Monday, July 30, 2012
Monday, July 23, 2012
Tuesday, July 17, 2012
First, he lays out four basic arrangements for health care among the developed nations:
The Bismarck Model is found in Germany, Japan, France, Belgium, and Switzerland (among others). It uses private health insurance plans, usually financed jointly by employers and employees through payroll deductions. But unlike our health insurance industry, these health insurance companies are "basically charities: They cover everybody, and they don't make a profit. The doctor's office is a private business, and many hospitals are privately owned." Moreover, "tight regulation of medical services and fees gives the system much of the cost-control clout..."
The Beveridge Model. Medical care is "a public service, like the fire department or the public library. .... many (sometimes all) hospitals and clinics are owned by the government; some doctors are government employees, but there are also private doctors who collect their fees from the goverment. These systems have low costs per capita, because the government, as the sole payer, controls what doctors can do and what they can charge." Example: the U.S. Department of Veterans Affairs.
The National Health Insurance Model: "providers are private, but the payer is a government run insurance program that every citizen pays into. The national, or provincial, insurance plan collects monthly premiums and pays medical bills." Example: Canada. No marketing, no underwriting offices to deny claims, no profit: so it all tends to be cheaper and simpler than American-style insurance.
The out-of-pocket model. "The rich get medical care; the poor stay sick or die." And "Generally, the world's poorest countries have the highest percentage of out-of-pocket payment for health. In America, with more than 45 million uninsured (before the Affordable Health Care Act), 17% of health care costs are out-of-pocket.
And four issues:
Coverage. People talk about rationing, but it's worth considering that in America we ration health care because we don't cover so many people.
Quality. "The other industrialized countries produce better results, in terms of overall national health and longevity, than American medicine does."
Cost. Other nations pay less per capita than we do.
Choice. In America, you have networks. Great Britian doesn't, France doesn't, Japan doesn't. You can go to any doctor. "The patient, not the insurance plan, decides which doctor to use."
So the next time someone spouts off about about the dangers of socialized medicine, or about how we have the best medical care in the world, ask them if they've actually read anything about it. Then refer them to this book, written by a man who says, "In industry, finance, music, science, arts, academics, athletics, Americans can match or surpass any other country. Why can't we do that when it comes to health care?"
Friday, July 13, 2012
Friday, July 6, 2012
That all could change if a new ruling by the Court gains traction, according to GoodEReader, an e-reading blog. Yesterday, July 5, 2012, the Court of Justice of the European Union ruled that "original buyers of a digital product license can resell that license to a third party, providing they no longer use the digital product themselves. This could have ramifications for e-books, which, like software, are licensed digital files." Let's hope this one makes it over the pond.
The Colorado EBook Environment—Overview and Talking Points
Leadership. Colorado libraries have been leaders in securing access to collections in many ways: working with distributors like OverDrive and 3M; experimenting with products like Freegal and Freading; checking out ereaders with bundled titles; and even hosting the works of independent publishers, including many Colorado authors.1
Reading. 21% of Americans have read an e-book. 88% of those who read ebooks in the past 12 months also read print books. Compared with other book readers, they read and purchase more books.2
Demand. There is growing demand for ebooks. In Colorado they now account for about 3-7% of overall circulation, but are increasing upwards of 500% annually. Budget. Colorado libraries are shifting more of our budgets—already stretched by recession—to buy more digital content.
Purchasing. Libraries are volume purchasers, accounting for 10% of the total print sales today, and 40% of children’s print market. Traditionally, that’s earned us significant publisher discounts, further demonstrating the power of cooperative purchasing that is a fundamental value of public libraries.
Publishers. Three of the Big Six publishers (Hachette Book Group, MacMillan Publishers, and Simon & Schuster) will not sell ebooks to libraries at any price. The three that do (HarperCollins, Random House, and Penguin Group) require us respectively) to buy popular books again after 26 uses, spend 3 times the commercial price, or wait six months after street date. This uncertain and inconsistent publishing market is further eroding the purchasing power of libraries.
Legal action. Colorado is one of 14 states in an anti-trust lawsuit filed by the U.S. Department of Justice alleging price fixing and other anti-competitive practices conducted by some of the largest publishers.3
What Is the Vision for the Future?
Working together. In five years libraries envision a world where they are working together with publishers for the good of all parties; where the ability to publish, find, and buy books is easy, seamless, and sustainable. Ultimately, libraries seek an eBook world without unnecessary constraints on access by and for the public.
Uniform accessibility. Libraries envision a nationally sponsored eBook model where they can get eBooks at a discount, own them, and treat them no differently than their print items are handled now. Libraries must stop being reactive, but keep at the center of the evolving discussion.
Defend the right of public access. Libraries must be vocal in speaking up to corporations that do not act in the best interest of those who use and rely on library materials no matter the format. Business models that exclude libraries’ and the public’s right to access information in any format must be rejected.
What can you do? What should you do?
Pay attention. This is a time of change and disruption. There is an opportunity for libraries to move "upstream" in the publishing world, stepping around expensive middlemen, and developing new partnerships and markets. And there is danger: the erosion both of library purchasing power, and public access to content.
