well to say that people shouldn't have to make those decisions on the basis of money. But that's all the government is going to do. Sure, there are some procedures that people just shouldn't have (like a lot of back surgery). But a lot of this is value judgements: hip replacements for elderly patients, expensive chemotherapy that may extend life by a few months, more convenient dosing schedules or better side-effect profiles for brand name drugs. Unless we simply rely on across-the-board reimbursement cuts--which would be moronic on every level--the government is mostly not going to be deciding which treatments are effective; it's going to be deciding which treatments are cost-effective. We haven't taken doctors out of the business of selling health care to patients; we've just added a middleman.

Now, maybe you think that the government is smarter than the consumers it's speaking for. But how does the government know what you value most: an extra three months of life when you have cancer, or an extra five years of walking after age 89, or an extra $4,000 right now?

The fundamental problem with government rationing is that cost-effectiveness is subjective. Every individual has their own needs and priorities, and a one-size-fits-all approach is profoundly inhumane.
Comparing Swiss health expenditures to ours
Ezra Klein, who is an advocate of the Swiss system for many of the same reasons that Krugman is/was, nonetheless says, "The example of the Swiss system shows a) that the consumer-driven model doesn't work to control costs and b) the irrelevancy of the argument over whether individuals are consumers at all."

Ezra points out that Swiss health expenditures per capita are the second-highest in the world (actually they're third, behind the U.S. and Norway), and cites this fact as an argument for why consumer-driven health care won't reduce health costs.

But there are several flaws with this argument: (1) Switzerland is a rich country, and one cannot discount the likelihood that citizens of a wealthy country will freely choose to spend more on health care; (2) Purchasing power parity adjustments may not fully account for higher Swiss costs of living; (3) the growth of health costs in Switzerland (and the U.S., for that matter) are below the OECD median: from 1996 to 2008, average PPP-adjusted per-capita expenditure growth in Switzerland was 4.6 percent, or 28th in the 34-country OECD rankings; the U.S. averaged 5.5 percent, ranking 22nd. (The U.K. ranked 13th at 6.7 percent.)

The performance of Switzerland is even more impressive when you consider how fiscally stable it is. The Swiss system, called Santésuisse, is striking in its differences to ours. Government spending on health care in Switzerland is only 2.7 percent of GDP, by far the lowest in the developed world. By contrast, in 2008, U.S. government spending on health care was 7.4 percent of GDP. If the U.S. could move its state health spending to Swiss levels, it would save more than $700 billion a year.

Despite this apparent stinginess, the Swiss have achieved universal coverage for all its citizens. The Swiss have access to the latest technology, just as Americans do, and with comparably low wait times for appointments and procedures. And the Swiss are among the healthiest people on earth: while life expectancy is not the ideal proxy for overall health, nor of a health care system's performance, life expectancy for a Swiss citizen on his 65th birthday is second only to that of Japan's.

How do they do it? Can their model be replicated in the U.S.?
Features of the Swiss health sysetm
Swiss citizens buy insurance for themselves; there are no employer-sponsored or government-run insurance programs. Hence, insurance prices are transparent to the beneficiary. The government defines the minimum benefit package that qualifies for the mandate. Critically, all packages require beneficiaries to pick up a portion of the costs of their care (deductibles and coinsurance) in order to incentivize their frugality.

The government subsidizes health care for the poor on a graduated basis, with the goal of preventing individuals from spending more than 10 percent of their income on insurance. But because people are still on the hook for a significant component of the costs, they often opt for cheaper packages; in 2003, 42% of Swiss citizens chose high-deductible plans (i.e., plans with significant cost-sharing features). Those who wish to acquire supplemental coverage are free to do so on their own.

99.5% of Swiss citizens have health insurance. Because they can choose between plans from nearly 100 different private insurance companies, insurers must compete on price and service, helping to curb health care inflation. Most beneficiaries have complete freedom to choose their doctor, and appointment waiting times are almost as low as those in the U.S., the world leader.
Switzerland's imperfections
Naturally, such a system will not be attractive to those who implacably oppose the idea of a private health-care sector. But conservatives will also find objectionable elements to the Swiss system. In important ways, the Swiss system resembles that of Massachusetts and PPACA. The Swiss have an individual mandate. The government defines the minimum benefit package, which has been subject to expansion from special-interest lobbying, and is more comprehensive and less consumer-driven than it could be. The government has enacted Medicare-style price controls for hospital and physician reimbursement. Insurers must charge similar rates to the young and old ("community rating"), must cover pre-existing conditions, and must operate as non-profit entities. Princeton economist Uwe Reinhardt describes Switzerland as "a de facto cartel of insurers and health care practitioners who transact with one another in a tight web of government regulations."

