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Wednesday, March 28, 2018

The Endangered American Family

How America Has Broken the Social Contracts for Our Children
Trump Administration Republicans are intent on cutting social contracts for middle-class and lower income Americans, by undermining funding, creating negative campaigns about publicly funded programs, and voiding enforcement of current regulations. This article examines these primary expenses for families; healthcare, childcare, housing, and education in the United States, as compared to other industrialized countries.
The cost of U.S. healthcare is higher than anywhere else, yet the benefits and access to care are at the bottom of industrialized countries. As discussed in my 2013, book and many articles over the past decade, this is primarily due to a system which has little cost controls and reimburses healthcare providers on the basis of volume. The Trump Administration has removed the tax penalty for nonexempt families who do not obtain health insurance, which will undermine participation in the ACA insurance exchange programs. Further, the current administration has threatened to remove the tax credits which enable middleclass and lower middleclass Americans to obtain insurance. According to the Kaiser Foundation, the average cost for health insurance for a family is now $18,301 for private plans through employers. (Kaiser Foundation State Health Facts, 2018) Republican plans to lower the cost of health insurance include; reinstating pre-existing conditions for people with health issues, excluding maternity coverage, and absurdly low maximum benefit levels.
Finally, the cost of healthcare, does not mean your insurance payments, it means the total cost of services, administration, out of pocket expenses, and of course the insurance premiums.  This link shows healthcare spending in 2015, using World Economic Forum data.

The ability to afford childcare is fundamental to economic mobility. Countries which do not produce enough children have challenges filling jobs, supporting social programs for current beneficiaries of social programs, like Social Security, and maintaining public services. Excluding Monaco, which is primarily a retirement haven for the wealthy, as well as a small French protectorate off the coast of Newfoundland, and Andorra the adorable tax haven situated in the Pyrenees, Japan still leads the pack for the lowest birth rate. For this criterion, the U.S. is in the middle of the pack, ranking 158 out of 226 nations. (CIA Factbook-2017, 2017)  Of the industrialized countries, here are top child producers:

Industrialized Country
Birth per 1,000
North Korea
Brazil and Ireland
New Zealand
United States

The most expensive childcare is in the U.K., which includes England, Scotland, and Wales. The U.S. has the next most expensive childcare, consuming over 25% of family household incomes. (Organisation for Economic Co-operation and Development, 2016) Currently, the U.S. has no mandatory paid maternity or family medical leave policy. The Family Medical Leave Act, enacted in 1993, required employers with 50 or more employees to provide up to 12 weeks of unpaid leave for an employee or family member engaged in the care of a family member. Employees are entitled to this leave every 12 months. Though 66% of women work during pregnancy, there has been no change in this mandate.

Scandinavian countries provide families with subsidized high-quality childcare, free preschool, and a monthly stipend per child. Parents receive anywhere from 12 to 20 weeks of paid maternity leave. These generous social policies mean that most women are able to work and support themselves while having children, at living wage jobs, including single mothers. Even the UK now provides 15 hours of free childcare for all children (as of 2017). Virtually all European nations provide some type of childcare for working families and in Western Europe this is typically 15 to 30 hours per week. (Janta, 2010)

Home Affordability
In the United States there are many variables to housing costs, depending on a rural or urban location and the availability of employment, which can support housing costs. This is why housing indexes tend to measure housing costs in major metropolitan areas and not the sparsely populated ones. Though housing costs for home buyers tend to be more affordable here than in other nations, for renters, costs are out of control in many regions of the country. That said, housing is a key issue for families so here is a metric illustrating how the U.S. compares to other developed nations with the most expensive listed first. This chart includes data from 2017 for 2018 cost of living values. (, 2018)

Multiple of Income   Housing Affordability Ratio
Hong Kong
Rio De Janeiro
Vancouver, CA
New York
San Francisco

