Robert Scheer SI Podcast

The US Spends Almost as Much on Healthcare as the Rest of the World Combined and Has One of the Worst Outcomes

Esteemed physician Dr. Stephen Bezruchka explains why spending the most in the midst of inequality and flawed politics produces an unhealthy prognosis.

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Health can be a complicated matter within a society. For example, the United States spends almost as much as the entire world combined on health care, yet millions remain uninsured and drowning in medical debt. To help understand this, Scheer Intelligence host Robert Scheer welcomes Dr. Stephen Bezruchka, a former emergency physician, current scholar of the impact of economic inequity on health, and author of “Inequality Kills Us All: COVID-19’s Health Lessons for the World.”

Dr. Bezruchka’s journey through some of the country’s most elite universities including Harvard, Stanford and Johns Hopkins landed him in a position to study medicine not only in the field but in the macroeconomic sense as well. In the 1970s, he worked as an emergency physician in the U.S. and taught medicine in Nepal, setting up a community health project there. Since then, he’s worked with Physicians for Social Responsibility, the 1985 Nobel Peace Prize winner, and drawing attention to socioeconomic factors affecting the health of societies.


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He points out that in the 1950s, life expectancy in the U.S. was within the top five or ten healthiest countries in the world. But other countries began surpassing us. By 1970, the U.S. ranked 17th, dropping to 22nd by the early ‘90s, and more recent data has the U.S. ranked as 44th. “That is, among UN countries, which doesn’t include Taiwan and Monaco and other small populations, there are 43 countries where people live longer lives” he said.

His new book explores just how deadly inequality can be to humanity and explores how even the smallest of policy changes, like parental leave, can make a huge impact on the long-term health of an individual’s life. “Only two countries in the world with a population of a million or more don’t provide [paid] time off to parents after you have your baby. So that is really important. Why do we not have a paid parental leave act in this country?… And this is for the richest, most powerful country in world history,” Dr. Bezruchka said.

Credits

Host:

Robert Scheer

Producer:

Joshua Scheer

Transcript

Robert Scheer:

Hi, this is Robert Scheer with another edition of Scheer Intelligence, where the intelligence, I hasten to say, comes from my guests. And in this case it’s Dr. Stephen Bezruchka. I hope I got that right. But who has written a fascinating book. He’s a fascinating guy, I’m going to let him describe his own life. He’s a mountain climber. He’s been in Nepal teaching medicine. You know, he worked with Physicians for Social Responsibility, which won the Nobel Prize for their concern of nuclear war. But this new book, which is just out now, as we’re doing this interview, is called “Inequality Kills Us All: COVID 19 Health Lessons for the World.” And tell me the thesis, because basically you acknowledge we’re in some ways doing more than we’ve done now with Medicare and everything, the Expansion and Affordable Care Act. And yet we have terrible outcomes and you even keep some kind of record like a health Olympics. So, you know, just basically tell us why we spend a lot of money. Why do we have such lousy outcomes? 

Stephen Bezruchka:

So I worked as an emergency physician for 30 years, and the easiest diagnosis I could make in the emergency department was that somebody was dead. So it’s very hard to fake being dead. And so I’d like to look at whether you’re dead or alive as a measure of health. And all rich countries collect birth and death information and this allows us to come up with a number called life expectancy or lifespan, average length of life for a year in question if the mortality didn’t change. So I got… So back in the 1950s, although we didn’t live such long lives, our health, measured by life expectancy, were within the top five or ten in the world. That is, we were one of the healthiest countries in the world. And the same is true for other mortality measures of health. But then other countries began seeing more rapid improvements in length of life than we did. So by the time I went to medical school in 1970 at Stanford, we ranked 17th among countries, remember we were in the top five or so in the early fifties. By the time I went to public health school—because I decided after playing doctor for so many years that I had to figure out why the United States was not so healthy compared to other countries—so when I went to public health school in 1992, we were 22nd, meaning people in 21 countries had longer lives. Well, in the most recent data published by the United Nations Human Development Report in September, we now rank 44th. That is, among UN countries, which doesn’t include Taiwan and Monaco and other small populations, there are 43 countries where people live longer lives. And I don’t know about you, but I think most of us would rather live a longer life than a shorter one. So among these countries that have longer lives are all the other rich countries, some like Chile or Czech Republic or Slovenia or China or even Thailand now have eclipsed us, people there appear to live longer lives. So this begs the question why? And so what I just described is what I coined the term health Olympics. Suppose health were an Olympic event and the race was how long you live. Countries compete in the Olympics and so if health were an Olympic event measured by life expectancy, we wouldn’t be there for the final day’s race. We would have been disqualified in the trials. 

Scheer: Course, in your book, I just want to jump in for a second because we have this recent example of the pandemic. And in your book, you discuss our terrible performance with the pandemic. And you, I want to say, what is so pressing about your book, I think, is that you raised the question of inequality, not just in delivery of health care, but inequality in the society. And one thing that’s happened to the states, income inequality for the last 40 years, we’ve had a terrible downward spiral. And we have, you know, a dramatically more unequal society in terms of how people live. So that, to my mind, reading your book was sort of the main contribution. We’ve had some recent books showing this horrible inequality. We’ve also had discussions about why we lead the world in and deaths connected with the pandemic. Could you connect those two subjects to where we are? 

