Life expectancy in America has declined for two years in a row
economist.com
economist.com
The general thoughts are (especially for those poo-pooing the findings):
- The cause is likely a massive increase in drug overdose deaths, whose average age of death is lower than other common causes (>20% year over year increase, mainly opioid-related) [2]
- The drop in life expectancy is not happening in other countries, just the US (not measurement error)
- It's sort of a big deal, especially if you consider that opioid-related deaths could be going down, or they could be accelerating, we just don't have the data. And if they are accelerating this could be much worse than it already is.
1: https://www.stitcher.com/podcast/voxs-the-weeds/e/52748846
2: https://www.cdc.gov/nchs/data/health_policy/monthly-drug-ove...
The entire power of the rest of the industries (film, media, pharmaceuticals) seems to rely on copyright, which is genius, since the US has guaranteed all other countries have to play by its rules as far as copying goes through GATT and all the other trade treaties signed since. Looking back, all of it has actually been brilliant, outside of disconsideration for what the destruction of industry would do for the middle class (See Vaclav Smil's comment - "without manufacturing there is no middle class"). But the idea of copyright, and replicating the US model of agressively pursuing violations of it everywhere, was genius in the digital age - it's a way of permanently entrenching and making sure no competitors can arise, because almost anything can be copyrighted, therefore any similar enough competition is opening itself up to a copyright violation lawsuit. Basically, the US has been rebuilt along the lines of the same people who decided all of this back in the 1990s as a way to construct a new american empire (which I'm fine it btw, I prefer it to its competitors), and the result has been the mass anihilation of livelihoods in the rural and industrial areas. The result of this "error in judgement" has been Donald Trump - anger at the establishment and a willingness to anihilate it all in exchange for a promise to return to the Valhalla of yesteryear, when making a living was easy and the government was making sure all boats were rising with the tide, instead of leaving some behind.
Anyway, back on the topic of opioids - in Portugal we had this problem. We solved it by decriminalizing drugs and treating hard drug users as people in need of help. Perhaps, in the end, we will inspire the rest of the world to follow suit. It has always been my hope.
This reminds me of the great collapse in Russian life expectancy for Russians after the end of communism: http://www.nybooks.com/daily/2014/09/02/dying-russians/
The country became extremely unequal and was effectively looted by its oligarchs.
> a willingness to anihilate it all in exchange for a promise to return to the Valhalla of yesteryear, when making a living was easy and the government was making sure all boats were rising with the tide, instead of leaving some behind
Quite a lot of people said they would have preferred to remain under totalitarianism in the Soviet Union than to die of hopelessness in the post-Soviet crony "capitalist" wasteland. I hear there are even people in Portugal nostalgic for Salazar?
Note how Russia was a cuddly uncle all the years under Yeltsin, while the oligarchs ran rampant.
Then came Putin, the oligarchs were beaten into submission, and suddenly Russia was back as the big bad bear.
Likewise, Russia’s problems today are not the west’s fault, no matter how much Putin tries to claim otherwise.
Only those that politically opposed Putin. The rest thrived.
There is a very strong and well studied relationship between unemployment, economic stress, and drug abuse. These are people who are depressed (clinically, economically, or often both), and they are self medicating.
https://www.theatlantic.com/health/archive/2017/04/joblessne...
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3935688/
Unfortunately the media-driven obsession with this topic is focused on everything other than the underlying problems driving the abuse, which is a guaranteed way to never solve anything.
Other countries went through the Great Recession, didn't recover as well as the U.S., and are not suffering from the problem. Also, the problem started in the last couple of years while the Great Recession began in 2008 (EDIT: and has since ended, with unemployment low for the last two years).
The sense of hopelessness in a truly fucked town is particularly brutal. Retraining and education sound nice, but aren't going to be all that appealing in practice for a lot of people, even if the money is there. So now the US suffers the hardest from the loss of this industry, the other side of the coin of getting to benefit the most from the growth of it. Add in a historical lack of awareness around the dangers of new painkiller drugs... and you've got the recipe for a disaster without needing any judgmental conclusions about a society as a whole.
Britain, another even-earlier industrial power, has similar things going on in some regions, but I'd argue never saw quite the same peaks as the US.
It will be interesting to see what a more controlled country like China does if/when all those jobs that first drew money to the country fully evaporate.
Also, the U.S. moved on from being an industrial economy decades ago, long before most people realize. In Detroit, for example, auto industry jobs began declining in the 1950s.
Overall, social security and disability spending per capita, and overall enrollment, is up. (at a very high rate since the 90s, comparatively to prior).[0]
However, out of pocket costs and private insurance costs have been increasing at even higher rates [1]
To look at food stamps, SNAP participation has been going down rather significantly in recent years.[2] It's an open question as to the relative contributions of increased employment rates vs. changes to eligibility (often via republican states imposing work requirements), let alone normalizing this against the various unemployment/"workforce participation" measures to find the "real rate" of unemployed, un-protected individuals, which has certainly not recovered since the recession [3]; implying that the SNAP cuts may not be from the "good signal" (employment is found) precondition.
Something that's not well captured in the above (chosen because they were a few "notable social programs" I could think about off the cuff) and someone more informed than I could likely tell me what the core metric for this would be; but there's an worrying pattern I keep hearing about regarding schools pushing for a four day school week. (here's an analysis showing the motivation of cost cutting, and the unfortunately lacking results [4]) If the implied need to cut costs is _that severe_, for whatever reason (my assumption would be a combination of state funding and taxbase) one can reasonably see this as another eroding facet of state/social support, if not necessarily intentionally.
All in all; I get the feeling that while local benefit cuts (and more importantly aspects such as increased out of pocket costs for healthcare) are probably not helping, it's only one aggravating facet along the side of a core deeper systemic trend(s).
