Posts Tagged ‘health’

Tom Toles Editorial Cartoon - tt_c_c170206.tif

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While I was finishing up the latest right-wing libertarian dystopian finance novel, I was also trying to figure out the dystopia that the U.S. healthcare system has become.

Clearly, for most Americans, the combination of private healthcare and private health insurance (and, now with Obamacare, public subsidies) is a nightmare. There is a glaring contradiction between healthy profits and the health of the U.S. population. Over the course of the next couple of weeks, I plan to explore various dimensions of that system.

To start with, consider how much of an outlier the United States is in terms of expenditures and outcomes compared to other countries. As Max Roser explains,

the US spends far more on health than any other country, yet the life expectancy of the American population is not longer but actually shorter than in other countries that spend far less.

If we look at the time trend for each country we first notice that all countries have followed an upward trajectory – the population lives increasingly longer as health expenditure increased. But again the US stands out as the the country is following a much flatter trajectory; gains in life expectancy from additional health spending in the U.S. were much smaller than in the other high-income countries, particularly since the mid-1980s.

This development led to a large inequality between the US and other rich countries: In the US health spending per capita is often more than three-times higher than in other rich countries, yet the populations of countries with much lower health spending than the US enjoy considerably longer lives. In the most extreme case we see that Americans spend 5-times more than Chileans, but the population of Chile actually lives longer than Americans.

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An anti-austerity protest has brought 150,000 people—students, workers, and others—to the streets of London to demand David Cameron’s resignation.

The March for Health, Homes, Jobs and Education was organised by activist group the People’s Assembly. The demonstrators called for an end to austerity, and demanded that David Cameron quit over the revelation that he profited from his father’s offshore investment fund. . .

The People’s Assembly used the protest to make “Four Demands”. With regards to health, they called for an end to Government spending cuts and the alleged privatisation of the NHS. The protestors’ demand over housing included rent controls and the protection of social housing.

On jobs, they called for a universal living wage and the scrapping of the Trade Union Bill, and they also demanded an end to student tuition fees and “the marketisation of education”.

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No, that’s not the democratic socialist candidate for the Democratic nomination. It was actually Al Capone who once said that “Capitalism is the legitimate racket of the ruling class.”*

That racket—and, with it, challenges to the legitimacy of capitalism—was evident in a wide variety of news stories yesterday.

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First, there was the issue of health. Once again, we’re learning that the capitalist racket is affecting health. In particular, the gap in life span between rich and poor is widening. The top 1 percent among American men live 15 years longer than the poorest 1 percent; for women, the gap is 10 years. These rich men and women have gained three years of longevity just in this century.

And for some groups—especially white working-class men and women—death rates are actually rising.**

Public health experts say the rising white death rate reflects a broader health crisis, one that has made the United States the least healthy affluent nation in the world over the past 20 years. The reason these early deaths are so conspicuous among white women, these experts say, is because in the past the members of this comparatively privileged group have been unlikely to die prematurely. . .

[Anne] Case said that the whites who are dying are not America’s elites.

“They may be privileged by the color of their skin,” she said, “but that is the only way in their lives they’ve ever been privileged.”

Second, consider the problem of international trade. Michael Riordan challenged Carrier Corporation’s recent decision to transfer its Indianapolis plant’s manufacturing operations and about 1,400 jobs to Monterrey, Mexico.

The transfers of domestic manufacturing jobs to Mexico and Asia have benefited Americans by bringing cheaper consumer goods to our shores and stores. But when the victims of these moves can find only lower-wage jobs at Target or Walmart, and residents of these blighted cities have much less money to spend, is that a fair distribution of the savings and costs?

Recognizing this complex phenomenon, I can begin to understand the great upwelling of working-class support for Bernie Sanders and Donald J. Trump — especially for the latter in regions of postindustrial America left behind by these jarring economic dislocations.

And as a United Technologies shareholder, I have to admit to a gnawing sense of guilt in unwittingly helping to foster this job exodus. In pursuing returns, are shareholders putting pressure on executives to slash costs by exporting good-paying jobs to developing nations?

