Europe in Crisis: What Lessons to Learn?
Browning, Steve Weissman and Frank
ARTICLES Europe in Crisis: What Lessons to Learn? STEVE WEISSMAN AND FRANK BROWNING Nothing feeds jolly bankers and dyspeptic pundits more than a tasty crisis, and this year's turmoil over the...
...What we're seeing in Greece is the death spiral of the welfare state," wrote the columnist Robert J. Samuelson...
...Three kids bundle up, draw $50 in cash for their account, and march off to the town shopping center...
...This new French technology will allow highspeed trains to compete over even longer distances, spewing out far less carbon pollution than air and auto travel...
...It is 8:30 a.m...
...Drumming his fingers on the table, the SNCF man held his fire...
...That is exactly the reverse of what we want...
...They decide they want to do it...
...The law requires salaried employees to carry health insurance, and the vast majority buy a basic, state-defined plan from one of some two hundred nonprofit "sickness funds...
...The system excludes certain nonessential medicines and requires the use of generic medicines when available...
...Charles de Gaulle negotiated many of these terms just after the Second World War, fearing that the Soviet-backed French communists would use the railroad workers (cheminots) to launch a revolution against his government...
...According to the CIA World Factbook for 2010, life expectancy is three years greater (81 against 78) in France while infant mortality is half that of the United States (3.31 per hundred thousand versus 6.14...
...The funds compete for customers, but must offer the standard policy, cannot reject anyone, and can only charge a set percentage of salaried income, regardless of the buyer's age, health, or pre-existing conditions...
...In the years just after the Second World War, private corporations in America led the world in building large, gas-guzzling automobiles and commercial aircraft, while the federal government built interstate highways and encouraged the building of regional airports...
...Deficit hawks and lenders on both sides of the Atlantic gleefully bash "the European social model," with demands for "Austerity Now" and calls for privatizing everything from British highways to the Acropolis...
...The equipment was especially rundown in the railways that ran between regions...
...At the first market they poke and sniff at vegetables that don't look fresh...
...GPs generally act as gatekeepers for most specialists, tests, and hospitals, writing prescriptions and often a letter explaining particular problems...
...From each according to ability, to each according to need...
...Most, if not all, of the French TGVs come from Alstom, a privately owned multinational that has become the world's leading producer of high-speed trains, many of which it now sells to China...
...The mix has grown far richer and infinitely more convoluted, a maze of public and private enterprises all tightly intertwined, with a zesty soup?on of competition among state-owned enterprises and even within them...
...Only major cutbacks in entitlements can avoid fiscal collapse...
...Vauday describes a contentious meeting that the SNCF's second-in-command recently had with union representatives and local officials, who were accusing the company of all kinds of chicanery...
...On the other side of the table, meet the winner...
...The latest focus is on combating childhood obesity in a new program called Shape Up...
...He runs down a score of bottom-up health promotion initiatives students have created in recent years...
...Pupils have to become aware that they are the people who are going to define and become involved in defining what health is...
...Even more surprising, the French National Railway (SNCF) runs its TGVs at a consistent profit, and it does so in the face of militant unions, long-standing employment contracts, special pay rates, early retirement, and other generous benefits...
...Since Browning did his report, Health Promoting Schools have spread across Europe and even into Central Asia (though only a few have taken off in France or the United States), pushing the idea of student-centered health education to tackle a wide range of problems...
...Much in the European Union is depressingly technocratic and undemocratic, but this is a competing trend that, if panic-driven austerity cuts don't kill it, will continue to embrace the public good rather than simply the public or private sector...
...Competition so far isn't necessary for the system to function better and less expensively," Demaris argues...
...American Medicare with Part B looks far more like single-payer health insurance, while Britain, Italy, and the Nordic countries lean more to governmental systems that we might properly call socialized health care...
...Once the railway workers become employees of a local or regional authority, they lose the rights and benefits they have won since the Second World War...
...citizens pay up to 8 percent of their income for the premiums and the rest is covered by the Swiss federal government...
...Shape Up Far below the commanding heights of the economy, one of the most promising public sector developments we've seen is a new approach to health education promoted by the European Union and World Health Organization...
...Other students lay the table in the teacher's lounge, including wine glasses...
...SNCF is also building new stations on the peripheries that will be modern glass and steel modules on concrete foundations, allowing SNCF to expand or reduce facilities as demand dictates and towns grow or shrink...
...Automatic machines will sell most of the tickets, reducing jobs and antagonizing the unions...
