A January Institute of Medicine report reinforces a series of studies finding the United States spending much more on health care than any other nation but getting much worse results. IoM's summary identifies four major explanations for our shorter lives and poorer health:
- Health systems. Unlike its peer countries, the United States has a relatively large uninsured population and more limited access to primary care. Americans are more likely to find their health care inaccessible or unaffordable and to report lapses in the quality and safety of care outside of hospitals.
- Health behaviors. Although Americans are currently less likely to smoke and may drink alcohol less heavily than people in peer countries, they consume the most calories per person, have higher rates of drug abuse, are less likely to use seat belts, are involved in more traffic accidents that involve alcohol, and are more likely to use firearms in acts of violence.
- Social and economic conditions. Although the income of Americans is higher on average than in other countries, the United States also has higher levels of poverty (especially child poverty) and income inequality and lower rates of social mobility. Other countries are outpacing the United States in the education of young people, which also affects health. And Americans benefit less from safety net programs that can buffer the negative health effects of poverty and other social disadvantages.
- Physical environments. U.S. communities and the built environment are more likely than those in peer countries to be designed around automobiles, and this may discourage physical activity and contribute to obesity [Institute of Medicine, "Report Brief: U.S. Health in International Perspective: Shorter Lives, Poorer Health," 2013.01.09]
In other words, if Americans followed practices and policies that the Madville Times regularly suggests—cover the uninsured, put down your booze and guns, fix poverty and income inequality, invest more in education, and build communities to favor walking and biking—Americans would live better and longer. Alternatively, living along the lines of Dakota War College or The Right Side will make you sicker and deader.
Another reader of the IoM report suggests we might want to act less like John Wayne and John Galt and more like Jean Chrétien:
One major impediment is that the US, which emphasises self-reliance, individualism and free markets, is resistant to anything that even appears to hint at socialism. Interestingly, as a group, classically liberal nations like the US and the UK – free market-oriented with less regulation, tax and government services – are the least healthy among wealthy democracies.
By contrast, social democratic countries such as Sweden – in which the state emphasises full employment, income protection, housing, education, health and social insurance – enjoy better overall health, although health inequalities within these nations are not always the smallest.
Debates about the relative merits of "cut-throat" US versus "cuddly" Swedish capitalism contend that there are important trade-offs between economic growth and innovation on the one hand, and growing inequality, high poverty and a weak social safety net on the other. Unfortunately, these debates often fail to factor in our health. That needs to change [Laudon Aron, "Why Is the Rich US in Such Poor Health?" New Scientist, 2013.07.15].
It's tough to innovate and generate wealth when you're sick or dead. If you want America to be economically competitive, you've got to pursue not just health care reform but a change in the American mindset that would allow a panoply of changes in public policy and private behavior.
Related [08:20 CDT]: If you're going to the Brookings Summer Arts Festival this weekend, remember that 6th Street from Main Street west to festival site Pioneer Park is all torn to heck. But festival vendor Connie Balcom says you'll be fine if you just park your car elsewhere and walk:
"I don't think that road is going to be a big fat pain," Balcom said. "For the person driving their car down that road, yes. But not after they once get here."
For those who don't want to mess with construction on 6th Street, festival organizers have set up a series of shuttles around the city where you can park and be taken to Pioneer Park for free [Hailey Higgins, "Brookings Art Festival," KELOLand.com, 2013.07.12].
And remember: walking will help you burn off that deep-fried alligator and funnel cakes!
One thing to look at when reading the actual report is the authors continued insistence that economically poor citizens are no worse of than rich white people. Instead this report was aimed at controlling all citizens.
The report was written in a way that makes it seem like the US Government has the obligation to become a true nanny state and take over all aspect of health. This would include what citizens are allowed to eat, what citizens are allowed to do for recreation, how much citizens will be forced to exercise, etc... Simply put the report was put out as a way to push the case that US Citizens should give up the right to live and die as they wish for "their own good". Is this really the direction of "social freedom" that Social Democrats want for US Citizens?
PS. Hmm, forgot about the Summer Arts Festival. Maybe I'll surprise my mom and head that way with the boys tomorrow. The Arts in the Park event here in Aberdeen just doesn't seem to be as good as the Brookings counterpart. (but maybe that's my bias from growing up in Volga).
freedom's just another word for pooping in the other guy's well and getting away with it because he has a bigger gun.
No—Ken—what?! The authors say that our poor health performance is consistent across ethnic and economic classes. Our poor people are worse off than French poor people. Our rich people are worse off than French rich people. It's not about control; it's about not being sick or dying early. How does having more infants dying represent greater liberty?
Yes, but the article talking about the study says: "the United States also has higher levels of poverty (especially child poverty) and income inequality and lower rates of social mobility." That would imply that poverty and income inequality is a source of the problems. Yet the authors make the case as you say that it affects all "classes" of people.
