from the world's big
America’s Sickening Health System
Jacob S. Hacker, Ph.D., is the Stanley B. Resor Professor of Political Science at Yale University and a Resident Fellow at the Institution for Social and Policy Studies. He is also a Fellow at the New America Foundation in Washington, D.C., and a former Junior Fellow of the Harvard Society of Fellows. His 2007 proposal for universal health insurance, "Healthcare for America," was instrumental in bringing the "public option" to the forefront of the national healthcare debate. He has testified before Congress and written articles for a variety of publications, including The New York Times, The Washington Post, The Nation, and American Prospect. His most recent book, "The Great Risk Shift: The New Economic Insecurity and the Decline of the American Dream," was published by Oxford University Press in 2006 (paperback, 2008).
Question: What has been your personal experience with the healthcare system?\r\n
Jacob Hacker: Well, I think my experiences with the healthcare system have been pretty similar to most Americans. I was born into American healthcare and have grown up not aware that there was anything different. When I was in college, I went and worked on Capital Hill for then-Representative Ron Wyden—he has since gone over to the Senate side—for his chief health assistant. While I was there I came to discover not only what I had already known, which is that there are a lot of problems in American healthcare, but that our system was very different from those systems in other countries.\r\n
So one of the things I did when I went back to college after that summer is started studying why the United States had ended up with such a distinctive system, and ended up writing my senior thesis on the rise and eventual fall of the Clinton health plan, and wrote my dissertation while I was at Yale on the development of America’s distinctive system of workplace social benefits, including healthcare but also retirement pensions.\r\n
So I've been studying this now for most of my adult life, and at the same time I've gotten more and more involved in it as a participant in the debate rather than just a student of it. The story there, which is worth telling, is that as I was studying the development of our distinctive system, I was always wondering why is it that it's so hard to reform American healthcare. After all, we've had efforts from the early 20th century to try to do this, to really address the problems in American healthcare, and they've only grown worse. My answer was that it's hard in part because we failed in the past and we've come to rely so heavily on the sort of jerry-rigged system of private employment-based benefits. And that Americans, while they're worried about the cost of those benefits and worried about their security, and millions of Americans don't have coverage at all or who are unprotected against medical costs, that at the same time people are fearful of changing the arrangements they've come to rely on.\r\n
That's why it's so hard. And I think that's the central reason why this debate is so bitter and fierce. There is really a lot of fear that can be provoked by opponents of reform, and it's amazing we've come as far as we have in the debate, given the history of past defeats.
Recorded on November 9, 2009
Interviewed by Austin Allen
Many of us cling to our "jerry-rigged" system even as it fails us, but early in his career, health reform expert Jacob Hacker saw a clear need for change.
Join multiple Tony and Emmy Award-winning actress Judith Light live on Big Think at 2 pm ET on Monday.
Frequent shopping for single items adds to our carbon footprint.
- A new study shows e-commerce sites like Amazon leave larger greenhouse gas footprints than retail stores.
- Ordering online from retail stores has an even smaller footprint than going to the store yourself.
- Greening efforts by major e-commerce sites won't curb wasteful consumer habits. Consolidating online orders can make a difference.
A pile of recycled cardboard sits on the ground at Recology's Recycle Central on January 4, 2018 in San Francisco, California.
Photo by Justin Sullivan/Getty Images<p>A large part of the reason is speed. In a competitive market, pure players use the equation, <em>speed + convenience</em>, to drive adoption. This is especially relevant to the "last mile" GHG footprint: the distance between the distribution center and the consumer.</p><p>Interestingly, the smallest GHG footprint occurs when you order directly from a physical store—even smaller than going there yourself. Pure players, such as Amazon, are the greatest offenders. Variables like geographic location matter; the team looked at shopping in the UK, the US, China, and the Netherlands. </p><p>Sadegh Shahmohammadi, a PhD student at the Netherlands' Radboud University and corresponding author of the paper, <a href="https://www.cnn.com/2020/02/26/tech/greenhouse-gas-emissions-retail/index.html" target="_blank">says</a> the above "pattern holds true in countries where people mostly drive. It really depends on the country and consumer behavior there."</p><p>The researchers write that this year-and-a-half long study pushes back on previous research that claims online shopping to be better in terms of GHG footprints.</p><p style="margin-left: 20px;">"They have, however, compared the GHG emissions per shopping event and did not consider the link between the retail channels and the basket size, which leads to a different conclusion than that of the current study."</p><p>Online retail is where convenience trumps environment: people tend to order one item at a time when shopping on pure player sites, whereas they stock up on multiple items when visiting a store. Consumers will sometimes order a number of separate items over the course of a week rather than making one trip to purchase everything they need. </p><p>While greening efforts by online retailers are important, until a shift in consumer attitude changes, the current carbon footprint will be a hard obstacle to overcome. Amazon is trying to have it both ways—carbon-free and convenience addicted—and the math isn't adding up. If you need to order things, do it online, but try to consolidate your purchases as much as possible.</p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a>, <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank">Facebook</a> and <a href="https://derekberes.substack.com/" target="_blank">Substack</a>. His next book is</em> "<em>Hero's Dose: The Case For Psychedelics in Ritual and Therapy."</em></p>
Chronic irregular sleep in children was associated with psychotic experiences in adolescence, according to a recent study out of the University of Birmingham's School of Psychology.