[0] https://www.ssa.gov/policy/docs/chartbooks/disability_trends... [1] https://www.usnews.com/news/health-care-index/articles/2015/... [2] http://www.newsweek.com/people-food-stamps-snap-decline-part... [3] https://data.bls.gov/timeseries/LNS11300000 [4] http://www.ecs.org/clearinghouse/93/69/9369.pdf
Most importantly, the Budget Control Act of 2011 (the "Sequester") was designed to set spending so low that both parties would be forced to compromise on regular-order spending bills in order to fund what was important to them (generally seen as defense for the GOP, domestic welfare programs for the Democrats). Instead, GOP spending hawks refused to compromise and spending has been locked at an insanely low level since then. That includes a lack of funding that is crippling even the supposed GOP priority, the military.
Speaking generally: Readiness is very low; large amounts of equipment is out of service do to lack of parts, and training is severely cut back, meaning the personnel are not ready to perform their jobs - a major issue when they may die and national security may be harmed; AFAIK training is what has long given the U.S. military its edge. There are not enough personnel, forcing the current ones to work exceptionally long and hard, which is also affecting morale. One recent example are the collisions of navy ships in the Pacific; basic navigation and seamanship training was cut for the officers, they were constantly deployed and exhausted, and they worked 100+ hour weeks. Here's a recent article I saw from a respected defense publication:
https://breakingdefense.com/2018/01/2018-forecast-can-the-na...
Also, the military cannot afford weapons programs it needs to compete with 'near-peer' threats such as China and Russia. Generals/Admirals and Secretaries of Defense, for multiple administrations, have been warning Congress for years that they are unable to fulfill their missions with current funding.
That's all off the top of my head; there certainly are more problems I'm not thinking of. Also, I don't understand what you mean by "non-civilian" programs.
If you want to keep up on these issues, I'd try these publications; budget is only one issue they cover, but they cover it well and seriously, without much political spin:
Defense spending by country (from Google):
Russia: $84.9 billion
China: $171.4 billion
US: $618.7 billion
If we can't compete with militaries that spend a fraction of what we spend, the problem isn't lack of funding, it's the people spending it. The military has an efficiency problem, not a funding problem.
Russia and China are "regional powers"; their goal is to dominate the areas in their geographic proximity. The U.S. has to dominate China in its region, Russia in its region, as well as the Middle East, the Americas, and everywhere else.
The U.S. has fought wars in Central Asia and in the Arabian Peninsula recently, as well as standing down an enemy in NE Asia (North Korea) and in Europe (Russia), facing a competitor in the western Pacific (China), and the Persian Gulf (Iran). There are deployments in over 100 nations, IIRC, and ongoing military operations all over, from the Philippines to Chad to Yemen to Somalia to many more. The U.S. Navy secures trade worldwide. And at the same time, the U.S. military must train and prepare for every contingency, from a Chinese invasion of Taiwan to revolution in Pakistan (endangering the nuclear weapons there) to a Russian invasion of the Baltics to a breakdown in order in Lebanon or Venezuala, to Iran restarting its nuclear weapons program ... China and Russia don't have those problems.
Here's an off-the-cuff summary of why: Since WWII, the U.S. has been the muscle behind the rules-based international order. Even domestically, under the rule of law, government needs force occasionally (e.g,, police) to maintain order and enforce laws. Internationally, there is no government; it's fundamentally anarchy. History has shown that the anarchy is very difficult to control and easily explodes into wars that destroy humans, cities, and set back civilization, and that's especially true in the nuclear age. Nothing is worse for humanity than war; WWI and WWII were major examples of that.
Post-WWII, the winning nations sought to prevent or minimize further wars by establishing a rules-based (i.e., legal) international order, centered around the United Nations and other institutions. The rules mean nothing unless someone can back it up, and post-WWII and even now, the U.S. is the only candidate with enough power to do so, military, cultural, and economic. The cost of the U.S. military is considered far less than the cost of anarchy, and in fact the U.S.'s preeminent position means that America has far greater say in international issues than any other nation.
The Trump administration is retreating from that responsibility, to a degree; we'll see how far they go and what the next administration does.
> The military has an efficiency problem, not a funding problem.
That idea has been around forever. Either it's not true, or it's intractable to a degree. Every large institution is wasteful, from Fortune 500 companies to large universities to the U.S. military. Unless you have a viable plan for reducing that waste, and can say what the savings will be, it seems wishful to say 'we'll just cut waste'.
> Unless you have a viable plan for reducing that waste
Yep. It's the same plan that works so well for dealing with type-II diabetes. You cut back significantly, funding rather than calories, and force the military to economize. The reason you get waste is a lack of accountability and consequences for overspending. Forcing the military to cut everything non-essential and then keep cutting the cost of the essential until they're spending no more than the next-largest military will force the tough decisions to be made. When you always say yes to military appropriations, those tough decisions are never forced.
The US military is an obese, lumbering 600lb gorilla. It needs to go on a diet to become a svelte, agile and precise tool of last resort. As a bonus, that would either come with tax cuts, national debt reduction or the prolonged life of Social Security. All three of those are, in my view, far superior ways to spend money.
You haven't established that there is significant waste or where; I don't even know what problem it solves, and the above has no basis. It's not good policy, it's a talking point.
I'd love to cut waste, but there needs to be a serious discussion, not wishful strategies based on wishful conceptions of the situation. I don't know about the parent, but often this argument is used by partisans who want to cut government no matter what, regardless of the consequences.
> I favor a far more coalitional approach where we don't have to lead nearly as often as we do now. I'd prefer our defense department focus more on actually defending us rather than defending US corporate interests overseas.