Speak up. The integration of ebooks into library collections is increasing scrutiny on how publishers do business. Your voice is important as the environment evolves. If your library isn't meeting public demand because of restrictions from the seller, say something. You won't be alone in wanting fair play for libraries and the consumer.
Experiment. While we may need to be patient as our environment changes, we dare not be complacent. Try something new. Let people know how it worked. Sharing knowledge is a library value. Some libraries will be early adopters—others will prefer to wait and adopt proven products. Both can prudent depending on how you view your role and stewardship of the community’s trust.
Be proud and positive. Today’s libraries are the result of hundreds of years of adaptation and action. Ebooks are but one aspect in the ongoing evolutionary trend. Like other products, they too shall pass into the library collection in ways that best meet community needs. You are one in a long line of people who have created the present and will shape the future of libraries through support, use, understanding and communication.
1 American Library Association (ALA) “E-content: The Digital Dialogue,” May 22, 2012. Multi-faceted articles on many aspects of eBook evolution.
2 Pew Research Center Internet & American Life Project. “The rise of e-reading” April 4, 2012. Report of eBook use and statistics.
3 Evoke Colorado. http://evoke.cvlsites.org/ – an open eBook forum and ad hoc discussion group for Colorado.
Sunday, July 1, 2012
Fair Use meant that we could quote it in reviews, use parts of it in other works (academic papers), and so on. We couldn't claim that we wrote it, or make whole copies.
Patron confidentiality meant that what you read was your own business. The library was only interested in what you currently had checked out, so we could remind you to bring it back, or charge you to replace it.
Upon these three pillars rested the public library. They worked. Library use has grown steadily over the years, and we have been a significant force for literacy. And as the data show, we contribute to the success of publishers and writers both.
When ebooks came along, suddenly all of these principles were up for grabs. Abruptly, instead of owning books, we were buying licenses just to access them. All kinds of new restrictions were experimented with, based on database licensing models: no discounts, no ILL, no reselling, no copying or printing parts of it, and now, a keen interest in patron statistics, down to the level of how many pages a patron may have gotten into a book before she lost interest.
I get the idea of restricting use to one person at a time; authors deserve to get paid, although the physical restriction no longer applies. That's an acceptable limit to me.
But here's my modest proposal. Let's take First Sale, Fair Use, and patron confidentiality as our baseline. Rather than meekly accepting each new encroachment on the public good, let's counter it with a request for offsetting rights that bring us back to the base.
For instance, there are now three constraints placed on library purchasing by Big Six publishers: repurchase (wherein HarperCollins requires us to "buy" again a book that has checked out 26 times; massive price increase (Random House's tripling of the cost of a new title); and the delayed release or "embargo" of Penguin. (Incidentally, I understand that publishers prefer the term "windowing" -- which is an excellent reason to continue to use the term "embargo." A fundamental rule of politics -- or let's call it the marketplace of ideas -- is not to cede the defining frame to your adversary, and in this case, the relationship does border on adversarial.)
Each of these deserves a response. So for instance:
* repurchase requirement. As I've written elsewhere, this redefines a purchase as a rental. And if that's the case, publishers shouldn't be able to require libraries to pick up both sides of the risk. We buy a lot of books that check out only a few times, or not at all. We assume that risk. So if we're now paying 70 cents per checkout, then it should apply to everything, not just what's popular. Alternatively, if we have to buy again things we've already bought, then we should have the freedom to sell the duds, at discount, to the community that paid for them in the first place. It's failed inventory at the library, although it might find another reader in another venue.
* tripling of the price. If the price of an item goes up by three times and adds no other value, then we should get a tripling of use. If I spend three times the retail cost of an item, then why not offer it to three patrons at a time?
* embargo. The bottom line is this: getting a book six months after street date makes it less valuable. So if there's a six month embargo, it should come with a 60% discount. Or, to get really creative, if we enable our patrons to buy things we cannot (through a "click to buy" option in our catalogs), every two consumer sales from the library should give us at least one copy of embargoed titles. This makes us publishing partners, not marginalized second-tier buyers.
* access to patron use data. First, let's just make it clear that we're talking about aggregate data only. Giving patrons a "click to buy" option is a convenience to them. But handing over individual reading histories to commercial entities is a betrayal of the trusted relationship between reader and library. On the other hand, the aggregate data could be genuinely useful to all parties. My point, though, is this: if publishers are now asking us to gather and provide new sources of information, that's work for us, a new cost. What do we get in exchange, other than the right to buy what should already be available in the marketplace? How about advance copies in exchange for patron reviews?
I have the distinct sense that the Big Six are trying, in rotation, a variety of new restrictions and demands to see which makes libraries squawk the least, and so will become the new normal. But every one of these restrictions not only erodes the purchasing power of libraries, but also restricts the flow of new stories and ideas to our communities.
I think we should let the Big Six know that we know that, and redouble our efforts to work with publishers who are still eager to connect their books with eager readers, instead of creating new barriers and costs.