How NASA Would Send Humans on Mars
By Charles Q. Choi
Special to SPACE.com
posted: 22 July 2009
09:18 am ET
As the 40th-anniversary celebrations of the moon landing end, a human voyage to Mars remains a holy grail for NASA.
"We're still looking at human exploration of Mars as one of the goals of the future at the top level," said NASA researcher Bret Drake with Lunar and Mars Integration at Johnson Space Center in Houston. "Having a human actually set foot on another planet would be one of the greatest adventures possible, one of the greatest monuments to history."
A crewed mission to the red planet is a daunting challenge that lies at the edge of current technological capabilities and possibly beyond. Still, NASA keeps a strategy to go there and constantly keeps up to date with new ideas.
"Mars is one of those targets of fascination that has been around a long time," Drake said.
How to get there
A voyage to Mars would take a crew about 180 days. So far NASA is exploring two options for propulsion there — a nuclear thermal rocket and a chemical engine.
A nuclear thermal rocket, based off designs from the '60s and '70s, would use a nuclear reactor to super-heat a gas and blast it out the nozzle to generate thrust. "It's a very high-performance vehicle, and we think it's very safe, not radioactive at launch, but it is a nuclear system," Drake said. "The idea for the chemical engine is similar to that used on the space shuttle, liquid oxygen and liquid hydrogen. It's a fairly well-known technology, but it's not as efficient as nuclear thermal."
To reach the Martian surface, NASA envisions an aerodynamic lander that flies down with thrusters to help it descend. The ascent vehicle that takes the crew back into space for the six-month trip home will likely rely on a combination of methane and liquid oxygen. "Oxygen is present in the Martian atmosphere in the carbon dioxide, so you can use resources on Mars to make it," Drake said.
Before the crew even gets to Mars, the plan is to send as much cargo there ahead of time as possible.
"That way we can know it's operating right before we ever commit the crew," Drake said. "A Mars mission is not like a lunar mission where you can come home at any time — once they're committed, a crew is out there for years."
By current NASA estimates, a crewed mission to Mars needs to lift about twice the mass of the International Space Station into space — roughly 1.76 million lbs. (800 metric tons) of technology. To launch the equipment, NASA plans on using the Ares V rocket, designed to be the most powerful rocket ever built and capable of carrying about 414,000 lbs. (188 metric tons) to low Earth orbit at one time.
"We're going to try to minimize the amount of assembly needed," Drake said. "The heavy lift capacity we'll have with the Ares V will allow for simple automatic rendezvous in orbit and docking of components."
The crew would ride up in one of the upcoming Ares I rockets before starting the voyage to Mars.
"Having humans in place could bring a wealth of experience and training and the ability to put into context what they see and to make real-time decisions, all things difficult to do with robots," Drake said.
The very habitat the crew stays at on the Martian surface would be sent ahead of time. "You can also do things like produce and store oxygen from resources at Mars beforehand for the crew and the ascent vehicle. You could generate water as well."
Big crew, long stay
NASA envisions a crew of six astronauts for a Mars mission. "That's about what's required for the skills needed — a commander, scientist, engineer, medical officer, things like that, as well as cross-training," Drake said. "They'll need expertise in a wide range of disciplines."
Currently NASA envisions a long stay for a crew at Mars, about 500 days.
"Crew autonomy is vital, because there's an up to 40 minute time delay in communication between Earth and the crew because of the distance," Drake said. "And the crew doesn't have a capability for re-supply — they'll just have what they send ahead or what they bring with them — so when things fail, they'll have to be able to repair them. They must be self-sufficient."
To survive the voyage, air and water need to be completely recycled regularly.
"We're learning a lot on the International Space Station right now on air revitalization and water recovery," Drake said. "What's nice about Mars is that there's carbon dioxide in the atmosphere, so that can help get us oxygen and water for the crew. In terms of food, we're looking at smaller systems, 'salad machines,' to grow food for the crew. Fresh food is not only good for nutrition, but good for the mind as well. A fresh tomato can really boost psychology."
Mental and physical challenges
The long hardship of roughly two-and-a-half years in space with only a few people in a potentially lethal environment will undoubtedly challenge the psyches of Mars explorers.
"The Russians are conducting a test right now that hopefully will shed light on the behavioral sciences aspect of a Mars mission," Drake said. "Looking at other remote exploration endeavors is helpful as well — Antarctica, or submarines — all that feeds into the human behavioral aspects of crew selection."
A key concern for astronauts as well as during the stay on Mars is dangerous radiation in the form of storms of high-energy particles from the sun as well as cosmic rays from deep space. "The best radiation protection material is hydrogen, or water, which is rich in hydrogen," Drake said.
On the surface of Mars, NASA envisions that cargo deployed ahead of time can produce water before the crew arrives to use as a shield during the crew's stay there. On the way to and from Mars, the ship could be configured so that water and food surround areas where crew spend most of their time, but "a 'storm shelter' aboard the ship will be an integral part for short events of radiation that can be lethal," Drake said.