As I noted above, Ezra and others believe that the similarities between PPACA and Santésuisse indicate that conservatives should support Obamacare. But there is an enormous difference between adding Swiss-style controls and subsidies onto a purely private, individual health insurance market, and bolting those same provisions onto the malformed American system, as PPACA did. The most significant difference between the Swiss and American systems is in the ability of individuals to consume health care in value- and cost-conscious ways. Only one tenth of Americans buy insurance for themselves, the rest getting coverage through their employers or the government. In Switzerland, everyone buys insurance for himself.
Politics is the art of the possible
An American adaptation of the Swiss system would not require an individual mandate: there are market-based alternatives for avoiding the "adverse selection death spiral," such as requiring those who opt to forego insurance to wait a few years before buying insurance again. Ideally, the American version would give insurers a lot more latitude to come up with innovative plan designs, so that insurance could remain inexpensive, while reflecting what consumers actually want. It wouldn't force young people, just entering the workforce, to subsidize the old. Also, the Swiss system's goal of preventing individuals from spending more than 10 percent of their income on health insurance exposes the system excessively to health cost inflation; instead, the U.S. would be better off adopting a defined-contribution system, like the one proposed by Paul Ryan, in which insurance subsidies grow at a pre-defined, sustainable rate.

Indeed, the fact that both liberals and conservatives would find objectionable elements to Switzerland is a large part of its appeal. It achieves the policy priorities of liberals (universal coverage; regulated insurance market) and of conservatives (low government health spending; privately-managed health care). Both sides could declare victory, and yet also have plenty to complain about.

In other words, Switzerland provides the contours of a bipartisan solution: one that stands a chance of gaining more than 60 votes in the Senate. Purists on either side will object, but as an accomplished Saxon reformer once put it, "politics is the art of the possible." Those of us who object to the current system need to ask ourselves: are we willing to give up on real entitlement reform, that could bring the U.S. back from the brink of bankruptcy, in order to maintain our philosophical purity?

It goes without saying that evolving the American health care system into the Swiss one is no small task. But Switzerland helps us visualize the direction that American reform should take, and provides a real-world example of how such reforms could work out.

UPDATE: Here's a video of Harvard Business School's Regina Herzlinger speaking about the Swiss system:

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Why Switzerland Has the World's Best Health Care System

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Our discussion of health care reform should start by compiling a set of bipartisan goals for an alternative health-care system: one in which everyone has access to affordable, fiscally stable, high-quality health care. Indeed, we have an example of such a system in Switzerland.

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di Bartolo, Domenico.  Care of the Sick. 1440-1447, Fresco, Pellegrino, Spedale di Santa Maria della Scala, Sienna

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National Hospice and Palliative Care Organization

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National Hospice and Palliative Care Organization

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The National Hospice and Palliative Care Organization is a national organization that seeks to improve care for terminally ill people and allow them to have the best life possible.

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National Hospice and Palliative Care Organization

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About Hospice | Palliative Care | Annual Reports | Board of Directors | Staff | Committees & Task Forces | Council of States | Governance News Room | Awards & Contests | Jobs @ NHPCO | Directions to NHPCO | Contact Us | Join NHPCO

Mission To lead and mobilize social change for improved care at the end of life.

Vision A world where individuals and families facing serious illness, death, and grief will experience the best that humankind can offer.

Values NHPCO believes in: Service... engaging customers; Respect... honoring others; Excellence... exceeding expectations; Collaboration...fostering partnerships; Stewardship... managing resources

The National Hospice and Palliative Care Organization (NHPCO) is the largest nonprofit membership organization representing hospice and palliative care programs and professionals in the United States. The organization is committed to improving end-of-life care and expanding access to hospice care with the goal of profoundly enhancing quality of life for people dying in America and their loved ones.

