U.S. Childhood Mortality Rate is 70% Higher Than Other Wealthy Countries

It is a moral disgrace for world history’s wealthiest country to have such a high child mortality rate. That’s part of the consequence of the U.S. lacking a national single-payer healthcare system, and it’s also a consequence of the U.S. Congress having prioritized support for the rich over reducing the plight of children.

American kids are 70 percent more likely to die during childhood compared with children in other wealthy, democratic nations, according to a peer-reviewed study published Monday by Health Affairs.

“This study should alarm everyone,” Dr. Ashish Thakrar, the study’s lead author and an internal medicine resident at Johns Hopkins Hospital and Health System, told CNN.

“The U.S. is the most dangerous of wealthy, democratic countries in the world for children,” he added. “Across all ages and in both sexes, children have been dying more often in the U.S. than in similar countries since the 1980s.”

The most common causes of death among children renews concerns about the American healthcare system, access to guns, and vehicle safety.

The risk of death is even higher for American infants and teenagers compared with their counterparts abroad. Babies in the U.S. are 76 percent more likely to die during their first year of life—often because of sudden infant death syndrome (SIDS) or complications related to being born prematurely—while 15- to 19-year-olds are 82 times more likely to die from gun violence, which Thakrar called “the most disturbing new finding.”

Thakrar and his fellow researchers examined the childhood mortality rates from 1961 to 2010 for the United States as well as 19 other nations in the Organization for Economic Cooperation and Development (OECD), including Australia, Canada, Japan, and several European and Scandinavian countries.

Thakrar told Vox‘s Sarah Kliff he believes the study’s findings are tied to a rise in childhood poverty in the U.S. during the 1980s, but also is in large part “the impact of our fragmented healthcare system” in the United States. For example, he said, “Mothers who are qualifying for Medicaid for the first time because they’re mothers might be seeing doctors for the first time. They might not have a family physician, or a clear support system.”

As numerous analyses and studies have shown over the years, the lack of a universal healthcare system in the U.S. has led to higher mortality rates and poorer healthcare outcomes than in countries that have robust systems that cover all people.

While the Republicans’ tax plan, which passed Congress and was signed by President Donald Trump late last year, partly dismantles the American healthcare system, lawmakers continue to put off refunding the national Children’s Health Insurance Program (CHIP)—which serves 9 million children—and Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, which expired at the end September.

Although federal lawmakers passed a short-term spending measure that provided some funds for CHIP just before the New Year, states are continuing to warn recipients that without further funding, they will soon run out of money and no longer be able to provide necessary healthcare services.

“Multiple states have sent out letters warning families that their kids’ health insurance could end on January 31,” Kliff detailed in another article. “Congress did pass a temporary bill that it expected to extend CHIP’s life span until March—but it turns out they got the math wrong, and states may run out of funding as early as January 19. Eleven days from now.”

Thakrar told Kliff he is concerned about how funding instability for programs that provide healthcare to American kids will continue to impact childhood mortality rates in the United States.

“We’re seeing the effects of instability right now,” he said. “All across the country families are waiting to hear if CHIP will be reinstated, whether they’ll continue to have health insurance, their household visitations are at risk. Programs that have proven their benefit in the country still face constant instability.”

Artificial Sweeteners Harmful to Metabolism and Stimulate Fat Growth, Study Finds

Reducing sugar intake in general is probably a good idea. Artificial sweeteners haven’t received enough scrutiny though.

Artificial sweeteners have an effect on the body’s metabolism and can lead to excessive fat accumulation in people, especially those who are already obese, according to a recent study.

Dr. Sabyasachi Sen, an associate professor of medicine and endocrinology at George Washington University, led the study, explaining in a press release by the Endocrine Society that while many people rely on these artificial sweeteners as a low-calorie alternative to natural sweeteners, “there is increasing scientific evidence that these sweeteners promote metabolic dysfunction.”