Bezruchka: 

Yes. So, you know, as I tried to figure out why this was happening, I came up with two ideas that really explain it. The primary one is, as you say, increasing inequality. And this is something we actually have chosen to have. That is, we decided to aggrandize the billionaires and let them have as much as they can take. Starting with Reaganomics back in the 1980s, and it’s continued at pace so that now our inequality is scandalously extreme. So how can inequality kill? I mean, that’s the title of the book and kills us all. There’s no one who can escape the mortality caused by inequality. Well, one thing inequality does is create a lot of stress in society. And we can see this in today’s newspaper with the mass shootings down in Colorado Springs. Inequality is creating more stress amongst us, and we act out this stress in a variety of ways. Studies have linked mass shootings to county inequality and the presence of high incomes in those counties. And in Colorado Springs, there are some pretty wealthy people there. The longest life expectancies are in two nearby counties in Colorado, in the whole country. Not that far away are the lowest life expectancies in the country, namely Pine Ridge Indian Reservation in Oglala Lakota County. So we have a huge difference in health outcomes within the country and studies show this is true. This is related causally to inequality and COVID comes into this because if you look at the states with the highest mortality or the counties with the highest mortality, depending on which particular period of the pandemic you look at, inequality kills people from COVID. 

Scheer: 

Can you explain how that works? 

Bezruchka: 

Okay. So when you have a highly unequal society, poorer people within that realm actually have poorer physiology. I tend to do this when I’m teaching a class by looking at lung function. If you take a deep breath and try to blow out as much as you can in one second, poorer people are going to blow out less air in one second than richer people. So poorer people through epigenetic mechanisms are constituted differently biologically than richer people. And the people who mostly succumbed in the pandemic have been poorer people by and large and older people, you and I fall into that realm, but older, poorer people rather than richer, poorer people. That’s the most important thing to consider. Poorer people have poorer health. And the reason is the inequality within the society that causes that. 

Scheer: 

But in your book, I just want to clarify, because I found it fascinating. You say it’s not just a question of what money we spend because we spend a lot on health care or the gadgets or the mechanics and so forth. You say it starts with birth or it starts with your first years. So take us through that because and connect it with the word you use in the book quite often, neoliberalism. I mean, we have an idea that has dominated us for the last 40 years. You know, Reagan and Bill Clinton, these were the two pioneers, really, of the kind of deregulation that led to increased inequality. But, you know, in your book, you mention we came out of World War II with a great belief in increasing, improving health care, improving everything, and we abandoned that. So show us how it actually works. 

Bezruchka:

So the first point or early life lasts a lifetime. So as we go from the erection to the resurrection, it’s the first thousand days after conception when roughly half of our health as adults is programmed. You know, there are exceptions. But by and large, if you don’t have a healthy early life, if you’re conceived in poverty and grow up in poverty, you’re not going to be so healthy later on. So, societies can privilege early life in a variety of ways. One way is to give a working woman who’s pregnant paid time off after she has her baby. Only two countries in the world don’t provide that ability. One is, of course, the United States. We can’t afford it, it said. And the other country is Papua New Guinea, half of a big island north of Australia. Only two countries in the world with a population of a million or more who don’t provide time off to parents after, paid time off, after you have your baby. So that is really important. And why do we have policies? Well, why do we not have a paid parental leave act in this country? Well, you know, it’s being discussed in the current administration, but it’s thought to be too costly. And this is for the richest, most powerful country in world history. Now, as you pointed out, we came out of World War II with a much more equal society where the people who gained the most income in the first decade or two after the war were the poorest fifth. In other words, the rising tide lifted the  rowboats more than it lifted the yachts. The rich didn’t like this of course, the rich have always wanted only one thing throughout history, and that’s everything. So they began scheming to lower the highest marginal tax rate, which was 96% in 1946, to, well, Reagan lowered it to below 30%. And now it’s a bit above that, but not much, not much above that. And that was through a variety of political policies that we embraced beginning in the 1970s called neoliberalism. And that basically means let’s go back to the liberalism of the 1800s, when markets sort of determined what happened and governments did not spend money for the people. And we were touted as a meritocracy. You know, you work hard and you get what you deserve. And so we’ve done this through decreasing taxes on the rich and somehow we believe in the American dream, namely before we die, we’ll strike it rich. But the American dream is a nightmare. You’ve got to be asleep to experience the American dream. So we have come up with a situation with absolutely staggering economic inequality and worse health outcomes than, well, 50 or so other countries. And to achieve this, we spend one sixth of our total economy on medical care, which is almost as much as the rest of the world combined. So having worked as a doctor… 

Scheer: 

Wait, I got to stop you right there. Now, I know you got a master’s in public health along with an M.D. and your book is well documented. Is that really true, what you just said? I’ve never heard that before. 

Bezruchka: 

Okay. So if you go to the World Health Organization or even to the… 

Scheer: 

Well, repeat the statement, first of all, because I just want to make sure I heard it right. 