Even Lawrence Summers, desperate (like most mainstream economists) to maintain free international trade and global integration, had to admit that the globalization agenda has been a racket by and for those at the very top:

The core of the revolt against global integration, though, is not ignorance. It is a sense — unfortunately not wholly unwarranted — that it is a project being carried out by elites for elites, with little consideration for the interests of ordinary people. They see the globalization agenda as being set by large companies that successfully play one country against another. They read the revelations in the Panama Papers and conclude that globalization offers a fortunate few opportunities to avoid taxes and regulations that are not available to everyone else. And they see the kind of disintegration that accompanies global integration as local communities suffer when major employers lose out to foreign competitors.

Finally, when coupled with the revelations in the Panama Papers, there’s the growing suspicion that the 1 percent are both abandoning the rest of society (by hiding their money and avoiding taxes) and remaking the rules of the game (by using their money to influence elections and legislation). As Aditya Chakrabortty explains,

the Panama Papers confirm that the super-rich have effectively exited the economic system the rest of us have to live in. Thirty years of runaway incomes for those at the top, and the full armoury of expensive financial sophistication, mean they no longer play by the same rules the rest of us have to follow. Tax havens are simply one reflection of that reality. Discussion of offshore centres can get bogged down in technicalities, but the best definition I’ve found comes from expert Nicholas Shaxson who sums them up as: “You take your money elsewhere, to another country, in order to escape the rules and laws of the society in which you operate.” In so doing, you rob your own society of cash for hospitals, schools, roads…

But those who exited our societies are now also exercising their voice to set the rules by which the rest of us live. The 1% are buying political influence as never before. Think of the billionaire Koch brothers, whose fortunes will shape this year’s US presidential elections. In Britain, remember the hedge fund and private equity barons, who in 2010 contributed half of all the Conservative party’s election funds – and so effectively bought the Tories their first taste of government in 18 years.

Capitalism, of course, has always been a racket of the ruling class. Now, it seems—with revelations about unequal health and life spans, the costs of globalization, the ability of a tiny group at the top to exercise both exit and voice, and much more—its legitimacy is being called into question.

 

*Chicago’s most famous gangster was no anticapitalist radical. On the contrary:

“Listen,” he said, “don’t get the idea I’m one of those goddam radicals. Don’t get the idea I’m knocking the American system. The American system…” As though an invisible chairman had called upon him for a few words, he broke into an oration upon the theme. He praised freedom, enterprise and the pioneers. He spoke of “our heritage”. He referred with contempuous [sic] disgust to Socialism and Anarchism. “My rackets,” he repeated several times, “are run on strictly American lines and they’re going to stay that way”…his vision of the American system began to excite him profoundly and now he was on his feet again, leaning across the desk like the chairman of a board meeting, his fingers plunged in the rose bowls.

“This American system of ours,” he shouted, “call it Americanism, call it Capitalism, call it what you like, gives to each and every one of us a great opportunity if we only seize it with both hands and make the most of it.” He held out his hand towards me, the fingers dripping a little, and stared at me sternly for a few seconds before reseating himself.

**Consider this extraordinary statistic:

Compared with a scenario in which mortality rates for whites continued to fall steadily after 1998, roughly 650,000 people have died prematurely since 1999 — around 450,000 men and nearly 200,000 women.

That number nearly equals the death toll of the American Civil War.

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We already knew that the number of Americans who are on disability has skyrocketed over the past three decades. But the usual response has been that they’re gaming the system, claiming disabilities that “lend themselves to subjective manipulation” and being encouraged to do so by overly generous government payouts. Therefore, the conclusion is, “taxpayers are paying able-bodied Americans to drop out of the work force, increasing the burden on those who are still working.”

That was the existing common sense—the widely shared view that society had the responsibility (in the name of all “those who are still working”) to identify the truly disabled, weed out the others who are falsely claiming disability, and force them to get back to work.