Again, this sounds like a nice theory, but do we have any reason to believe it works? AFAIK, history shows that in an anarchic situation like international relations, coalitions aren't stable; you need one actor. What I've read from international relations experts and practitioners is that coalitions don't work now: Effectively, very little happens in the international arena without the U.S. pushing it.
So before we take that plunge, we need to know. Mistakes are very, very costly.
What exactly are you afraid of, if we reduce the funding for US military by 90%? Fewer regime changes? Fewer regional conflicts? Fewer civil wars? Because US definitely has been behind some of those in the post Cold War era. What exactly is happening in the international arena, that wouldn't be happening without US interference?
P.S. You don't think there's waste? How about trillions of dollars spent on Iraq/Afganistan invasion, that ultimately led to destabilization of the entire region, deaths and destruction on a massive scale, and emergence of ISIS as a major source and inspiration of countless current and future terrorists worldwide?
I disagree.
I think the population we are discussing has not historically been heavy users of social benefits (although more than they usually know) and it is the change in status to being a potential user of such benefits that causes their desperation.
As someone who grew up in an impoverished, semi-rural community, it is my observation that everyone had a life narrative that explained how they "weren't just poor people".
It's a big, big blow when it becomes impossible to maintain that narrative.
Other countries (in the developed world at least) don't do as a shitty job dealing with welfare and healthcare, or have people feel like shit for not being "winners".
>and has since ended, with unemployment low for the last two years)
Unemployment is the easiest thing for government to sweep under the carpet. Heck, if they could fully get their way, working 12hours/day for $1/month would still qualify as employment.
Even so: https://www.theatlantic.com/business/archive/2017/12/great-r...
Or:
Economist Logan said that when he looks back, he sees a permanently changed economy. The downturn "left a lingering impact on jobs and on some sectors that never recovered," he said. For example, just before the recession, about 14 million Americans worked in manufacturing; today, that sector has about 1.5 million fewer jobs. And millions of families saw their home equity wiped away in foreclosures, Logan said. "A lot of people lost their jobs and their net worth. And then they had to take a lower paying job. ... It was a blow that they never recovered from," he said.
https://www.npr.org/2017/12/14/570556990/unhappy-10th-annive...
https://www.salon.com/2017/11/21/the-great-recession-is-the-...
Many smaller manufacturing businesses both depended on selling to and buying from small impacted businesses... self-contained systems that keep money and management local. Restarting those economic ecosystems requires more than just lowering rates.
Anecdotally, banking consolidations have made it much harder for niche local businesses to attract financing - the town where I went to college had its entire industry of small farming equipment manufacturers killed off. The big banks refused to finance a "John deer competitor" that built tractors from local parts manufacturers, even though the local farms despised buying from John Deer - their only presence was low-wage retail/repair jobs, extracting profit from the community.
If by "we" you mean the U.S. government, it spent about $700 billion to stimulate economic activity and employment.
The US recovery looks decent in top-line aggregate terms, but the distributional aspects are quite bad. (And that was true of the recovery from the previous recession, as well.)
For broad social impacts, the distributional aspects are more significant than the top-line aggregates.
* "This year, the number of domestic undergraduate students dropped 224,000"
https://www.nytimes.com/2018/01/02/us/international-enrollme...
* If nothing is done, the number of Americans with health insurance is expected to decline by millions this year (due to the repeal of the health care tax (I forget the term they used) in the new tax law).
* With CHIP not being funded, the number of children with health insurance also should decline.
I don't know what "break" means, but I don't think it will be pretty.
Is that even possible? It's not as if we're swimming in demand for unskilled labor at a living wage.
The underlying problem seems to be that college (along with housing and healthcare) are too expensive and people can't afford them.
Is college too expensive or is it over-required, or both? Even if it was free, that's a pretty substantial 4 year opportunity cost.
The other part, a drop in international students is something different, though. To conclude how damaging that is, we'd need to know how much of the cohort that dropped off would've otherwise stayed in the country, etc.
This comes from misalignment of specialization. We have too many English majors and not enough physicians and engineers, and the English majors can't all find skilled employment.
That allows the unskilled employers to require a college degree, because the unemployed English majors will take an unskilled job over nothing, so the availability of degree-holding job seekers allows employers to use a degree as a filter to include only people who have demonstrated the ability to follow instructions and stick with something for multiple years.
But that doesn't mean we have too much education, it means we need to educate more people in things that are in higher demand rather than lower demand so they don't end up doing unskilled labor (and depriving actually-unskilled people of that work).
So we could do with fewer low-demand graduates, but we want all of them and more to instead become high-demand graduates, which means the cost still matters.
But here's where I run into a problem with this theory: why haven't we already, then? If the demand is that imbalanced, why aren't more companies desperate for labor to the point of training workers themselves despite mismatched (or no!) degrees, or why isn't the big pool of under-employeed workers finding massive benefit to individual re-training that should pay off in spades? Even in the most immediately obvious areas, software, a lot of bootcamps have mixed or dubious outcomes, yet in theory it should be easy to do extremely well with that.
By what mechanism would you do this? It's not as if there is a centralized bureau of programs for all universities.
In theory you could stop offering student loans to students studying low demand subjects, but we haven't actually done that.
> If the demand is that imbalanced, why aren't more companies desperate for labor to the point of training workers themselves despite mismatched (or no!) degrees, or why isn't the big pool of under-employeed workers finding massive benefit to individual re-training that should pay off in spades?
The reason employers don't train workers is that it's all risk no reward. If the person drops out without finishing, or worse quits the day after you train them, you lose money. It's easier to just pay high salaries to qualified graduates from normal schools, which is what they do.
