at large medical expenditure (such as for inpatient hospital services and costly outpatient drugs) is a major cause of poverty (Preker & Carrin).' This is exactly the case in Egypt, where about 60% of outpatient drugs are paid for out-of-pocket (www.who.int/en). And yet, Egypt is able to meet the basic health needs of its people to such an extent that all threat from communicable diseases has been eliminated. Such killers as malaria, which are so prevalent in the rest of Africa, are no longer an issue in Egypt (www.who.int/en). The government has even taken steps to solve its micro-inefficiency problems, and has established conferences and brought in consultants to help address hospital management, the training of hospital personnel, and the efficient allocation of government resources to a powerful and accountable Ministry of Health that oversees all of Egypt's public health centers.
This all looks great, from an Egyptian standpoint. They are doing a lot of positive infrastructure restructuring with relatively few domestic resources. For a country without a significant tax base, I have learned that is a difficult thing. In Morocco, 2 ½ million people are considered poor even by Moroccan standards, 'of whom 72% live in rural areas and more than half are extremely poor (Understanding.).' Taxing the poor is not something a government can do, even a government such as Morocco's, where the king is not accountable to a higher power. In Morocco, the poor cannot be taxed because they do not have jobs, and do not have an income. The poor also do not have a political voice, since they have no money (Feldstein). And money is power.
This is easily seen in America as well. The American poor do not live in abject poverty, as the Moroccan poor do. And while the middle class in America is easily the largest economic block, there are approximately 41 million uninsured persons in America (Ernst & Young), many of whom are not even poor. The thought crossed my mind that so many poor and uninsured persons should also constitute a large voter percentage, and as such could formulate into an impressive electoral force. Unfortunately, the poor generally do not have a voice in political affairs. 'There's no American Association of Uninsured Persons issuing report cards on candidates or holding feet to the fire,' says a New York Times associate in an article focused on American health care. This problem is exacerbated by the fact that American voter turnout has been poor in recent times. In the 2000 elections, 92% of those who voted had health care insurance (www.nytimes). This gives political candidates no incentive to change anything.
In fact, candidates have retrograde incentive to change the health care system. In America, there are a few issues that you just do not touch if you want to stay in politics. In no particular order: abortion, homosexuality, and then comes health care issues like Social Security, Medicaid, and health care reform. You do not mess with old people's medication, you do not try and tax people and tell them that it's for the benefit of future generations, and you sure as heck do not try and give poor people a tax increase to force them to pay for their own coverage. When Bill Clinton addressed the issue of health care reform in 1994, the political result was a Republican coup of what was a Democratic Congress, which led to many fights and hardships for the Clint
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