No firm date has been set for any potential Mars mission, but it remains of keen interest not just to NASA, but also others, such as China.
"It's humanity's next step to understanding and expanding our presence outward," Drake said. "We view human exploration of Mars as being an international endeavor, most likely not limited to just one country, but probably of global scale.
Gallery: Mars Base of the Future
Top 10 Russian Space Missions
All About Mars
Saturday, October 3, 2009
Our World Is Falling Apart
Saturday, October 03, 2009
Our World Is Falling Apart
Yesterday afternoon and evening I gave a lot of thought to what has happened over the past year. It has been some of the hardest times I have lived through in my life. All of the anchors and familiar things we came to depend on and trust in life are crumbling as follows:
We banked at Washington Mutual Bank from September of 1999 to October of 2008. The bank suddenly closed its doors and failed. It was the biggest bank failure in US history and probably world history also.
We had our home loan with Country Wide Home Loans. It was the largest housing lender in the US. Country Wide first got a bailout from the US government. That could not stop the collapse. Bank of America stepped in and took a big loss to absorb the company. Tens of thousands of employees lost their jobs. Elena and I got caught up in the nightmare. We had a bad loan. In order to qualify for a loan modification we literally had to default on our loan and ruin our credit. We went through a torturous 3-month battle just to qualify for a loan modification. We have been waiting almost a year and we have heard nothing from the lender. We refuse to make payments. The bank makes no move to foreclose us. We have proof of income and the ability to pay. What the public is not aware of is that the $75 billion US that President Obama allocated for people to refinance their homes is now being used to reimburse banks and investors for their losses as they modify loans. This money all goes to people lucky enough to have a job and ability to pay. If you do not have a job, you're out of luck. You become one of the 300,000 families per month losing your home to foreclosure.
Elena's got her first car in the United States In May of 2001. It was a shiny-red 4-door Saturn. For the last eight and a half years we have been Saturn owners. We got the sad news yesterday that Saturn will soon close its doors for good. Some 13,000 employees will be thrown out of work. The resale value of our two cars is questionable at best.
Last night we went to see Michael Moore's new film Capitalism: A Love Story. We went to our normal theater complex in Daly City, California. We were shocked to see that Fudpucker's had closed. This is a large hamburger restaurant with a reputation for serving the best hamburgers in the San Fran Cisco Bay area.
We have seen our home state of California literally go right to the brink of bankruptcy.
One year from now I will be sixty-two years old. I will be allowed to draw my meager Social Security Administration pension of $1,187 per month. There will be a big deficit because of all the people like me taking early retirement.
We have seen 60-year old store chains like Circuit City and Mervyn's fail.
We have seen 150 year old landmarks of the US financial system like Lehman Brothers fail.
We have seen our government hand out over $2 trillion US dollars in bailout funds to the big banks like Citibank, Bank
of America, JP Morgan Chase, AIG, Fannie Mae, Freddie Mac
General Motors and Chrysler.
We have seen over 100 banks fail in the US this year. We got the sad news that 20% of the banks still in business should have failed but the government lets them continue. We see that the FDIC that insures all bank deposits is broke. They are seeking $45 billion US in fees from banks still in business to pay for their operations.
We now hear that the Federal Housing Administration that guarantees many of the mortgages in this country is short of cash and in bad shape.
My wife and I disagree on which American president Obama is a model of. She says he is Abraham Lincoln. I say that he is Franklin Delano Roosevelt. I say this because in the horrible days of the Great Depression, Roosevelt was a calming and reassuring influence who kept the country going in the hardest times imaginable. Things are much worse than the government wants us to know.
Posted by ohomen171 at 10/03/2009 10:54:00 AM 0 comments
Our World Is Falling Apart
Yesterday afternoon and evening I gave a lot of thought to what has happened over the past year. It has been some of the hardest times I have lived through in my life. All of the anchors and familiar things we came to depend on and trust in life are crumbling as follows:
We banked at Washington Mutual Bank from September of 1999 to October of 2008. The bank suddenly closed its doors and failed. It was the biggest bank failure in US history and probably world history also.
We had our home loan with Country Wide Home Loans. It was the largest housing lender in the US. Country Wide first got a bailout from the US government. That could not stop the collapse. Bank of America stepped in and took a big loss to absorb the company. Tens of thousands of employees lost their jobs. Elena and I got caught up in the nightmare. We had a bad loan. In order to qualify for a loan modification we literally had to default on our loan and ruin our credit. We went through a torturous 3-month battle just to qualify for a loan modification. We have been waiting almost a year and we have heard nothing from the lender. We refuse to make payments. The bank makes no move to foreclose us. We have proof of income and the ability to pay. What the public is not aware of is that the $75 billion US that President Obama allocated for people to refinance their homes is now being used to reimburse banks and investors for their losses as they modify loans. This money all goes to people lucky enough to have a job and ability to pay. If you do not have a job, you're out of luck. You become one of the 300,000 families per month losing your home to foreclosure.