Sen and his colleagues tested the popular low-calorie sweetener sucralose on stem cells taken from human fat cells. They placed these cells in Petri dishes for 12 days, adding 0.2 millimolars of sucralose. The dosage is based on the concentration of sucralose in the bloodstreams of people with high consumption levels of the artificial sweetener — about four cans of diet soda per day.

The researchers observed increased expression of genes that produce fat and inflammation. They also saw an increased accumulation of fat droplets in the cells, especially when they increased the concentration of sucralose.

The Pay of Doctors in America

The article by the economist Dean Baker illustrates why doctors in the U.S. have such high incomes. Directly, it’s basically because limits are imposed on foreign and domestic competition by restricting professional medical practice to those who have completed U.S. residency programs that are too limited in providing opportunities.

It’s $100 billion ($700 per U.S. family) a year in added costs to pay doctors as much as the U.S. does, but in a more ideal world, in world history’s richest country, good doctors could be permitted to make that much money. If the U.S. cut costs in substantial ways — such as switching to single-payer, saving $500 billion from only that annually — I wouldn’t have an issue with doctors making over 200k annually. I’d want a subsidy that allows doctors to earn that much income, however, rather than them earning it through a rigged market structure. That’s my view of the article and possibly the only major point expressed in it that I seem to disagree with the economist on.

Rx-Rolls-Royce

The United States pays more than twice as much per person for health care as other wealthy countries. We tend to blame the high prices on things like drugs and medical equipment, in part because the price tag for many life-saving drugs is less than half the U.S. price in Canada or Europe.

But an unavoidable part of the high cost of U.S. health care is how much we pay doctors — twice as much on average as physicians in other wealthy countries. Because our doctors are paid, on average, more than $250,000 a year (even after malpractice insurance and other expenses), and more than 900,000 doctors in the country, that means we pay an extra $100 billion a year in doctor salaries. That works out to more than $700 per U.S. household per year. We can think of this as a kind of doctors’ tax.

Doctors and other highly paid professionals stand out in this respect. Our autoworkers and retail clerks do not in general earn more than their counterparts in other wealthy countries.

Most Americans are likely to be sympathetic to the idea that doctors should be well paid. After all, it takes many years of education and training, including long hours as an intern and resident, to become a doctor. And people generally respect and trust their doctors. But they likely don’t realize how out of line our doctors’ pay is with doctors in other wealthy countries.

However, as an economist, I look for structural explanations for pay disparities like this. And when economists like me look at medicine in America – whether we lean left or right politically – we see something that looks an awful lot like a cartel.

The word “cartel” has some bad connotations; most people’s thoughts probably jump to OPEC and the 1970s crisis caused by its reduction in the supply of oil. But a cartel is not necessarily completely negative. It means that the suppliers of a good or service have control over the supply. This control can be used to ensure quality, as is the case with many agricultural cartels around the world. However, controlling supply also lets the cartel exert some control over price.

In the United States, the supply of doctors is tightly controlled by the number of medical school slots, and more importantly, the number of medical residencies. Those are both set by the Accreditation Council for Graduate Medical Education, a body dominated by physicians’ organizations. The United States, unlike other countries, requires physicians to complete a U.S. residency program to practice. (Since 2011, graduates of Canadian programs have also been allowed to practice in the U.S., although there are still substantial obstacles.) This means that U.S. doctors get to legally limit their competition. As a result, U.S. doctors receive higher pay, and like anyone in a position to exploit a cartel, they also get patients to buy services (i.e., from specialists) that they don’t really need.

There are two parts to the high pay received by our doctors relative to doctors elsewhere, both connected to the same cause. The first is that our doctors get higher pay in every category of medical practice, including general practitioner. If we compare our cardiologists to cardiologists in Europe or Canada, our heart doctors earn a substantial premium. The same is true of our neurologists, surgeons, and every other category of medical specialization. Even family practitioners clock in as earning more than $200,000 a year, enough to put them at the edge of the top 1 percent of wage earners in the country.