Bezruchka: 

So we spend on health care about $4 trillion. If you take the amount of money that other countries spend on health care, all the other countries in the world, it’s a little over $4 trillion. All the other countries combined. But not much. 

Scheer: 

How come? How come? I’ve never heard this statistic. It’s stunning. I’ve heard a statistic that we spend as much on the military as the rest of our countries combined. I’ve never heard this. Because if that’s true, how could we have such miserable outcomes? 

Bezruchka: 

Well, that assumes that health and health care are synonymous. You know, do you want health or health care? Most people in this country use the phrase health to mean health care. We invest in health access. Help pay for health. Ensure health. So just by using that phraseology, we think it’s healthcare that is produced, it’s healthcare that produces health. You know, so we should ask the question, do we want health or health care? Clearly, we don’t have health. We have a lot of uninsured people now numbering in the tens of millions or more. A lot of people don’t have access to health care while it’s being considered now, you know, Bernie Sanders and AOC are talking about Medicare for All. Ralph Nader, people like that. At least it’s on the table. But it was never discussed, it was off the table for discussions about the Affordable Care Act. So you know, if you ask the question, how much do we spend, it’s easy to come up with the figures on the Internet. For 2019, it was $3.8 trillion. We don’t have accurate figures for 2021, although most people estimate it’s in the same $4 trillion ballpark and adding up the rest of the country’s expenditures. You can get that from our own, well from the Institute for Health Metrics and Evaluation website, funded by the Gates Foundation. You can get it even. Well, our Central Intelligence Agency in its World Rankings website, this is our own country’s CIA, produces a lot of this data. So if you think I’m spinning a lie, just go to the CIA World Rankings website. There’s no question that what I’m presenting is out there in the public domain. 

Scheer: 

So let me just get the statement correctly. We, the United States, with hardly the largest population, spent as much or roughly as much as the rest of the world combined. And yet, where we’ve got, what, 50 nations that have better outcomes? 

Bezruchka: 

Yes, that’s right. 

Scheer: 

How do you square that? 

Bezruchka: 

Well, you assume it’s health care that produces health. And the evidence for that is actually very limited. I think in the book I cite a study that shows, from Stanford University, that looks at all the studies, considering the rigorous studies, considering the impact of health care on health, and concludes that at most, health care is responsible for about 10% of mortality, avoiding health outcomes. 

Scheer: 

All right. So what are we doing wrong? And why is it connected with income inequality? Because that is the thesis of the book. And you make a compelling case and I forget his name, Pinckney, or whatever, the French scholar who did the major most important recent work on inequality demonstrates that… What’s the causal connection? 

Bezruchka: 

So you’re probably talking about Thomas Piketty. 

Scheer: 

Yeah. 

Bezruchka: 

Right. No capital in the 21st century and in ideology and his most recent book. A lot of people point out the adverse effects of inequality, but very few want to point out the tremendous number of studies that causally show that inequality produces worse health. First studies appeared in 1979. Now there are but at least 400 studies produced, making the link between inequality and worse health. Income inequality. Wealth inequality. And worse health. And it takes a fair amount of courage to say this in public, even if you believe it, because it sounds preposterous. But, you know, as I say, I look at the morning newspaper today and here’s this mass shooting. And we have quite a few studies linking mass shootings in the United States to measures of income inequality at the county and state level. 

Scheer: 

All right. So let’s you know, we’re going to run out of time here. And I it is probably the most important discussion we could be having, because there is an assumption that if you throw money at problems or spend money and we haven’t talked about the inequality of how that’s spent, but nonetheless, there’s an assumption of a moderate modernity is this assumption with high tech, we have a great medical system and and yet we have lousy outcomes. So give me the main thesis here and how do you fix it? 

Bezruchka:

So we need to rein in inequality… 

Scheer: 

Why? Other than that, it’s, I think, morally defense…I mean, how is inequality killing us? Let’s cut to the chase. 

Bezruchka:

By producing a highly stressed society. For example, if you try to measure stress among countries, we’re in the top five of self-reported stress. So we’re a highly stressed society, and that stress is killing us through a variety of mechanisms I began to describe earlier. The stress is most important when it is there in early life. In other words, if your mother and father were stressed as you were conceived and you lived in a stressful uterus, looking at the world outside, you programmed your physiology to survive, to reproduce. That’s all we’re here for. We’re here to reproduce so the species doesn’t die out and then we pay the price later with all the chronic diseases that we suffer from. Other countries… And another important thing to consider is that other countries have different ways of taking care of the stress in society. Japan, the longest lived country, everybody is stressed there. It’s a stressful society, but they do things together. And one way to observe that is: do you ever see a lone Japanese tourist? No. They’re always together. Have you ever seen a lone American tourist? All the time. I mean, COVID sort of put tourism into a bit of a quiet zone, but it’s recurring now and once again, Americans do things individually. We don’t work together. The big income gap fosters that. I mean, this is a whole variety of ideas that I’m throwing at you. And to try and put them all together is difficult in this short period of time. 