Elena's got her first car in the United States In May of 2001. It was a shiny-red 4-door Saturn. For the last eight and a half years we have been Saturn owners. We got the sad news yesterday that Saturn will soon close its doors for good. Some 13,000 employees will be thrown out of work. The resale value of our two cars is questionable at best.
Last night we went to see Michael Moore's new film Capitalism: A Love Story. We went to our normal theater complex in Daly City, California. We were shocked to see that Fudpucker's had closed. This is a large hamburger restaurant with a reputation for serving the best hamburgers in the San Fran Cisco Bay area.
We have seen our home state of California literally go right to the brink of bankruptcy.
One year from now I will be sixty-two years old. I will be allowed to draw my meager Social Security Administration pension of $1,187 per month. There will be a big deficit because of all the people like me taking early retirement.
We have seen 60-year old store chains like Circuit City and Mervyn's fail.
We have seen 150 year old landmarks of the US financial system like Lehman Brothers fail.
We have seen our government hand out over $2 trillion US dollars in bailout funds to the big banks like Citibank, Bank
of America, JP Morgan Chase, AIG, Fannie Mae, Freddie Mac
General Motors and Chrysler.
We have seen over 100 banks fail in the US this year. We got the sad news that 20% of the banks still in business should have failed but the government lets them continue. We see that the FDIC that insures all bank deposits is broke. They are seeking $45 billion US in fees from banks still in business to pay for their operations.
We now hear that the Federal Housing Administration that guarantees many of the mortgages in this country is short of cash and in bad shape.
My wife and I disagree on which American president Obama is a model of. She says he is Abraham Lincoln. I say that he is Franklin Delano Roosevelt. I say this because in the horrible days of the Great Depression, Roosevelt was a calming and reassuring influence who kept the country going in the hardest times imaginable. Things are much worse than the government wants us to know.
Posted by ohomen171 at 10/03/2009 10:54:00 AM 0 comments
A Letter To A Brasilian Woman Doctor After Rio de Janeiro Was Chosen To Host The 2016 Olympics
October 3, 2009
Dear Carla:
I am asking Elena to deliver this note to you because I do not have your email address. When I was in LA the sun had baked my brain. You warned me. When I was asked what my favorite word is in Portuguese, I should have responded amoa.
Elena told me how happy you were when she told you that Rio got the Olympics in 2016. I was happy also.
Elena is amazed about how passionate people in Brasil are about their country. The day I arrived for the first time in Rio in 1975, I was in utter shock about all the poverty and the favelas. When I went through customs, my bags were inspected by a charming and well-dressed Brasilian man who spoke perfect English. He was smoking a pipe. When I looked at my bags later at the hotel, I realized that he had stolen a bottle of whiskey and a tin of pipe tobacco from my bag. When I got in a taxi to go to the Acapulco Hotel in Copacabana, I had no Cruzeiros. I gave the taxi driver US money and got cheated out of $50.00 US.
It was a bad start. Over the next five years I fell madly in love with Brasil and Brasilian people. Under all of the hard times and violence there is happiness, love, and a great social life. Brasil always touches my heart in a special way. I’m sad that Elena never spent enough time in Brasil to get to know it the way we both do.
Felicidades sempre,
Dear Carla:
I am asking Elena to deliver this note to you because I do not have your email address. When I was in LA the sun had baked my brain. You warned me. When I was asked what my favorite word is in Portuguese, I should have responded amoa.
Elena told me how happy you were when she told you that Rio got the Olympics in 2016. I was happy also.
Elena is amazed about how passionate people in Brasil are about their country. The day I arrived for the first time in Rio in 1975, I was in utter shock about all the poverty and the favelas. When I went through customs, my bags were inspected by a charming and well-dressed Brasilian man who spoke perfect English. He was smoking a pipe. When I looked at my bags later at the hotel, I realized that he had stolen a bottle of whiskey and a tin of pipe tobacco from my bag. When I got in a taxi to go to the Acapulco Hotel in Copacabana, I had no Cruzeiros. I gave the taxi driver US money and got cheated out of $50.00 US.
It was a bad start. Over the next five years I fell madly in love with Brasil and Brasilian people. Under all of the hard times and violence there is happiness, love, and a great social life. Brasil always touches my heart in a special way. I’m sad that Elena never spent enough time in Brasil to get to know it the way we both do.
Felicidades sempre,
Friday, October 2, 2009
Rio de Janeiro Wins 2016 Olympics In Surprise Upset
http://www.huffingtonpost.com/2009/10/02/2016-olympics-vote-announ_n_307464.html
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In A Surprise Move Iran Agrees To Send Processed Nuclear Materials To Russia and France; President Obama's Diplomatic Initiative May Be Working
Iran Agrees to Send Enriched Uranium to Russia
Pool photograph by Dominic Favre
European Union foreign policy Chief Javier Solana, left, with Iran's chief nuclear negotiator Saeed Jalili as they arrive for talks over Iran's nuclear ambitions at a villa in Genthod, near Geneva, on Thursday.
