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"Life insurance Social aspects United States History."
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Dead on arrival
Why, alone among industrial democracies, does the United States not have national health insurance? While many books have addressed this question, Dead on Arrival is the first to do so based on original archival research for the full sweep of the twentieth century. Drawing on a wide range of political, reform, business, and labor records, Colin Gordon traces a complex and interwoven story of political failure and private response. He examines, in turn, the emergence of private, work-based benefits; the uniquely American pursuit of social insurance; the influence of race and gender on the health care debate; and the ongoing confrontation between reformers and powerful economic and health interests.Dead on Arrival stands alone in accounting for the failure of national or universal health policy from the early twentieth century to the present. As importantly, it also suggests how various interests (doctors, hospitals, patients, workers, employers, labor unions, medical reformers, and political parties) confronted the question of health care - as a private responsibility, as a job-based benefit, as a political obligation, and as a fundamental right.Using health care as a window onto the logic of American politics and American social provision, Gordon both deepens and informs the contemporary debate. Fluidly written and deftly argued, Dead on Arrival is thus not only a compelling history of the health care quandary but a fascinating exploration of the country's political economy and political culture through the American century, of the role of private interests and private benefits in the shaping of social policy, and, ultimately, of the ways the American welfare state empowers but also imprisons its citizens.
eBook
Beyond Medicine
In Beyond Medicine, Paul V. Dutton provides a penetrating historical analysis of why countless studies show that Americans are far less healthy than their European counterparts.
Dutton argues that Europeans are healthier than Americans because beginning in the late nineteenth century European nations began construction of health systems that focused not only on medical care but the broad social determinants of health: where and how we live, work, play, and age. European leaders also created social safety nets that became integral to national economic policy. In contrast, US leaders often viewed investments to improve the social determinants of health and safety-net programs as a competing priority to economic growth.
Beyond Medicine compares the US to three European social democracies—France, Germany, and Sweden—in order to explain how, in differing ways, each protects the health of infants and children, working-age adults, and the elderly. Unlike most comparative health system analyses, Dutton draws on history to find answers to our most nettlesome health policy questions.
eBook
Neighbourhood greenness and depression among older adults
Neighbourhood greenness or vegetative presence has been associated with indicators of health and well-being, but its relationship to depression in older adults has been less studied. Understanding the role of environmental factors in depression may inform and complement traditional depression interventions, including both prevention and treatment.AimsThis study examines the relationship between neighbourhood greenness and depression diagnoses among older adults in Miami-Dade County, Florida, USA.
Analyses examined 249 405 beneficiaries enrolled in Medicare, a USA federal health insurance programme for older adults. Participants were 65 years and older, living in the same Miami location across 2 years (2010-2011). Multilevel analyses assessed the relationship between neighbourhood greenness, assessed by average block-level normalised difference vegetative index via satellite imagery, and depression diagnosis using USA Medicare claims data. Covariates were individual age, gender, race/ethnicity, number of comorbid health conditions and neighbourhood median household income.
Over 9% of beneficiaries had a depression diagnosis. Higher levels of greenness were associated with lower odds of depression, even after adjusting for demographics and health comorbidities. When compared with individuals residing in the lowest tertile of greenness, individuals from the middle tertile (medium greenness) had 8% lower odds of depression (odds ratio 0.92; 95% CI 0.88, 0.96; P = 0.0004) and those from the high tertile (high greenness) had 16% lower odds of depression (odds ratio 0.84; 95% CI 0.79, 0.88; P < 0.0001).
Higher levels of greenness may reduce depression odds among older adults. Increasing greenery - even to moderate levels - may enhance individual-level approaches to promoting wellness.Declaration of interestNone.
Journal Article
Exploring the Social Determinants of Mental Health by Race and Ethnicity in Army Wives
Objective
To explore the social determinants of mental health (SDoMH) by race/ethnicity in a sample with equal access to healthcare. Using an adaptation of the World Health Organization’s SDoMH Framework, this secondary analysis examines the socio-economic factors that make up the SDoMH by race/ethnicity.
Method
This paper employed configurational comparative methods (CCMs) to analyze various racial/ethnic subsets from quantitative survey data from (
N
= 327) active-duty Army wives. Data was collected in 2012 by Walter Reed Army Institute of Research.
Results
Initial exploratory analysis revealed the highest-scoring factors for each racial/ethnic subgroup:
non-Hispanic Black
: employment and a history of adverse childhood events (ACEs);
Hispanic
: living off post and a recent childbirth;
junior enlisted non-Hispanic White
: high work-family conflict and ACEs;
non-Hispanic other race
: high work-family conflict and not having a military history. Final analysis showed four models consistently explained clinically significant depression symptoms and four models consistently explained the absence of clinical depression symptoms, providing a solution for each racial/ethnic minority group (non-Hispanic Black, Hispanic, junior enlisted non-Hispanic White, and non-Hispanic other).