...Why would we want to keep repair and maintenance sheds for equipment we no longer own...
...Finally they settle on a third shop, load up their parcels, and return to school, where another student crew sets to peeling potatoes, chopping onions, calculating measurements (with the teacher's help) and simmering sauces...
...The same situation existed throughout Europe's railroads by 1990, with the system "verging on collapse," according to Demaris...
...New tracks, more powerful engines, and sophisticated suspension systems will increase the speeds, cut the times, and extend the service within France and on the Trans-European high-speed rail network...
...All of which gives the state-owned SNCF sufficient bulk to call itself the world's largest transport operator...
...Germany takes a very different approach to universal health care, depending far more on the private sector...
...In Bonn, Germany, a group of students ages seven to thirteen worked with an architect to build a Viking boat in their otherwise unused and boring schoolyard...
...This is the same situation railway workers faced with decentralization in Germany, and the human face of why local and regional control can bring down employment and operating costs in France as well...
...In one of our meetings recently, one of my colleagues suggested we could ask local farmers to stock refrigerated vending machines with their produce, and I said, 'No...
...Compared to a traditional American classroom, the scene looks chaotic, but the kids seem to know their way around stoves, sinks, and cutting boards...
...Even in France, most doctors work for themselves, many hospitals (or polycliniques) remain private or independent nonprofits, and most citizens have private, often nonprofit insurance to pay the part of their medical bills that mandatory government health insurance does not generally cover...
...To be fair, not everyone in France or Italy loves the TGVs, which make an enormous racket and shake local buildings as they roar through or near villages and towns...
...The following year, the European Parliament passed a new law "to modernize what was clearly an aging and failing rail transport system...
...It runs TGVs in Belgium, the Netherlands, Sweden, and parts of Germany...
...All the while they are using computers, learning mathematics, and developing creative skills, as they would in an ordinary school...
...Three examples—railroads in France, schools in Denmark, and health care in various countries—reveal a fascinating and rapidly evolving reality that is still awaiting a persuasive theorist...
...Wherever you look around the world—Mexico, Chile, Japan—ridership on regional trains has been rising for the last decade at roughly 7-9 percent per year...
...He now lives and works in France...
...If we don't own the trains or maintenance facilities, why would we want to keep you from having the privilege and responsibility for the employees...
...Jensen and the students talked together about how aggressive people got when they drank, how they fell asleep, and how one local young man had died from drinking...
...How good is the medical care...
...You want to know if we're going to turn over the ateliers...
...What the vast majority of French people enjoy is partly socialized health insurance with one of three state schemes paying the lion's share...
...And it works in joint operations to run buses and trams in eight European Union nations, plus Algeria, Australia, Canada, and the United States...
...I said to them that 'the only way you can change something is by trying,'" she said...
...Rigid national curricula and a growing push for "objective testing" and "result-oriented teaching" leave little room for innovation...
...To get prescriptions, patients present their computerized health service smart cards, and the government and top-up insurance pay the pharmacist directly...
...Riding the Rails Nothing unnerves free market fundamentalists faster than riding a French TGV, the high-speed, electric-powered trains that regularly race through the countryside at over 185 miles an hour...
...For some costly long-term ailments, the government pays the full whack...
...At the organic market, they decide the prices are too high...
...The Swiss, as well, depend upon mandated private insurers that are not allowed to make a profit...
...In the end, the students held their party with non-alcoholic cocktails that they made themselves, and none of them seemed to mind...
...Nurses also make house calls to give shots or take blood for testing...
...Surveys by the World Health Organization have rated the French system as the best in the world, far better than average health care in the United States...
...He has reported for National Public Radio for twenty-five years, the last ten from France...
...They also lose the clout they have enjoyed in national negotiations, while their new employers will never have the same capital reserves and access to central government finances to meet worker demands...
...The key is inculcating in them the idea that they "own" their own health and can take responsibility for it and the health of their communities...
...These wholly state-owned trains, some of them double-deckers, whisk passengers in comfort and safety from Paris to Cologne, Amsterdam, or London in just over two hours...
...A test TGV has clocked 357.2 mph, setting a world record and opening the way for a new generation of AGVs, with motors under individual carriages...
...Aging populations have been promised huge health and retirement benefits, which countries haven't fully covered with taxes...
...But here they are learning why...
...Bjarne Bruun-Jensen, the Dane who led the movement, says it matters little what specific issue the students develop...
...Test results arrive in the mail, usually within a day or two...
...Do European decision-makers really want a lost decade similar to the one that once-powerful Japan Inc...
