We Aren’t Number One…Not Even Close

Donald Trump is accelerating America’s retreat from the world stage, illuminating our national flaws and demonstrating the contradictions between our aspirations and our performance.

Let’s be honest: a nation that could elect this ignorant, unstable man is a nation seriously in decline. If we are really prepared to be honest, we will also concede that America’s social and racial divisions, extremes of inequality and lack of anything approaching an adequate social safety-net aren’t exactly attributes that confer bragging rights, either.

A prime example is our overpriced and underperforming health care system, which our Congressional overlords are eager to make even worse. How long can intellectually dishonest pundits and politicians keep a straight face while peddling the myth that American medical care is “the best in the world”–that “we’re number one”?

The truth is that, if you are very wealthy or have exceptionally good insurance, you can get extremely good care for serious illnesses in the United States. If you don’t fall into one of those categories, not so much. And if you are an average American with a treatable ailment–or an ailment that should be treatable– your prospects are even worse.

Over at Dispatches from the Culture Wars, Ed Brayton reports on yet another in a long line of studies ranking national healthcare systems.

A new study that looks at the effects of highly treatable diseases, ones for which greater access to continual medical care can mean the difference between life and death, finds that the American health care system lags behind much of the developed world.

There are a number of ways to evaluate healthcare systems, but if you are measuring outcomes over a country’s population, rather than touting cutting-edge therapies available only to the privileged few, the U.S. has long lagged other industrialized countries.

Christopher Murray, a researcher at the University of Washington, and his collaborators looked at 32 causes of death in 195 countries from 1990 to 2015 to create a health-care quality index they used for rankings. Murray described the findings as “disturbing.”

“Having a strong economy does not guarantee good health care,” he said. “Having great medical technology doesn’t, either. We know this because people are not getting the care that should be expected for diseases with established treatments.”…

As might be expected, many highly developed nations, such as Norway, Australia and Canada, scored well. Those in more-remote areas in sub-Saharan Africa, South Asia, Latin America and the Caribbean scored poorly…

The United States measures well for diseases preventable by vaccines, such as diphtheria and measles, but it gets almost failing grades for nine other conditions that can lead to death. These are lower respiratory infections, neonatal disorders, non-melanoma skin cancer, Hodgkin’s lymphoma, ischemic heart disease, hypertensive heart disease, diabetes, chronic kidney disease and the adverse effects of medical treatment itself.

The United States spends enormously more for medical care than any other country–twice as much per capita has the next most expensive system. We just spend our dollars in the least efficient ways possible: multiple non-standard insurance forms, laws that prohibit government agencies from negotiating drug prices, and private insurers whose high overhead costs include everything from marketing to sky-high management salaries and corporate jets. (Medicare’s overhead runs about 3% in contrast to 24-26% for private insurance companies.)

Obamacare is far from perfect (what we really need is “Medicare for All”), but its passage did represent a move in the right direction–and an acknowledgement that access to healthcare is a human right, not a consumer good to be made available only to those with sufficient disposable income. But rather than working to improve it with “fixes” that are fairly simple and obvious, the White House and  the Congressional GOP consistently sabotage it, most recently by threatening to end crucial Affordable Care Act payments to insurers. Politico has reported on the move, and the fact that it would guarantee huge premium increases, the withdrawal of insurers from the O-Care markets, and generally cause chaos across the individual health insurance marketplace.

It’s enough to make you think American policymakers put a higher priority on the bottom lines of Big Pharma and Big Insurance than they do on the health of average citizens.

But then, what do we expect when we elect people so corrupt and self-serving they don’t even care about the health of the planet their children and grandchildren will inherit?


  1. We have elected social Darwinists and a demented top dog to positions of power and should not be surprised at the outcome, i.e., a system in which enrichment of the few is favored over the healh and welfare of the many, hardly what Jefferson’s Preamble was about. We should have guessed what would happen with an Ayn Rand Speaker and ruthless majority leader on their respective thrones, all accompanied by statehouse Republican governors who are gerrymandering democracy to death with the aid and support of libertarian nihilists such as the Kochs, Mercers and others who are financing our decline.

    To do: Ruthlessly remove these people from power at the polls and ruthlessly resist their right wing policies that are driving America’s accelerating descent to Third World status. It is ultimately not about who wins and loses political campaigns per se; it’s about survival as a functioning democracy, a goal I often blog about that is one of the last few things left worth dying for.

  2. Unless they have found ways to circumvent the ACA, the overhead costs at private health insurance companies are supposed to be capped at 20%.

  3. Prof K Said
    “It’s enough to make you think American policymakers put a higher priority on the bottom lines of Big Pharma and Big Insurance than they do on the health of average citizens.”