Rental Housing
However, when viewing housing affordability and rent, a 2015 Harvard study of 11 countries revealed the U.S. was the second most expensive for renters, after Spain. U.S. renters spend 34% of disposable income on housing and low-income households are much more likely to spend 50% of household income on rent (28% of U.S. renters spend >50%). The study found that the degree of income inequality, which is by far greater in the U.S. than these nations and the availability of housing allowances determined the level of affordable rentals. This exhibit shows the housing subsidies provided by European countries compared to the U.S. (Micheal Carliner, 2016)

Percentage of the nation Receiving Housing Allowance
Value of Annual Housing Allowance in USD
United Kingdom
Not listed
Not listed
Local funding
Local funding

*These values were drawn from other sources for the 2015 year, due to the way the Harvard article expressed the data. (Organisation for Economic Co-operation and Development, 2016)

Though obtaining a university education is not a goal for all residents, it is considered a measure of upward mobility, not only for the individual but for generations of family members. Since the U.S. has continued to under fund public universities, universities have relied more on user’s fees, tuition increases, and private endowments to pay for higher education. Follow this link to a Forbes article citing the Organisation for Economic Co-operation and Development, which shows U.S. tuition costs compared to the world, based on 2017 data. (Organization for Economic Development, 2018)
Education policy changes under consideration in the Trump Administration include: eliminating PELL grants for low-income students, cutting back on federally subsidized student loans, eliminating loan forgiveness for those who go into public service roles like nursing or education, and turning loan programs over to for-profit entities, which will raise the costs for students. None of these changes would impact children of the wealthy, whom have already been gifted the biggest tax break under the Trump budget, since Ronald Reagan, only working-class people trying to better themselves.

Anyone with a pulse would conclude the U.S. is not a very easy place to raise children, with the highest rate of mass shootings in the world (the only places that come close are war zones), laws that allow employers to discriminate against working parents, and a nominal social safety net. Not only are these factors impacting highly skilled workers, where out migration has increased since George W. Bush, but the continued efforts by the Republicans to cut social safety-net funding jeopardizes future generations. The U.S. government doesn’t effectively track residents who move to other countries, but maybe it should learn why natives are fleeing the country. The number of Americans who have left the country is anywhere from two to nine million and those legions include retirees, professionals working elsewhere, and those who don’t want to raise their families in the U.S. If Trump wants to make America great again, why doesn’t he look at the adverse policies making it extremely expensive to raise children, who are after all, future tax payers. The proposed federal budget further increases the federal deficit to give tax breaks to the super rich further undermining the nation’s ability to meet Social Security and Medicare/Medicaid obligations. Let’s be clear, these are the only working class social programs for Americans and Trump, Ryan, and Mulvaney would like to get rid of them through program and funding cuts.

This article was written by Roberta Winter, an independent journalist and author of :

For the next three months I will be raising money for the inaugural Russell Ride, an epic 858 mile bicycle ride from Washington to California, in memory of my brother. All proceeds go to the Benaroya Research Institute to cure Type 1 Diabetes. For more information, follow these links:

Agency, U. S. (2017). CIA Factbook-2017. In C. I. Agency, The World FactBook 2017. Retrieved March 27, 2018, from

Janta, B. (2010). Caring for Children in Europe-How Childcare, Parental Leave, and Flexible Working Arrangements Interact in Europe. Rand Rand Corporation-Europe. Retrieved March 28, 2018, from

Kaiser Foundation State Health Facts. (2018, March 28). Kaiser Foundation State Health Facts. Retrieved from Henry J. Kaiser Family,%22sort%22:%22asc%22%7D

Micheal Carliner, E. M. (2016, September 1). Rental Housing-An International Comparison. Harvard University Joint Center For Housing Studies. Retrieved March 28, 2018, from (2018, March 27). Property Prices Index 2018. Retrieved from

Organisation for Economic Co-operation and Development. (2016). Affordable Housing Database-Key Characteristics of Housing Allowances. Paris: Organisation for Economic Co-operation and Development (OECD). Retrieved March 28, 2018, from

Organization for Economic Development. (2016, December 22). These Are The Countries Where The Parents Spend The Most On Childcare. World Economic Forum. Retrieved March 27, 2018, from

