Word: states
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Dates: during 2000-2009
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...Nature vs. Nurture Tulasidas mandase of bivara barsa village in Vidarbha couldn't agree more. Though he has received aid from the government, Mandase, 38, complains that it hasn't been the right kind. The state donated a metal plow and a pesticide sprayer, but neither worked. To get subsidized soybean seeds, he spends a full day traveling by bus to a nearby town. It often takes two or three trips, and, with bus fares costing him 60? per roundtrip, he wonders if the cheaper seeds are worth the effort. What he really requires, he says, is better infrastructure...
...aside from a free plow, the government's ample funds have yet to trickle his way. Sidam gets no subsidies for his seeds, no guaranteed rural work has been available in the area and no new water resources have been developed near his farm, nor did he get state help with his $350 debt. Government agricultural officials hardly ever visit the village, he says, and he appears uninformed about the new initiatives that might help him. He is still dependent on the cotton crop he grows on his small farm, supplemented by the wages his sons can earn in part...
...that is for consumers and the national debt, it's also turned doctors into fee chasers. More and more of them invest in labs or radiology clinics so they generate revenue not just from the procedures they do themselves but also from the ones they farm out. Others buy state-of-the-art diagnostic hardware and charge state-of-the-art fees to use it. "Focus on your bottom line," urges a brochure for in-office CT-scan machines from one manufacturer. And as long as insurers pay the bills, patients don't ask what things cost. "A colonoscopy used...
...contracts, and 28% of group practices include performance benchmarks. Since 2007, Massachusetts has required all its citizens to have health insurance, about 20% of which involves some kind of global coverage - handling all of a patient's health-care needs for the duration of the policy. In July, the state announced plans to go further, eliminating fee-for-service entirely within five years and mandating global care statewide. Similar plans are ramping up in Minnesota and Wisconsin. "We're going to do this incrementally," says JudyAnn Bigby, Massachusetts' secretary of health and human services. "We want to increase...
Still, significant unforeseens remain, as history shows. Massachusetts' highly touted experiment with universal coverage has taken hits for failing to lower health-care costs. Bigby attributes this partly to high housing and labor costs and the fact that the state is home to so many pricey academic medical centers. That may be true, but you can bet that Massachusetts' remaining one of the priciest health-care providers in the U.S. was not among the selling points when advocates of universal coverage were stumping for the plan. Similarly, global care may correct the problem - or harbor bear traps...