Scheer: 

Well, that’s a reason to buy the book, by the way. We’re talking about a new book and which spells all this out. I don’t expect that in a podcast. This is not a substitute for buying, let alone reading a book. The book is called Inequality Kills Us All. Incredibly documented, thoughtful by a leading expert on health care, Dr. Bezruchka. And the subtitle is COVID-19’s Health Lessons for the World. Okay, so what are COVID-19’s health lessons? I want people to get the book. Check it all out. But just in the time we have, give us the urgency of your message. 

Bezruchka: 

So we are… It is speculated that the SARS-CoV-2 virus is going to continue to pester us, and I think we’re at the end of the beginning of the pandemic. We have had the most deaths of any country in the world and the population in the top ten or 20. And what needs to be done to prepare for the next contagion in what I call the pandema-scene? That is, we’re going to be seeing an era of a lot of these contagions that are going to kill us. And we have to change the political system that has created the catastrophe that COVID visited upon us in the last few years. That will require political choices that we, the people, make. We have chosen to have a few billionaires, and we can choose to not have them. 

Scheer:

Well, what does that really mean? I mean, we spend a lot of money, but some people spend more money and have more money spent on them. What is your subtitle is COVID-19’s Health Lessons for the World. What are they? If I’m preparing for the exam. Okay, I’m going to take the final now. And what are you looking for here? You’re going to ask that question. What are COVID-19’s health lessons for the world? 

Bezruchka: 

Very simply, economic inequality portends worse. COVID 19 outcomes. We have studies of 84 countries. We have studies within the United States at the state and county level. You know, the studies are very clear. And so the lesson is we have to decrease inequality. We also have to do something about poverty in this country. Inequality and poverty are close cousins. And we have more poverty within the United States than any other rich country. And this is killing us. 

Scheer: 

How? How does this inequality kill us? 

Bezruchka:

I go back to the same idea. It causes more stress. Basically, for example, there’s a study done on air rage, namely, if you go in a passenger airplane that has a first class cabin. And there’s more air rage, you know, various kinds of behaviors in the plane, then if there is no first class cabin, if you enter through the first class cabin rather than behind it, as on many jumbo jets, there’s less air rage in first class. So when the people in first class see us walking by, they really get wigged out if they don’t see us walking by, there’s a little less air rage, but it’s especially present in coach class. What is that telling us? It’s telling us that class differences are making a huge impact on our society. That’s air rage. And there’s been more air rage now with the pandemic just because inequality has soared. Similarly, there’s more road rage. You can read about that in the papers as well. People are driving more expensive, you know, two garage cars. They’re the ones perpetrating the road rage. What are they doing? They’re expressing the stress in their lives. 

Scheer: 

Well, we saw that in an election. I mean, people seizing the house. Yes. You know, the people’s house of Congress and supporting a president, soon not to be a president then, you know catered to that rage or, you know, as demagogues often do of any party. You know, is that also a health problem? 

Bezruchka: 

Of course. Of course. And who were the people in the, you know, storming the Capitol? They were from Republican jurisdictions who were relatively poor. And so we’ve actually seen that coming from a Republican state or county. Your health is going to be worse than coming from a more Democratic county. You see this at the political jurisdiction level. And that’s because, you know, there are these factors called deaths of despair. White, middle aged adults are dying in greater numbers from alcohol, drug and suicide causes of death because they’re not achieving the American dream and they’re blaming themselves. That’s the weird thing in this country. You know, you blame yourself for what is basically a political problem. It’s not your personal failing. 

Scheer: 

Well, you know, we’re both of an advanced age. And in your book, you talk about how our consciousness about class has evolved. And I would say in the post World War II period, there was an illusion. It had long been a powerful idea in the American experience, that we were going to become a classless society in terms of at least opportunity. It didn’t happen. It went the other way, actually. We haven’t solved our systemic racial problems. So that’s an important source of class distinction. But now we, as you point out in the book, have all of these mechanisms for increasing class distinction. And so I wanted to tap into your wisdom as a practicing physician who’s practiced in other countries as well, but also, given your master’s in public health, the idea of your book and really introduces is that the main reason America has become less healthy, considerably so, is because we have failed really the early promise of that postwar period of the New Deal, of a kind of idealism that we grew up. People like us grew up accepting it as the norm. 

Bezruchka: 

Yes. I mean, what can I say? You brought up racism. And, you know, we’re a very highly racialized society and African-Americans have much worse outcomes, not as bad as the American Indians or indigenous populations. And the other thing is that I mentioned several times, poorer people have poorer health. And that’s a class distinction. And the two are tied together as Isabel Wilkerson’s book on class, The Origins of Our Discontents, points out we, you know, we’re supposed to be a middle class society, but the middle class has been hollowed out. You know we have half of the country really… it can be classed as being poor and we have a much smaller middle class. And then we have not the richest 1%. It’s really a 100th of that, that basically has all the power in society. They make the decisions. They control the corporations. We think we have democracy in terms of electing our political leaders. But given the corporate power, we don’t have democracy in the workplace. So that’s another thing that needs to be worked on. But, you know, you get what you measure. And as long as we measure wealth creation, remember the Dow Jones Index, that’s about wealth creation or the Nasdaq. We need to measure our health compared to other countries. And rather than seeing our health decline now, absolutely. We need to reverse that and get it moving, improving and improving compared to other countries. And what’s that going to take? Well, it’s becoming aware of how healthy we are in comparison to other countries. So we should report the Doug Jones index. You know, how is Doug and his family doing rather than the Dow Jones index? And I would offer Doug Jones and his family, they’re not doing so well. 

