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Inequality Kills
April 3, 2014 8:16 AM   Subscribe

For nearly two hundred years America was one of the healthiest and longest-lived countries, but today, over thirty countries have better health by many measures. What happened? "If the culprit of the decline in health is not health care, are individual health-related behaviors, often blamed for the high death rates in some groups, causing our low ranking in health? Apparently not."

"Everyone in a society gains when children grow up to be healthy adults. The rest of the world seems to understand this simple fact, and only three countries in the world don’t have a policy, at least on the books, for paid maternal leave—Liberia, Papua New Guinea, and the United States. What does that say about our understanding, or concern, about the health of our youth?"
posted by MisantropicPainforest (77 comments total) 53 users marked this as a favorite

 
I was just thinking about this. Last week CBC had a good documentary on early childhood interventions and how much it saves in special programs and prison sentences (radio interview here for American internet users). They said $1 in intervention saved $17 later. (Saved it ~20 years later.... and political terms are every 4-5 years so the governments have a hard time justifying spending money that they won't see returned until well after they're gone.)

Yeah we get taxed to death up here in Canada and most of us never use the taxes we pay... directly. I go to the hospital once every 5 years. But I benefit daily from lower crime rates, less gun violence and the general sense of ease and relaxation about healthcare and mat leave. It's really important not to feel totally alone in life if you fall on hard times. Christ there was even a poster in the Toronto subway "See a new Canadian? Help them out!" which my Chicago friends could not believe existed.
posted by St. Peepsburg at 8:30 AM on April 3 [49 favorites]


i often wish i were a new canadian.
posted by quonsar II: smock fishpants and the temple of foon at 8:35 AM on April 3 [51 favorites]


Sixty years ago:

In 1947, Salk accepted an appointment to the University of Pittsburgh School of Medicine. In 1948, he undertook a project funded by the National Foundation for Infantile Paralysis to determine the number of different types of polio virus. Salk saw an opportunity to extend this project towards developing a vaccine against polio, and, together with the skilled research team he assembled, devoted himself to this work for the next seven years. The field trial set up to test the Salk vaccine was, according to O'Neill, "the most elaborate program of its kind in history, involving 20,000 physicians and public health officers, 64,000 school personnel, and 220,000 volunteers." Over 1,800,000 school children took part in the trial.[4] When news of the vaccine's success was made public on April 12, 1955, Salk was hailed as a "miracle worker," and the day "almost became a national holiday." His sole focus had been to develop a safe and effective vaccine as rapidly as possible, with no interest in personal profit. When he was asked in a televised interview who owned the patent to the vaccine, Salk replied: "There is no patent. Could you patent the sun?"[5]

Today:

But extra protection comes at a price. French drugmaker Sanofi, whose Sanofi Pasteur unit is the world's biggest supplier of flu vaccines, with sales of 884 million euros ($1.2 billion) in 2012, says it expects a premium of some 50 percent or more.

It reflects a determination by manufacturers to move up the value chain by developing more innovative and expensive vaccines, following the recent success of novel products such as HPV shots to protect girls against cervical cancer.

Contracts struck with the U.S. Centers for Disease Control and Prevention (CDC) confirm a hefty price jump for the new four-strain flu vaccine, with GSK's quadrivalent Fluarix, for example, costing $12.03 per dose against $8.08 for the standard version, according to the agency's website.


Shit. I wonder where we went wrong here?
posted by Talez at 8:37 AM on April 3 [38 favorites]


I recently read an article ranking the counties of the state where I grew up by levels of health, measured by a bunch of different indicators. The particular county where I grew up was fourth from the bottom. It also has one of the highest unemployment rates in the state.

So, yeah, the idea that income inequality leads to general poor health outcomes is brought to you by a Water is Wet grant from the No Shit, Sherlock Foundation. But I'm glad to see studies and articles coming out confirming it, just in case there are any policymakers who haven't made the connection.
posted by The Underpants Monster at 8:41 AM on April 3 [7 favorites]


Policymakers made the connection eons ago, they just don't care: the children of the rich are well-treated, that's the main thing. The rest should have had the foresight to be born to someone with money, so it's their own damn fault.

Sure, yes, some lip-service here and there to keep the proles in line, but don't doubt for a moment that they A) know and B) don't care.
posted by aramaic at 8:44 AM on April 3 [12 favorites]


For most people - the vast majority of people, in fact, who can't afford to run some sort of personal fiefdom - spending money via taxes will getg you a far better quality of life than you could possibly manage on your own. Anerica seems devoted to holding that fact heretical, and furthermore spreading this view throughout the world.

Please stop ithat. It's making me nervous.
posted by Devonian at 8:45 AM on April 3 [26 favorites]


[comment removed - don't pre-doom the thread please.]
posted by jessamyn at 8:48 AM on April 3 [2 favorites]


i often wish i were a new canadian.

Mmmm, with that New Canadian smell.
posted by Panjandrum at 8:52 AM on April 3 [23 favorites]


The majority of people voting for "small government" candidates would directly benefit from more progressive taxation and spending but for a variety of reasons vote against that economic interest. In the abstract that's fascinating but in the particular it's extraordinarily frustrating.
posted by Dip Flash at 8:56 AM on April 3 [4 favorites]


Maternal infant bonding is an interesting area of study- but it says something about Americans that "I want to be with my baby" isn't enough in and of itself for us to respect a period of a few years that many women (or sometimes fathers) naturally want to be with their babies. That being overworked and exhausted is not good for parenting. That not having enough resources is not good for parents or their pregnancies or their infants or children.

The very fact that as a woman I have to prove WITH SCIENCE that the bond I feel with my infants is a real thing reflects a sort of innate ability to demean human welfare with the power of using "science" and calling people's instincts and emotions woo to domineer them out of doing what they want...

I like science.... I like challenging behavioral norms and superstitions, but doing so should involve respecting that often these things are doing valuable things for the individuals and societies using them and even if the logic behind it is woo, it may have conferred survival benefit or even just ENJOYMENT that is worth considering beyond just numerical values of health in a chart. Or trying to enforce behavioral norms that match efficiency and output of product rather than considering how those individuals are experiencing enforcement of such norms onto family life.

Sure putting infants in day care at 6 weeks might not result in immediate scientifically provable harm, but have you seen a mother leaving her infant those first days? While woman vary and mothers are not a monolith, as someone who'se worked in infant care and preschools I've watched many a mother (and friend) go through a very emotionally painful experience of leaving her child well before she feels ready or that it's in her child's best interests (despite feeling forced to decide for financial reasons of survival or emotional reasons of needing to work outside the home). I have been the one to watch one and two year olds transition to 50 hours in care and how exhausted they are at the end of the day.