More infants dying is not a liberty issue. However the statistics used in this study have been debunked many times. Most of the countries on the list do not count an infant death that happens with 24 hours of birth. Prematurely born babies are also not counted as "born" if they do not survive the process. In the US these case are counted as born. The apples to oranges methodology of the study means there is no common ground for comparison. The study has lacked credibility from researchers that believe in little things like scientific method and bias reduction.
However the infant mortality "research" was used in January as a cause to prop this new "research". This was used for the conclusion that the government must intervene in more areas of Americans lives because "statistics" say so. Of course they failed to mention the fact such statistics were debunked...
WWZ: best advertisement for the UN yet. May it descend on Pierre soon before anarchy does.
First Lady Linda Daugaard is raising awareness about what someone perceives is the lacking state of foster care. Each family receives a stipend with government written all over it.
Pick a lane, Santema.
Hey, Ken: explain why the People's Republic of Brookings is the fifth most whatever-it-just-won-for.
and why Spanish is being spoken in some businesses in that town.
Since I actually have a few moments available, I'll bite for once.
I really don't care about the govs wife and her FosterOne program. Personally I think its a ploy to show that her husband is a "true caring" conservative going into the 2014 election. Even though the program doesn't appear to actually help anyone, it makes people feel "good" and they will ignore the wasted taxpayer dollars. Its a program that should go away, but honestly there are bigger fights out there.
I found it odd that Brookings got voted #5 for small towns. I can only think it has to do with the Childrens Museum. It is a very cool and unique place. My little boys love spending hours there! It also interestingly enough was created, funded, and is ran by a private non-profit group (I think from the Larson family). This is NOT a government run or mandated facility.
And finally I have no problem with Spanish speaking people in Brookings, or anywhere. I believe both the left and right have the immigration "debate" wrong in DC. Both sides use the Immigration bill as a means to insert completely unrelated pork. The requirement to "build a wall" first from the right is just silly. The current wall down there has been proven ineffective and ill-conceived. The left rightfully mentions that immigrants (even illegal ones) have rights and should be treated as humans with natural born-rights. But then they go on to talk about "immigrants" as if they are children and must be cared for as such. Both sides of the immigration "debate" need to take a step back and actually analyze the situation. No overly-large bi-partisan comprehensive legislation is going to make the current immigration situation better.
I, I, I, I: libertarianism in a nut's shell.
curious whether you could recompose that soliloquy without using the first-person singular nominative case.
unless you're too busy out pooping in other people's water.
That would be silly to take "I" out of an opinion piece. By doing so one would make the presumption they speak for all parties.
like private enterprise is doing such a good job managing prisons and running the military: government is only as good as the team that serves it. good leaders are forced to the top buoyed by staff and supporters.
It is good to see you taking a good libertarian approach against crony corporatism!
With that said I will bow out of the conversation now. We've left poor Cory with a mess of non-related comments to his post.
don't sue the owner of the door when it hits on the way out.
Higher levels of poverty based on comparative percentages or true numerical values?
yeah, the koch's think the poorest in america are rich compared to the rest of the planet.
let them eat petit fours.
The poorest in America are rich compared to the rest of the world. Some people work for less than a dollar a day. In America addicts who choose to live on the street get handed twenties out of "sympathy." Some of us would define that naive "sympathy" as enablement. I prefer, as a logical human being, to help the actual poor rather than the poor as defined by accountants.
Sully County is among the poorest in America, BS: howz that goin' for ya?
That's a good example of nonsense statistics based on convenient accounting (taxable income?) Or maybe you're just being funny.
what crops should be growing in sully county, bree?
Nothing but prairie grass if you had your way Larry. Of course if you had your way half the world would starve and half the nations would go up in flames.
actually, oacoma is the eastern border of my delusion. what should be growing in sully county?
on that side of the river of course.
All the way back in the first comment, Ken says:
The report was written in a way that makes it seem like the US Government has the obligation to become a true nanny state and take over all aspect of health. This would include what citizens are allowed to eat, what citizens are allowed to do for recreation, how much citizens will be forced to exercise, etc..
Hmmm. I'm not reading it quite that way.
As for Sweden as an example, I don't see that the people there are controlled by their government insofar as what they're allowed to eat, how much and in what form they must take their "exercise," etc.
I see my daily swims as "meditational recreation" anyhow, not "exercise." Or is that "recreational meditation"? And although my "diet" (translation = mode of eating) might not coincide with every Pritikinian's wet dreams, I think it's in general healthier than the average American "diet."
I do sense that in places like Sweden and Denmark, the people trust their governments more than we here in the USA trust ours. We do have a certain history of enduring tyranny and external aggression, only a little more than two short centuries ago, that the Swedes and Danes might not have recently enough to still have it in their DNA ...
All that said, I favor a single-payer, socialized health care system, but not to the extent that they tell me that merely swimming a mile a day is not enough for me; I must also walk two miles and/or bike 10 miles. And eat stuff that causes my guts to roar with gas and cramp, telling me that all that misery is "good for me."
