Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees
cdc.gov
cdc.gov
The measure can be very different elsewhere. The WHO defines a maternal death as "the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes."
you'll notice in this study that 30.0% of deaths occurred 43–365 days postpartum, so you will have to adjust numbers accordingly if you are comparing the USA to what most other countries measure. (and not all use the WHO definition!) The reason they use the 42 day cutoff is I assume to aid with other-country comparison. Still lots of websites that compare maternal mortality across the world get this wrong, and compare USA deaths for a full year vs other country deaths for 30-60 days postpartum.
"A death is considered preventable if the committee determines that there was at least some chance of the death being averted by one or more reasonable changes to patient, community, provider, facility, and/or systems factors."
They said that the deaths are preventable, not the conditions themselves.
While it's unwise to try and simply reduce all mental health conditions to 'circumstances' or 'chemical imbalance', there are lots of things you can do to keep a person in balance to the point that any latent conditions they have aren't enough of a problem to interfere with their daily lives. Motherhood is already very difficult so it is worthwhile to try and keep as many challenges out of a new mother's life as we can.
By that definition, cancer is preventable. Actually, nearly every possible cause of death is preventable if you're definition is "doing something might reduce risk factors".
That's not the normal usage of "preventable death".
Do they consider treatments that couldn't possibly be performed on every pregnancy that it might help? (due to finite medical resources, cost that insurance companies won't pay, etc.)
I'd much rather see a focus on the basics that other countries do that are consistently missed. Especially when it comes to over-using C-sections and how race plays into treatment.
Deaths by suicide and drug abuse are indeed preventable. Are you misconstruing the word preventable to mean 100% preventable?
> Among 11 developed countries, the United States has the highest maternal mortality rate, a relative undersupply of maternity care providers, and is the only country not to guarantee access to provider home visits or paid parental leave in the postpartum period.
> Women in the U.S. are the most likely to die from complications related to pregnancy or childbirth.
[edit] NPR did a thing on it in 2017 too. [2] In 2015 you were 7X as likely to die as a mother in the US as compared to Finland (and 4X Canada) - and while the rest of the world saw dropping numbers, the US saw accelerating increases. And for every woman who dies in childbirth in the US 70 come close.
[1] https://www.commonwealthfund.org/publications/issue-briefs/2...
For reference (so someone doesn't have to click through): 17.4 per 100,000 vs the two closest: France at 8.7 and Canada at 8.6
Does that account for the far higher proportion of people living in rural areas in the US? What about obesity, ethnicity, etc?
Every place has its economically disadvantaged, but America's poor seem to be more neglected and left behind than in other countries. A lot of other rich countries have better aggregate numbers because they bottom quartile is not as low.
More urbanized than France, Spain, Canada, Taiwan, Switzerland, Italy, etc.
They may have a higher percentage of their populations in rural areas, but the US may have a higher percentage of its population far away from urban medical care.
The rate seems about the same as France and Canada?
https://data.worldbank.org/indicator/SP.RUR.TOTL.ZS?contextu...
This kind of thing also applies to the oft-repeated "infant mortality" metric. Where other countries don't count premature births or count birth within a certain period as stillbirths instead of infant mortality.
My sister's death in 2017 while 8 months pregnant is (apparently) included in this data, but I wonder how they would rate it.
She experienced sudden cardiac death, but had no prior indication anything was wrong with her heart, and no symptoms that would otherwise cause someone to examine her heart.
Had anyone examined it, they might have realized it was compromised, but does "we could require cardiac ultrasounds on all pregnant women, and sign vulnerable ones up for transplants" count as "somewhat preventable"? Can you even do a heart transplant on a pregnant woman?
I don't think her death was preventable, but the fact that I don't know how they would have counted it based on the information here makes me wish for more details.
> A death is considered preventable if the committee determines that there was at least some chance of the death being averted by one or more reasonable changes to patient, community, provider, facility, and/or systems factors. MMRIA allows MMRCs to document preventability decisions in two ways: (1) determining preventability as a yes or no, and/or 2) determining the chance to alter the outcome by using a scale that indicates no chance, some chance, or good chance. Any death with a yes response or a response that there was some chance or a good chance to alter the outcome was considered preventable. Deaths with a no response or no chance were considered not preventable.