It's ridiculous that we're not allowed to say based on what we see in front of us, this is hurting a lot of families and infants and children. Not that the REASONS, the poverty and strife, families are driven to this aren't valid, not that families are bad for being driven to this, but that as a culture we could stand to support families more and stop pushing families into situations like this since "There's no proof it's harmful".

Sure, I guess, now that science says we've been harming families and children maybe people will stop the denial. But it's sad that suffering itself isn't enough to make us pause and do more to value and protect families and children.

Hatred towards poor parents for "causing" their children's poverty seems to be the solution, placing responsibility on the poor for their poverty and blaming them for being poor or daring to have children while poor frees people up from looking at what a horrible social structure we have set up and allow to thrive. The second people start being the ones benefiting from the way things are, suddenly it all starts getting easier and easier to justify why standing up against it just isn't possible or it's "idealistic" to pretend it could ever be better. Just keep trying to get yours and do your best to forget about everyone else. Obviously if you're one of the have not's you think things should change, but that's just because you're desperate. Everyone else knows things are fine like they are, and the struggles of the needy don't matter.
posted by xarnop at 8:57 AM on April 3 [33 favorites]


The world is running what economists call a 'natural experiment'. A certain number of countries have chosen one hypothesis, and the USA has chosen another, and we've all proceeded with the experiment for a while now. The results are coming in, and now we see whose hypothesis is providing cheaper and more humane results. But sadly, science doesn't trump politics, stupidity and greed.
posted by Mary Ellen Carter at 9:02 AM on April 3 [41 favorites]


I have a hard time with these articles. On one hand they repeat over and over again how inequality is the problem, yet almost inevitably the solutions they suggest point to poverty. If inequality is the problem it should be sufficient to just steal from the rich -- no giving to the poor necessary.

The only evidence to the contrary -- and it's a biggie -- is that even though just about EVERYONE in the US is richer now than they were 30 years ago, the problems haven't disappeared. The contentious point seems to be how much better things are now.
posted by mikewebkist at 9:04 AM on April 3 [1 favorite]


only three countries in the world don’t have a policy, at least on the books, for paid maternal leave—Liberia, Papua New Guinea, and the United States.

wow.
posted by ghostbikes at 9:05 AM on April 3 [5 favorites]


I am wondering to what extent the theoretical 'American' portion of any metric is skewed by so many people from different backgrounds and in what direction.
posted by sfts2 at 9:05 AM on April 3 [2 favorites]


To be fair, other countries benefit from the enormous amount of tax money they don't have to spend on defense because America has decided to be Supercop of the world. If we decided here in the US that our internal issues were more important than running the world for a few decades maybe we could solve some of these issues with the resulting tax re-distribution away from military and foreign aid.
posted by spicynuts at 9:06 AM on April 3 [13 favorites]


On one hand they repeat over and over again how inequality is the problem, yet almost inevitably the solutions they suggest point to poverty.

Not quite. Poverty is the symptom. The problem is the emotional imprints we pass along to our children - is the world a safe place, are you lovable, are others generally decent; do we take care of each other; how do you handle your own emotions and focus on a goal and handle setbacks.

We need proper interventions targetted at improving self-esteem and self confidence... REAL self-esteem & confidence, not the 80s bullshit "everyone gets a medal" confidence.

Psychologists are slowly getting to the point, eventually lawmakers will too.
posted by St. Peepsburg at 9:10 AM on April 3 [4 favorites]


also:

These efforts will be resisted by the elite, although even the top 1 percent will be healthier when there is less inequality.

I don't know about that, they seem to be doing pretty okay right now.
posted by ghostbikes at 9:14 AM on April 3


I'm reminded of the stories about coal mining towns after one of the recent environmental disasters. About how everyone knows that working for The Man and living near his mines/factories/etc. is literally killing them and their kids, but they put their heads down and work hard until they die and they're proud of it because that's their culture.

I get the feeling the rest of America isn't much different from those towns, it's just that the poison is slightly more subtle. And getting away from it means moving a lot farther than just the next county.
posted by Foosnark at 9:15 AM on April 3 [9 favorites]


only three countries in the world don’t have a policy, at least on the books, for paid maternal leave—Liberia, Papua New Guinea, and the United States.

wow.


And I bet Liberia and Papau New Guinea are working on it, actually discussing it as a serious political issue.
posted by Theta States at 9:15 AM on April 3


Yeah we get taxed to death up here in Canada...

This is a weird idea that Canadians and Americans seem to have.

US federal income tax rates for 2014:

- 10% on taxable income from $0 to $9,075, plus
- 15% on taxable income over $9,075 to $36,900, plus
- 25% on taxable income over $36,900 to $89,350, plus
- 28% on taxable income over $89,350 to $186,350, plus
- 33% on taxable income over $186,350 to $405,100, plus
- 35% on taxable income over $405,100 to $406,750, plus
- 39.6% on taxable income over $406,750.


Canadian federal income tax rates for 2014:

- 15% on the first $43,953 of taxable income, plus
- 22% on the next $43,954 of taxable income (on the portion of taxable income over $43,953 up to $87,907), plus
- 26% on the next $48,363 of taxable income (on the portion of taxable income over $87,907 up to $136,270), plus
- 29% of taxable income over $136,270.


Plus each state and province have their own additional income taxes and sales taxes.

I know this is an oversimplification, but it isn't about how much taxes are charged but rather how they are allocated.
posted by keeo at 9:17 AM on April 3 [34 favorites]


Panjandrum: Mmmm, with that New Canadian smell.

I think that's authentic maple syrup.
posted by filthy light thief at 9:17 AM on April 3 [3 favorites]


Recently a friend on FB posted regarding anti-vaxx, and the comment I left touches on this issue, I think:
Not sure if I mentioned this in another thread, but the anti-vax crowd in general (and I'm glad Heidi above, isn't telling her story as a means to scare people away from vax) is quite libertarian in the sense that it comes down to a narrow, self-centered view.

"The reduction/nullification of the risk of my child having autism (or other complications from vaccines) is more important than the right of thousands or millions of people to not get polio, rubella, scarlet fever, mumps, measles, pox, flu etc etc etc..."

It's a perfect expression of personal rights over social responsibility. Though it's usually put forth in the capitalist money or property rights concept, extending it to ones personal health (or child's health) is a logical consequence of this anti-social mentality.

