reform

From 1980 until the start of the financial crisis of 2007 and 2008, U.S. households accumulated debt at an unprecedented pace. Back in the 1960s and 1970s, the ratio of total debt to disposable income – a measure that reveals households’ ability to service their debts out of current income – hovered around 70 percent. Thereafter it rose, increasing to 90 percent by 1995 and peaking at 135 percent in 2007, before declining to 110 percent in 2013.

The financial meltdown brought new attention to the debt loads facing American households, in part because many analysts fingered defaults on subprime mortgages as a chief cause of the crisis. But policy responses have focused too narrowly on financial market reforms. Certainly it makes sense to curb the unfair and fraudulent lending practices that have proliferated over the past few decades, yet new financial regulation alone won’t make most working families more economically secure. For that, we must understand and address the intertwined social, political and economic trends that have created insecure labor markets and heightened debt risks. more...

Each year, 48 million Americans suffer from illnesses caused by dangerous microbial pathogens lurking in the food they eat. For most people, food poisoning just leads to temporary stomach aches or diarrhea. But the effects can be much more serious. According to the Centers for Disease Control and Prevention, more than 125,000 Americans are hospitalized and 3,000 die each year from pathogens in our food. Estimates of the cost of food borne illness exceed $75 billion a year – taking into account the cost of health care and lost time on the job for people who get sick. The actual suffering and economic cost could be much greater, because many incidents of mild illness caused by tainted food go unreported.

That eating dinner can result in disability or death comes as a shock to most Americans. Most of us believe that the United States fixed these problems more than a century ago, after Upton Sinclair’s famous book, The Jungle, revealed the ghastly facts about unsafe methods of commercial food processing for a mass market economy. But in fact, the rules and regulations we assume will protect us are inadequate. Duplication and gaps in government responsibilities leave Americans highly vulnerable to a variety of risks from industrial food production. more...

Chronic diseases and injuries are the leading causes of premature death and preventable illnesses in the United States and around the world. Injuries cause many unnecessary deaths among young adults and children. Traffic crashes hurt 50 million worldwide each year, and firearms and alcohol are also leading threats. Meanwhile, half of all Americans suffer from chronic conditions like heart disease, diabetes, and cancer that account for seven out of every ten deaths and eat up three-quarters of health care dollars. By 2030, chronic diseases will cause more than three quarters of deaths worldwide, costing some $47 trillion over the next two decades.

Conventional wisdom attributes the growth of injuries and chronic illnesses to seemingly inevitable causes such as population aging and changing lifestyles. Such forces are at work, of course, but it is the task of public health scientists like me to probe more deeply.

A closer look reveals that many unnecessary injuries and chronic health problems are spurred by what might be dubbed the “corporate consumption complex” – a network of consumer products companies, financial institutions, trade associations, and public relations firms that deliberately urges people to buy unhealthy foods and unsafe products. In 1961, President Dwight Eisenhower warned that the military industrial complex posed a danger to our democracy and well-being. Today, the consumption complex constitutes a similarly grave threat. more...

New England is a compact and relatively liberal region, and its six states—Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, and Connecticut—all had relatively high levels of health insurance coverage before the Affordable Care Act. Yet rates of prior coverage still varied, and these states have made different choices about implementing reform.

Leading into 2014, each U.S. state had two key decisions to make: whether to use federal funds appropriated by the Affordable Care Act to expand its Medicaid program to include people just above the poverty line; and whether to set up and run its own exchange, an online market place where residents can comparison shop for private health insurance plans and find out about their eligibility for federal subsidies to help pay the premiums. more...