Scheer: 

So that’s a summary. I mean, you’re looking at the world figures as well as the U.S. So which countries are doing better and how do they escape this or minimize the impact of this insecurity? I mean, what you know is that they were social democratic countries like Germany, France and England to some degree or once of considerable degree. What is the difference? 

Bezruchka: 

So let’s take the longest lived country in the world, Japan. We have a lot of lessons to learn from Japan because in the Second World War… 

Scheer: Oh, can I just interrupt you? I found that fascinating in your book, you point out that we encouraged the Japanese in the occupation to do sensible things that we haven’t done ourselves. 

Bezruchka: 

Exactly. Exactly. We put in place the policies that Japan needed to have to become the healthiest country in the world. So what were those? You know, we had destroyed Japan at the end of the Second World War, dropped two atomic bombs on them, firebombed Tokyo, and their life expectancy was estimated to be around 24, 25 years at the end of the war. We then occupied the country and sent the world’s greatest population health doctor there, General Douglas MacArthur, to occupy the country and revive it, resurrect it, so to speak. And so he came up with three policies that he actually wrote into the Constitution. The United States is responsible for producing Japan’s post-World War Constitution. One of the articles was Article nine, which said Japan shall never maintain a military, an army. They shall resolve disputes peacefully that’s written into their constitution. They put a public health clause into the Constitution, namely, the government is responsible for the health of the people. That’s Article 23, and they also broke up the large concentrations of power. There were 13 big family owned corporations, Zaibatsu. And MacArthur said, you can’t have such concentrations of wealth and power and have a democracy. That was another part of the constitution, namely universal suffrage. They’re going to have a democracy. But he broke up the concentrations of power of the 13 Zaibatsu. Also, Japan has a rice farming economy and some 37,000 landowners. Had 50 million peasants working the rice farms. And again, MacArthur said, you can’t have such concentrations of power. He bought the land from the landlords, sold it to the rice farming tenants, and gave him a 30 year low interest loan to pay for the land. And the Japanese had poor loans so most of them had paid off the loans in a year and 94% of all the land in Japan changed hands. Historians call it the most successful land reform program in history. So by democratization, decentralization, that is redistributing, and demilitarization, those three principles produced the most rapid improvements in health ever seen on the planet. And by 1978, Japan was the longest lived country. 

Scheer: 

And they are today. 

Bezruchka: 

And remain so today. And Japan is a lesson for us to understand that the political nature matters far more than personal behaviors. Out of all the countries, out of all the rich countries, Japan has three times as many men smoking cigarettes as in the United States. If I told you that’s the reason Japan’s so healthy, namely, everyone smokes there, and by the way, if you’ve been to Japan, you can easily observe their smoking behaviors everywhere. So Japan is an example of a country that achieved the best health status in the world by means of policies that we enforced upon it. And personal behaviors don’t matter so much in producing this. And similarly, health care doesn’t matter that much. 

Scheer: 

But you know, I could stop you there and we’ll get people who will be shocked by this smoking example. But I want to wrap this up. And I didn’t give you a proper introduction, but you’re the rare figure out of the very successful, you know, the best colleges and all. And you haven’t sold your soul to, you know, people try to charge us more money for medical or just collecting greater wealth. So it’s late in the discussion. But I’m trying to get people to read your book because I thought it was fascinating. And who are you? You went to Harvard and then took us through mountain climbing briefly, everything else you’ve done. But how come you didn’t use your privilege to just make our health system worse? 

Bezruchka: 

Well, I started, I grew up in Toronto, Canada. My father repaired shoes. We lived above the shoe repair store. And I grew up in a working class neighborhood. And I never appreciated inequality because most of us were all pretty similar in this neighborhood. And then when I studied mathematics and then I went to the University of Toronto, and then I went to Harvard to graduate School of Mathematics, and suddenly I was among all these privileged people. And I came to understand that there was something wrong about that. I had been climbing mountains. And so I decided to go to Nepal and get close to the highest mountains in the world. And I lived amongst people who had essentially nothing, and they didn’t realize how little they didn’t have because we didn’t have the fancy communications channels that we have today. I then had the privilege of going back to the United States to go to medical school, and I chose Stanford again. How did a shoe repairman’s son do something about his step? But are you still there? 

Scheer: 

Yeah.

Bezruchka: 

How does a shoe repairman’s son up his status? Well, since I did well in school. I went to prestigious schools. So Harvard, Stanford, then Johns Hopkins. But I realized that that kind of status was not something that I really wanted to achieve. I would rather be known for what I did and taught and talked about than the prestigious schools I went to. So although it’s a way to improve your status, I’m hoping that the ideas that I talk about and express are far more important than that. 