  4. “We should have guessed what would happen with an Ayn Rand Speaker and ruthless majority leader on their respective thrones…”

    Gerald; sorry but, I take serious issue with this petty comparison. It didn’t take until Trump pulled us out of the Paris Accords yesterday for this government to reach the unquestionable status of Machiavellianism. Even “W” and Cheney with their war mongering didn’t reach this level of degeneracy in American leadership which rivals Stalin, Hitler and Idi Amin. It began in Congress after 2:30 a.m., November 9, 2016, when Trump’s election was assured, for them to begin our downward spiral into oblivion.

    Regarding our current health care, or lack thereof, it is not only pre-existing condition coverage which is in danger but, sudden illnesses and injuries. Pete; back to my personal level as always, my son who works for a small masonry company fell at work almost three weeks ago, injuring his knee. After seeking medical care which resulted in the diagnosis of “his age” (he is 49) causing the swelling, severe pain and popping noise his family can hear and refusal by his employer to seek workmen’s compensation to prevent an increase in his premiums; he is in danger of resulting in a permanent disability. It is my firm belief that many people are facing a lack of all forms of medical care at this particular time because ALL health care systems have no idea what their future is or IF they have a future so they are denying care rather than chancing the possibility of no payment when the change comes – whatever that change will bring.

    “It’s enough to make you think American policymakers put a higher priority on the bottom lines of Big Pharma and Big Insurance than they do on the health of average citizens.”

    Well; we can dream, they are still free and one of our freedoms.

  5. I agree that the country is in decline, and it has been for decades as we the people have allowed education to sink to such a level of mediocrity that a large percentage of the population actually believed that a New York City gangster was fit to be president.

    But it has been more than the decline of education that has brought us to this point. It has been the abandonment of morals and principles as churches and civic leadership have given themselves over to the new religion of America, the one true religion of America: the worship of money as god. Little wonder that every single institution in this country has been corrupted to the core.

    Sorry, no dreams… just nightmares becoming real.

  6. I love America, niet Son married a lovely hiel from New Jersey. What astonishes me is that political and cultural “That what separates us is more profound than what binds us.”
    So I would advise you, the people, Make America whole again” E pluribus unum. Love ❤️, from Amsterdam The Netherlands.

  7. This is an abject catastrophe and as David Gergen said on CNN, “grossly irresponsible”. Many thanks to all those that voted for this total train wreck and continue to support it as those in positions of responsibility in this “Administration” continue to obfuscate and lie outright on everything under the sun. It is shameful, totally shameful.

    At some point will the American people snap out of their spin-doctor massaged stupor and realize that we’ve been had and that we have to save this country and its position as a global leader? Are we just going to sit in our lawn chairs and watch everything collapse around us and do nothing? In the long run are we so dulled down by propaganda and “civilization fatigue” that we really don’t care, thinking that things will just work out as they always have? This time they very likely will not.

  8. I am sorry ?, the first sentence of my reaction should be: I love ❤️ America, my son married a lovely girl from New Jersey.

  9. Tom; remember this is a country whose government actually invited the public to bring their families with those lawn chairs and picnic baskets to watch the military test atomic bomb blasts in the deserts outside Las Vegas. “They built it and the people DID come.” The government is now playing around with nuclear weaponry in a pissing contest no one will win and Climate Change and Global Warming will mean no more that a fart in the wind of the nuclear explosions.

    I have yet to see any mention of the total destruction of the ocean where North Korea is testing nuclear weapons; the destruction of our oceans due to melting ice caps and glaciers is due to Global Warming caused by humans. The Great Barrier Reef is reportedly dead; Fukushima is still a major disaster area causing further destruction of Japan and the ocean surrounding that country – destruction from Fukushima’s hazardous nuclear waste making its way to our own west coast.

    Can any of you think of one day; only one day, over the past almost three years that Donald Trump has NOT been the primary news of the day? Are any of you aware of the fact that this is world-wide FREE publicity for all of his businesses? Can any of you see an end in sight? IF there is an end; will any of us be alive to see it?

  10. The downward spiral began with “trickle down” economics under Reagan. Greed is good! It accelerated with the GOPAC policy of nastiness promoted by Newt Gingrich in the 90s. He trained Republicans to go ahead and call Democrats traitors, if that’s what it took to win. “W” elevated mediocrity to the highest office in the land (not that we hadn’t had mediocre Presidents before, but they were at least well read). Then came the Tea Party and with it the end of civil discourse and the beginning of total obstructionism.

    Instead of working with the Obama administration to fix the ACA, the Republicans sued over nearly every aspect of the bill, chipping away at the measures that might keep it solvent for the long term, while denying coverage to millions under the Medicaid expansion.

    So we’ve been asleep at the wheel for over 35 years while our country and all it used to stand for have been stolen. Time to wake up and vote!