I wholeheartedly concur that the best scientific measures should be taken to reduce risks of vaccines, but that can't happen if we shut down all research and demand vaccines as some evil to be abolished based upon wild theories and confabulations. If there are statistical problems and risks to people, but the benefits still outweigh the risks on the large scale, the goal should not be to abandon the entire edifice, but to refine, learn,educate and advance our knowledge to do a better job than before.
posted by symbioid at 9:20 AM on April 3 [11 favorites]


Syrup and denim
posted by zippy at 9:21 AM on April 3


Shit. I wonder where we went wrong here?

It's not really fair to compare what Salk did with current drug/vaccine pricing practices, or even contemporaneous practices at the time. It's not like Beecham was giving ampicillin away for free.

Really though, the point the article makes is not that the relatively poor health of the US compared to a certain group of other nations is directly tied to the more avaricious practices of pharma firms (although they certainly aren't helping). It's that there are even larger, more diffuse issues at play. Vaccine pricing is kind of moot to your overall health status if you're working two jobs just to stay at the poverty line, and that leaves you with far too little time to even find the time to get to a local pharmacy which is offering flu shots. And besides, you're fucking exhausted and stressed out, and you've got a million other things you need to take care of. A flu shot is the least of your concerns at that point.

The tragedy of the US healthcare system (or *systems* really, given the federal nature of the country), is that we did have downright heroic successes in tackling big scary health bugaboos. The average person in the US has access to clean water; the flouridation of that water helps prevent cavities; doesn't have to worry about polio; has never even seen a case of measles; can get bit by a mosquito without worrying about malaria; and enjoys the benefits of innumerable other projects set out to rid the nation of obvious threats to public health.

When it comes to the more abstract problems though, the ones that fall under that rubric of "structural violence," progress has ground to a halt, or even reversed. Endemic poverty, overwork for underpay, lack of worker protections, and all sorts of other economic issues that do tie into public health are not so easy to frame as "we just need to give everyone a shot." What went wrong is that everyone could get righteously angry at pictures of kids in Iron Lungs, but show those same people pictures of kids living in rundown public housing, or ramshackle rural homes, and their empathy centers shut off.
posted by Panjandrum at 9:29 AM on April 3 [8 favorites]


35% on taxable income over $405,100 to $406,750, plus

Can I take a moment to point out how weird it is that the US has a separate tax bracket for that $1650? That has to be a loophole or something.
posted by Panjandrum at 9:31 AM on April 3 [7 favorites]


Defining poverty is complex--- if we are willing to essentially abandon people to their own ability to master the world the second they turn 18, then no the world is not safe and it's a matter of the reality of our lack of a safety net not necessarily what we teach our children.

People have a lot of complex different types of needs and social interaction and participation and acceptance, these are all real needs. But so is adequate rest, healthy food, relaxation, time off, the ability to participate in leisure pursuits.

ALL of these things involve money especially when you realize time off costs money. Knitting costs money. Drawing costs money. Learning yoga costs money. "Doing it yourself" costs time, energy-- that you don't have if you're overworked and exhausted, nor can you necessarily afford the tools or raw materials to do it yourself. Buying land costs money, keeping land costs money.

Defining poverty in terms of access to resources needed for health and enrichment to maintain a healthy life into old age--- this is a totally different definition than what we use. Emotional resources are real resources too, nurturing and attention are actually needs that are most intense in younger years but are still part of our health needs as we grow older. Being blocked from participation is a real harm because you can't develop the same learning and understanding and access to opportunities for job and money and power to maintain access to needed resources if you can access the activities and pursuits you are expected to be knowledgeable about. What's more developing the brain requires stability, safety, nurturing, and using it, and it's very hard to create developmental activities that promote cognitive development out of literally NOTHING which is what some families have and when you don't have time to sit in a library researching all day which can take months worth of time to find the right books and resources to create such a program not to mention you haven't even been exposed to the concept that is what you could be doing to begin with because you've been too busy struggling to eat and dealing with the load of a really toxic diet and lifestyle and the side effects of the pain killers you need to sooth your exhausted overworked nerves and/or the many other variables that go into not having access to needed support and resources or even the ability to spend time together.
posted by xarnop at 9:31 AM on April 3 [9 favorites]


What happened? Racism and white supremacy. Americans were perfectly happy to build projects for the collective good (New Deal, mass vaccination, public universities, etc) until blacks and other minorities compelled the legal system to recognize their right to access. At that point, white America decided to shut it all down. Western Europe and Scandinavia are going through a similar process today.

The apotheosis of the shutdown is the term "lawfare," which is taken to mean the use of the law by individuals who are outside the boundaries of whiteness. Previously, people claimed that Law was universal, part of a universal system of values. But once enough inconvenient non-whites decided that they wanted the law to apply equally to them as well, of course, that could not stand. Hence "lawfare."
posted by wuwei at 9:35 AM on April 3 [24 favorites]


Canadian federal income tax rates for 2014:

- 15% on the first $43,953 of taxable income, plus
- 22% on the next $43,954 of taxable income (on the portion of taxable income over $43,953 up to $87,907), plus
- 26% on the next $48,363 of taxable income (on the portion of taxable income over $87,907 up to $136,270), plus
- 29% of taxable income over $136,270.


Provincial taxes are significant, though. For Ontario, add:
5.05% on the first $39,723.
9.15% on the next amount, up to $79,448
11.16% on the next amount, up to $509,000
13.16% on amounts over $509,000
+ add another 50% on top of that result for the mysterious "ontario tax"

So if you make $1,000,000, you would have:
$277,591 in federal taxes
$181,695 in provincial taxes
(and that is after credits are applied)
for a tax bill of $459,286

Not sure how that lines up to the USA, since I don't understand their deductions.
But I think Ontario has the highest provincial taxation.
Switch to Alberta, your total tax bill would be $375,831
posted by Theta States at 9:39 AM on April 3 [1 favorite]


Mind you, on a $50,000 annual income in Ontario, your tax bill is more like $9190, or under 20% of gross. (not including CPP + EI contributions of course)
posted by Theta States at 9:40 AM on April 3


I thought here in Quebec we had the lock on being taxed the most!
posted by Kitteh at 9:41 AM on April 3


This subject is being discussed right this second on WAMU's The Kojo Nnamdi Show and, if I recall correctly, the recording will be available for listening around 6p EST.
posted by phearlez at 9:42 AM on April 3


Isn't Alberta kind of screwing themselves over by engaging in a libertarian wet dream and eliminating most tax revenue that isn't correlated with the price of tar sand oil?

I recall something like everybody getting a $2,000 income tax rebate maybe a decade ago, just for the privilege of being Albertan.
posted by pmv at 9:49 AM on April 3


BTW --St. Peepsburgh I think it sounded like I was disagreeing but I should have stated I agree with you-- but that if we see people as equal we should care they have the resources to survive, have housing, eat health food and participate in enjoyment like everyone else. So yes the inequality is that anyone thinks punishing low performers by taking away the resources they need for health is the way to force them to achieve more. It's literally a counter-factual ideology and it doesn't work. Taking away video games from a child might help them change their behavior but starving them or threatening them with life on the streets or depriving them of medical care will not help their behavior. Quite the opposite.