Considered to be the model for quality, compassionate care at the end of life, hospice care involves a team-oriented approach of expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient's wishes. Emotional and spiritual support also is extended to the family and loved ones. Generally, this care is provided in the patient's home or in a home-like setting operated by a hospice program. Medicare, private health insurance, and Medicaid in most states cover hospice care for patients who meet certain criteria.

With headquarters in Alexandria, Virginia, the National Hospice and Palliative Care Organization advocates for the terminally ill and their families. It also develops public and professional educational programs and materials to enhance understanding and availability of hospice and palliative care; convenes frequent meetings and symposia on emerging issues; provides technical informational resources to its membership; conducts research; monitors Congressional and regulatory activities; and works closely with other organizations that share an interest in end of life care.

The National Hospice and Palliative Care Organization was founded in 1978 as the National Hospice Organization. The organization changed its name in February 2000 to include palliative care. Many hospice care programs added palliative care to their names to reflect the range of care and services they provide, as hospice care and palliative care share the same core values and philosophies. Defined by the World Health Organization in 1990, palliative care seeks to address not only physical pain, but also emotional, social, and spiritual pain to achieve the best possible quality of life for patients and their families. Palliative care extends the principles of hospice care to a broader population that could benefit from receiving this type of care earlier in their illness or disease process. To better serve individuals who have advanced illness or are terminally ill and their families, many hospice programs encourage access to care earlier in the illness or disease process. Health care professionals who specialize in hospice and palliative care work closely with staff and volunteers to address all the symptoms of illness, with the aim of promoting comfort and dignity.

NHPCO participates in the Combined Federal Campaign (CFC #11241) and is a member of the CFC Community Health Charities program.

Our affiliate Organizations:

Hospice Philosophy and Ethical Statements from NHPCO

NHPCO Logo - the evolution of the design

The NHO logo as originally created.

As the logo evolved, the lotus remained the focal point.

The organization's current logo continues to focus on the lotus image.

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About Hospice | Palliative Care | Annual Reports | Board of Directors | Staff | Committees & Task Forces | Council of States | Governance News Room | Awards & Contests | Jobs @ NHPCO | Directions to NHPCO | Contact Us | Join NHPCO Mission To lead and mobilize social change for improved care at the end of life.

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In California, hospitals, health clinics, and emergency departments serve as safety nets for people with low or no income. Medi-Cal helps finance these insitutions.

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The International Medical Corps offers health care, psychological support, and emergency supplies to refugees from the Middle East, especially those from Syria.

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Now in its eighth year, the Syrian war continues to inflict incomprehensible levels of suffering on civilians and fuel the largest displacement crisis in the world today. Hundreds of thousands of people have been killed. More than six million Syrians are displaced inside the country, while another five and one-half million have fled to the relative safety of other countries.

International Medical Corps works in Syria as well as in Turkey, Jordan, Lebanon and Iraq-the four countries shouldering the highest number of Syrian refugees-to provide medical care, mental health and psychosocial support, gender-based violence prevention and response, and other vital services to Syrian families whose lives have been shattered by conflict.

Countries Impacted

13.5 Million

people inside Syria need assistance

5.6 Million

Syrians who have fled Syria and are living as refugees

50 %

Half of the displaced are children and youth

Brutal Civil War in Syria Enters Eighth Year

Violence, Barbarity Go On Unabated, but Global Outrage Wanes as the World Begins to View the Century's Bloodiest Conflict as Syria's New Normal

READ MORE

Frequently Asked Questions

When did the Syrian war start?

The Syrian civil war started in March 2011 amidst the so-called "Arab Spring" when peaceful protests escalated to violence following a government crackdown. In the years since, the conflict has steadily become more intense, fractured and complicated as the number of armed Syrian opposition groups fighting for power multiplied and the Islamic State emerged as a major presence in 2013. That mix drew in outside powers both from the region and further afield.

What is happening to families inside Syria?

Civilians in Syria are exposed to horrific levels of violence that have claimed the lives of hundreds of thousands of people and reduced entire cities and towns in rubble. Millions of Syrians have been trapped in hard-to-reach and besieged areas, where they are at-risk of grave human rights abuses and are cut-off from receiving very basic assistance, from food to medical care. More than six million Syrians are also displaced from their homes inside Syria, while 13.5 million across the country are estimated to need humanitarian assistance.