Scheer: 

So I feel that’s why we’ve taken this time to get at the book and we haven’t done it justice. The book is a really important contribution to the discussion about health care and the quality of life. It’s called Inequality Kills Us All is just out now. The subtitle is COVID-19’s Health Lessons for the World. Dr. Bezruchka, I always get that wrong. But let me say, it’s really, if you want to read one book about what’s wrong with our healthcare system and what we can do about it, that’s it. And that statistic that we talked about before, I’m still going to as soon as I get off, I’m going to check that out. But if it is true that we spend more. And let me get it right, we spend more or as much on health care as approximately the rest of the world. And we have this poor outcome. Have I stated it correctly in conclusion? 

Bezruchka: 

Yes. I mean, not as much as the rest of the world combined. It’s just, you know, close to where we’re talking about 44% of the world’s health care bill back in 2019 was spent. 

Scheer: 

And where do we rank? Where are we? 

Bezruchka: 

The best figures are those of the United Nations. And there we ranked 44th behind Barbados, Croatia, Thailand, Qatar. And all the other rich countries. 

Scheer: 

Well since you were at one point active in the Nobel Prize winning Physicians for Social Responsibility, there is a parallel where we also spent, you know, roughly about somewhere 40% or whatever to 50% of our military. And yet we’ve had one of these winless wars and endless wars and nonsensical wars after another. So there is a parallel. Anyway, I want to thank you for doing this. Urge people to get Inequality Kills Us All. I want to thank the folks at our NPR station, KCRW in Santa Monica, and for hosting this show, Laura Kondourajian and Christopher Ho. I want to thank Joshua Scheer, our executive producer and J. K.W. Foundation in memory of Jean Stein, a terrific writer and journalist who helped fund these shows. See you next week with another edition of Scheer Intelligence. 


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  1. Excellent article! Going from 5th healthiest in the 1950’s to 44th healthiest today shows a long process where parallels can be made to many other factors besides the all important inequality (as noted, chosen by Americans, or at least our simpleton leaders). The off-shoring of jobs, innovation, the satisfaction of a job well done, manufacturing industry now largely replaced by financials, a “do you want fries with that?” service economy, and of course the military industrial complex and MICIMATT, which dominates American life and no doubt contributes to the violence of American society. While the Rich coastal elite Democrats no doubt benefit from this re-structuring since the 1950s, the biggest bloc of Democrat voters, Blacks who have voted at least 80% more for Democrat Presidential candidates at least the last dozen elections, have not really benefitted.
    I think the good doctor is totally wrong about Covid, which is a disease which predominantly kills the Elderly. While median age of death in the US is 78 years old, this likely reflects incompetence and poor decisions; the median age of Covid death in most of the globe is 82 (in Australia 85). For sure rapid, free medical care will impact outcomes at all ages, but Covid mostly kills the Elderly (and the Seriously Ill– those with cancer, organ transplants, depressed immunities. Marty Makary infamously noted that going through cases of children’s death from Covid, he never saw and cases of healthy children dying).
    The US (and the WHO) refused to use glucocorticoids to treat serious Covid cases (though reported to be extremely helpful by the Chinese in March 2020 and by the Brits in mid-June 2020; the WHO grudgingly accepted use “in some cases” in August 2020. My veterinarian friends were shocked; glucocorticoids are Standard of Care for serious viral respiratory infections in animals. Conservatively, 30% of early deaths (mostly in Northeastern states could have been prevented with dexamethasone or methylprednisolone treatment. The plus side for the Northeastern states is that the survivors had excellent natural immunity from Covid infection which has served them well since, probably more so than the mRNA vaccines).
    SE Asian countries have pandemics every few years. They shut their borders to China and other infected countries and stopped entry of anyone sick with Covid with standard public health measures. They quarantined the exposed. As a result, they avoided most Covid deaths for over a year, by which time the “leaky” vaccines (not getting into that!) were available. The US refused (“racist!”) to implement border control until after Covid had become “community spread”; border control is useless/ pointless after Covid gets in.
    Our “experts” were all AIDS career researchers (like orthopedic surgeons doing brain surgery). We must not have any respiratory or coronavirus experts in the US?

  2. Excellent interview, but with one exception that I would have liked provided. Firstly, Dr. Berzruchka speaks about causes concerning health care, whereas he states: ” So they began scheming to lower the highest marginal tax rate, which was 96% in 1946, to, well, Reagan lowered it to below 30%. And now it’s a bit above that, but not much, not much above that.
    And that was through a variety of political policies that we embraced beginning in the 1970s called neoliberalism. And that basically means let’s go back to the liberalism of the 1800s, when markets sort of determined what happened and governments did not spend money for the people. And we were touted as a meritocracy [a ruling or influential class of educated or skilled people]. You know, you work hard and you get what you deserve. And so we’ve done this through decreasing taxes on the rich and somehow we believe in the American dream, namely before we die, we’ll strike it rich. But the American dream is a nightmare. You’ve got to be asleep to experience the American dream. So we have come up with a situation with absolutely staggering economic inequality and worse health outcomes than, well, 50 or so other countries. And to achieve this, we spend one sixth of our total economy on medical care, which is almost as much as the rest of the world combined. So having worked as a doctor… ”

    Indeed, economic conditions cause poor health as well as good to excellent heath but using those dates (the mid-forties through today), what with the introduction of processed foods, in light of these dates (I was born in 1955 when such things as processed foods hardly existed, at least not on the levels they do today) have done to and/or for a healthy/non-healthy population? And going along with Berzruchka’s general thesis of a healthy/non-healthy population based on one’s economic situation (as exists in poor rural white and minority communities), we can conclude that eating whole foods and organics is more prevalent in better situated economic communities.