Those who have this ideology really need to let go of this idea that starving people of resources will force better behavior out of them. Desperation leads to less mental clarity, less long term thinking ability, and more... well you know.. desperate behavior. In general people with learning disabilities or difficulties performing tasks often need MORE resources to build both their physical and emotional health as well as more coaching and kind training to help them find the skills they are able to do and strengthen them.
posted by xarnop at 9:49 AM on April 3 [2 favorites]


To be fair, other countries benefit from the enormous amount of tax money they don't have to spend on defense because America has decided to be Supercop of the world. If we decided here in the US that our internal issues were more important than running the world for a few decades maybe we could solve some of these issues with the resulting tax re-distribution away from military and foreign aid.

Taking the central claim here as true (which it may not be), this still doesn't go very far in explaining the between-country differences, because the core problems in the US result from policy failures, not a lack of money. We have plenty of money, as a nation. It's just distributed extremely unevenly.

The US currently spends about 800 billion per year on Medicare and Medicaid these days, but if the government could set prices for medical goods and services like it does in every other developed nation, we could probably cut that in half or more, and get much better care at the same time. That would require good legislation, not a diversion of cash from the Defense Department.
posted by clockzero at 10:02 AM on April 3 [8 favorites]


Yes, Quebec seems to be the highest by quite a large margin, 25.75% provincial rate over 100k, and pretty high rates under 100k as well.

The maritimes and BC are higher than Ontario as well: Canadian provincial tax rates

Doing some basic calculations not including any deductions or anything, $1 mil income in AB would be around $620k take home, in Quebec that would be about $470k. Ontario is around $600k. Nova Scotia is pretty bad at $520k take home.

pmv: Those were called Ralph Bucks, and it was around $400.
posted by ryanfou at 10:02 AM on April 3


Those who have this ideology really need to let go of this idea that starving people of resources will force better behavior out of them. Desperation leads to less mental clarity, less long term thinking ability, and more... well you know.. desperate behavior. In general people with learning disabilities or difficulties performing tasks often need MORE resources to build both their physical and emotional health as well as more coaching and kind training to help them find the skills they are able to do and strengthen them.

Not to mention basic nutrition affects the ability of people to ward off ego depletion and decision fatigue. Most poor decisions aren't because of some people being innately lazy or evil, it's because they're so wrongly nourished that they mentally can't comprehend how this would be A Bad Thing™.
posted by Talez at 10:04 AM on April 3 [5 favorites]


only three countries in the world don’t have a policy, at least on the books, for paid maternal leave—Liberia, Papua New Guinea, and the United States.

I think this is a disingenuous statement, or at least deserving of an asterisk. The United States doesn't have a Federal policy on maternal leave, no. But the United States doesn't have Federal policies on a lot of things. Why so many progressives seem to pretend that government starts and ends in DC is beyond me.

California, in particular, has had a paid parental leave program operated as an insurance scheme (similar to Workers Comp, which is also a state-level program) since 2002. So that's ~12% of the US population that's covered, and has been for more than a decade. New Jersey has a similar setup, as does Rhode Island. Washington state is working on one as well. Several more states have programs for public sector employees.

So rather than looking internationally, we have ample grounds for comparison — an ongoing "natural experiment" — right here in the US.

Trying to ram through some sort of maternal leave at the Federal level is likely to result in a compromise that makes nobody happy (cf. FMLA), not to mention decades of court challenges and litigation. The best path forward — given, again, that there are a number of states with meaningful paid-leave policies right now — is to demonstrate that they're not harmful to business, not a burden on employers or employment generally, and are beneficial to the public. Other states will, and are, following.

Incrementalist, state-by-state approaches aren't sexy and they don't seem to satisfy the revolution-or-martyrdom urges of some on the far left. But they're effective. Conservatives know that, which is why they've been very successfully pushing their own agenda on the state level for decades.

All the moaning about how far behind the rest of the world the US is when viewed purely from the Federal level, overshadows the really good work people are doing at the state level. And when you get a critical mass of states to change their laws, there is a definite domino effect and it becomes easier to get other states to harmonize with them. The vast majority of laws which are similar between states (i.e. the uniform acts, such as the UCC) aren't that way because of Federal intervention, they're that way because of voluntary adoption at the state level.
posted by Kadin2048 at 10:07 AM on April 3 [6 favorites]


Other states will, and are, following.

How many decades are we talking about here? Alabama, Louisiana, South Carolina and Tennessee still have no minimum wage law on the books.
posted by Talez at 10:14 AM on April 3 [2 favorites]


I don't know, from the US maternity leave wikipedia page it looks like there are five or six states that have paid maternity leave in the US. It doesn't sound all that promising.

And looking at the nifty chart also on wikipedia comparing paid and unpaid leave available by country the US has 12 weeks unpaid leave for ELIGIBLE employees. Which means that for example myself, the option was 6 weeks and that's the case for a huge portion of mothers in the US.
posted by xarnop at 10:18 AM on April 3


In my old county, the level of physical activity was lower than the state average, which is to be expected if you;re unemployed. The ratio of population to available primary care physicians is nearly double the state average, and prevantable hospital stays is about 150% of the average (the latter is understandable given the former.)
posted by The Underpants Monster at 10:19 AM on April 3


What happened? Racism and white supremacy.
I was reading something last year, probably "The Price of Inequality", where the author put forth that view. Truman tried to get universal health care in 1949 as part of the Fair Deal, but the author said the southern democrats wouldn't do it if it included non-whites. Wikipedia seems to give the credit to the AMA.
posted by MtDewd at 10:27 AM on April 3


Kadin2048: "I think this is a disingenuous statement, or at least deserving of an asterisk. The United States doesn't have a Federal policy on maternal leave, no. But the United States doesn't have Federal policies on a lot of things. Why so many progressives seem to pretend that government starts and ends in DC is beyond me."

Kadin1848: "This needs an asterisk. The US doesn't have a Federal Policy against Slavery, no. But the United States doesn't have Federal policies on a lot of things."

The REASON so man of us talk about these issues regarding Federal, is because we believe the US is a country as a whole, despite the states-righters. That means, especially when considering the 14th amendment, that we think ALL US Citizens deserve these rights. The difference here is whether you think maternity leave is a right or a privilege.