Where are Syrians fleeing to?

The Syrian crisis has fueled the largest displacement crisis since World War II. More than 6.6 million Syrians are displaced inside Syria, while another 5.6 million have fled to other countries. The vast majority of Syrian refugees are living in neighboring countries-Turkey (3 million), Lebanon (1.5 million), Jordan (660,000), Iraq (240,000) and Egypt (122,000) while another one million have requested asylum in Europe.

What specifically is International Medical Corps doing?

International Medical Corps works inside Syria to provide emergency medical care as well as mental health and psychosocial support, protection and emergency assistance to families caught in the conflict. We also support Syrians living in Turkey, Lebanon, Jordan and Iraq by delivering health care and other lifesaving services to families living in both camps and host communities. With the war in Syria raging on with no end in sight, we are also providing informal education and training opportunities to help refugees integrate and rebuild their lives in their new communities.

The Challenges

Ongoing Conflict

Fighting continues to endanger civilians and force them from their homes

Weak Systems

The war has decimated much of Syria's infrastructure

Displacement

More than half of Syria's pre-war population of 21 million has been uprooted from their homes, fueling the largest displacement crisis since World War II

Our Response

Psychological Toll Of War And Uncertainty

Like nearly five million others, Hana and her family lost everything to Syria's brutal and unending civil war. They left their home in the western Syrian city of Homs more than three years ago and, today, are scattered across the globe, unsure of when they will reunite again, if ever.

READ MORE

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Refugee Crisis | International Medical Corps

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Now in its eighth year, the Syrian war continues to inflict incomprehensible levels of suffering on civilians and fuel the largest displacement crisis in the world today. Hundreds of thousands of people have been killed. More than six million Syrians are displaced inside the country, while another five and one-half million have fled to the relative safety of other countries.

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The Prison University Project is a nonprofit organization that provides higher education to prisoners in San Quentin State Prison in California. It also aims to reform the criminal justice system.
https://prisonuniversityproject.org/

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Norway has the best prison system in the world as they have the low incarceration and recidivism rates. In addition, it concentrates on restorative justice and tries to keep life in prison as similar to life in the real world.

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In Norway, fewer than 4,000 of the country's 5 million people were behind bars as of August 2014.

That makes Norway's incarceration rate just 75 per 100,000 people, compared to 707 people for every 100,000 people in the US.

On top of that, when criminals in Norway leave prison, they stay out. It has one of the lowest recidivism rates in the world at 20%. The US has one of the highest: 76.6% of prisoners are re-arrested within five years.

Norway also has a relatively low level of crime compared to the US, according to the Bureau of Diplomatic Security. The majority of crimes reported to police there are theft-related incidents, and violent crime is mostly confined to areas with drug trafficking and gang problems.

Based on that information, it's safe to assume Norway's criminal justice system is doing something right. Few citizens there go to prison, and those who do usually go only once. So how does Norway accomplish this feat? The country relies on a concept called " restorative justice," which aims to repair the harm caused by crime rather than punish people. This system focuses on rehabilitating prisoners.

Take a look at Halden Prison, and you'll see what we mean. The 75-acre facility maintains as much "normalcy" as possible. That means no bars on the windows, kitchens fully equipped with sharp objects, and friendships between guards and inmates. For Norway, removing people's freedom is enough of a punishment.

Like many prisons, Halden seeks to prepare inmates for life on the outside with vocational programs: woodworking, assembly workshops, and even a recording studio.

Halden isn't an anomaly either. Bastoy prison is also quite nice.

As Bastoy prisoner governor Arne Wilson, who is also a clinical psychologist, explained to The Guardian:

In closed prisons we keep them locked up for some years and then let them back out, not having had any real responsibility for working or cooking. In the law, being sent to prison is nothing to do with putting you in a terrible prison to make you suffer. The punishment is that you lose your freedom. If we treat people like animals when they are in prison they are likely to behave like animals. Here we pay attention to you as human beings.

All of these characteristics are starkly different from America's system. When a retired warden from New York visited Halden, he could barely believe the accommodations. "This is prison utopia," he said in a documentary about his trip. "I don't think you can go any more liberal - other than giving the inmates the keys."