    Yes, it has everything to do with class, but what we consume needs to be in the basic argument and what needs to be done to improve, going forward, in our social structure here in the U.S. For example, in black communities you will have trouble finding grocery stores which possess fruits and vegetables, but you will find fast-food everywhere. And when you move into the realm of pandemics and other such diseases, a healthy immune system will be crucial as to a healthy or unhealthy outcome (and by the way, look into what seniors are fed in “their” assisted living facilities, run by? you guessed it, Wall Street hedge funds and the whatnot).

    One final word: Please look into the work of Gabor Maté MD and especially his new book ‘The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture’ by Gabor Maté MD and Daniel Maté as he’s taking the very same approach to well-being as Dr. Bezruchka has, class and its economic situations reveal.

    A side not: on The Jimmy Dore Show there an interview with Gabor Mate as well as The Chris Hedges Report: Dr. Gabor Maté on trauma, addiction, and illness under capitalism.

  3. A lot of the health problems are solved if people eat organically grown whole grains and vegetables. You are what you eat. I love the idea of breaking up the thousands of acres and letting the small farms grow our food, but don’t think that can happen in this country, however we could be teaching people how grow or select food and prepare how to prepare that food.

    1. This, unfortunately, is simplistic oversimplified and horribly inefficient. Science (good, sustainable healthy science) supports what I just stated. Of course, if you drop the world population from 8 billion, back to 1 billion, it will work.

  4. “busy busy numb: Americans cannot feel themselves alive unless they feel themselves busy”. Thomas de Zengodita.
    concepts of health and disease are culturally normative most famously demonstrated by Foucault. Puritanism is not cherished in Europe S America etc. It should surprise nobody that since 2010 americans have consumed 80+% of the legal psychotropics, 66% anti-depressants on earth.

  5. While this interview is accurate and well founded commentary by a very valid and thoughtful Dr. my response as a long-experienced physician is, “It is worse than you think.” The horror of the details is lost in the broad general comments. The moneyed Power Elite has carefully co opted government agencies to keep these outrageous prices elevated, usually in the range of 10x to 100x their actual cost. That is not an exaggeration. The sophistication usually leaves the well intended reader in the dust. You have to really dig to get the details and to connect the dots. Criminalization is used if BS and confusion are not adequate tools. This is not an accident.
    To make it even worse, these government agencies have now evolved this criminal behavior (criminal if you or I did it, not if they do it) to making them money directly, as opposed to having to collaborate with industry. Health and safety have become perverted tools to achieve just the opposite at great profit to those in power. Remember the CIA using your tax dollars to import drugs to sell to Americans to fund their clandestine activities? The magnitude and sophistication has advanced very far since then. Check out Civil Asset Forfeiture. Check out “Administrative Law ” as a perverted way around those pesky Constitutional rights you thought you had. Misinform you. Keep you fearful. Extract your money. Welcome to the Fascist States of America (Mussolini – “fascism is the perfect union of the State and the Corporation. The individual does not count.” )
    Yes, I can give you detail after horrifying detail of the above.

  6. To me the most significant thing he said was
    “And we have to change the political system that has created the catastrophe that COVID visited upon us in the last few years. That will require political choices that we, the people, make. We have chosen to have a few billionaires, and we can choose to not have them.”
    Well, let’s see – for decades now we have made political choices between 2 parties, D/Rs, and those choices have indeed produced the mess we are in – the inequalities he credits as the cause – as he says, we have chosen to have a few billionaires, and we can choose not to …. That’s a good beginning, now what – can we FINALLY discuss how we indeed move beyond those 2 political parties or are we still stuck in trying to make “better choices” within those parties – why haven’t we figured out, after all these years, that trying to “reform” these Parties for the better is like trying to reform the Mafia from within –
    Mafia – running protection rackets – promising protection to businesses in return for payoffs
    D/Rs – passing protection regs – promising protection to Big Corps in return for payoffs, euphemistically called “campaign contributions”
    Mafia – dividing up territories and keeping other “gangs” out
    D/Rs – dividing up territories and keeping other parties off ballots and out of debates – calling their candidates before Sen Subcommittees as “Putin puppets”