People like me... It's a right. People like you, I'm guessing, see it as a privilege, not to be guaranteed. Of course, that's just formalisms. We can do whatever the fuck we want, and if we WANT to guarantee the right to a proper maternity leave or sick leave or vacation days, then it's in our purview to do so. If that entails upending and throwing out the entire US Constitution to do so, then I'm ok with that. Other so called "progressives" still have too much faith in the US system of governance, alas.
posted by symbioid at 10:27 AM on April 3 [8 favorites]


I mean, umm. AMENDING the constitution! Yes, that's it, I would never say we need to get rid of the Constititution, nope, no sirree!
posted by symbioid at 10:28 AM on April 3


Shit. I wonder where we went wrong here?

On rare occasions people with sufficient money and support can pursue endeavors that are for the greater good, but it is relatively rare that someone with the drive and knowledge also has the money and support. On the other hand, it is common for corporations to have sufficient money and support to hire the drive and knowledge to pursue any damn endeavor the board/CEO wants, and since people on boards/CEOs typically aren't noted for their altruism (with some exceptions), they're highly unlikely to pursue an altruistic endeavor (unless that's a secondary effect of making more money for more endeavors, which is the most important corporate endeavor of all.)
posted by davejay at 10:33 AM on April 3


symbioid: your passion is noble, but are you too young to remember the decades of rule by presidents Reagan, Bush and Bush? Do you expect eternal liberal leadership, with the good guys in charge of a nations' well being in perpetuity? The liberal (and understandable) distrust of "states rights" has had consequences for the fight against poverty, the war on drugs, gay marriage, etc...
posted by mikewebkist at 10:39 AM on April 3 [1 favorite]


I feel like the elephant in the room here is breastfeeding and breastfeeding outcomes and their correlation to infant health. But maybe that's because I find myself thinking about boobs a lot these days.

My best friend, who had a child three months before me, works for the Army Corps of Engineers, and though she lives in a blue state, I tend to think of the reactions of her co-workers and supervisors as a pretty good gauge of the attitudes toward middle-of-the-road Americans when it comes to workplace benefits and parental rights. Her co-workers, mostly men, treated her (largely unpaid) 12-week maternity leave--following a c-section--like a vacation. In fact, they have often made jokes about how they'd love to have been able to take a three month vacation, like she did. They often will give her work tasks just as she's about to go pump and give her a hard time about not waiting for her lunch breaks to pump. Her supervisors--many of whom have wives who stay at home to watch their children--stick to the letter of the law but still, it's clear that the things she needs to do to maintain a breastfeeding relationship are barely tolerated.

As a breastfeeding woman, I think a lot about how our entire infrastructure is built around preventing women access to their babies, which often has detrimental effects to milk supply and breastfeeding outcomes. It's not entirely intentional. Poverty and the necessity to work plays a big role. A lack of workplace support and understanding plays another. I'm glad we have formula available for women who want or need it, but I also know so many women who wanted to breastfeed for the WHO guideline of at least a year and made it less than three months because they had to return to work and their supply tanked and they got bad advice from their doctors about it (I've been shocked by how poorly understood breastfeeding is even by many pediatricians) and because formula was readily available and bottles and formula feeding were better tolerated in their workplaces or daycares. Breastfeeding outcomes are especially poor among the impoverished. It sometimes feels to me like our entire infrastructure is unintentionally built around undermining successful breastfeeding.
posted by PhoBWanKenobi at 10:51 AM on April 3 [26 favorites]


BTW --St. Peepsburgh I think it sounded like I was disagreeing but I should have stated I agree with you

Not at all it sounds like we're in passionate agreement actually.

I sure like the 'h' by the way. Sure makes me sound dignified. Cus, you know, I like named myself after a candy marshmallow, so clearly dignity was high on my list.
posted by St. Peepsburg at 10:52 AM on April 3 [5 favorites]


On rare occasions people with sufficient money and support can pursue endeavors that are for the greater good, but it is relatively rare that someone with the drive and knowledge also has the money and support. On the other hand, it is common for corporations to have sufficient money and support to hire the drive and knowledge to pursue any damn endeavor the board/CEO wants, and since people on boards/CEOs typically aren't noted for their altruism (with some exceptions), they're highly unlikely to pursue an altruistic endeavor (unless that's a secondary effect of making more money for more endeavors, which is the most important corporate endeavor of all.)

Sixty years ago the government put massive amounts of money into letting really smart people solve a public health crisis.

Now we required people to be independently wealthy to conduct research for the good of humanity.
posted by Talez at 10:57 AM on April 3


California, in particular, has had a paid parental leave program operated as an insurance scheme (similar to Workers Comp, which is also a state-level program) since 2002.

Yeah, but California's plan only provides 6 weeks of benefits at half your pay, and you have to use all of your vacation days before you can start to claim benefits.

On an international standard, that's still pretty crumby. And that's the best in the US?
posted by Garm at 11:01 AM on April 3 [8 favorites]


I feel like part of the problem is that we want to make sure that women who leave for work at 6 weeks are not shamed for leaving their children behind, so we say, "Oh it's just the same!" however a lot of women want to stay because they DO think it matters, not out of individual preference but because they think babies bonding with their mothers is important.

This is tricky because how do you create an infrastructures that ensures women are allowed to do something they think should be a right for health reasons of their children without stating that and therefore inadvertently coming across as shaming women who want to go to work at 6 weeks and like work life more than family life for those 40 hours of the work week?

I think this sort of in-fighting has crippled the ability to stand up for the rights of women who feel forced into the workforce (or literally are forced for survival to go back to work at 6 weeks) to have more time with their children because we're so worried about offending the feelings of women who often have much greater wealth and are choosing work so early BECAUSE their job will bring in enough resources they can pay for someone else to do the tasks of rearing the family. Sometimes the women with higher paying careers also feel "forced" but there is difference of degree or lack of options for a single parent minimum wage employee with no benefits and a salaried employee who feels poor but is making 30,000 or more a year in additions to a spouses income in the degree of "Force" to be in the workforce.

A lot of effort is put into proving that families with full time working mothers are healthier and better but this is really a middle class (typically white) liberal construct that not all women share- but working women who left their families for intensive time consuming careers are more likely to be in STEM or doing research that shapes how we view health and family or how we direct policy and a lot of emphasis is put on getting poor women more education rather than even asking them what they want (i.e. do they want to have a STEM education? What if they like working in childcare they just want good pay and more flex time with their families including paid maternity leave?)
posted by xarnop at 11:06 AM on April 3 [4 favorites]


Fact 1: The US spends more per capita on health care than almost any country in the world.

Fact 2: Not all forms of health care spending are created equal.