The other reason that our physicians earn so much more is that roughly two-thirds are specialists. This contrasts with the situation in other countries, where roughly two-thirds of doctors are general practitioners. This means we are paying specialists’ wages for many tasks that elsewhere are performed by general practitioners. Since there is little evidence of systematically better outcomes in the United States, the increased use of specialists does not appear to be driven by medical necessity.

In recent years, the number of medical residents has become so restricted that even the American Medical Association is pushing to have the number of slots increased. The major obstacle at this point is funding. It costs a teaching hospital roughly $150,000 a year for a residency slot. Most of the money comes from Medicare, with a lesser amount from Medicaid and other government sources. The number of slots supported by Medicare has been frozen for two decades after Congress lowered it in 1997 at the request of the American Medical Association and other doctors’ organizations.

Furthermore, Medicare exerts little control over the fields of specialization in the residency slots it supports, largely leaving this up to the teaching hospitals, which have an incentive to offer residencies in specialties from which they can get the most revenue per resident. This means they are more likely to train someone in neurology or cardiology than as a family practitioner.

Policymakers have a number of tools to use to introduce more competition, weaken the doctors’ cartel and get their pay more in line with counterparts elsewhere. One would be simply to fund more residency slots. Medicare could also limit the slots for many areas of specialization and instead insist that more of its funding go to train people as family practitioners.

A second route would be to end the requirement that foreign doctors complete a U.S. residency program in order to practice medicine in the United States. This means setting up arrangements through which qualified foreign doctors could be licensed to practice in the United States after completing an equivalent residency program in another country. The admission of many more doctors would put downward pressure on the pay of doctors in the United States, as insurers would have a new pool of physicians to add to their networks who will accept somewhat lower compensation.

Another approach is to not only change the rules around who can practice, but to change the rules around what doctors do. There are many procedures now performed by doctors that can be performed by nurse practitioners and other lower-paid health professionals. For example, many states now allow nurse practitioners to prescribe medicine without the supervision of a doctor, and there is no evidence that this has resulted in worse outcomes for patients. (It does, however, reduce health care costs.) The scope of practice of nurse practitioners and other health professionals can be extended in this and other areas for which they are fully competent. This would both directly save money and further reduce the demand for doctors, putting more downward pressure on their pay.

Yet one more approach is being tested in Missouri: While a doctor can’t practice independently without completing a U.S. residency program, Missouri will now allow foreign-trained doctors to practice under the supervision of a U.S.-trained doctor. This should also help to increase the supply of doctors.

51 Republican Senators Vote to Cut $1.5 Trillion from Medicare/Medicare to Give the Rich Tax Cuts

In a few words, that’s absolutely terrible.

Along strict party lines, the Republican-controlled Senate on Thursday night voted to pass a sweeping budget measure—one criticized as both “despicable” and “horrific” for providing massive giveaways to corporations and the super-rich while eviscerating funding for social programs, healthcare, education, and affordable housing.

The measure passed by 51-49 vote, with only one Republican, Sen. Rand Paul of Kentucky, joining every Democrat and the chamber’s two Independents who voted against it. Its approval now paves that way for massive tax giveaways to the wealthy and corporations envisioned by President Donald Trump and the GOP in both the House and the Senate.

“51 Republican Senators just voted to cut Medicaid by $1 trillion and Medicare by $500 billion so that millionaires and corporations can get a tax cut. It’s immoral and despicable,” said TJ Helmstetter, a spokesperson for Americans for Tax Fairness, in a statement immediately following the vote.

Though the budget resolution itself is nonbinding, MoveOn.org’s Ben Wikler notes how the Senate passage on Thursday represents the “starting gun for what might be the most consequential legislative fight of the Trump era: the looting of the U.S. treasury to reward billionaire GOP donors and mega-corporations, at the expense of the rest of us.” And with the Senate resolution now in place, a reconciliation process can begin with Republicans in the House, meaning the GOP can “shoot for a tax bill without a single Democratic vote.”