In general, prison should have five goals, as described by criminologist Bob Cameron: retribution, incapacitation, deterrence, restoration, and rehabilitation. In his words though, "Americans want their prisoners punished first and rehabilitated second."

Norway adopts a less punitive approach than the US and focuses on making sure prisoners don't come back. A 2007 report on recidivism released by the US Department of Justice found that strict incarceration actually increases offender recidivism, while facilities that incorporate "cognitive-behavioral programs rooted in social learning theory" are the most effective at keeping ex-cons out of jail.

The maximum life sentence in Norway shows just how serious the country is about its unique approach. With few exceptions (for genocide and war crimes mostly), judges can only sentence criminals to a maximum of 21 years. At the end of the initial term, however, five-year increments can be added onto to the prisoner's sentence every five years, indefinitely, if the system determines he or she isn't rehabilitated.

That's why Norwegian extremist Anders Behring Breivik, who killed 77 people in a bombing and mass shooting, was only sentenced to 21 years. Most of the outrage and incredulity over that sentence, however, came from the US.

Overall, Norwegians, even some parents who lost children in the attack, seemed satisfied with the sentence, The New York Times reported. Still, Breivik's sentence, as is, put him behind bars for less than 100 days for every life he took, as The Atlantic noted. On the other hand, if the system doesn't determine Breivik "rehabilitated," he could stay in prison forever.

To those working within Norway's prison system, the short sentences and somewhat luxurious accommodations make complete sense. As Are Hoidel, Halden Prison's director, puts it: "Every inmates in Norwegian prison are going back to the society. Do you want people who are angry - or people who are rehabilitated?"

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Why Norway's prison system is so successful

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"Here we pay attention to you like human beings."

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The Lionheart Organization is an organization in the United States that seeks to help prisoners successfully reenter into society. This is primarily done through their House of Healing program, a program that helps prisoners come to terms with their deeds and rebuild from them through various teaching mediums. The program is known for being inherently spiritual in order to help prisoners in their path to rehabilitaiton.

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The National Emotional Literacy Project for Prisoners

Lionheart's prison program provides education, rehabilitation and reentry support to incarcerated men and women in prisons and jails throughout the United States. At the heart of this initiative is a powerful emotional literacy program, Houses of Healing. This program offers prison inmates encouragement and the necessary support to take stock of the life experiences that have propelled them into criminal activity, take responsibility for their criminal behavior, change life-long patterns of violence and addiction, and build productive lives.

Houses of Healing is being taught by hundreds of corrections professionals, chaplains and volunteers in prisons, jails and reentry programs across the country and abroad. It can be used on its own, or to complement other existing prison counseling efforts such as alcohol and drug abuse, stress and anger management, and life skills development. Houses of Healing has proven successful in group classes, one on one counseling, and individually by prisoners who often have access to the book, Houses of Healing: A Prisoner's Guide to Inner Power and Freedom , through the prison library.

Corrections professionals report that Houses of Healing is the most effective program they have seen for prisoner growth and transformation. Many prison chaplains embrace the program because it is infused with an inclusive spirituality. This is particularly the case in multi-faith contexts. Inmates gain greater self-awareness, the capacity to manage their emotions, empathize with the feelings of others, and increase their spiritual development though, among other things, mindfulness meditation, the quiet motor that underlies the Houses of Healing program. Thousands of lives are being turned around through the guidance and inspiration that this prisoner education and rehabilitation program offers.

The expanding prison population continues to grow as a major national crisis. Taking a proactive stance, Lionheart is committed to playing an integral part in redefining our nation's prisons as places for healing and positive growth. More than 90,000 copies of the book, Houses of Healing, are now in circulation, 50,000 of these have been distributed free of charge to individual prisoners, prison libraries and prison programs.

To read more about Lionheart's project for prisoners click here.
To purchase Houses of Healing resources, click here.

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Prisoner Rehabilitation and Reentry Program in Prisons and Jails |

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The National Emotional Literacy Project for Prisoners Lionheart's prison program provides education, rehabilitation and reentry support to incarcerated men and women in prisons and jails throughout the United States. At the heart of this initiative is a powerful emotional literacy program, Houses of Healing.