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By STEVEN ERLANGER and MARK LANDLER
Published: October 1, 2009
GENEVA — Iran agreed on Thursday in talks with the United States and other major powers to open its newly revealed uranium enrichment plant near Qum to international inspection in the next two weeks and to send most of its openly declared enriched uranium outside Iran to be turned into fuel for a small reactor that produces medical isotopes, senior American and other Western officials said.
Multimedia
The Takeaway With Mark Landler
The Takeaway With Steven Erlanger
Related
Possibility of a Nuclear-Armed Iran Alarms Arabs (October 1, 2009)
Iran’s Statement May Offer Window Into Nuclear Efforts (October 1, 2009)
Room for Debate: Can Sanctions Work Against Iran? (September 25, 2009)
Enlarge This Image
Caren Firouz/Reuters
Iran’s top nuclear negotiator, Saeed Jalili, said in Tehran that he was heading for talks in Geneva with a “positive approach.”
Readers' Comments
Share your thoughts.
Post a Comment »
Read All Comments (107) »
Iran’s agreement in principle to export most of its enriched uranium for processing — if it happens — would represent a major accomplishment for the West, reducing Iran’s ability to make a nuclear weapon quickly and buying more time for negotiations to bear fruit.
If Iran has secret stockpiles of enriched uranium, however, the accomplishment would be hollow, a senior American official conceded.
The officials described the long day of talks here with Iran, the first such discussions in which the United States has participated fully, as a modest success on a long and complicated road. Iran had at least finally engaged with the big powers on its nuclear program after more than a year and had agreed to some tangible, confidence-building steps before another meeting with the same participants before the end of this month.
But despite the relatively promising outcome, the Obama administration was at pains to strike a cautious tone, given Iran’s history of duplicity, its crackdown on its own people after the tainted June presidential elections and President Obama’s concern about being perceived as naïve or susceptible to a policy of Iranian delays.
Mr. Obama, speaking in Washington, called the talks “constructive,” but warned Tehran that he was prepared to move quickly to more stringent sanctions if negotiations over Iran’s nuclear ambitions dragged on.
“We’re not interested in talking for the sake of talking,” Mr. Obama told reporters in the White House Diplomatic Reception Room. “If Iran does not take steps in the near future to live up to its obligations, then the United States will not continue to negotiate indefinitely.”
France and Britain have spoken of December as an informal deadline for Iran to negotiate seriously about stopping enrichment and cooperate fully with the International Atomic Energy Agency. American officials say that timeline is “about right,” but Iran continues to insist that it has the right to enrich uranium for what it calls a purely civilian program.
Mr. Obama said Tehran must allow international inspectors into the site near Qum within the next two weeks, a timeline Iran’s chief nuclear negotiator, Saeed Jalili, agreed to here.
The atomic energy agency’s director general, Mohamed ElBaradei, will travel to Tehran this weekend to discuss the details and timing of the inspections, officials said. But the Americans also want Iran to cooperate with the inspectors and make personnel and documents about the site near Qum available.
Besides the scheduling of another meeting, the main practical accomplishment on Thursday was Iran’s agreement in principle — to be worked out by experts later this month in Vienna — to ship what American officials called “most” of its declared stockpile of lightly enriched uranium to Russia and France to be turned into nuclear fuel.
While American officials refused to specify the amount, other Western officials said it could be 1,200 kilograms, or more than 2,600 pounds, of enriched uranium, which could be as much as 75 percent of Iran’s declared stockpile. While there may be hidden stocks of enriched uranium, such a transfer, if it occurs, “buys some time” for further negotiations, a senior American official said.
Given the assessment that Iran has made enough low-enriched uranium to produce at least one nuclear weapon at some time in the future, a sharp reduction in its stockpile would be “a confidence-building measure to alleviate tensions and buy us some diplomatic space,” the official said.
Israel, the nation most concerned about a nuclear-armed Iran, has been informed of the discussions, another American official said.
Iran’s uranium is enriched to about 3.5 to 5 percent, the officials said; the Tehran reactor for making medical isotopes, last powered by Argentine-made fuel in 1993, needs uranium enriched to 19.75 percent, still far below weapons grade. And that uranium must then be fabricated into metal rods for the reactor.
Iran had told the International Atomic Energy Agency that it needed fuel for the Tehran reactor before December 2010. Washington, with its allies, pushed the agency to offer Iran the fuel, but made from Iran’s own enriched uranium as a feedstock. Mr. Jalili agreed to that in principle on Thursday.
The talks were between Iran and the five permanent members of the United Nations Security Council — the United States, Russia, China, Britain and France — as well as Germany, and led by the European Union’s foreign policy chief, Javier Solana.
1 2 NEXT PAGE »
Steven Erlanger reported from Geneva, and Mark Landler from Washington. Reporting was contributed by Helene Cooper from Washington, Sharon Otterman and William J. Broad from New York, and Neil MacFarquhar from the United Nations.