"Some chance"? " Reasonable changes"? "System factors"?
Cardiac ultrasounds are fairly inexpensive. There is some chance of discovering critical heart problems through them through a systems change. And heart replacement surgery would likely be covered by insurance anyway, so is not an unreasonable new cost to the system.
I can't determine what their decision in her case would have been by the criteria they did list, which is why I said I would be interested in more details.
The above article is describing amenable medical errors. I don’t want to make assumptions about how your sister’s death would be classified.
However, I am so sorry for your loss, which is a tragedy. We need to do better, as this should not be happening.
I don't think her doctors missed anything that ought to have been caught. She seemed completely fine five minutes before she was irrecoverably dead (i.e., her heart muscle hadn't just stopped, but part of it had died).
And that's what confuses me about this rating system for evaluating what was and wasn't preventable. My best guess is that there truly wasn't anything anyone should have done, that it was just a freak thing that happened.
And I guess that's emotionally simpler. The grief isn't any less deep, but it's not complicated by anger. "Sometimes bad things just happen with no warning" sucks, but it's not complicated.
I suppose I do have a bias toward continuing to assume that's true in her case, for my own sake.
"Sudden cardiac death" is more of a description than a diagnosis, so it's hard to say. You may be being intentionally vague for her privacy, which makes sense.
Common causes vary widely, from cardiac dysrhythmia (perhaps due to pregnancy-related cardiomyopathy or an electrolyte imbalance?) or a pulmonary embolism... I'd say the level of "preventability" depends on the etiology.
I've had three doctors read it to make sure I'm not missing anything (including the cardiologist I saw as a result), and they've all said, "It says her heart muscle just died, for no clear reason. It speculates about a heritable cardiac channelopathy, which is why you and your brother needed cardiac ultrasounds and stress tests, but ultimately they don't actually know why her heart died."
It's as close to a diagnosis as we'll ever have.
First is that we report maternal mortality even when not directly associated with birth -- "Among pregnancy-related deaths with information on timing, 53% occurred 7–365 days postpartum." Is that standard for reporting countries? Is our problem with maternity healthcare really a problem of better reporting?
Secondly is that 22.7% of the deaths are related to "mental health conditions". From the footnote, "Mental health conditions include deaths of suicide, overdose/poisoning related to substance use disorder, and other deaths determined by the MMRC to be related to a mental health condition, including substance use disorder." This is extraordinarily disturbing!
https://www.ncsl.org/research/labor-and-employment/state-fam...
https://www.zippia.com/advice/average-paid-maternity-leave/
There are a few North Korea comparisons in here that I think are tongue-in-cheek but two statistics jumped out at me:
(1) 1/3 of new mothers take little to no time off after [...] new child and instead opt to return to work as soon as they’re able
(2) The highest rates of paid family leave across any segment or industry appear to be in the 30% range. So only 30% of the jobs most likely to offer this benefit actually do.
This time around I’m a full time indie hacker and I see my son for hours every day. He’s six months old now. I’m insanely fortunate to have a profitable and growing business, but I’ve come to believe that everybody should be able to have months with their children without losing their house, insurance, etc.
It may seem crazy but 100 years ago a 40 hour work week seemed crazy to many.
Nine months is excessive for paternity leave. I can't comment to maternity leave, but it would make more sense there.
Long paternity leave drives everyone crazy.
how though. Mothers go down the path of abusing substances because they know they wont paid get days off at work?
I'm about to go on paternity leave in 2 weeks until the end of the year. California will directly pay me some amount for 8 weeks of it due to paying the relevant workers comp taxes. Companies within the state are required to allow at least 12 weeks of unpaid leave. I work for a great, supportive company that will pay whatever the difference is to make my salary whole. In general, I set my own schedule and am able to prioritize my family's well being over work.
My wife's preference is to raise our children, and we're lucky enough to be able to live comfortably on my income alone. Anecdotally, that was the case for our first child as well, and my wife still suffered from rather severe post partum depression a bit less than a year after giving birth.
The person you're responding to is Brazilian. To most people outside of the US there is a wrong assumption that the entire United States is a monoculture with one mind and one voice. It's also a readily abundant point of view on the internet.
It's almost like judging the entirety of British culture off of the sum of the Harry Potter stories.
