The National Research Council and Institute of Medicine yesterday released the results of a study addressing mortality in the United States as compared to other developed nations. The full report can be purchased here, where a summary also can be downloaded as a free pdf file. The press release on the study frames the questions addressed:
On average, Americans die sooner and experience higher rates of disease and injury than people in other high-income countries, says a new report from the National Research Council and Institute of Medicine. The report finds that this health disadvantage exists at all ages from birth to age 75 and that even advantaged Americans — those who have health insurance, college educations, higher incomes, and healthy behaviors — appear to be sicker than their peers in other rich nations.
“We were struck by the gravity of these findings,” said Steven H. Woolf, professor of family medicine at Virginia Commonwealth University in Richmond and chair of the panel that wrote the report. “Americans are dying and suffering at rates that we know are unnecessary because people in other high-income countries are living longer lives and enjoying better health. What concerns our panel is why, for decades, we have been slipping behind.”
From the summary, we have this long explanation of the causes of high US mortality, where I have added emphasis:
The panel’s inquiry found multiple likely explanations for the U.S. health disadvantage:
• 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.
No single factor can fully explain the U.S. health disadvantage. Deficiencies in the health care system may worsen illnesses and increase deaths from certain diseases, but they cannot explain the nation’s higher rates of traffic accidents or violence. Similarly, although individual behaviors are clearly important, they do not explain why Americans who do not smoke or are not overweight also appear to have higher rates of disease than similar groups in peer countries.
More likely, the U.S. health disadvantage has multiple causes and involves some combination of inadequate health care, unhealthy behaviors, adverse economic and social conditions, and environmental factors, as well as public policies and social values that shape those conditions.
What stands out to me is that the list of reasons Americans die early overlaps significantly with the social goals of right-wing libertarians who worship Ayn Rand and John Galt. Continue reading
Most of what I have to say about Mitt Romney’s pick of Paul Ryan I said on Virtually Speaking Sunday. I think the Ryan pick will hurt Mitt, and I think it opens up an opportunity for progressives to even box Obama in.
But I am enjoying the response from Republicans, who almost immediately started bad-mouthing the pick. First there was the BuzzFeed story–less than 48 hours after the pick!–describing how the political pros in Mitt’s staff opposed the pick. And now Politico describes the opinions of some three dozen Republican operatives, all of whom except Mary Matalin are queasy about the choice. (The Hill has a similar story.)
In more than three dozen interviews with Republican strategists and campaign operatives — old hands and rising next-generation conservatives alike — the most common reactions to Ryan ranged from gnawing apprehension to hair-on-fire anger that Romney has practically ceded the election.
It is not that the public professions of excitement about the Ryan selection are totally insincere. It is that many of the most optimistic Republican operatives will privately acknowledge that their views are being shaped more by fingers-crossed hope than by a hard-headed appraisal of what’s most likely to happen.
And the more pessimistic strategists don’t even feign good cheer: They think the Ryan pick is a disaster for the GOP. Many of these people don’t care that much about Romney — they always felt he faced an improbable path to victory — but are worried that Ryan’s vocal views about overhauling Medicare will be a millstone for other GOP candidates in critical House and Senate races.
One big reason the operatives don’t like this choice is it makes their job–getting down-ticket Republicans elected–harder.
And that’s just what it does to the Romney-Ryan ticket. Forget how it plays in close House and Senate races.
“Very not helpful down ballot — very,” said one top Republican consultant.
“This is the day the music died,” one Republican operative involved in 2012 races said after the rollout. The operative said that every House candidate now is racing to get ahead of this issue.
And what Politico doesn’t dwell on–but what Crooks & Liars noted the other day–is that it’s already too late for most of the Republicans running for reelection to separate themselves from Ryan’s signature policy. Because they already voted for it.
Even as Mitt Romney was introducing Wisconsin Rep. Paul Ryan as his running mate, his campaign was preparing a defense of the House Budget Chairman’s draconian Medicare proposals. With good reason. After all, in April 2011 the nonpartisan Congressional Budget Office forecast that Ryan’s scheme to convert today’s guaranteed Medicare insurance program into an underfunded voucher system would dramatically shift the health care costs onto America’s seniors. And in February 2010, Ryan acknowledged his privatization plan for millions of future elderly constituted rationing.
But it’s not just Team Romney that should be concerned about being caught red-handed with the proverbial gun pointed at the wildly popular program. Last year, 235 House Republicans and 40 GOP Senators–98 percent of all Republicans in Congress–voted for Paul Ryan’s budget and its blueprint to rationing Medicare.
What’s particularly remarkable about the Politico piece is that, in spite of widely expressed admiration for Ryan, just about all the anonymous sources admit that people hate his plan. The plan their bosses have already voted for.
I don’t think any of the geniuses in DC–whether Republican or Democratic–planned for this. I don’t think they intended to turn Mitt Romney into the poster child for the elites who have been looting our country. I don’t think Mitt realized that by picking Ryan, he would make the problem worse, not better.
But this election has now crystalized into a referendum on the austerity, oligarchy, and looting the Republicans (and more recently, the Democrats too) have been gradually introducing into our country.
Obama may still screw up the election. The economy may recrash, the drought may bring a price spike that makes people desperate enough to vote for Mitt, or there may be an October surprise.
And I’m sure Obama didn’t want to be running this election, pointing out how unpopular and disastrous are Ryan’s policies–policies which are not that different from some of his own.
But that seems to be where we’re heading. A referendum, from the top of the ticket on down, on the unpopular elitist policies that both parties in DC have been pushing for the last decade or so.
Congratulations to Kathy Hochul, who rode a disciplined campaign against Paul Ryan’s plan to privatize Medicare to victory in a Republican Congressional district tonight.
There’s a lesson here. Republicans voted on Ryan’s shitty plan. Which allowed Democrats to highlight how shitty it, and Republicans, are. And … Victory!!!
Obama, however, seems to be missing that lesson:
I want to extend my congratulations to Congresswoman-elect Kathy Hochul for her victory in New York’s 26th Congressional District. Kathy and I both believe that we need to create jobs, grow our economy, and reduce the deficit in order to outcompete other nations and win the future. Kathy has shown, through her victory and throughout her career, that she will fight for the families and businesses in western New York, and I look forward to working with her when she gets to Washington.
One corner of real America just made it very clear they don’t want anyone messing with Medicare. And yet Obama’s off negotiating just that, rather than making it clear that Republicans want to hold Medicare hostage along with the rest of the government.