...Frank Browning worked at Ramparts at the same time as Steve Weissman...
...What actions could they all take together...
...More to the point, they are learning what Bruun-Jensen calls "action competence," with a very tangible pay-off for their collective effort...
...Many Americans still insist on calling the French approach "socialized medicine" or "single-payer health care," though neither label truly fits...
...They were about to have a party, and another teacher had reminded them that they could not have alcohol...
...But they created cutbacks and losses in other rail traffic, especially in the regional service that had old equipment that had not been updated or replaced...
...As predicted, this enormous success is somewhat reducing the use of cars to make the same journeys, cutting pollution, highway congestion, and urban parking problems...
...Employees with larger incomes, the self-employed, and public officials can opt instead for private insurance as most Americans know it...
...All very nice, but two groups are footing most of the cost...
...La Fiance Profonde The rebuttal, in part, comes from the regional railway systems, which have their own unhap-piness with SNCF...
...The government system generally reimburses 70 percent of full cost and arranges for the top-up insurance to pay most of the rest, all with direct deposits to personal bank accounts...
...Universal Health Caie Almost every country in Europe provides its citizens with health care, but generally not with a completely state run health service...
...You want to know if we're really going to turn over the rolling stock," he said...
...Could they petition the school to change the rule...
...After all, the railroad workers have kept the TGVs on their tracks...
...Regionalization has been an incredible success," says the SNCF's Beatrice Vauday, who works to make regional stations better serve passenger needs...
...The French responded in a happily uncharacteristic way...
...All choose their own general practitioners, specialists, and hospital care, with no insurance company limiting the choice...
...Employers pay half the charge, and the funds must cover spouses as well...
...He has written six books, including The American Way of Crime and The Culture of Desire...
...So they rebuilt some rundown and unsafe walking and bicycle lanes...
...First they make a shopping list...
...They also warn that tough austerity budgets will bring real suffering to large parts of the population, put the brakes on continued recovery, and drive Europe into a double-dip recession...
...They use the boat to play games and do exercise...
...Paying the subsidies is a social decision that countries all over the world make...
...The reckoning has arrived in Greece, but it awaits most wealthy societies...
...It's a nuance that Americans would do well to learn...
...Besides citing alleged environmental damage, these critics oppose the very idea of high-speed trains that bypass so many smaller cities...
...STEVE WEISSMAN AND FRANK BROWNING Nothing feeds jolly bankers and dyspeptic pundits more than a tasty crisis, and this year's turmoil over the Euro has provided an especially rich diet to critics of state-owned enterprises and public sector social programs...
...If you need to save money then you must sell your jewelry," said Frank Schaeffer, of Germany's Free Democrats, part of the country's ruling coalition...
...The journey southward over 489 miles to Marseilles on the Mediterranean takes slightly over three, the same time Amtrak needs to crawl 200 miles from New York City to Washington, D.C...
...The regional systems bought new rolling stock, much of it attractive, comfortable two-car trains with platform-level entry, wide doors, and racks for bicycles...
...Like the regional transportation systems and Health Promoting Schools, the very different health care systems are turning increasing responsibility over to individuals, localities, and regions...
...None of this is free, of course...
...The approach is exciting, but its further expansion faces enormous obstacles...
...The Greeks "must privatize to raise money...
...Many specialists and test-givers also write up their reports on the spot and hand them directly to the patient, though computers will soon transmit digital x-rays and other results directly to the GP...
...We've already said we would...
...In response, demonstrators have forced SNCF to erect miles of architecturally-enhanced sound barriers, while Greens, some smaller parties on the Left, and followers of the Italian comic Beppe Grillo continue to protest the extension of the Paris-Bordeaux TGV to the Spanish border and ultimately to Madrid and the extension of the Paris-Lyon line to Turin, Italy...
...With the exception of wartime, "the public finances in the majority of advanced industrial countries are in a worse state today than at any time since the industrial revolution," warned Citigroup's top economist, Willem Buiter, in a recent OECD report...
...Steve Weissman, a veteran of the Berkeley Free Speech Movement and the New Left monthly Ramparts, lived for many years in London, working as a magazine writer and television producer...
...In the United States as well, even Democratic congressmembers sound gun-shy about government spending, while President Barack Obama has formally turned to his National Commission on Fiscal Responsibility and Reform, led by former Republican senator Alan Simpson and Bill Clinton's former chief of staff Erskine Bowles...