In the wake of its passage, Sen. Bernie Sanders (I-Vt.)—who earlier this week called the proposal “Robin Hood in reverse” for taking from the poor to give to the rich— said the “Republicans’ budget is not a bad bill. It’s a horrific bill.”

Statement from Patriotic Millionaires:

This morning, in response to the Senate’s passage of a budget resolution that would cut nearly $1.5 trillion from Medicare and Medicaid and give massive tax breaks to wealthy individuals and corporations, the Chair of the Patriotic Millionaires Morris Pearl, former Managing Director at BlackRock, Inc., released the following statement:

“The budget just passed by the Senate is not only irresponsible, it is downright cruel. This horrific budget would harm millions of vulnerable Americans all to give even more money to the richest among us. The Senators who voted to cut Medicare and Medicaid by a combined $1.5 trillion just to give millionaires like me a tax cut have betrayed their constituents, catering instead to the demands of their wealthy donors. Both the Senators and their donors should be ashamed to trade the future of this nation for their short-term financial self-interest.”

Here’s an image that illustrates what class war looks like:

Saddening

Horrible Trumpcare Proposal Returns, Threatening Millions

The cruelty of the proposal to remove the health insurance coverage of millions — to receive a tax cut for the richest people in the country — is being seen again, unfortunately. Even business interests with some moral decency should support the vastly more efficient single-payer model instead.

The Trumpcare zombie has risen from the grave to terrorize the American public once more.

Progressive organizations, lawmakers, hospital groups, and healthcare specialists have issued a “red alert” as reporting over the weekend indicated that Senate Majority Leader Mitch McConnell (R-Ky.) is considering a vote by the end of this month on what Sen. Bernie Sanders (I-Vt.) called Sunday “yet another disastrous Republican proposal to throw millions of people off health insurance.”

In an email to supporters Sunday night, Ben Wikler, Washington director of MoveOn.org, warned that the Republican Party “is now a hair’s breadth away—closer than they’ve ever been—to passing a devastating healthcare repeal bill, shredding the Affordable Care Act  (ACA), and gutting Medicaid.”

“All we need is one more [vote],” Sen. Pat Roberts (R-Kan.) concluded.

The plan under consideration was authored by Sens. Lindsey Graham (R-S.C.) and Bill Cassidy (R-La.). Summaries of the bill indicate that, if passed, it would be every bit as harmful as the Trumpcare proposals that failed to escape the Senate in July.

The Graham-Cassidy plan—”Trumpcare by another name“—has yet to be analyzed by the Congressional Budget Office (CBO), but McConnell has asked for the scoring process to be fast-tracked, the Washington Post reports.

But even without a CBO score, experts have said there is enough evidence to conclude the plan would impose devastating and deadly cuts to key safety net programs and disproportionately harm America’s most vulnerable communities.

In a recent analysis, the Center on Budget and Policy Priorities (CBPP) found that the Graham-Cassidy plan would “gut protections for people with pre-existing conditions,” impose “damaging cuts” to Medicaid, and “cause many millions of people to lose coverage.”

By 2027, the Graham-Cassidy plan “would be virtually identical to a repeal-without-replace bill,” the CBPP concluded. “CBO estimated that the repeal-without-replace approach would ultimately leave 32 million more peopleuninsured. The Cassidy-Graham bill would presumably result in even deeper coverage losses than that in the second decade.”

Andy Slavitt, who ran the Centers for Medicare and Medicaid Services during the presidency of Barack Obama, posted a bullet-point summary of the proposal on Twitter last week. The post has since garnered over 42,000 retweets—just one indication of the groundswell of opposition the legislation will likely provoke.

Horrible Trumpcare

As the Post‘s Elise Viebeck and David Weigel observe, the GOP is working with an imposing deadline: September 30 marks the last day the Republicans can ram through budgetary legislation with merely a simple majority. Beyond that date, the GOP will need 60 votes.

The Senate may vote without an adequate CBO score too.

CBO-Scoring-Sept-2017