Discussion
These findings highlight that Army wives are not a monolithic group, despite their collective exposure to military-specific stressors. These findings also highlight the potential for applying configurational approaches to gain new insights into mental health outcomes for social science and clinical researchers.
Journal Article
United States trends in active surveillance or watchful waiting across patient socioeconomic status from 2010 to 2015
BackgroundProspective evidence supports active surveillance/watchful waiting (AS/WW) as an efficacious management option for low-risk prostate cancer that avoids potential treatment toxicity. AS/WW schedules require regular follow-up and adherence, and it is unknown to what extent patient socioeconomic status (SES) may impact management decisions for AS/WW. We sought to determine whether AS/WW use in the United States differs according to patient SES.DesignUsing the Surveillance, Epidemiology, and End Results Prostate with AS/WW Database, all adult men diagnosed with localized low-risk prostate cancer (clinical T1–T2a, Gleason 6, and prostate-specific antigen <10 ng/mL) and managed with either AS/WW, radical prostatectomy, or radiotherapy were identified between 2010 and 2015. SES tertile was measured by the validated Yost Index (low: 0–10,901; middle: 10,904–11,469; high: 11,470–11,827). AS/WW trends were defined across SES tertiles from 2010 to 2015. Logistic multivariable regression defined adjusted odds ratios (aOR) for receipt of AS/WW by SES tertile.ResultsIn 50,302 men, AS/WW use was higher with increasing SES tertile (24.6, 25.3, and 30.5% for low, middle, and high SES tertiles, respectively; PTrend (SES) <0.001). From 2010 to 2015, AS/WW use in the low, middle, and high SES tertiles increased from 11.2 to 37.3%, 14.1 to 45.8%, and 17.6 to 46.4%, respectively (PTrends <0.001). By 2015, likelihood of AS/WW became comparable among the middle vs. high SES tertiles (aOR 0.96, 95% confidence interval (CI): 0.83–1.11, P = 0.55), but remained lower among the low vs. high SES tertile (aOR 0.73, 95% CI: 0.64–0.83, P < 0.001).ConclusionsAS/WW use for low-risk prostate cancer in the US differs by SES. Despite increases in AS/WW across SES from 2010 to 2015, patients from low SES received significantly lower rates of AS/WW compared with higher SES groups. SES may therefore influence management decisions, where factors associated with low SES might act as a barrier to AS/WW, and may need to be addressed to reduce any disproportionate risk of unnecessary treatment to lower SES patients.
Journal Article
Pandemics: avoiding the mistakes of 1918
As bodies piled up, the United States' response to the 'Spanish flu' was to tell the public that there was no cause for alarm. The authority figures who glossed over the truth lost their credibility, says John M. Barry.
Journal Article
A Political History of Medicare and Prescription Drug Coverage
This article examines the history of efforts to add prescription drug coverage to the Medicare program. It identifies several important patterns in policymaking over four decades. First, prescription drug coverage has usually been tied to the fate of broader proposals for Medicare reform. Second, action has been hampered by divided government, federal budget deficits, and ideological conflict between those seeking to expand the traditional Medicare program and those preferring a greater role for private health care companies. Third, the provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 reflect earlier missed opportunities. Policymakers concluded from past episodes that participation in the new program should be voluntary, with Medicare beneficiaries and taxpayers sharing the costs. They ignored lessons from past episodes, however, about the need to match expanded benefits with adequate mechanisms for cost containment. Based on several new circumstances in 2003, the article demonstrates why there was a historic opportunity to add a Medicare prescription drug benefit and identify challenges to implementing an effective policy.
Journal Article
When I'm sixty-four
A crisis is looming for baby boomers and anyone else who hopes to retire in the coming years. In When I'm Sixty-Four, Teresa Ghilarducci, the nation's leading authority on the economics of retirement, explains how to confront this crisis head-on, revealing the causes behind the increasingly precarious economics of old age in America and proposing a bold plan to guarantee retirement security for every working citizen. Retirement is one of the hallmarks of a prosperous, civilized market economy. Yet in America today Social Security is on the ropes. Government and employers are dismantling pension security, forcing older people to work longer. The federal government spends billions in exemptions for 401(k)s and other voluntary retirement accounts, yet retirement savings for most workers is falling. Ghilarducci takes an unflinching look at the eroding economic structure of retirement in America--and what she finds is alarming. She exposes the failures of pension regulators and the false hopes of privatized Social Security. She tells the ugly truth about risky 401(k) plans, do-it-yourself retirement schemes, and companies like Enron that have left employees without any retirement savings. Ghilarducci puts forward a sweeping plan to revive the retirement-income system, a plan that will ensure that, after forty years of work, every American will receive 70 percent of their preretirement earnings, guaranteed for life. No other book makes such a persuasive case for overhauling the pension and Social Security system in order to provide older Americans with the financial stability they have earned and deserve.
eBook