The reality is that the US spends an absolute ton on certain kinds of care while spending almost nothing on many others. Other countries almost uniformly allocate their funds differently, and the result is the differences in health outcomes described here.

Specifically, the US spends an enormous amount on cancer treatments, dialysis, and end-of-life-care generally. Cancer survival rates in the US are the best in the world by a large margin. Every American diagnosed with chronic kidney failure receives free dialysis treatments (courtesy of Medicare) two or three times a week at centralized dialysis facilities that have been found to be enormously inefficient and not even the best way of providing that service. And it can cost $10k to spend a day in the ICU. A significant majority of Americans spend the last few days of their lives there, and many, many spend weeks or even months there before the end. And just speaking of surgery generally, outside the US, any surgery that isn't necessary right now can often come with a waiting list of months or even a year unless you're willing to pay cash to a private hospital. The easiest way of spending less money on surgery is doing fewer surgeries.

Other countries don't do things this way. Americans die of cancer at far lower rates than elsewhere (stats, though I assume Luxembourg is 93.8, not 938). Dialysis is provided differently elsewhere. And other countries tend to emphasize palliative care--keeping you comfortable until you die--far more than the US does, as there is a distinct tendency to use every available option right up until the end.

Unfortunately, those huge cost drivers do very little to improve public health. It's spending a ton of money on sick people who are going to stay sick and soon die. But other countries tend to spend *more*, proportionately, on things like access to GPs, pediatrics, chronic disease management for people under 65, etc. Those cost a lot less money and do have distinct positive public health benefits.

Other countries do this by basically saying that if you want the public to pay for your health care, you take what the public offers. It tends to be more generous on the younger, routine end, but much less generous on the geriatric, high-cost end. Want a regular physical and monitoring of your diabetes and hypertension? No problem. Want an experimental or latest-generation cancer treatment or a knee replacement? The former isn't likely to happen, and the latter may take a while if you can even get it. Americans--particularly seniors, who vote like mad--simply won't put up with the idea that there are health care options out there that we aren't allowed to have, whether or not someone else is paying for it.

Until we're ready to stop pouring useless billions down death's gullet and spend a little more keeping younger, healthy people healthy, nothing is going to change.
posted by valkyryn at 11:12 AM on April 3 [14 favorites]


Mmmm, with that New Canadian smell.

Smells Like Poutine Spirit
posted by ryoshu at 11:14 AM on April 3 [14 favorites]


Agnotologists—those who introduce ignorance into our scientific debates—
I always thought it was spelled Agnewtologists.
posted by MtDewd at 11:16 AM on April 3


The reality is that the US spends an absolute ton on certain kinds of care while spending almost nothing on many others. Other countries almost uniformly allocate their funds differently, and the result is the differences in health outcomes described here.

If I get treated for cancer in Australia I get treated in a government funded hospital with salaried doctors and nurses using drugs at a low negotiated price paid for by a single agency, the PBS.

If I get treated for cancer in the United States I get treated in a for-profit hospital who takes their piece, with drugs that are paid for at the highest possible rate who then take their piece by the insurance company who takes their piece.

All of the little pieces that each for-profit entity takes out of the system ends up being a fuckton of money.
posted by Talez at 11:27 AM on April 3 [3 favorites]


William Dressler has been saying this for years. His theory of cultural consonance goes a long way to predict and explaine who gets insulated from the devastating health effects of poverty, poor diet, and other things that we "agree" are terrible for ones well being.
posted by bilabial at 11:37 AM on April 3 [2 favorites]


Here's a chart that illustrates US life expectancy at birth vs. 21 other high-income countries from 1980 - 2006.
posted by mhum at 11:38 AM on April 3 [1 favorite]


Specifically, the US spends an enormous amount on cancer treatments, dialysis, and end-of-life-care generally...Until we're ready to stop pouring useless billions down death's gullet and spend a little more keeping younger, healthy people healthy, nothing is going to change.

That's true, but we also overspend on literally everything: medication, surgery, medical devices like prosthetics or pacemakers, everything costs more in America, because we mostly let private actors determine prices.

So we spend too much, in general, and on top of that, we allocate care and resources in sub-optimal ways with respect to cost vs. best-case-scenario outcomes. I don't have the figures on hand to determine which accounts for more cost, but both are systemic issues that desperately need fixing.
posted by clockzero at 11:44 AM on April 3 [3 favorites]


But I think Ontario has the highest provincial taxation.

No, not even close - see the chart on this page. We have one of the lower provincial tax rates in Canada.
posted by barnoley at 11:59 AM on April 3 [1 favorite]


Syrup and denim

Easily April Wine's best album.
posted by BigHeartedGuy at 12:14 PM on April 3 [1 favorite]


Americans die of cancer at far lower rates than elsewhere (stats, though I assume Luxembourg is 93.8, not 938).

All but three of those countries have a longer life expectancy than the US. How much of that list is proof of our clearly superior cancer-fighting ability and how much is just a showing that people in those other countries live long enough to get cancer?
posted by dirigibleman at 12:18 PM on April 3 [3 favorites]


A political system that fosters inequality limits the attainment of health.
This sentence appears twice in the article, but I still have to QFT. Of course poor folks die faster. Even if we make it through infancy unscathed, we are subsequently discouraged from seeking out more than the most basic health care because we don't want to go to the doctor and find out that our proposed treatment is not covered by Medicaid. The longest-lived member of my family tree made it to 74, and the rest kicked the bucket between the ages of 45 and 70. When you're constantly broke and stressed out and you have to refuse to seek medical attention out of financial desperation, of course you're going to keel over sooner than later.

Not to mention basic nutrition affects the ability of people to ward off ego depletion and decision fatigue. Most poor decisions aren't because of some people being innately lazy or evil, it's because they're so wrongly nourished that they mentally can't comprehend how this would be A Bad Thing™.

Speaking for myself and the folks I knew growing up, it was more like:
1. There is no one anywhere in your world who can show you what A Good Thing™ even looks like, so you have to hustle to cobble together a mask that will help you get ahead. You must create the mask with the only resources available to you: The emulation of people you perceive as successful (who might not be making the best decisions themselves) and the daily grind that is absolutely necessary for your ongoing survival (which is often innately discouraging, like when you earn $5.15 $7.25 an hour cleaning up rich people's actual shit). And library books, if you're lucky.

2. Teachers and guidance counselors treat you like you're contemptible trash because you can't hide the fact that you come from poor stock; you don't know anything about manners, respectable/well-fitted clothes, 'correct' English grammar and usage, etc. Why would they waste their precious time on someone who is so obviously going nowhere? (Spoiler alert: They don't.) The myth that there's probably an authority figure available to champion one or more smart, dedicated, and hopelessly poor students more than once every generation or so is an extremely fucking dangerous one, and it can't die soon enough. Dangerous Minds is not real. Freedom Writers is not real.