RecommendNext Article in World (2 of 45) »A version of this article appeared in print on October 2, 2009, on page A1 of the New York edition.
Pool photograph by Dominic Favre
European Union foreign policy Chief Javier Solana, left, with Iran's chief nuclear negotiator Saeed Jalili as they arrive for talks over Iran's nuclear ambitions at a villa in Genthod, near Geneva, on Thursday.
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By STEVEN ERLANGER and MARK LANDLER
Published: October 1, 2009
GENEVA — Iran agreed on Thursday in talks with the United States and other major powers to open its newly revealed uranium enrichment plant near Qum to international inspection in the next two weeks and to send most of its openly declared enriched uranium outside Iran to be turned into fuel for a small reactor that produces medical isotopes, senior American and other Western officials said.
Multimedia
The Takeaway With Mark Landler
The Takeaway With Steven Erlanger
Related
Possibility of a Nuclear-Armed Iran Alarms Arabs (October 1, 2009)
Iran’s Statement May Offer Window Into Nuclear Efforts (October 1, 2009)
Room for Debate: Can Sanctions Work Against Iran? (September 25, 2009)
Enlarge This Image
Caren Firouz/Reuters
Iran’s top nuclear negotiator, Saeed Jalili, said in Tehran that he was heading for talks in Geneva with a “positive approach.”
Readers' Comments
Share your thoughts.
Post a Comment »
Read All Comments (107) »
Iran’s agreement in principle to export most of its enriched uranium for processing — if it happens — would represent a major accomplishment for the West, reducing Iran’s ability to make a nuclear weapon quickly and buying more time for negotiations to bear fruit.
If Iran has secret stockpiles of enriched uranium, however, the accomplishment would be hollow, a senior American official conceded.
The officials described the long day of talks here with Iran, the first such discussions in which the United States has participated fully, as a modest success on a long and complicated road. Iran had at least finally engaged with the big powers on its nuclear program after more than a year and had agreed to some tangible, confidence-building steps before another meeting with the same participants before the end of this month.
But despite the relatively promising outcome, the Obama administration was at pains to strike a cautious tone, given Iran’s history of duplicity, its crackdown on its own people after the tainted June presidential elections and President Obama’s concern about being perceived as naïve or susceptible to a policy of Iranian delays.
Mr. Obama, speaking in Washington, called the talks “constructive,” but warned Tehran that he was prepared to move quickly to more stringent sanctions if negotiations over Iran’s nuclear ambitions dragged on.
“We’re not interested in talking for the sake of talking,” Mr. Obama told reporters in the White House Diplomatic Reception Room. “If Iran does not take steps in the near future to live up to its obligations, then the United States will not continue to negotiate indefinitely.”
France and Britain have spoken of December as an informal deadline for Iran to negotiate seriously about stopping enrichment and cooperate fully with the International Atomic Energy Agency. American officials say that timeline is “about right,” but Iran continues to insist that it has the right to enrich uranium for what it calls a purely civilian program.
Mr. Obama said Tehran must allow international inspectors into the site near Qum within the next two weeks, a timeline Iran’s chief nuclear negotiator, Saeed Jalili, agreed to here.
The atomic energy agency’s director general, Mohamed ElBaradei, will travel to Tehran this weekend to discuss the details and timing of the inspections, officials said. But the Americans also want Iran to cooperate with the inspectors and make personnel and documents about the site near Qum available.
Besides the scheduling of another meeting, the main practical accomplishment on Thursday was Iran’s agreement in principle — to be worked out by experts later this month in Vienna — to ship what American officials called “most” of its declared stockpile of lightly enriched uranium to Russia and France to be turned into nuclear fuel.
While American officials refused to specify the amount, other Western officials said it could be 1,200 kilograms, or more than 2,600 pounds, of enriched uranium, which could be as much as 75 percent of Iran’s declared stockpile. While there may be hidden stocks of enriched uranium, such a transfer, if it occurs, “buys some time” for further negotiations, a senior American official said.
Given the assessment that Iran has made enough low-enriched uranium to produce at least one nuclear weapon at some time in the future, a sharp reduction in its stockpile would be “a confidence-building measure to alleviate tensions and buy us some diplomatic space,” the official said.
Israel, the nation most concerned about a nuclear-armed Iran, has been informed of the discussions, another American official said.
Iran’s uranium is enriched to about 3.5 to 5 percent, the officials said; the Tehran reactor for making medical isotopes, last powered by Argentine-made fuel in 1993, needs uranium enriched to 19.75 percent, still far below weapons grade. And that uranium must then be fabricated into metal rods for the reactor.
Iran had told the International Atomic Energy Agency that it needed fuel for the Tehran reactor before December 2010. Washington, with its allies, pushed the agency to offer Iran the fuel, but made from Iran’s own enriched uranium as a feedstock. Mr. Jalili agreed to that in principle on Thursday.