...The students run the whole business, from keeping books to hiring cooks and waiters to marketing the cafe to the school's teachers...
...Instead, she turned the question back on them...
...They were quite upset...
...Whoever the operators, the electricity to power French TGVs comes mostly from the 90 percent state-owned Areva nuclear corporation, whose plants have such a sterling record that they have won the favor of such formerly anti-nuclear stalwarts as Greenpeace founder Patrick Moore and the Whole Earth Catalog's Stewart Brand...
...SNCF then saw itself running out of capacity on its main line between Paris and Lyon, the country's third largest metropolitan area, and started in 1966 to study the possibility of high-speed rail, which the Japanese had earlier pioneered with their bullet trains...
...But the new stations will have a human touch as well...
...On the Right, they universally decry "bloated public bureaucracies...
...Restoring fiscal balance will be a drag on growth for years to come...
...We want the farmers or their families to have inexpensive stands inside the stations to create a positive social atmosphere, a place where passengers get to know the vendors, where they can leave off keys for someone who is arriving later or pass on messages.'" "You have to see the station of the future as a base around which a rich, active social life is built," she insists...
...According to Bowles, Obama told them that "everything's on the table," including Medicaid, Medicare, and Social Security...
...And they do this best through learning situations that challenge them to think through the choices they have to make, whether about what to eat, whether to smoke, how much exercise to do, or how best to confront schoolyard bullies...
...How much of SNCF's profits come because it has no direct competition to its TGVs...
...In Monza, Italy, students established a bicycle workshop to encourage cycling to school...
...In France, the system remains surprisingly non-bureaucratic, at least for patients...
...In France, as in most of Europe, the public sector focused more on rebuilding the railways and providing mass transportation...
...Stopping at only a handful of stations along their route, the TGVs have also depressed the economies of local town centers...
...They decentralized, transferring responsibility for regional railways away from Paris...
...Then he unloaded...
...Even Air France-KLM, Europe's biggest airline, will soon start running its own trains over the same tracks as it cuts back on less efficient short-haul air routes...
...We have to see these new stations as human environments that attract people and make it a pleasure for them to spend time," Vauday explains...
...The second group to pay: the cheminots...
...The company will transfer many old stations and railroad yards to local or regional governments for shops, apartment developments, parks, and entertainment centers linked to the town center transportation hub...
...They then decided that their books were too heavy to carry, and built their own lockers in their school and created places to park their bikes...
...In Athens, Greece, pupils created a book of recipes, stressing the use of olive oil and a healthy Mediterranean diet...
...If George Orwell saw the BBC of the 1940s as the model for the faceless bureaucracy in his book 1984, he could as easily have used today's SNCF...
...And they do it to provide comfort and security for the many while strengthening the infrastructures essential for economic growth and prosperity...
...Chalk up one for far-sighted state enterprise, though continued growth will slow dramatically if the deficit hawks and international lenders have their way...
...The pattern here could not differ more from that in the United States...
...Their solution was to break through existing rigidities by enforcing competition, whether from private or state-owned enterprises...
...suffered following its economic collapse in the late 1980s...
...None of these systems is perfect, and all of them are struggling to cope with rising costs...
...The Dutch system, which claims one of the highest user satisfaction responses in Europe, is similar to the German model...
...So each one has to be subsidized, and the more passengers you carry, the more money the system is going to lose...
...But, in their varied approaches, they all show a willingness to solve human problems with a pragmatic mix of public and private resources, a sense of social solidarity, and little regard for grand theory...
...On the Left, observers generally embrace the public sector, whatever its failings...
...It's not just a place you pass through to get on or off the train...
...GPs still make house calls, even in the boondocks...
...A second question could raise an even greater challenge to standing orthodoxies...
...One of the big themes that year in Health Promoting Schools was the problem of teenage drinking, which teacher Kate Jensen approached by letting her students take the lead...
...We have it with our parents," a third explained...
...Weren't they being taught to make their own decisions, one of them asked...
...Employers chip in as well...
...In Europe, as in the United States, educators have traditionally relied on authoritarian, moralistic public health lectures like "Just Say No" or "This is your brain on drugs...
...The kids move on...
...A rapidly expanding number of passengers now take these to connect with TGVs and other national trains or to commute to jobs and schools in the larger regional cities...
...Tax increases will not fix things," he wrote...
...There is no question that the TGVs were very good for SNCF as a whole," explains Christian Demaris, a widely respected transportation economist at the University of Lyon...
...So maybe they will do that now...
...SNCF's response shows creativity that most critics never expect from a state-owned enterprise...