I don't think that they dictate to people that much even in China, nor did they even in Soviet Russia.
In conclusion, if anyone tells me that I have to give up my slime and my fizz, I'll tell them where they can go straightaway and in no uncertain terms.
I can’t speak for the rest of the crowd at the SDWC, I can speak for myself.
The one thing that truly stuck me was how little was spent on other aspects of the health equation. Maybe I'm wrong but intellectual, emotional, and spiritual aspects work with physical aspects to affect the entire person. Neglect one the others will suffer. All four must be built up together equally.
This report only showed the symptoms not the cause or how to fix it.
Health Care is not a right. Health Care is a personal responsibility. This means we need to take care of ourselves, if we don’t, we should pay the price. Better access to doctors doesn’t mean everyone needs health insurance, it means we need more doctors in more clinics in undeserved areas practicing medicine without having to practice law at the same time. Giving everyone just insurance without any doctors or medical infrastructure is like giving away money and no place to spend it.
The social economic part is what stuck me the most. Is their poor health a result of their status or is their status a result of their poor health?
We as a soceity, not the government, need to work on all four parts of health, until we do....well you know
Stan,
It has been a few months since I've read the actual report (and I am too tired to read it again today). So maybe I am remembering a portion of it wrong.
But I seem to remember a whole section on Social Policies or Social Values that made the implication several times that our government having a de-centralized approach to social issues allows American citizens to behave in "bad" means. I also seem to remember a recommendation that policies and taxes should be used to "push" people towards certain behaviors and "punish" people who don't comply.
Maybe tomorrow I'll read the report again. I seem to remember getting a "nanny" feel from a section of the report, so it shouldn't be that hard to find the relevant section again.
Health care is free, medical insurance costs money. Pick your lanes, people.
MC, I appreciate your comment. Thanks.
I don't want to see undeserving people get government assistance. I don't think anyone does. I know that one of the surest ways to get anyone to change their behavior is to let them endure the consequences. When those consequences get too painful, change begins. That's how human beings work.
For instance, I briefly served a client here in St. Paul, Helen, who complained of back pain and got disability money from Social Security because of that. She went to doctors to get pain medications, specifically Oxycodone. Her purse was stolen with the med inside so Helen had to get more. She went to the police and got a report because she knew she would have to show it to the doc. I took her to the doc. She (doc) did not believe my client and refused to refill her scrip. Great. I didn't believe my client either. But Helen was smart and knew exactly how to manipulate the system.
Then there is my client Sue. She is schizophrenic. Voices tell her to hurt herself. Her IQ is in the lower 90s. She has worked at McDonalds cleaning tables and such, but her illness seems to be getting worse. Sue smokes cigarettes and is obese because she eats too much and exercises too little. Sue has occasional seizures. She receives Soc Sec disability money, lives in public housing, all her medical bills are paid by Medicare and MN. She regularly sees a neurologist, psychologist, psychiatrist, dentist (doesn't take care of her teeth), pulmonologist (asthma and smoking), and primary care doctor. She has a pet cat.
Sue gets help from her brother to manage all the paper work. She used to live with him until he could no longer afford it.
In the past 5 years I've worked with 34 clients. 2 were cheats. How are we going to change the system to get the cheats, yet not throw the people like Sue, who would not survive, off the streets and an early death?
That's the whole of my problem with talk of reform. How are we going to care for people in real need, like Sue? Or don't we? Do we just ignore human beings like her? Churches can't do it. They try, my Lutheran Church tries. There are too many right now. "Tightening up rules", as it is often artfully put, will add millions more people.
So? Any suggestions anyone?
One another small note, those who seem poor are willing to give you the shirt off their back to help. They will ask you join them for dinner. In contrast those with money seem unhappy, they are less willing to help and will walk by some one truly in need. Getting them to sit down for a dinner is almost impossible. They always on the go, to make the next deal or what ever.
I wonder who is really poor and who isn't
That's another good point MC. Psychic happiness definitely counts. However, when one can't afford to care for oneself or family, that is psychic pain in any book.
Deb, your comment, “I know that one of the surest ways to get anyone to change their behavior is to let them endure the consequences. When those consequences get too painful, change begins. That's how human beings work.” isn't without merit.
Way back in the late 1700's The Brits had our back to the wall, and we fought back, and sent them packing (with some wee help from the French)
During WWII Hitler was getting ready to take over the world. What we doing wasn't working. We changed and sent Hitler to meet his maker. Oh we returned the favor to France as well.
In the late 1980's and 90's the Y2K 'bug' was promising a world wide computer/internet collapse. Working together with the rest of the world, we survived. There were a few humorous date changes but nothing too serious.
Now we face a totally different challenge. What ever the answer is, it is going to take us, all of us, as a society, to fix it.