As to why people don't take on the retraining themselves, part of that is the cost. Which includes the opportunity cost. You not only have to pay tuition, you're spending all day studying instead of working.
And that can be a deterrent even if it balances in the long term. If you're making $30K/year now but would make $80K/year with a degree that costs $120K in tuition and another $120K in opportunity cost, you break even within a few years after graduating. But only if you have or can get somebody to loan you $240,000 at a low interest rate.
Obviously that becomes more attractive if either the tuition is lower, or there is less opportunity cost because the alternative pays less than $30K/year.
I'd favor a less prescriptive method around "study this, not that" and a more responsive one: your loans are in danger if your students' debt-to-income ratios are bad, or they aren't employed, etc. Probably "employed" is fine as long as debt-vs-income is checked too, vs "employed in the field," as I do find the liberal arts valuable in general for critical thinking skills even if not directly tied to specific careers. That's the five minute version, it doubtless needs some tweaks, but I wouldn't want to over-target it for today's specifics.
On the point of whether or not university education, as currently practices, is needed more or less:
> The reason employers don't train workers is that it's all risk no reward. If the person drops out without finishing, or worse quits the day after you train them, you lose money. It's easier to just pay high salaries to qualified graduates from normal schools, which is what they do.
That just makes me skeptical to if they really need the workers that much, though. Emerging industries can't work like this - someone has to do the work before the universities catch up - so how do we quantify e.g. how desperate we truly are for programmers? Heck, we even have people with degrees we generally don't want to hire because they somehow still fail fizzbuzz! Doesn't that speak terribly of our ability to produce high-demand graduates?
I'm sure there's a middle ground between "the risk of training this person and them leaving is small enough compared to the potential return they'd give us since the field is so ripe" and "nah, we're totally good," but how do we find out where in that space we are?
Creating something new and teaching people the current state of the art are two separate things. And universities do both of them.
The things invented in Bell Labs in the 1950s are taught in universities today, but the researchers at Bell Labs had college degrees. It's a feedback loop.
> so how do we quantify e.g. how desperate we truly are for programmers?
Median salary is a very strong quantification, especially accounting for sub-specialization. It's possible we need more DBAs but not more web designers.
> I'm sure there's a middle ground between "the risk of training this person and them leaving is small enough compared to the potential return they'd give us since the field is so ripe" and "nah, we're totally good," but how do we find out where in that space we are?
They just don't benefit from it at all.
Suppose you pay $150,000 to train someone with the expectation that you'll pay them $50,000/year for five years and the training will allow them to do the work of an $80,000/year employee, so you'll break even (ignoring time value of money). Except that once they can do the work of an $80,000/year employee, they can immediately quit and get a job paying $80,000/year and you can't retain them by paying $50,000/year.
The alternative is to loan them the money, so if they leave they still have to pay you back for the training. But now you've just reinvented universities and student loans and companies don't get anything out of doing it in house that they wouldn't from hiring graduates from normal schools who borrow money from normal banks.
Companies know that they aren't any better at being a university than a university is and they aren't any better at being a bank than a bank is, so they don't try to be.
Often, in fields that are just emerging into commercial viability, the people doing the new work before it gets taught in universities or commercially applied are researchers at universities (professors leading, but graduate students often doing the heavy lifting and often undergraduates working in supporting roles), who are then also (both via publication and personal contact and advisory councils) taking it to industry to further development.
So, yeah, while someone is doing work before university classroom instruction catches up, a lot of that advance work is done in universities, across the whole professor-to-undergraduate academic heirarchy.
Can you back that up? As far as I know, it's a myth about employment; generally, the world is run by liberal arts majors and not by engineers (at least outside SV).
Also, as I point out in another post, college is not vocational school; it's far more important:
I’ve worked with a bunch of MDs with undergrad degrees in things like art history.
Sure, this is all anecdata but let’s not pretend a liberal arts degree necessarily dooms one to a life of flipping burgers
Still it seems that we haven't beaten it into nearly enough peoples' heads that we all live on the same planet, that resources are finite, and that those who don't know history are doomed to repeat it. What, if not education – of the liberal arts kind – to fix that, and quick?
That's fair, but it doesn't really lead to "less education is a good thing" as a conclusion.
We may need to replace college with something more practical, but that doesn't mean it's fine to have less of it without having more of something in its place.
That will be obsolete in ten years? The whole job, I mean.
This wasn't a bad line, but today it did lose its luster.
Can you back this up? It's a big statement. Even if it's commonplace, I don't think it's well thought through. Education is for far more than jobs: People have to be citizens, community members, parents, individuals, and more - they need to be able to understand and reason critically about the world.
I'll note that the world's major problems now are not a lack of software and science, it's a lack of critical thinking about the (mis)information they read, and lack of understanding of politics and public affairs. For example, we know about climate change; the science isn't the obstacle. We've developed Facebook; more technology isn't the need.
The problem with that, however, is that there's a large proportion of the population that quite simply isn't capable of doing that (or who are located where those skills are irrelevant). They're just usually hidden from the sight of people that are, in the exact same ways and for the exact same reasons that people of different political leanings self-segregate.
The American upper class needs to find a way to make the American lower class objectively useful again. Let-them-eat-cake "just get An Education and it'll magically make things better" is not helping the people who plain aren't smart enough to get a good job any more. An objective-focused education that trains an individual to be useful at doing a certain class of tasks (like fixing automated machines as they break), however, does.
20th century American history (as well as Maslow's Hierarchy of Needs) demonstrates that society cannot advance until _everyone_ has a sense of purpose and food on the table. Since the balance of political power in the US skews rural (lower class dominant), those in urban areas (upper class dominant) need to work harder to keep things equal.