The talks were between Iran and the five permanent members of the United Nations Security Council — the United States, Russia, China, Britain and France — as well as Germany, and led by the European Union’s foreign policy chief, Javier Solana.
1 2 NEXT PAGE »
Steven Erlanger reported from Geneva, and Mark Landler from Washington. Reporting was contributed by Helene Cooper from Washington, Sharon Otterman and William J. Broad from New York, and Neil MacFarquhar from the United Nations.
RecommendNext Article in World (2 of 45) »A version of this article appeared in print on October 2, 2009, on page A1 of the New York edition.
Ardi: Further Proof That Africa Is The Cradle Of All Human Evolution
http://www.huffingtonpost.com/2009/10/01/ardi-oldest-human-skeleto_n_306033.html
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Thursday, October 1, 2009
Swiss Health Care System
Swiss Health Care Thrives Without Public Option
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By NELSON D. SCHWARTZ
Published: September 30, 2009
ZURICH — Like every other country in Europe, Switzerland guarantees health care for all its citizens. But the system here does not remotely resemble the model of bureaucratic, socialized medicine often cited by opponents of universal coverage in the United States.
Enlarge This Image
Dominic Büttner for The New York Times
Dr. Gerlinde Schurter, center, with a patient and a nurse. She says regulators and insurers have fought to hold down costs.
Related
Incentives and Costs of the Swiss Government Model (October 1, 2009)
Times Topics: Health Care Reform
Swiss private insurers are required to offer coverage to all citizens, regardless of age or medical history. And those people, in turn, are obligated to buy health insurance.
That is why many academics who have studied the Swiss health care system have pointed to this Alpine nation of about 7.5 million as a model that delivers much of what Washington is aiming to accomplish — without the contentious option of a government-run health insurance plan.
In Congress, the Senate Finance Committee is dealing with legislation proposed by its chairman, Max Baucus, Democrat of Montana, which would require nearly all Americans to buy health insurance, but stops short of the government-run insurance option that is still strongly supported by liberal Democrats.
Two amendments that would have added a public option to the Baucus bill were voted down on Tuesday. But another Senate bill, like the House versions, calls for a public insurance option.
By many measures, the Swiss are healthier than Americans, and surveys indicate that Swiss people are generally happy with their system. Switzerland, moreover, provides high-quality care at costs well below what the United States spends per person. Swiss insurance companies offer the mandatory basic plan on a not-for-profit basis, although they are permitted to earn a profit on supplemental plans.
And yet, as a potential model for the United States, the Swiss health care system involves some important trade-offs that American consumers, insurers and health care providers might find hard to swallow.
The Swiss government does not “ration care” — that populist bogeyman in the American debate — but it does keep down overall spending by regulating drug prices and fees for lab tests and medical devices. It also requires patients to share some costs — at a higher level than in the United States — so they have an incentive to avoid unnecessary treatments. And some doctors grumble that cost controls are making it harder these days for a physician to make a franc.
The Swiss government also provides direct cash subsidies to people if health insurance equals more than 8 percent of personal income, and about 35 to 40 percent of households get some form of subsidy. In some cases, employers contribute part of the insurance premium, but, unlike in the United States, they do not receive a tax break for it. (All the health care proposals in Congress would provide a subsidy to moderate-income Americans.)
Unlike the United States, where the Medicare program for the elderly costs taxpayers about $500 billion a year, Switzerland has no special break for older Swiss people beyond the general subsidy.
“Switzerland’s health care system is different from virtually every other country in the world,” said Regina Herzlinger, a Harvard Business School professor who has studied the Swiss approach extensively.
“What I like about it is that it’s got universal coverage, it’s customer driven, and there are no intermediaries shopping on people’s behalf,” she added. “And there’s no waiting lists or rationing.”
Since being made mandatory in 1996, the Swiss system has become a popular model for experts seeking alternatives to government-run health care. Indeed, it has attracted some unlikely American admirers, like Bill O’Reilly, the Fox News talk show host. And it has lured some members of Congress on fact-finding trips here to seek ideas for overhauling the United States system.
The Swiss approach is also popular with patients like Frieda Burgstaller, 72, who says she likes the freedom of choice and access that the private system provides. “If the doctor says it has to be done, it’s done,” said Mrs. Burgstaller. “You don’t wait. And it’s covered.”
While many patients seem content, the burdens fall more heavily on doctors, especially general practitioners and pediatricians.
Dr. Gerlinde Schurter, Mrs. Burgstaller’s physician, says she feels squeezed by government regulators and insurance companies that have fought to hold down costs — most recently with a 15 percent cut in lab fees that forced her five-member group to lay off its principal technician.
Dr. Schurter also fears a so-called blue letter, a warning from an insurance company that she is prescribing too many drugs or expensive procedures.
If doctors cannot justify their treatments, they can be forced to repay insurers for a portion of the medical services prescribed. And while prescriptions are covered, the government has insisted that consumers fork over a 20 percent co-payment if they want brand-name drugs, rather than 10 percent for generics.