3. If no one appears to whisk you out of the ghetto and into Harvard, people will tell you to your face that you must not have worked hard or wanted it badly enough. For the rest of your life.

4. Almost everything that you are taught in school is forgotten immediately because it is utterly useless when it comes to being able to put food on the table. Who has time for quadratic equations when it's the 24th of the month and you're already out of milk?

5. As you get older, people start to expect that you not only already know how to cook for and dress yourself, but that you will soon be able to enter a 100% DIY life that does not actually look very much like the ribbon-topped mason jars and handcrafted copper plant markers of Pinterest would have you believe. You're expected to be able to grow and preserve most of your own food even if you live in Section 8 housing where your only yard space is a concrete slab, you're expected to have an encyclopedic knowledge of flavors and technique so you can cook three delicious and nutritious meals per day using only the absolute cheapest raw ingredients, you're expected to be able to pluck a tidy, professional wardrobe from castoffs at Goodwill and Salvation Army -- and if you have kids, breastfeeding your babies and handwashing all of their eco-friendly cloth diapers are, of course, a given. You're expected to have more than enough time to do all of this because the only reason you aren't rich must be because you spend most of your time sitting around doing nothing.

6. In reality, you don't know how to cook because the adults in your life are totally absent and you need to be able to feed yourself with whatever easy-to-prepare stuff they've left behind, and that stuff is not exactly Mark Bittman territory. Alternately, no one you know has ever had time to cook because they are busy working full-time jobs in a feeble attempt to stave off even more crushing poverty. (A full-time minimum wage worker earns $15,800/year and nets around $12,000/year depending on their state income tax rate; the 2013 federal poverty line for a single person was $11,490/year.)

7. Prospective employers either overwork and underpay you because they know you're desperate enough to stay or they give you a pass altogether because you didn't go to college and everyone knows people who don't go to college are stupid layabouts who don't work hard and utterly lack the ability to follow direction.

8. You don't go to college because you have been discouraged from even attempting to do so since you were born, and your peers and elected representatives tell you in actions and words that you should not be fed or housed without bowing and scraping and somehow deserving it. Even community college costs more money than you can possibly imagine having in a lifetime, and why would you spend that money on anything that doesn't demonstrably help you survive from one day to the next?

9. You start to resent people who think you're a stupid layabout just because of where/what you came from, and you adamantly resent people who will never have to worry about staying fed or housed for their entire lives. Eternal internal class war. It's all you can do to stop from showing up at a GOP rally with a sign that says, "Well, fuck you, too."

10. You start to behave accordingly. This does very little to disabuse said people of their preexisting notions of What Poor Folks Are Really Like (indolent, indignant, dirty, occasionally prone to rioting). This often serves to cement bad decision-making from what feels like a temporary necessary evil to a permanent way of thinking.
posted by divined by radio at 12:42 PM on April 3 [43 favorites]


>I know this is an oversimplification, but it isn't about how much taxes are charged but rather how they are allocated.<

Interesting. More so, a break down on how they are spent :)

We are sooo screwed.
posted by twidget at 12:47 PM on April 3


Who By Very Slow Decay
Well, this is an atheist/skeptic blog, so let me do my job of puncturing all your pleasant dreams. You’ll probably never become an astronaut. You’re not going to bang Emma Watson. And your last words will probably be something like “mmmrrrgggg graaaaaaaaaaaHAAACK!”

I guess I always pictured dying as – unless you got hit by a truck or something – a bittersweet and strangely beautiful process. You’d grow older and weaker and gradually get some disease and feel your time was upon you. You’d be in a nice big bed at home with all your friends and family gathered around. You’d gradually feel the darkness closing in. You’d tell them all how much you loved them, there would be tears, you would say something witty or pious or defiant, and then you would close your eyes and drift away into a dreamless sleep.

And I think this happens sometimes. For all I know, maybe it happens quite a lot. If it does, I never see these people. They very wisely stay far away from hospitals and the medical system in general. I see the other kind of people.

If you are like the patients I see dying, then here is how you will go.
posted by the man of twists and turns at 1:01 PM on April 3 [5 favorites]


To expand a little on why I linked to Dressler's work on Cultural Consonance. We say that motherhood is important and parents are totally and completely responsible for the wellbeing and growth of their children. And then we deprive parents of the resources need to accomplish that wellbeing and growth. Not only that, but then our American culture provides a never ending stream of shame and demoralization when parents reach out for help, seeking the very few resources that are allegedly in existence for parents. I'm looking at drug testing in Florida for SNAP benefits, difficulty getting

That is a failure of cultural consonance and a major case of structural violence.
posted by bilabial at 2:03 PM on April 3 [5 favorites]


Yeah we get taxed to death up here in Canada and most of us never use the taxes we pay... directly. I go to the hospital once every 5 years. But I benefit daily from lower crime rates, less gun violence and the general sense of ease and relaxation about healthcare and mat leave. It's really important not to feel totally alone in life if you fall on hard times. Christ there was even a poster in the Toronto subway "See a new Canadian? Help them out!" which my Chicago friends could not believe existed.

I favorited this comment for this sentence alone: It's really important not to feel totally alone in life if you fall on hard times.

But the rest was good too.
posted by vitabellosi at 2:53 PM on April 3


Yeah we get taxed to death up here in Canada

Have you run the numbers? For my wife and I the taxes are pretty much the same in the US as they were in the UK and Canada once you factor everything in. The only really noticeable difference is that the booze is way cheaper in the US and the cost of everyday groceries are about 10-30% lower.

Health care in the US is infinitely worse however. It may be that the services are just as good or maybe even better but it is all on you to navigate them, request the right treatments and figure out your insurance. It practically requires a triple major in law, insurance and medicine.

I don't think it is inequality that has driven this (unlike many here) though it is a factor in everything American so it probably has inequality as an influence and an effect however major inequality existed before American national health outcomes started lagging and I don't see how the extreme inequality of 1% can even come into play - Paris Hilton is not eating your health care up. I think this has happened because of regulatory capture by the health insurance & care industries enabling massive rent seeking. And I say this as a non-conservative seriously anti-libertarian left-wing statist.

I've been curious for a while just how bad domestic economic numbers would be if there were a miraculous rationalization of health care in the US. Just how much of GDP is Keynesian health care ditch digging with no positive effects on outcome? How dependent is employment in the Health care sector on inefficiencies in delivery and insurance?
posted by srboisvert at 4:08 PM on April 3 [3 favorites]


If I get treated for cancer in the United States I get treated in a for-profit hospital who takes their piece

Unlikely. Most hospitals in the US are non-profit or not-for-profit. You probably also don't have the option of the same treatments that US patients would.