Brazil is a median income country and our society decided that every woman gets 120 days (17.14 weeks) of paid maternity leave. Good companies give 180 days.
The salary is paid by Social Security
It sounds like a pretty nice deal for mothers in Brazil, though. Googling the paternity leave policy, fathers in Brazil are only entitled to five days paid leave. In my personal situation, 8 weeks seems pretty nice in comparison. For a nuclear family, that's potential for 16 weeks total, vs. Brazil's ~18 weeks.
Also keep in mind that, legally within California, there's a distinction between paid leave for parental bonding vs. paid leave for recovering from injuries related to pregnancy. I believe mothers in CA are entitled to up to 52 weeks of paid leave if their medical situation warrants it. What's the equivalent social policy in Brazil?
If someone gets a surgery and then dies 8 days later due to complications from the surgery, you don't go around saying the death was "not directly associated" with the surgery. There are lots of things that affect the body during pregnancy that can lead to death in the year after. [1]
[1] https://www.cdc.gov/vitalsigns/maternal-deaths/index.html#:~....
But 365 days?
That's sounds like it's mental health related.
It seems like we should track cause of death so we can have richer and more actionable information.
Edit: I didn't mean to imply that this wasn't postpartum depression. I was curious if/why other nations aren't tracking the full calendar year after birth, and if our way of counting prevents us from directly comparing figures. I want to mathematically compare. Our figures are alarming.
Directly from the cited link in the post you're responding to:
>Cardiomyopathy (weakened heart muscle) is the leading cause of deaths 1 week to 1 year after delivery.
That's not actually the case. If you look through the original linked article for the word "suicide" you come across the following...
>Pregnancy-related deaths determined by the MMRCs to be suicides...
... which, by used of the word "determined" suggests that they're not just assuming all suicides within a year of giving birth are pregnancy related. In point of fact, this is covered at the very beginning:
>Maternal Mortality Review Committees (MMRCs) are multidisciplinary committees that convene at the state or local level to comprehensively review deaths during or within a year of pregnancy (pregnancy-associated deaths). MMRCs have access to clinical and non-clinical information (e.g., vital records, medical records, social service records) to more fully understand the circumstances surrounding each death, determine whether the death was pregnancy-related...
I hope I'm remembering this right, and please correct me if my memory or interpretation of this isn't correct.
When Covid first emerged and people were diving deeply into all kinds of mortality statistics, one story I saw that was kind of shocking is that there's been no genuine system for counting flu deaths in a normal year. You'd think flu deaths are basically counted by doing something relatively sane such as tallying up deaths in a database labelled with flu (more or less), but it's actually sort of a statistical guess based on number of deaths in a given time period, subtracted by other causes (accidents, cancers, murders, etc), and whatever's left over is labelled with flu.
This is one of the big reasons that I total distrust and reject the provided mortality statistics with Covid. Statistical comparisons have to be made in similar ways or they're worthless.
https://public.tableau.com/app/profile/dataviz8737/viz/COVID...
Youve got to start tracking at some point, covid was that point
This isn't as much of a problem with maternal care as it is a problem with drug addiction, and this is simply the downstream consequence of that.
The uk equivalent report is much more nuanced - note the use of "might have made a difference" vs "preventable":
"Mental health remains one of the leading causes of maternal death in pregnancy and the first postnatal year. Many of the women who died from suicide or substance misuse faced multiple adversity. Assessors felt that improvements in care might have made a difference in outcome for 67% of women who died by suicide, 29% who died from substance misuse and 18% of those who died by homicide. This report emphasizes once again the importance of immediate risk management and the potential for rapid deterioration, particularly postnatally. These messages are equally important across pregnant women of all ages, especially those who have had a pregnancy loss event, but this report does show a need for special attention around mental health for pregnant teenagers."
I actually think this ought to be a root standard that the government sets. Then every industry will have a baseline by which they are strictly required to care (and at risk monetarily if they're negligent) .
eg: $1M per life expectancy year remaining.
Likely related to a racial divide in healthcare infrastructure?
[0] https://tcf.org/content/commentary/worsening-u-s-maternal-he...
But (to be fair and balanced) one pro of the US’s system that other countries don’t have is that black and white people (and all other races) are allowed to use their HSAs as a tax shelter for their investments.