Organization for Economic Development. (2018, March 27). Education At A Glance. Retrieved from Organization for Economic Development:    

Sunday, March 11, 2018

Suicide-How Does Your State Compare

Washington State has been undergoing an outcomes-based, health systems improvement plan and a health outcomes scorecard is part of that process. While perusing the most recent health scores for the 2016 calendar year, I was astounded to learn that Washington has a much higher suicide rate which is 16 persons per 100,000 compared to the national average of 13 per 100,000. (Department of Health, 2018) In other words, there are 20% more suicides in Washington based on a population rate, than the average rate for the United States. Even more disturbing is the rate of suicide is increasing in Washington. This astounded me, so I reviewed national data from the Centers for Disease Control and here are the findings from the 2015 survey. (National Center for Health Statistics, 2018)

States posting the highest suicide rates per 100,000 lives were cold and sparsely populated outposts:
  1. 28.0-Wyoming
  2. 26.9-Alaska
  3. 25.3-Montana
States with the Lowest Suicide Rates per 100,000 lives were all on the east coast, which is a densely populated region with good health care access.
  1. 7.2-New Jersey
  2. 8.0-New York
  3. 8.8-Massachusetts

1    Despite all of the news coverage on murders, suicides outnumber murder in the U.S. two to one. It is estimated that there are 45 attempts for every suicide. A 2002 Harvard study of all fifty states found that where there are higher levels of gun ownership, suicide rates are higher. (Kiewra, 2008) For example, Wyoming has a 63% rate of gun ownership and the highest suicide rate in the country.

Comparing the U.S.’s Statewide Bipolarity of Suicide Rates to the World
Suicide is a global problem and though it is higher among poverty-stricken countries, even wealthy European nations have high suicide rates. In fact, the seat of the European Union, Belgium, has one of the highest rates of suicide in the world, with 20.5 deaths by suicide out of 100,000 in 2015. (World Health Organization, 2017) Eastern Europe led the pack for suicides, with Lithuanians doing the deed at a rate of 32.7 out of 100,000. In fact, Europeans collectively had the highest suicide rate in the world in 2015, according to the World Health survey. Even the beautiful country of France had a markedly higher suicide rate than the U.S. with 16.9 deaths per 100,000 people.
The highest suicide rate in the world in 2015 was in Sri Lanka with 35.1 deaths per 100,000, equal to the rate of deforestation of their tropical rain forests(49% loss of forests by 2005). Belgium was only in 2nd place, followed closely by Koreans at 32 deaths per 100,00 souls.
In the Americas, the U.S.A. ranked 6th for its overall suicide rate in 2015, with 14.3 suicides per 100,000 people. The worst suicide rate in the Americas was Guyana, with 29 self-inflicted deaths per 100K, followed by Surinam at 26.6, and Bolivia at 18.7. But even Cubans have a robust suicide rate of 14.1 deaths per 100,000. Amazingly, Canadians, the well-mannered neighbor to the north with national healthcare has a high suicide rate at 12.3 deaths per 100,000.
 In the Pacific, New Zealanders, in the dreamscape without predators, scored a relatively high rate of suicide as well, with 12.6 deaths per 100,000.
Good News
Now for the good news potential retirees, the least suicidal place in the world in 2015 was Barbados at  .40 or less than one half of a person per 100,000 very content souls. Brunei was next at 1.3 lives, followed by Jamaica at 1.4 lives lost to suicide per 100,000 happy folks.

Information on Which to Act
Given the prevalence of suicide, which occurs in both our youth and people in the prime of their earnings years (the Washington survey revealed that males aged 45-55 had the highest rate of suicide) this is a public health crisis. The most popular suicide method is a gun, causing 51% of the deaths. In a recently published study, examining 32 years of firearm ownership in households and suicide data across all fifty states these were the conclusions: (Michael Siegel)
  • ·         State levels of firearm ownership were associated with increased levels of firearm related suicide among males and females
  • ·         Higher levels of gun ownership were associated with increased rates of suicide by any means for males

Whites were found to have the highest suicide rates, followed by American Indians, Pacific Islanders, and Blacks. Speaking to gender, girls attempted suicide twice as often as boys, with Hispanic girls posting a 15.1% suicide rate, compared to 6.8% for White females. Further examination of methods to reduce this disturbing phenomenon is merited, but in the short term here are resources for those in need.