Of course, the treatments that you don't have access to are only incrementally better but exponentially more expensive.

My whole point is that we're spending an absolute crap ton of money on stuff that we shouldn't be spending money on. I do not think it a rational, efficient, or moral use of funds to spend half a million dollars trying to give a terminal neuroblastoma patient an extra two or three months of life. In countries other than the US, the option might not even be offered. In the US, it's the norm, not the exception.

New designer drugs? Usually either combinations of one or more generic medications that have existed for years and can be taken in two pills perfectly easily but drug companies can charge tons of money for combining in a single pill and which American patients insist on taking because price information is completely opaque, or again, an incremental improvement on a tried-and-true generic that costs $0.10 a pill but the 5% New and Improved version can be sold for $10, yet American patients insist on taking that too for the same reason.

So yes. We're spending way, way too much on health care. It's because we consume way, way, more health care services than we need, the vast majority of which are some combination of futile or unnecessary. Even on the useful and necessary stuff!
posted by valkyryn at 4:58 PM on April 3 [1 favorite]


Just how much of GDP is Keynesian health care ditch digging with no positive effects on outcome?

An enormous amount.

How dependent is employment in the Health care sector on inefficiencies in delivery and insurance?

A huge chunk of it. The entire discipline of medical coding and billing should not exist, just for starters.
posted by valkyryn at 5:00 PM on April 3 [2 favorites]


For nearly two hundred years America was one of the healthiest and longest-lived countries, but today, over thirty countries have better health by many measures. What happened?

We let Republicans get their hands on the levers of power.
posted by AsYouKnow Bob at 5:48 PM on April 3 [2 favorites]


The entire discipline of medical coding and billing should not exist,

Coding sure, but billing is necessary unless you have single payer, and even then just in a highly reduced form.
posted by spaltavian at 7:55 AM on April 4


billing is necessary unless you have single payer, and even then just in a highly reduced form.

What I meant is that medical billing shouldn't be any different than any other kind of service billing. You go to the mechanic, they give you an estimate before the job starts and a bill as soon as they're done. Same with any other service. You should be able to drop a bookkeeper who does A/R into a health care provider. You can't.
posted by valkyryn at 7:39 AM on April 5


What I meant is that medical billing shouldn't be any different than any other kind of service billing.

You of course mean billing in the holistic sense, but I feel compelled to point out that the medical insanity happens WAY before the point a bill is issued. It is practically and often literally impossible to know what the cost of a hospital procedure is when it's ordered. Even if you can get someone to look at the chargemaster and add up the component pieces there's nobody with any coverage who is actually paying that rate. Insurance companies negotiated some discount off of it.

If a bus had an accident and the entire load of people came into the ER and got identical workups the chances are every single one of them would have a bill that totalled up differently based on their insurance companies having different negotiated service rates. Even if half of them had Blue Cross Blue Shield there's a good chance their different plans would have different reimbursal rates. It's just insanity.
posted by phearlez at 3:14 PM on April 5


Forget Obamacare: Vermont wants to bring single payer to America
posted by homunculus at 12:17 PM on April 9


I feel compelled to point out that the medical insanity happens WAY before the point a bill is issued.

This is true, but hardly limited to health care. Auto mechanics, construction contractors, hell, plumbers, all start with estimates predicated on the assumption that things will be uncomplicated. If the situation changes, the estimate changes. That's okay in other contexts, it should be okay in health care too.

It is practically and often literally impossible to know what the cost of a hospital procedure is when it's ordered. Even if you can get someone to look at the chargemaster and add up the component pieces there's nobody with any coverage who is actually paying that rate. Insurance companies negotiated some discount off of it.

You're saying two different things here. One is that it's impossible to know the cost of a medical procedure before it's performed. I say that other than the possibility of unforeseen complications, that's bullshit. Health care providers are entirely capable of knowing their own business model, cost structure, and O&P ratios.

The other is that it's impossible to know the price of a medical procedure before it's performed. While that's true as a practical matter today, there's no good reason for that to be true. It's true because we've allowed it to be. We're somehow okay with patients not knowing the price of their health care until long after it's been provided, and with two similarly-situated patients paying radically different prices based upon what may as well be the phase of the moon for all the patients understand it. I recognize that this is the case, but I'm saying that it shouldn't be.

. . .Even if half of them had Blue Cross Blue Shield there's a good chance their different plans would have different reimbursal rates. It's just insanity.

Yep. Which is why I think we should ban that practice.
posted by valkyryn at 7:40 AM on April 21


I recognize that this is the case, but I'm saying that it shouldn't be.

I don't disagree at all, but you mentioned an accounts receivable person. I merely wanted to elaborate explicitly that this is a situation arising from a configuration that goes far beyond just the last phase of goings-ons. The entire way medical care happens makes it impossible for accounts receivable to be like any other business without major structural change to the entire system of health care as it stands now. It's not just fee-for-service, specialization, competing drug options, or any one or two things. I'd love to see a sea change too, but the scope of it deserves more than a hand-wave.
posted by phearlez at 11:02 AM on April 21


Most of the discussion here seems to focus on health and health care in the United States in general, when the article really says the issue in the USA is poverty. Well, it mostly focuses on inequality but I think they really mean that poverty is the issue, because in theory even a relatively unequal country could have a strong welfare state or low rates of un or underemployment.

The prescriptions to fix the issue from the article are:

1. We could follow the lead of other countries and consider having a maximum pay ratio within companies.

2. We could return the maximum tax rates to the levels they were when we were much healthier relative to other nations; many today are shocked to hear that in 1966 the highest marginal tax rate was 70 percent. Similarly, we could tax corporations at rates that more realistically reflect their profit levels as we did in the past.

3. Public banks, as an alternative to corporate, profit-oriented ones, could stabilize the public economy. North Dakota has had a state bank for over ninety years, and that state suffered far less during the 2008–9 economic meltdown than the rest of the country.

While I think this article does a good job of helping people to understand that America has a poverty problem more than a health care crisis, I don't think their ideas for fixing it are very inspired or realistic.
posted by cell divide at 11:46 AM on April 21


We could follow the lead of other countries and consider having a maximum pay ratio within companies

I am really curious how this actually works in practice. Non-salary compensation is *huge* in the United States. Is it really true CEOs in Europe do not make insane amounts of money? How do equity grants and perks fit in?

Poor people often think of compensation and wealth in terms of salary. That is so far from reality as to be comedy.
posted by rr at 11:51 AM on April 21


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