Similarly, the government health office also lowered reimbursements across the board for medical devices in 2006.
These are among the reasons health care costs consume 10.8 percent of gross domestic product in Switzerland, compared with 16 percent in the United States, the highest level of spending among industrial countries, according to the Organization for Economic Cooperation and Development.
Still, along with lower costs and the freedom to choose doctors come bigger bills for individual patients. On average, out-of-pocket payments come to $1,350 annually. That is the highest among the 30 countries tracked by the O.E.C.D. and well above the $890 average for the United States, which comes in second.
Related
Incentives and Costs of the Swiss Government Model (October 1, 2009)
Times Topics: Health Care Reform
Then there are the hefty prices of the insurance policies themselves, which can top 14,000 Swiss francs a year for a family of four in Zurich, or about $13,600. That is roughly comparable to the national average annual premium for a family policy under employer-sponsored group plans in the United States, but in high-cost American cities the figure can be much higher.
Direct comparisons are hard to make, however, because in the American system, employers and employees share the cost of premiums, which are also exempt from individual and corporate income taxes.
Nevertheless, Swiss citizens relish the lack of bureaucracy, especially compared with systems in Britain and Germany, even if their doctors grumble.
As in the United States, practitioners typically are paid on a fee-for-service basis, rather than on salary. But they make less than their American counterparts. According to the O.E.C.D., specialists in Switzerland earn three times more than the nation’s average wage, compared with 5.6 times for American specialists. General practitioners in Switzerland make 2.7 times more than the average wage, versus 3.7 in the United States.
That is partly because the Swiss health insurers are not shy about using their muscle with physicians.
Pius Gyger, director of health economics and health policy at Helsana, the country’s biggest insurer, cannot suppress a smile when asked about the effectiveness of the so-called blue letters.
“If there’s something strange, we knock at the doctor’s door,” he said. “For doctors, it’s an incentive to treat economically, but often perceived as a threat.”
He estimates that only about 3 percent of doctors get the letters and that fewer than 1 percent actually have to return money. Still, Mr. Gyger said, “it’s an easy exercise for us and it has an effect.”
Despite pressure on general practitioners, hospital physicians like Edouard Battegay at the University of Zurich say universal coverage also lowers costs by reducing emergency room visits.
Indeed, his E.R. is as quiet and efficient as a Swiss watch, and he still expresses amazement at what he saw when he worked briefly in Seattle.
“I’ve seen things in the U.S. that I’ve never seen here; it was a state of disaster,” he said. “Chronic disease management is better here. If you don’t treat hypertension, you treat strokes. Not treating patients is expensive.”
And even Dr. Schurter — who says her income has been flat for the last five years — praises the virtues of the Swiss system for patients struck by catastrophe.
When her daughter was found to have leukemia seven years ago, “I never worried for a second how and if she’d get treatment and if it would be paid for,” she said. “All was granted as naturally as the air we breathe.
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By NELSON D. SCHWARTZ
Published: September 30, 2009
ZURICH — Like every other country in Europe, Switzerland guarantees health care for all its citizens. But the system here does not remotely resemble the model of bureaucratic, socialized medicine often cited by opponents of universal coverage in the United States.
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Dominic Büttner for The New York Times
Dr. Gerlinde Schurter, center, with a patient and a nurse. She says regulators and insurers have fought to hold down costs.
Related
Incentives and Costs of the Swiss Government Model (October 1, 2009)
Times Topics: Health Care Reform
Swiss private insurers are required to offer coverage to all citizens, regardless of age or medical history. And those people, in turn, are obligated to buy health insurance.
That is why many academics who have studied the Swiss health care system have pointed to this Alpine nation of about 7.5 million as a model that delivers much of what Washington is aiming to accomplish — without the contentious option of a government-run health insurance plan.
In Congress, the Senate Finance Committee is dealing with legislation proposed by its chairman, Max Baucus, Democrat of Montana, which would require nearly all Americans to buy health insurance, but stops short of the government-run insurance option that is still strongly supported by liberal Democrats.
Two amendments that would have added a public option to the Baucus bill were voted down on Tuesday. But another Senate bill, like the House versions, calls for a public insurance option.
By many measures, the Swiss are healthier than Americans, and surveys indicate that Swiss people are generally happy with their system. Switzerland, moreover, provides high-quality care at costs well below what the United States spends per person. Swiss insurance companies offer the mandatory basic plan on a not-for-profit basis, although they are permitted to earn a profit on supplemental plans.
And yet, as a potential model for the United States, the Swiss health care system involves some important trade-offs that American consumers, insurers and health care providers might find hard to swallow.
The Swiss government does not “ration care” — that populist bogeyman in the American debate — but it does keep down overall spending by regulating drug prices and fees for lab tests and medical devices. It also requires patients to share some costs — at a higher level than in the United States — so they have an incentive to avoid unnecessary treatments. And some doctors grumble that cost controls are making it harder these days for a physician to make a franc.