What populations are getting the jobs that provide an HSA? What population has money left over to put into an HSA?
etc., etc.
IRL some of the poorest people I know have been screwed over by attempting to use similar programs.
Myself, I really don't want to have to fucking rebalance my healthcare portfolio. As opposed to, y'know, just walking in the building, getting my healthcare, walking out, and squaring up at tax time on a progressive curve.
Besides looking at other industrialized countries, it also insightful to look at the health outcomes of the us against other Caribbean and African states, particularly in the places where most of the Black women in the us live. In 2019, the reported maternal mortality rate (MMR) for Black women in the US state of Georgia was 66 / 100,000.
Barbados MMR of 12.6 / 100,000. Bahamas, MMR of 22.4 / 100,000. Zimbabwe, MMR of 53.9 / 100,000. Botswana, MMR of 45.9 / 100,000 (the MMR of white women in Georgia) Jamaica, MMR of 13.7 / 100,000. Cuba, MMR of 5.1 / 100,000
“Of note, black mothers who are college-educated fare worse than women of all other races who never finished high school. Obese women of all races do better than black women who are of normal weight. And black women in the wealthiest neighborhoods do worse than white, Hispanic and Asian mothers in the poorest ones.”
I'll do my part. Here's an article on all the ways you can die from household accidents which kill 18,000 Americans, probably including mothers with newborns, every year. I am sure that almost all of these were preventable.
https://money.usnews.com/money/blogs/the-home-front/2009/08/...
My wife ended up in L&D triage a lot due to high blood pressure. Every single time a woman would walk in, purportedly in labor, without any prenatal care. This was in California, where pre-natal care for those who cannot afford it is... free.
Would it be nice if they’d had the forethought, budget and/or power in their relationships to reliably use birth control? Yes, and not just because of unwanted kids, but because their lives would be all around better. When I say “budget,” I don’t just mean the direct cost of birth control, but all the stuff around it, like doctor’s appointments to get and maintain the prescription.
But those things don’t line up for a lot of women in America, and now we’ve taken away the main safety valve. Few of them can afford to fly to friendlier states on short notice - they’re often in the kind of jobs where you can’t just call in sick for a few days and expect to have a job to go back to.
Gonna be a fun next 20+ years.
In 2020, there were 861 deaths total, at a rate of 23.8 per 100k births. If my math is correct that's roughly a .024% chance across all age groups of maternal mortality including deaths caused by suicide/mental health issues.
The number of pregnancy related deaths is incredibly low.
Interesting. According to https://www.statista.com/statistics/241572/death-rate-by-age...
Death rate by age and sex
Male Female
15-24 99.7 38.4
25-34 177 78.9
35-44 257 141.6
Anyways, I have never been pregnant, but if you saw what happened to me medically this summer, you would be doing everything you could to be leaving the US. Anyways, I am a dual citizen. My other nationality is Croatian, but I don’t plan on living there.
Even Croatia, you know which went through a horrific war 30 years ago, has a better life expectancy than the US now. But even before the pandemic, they were very close to convergence with the US life expectancy. And Croatia only spends $1,100 on healthcare per citizen per year!!!
Honestly, the quality of care is not OK at all in the US. Just check out r/medicine and r/nursing. We are in for a whole lot of really terrible stuff.
Seriously, if someone in your immediate family gets sick and needs to be hospitalized, stay with them 24/7, even if it means sleeping on the floor. Nurses say they will do the same thing for their family members.
Anyways, I ended up spending 9 weeks in the hospital this summer. It started at a trauma hospital, where I stayed for 18 days. The first 90 hours (3.5 days) they did not even give me any long acting insulin, even though my body does not produce any insulin and I can not metabolize without long acting basal insulin. (I was never on an insulin drip either, and I was never on a high dependency unit where the insulin drip could occur.) My family had to beg and plead with them to give me basic diabetes care, including the long-acting insulin. (I was too, the whole entire time.)
The first week my blood sugars averaged overall around 400 mg/dL (22 mmol/L), and chief trauma resident and trauma fellow were explaining to trauma residents outside of my room when someone with type 1 diabetes is at risk of diabetic ketoacidosis. Such a basic matter.