Washington State has a number of suicide prevention coalitions which may be found at:

Other Washington State Resources include a Suicide Prevention Resource Center at the capital in Olympia:

Harvard’s Injury Control Research Center created a campaign to reduce suicide called Means Matter, which educates the public to keep guns out of the hands of the vulnerable and youth.[1] Reducing access to guns can reduce suicide in the depressed. Other initiatives to reduce suicides in the U.S. include:

National Institute for Mental Health has a suicide hotline-800-273-TALK (2735)

American Foundation for Suicide Prevention has a support network for those with suicidal thoughts and their family members found at:

This is the healthpolicymaven signing off wishing you fully informed consent and a more positive outlook. The healthpolicymaven is a trademark, continuously in use since 2007, owned by Roberta E. Winter, a freelance journalist and healthcare analyst. Winter is the author of a consumer’s guidebook to the U.S. healthcare system,


Department of Health, W. S. (2018). Washington State Public Health Survey 2016 Results. Washington State Department of Health. Retrieved March 11, 2018, from
Kiewra, K. (2008). Guns and Suicide: A Fatal Link. Retrieved March 11, 2018, from
Michael Siegel, M. M. (n.d.). Firearm Ownership and Suicide Rates Among US Men and Women, 1981–2013. 106(7)(July 2016). doi:
National Center for Health Statistics. (2018). Suicide Mortality By State. U.S. Centers for Disease Control, Department of Health and Human Services. Centers for Disease Control. Retrieved March 11, 2018, from
World Health Organization. (2017). Suicide Mortality Rates in 2015. World Health Organization . World Health Organization. Retrieved March 11, 2018, from

Sunday, January 14, 2018

Trump is Still in Office-Resources for Defending the Attack on Your Health

Donald Trump has been the President for a year and it has been as nightmarish as imagined. This article provides information on organizations which are providing government reports and consumer information which have been stricken from government web sites. The federal government, under orders from the Trump Administration and his cabinet, are no longer protecting citizens. We must be vigilant in our clarion call to the electorate and disseminate documents which are based on scientific rigor and impact your health and well being.
Further, since 2018 launches a new year, whether you follow the Christian or Lunar calendar, it is a time for reflection and renewal. Despite dislocating my shoulder in a bike accident on Burlington Northern Railroad tracks and later getting hit by a car in March of 2017, I still managed to log over 3,000 miles (4,828 kilometers) on bike, which is my preferred mode of transportation. In addition to publishing this column for eleven years, I have also been a health and public policy book reviewer for the New York Journal of Books for the past seven years. My advocacy work extends to promotion of the Lown Institute's Right Care Campaign and scientific research projects conducted at universities and foundations.

Books which will inspire the awake state and include helpful information on resources to help you:
Dr. Elisabeth Rosenthal's An American Sickness-How Healthcare Became Big Business and How You Can Take It Back is chock full of examples and tips on how to avoid opportunistic behavior in the U.S. healthcare sector. Rosenthal provides direct references for identifying medical procedure prices, how to vet hospitals (as I did in my 2013 book, Unraveling U.S. Healthcare-A Personal Guide), understanding medical bills, assessing whether a test or procedure is necessary, and how to protest against surprise bills and outrageous charges.

Geoff Dembicki's Are We Screwed? How a New Generation is Fighting to Survive Climate Change, shows how social media and the millenial generation are forging consumer driven organizations to promote incorporation of healthy environmental stewardship and action.