A time for sleep<div class="rm-shortcode" data-media_id="Mt29uUqI" data-player_id="FvQKszTI" data-rm-shortcode-id="931343dee3c02121445e51e94ba22446"> <div id="botr_Mt29uUqI_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/Mt29uUqI-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/Mt29uUqI-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/Mt29uUqI-FvQKszTI.js"></script> </div> <p>Previous studies had already suggested a link between persistent nightmares in childhood and psychosis and borderline personality disorder (BPD) by adolescence, but researchers at the University of Birmingham's School of Psychology wanted to see if a similar connection existed between these mental disorders and other childhood behavioral sleep problems.</p><p>To do this, they scoured data from the Avon Longitudinal Study of Parents and Children, a longitudinal cohort study that followed approximately 14,000 children born in Avon, England, in the early 1990s. The study followed the children for more than 13 years. During that time, mothers filled out questionnaires asking about the children's lives. Factors looked at included housing, parenting, nutrition, physical health, mental wellbeing, environmental exposures, and so on. </p><p>The cohort study inquired about sleep routines, sleep duration, and awakening frequency when the children were 6, 18, and 30 months old, and then again at 3.5, 4.8, and 5.8 years. It also assessed mental health in adolescence using semi-structured interviews, such as the Psychosis-Like Symptom Interview.</p><p>"We know that adolescence is a key developmental period to study the onset of many mental disorders, including psychosis or BPD. This is because of particular brain and hormonal changes which occur at this stage," <a href="https://www.birmingham.ac.uk/staff/profiles/psychology/marwaha-steven.aspx" target="_blank">Steven Marwaha</a>, professor of psychiatry at Birmingham and senior author on the study, <a href="https://www.sciencedaily.com/releases/2020/07/200701125431.htm" target="_blank">said in a release</a>. "Sleep may be one of the most important underlying factors—and it's one that we can influence with effective, early interventions, so it's important that we understand these links."</p><p>After compiling the data, the researchers discovered an association between children with irregular sleeping patterns and teenagers with <a href="https://www.mind.org.uk/information-support/types-of-mental-health-problems/psychosis/about-psychosis/" target="_blank">psychotic experiences</a>—that is, episodes when the person perceives reality differently than those around them. Even when depression at 10 years old was considered as a mediating factor, their findings still suggested "a specific pathway between these childhood sleep problems and adolescent psychotic experiences." </p><p>Toddlers with shorter nighttime sleep duration and late bedtimes were likewise associated with a <a href="https://www.nimh.nih.gov/health/topics/borderline-personality-disorder/index.shtml" target="_blank">borderline personality disorder</a>—a disorder marked by a pattern of varying moods, self-images, and behaviors—in their teenage years. Depression at age 10 did not mediate this particular association, suggesting a separate and more specific pathway. </p>
A more restful tomorrow<p>While the sample size was large and mental health was assessed with a validated interview, there nevertheless remain limitations to this data. For starters, sleep habits were based on mothers' reports. Because they came from memory, versus a more direct observation method such as actigraphy, these data may be prone to imperfect recollection and reporting error. There are also many confounders that could be secretly nudging the results, such as family conditions, prenatal medicines, and a host of environmental factors. Finally, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6024884/#:~:text=Sleep%20difficulties%20in%20youth%20with,fear%20of%20dark%20%5B13%5D." target="_blank">the relationship between sleep problems and mental disorders</a> is both complex and two-way.</p><p>As such, the study shows an association between poor childhood sleep later mental disorders but does not prove a causal link. Parents need not worry that a string of nightmares or the eternal struggle settle into bed will be the first ingredients in a witches' brew of debilitating mental disorders. The goal of the study, the researchers point out, is not to create undue worry but improve our ability to recognize the signs of at-risk children and deliver necessary interventions earlier.</p><p>"The results of this study could have important implications for helping practitioners identify children who might be at higher risk for psychotic experiences or BPD symptoms in adolescence, and potentially lead to the design of more effectively targeted sleep or psychological interventions to prevent the onset or attenuate these mental disorders," Isabel Morales-Muñoz, the study's lead researcher, <a href="https://www.healio.com/news/psychiatry/20200702/childhood-sleep-problems-linked-to-adolescent-psychosis-borderline-personality-disorder#:~:text=Sleep%20problems%20during%20early%20childhood,study%20published%20in%20JAMA%20Psychiatry." target="_blank">told Healio Psychiatry</a><u>.</u></p><p>If a parent reading this is worried that their child's sleep patterns are deleterious, the take away should not be despair over an unyielding fate. It should be to seek professional help as soon as possible to begin improving sleep duration and quality. Even if you aren't worried, it's worth remembering that childhood experiences lay the foundation for a lifetime of salubrious sleeping habits. It's so much more than beauty rest.</p>
Construction of the $500 billion dollar tech city-state of the future is moving ahead.
- The futuristic megacity Neom is being built in Saudi Arabia.
- The city will be fully automated, leading in health, education and quality of life.
- It will feature an artificial moon, cloud seeding, robotic gladiators and flying taxis.
The Red Sea area where Neom will be built:
Saudi Arabia Plans Futuristic City, "Neom" (Full Promotional Video)<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="c646d528d230c1bf66c75422bc4ccf6f"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/N53DzL3_BHA?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span>
Are we genetically inclined for superstition or just fearful of the truth?
- From secret societies to faked moon landings, one thing that humanity seems to have an endless supply of is conspiracy theories. In this compilation, physicist Michio Kaku, science communicator Bill Nye, psychologist Sarah Rose Cavanagh, skeptic Michael Shermer, and actor and playwright John Cameron Mitchell consider the nature of truth and why some groups believe the things they do.
- "I think there's a gene for superstition, a gene for hearsay, a gene for magic, a gene for magical thinking," argues Kaku. The theoretical physicist says that science goes against "natural thinking," and that the superstition gene persists because, one out of ten times, it actually worked and saved us.
- Other theories shared include the idea of cognitive dissonance, the dangerous power of fear to inhibit critical thinking, and Hollywood's romanticization of conspiracies. Because conspiracy theories are so diverse and multifaceted, combating them has not been an easy task for science.