Anyways the rest of the story is for another time.
You’re right about the American hospital, generally and for now. They have better resources, equipment, and are cleaner, among many other things. You have more rights in an American hospital (no bribe expected).
But, a country like the United States could learn from a country like Croatia and make the best out of its resources. The US could spend the same on healthcare without taking away resources from the general American populace (minus oligarchs) and allow people to be so much more healthier.
The fundamental problem is that a lot of Americans lead very unhealthy lifestyles, and this is reflected in the outcomes and the medical spend, despite world class medical care doing its best.
It's important to note that risk factors for mortality overlap significantly with the risk factors for other serious adverse events (see e.g. disability status [1], or HELPP syndrome [2]). In a sense, mortality (although fortunately rare as noted in other comments) is therefore a useful proxy for other severe, potentially life-changing adverse pregnancy-related medical events which are much more common than just plain death. (As an analogy, something like 10-15% of heart attacks are fatal, but many more are debilitating.)
[1] doi:10.1001/jamanetworkopen.2021.38414
[2] doi:10.1111/1471-0528.16225
Protecting the unborn is very convenient. They make no demands of you.
Edit: WIC: Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) https://www.fns.usda.gov/wic
It is crucial that we have lots of programs with distinct eligibility criteria to make sure that poor people are suffering sufficiently.
1 in 6 American kids live in a household that receives SNAP benefits. I don't have the stats handy, but some large plurality of Americans receive SNAP benefits at some point during their lives.
Are you under the assumption that your suggestion hasn't been tried (and subsequently found wanting)?
Just cut out the bloat and give the cash, IMO.
Personally I am against violence imposed welfare (taxation based). But I see cash remuneration as a win-win because we could say give $0.50 more out in welfare for every $1.00 of overhead eliminated, and both recipients and the taxpayers would be better off.
This is a very common tactic used by opponents of the US social safety net. Basically, the idea is to transform something that is broadly sympathetic to voters, like "giving money to poor moms so they can buy food for their kids, who otherwise will suffer from malnutrition" into something with no constituency, like "another Big Government Bureaucracy wasting your tax dollars." You can then attack the Big Government Bureaucracy without talking about the fact that you're effectively advocating for poor kids to go hungry.
The basic flow is you start with objections that sound reasonable to a set of middle-class voters: "we need to drug test the residents of public housing," or "we need to make sure they aren't buying sodas with Food Stamps," or "we need to have enforcers make in-person visits to ensure that they are as poor as they say" or whatever. You add in a bunch of those requirements over time. Eventually, you have created a bloated system that costs more while doing less for poor people (obviously, the money spent on the overhead is not available to buy food for hungry kids). And that bloated system is ripe for calls to be dismantled altogether.
Or, some kids can be denied access (even temporarily is a shame):
https://www.kold.com/2022/10/01/teen-girl-denied-medication-...
After all, both their politicians and their court nominees insisted that abortion is a long-settled issue, and have not reneged on it the second they had the power to - we can trust them to continue operating in good faith, and in a matter that respects public opinion.
At the risk of hurting the feelings of party members, I do not associate "good faith" with them.
Edit: I missed the sarcasm. Poe's Law, ya know.
Shockingly, I have several classmates who were grandmothers before I became a mother.
There's no reason abortion should be safe, legal and rare. And there's no reason we should be having such a high rate of preventable maternity related deaths.
Of course, they might not get those issues under control. They might still have died of substance abuse or suicide. But the stress of being a new mother is well known (if not well understood or well supported by society or the American medical system - clearly). If a person is already predisposed to substance abuse and/or self-harm, maybe the additional impacts of post-partum mental conditions would push them further down that road.
Especially as it pertains to the maternal-mortality/abortion discussion, I think its important to remember that the would-be mother's material conditions are not guaranteed to be static over the course of the pregnancy and post-partum period. The decision to conceive might be made in accordance with the best possible medical and financial advice, and still result in a bad situation for mother or child at the end of it all.
My wife had a pretty easy time with both of our kids, but I am constantly haunted by stories from folks who made the same decisions we did, and lost mother, child, or both.
These are women who don’t present with symptoms of mental illness until after birth.
This isn’t an edge case. This is common.
How is abortion going to help here?