David Cay Johnson's It's Even Worse Than You Think-What The Trump Administration is Doing to America is released this month. He provides information on how you can get access to workplace injury and deaths, which have been stricken from the Department of Labor's Occupational Safety and Health Administration site.(David Cay Johnston, It's Even Worse Than You Think, p. 61) As a part of the Trump Administration's war on regulation, they don't want to report workplace deaths. Jordan Barab, former administrator at OSHA has created a site to post this information, which is found at:
Other rules which will impact workers include silica, widely used in construction and dental labs . The Trump Administration has ordered a freeze on regulations to protect workers from silica dust. Here is a link to an article detailing mortality with exposure to silica dust, from the Centers for Disease Control. (David Cay Johnson, It's Even Worse Than You Think, p.66)

And this is the healthpolicymaven signing off wishing you good health informed by information you can trust. Roberta Winter is an independent journalist, health policy analyst, and author of the 2013 guidebook, Unraveling U.S. Healthcare-A Personal Guide, Rowman and Littlefield.

Sunday, December 3, 2017

Changes Impacting Consumers Under the Trump Administration-What You Need to Know

Americans have survived a jarring first year under the Trump right-wing juggernaut. This article shows changes which have already occurred in the government, which will have far reaching effects on your wallet, liberty, health, and security. The critical areas are listed in alphabetical order, not necessarily in order of importance.
Banking-Consumer Protections

Consumer Financial Protection Agency (CFPA)
Dodd-Frank Act was created to prevent the global banking collapse of 2007, due to big banks and hedge funds trading on unsecured junk quality mortgages. The U.S. gov. under President Obama had to lend money to banks to prevent a total collapse- 623 billion was loaned and 390 billion has been repaid.
The CFPA was created to fight predatory behavior by banks. When lenders have violated federal regulations, they must pay a civil penalty and/or make financial amends to the consumer. Here is a link to the companies whom have had to pay up:
So far, the CFB has awarded 11.5 billion to 29 million consumers from abusive lenders. This works out to $407 per individual.[1] Money has come from auto lenders, payday operations, and student loans scammers

Banks have been whittling away at the core requirements for adequate reserves. This means banks want to get back to the wild west of gambling with your money. Janet Yellen, retired head of the Federal Reserve oversaw compliance and enforcement of these provisions. Republicans are saying Dodd-Frank is stagnating the economy when the unemployment rate is 5%. Billionaire Treasury Secretary Steve Mnuchin a former Goldman Saks investment banker, is responsible for the rollback. Here is an article on the billionaire banker’s wife expressing no empathy for the average Americans these laws protect.[2]
Congress passed the Financial Choice Act on June 8, 2017.[3] This law will kill many of the Dodd-Frank fiscal responsibility requirements.
Under Obama, in November 2017, Congress approved a rule voiding banks (credit card companies) from mandatory arbitration requirements in contracts with consumers. [4]  Arbitration is a legal trick to limit consumers ability to seek legal remedy (class action settlements) for rip-offs by banks.)
 Trump appointed Mick Mulvaney director of the Consumer Financial Protection Agency, against the recommendations of the outgoing director. Mulvaney, former cabinet appointee of the Office of Management, responsible for slashing funding to healthcare and other programs is determined to limit its effectiveness. This means, no consumer watchdog and a free-for-all for the banking industry.  You can look forward to more of the predatory Wells Fargo behavior reported this year.[5]

Former head of Health and Human Services, Tom Price was fired due to overuse of expensive tax payer funded charter flights. He is replaced by drug company executive, Alex Azar, whose approval is pending.

Republican congressmen are resolute on cutting funding to healthcare, including stopping the subsidies under the Affordable Care Act, removing the requirement that businesses with 50 or more employees provide insurance, and equal access to women’s health services.