    Prog Dems – putting lipstick on a pig, “see, we are making progress, moving toward M4A, e,g.!” Baloney – they have been saying that for years, even as they go in the opposite direction, “improving” the ACA, a gift to insurance companies – indeed “we” are spending more for “healthcare”, without getting it because we confuse health “insurance” for healthcare – going bankrupt trying to pay for health insurance – choosing between paying deductibles/co-pays and food, rent while the insurance companies get rich off premiums which are useless until those “deductibles” are met … This is a joke, or would be if the results were not so dire – why can’t folks, like Mr. Scheer see this – or do they but refuse to go where we need to go – in support of 3rd parties who are NOT bought by the same interests who own the D/Rs
    What is this Prog loyalty to a Party that has stabbed them in the back over and over – have they really bought this TINA/LOTE BS, what is this addiction to a Party that keeps on screwing us over – when there IS an alternative, and has been one on the ballot for decades – which the Ds KNOW are a legitimate challenge and would be quite popular if allowed to be heard – which is why they are creating absurd barriers to their getting ON ballots – keeping them out of debates – etc – look what happened the last time a 3rd Party was in a Pres debate – Perot in ’92 – “Perot won 18.9% of the popular vote, the highest share of the vote won by a candidate outside of the two major parties since 1912.” After that – no more 3rd parties in debates …
    I truly do not understand how the results of the recent election can be celebrated by Progs as “saving democracy” when they return to office basically the same folks who are helping to produce its crisis
    I am truly dismayed that all our Prog leaders and gurus seem satisfied with “blah, blah, blah” ,,,

  7. The core insight shared by Dr. Bezruchka is ignored by 3 earlier commentators in favor of repeating their favorite hobby horse memes of individualistic self-preservation. What he says is that the United States is 44th in life expectancy, although we are 1/25th of global population but spend as much on billable medical care as the rest of the world combined.

    Michael gestures to the declining ranking (over 70 years), then goes off on a poorly reasoned Covid 19 tirade, without ever asking how Covid originated or where we are in the response. All this while about 9,000 patients continue to die from it every month. Yes, Michael, we are a violence prone police state with phenomenal wealth disparity, but how this makes your pro-eugenic assessment (letting the aged and infirm die) OK I can’t understand. Let’s just say you don’t expect to expire from Covid, and that if you do you’ll be unpleasantly jarred. Your border closing, steroid dosages, and bias against AIDS doctors sounds a little whacky in retrospect. I am thankful (it’s Thanksgiving) that a veterinary dabbler like you was not in charge.

    Mark Ogelsby, no one can deny that Gabor Mate’ is a gem, but I can’t see how you jump from his theories of lifelong and epigenetic trauma to blaming consumers of fast food. (Gabor is a pretty flexile guy, and so I can see him indulging in airport Cinnabon sometimes.) Like Barbara, I don’t eat it myself, but when it represents the bulk of the extant affordable calories available we can estimate that the structural shift necessary to change from junk to quality foods will likely never happen. Mark and Barbara enjoy a restricted premium diet and recommend the same for others, but what they are really celebrating is their financial privileges and immunity from the fate of their inferiors.

    My aim here is not to abuse my fellow commentators but to belittle attitudes instilled in most Americans by our socialization and economic expectations.
    People are better prepared for the advent of nuclear war than for the demise of consumer capitalism, and I include myself. My hobby horse is the demand for universal healthcare administered by a federal bureaucracy, which would produce savings and cut some profit motivation out of the equation.
    Dr. Bezruchka’s observations demonstrate why this is justified immediately, and how it is an interim solution necessary if we are ever going to advance toward a healthier population. Well, maybe we won’t, because some people like me waste their money ordering new sneakers from J.C. Penney online, and others ordering supplements and pristine kale from Japan. I like (degenerate) Larry Summers’ word “stagnant” as a description of where health care restructuring stands, that it is stuck in the collapsing morass of late stage Capitalism, propelling the terminal Anthropocene Epoch. What I suggest is that it is our minds (including Bob Scheer and Stephen Bezruchka) that are stagnant. We are stuck and stinking because we are afraid to loosen our grip on what we mistake as our property birthright. WE fail to understand that health is a collective social concern that can’t be individually owned and that no one is ever hermetically distinct in this biological system. Once we get off the rocking horse (Peloton?) it becomes impossible to keep our mouths shut. It is normal and rational to demand things like Medicare for All (or equivalent) because that is the dynamite that will break the logjam and potentially give us justice, fairness and peace. In my estimation either the cat has just about clawed and chewed out of the bag and that now only a bullet from the dog catcher can stop it .

  8. If we don’t get universal healthcare life will not go on, believe me.
    (Why’d you censor my earlier well thought-out comment?)
    If Scheerpost can show nothing to me, what good would living do me?
    (What I said was that medical restructuring in our sick nation is the best way to break the logjam, that we could advance life quality in other ways once people experienced a better system.)

  9. What does a society value most, treat as its highest priority? Profits? Safety and Happiness of its Citizens? The lives of its Citizens? America has 1,000,000 dead (a certain under-count) because it puts Profits at a much higher priority than the lives of its citizens. And the heck with Safety and Happiness.

    If you live in a society which places your life at a lower value and priority than something else, that is not good. You should not sleep well at night in such a society, as your life can be risked for anything that someone with power regards as higher value than your life.

    You can also expect that the same society won’t care if you shiver this winter because you can’t afford the heat? Profits must be made. The same society will give you a real pay cut in terms of inflation. Profits must be made. It does not matter whether you wear Red or Blue. The great golden calf of Profit rules all, and anyone can be trampled by it.

    Of course, Team Red will try to blame all the troubles on Team Blue, and Team Blue will blame all the suffering on Team Red. That will of course solve problems and lead to better lives for Americans. Just like its done over and over in this century.

    Meanwhile, the only rule that counts in the Rules Based Order still applies …. the rich get richer.

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