Now we know, thanks to a recently published study by Anne Case and Angus Deaton, that something else has been going on: American workers are suffering from an “epidemic of pain, suicide, and drug overdoses.”

Specifically, Case and Deaton show that, after 1998, there was a marked increase in the morbidity and mortality of middle-aged white non-Hispanic men and women in the United States, especially for workers with less education.

The changes are dramatic. As we can see in the chart at the top of this post, even while mortality rates in other rich countries were declining (as were the rates for Hispanic and black Americans), U.S. white non-Hispanic mortality rose by half a percent per year. As they observed, “No other rich country saw a similar turnaround.” That turnaround in mortality was driven primarily by increasing death rates for those with a high-school degree or less. And, while their focus is on middle-age, they also make clear that all 5-year groups between 30 and 64 have also suffered increases in mortality.

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According to Case and Deaton, the three causes of death that account for the mortality reversal among white non-Hispanics are not lung cancer (which is declining) or diabetes (which has remained relatively constant), but drug and alcohol poisoning, suicide, and chronic liver diseases and cirrhosis. All three increased year-on-year after 1998.

And it’s not just that white Americans are being killed by this epidemic; they’re also increasingly victims of poor health, both physical and mental, as well as of pain and alcohol consumption. What we’re talking about here is a dramatic increase in the walking wounded (who often find it difficult to even walk).

The question is, why? Why have the rates of mortality and morbidity for white non-Hispanic Americans risen so dramatically in the past 15 years?

Case and Deaton suggest the epidemic may have been caused by the increased availability of opioid prescriptions for pain (although it’s not at clear if the increase in opioid use or the increase in pain came first) as well as growing economic insecurity (which started even before the crash of 2007-08), which may in fact continue into the future, given the shift away from defined-benefit to defined-contribution pension plans, if U.S. workers “perceive stock market risk harder to manage than earnings risk, or if they have contributed inadequately to defined-contribution plans.”

What they don’t mention is the role of jobs. The fact is, most Americans are forced to have the freedom to sell their ability to work to someone else—and they suffer both when they have a job and when they don’t. When they’re fortunate enough to have a job, they’re working in Walmart stores, Amazon warehouses, and fast-food restaurants and suffering the physical and mental pains and indignities imposed by their employers. And when they don’t have a job—when they’ve been discarded by their employers—they’re suffering from the jobs they once held and from the struggle to find another job. As a consequence of both having jobs and joblessness, an increasing number of middle-age Americans are dying, committing suicide, and are the victims of pain, poor health, and psychological distress. And, unless we do something about it, the middle-age Americans who do survive the current epidemic will carry their pain and ill health into old age.

And the corporate elite doesn’t want to take responsibility for having used up and pushed aside these Americans or, once they’re disabled, paying the taxes to support them. It has simply discarded them.

As for the political consequences, Paul Starr suggests we may be witnessing a “dire collapse of hope.”

The role of suicide, drugs, and alcohol in the white midlife mortality reversal is a signal of heightened desperation among a population in measurable decline. We are not talking merely about “status anxiety” due to rising immigrant populations and changing racial and gender relations. Nor are we talking only about stagnation in wages as if the problem were merely one of take-home pay. The phenomenon Case and Deaton have identified suggests a dire collapse of hope, and that same collapse may be propelling support for more radical political change. Much of that support is now going to Republican candidates, notably Donald Trump.

And, I would add, support to Kentucky’s new elected governor Matt Bevin and to Tea Party favorites in other states (such as Maine’s Paul LePage, Kansas’s Sam Brownback, and Wisconsin’s Scott Walker). They’ve all enacted—or promised to enact—a wide variety of radical measures, from Right to Work laws to restrictions on welfare and federally funded healthcare programs.

We now live in a society in which, on one hand, those at the top have simply disabled the white non-Hispanic working-class and left it to suffer “an epidemic of pain, suicide, and drug overdoses.” And, on the other hand, many of those same workers have responded, out of fear and hopelessness, by electing public officials who are making their plight even worse.