Don’t expect to see any reduction in drug prices. He worked for Eli Lily for 10 years. He will look at ways to change the Affordable Care Act. He will certainly review FDA processes. Not sure what he will do about funding.
Currently, the Republican’s have refused to reauthorize funding for the Children’s Health Insurance Plan, which has been used to provide healthcare for low-income children for the last 4 presidencies. Currently 8 million children receive healthcare this way. Republicans are willing to give tax breaks to billionaires but not provide healthcare for kids.[6]
Judiciary-Your Liberty
Republican Congressmen refused to appoint Obama appointees for federal judgeships,[7] the backlog is over 100 open court positions in the circuit court, district courts, and federal court positions.
Trump has nominated 50 judges for lifetime appointments. Currently right wing Republican Congressmen are fast tracking lawyers considered unqualified by the American Bar Association, those whom have never tried a case, and whom have sworn loyalty oaths to obscure religious sects.[8] [9] (Goodstein, 2017) Are these the people you want deciding case law for your property, liberty, and punitive rights? And of course, Republicans want to gain a majority on the Supreme Court to overturn Roe-v-Wade.
National Security

State Department
Republican Congress is shutting down the bioterrorism prevention lab in NY. The department of Homeland Defense already absorbed a 28% budget cut this year and is slated for more. These cuts are short sited and will go to fund tax breaks for corporations and billionaires.

Rex Tillerson, Secretary of State has cut 2,000 international experts from the State Department. Tillerson repeatedly turned down briefings from Chief of Security, Bill A. Miller, whom had to cite the federal law mandating the Secretary of State listen to security briefings before Tillerson would give him fifteen minutes. It is noteworthy that the entire senior diplomatic staff quit rather than work with this administration. Senior Congressman from both sides of the aisle are concerned about the cuts to the department.

Anthrax spores can kill many people and is undetectable in the mail. Lethal bacteria for which there is no known effective treatment exist. The risk of a bioterrorism event is real and growing. The U.S. is underfunded and unprepared. Every hospital administrator in the country is worried about this.

For all of the hatred sowed toward Hilary Clinton over Benghazi, the current Secretary of State is endangering diplomats all over the world by understaffing, under budgeting, and ignoring security briefings.  It takes decades for someone to learn the customs, languages, and protocols required to be a key asset in foreign affairs and these ignorant actions will cost the U.S. dearly just when we need diplomacy the most.
Personal Safety
Even after the Las Vegas massacre the Republican Congress is trying to pass the Sportsman’s Heritage and Recreational Enhancement Act, which will make it easier for people to acquire silencers, high velocity weapons, and explosives.
The NRA is backing this bill and cares nothing about the toll high velocity weapons have had on the general public. It is all about profit for them. Why should a few people who need to owe machine guns and conversion bump stock kits be allowed to endanger us all? There are more regulations to drive a car than for gun ownership. Congress banned funding for gun violence and cut 2.6 million from the CDC budget after a 1993 study found that homes with guns are three times more likely to have a homicide. The NRA was so concerned that the true costs of gun violence would become widely known, it lobbied for the ban. (Sudermann, 2017)
Both the House and the Senate have passed bills to reduce corporate taxes and those for the top 5% of income earners, ballooning the deficit. The bill cuts corporate taxes by 40% and reduces the top income tax rate. Also, 91% of those earning $500,000 or more per year would get a tax cut. The middleclass are paying for a tax cut for the rich while their healthcare is being stripped.
The nonpartisan Joint Committee on Taxation has stated this budget will add 1 trillion dollars to the federal deficit. The only Republican who had cojones to vote no was Senator Bob Corker. If approved, this will assure higher taxes on working class Americans to pay for existing Medicare, Medicaid, and Social Security obligations. It also will adversely impact the ability of the country to meet future obligations. The Republican Congress have federal pensions and healthcare and they do not care if you have even the skimpiest programs. The bill is fiscally irresponsible.

Merry Friggin Christmas from the Republicans. Let us hope for a better New Year.

And this is the healthpolicymaven signing off, encouraging you NOT to sign blank release forms for healthcare treatment. Do stipulate that for which you consent and that for which you do not. Americans are too often asked to sign a blank check to subsidize some profit-making organization's bottom line. Just as our children will be picking up the tab for the Republican tax cut for the privileged in corporate America.
This article was written by Roberta E. Winter, a health policy analyst, nonfiction author, and independent journalist. Please do share this article virally.