And when everyone's happy, progress happens fast (though it tends to lag about a decade behind). Civil rights in the 60s, sexual revolution in the 70s, objective gender equality movements in the 70s, EPA in the 70s (and sufficient political goodwill to get the Montreal Protocol implemented), technological revolution in the 80s (read: automation that anyone could afford to invest in).
Progress has slowed down after that. Modern education has obviously failed to provide the educated with the critical thinking skills necessary for them to understand why, but that's a topic for another day.
> "just get An Education and it'll magically make things better" is not helping the people who plain aren't smart enough to get a good job any more.
Do you have any evidence that it's an issue of smarts or natural ability? In fact, the best predictor of educational level is parental wealth. I believe almost anyone can achieve if they work hard, and that the goal of society is to give opportunity to all, including college.
The big and evil presumption here is that economic class is fixed. There's nothing about children of the wealthy that makes them any better than children of the working class. The latter have every talent and deserve every opportunity. Let people achieve whatever they can; that is freedom and the American Dream; telling them at birth that they aren't worthy of college is just lazy oppression.
Social mobility used to be much higher in the U.S., and it remains higher in other developed countries. One reason is that college tuition was lower.
The point about climate change shows why more education isn’t what we need: https://www.russellsage.org/sites/default/files/Fig10_Compar.... Countries like Germany are willing to pay twice as much for electricity to fight climate change despite far fewer people having a college degree. The fact is, even most people in the US who have been brow beaten enough by liberal academia,[1] to accept climate change aren’t willing to make any lifestyle compromises as a result. What you want is a change in peoples’ values, not their education.
[1] I of course accept climate change is happening. But despite having a STEM degree, I don’t really understand it in any way I couldn’t have with a 12th grade education. I’ve simply been inculcated with values, as a result of my upbringing, that cause me to defer to academic experts on points that I haven’t personally researched.
What basis is there for this statement? Why can't they learn far more in college? What is magical about 12th grade that makes it the perfect end to education? Why wouldn't we want everyone to learn far more?
I went to a good high school, but I learned much more in college that has been extremely valuable to my life.
A major point of college is not to personally perform climate change science, but to develop the skills to understand complex information (not something reasonably possible in 12th grade), to learn complex skills, and to be able to think critically about and evaluate information, such as what the experts, politicians and people on HN say about climate change. I spent years in college studying the best thinkers in history; IME it's given me a huge advantage over people who spent that time in vocational school or working.
I'll add that it's mostly the wealthy and college educated who say college isn't needed, and yet their kids always go to college. What they mean is, 'college isn't for the other kids, the poor ones'. And today, the biggest predictor of college education is parental wealth.
It is incredibly condescending and shortsighted of you to say that those of us who did not attend college are not capable of participating in, or even excelling at those roles in society.
I was just there to contribute financially to the system, be herded from one lecture hall to another, and just generally stay quiet. Only when I showed interest in graduate school did I get any attention.
I had to teach myself nearly everything, and were it not for the motivation that comes from attending classes, labs and exams with my peers, I could have easily done the whole things independently and remotely.
More to your point about job training, I studied math, which I thoroughly enjoyed, but I use little of it from day to day as a software engineer, and I've forgotten most of it.
This is a bad metric. We should be worried about healthcare costs, not insurance coverage. You can have "universal coverage" and still be wrong, because people are paying $5000+/year in insurance premiums they can't afford.
If it didn't cost a hundred thousand dollars to get sick then it wouldn't be a problem for people to not be insured against it.
This is a dicey one. One of the things that drives treatment costs up is more advanced technology. Should we go back to 70s/80s-era cancer treatments, HIV treatments, surgical outcomes?
We need a lot more national discussion about where the real opportunities to save money are, and what should and shouldn't be covered, and if there's a one-size-fits-all solution or not, because some of the costs will continue to trend upwards as we become more able to keep more people alive for longer (otherwise a good thing!). Some [surgeries, drugs, treatments] cost tens of thousands of dollars and save lives. Some cost tens of thousands of dollars with dubious outcomes. That's where the meat is.
But we have no hope whatsoever of getting there if we can't even agree that mandated health insurance at at least some minimum level is necessary policy. Insurance needs that much to be able to work at all. Or give me the reverse: if you opt out of health insurance when you're healthy, saying the sick can fend for themselves, then you don't ever get to opt back in. (That's not gonna happen, obviously.)
I worry, a bit, that this is an area where other wealthy countries act in somewhat bad faith through their health services, to keep their own costs down while knowing that a corporation will make the deal since it's still greater total income and profit than not selling for full cost overseas.
I fear a race to the bottom where new treatments are impractical to pursue much more than I fear a stratified market where new treatments are only available to the rich at first. Look at how totally we've managed to fuck up the incentives for academic research -- I want to tread lightly, in these areas.
Profits seem pretty healthy, but R&D spending is also quite high. I'd expect a high-research growth industry to have much higher profit margins than mature things like oil and gas or media. Boggles my mind why banking is comparable, though. :|
Believe it or not, I'm not making claims. I'm trying to get people to go deeper on the issue sooner, rather than later, since a lot could change around it in the US in the near future.
> And it's not just cancer drugs - between April and June this year, drug company Gilead clocked sales of $3.5bn for its latest blockbuster hepatitis C drug Sovaldi.
This sort of thing - breakthrough new drug being ridiculously expensive at first - doesn't seem necessarily bad to me, as long as the price comes down over time and the drugs deliver the goods. We just need to make sure we know the numbers to watch to make sure we don't either bankrupt ourselves, or kill the motivation for research (jacking up the prices of old drugs is a scary recent trend I want us to crack down on).