Also … you say:
> if the mothers had been allowed to abort the baby, they would be in addition allowed to get the mental health or substance abuse issues under control.
There are lots of social services available to pregnant women and new mothers. Including screening for mental illness. Are similar services available to women undergoing abortions? You seem to imply there are.
In some cases, ending pregnancy is how you eliminate maternal death.
The real questions are "At what point does human life begin / become valuable?" and "Should governments provide for their citizens or merely punish those who harm them?".
There are good arguments to be made by decent people on all sides of those debates, so let's not make cheap shots which detract from reaching a better understanding.
They can shield themselves by extremist interpretations of 'word of god' (which takes some mental gymnastics since his are, if at all, only 10 commandments and thats it, rest is just human-made stories). Funnily most of those folks fail with following even those 10 basic rules, but thats another topic.
We went through this decades ago in Europe and largely emerged as better, more democratic and freer societies. Those times are regarded as dark primitive times when looking back, when a lot of trauma was done and a lot of regretful actions happened.
"The unborn” are a convenient group of people to advocate for. They never make demands of you; they are morally uncomplicated, unlike the incarcerated, addicted, or the chronically poor; they don’t resent your condescension or complain that you are not politically correct; unlike widows, they don’t ask you to question patriarchy; unlike orphans, they don’t need money, education, or childcare; unlike aliens, they don’t bring all that racial, cultural, and religious baggage that you dislike; they allow you to feel good about yourself without any work at creating or maintaining relationships; and when they are born, you can forget about them, because they cease to be unborn. You can love the unborn and advocate for them without substantially challenging your own wealth, power, or privilege, without re-imagining social structures, apologizing, or making reparations to anyone. They are, in short, the perfect people to love if you want to claim you love Jesus, but actually dislike people who breathe. Prisoners? Immigrants? The sick? The poor? Widows? Orphans? All the groups that are specifically mentioned in the Bible? They all get thrown under the bus for the unborn.
There is no argument about when a fetus becomes an citizen. Having the government protect its citizens from harm is a radically prochoice stance.
Laws vary between countries, but basically Poland is not Europe. Generally you can get late stage abortion for variety for health issues (abd even social ones). Also, you won't be denied prescribed medicine you need for pregnancy unrelated condition just because you are woman and it might also end pregnancy.
Also, there is no ban on talking about abortion.
Isn't this true in even the most extremely anti abortion states of the US?
As that says "with narrow exceptions for victims of rape or incest, to save the life of the pregnant person and in cases where the fetus is diagnosed with a lethal anomaly. That law took effect on Sept. 15."
There is doubt that she had to travel out of state.
(expecting)Mothers experience a lot of death from Mental health conditions because America experiences a lot of death from Mental health conditions. What I mean by this is that it's no surprise because it's widespread across the populace... now does it exactly line up with the expected rate for a random member of the population? IDK because I dont have those numbers handy.
But I thought that I'd point this out to indicate, we don't just need to help (Expecting)mothers but really the whole population deal with mental health.
See https://www.nature.com/articles/pr9201134
From the Nature article:
"Obesity is associated with increased risk of almost all pregnancy complications: gestational hypertension, preeclampsia, gestational diabetes mellitus, delivery of large-for-GA infants, and higher incidence of congenital defects all occur more frequently than in women with a normal BMI."
> A death is considered preventable if the committee determines that there was at least some chance of the death being averted by one or more reasonable changes to patient, community, provider, facility, and/or systems factors.
This isn't science or even data, it's the opinion of some reviewing doctors.
The statistics are staggering. USA has the worst infant mortality in the rich world.
We spent 1/5th of our GDP on health industries, and we're getting nothing for it. Just a handful of really rich people.
> Upon examination, however, the discrepancy between the U.S. and other countries appears largely due to country-to-country differences in the way infant mortality statistics are compiled. Infant mortality is defined differently in different countries, and the U.S. definition is notably broader than that of most other countries.
https://worldpopulationreview.com/country-rankings/infant-mo...
Also, it's missing the crucial implication: at what price?
With infinite amount of money, there are many things we could do. We don't have infinite money.
Consider how the richest EU state in adjusted PPP per capita (so price levels can't be blamed) is just now barely richer than the poorest US state, in both the median and average
Do we really want to become that poor? Is equality (in everyone being poor) a social goal?