The Swiss government also provides direct cash subsidies to people if health insurance equals more than 8 percent of personal income, and about 35 to 40 percent of households get some form of subsidy. In some cases, employers contribute part of the insurance premium, but, unlike in the United States, they do not receive a tax break for it. (All the health care proposals in Congress would provide a subsidy to moderate-income Americans.)
Unlike the United States, where the Medicare program for the elderly costs taxpayers about $500 billion a year, Switzerland has no special break for older Swiss people beyond the general subsidy.
“Switzerland’s health care system is different from virtually every other country in the world,” said Regina Herzlinger, a Harvard Business School professor who has studied the Swiss approach extensively.
“What I like about it is that it’s got universal coverage, it’s customer driven, and there are no intermediaries shopping on people’s behalf,” she added. “And there’s no waiting lists or rationing.”
Since being made mandatory in 1996, the Swiss system has become a popular model for experts seeking alternatives to government-run health care. Indeed, it has attracted some unlikely American admirers, like Bill O’Reilly, the Fox News talk show host. And it has lured some members of Congress on fact-finding trips here to seek ideas for overhauling the United States system.
The Swiss approach is also popular with patients like Frieda Burgstaller, 72, who says she likes the freedom of choice and access that the private system provides. “If the doctor says it has to be done, it’s done,” said Mrs. Burgstaller. “You don’t wait. And it’s covered.”
While many patients seem content, the burdens fall more heavily on doctors, especially general practitioners and pediatricians.
Dr. Gerlinde Schurter, Mrs. Burgstaller’s physician, says she feels squeezed by government regulators and insurance companies that have fought to hold down costs — most recently with a 15 percent cut in lab fees that forced her five-member group to lay off its principal technician.
Dr. Schurter also fears a so-called blue letter, a warning from an insurance company that she is prescribing too many drugs or expensive procedures.
If doctors cannot justify their treatments, they can be forced to repay insurers for a portion of the medical services prescribed. And while prescriptions are covered, the government has insisted that consumers fork over a 20 percent co-payment if they want brand-name drugs, rather than 10 percent for generics.
Similarly, the government health office also lowered reimbursements across the board for medical devices in 2006.
These are among the reasons health care costs consume 10.8 percent of gross domestic product in Switzerland, compared with 16 percent in the United States, the highest level of spending among industrial countries, according to the Organization for Economic Cooperation and Development.
Still, along with lower costs and the freedom to choose doctors come bigger bills for individual patients. On average, out-of-pocket payments come to $1,350 annually. That is the highest among the 30 countries tracked by the O.E.C.D. and well above the $890 average for the United States, which comes in second.
Related
Incentives and Costs of the Swiss Government Model (October 1, 2009)
Times Topics: Health Care Reform
Then there are the hefty prices of the insurance policies themselves, which can top 14,000 Swiss francs a year for a family of four in Zurich, or about $13,600. That is roughly comparable to the national average annual premium for a family policy under employer-sponsored group plans in the United States, but in high-cost American cities the figure can be much higher.
Direct comparisons are hard to make, however, because in the American system, employers and employees share the cost of premiums, which are also exempt from individual and corporate income taxes.
Nevertheless, Swiss citizens relish the lack of bureaucracy, especially compared with systems in Britain and Germany, even if their doctors grumble.
As in the United States, practitioners typically are paid on a fee-for-service basis, rather than on salary. But they make less than their American counterparts. According to the O.E.C.D., specialists in Switzerland earn three times more than the nation’s average wage, compared with 5.6 times for American specialists. General practitioners in Switzerland make 2.7 times more than the average wage, versus 3.7 in the United States.
That is partly because the Swiss health insurers are not shy about using their muscle with physicians.
Pius Gyger, director of health economics and health policy at Helsana, the country’s biggest insurer, cannot suppress a smile when asked about the effectiveness of the so-called blue letters.
“If there’s something strange, we knock at the doctor’s door,” he said. “For doctors, it’s an incentive to treat economically, but often perceived as a threat.”
He estimates that only about 3 percent of doctors get the letters and that fewer than 1 percent actually have to return money. Still, Mr. Gyger said, “it’s an easy exercise for us and it has an effect.”
Despite pressure on general practitioners, hospital physicians like Edouard Battegay at the University of Zurich say universal coverage also lowers costs by reducing emergency room visits.
Indeed, his E.R. is as quiet and efficient as a Swiss watch, and he still expresses amazement at what he saw when he worked briefly in Seattle.
“I’ve seen things in the U.S. that I’ve never seen here; it was a state of disaster,” he said. “Chronic disease management is better here. If you don’t treat hypertension, you treat strokes. Not treating patients is expensive.”
And even Dr. Schurter — who says her income has been flat for the last five years — praises the virtues of the Swiss system for patients struck by catastrophe.
When her daughter was found to have leukemia seven years ago, “I never worried for a second how and if she’d get treatment and if it would be paid for,” she said. “All was granted as naturally as the air we breathe.
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