Here's the core thing: "the pharmaceutical industry is one of the industries with the highest profit margins" is not a policy suggestion. "Costs are too high" is not a policy suggestion. They suggest a few possible things - price controls, or higher taxes, come to mind immediately, but don't do anything beyond that. The US is in dire need of useful policy suggestions (even "medicare for all" is pretty thin, and ignores some disadvantages Medicare has compared to a lot of people's current private coverage), and in even more dire need of people who talk about things with more nuance than "socialize it all!" or "individual liberty is the most important thing!"
A) Americans need to be more health centric. Half the problem is that a minority of chronic patients account for 50% of the costs.
Drive through rural America, fast food is the only option. Grocery shopping at Dollar stores and gas stations.
Solving Americas obesity epidemic is step one in fixing US healthcare.
B) Big pharma regulations. I like the idea of importing drugs and creating more competition. I also think it should be a national embarrassment that we let drug companies advertise to people. Drug decisions should be between doctors and their patients, not patients and the marketing wing of a big pharma company.
C) More access to preventative care. Maybe socializing everything healthcare is way too much to ask right now. But, EVERYONE should have access to regular doctor appointments at least for annual checkups. Earlier recognition of problems will greatly cheapen downstream costs if people aren't waiting till they are having a heart attack to seek care.
These are just a few pragmatic approaches imo.
Personally, to avoid being someone just criticizing but not offering my own ideas, here's my initial recipe at the moment based on what I've learned so far is (subject to change from new information, of course :) ). It actually includes all three:
* Government-mandated health insurance coverage at a certain useful minimum level. Insurance companies allowed to offer bettter plans as well, at higher prices. Keeping insurance coverage private reduces transitional shock to the system.
* Government subsidies based on income to make the minimum mandated coverage level attainable.
* Employer-sponsered plans are banned. Get rid of some corporate power imbalance vs small companies/individuals, and get hidden private subsidies out of the system.
* I'd try to take your (A) a bit further: the minimum-coverage plans could have some coverage gaps around self-inflicted conditions, and very little coverage for optional/purely cosmetic/not-necessary treatments. This may not be politically feasible - it could be seen as too cruel, or it could catch on with America's latent "personal responsibility" instincts; either way, I think it's the fairest place to treat as a first-line cost-control location for coverage. I need a second part, here, though, about making healthier options easier to come by for some, though.
* Completely agreed on banning drug B2C marketing. Let the drug's effectiveness sell itself to doctors, let that sell it to consumers.
* Beyond that, aggressively pro-research pricing and tax incentive policies, both for domestic drug companies and foreign ones - some of this might require policy discussions with other countries, but ultimately it's in everyone's interest if we get a bunch of research funded as in the long run, we'll make way more things treatable and have way more cheap drug options available. I think as long as we have a healthy market that we make sure rewards performance, not marketing we can keep the incentives in the right place.
* I think an annual physical is a good thing to include in the individual healthcare mandate as part of the insurance re-up process.
Obesity is a particularly tough one, though. Generally, populations that eat less (and less unhealthy simple-carb-based-stuff) and walk more appear to have less obesity, but politically this isn't a big winner, and would run into a lot of resistance if pitched as a "fixable by individual action" thing. And penalties for not meeting certain targets might be impossible - does anyone really want to put someone in jail for not paying a health fine for not getting healthier compared to the previous year? I don't, but if there's no teeth to it, how would it ever work?
The reason people are obese also has to do with many other factors.
Fat food is very, very cheap in the US, especially compared to normal food and greens. one solution to this is to tax fat food and use this tax to lower the tax on healthier foods, thus subsidizing healthy behaviour. This makes healhy food available for the poor strata.
No need to ban them, which would likely be challenged successfully in court. But removing the tax deduction would come pretty close to ending the practice. If you look at why employers started offering sponsored health insurance, it all came down to tax incentives that, if they were forced to offer equivalent pay, would be subject to payroll taxes.
It's not so much the technology as it is the setting in which the technology is deployed. Compare US costs to costs for the same procedures and technology in top medical tourism destinations. Quality of care and outcomes are much better at a fraction of US costs. It's the big morass of stuff around the US health care environment that adds big multiples to the cost of deploying new technology.
Are one-off procedures amenable to medical-tourism destinations a major part of US total healthcare costs? Or is it expensive, often-for-rest-of-life, prescriptions and treatment courses for certain conditions? Or just the simple requirements of keeping an ever-larger/ever-older aging population alive through falls/heart attacks/kidney failures/whatever?
Pointers to the data would be appreciated, here. :)
Or numbers around research budgets: what does the international research profile around, say, lab-grown replacement organs look like compared to the in-US one?
What I have found so far is that even within the US, quality of care and outcomes vary wildly (doctors and nurses are only human, too, after all) and you can generally figure out where you should go for what condition, but it's not very easy. And it's problematic at a certain point to say that it should be easier: the best 10% of practicioners for a certain condition likely can't see 100% of the patient load. How do you decide who gets the crappy doctors? (International medical tourism is a slightly different can of worms, but one I understand less because my experience is that most health coverage doesn't give you much internationally, so domestic medical tourism seems much more attractive.)
The question of on-going health care costs would normally be of interest only to expats since most medical tourists plan to go back to their home country after treatment. As an expat I have some anecdotes of my on that subject. In short, they also seem to be a fraction of the cost for better care and service. Full time elder care/nursing home care, for example. When my family researched it in the US it was very expensive and mostly quite depressing conditions. We were able to obtain 24-hour care for about US$1,000 per month in Thailand and the care was quite good. An acquaintance mentioned comparative cost of dialysis - about US$10,000 per year at a Thai private hospital versus US$90,000 in the US (assuming you paid the actual cost).
One thing that remains expensive is any specialty medicines that must come from big pharma in the west, although there are more options for sources and not the racket that people experience in the US - think of meds from Canada for example.