Well, that depends. Are we talking about your child or my child?
Give it a few generations and it doesn't matter.
Funny enough, in the US, our rich and retired try to move to the EU, while young people from the EU try to move to here.
So if the people flow is to be believed, it's clear which place favors the working class, and which places favor a rentier approach.
The choice isn't about getting massively poorer, it's just whether you want to be able to look your fellow citizens in the face and know you aren't for supporting a system that sees their children die so you can save a few dollars more in tax.
Also talk about ajusted PPP, to account for higher or lower local costs (and accounting shenanigans like double irish with dutch sandwich)
When not cheating, US is #2, only behind Luxembourg, even if my local observations do not support this conclusion:
Apparently healthcare in the US is something like $10k per person per year? Seems fair to take that from the US median income so we are comparing apples with apples. Looking at your wikipedia link that would put the US down around 11th... After Belgium, Norway, Austria, etc and that is before we start talking about education.
Look - your point that people in USA have more money is mostly true. But when you add in the extras you have to pay for the difference is not as big as you might think. And none of that explains why pregnancy related deaths are so comparatively high.
No, because it's a choice.
Many people don't go to university etc and do just fine.
Likewise, healthcare is a choice: some people don't want that (ex: DNR)
You want to push your values, and say impose higher education, but the way I look at it, since the people with the more education are generally at the top of the "foodchain" in the EU, I only see that as them voting for themselves a right to paid education, in theory accessible to the poor/immigrants etc but in practice that is mostly used by those at the top of the foodchain themselves, yet and subsidized by the rest of the population.
I'm not a big fan.
> Look - your point that people in USA have more money is mostly true. But when you add in the extras you have to pay
You don't have to pay for them - it's OPTIONAL. That's freedom.
Incidentally, it's also the only country in the EU with a higher GDP/capita than the US.
[1] - https://en.wikipedia.org/wiki/List_of_countries_by_GDP_(PPP)...
As for national incomes - see my comment below but unless you are subtracting out costs for healthcare and other services offered to all citizens that are not offered by the US government you are not comparing apples to apples either.
[1] https://data.worldbank.org/indicator/NY.GNP.PCAP.CD?location...
If you would travel to those places, you would find stark differences in real quality of life which can't be easily measured by simple aggregate numbers, people's happiness and life satisfaction.
A better question is, why should the state support people getting fired?
> If you would travel to those places, you would find stark differences in real quality of life which can't be easily measured by simple aggregate numbers, people's happiness and life satisfaction.
I did: oh yeah it's nice, as a tourist. But here is no amount of money you could pay me to work and live there - and that's assuming the money would make sense on the paper, unlikely given the high taxes while the prices are also high.
The killing factor is the very small amount of private options if you want to avoid dysfunctioning government monopolies.
See, you admit it yourself - you went as a tourist. Thus you have clue how people actually live, how happy they are etc. Europe is cca 30 very different and diverse states and you clearly saw tiny fraction since what you state is simply not true in quite a few.
For my case point - I've lived in US, LA and Maine. While I loved common folks for their openness, the system is utterly fucked up for me and I would never want to live and raise my kids there, regardless of paycheck (which as I stated is useless measure since its not what you save if you actually live and manage to get old). Also - high criminality, police state and messed up jail system, workoholism attitude, effective class system based on career/income/wealth. And so on.
Since you don't react to that use of your tax money to wage wars and killing of hundreds of thousands of innocents I guess you don't care about that at all.
About the only thing I'd be unhappy about trading with Europe, as far as income plus services and worker standards (time off, healthcare, retirement, primary-university education, child care, et c.) goes, is their housing situation.
Of course, ours is completely fucked too and some of us are only doing better because wages are more uneven here.
Like, if we could actually get all their social services and other perks in exchange, I'd be OK with a big pay cut. I mostly need this much money here to make up for not having those things, or for the ones provided being terrible and having to be supplemented or replaced out of pocket.
What even is wealth if you won't use it to prevent the death of children when that is in your power to do?
The price can't be that high because countries poorer than ours find a way to pay it. What are we getting instead? What is it you're afraid to give up, for this?
US politicians when someone proposes a military budget: here, have 50% more just in case