  11. It isn’t just health care. It’s education as well. The sow from Hell, Betsy DeVos is the tip of the evil Republican spear that wants to decimate public schools for the sake of her rich pals wanting to make profits off of our tax dollars. We must all fight like hell to stop these people before we do indeed go down the tubes.

    Here is my last essay that you might want to pass along to your friends who may be too lazy to vote.
    What Will it Take, People?


    Vern Turner

    The volume and intensity of news regarding the Trump administration is becoming more convoluted than a John LeCarre’ spy novel. It seems that the corruption, lies, deceit, sedition, incompetence and embarrassing episodes have no limits with this latter-day Romanov impersonation. With each breaking story line, that wonderfully salient line from All the President’s Men keeps cropping up: “Follow the money.” Yes. The money. It’s always been about money for Trump and the Trump-ites, hasn’t it?

    As each investigation plods along, more and more evidence and suspicion is unearthed to cast a dark, thick pall over this presidency and its players. Is it any wonder that Trump has surrounded himself with his faithful family, sycophants of high loyalty and nobody to tell him the truth…who are still around. Firing the unfaithful seems to be the modus operendi for Trump’s management “style”. Ironically, it is this action plus the words from the recently departed Mike Flynn that damns this group of miscreants the most: If they have to invoke the Fifth Amendment or ask for immunity from prosecution, they must be guilty of some crime. Mike must be gagging on his own words these days.

    O.K. Enough about the current news avalanche. I can’t keep up with it and still write a coherent essay without it being out-of-date by the time you read it. No, this essay is about you. You, the voter, or the potential voter. Voting is all we have short of outright revolution, you know. So, which will it be? Will you educate yourself by following the truth? Will you finally realize that much of the media that Trump whines about is indeed worthless? That’s the part that includes Fox News, the Sinclair Group, Alex Jones, Rush Limbaugh and Texas’ own Lt. Governor, Dan Patrick. These entities are indeed fake news. The rest of the ink-stained wretches are actually trying to do their job that the Constitution itself asks them to do and that guarantees them that right to investigate. THEY are not fake news. The irony about Trump’s “fake news” rants is that HE is the fake. His latest adventure to Europe laid to rest any doubts that he is absolutely clueless about anything but himself.

    So, people, here we are stuck with a complete incompetent fool as our national mouthpiece (with a little help from the frightening ideology twins, Steven Miller and Steve Bannon), and a Congress that is shamelessly whoring itself out to him in order to get some bizarre, mean-spirited and self-immolating budget passed. They do this so that the rich Republicans running these Congressional Republicans get yet another pound or three of tax relief flesh from the somnolent taxpayer who isn’t paying all that much attention. That’s the con, folks. The Republican agenda fronted by Paul Ryan and Mitch McConnell are, and have been, predicated on lies about economic realities and regulations that have saved us all from the evil of unchecked greed and avarice from the money moguls.

    Trump and the current collection of Republicans – especially the completely mis-named Freedom Caucus – are there at the explicit invitation of the 0.1% of the richest people in this country. Their sole purpose is to create even more wealth for themselves. It is no coincidence that Congressional districts have been gerrymandered to the point of meaninglessness to the people who live in them. It is no coincidence that brain-dead ideologues like Ryan, McConnell and the rest have only one purpose: to create an oligarchy run by the plutocrats through what is left of the Constitution – which Trump sees as an inconvenience for his dictator wannabe self-serving ideals.

    Do you not see what is happening? Have you been so subsumed by the anti-Hillary and anti-Obama propaganda by the racist white people who want to deny so many of our citizens their rights, that you can’t fathom that our democracy hangs by a thread now? Think of the following scenario the next time you read or hear Trump’s mouth or the Congress’s apology for him:

    The investigations into the Trump collusion, treason and corruption cases starts to identify family members and close associates of Trump that lead directly to him.
    Trump invades North Korea, or bombs them back to the stone age. He could also declare war on Iran for sponsoring the terrorism we can’t defeat.
    Trump suspends the Constitution and declares that Congress is no longer valid. He places himself as absolute authority. Sound familiar?

    Game over. Democracy in the United States dies. No elections. No free press. Suppression of protests. Sounds other-worldly, doesn’t it? Well, the model is well-worn. Every third-world, tin-pot dictatorship has done it this way. Clearly, Trump has the mindset of one of these pots. Remember: “I alone can fix the system.” Get it yet?

    Yes, I mean to scare the daylights out of you, and I don’t mind if you think my concerns are too far-fetched or around the bend. What I care about is that YOU and anyone you can influence get off your asses and start organizing while we still can. We must prepare to defeat every Republican we can in the coming elections – AT EVERY LEVEL, IN EVERY ELECTION, local or national. It is the Republican brand that is undermining our democracy and destroying the American dream for those who work for a living.