In theory you can actually have a free market for healthcare. You get cancer, there are multiple competing providers of cancer treatment products and you choose one based on effectiveness and price. A better treatment can charge more, but if it's only 5% better and costs a hundred times as much then most people won't use it. Which will bring the price of the best treatment down to something most people can afford.
The alternative to that is that the government imposes prices regulations, sets low prices for everything and then funds medical R&D with tax money instead of having high margins for medical procedures. The main problem with that is that the government may not fund the right things in the right amounts, either failing to fund very effective research or wasting money on ineffective research.
What we actually have is a bastardized hybrid that doesn't work at all, because when the insurance is paying for it but there are no price regulations, people will always choose the treatment which is 5% more effective but costs a hundred times as much, and then the provider obviously has no incentive to lower the price. So the price of everything gets completely out of control.
Don't confuse Freedom Markets™ with incentives.
No. We don't.
1/3 to 1/2 of our health care costs is overhead (blame shifting, profiteering).
Compare and contrast is sufficient. We don't even have to compare USA & Canada. We could just compare Medicare to everything else.
I agree with your general point. However, I'll add that some people will be too poor to pay for health care, no matter what it costs, and they may be the people who need it most (the indigent).
Addressing the more specific issues of metric, I think the best metric is QALY (qualty-adjusted life years) lost due to lack of health care delivery.
But my strong impression is that insurance availability correlates strongly with lost QALY.
The next few years of Americans to turn 18 are smaller than the year before them. If the likelihood of Americans to go to college remains similar, domestic student populations will decline for reasons of demography, not malaise.
That's a problem. Prior generations became more educated than their predecessors, more able to understand the world, and did higher-skilled and better-paying work. Now, it's stagnated (or is going backward).
“Life expectancy at birth decreased 0.1 year from 78.7 years in 2015 to 78.6 in 2016, largely because of increases in mortality from unintentional injuries, suicide, and Alzheimer’s disease, with unintentional injuries making the largest contribution. This is the second year in a row life expectancy has declined (1). Changes in death rates at younger ages have a larger impact on life expectancy than changes at older ages. The increases in death rates at the younger ages from 2015 to 2016 resulted in the decrease in life expectancy observed during that period.“
PS I got this link from another commenter here.
Taco Bell, KFC, Dunkin Donuts, Burger King, Shakeys, Pizza Hut, Little Caesars, IHop, Carl's Jr, McDonald's and on and on.
And by "it's", I refer to the fact that this is known, not to the reason why this happens. Unemployment rates, declining middle class, bleeding working class, and people working shitty subsistence jobs that count as "full employment" would be my guess for the latter (and all that comes from eat: low self esteem, depression, drinking, drugs, poor health coverage, homelessness, et al).
If an infant is born alive, and dies, it is an infant death in the US. Even if it is completely nonviable (e.g. no heart). In the Netherlands any baby that dies in < 2 weeks after birth is not an infant death. If a child dies < 5 years it is not counted in life expectancy calculations. I'm not sure what the situation in the US is. But frankly, any time a number sounds extreme (and this one does) your first thought should frankly be "how have governments faked this number". Just like for private companies, if a number sounds too good to be true, it almost always is.
So the numbers aren't as comparable as people claim. There is obviously a difference, but it's not as dramatic as advertised.
Seems like that would be a more meaningful metric for an individual, rather than lumping them in with every drug addict.
We can have a medical break through that lets us revive stroke victims as brain dead patients that live for years in beds. Simultaneously we can have a smaller opioid epidemic that kills fewer people than the stroke victims and makes way more addicts. Average life expectancy increased, but who really gives a crap in that case?
Sure, to some degree of similarity, if you want to spend effort analyzing the multidimensional demographic and other factors in mortality data; there's very little public policy value in that, so the public organizations that compile public health information to support policy aren't likely to package that up for you, though.
https://www.cdc.gov/nchs/products/databriefs/db293.htm
I wouldn't be that surprised if they also sliced out "substance abuse", because mortality of the using population is likely a useful metric in characterizing the problem.
That's incredibly myopic and would point to a massively flawed system if that's true. It's incredibly valuable for public policy on both ends of the political spectrum to know if certain demographics are dying much sooner than others.
A single national average is about as useless as you can get unless your goal is to bemoan the decline of the US or highlight how much better one nation is than another.
Wow.. whenever someone asks me why the US doesn't have humane social services and still regards drug addiction as a crime in need of punishment, I'll point them to this comment.
We already serve up content based on people similar to you or making similar choices as you, why not health forecasts?
If I eat healthy, exercise, get the proper amount of sleep and am not addicted to drugs, why not show me how other people with similar habits as me are doing, instead of averaging in people who treat their body like a dumpster?
Showing me the life expectancy averaged across an entire country of 300 million doesn't motivate me to do anything. There is nothing I can do that will make any impact on that number. By this logic we should show life expectancy as the average of the entire planet, that would be the best wouldn't it? No.
Showing people an accurate life expectancy however, could motivate them to make changes to their lifestyle or stay the course if they are happy with it.
I don't know, maybe people just have negative knee-jerk reactions to anyone proposing individualist sentiments.
This is not the point of life expectancy statistics. It's not to motivate people. And It's not about you. Just because you're thinking it's about you and that it's not relevant to you to be put in the same bucket with others proves my point.
This is an intentionally nation-scale barometer which is used to asses the Human Development Index. It's more tied with Income inequality than with your diet and exercise regimen.
Life expectancy if you get the surgery and medicate with pot: 80 years.
Life expectancy if you get the surgery and use the opioids: 60 years.
That seems immeasurably more useful than a national average alone which only can be used for political talking points.