...Strikingly, even as the ax blows fall, few Americans bother to look at how Europe actually works...
...We may soon know...
...That cut to the quick...
...on a frosty December morning...
...Sadly, severe budget cutbacks will only slow the growth of a very good thing...
...France is experiencing the same growth...
...First are taxpayers, who provide the growing subsidies that the regional railways require...
...Private insurers then pay most of the rest, and individual patients make a nominal co-pay...
...But, the "everything" excludes outlays for the war in Afghanistan, the continuing military occupation of Iraq, and costly weapons systems that we do not need and cannot afford...
...Government officials manage the system by overseeing medical facilities, negotiating prices for medicines, setting an upper level on the fees they will reimburse, and regulating private insurers...
...In Nicosia, Cyprus, grade-school students decided it would be better for their health if they stopped having their parents drive them to school...
...But, even in public education, competing approaches can still trickle up...
...Jensen listened and never told them not to drink...
...An anonymous set of initials, the company has now expanded well beyond the borders of France...
...For those out of work, unemployment insurance pays their health care premiums, while pension funds help to pay for the elderly and the government pays for children...
...It has an international parking subsidiary...
...We don't tell them to do it," explains the guidance counselor...
...The problem with these top-down tactics is that they don't work, explains Professor Bjarne Bruun-Jensen, co-founder of Denmark's Steno Health Promotion Center and one of the creators of the new, more holistic approach...
...Everyone is required to enroll...
...In what Demaris calls "a polygamous marriage," SNCF retained a monopoly on operating the trains, at least until 2019, but it works for a series of regional authorities, which own the trains, maintain the tracks, and bring forth the passengers...
...Scholarly evaluations are beginning to show that Health Promoting Schools produce positive results, and they are now spreading, notably in Denmark, Scotland, and Australia, where they have become part of standard curricula...
...It runs other transport and urban land management operations in Eastern Europe and Central Asia, taking full advantage of weaker unions, lower wages, and minimal benefits...
...The system appears to keep paper-shuffling to a minimum...
...A class of twelve-year-olds is preparing a low-fat gourmet lunch for twenty diners in their "caf...
...But Europe today goes far beyond classic private enterprise, state capitalism, or even the old social democratic catchall, mixed economy...
...For each visit to the GP, patients pay ?22—with the falling Euro, less than $28...
...It seems likely, though unproved, that pampering the cheminots actually contributed to SNCF's profitability...
...The first TGVs began running in the early 1980s, and passenger traffic has exploded ever since, initially with business travelers and increasingly with people taking leisure trips and vacations to visit family, beaches, or ski resorts...
...To cover their health insurance, pensions, and other social benefits, the government requires everyone in the work force to pay a percentage of taxable income...
...More thoughtful economists, especially those of a Keynesian bent, quietly counter that Europe's social safety nets helped pull the old continent out of recession...
...Two of the students opened Internet chats with a twin health promotion school in Macedonia that was also looking at alcohol use...
...Three publicly regulated private health insurance companies cover most people while a single state-run insurance fund covers long-term illnesses, the disabled, and the poor...
...You want to know whether we will give you responsibility over the conductors and other personnel...
...It is also a major producer of hydroelectricity and wind turbines...
...Or could they find somewhere else they could afford that would let them serve alcohol...
...This generally costs more, takes into account age, health, and previous conditions, provides added benefits, and often allows policy-holders to get quicker medical care...
...Under pressure from the European Union, the monopoly is scheduled to end as early as 2012, with competition expected from a privately owned French company, the Italian government's Trenitalia, Spain's national railway with its high-speed Talgos, and the German Deutsche Bahn with its ICE...
...In reporting on these "Health Promoting Schools" several years ago for NPR's All Things Considered, Frank Browning found a pioneering example in Denmark, in a suburb of Copenhagen...
...Many teachers and their unions see only an added burden, and many school administrators still prefer authoritarian teaching to a more democratic, student-centered approach...
...Each passenger produces a loss to the system," explains Demaris...
...We are thirteen years old now so I think we can have alcohol," said another...
...Harvard economist Jeffrey A. Miron honed the knife even sharper...
...SNCF expects to have four times more regional passengers in 2030, which will inundate current stations at the center of regional towns and cities...
...If they make a profit on the caf?, they will earn a trip to Scotland during winter break...
...Most often, they do this during office visits, not after...
...Virtually every advanced nation, including the United States, faces the same prospect...
Vol. 57 • October 2010 • No. 4