    Our middle classes don’t go to work every day and shift billions of dollars around the world for the sake of the rich and the enrichment of themselves. They actually make stuff. They actually come home and put their elbows on the table and try to figure out how they’re going to pay for everything including their child’s education. Ask Betsy DeVos about how they’re going to pay for private school when their tax dollars AND more will be needed because the public schools failed for lack of funding. Go ahead. Ask. What you’ll get is a vapid smile and silence. She is one of the most egregious entities in our government today. Why? Because she is attacking our children’s future and their education quality.

    It’s never been more important to get involved. Your country’s future depends on it.

  12. My high school friend has lived in Vienna, Austria for almost 30 years. When he first moved there he says it was like going back in time. Now, for the past 5-10 years he says when he comes home to visit it is like going back in time. While Europe and the rest of the industrialized world has been moving forward, we have been moving backward.

    He enjoys amazing health care that costs very little. While describing their annual physicals to me last week I had never heard of some of the blood tests and other types of tests that are performed to ensure the good health of their citizens. We have moved backward in so many ways.

    I could go on and on about how they treat their citizens so much better than we are treated here, but that would take up too much time and space. One last item of note though – he commented about how the internet service is SO much slower here than in Europe.

  13. No matter if it is ACA (Obama Care) or Ryan-Trump Care, Insurance Companies are still the Middleman or Gate Keeper for Health Care. Even if you have health care through your employer, the Insurance Company is still the Middleman or Gate Keeper. You have deductibles and co-pays, plus in and out of network scenarios.

    HR 676 sponsored by John Conyers of Michigan – Enhanced Medicare for All. It is health care that includes all medically necessary care, such as primary care and prevention, dietary and nutritional therapies, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care. HR 676 is Single Payer – HR 676 now has 112 Co-Sponsors. https://www.congress.gov/bill/115th-congress/house-bill/676?r=6

    There are 194 Democrats in the House. One important Representative that is absent from the list of Co-Sponsors is Nancy Pelosi the Democratic Leader.

    So why are so many Democrats failing to support HR 676??
    1.) Bull headed Ideology – the fanatic belief in the Free Market.
    2.) Campaign Contributions from Insurance Companies and Big Pharma.
    3.) They do not care about us Proles. I have my Health Care, too bad, so sad your not healthy and wealthy.
    4.) Fear of change.

    If you want to do something positive find out if your Representative is a Co-Sponsor of HR 676, the link I provided has the Co-Sponsors. Andre Carson and Pete Visclosky are Co-Sponsors. If they are not a Co-Sponsor of HR 676, ask them to add their name to the list.

  14. It’s going to take a long time to get medical care where it should be–perhaps a generation or more. Health care outside the home began as the charitable mission of groups of religious women–Catholic nuns, Protestant Deaconesses and Jewish women. The purpose behind their work was to take care of the sick and alleviate suffering by offering compassionate care to enhance human dignity. Eventually, someone figured out that a lot of money could be made for relieving suffering and preventing unnecessary or early death. Medical schools, for a time, actually limited enrollment for the purpose, some say, to keep incomes high. More doctors means fewer patients per doctor, which translates into less income. Next came the insurers, which only encouraged health care to become too expensive for the average person. If there’s insurance, there’s incentive to raise costs. It seems unthinkable that one should need to be insured in order to pay the cost for routine checkups, emergency care and routine prescriptions just to stay alive and not suffer needlessly or die prematurely.

    Now, the system is so bloated and fat with profits for Big Pharma, Big Insurance, massive hospital systems and physicians who went into medicine because it pays well. Yes, I did say that–it’s not universally true, but certainly true in too many cases. Studies show that medical students fight to get into the most-lucrative specialties–which happen to be the ones that pay the most. Specialties such as family practice go begging because the income potential isn’t there. Small communities can’t compete with big cities to get physicians–why? Money, Money, Money. Foreign doctors leave other countries to come to the U.S. as soon as they are eligible, even though the need for care is much greater at home. Why? Money, Money, Money.

    Something must be done to staunch the flow of money. Obamacare attempted to do that. Universal coverage would certainly accomplish this but big insurance, big Pharma, big hospital systems and doctor groups that pull huge incomes aren’t going to go away without a huge fight. People will suffer and die unnecessarily until enough voters get fed up and demand change. Once costs come under control, then perhaps people will go to medical school because of a desire to heal, instead of the desire to become wealthy. Once costs come under control, hospital systems will stop the ridiculous building projects–tearing down perfectly sound buildings, constructing new ones, putting up new hospitals in every little suburb where people have good jobs and good health insurance, throwing away perfectly good beds and other medical equipment once they can’t be written off any more–and sanity will return. I’m afraid this may take a generation, but it must start with slowing down the flow of money.

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