So you won't find them for all the options of interest, and you emphatically won't find them for emerging options (including pot, which hasn't been even quasi-legal long enough to support good data.)
It's a reasonable question. Is there life expectancy data for different segments of the population?
Age, sex, and socioeconomic status dominate.
There are a number of conditions linked to genetics -- types of anemia, heart disease, Tay-Sachs syndrome, off the top of my head.
Environmental exposures map strongly to socioeconomic status, though there are of course regional variations.
Weight, "body mass index" (a horrible measure), body fat percentage (far more useful, but harder to obtain), and various specific exposures and behaviours will cover much else: drink, smokes, injectable drugs, unprotected sex, other high-risk activity.
This is pretty much the life work of epidemiologists, public health statisticians, and actuaries.
Personally, I'd characterize the US as a plutocracy.
Viable to whom? And who gets to decide? If the Chinese solution is so popular, why don't they hold an election?
There is no legitimate government without democracy, without the people deciding who should govern them and how.
Yes, absolutely, and I loathe him. Democracy isn't simply majority rule (which is mob rule, not really democracy). While I have mixed feelings about the Electoral College, it's the law made by the American citizens and their representatives; he is President.
Also, the U.S. is a republic, not a direct democracy. For very good reasons, elected representatives don't need day-to-day majority approval; that would get bad results.
The only exception is if the actual vote was altered in his favor, such as if someone hacked election machines or vote counts, or if voters were substantially denied their voting rights. I know of no evidence of hacking - and I'm someone who is very skeptical of election systems security. The latter there is some evidence of, but it's hard to define the line between difficulty and denial of rights, and the net impact on results of everyone of any party who had a problem voting.
How so?
But let's be sane here : the situation in China is far, far worse than in the US. Just talk to a few recent immigrants, it's not like they're hard to find. A few of their stories should cure you of the notion that US health care, even for the poorest of the poor, is bad. But the numbers tell a different story.
But no worries, if a country has a oppressed population, it can rapidly end the use of plastic grocery bags, and therefore progressive get enamored with it.
And faking it ... well we accidentally got shown what US politicians meant by recycling, didn't we ?
An outsider was elected even though he was running against establishment candidates with huge money backing them.
I say democracy won.
[1] https://www.bloomberg.com/politics/graphics/2016-presidentia...
[2] https://www.nytimes.com/2016/12/09/us/politics/campaign-spen...
It's easy to show your country is doing well when you don't have free press?
The US is only 5% of the World's population. There are plenty of Developed countries doing much, much better than the US.
You're doing it wrong, but the rest of the world is ticking along.
No, Empire failed (or, rather, is failing), as empires do.
America has also pretty much failed to democracy, and part of that was trying to democracy and empire together, or maybe just neglecting issues with democracy because empire was more important. Democracy works a lot better where people are actually practicing something that produces democratic outcomes, and the US is very close to the worst of established “democracies” at doing that, and has steadfastly refused to even consider trying to do better.
> Is it time for a rekindling of the study of comparative politics?
“Rekindling” implies that it died out; it didn't, and remains an active field.
> It seems the Chinese have a viable solution to the problem of a largely uneducated and passive populace.
In what way?
While this is a few years old, the data should be relevant; alcohol takes years to manifest into full-blown health crises: https://pubs.niaaa.nih.gov/publications/Surveillance95/CONS1...
Additionally, there has been an upswing in youth consumption in the past decade directly. We need to have a public conversation about what we’re doing to ourselves, especially in places with the extreme “beer culture” like SV, Seattle and Portland.
Sounds like you only prefer to read stuff that is pro-Keto.
Saturated fat and cholesterol are the cause of many western diseases. Cholesterol-deniers are setting people up to get fatty streaks in their artieries. A low fat/cholesterol diet (especially plant based) is the only one that has been proven to reverse heart disease and type 2 diabetes. Many diets are good for losing weight, but that doesn't make them healthy.
Sounds like you need to check your assumptions as you have no way of knowing what I prefer to read.
Others have already provided studies to refute your claim, but here's one more: https://www.ncbi.nlm.nih.gov/pubmed/20071648
It’s also a highly “incentivized” industry. There’s a lot of misinformation or noise out there, as evidenced in the above.
You said yourself that EVERYTHING you've read in the last couple years has been pro-fat and cholesterol. Am I wrong in assuming that you prefer to read such things?
Cite? According to this[1] paper, there was a decline in underage alcohol consumption between 1991 and 2013, but that doesn't quite contradict what you said.
[1] https://pubs.niaaa.nih.gov/publications/surveillance101/Unde...
This guy predicted the downfall of the Soviet Union in his mid 20ies based on statistical indicators like life expectancy.
Nothing really bad happened in 1962 or 1963. So couldn't the current two-year "trend" be explained by randomness? Life expectancy can't continue to rise forever.
And according to an article published at [1] (and of course, by intuition for many of us), there seems to be an association between a person's wealth and that person's longevity.
If the income gap between different social strata has been widened in the past decade, then it is very likely that the life expectancy of poor people in the country decreases much faster than that overall data could tell us....
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Also, it's not just addicts who die from an overdose that is contributing to this effect. A hidden/functional addict is still going to die sooner on average than a non addict.
Looks like it's attributed to drug epidemic
edit: I've posted this WP article because I couldn't actually read the Economist article due to paywall, and I figured other readers may have same issues.
A few ways life expectancy can go down:
- babies that other would have died and not counted live long enough with modern medicine that they drag the average down
- refugees or immigrants in poor health increase, dragging the average down
- a change in methodology in how life expectancy is calculated
Something similar happened when seat belts (or was it airbags?) became mandatory. There was a sudden spike in serious injuries from car crashes, as what would have been instant fatalities became injured survivors.