Search This Blog

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