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    We need to talk about America’s mental health crisis – and its larger causes | Robert Reich

    I want to talk about an uncomfortable topic that needs much more open discussion than it’s receiving: the United States’ extraordinarily high level of anxiety.A panel of medical experts has recommended that doctors screen all patients under 65, including children and teenagers, for what the panel calls anxiety disorders.Lori Pbert, a clinical psychologist and professor at the University of Massachusetts Chan medical school, who serves on the panel, calls mental health disorders “a crisis in this country”.A recent New York Times article discussed what’s called “persistent depressive disorder”, or PDD, which an estimated 2% of adults in the United States have experienced in the past year.Nearly 50,000 people in the US lost their lives to suicide last year, according to a new provisional tally from the National Center for Health Statistics. (The agency said the final count would likely be higher.)The suicide rate, now 14.3 deaths per 100,000 Americans, has reached its highest level since 1941, when the US entered the second world war.Men aged 75 and older had the highest suicide rate last year, at nearly 44 per 100,000 people, double the rate of people aged 15-24. While women have been found to have suicidal thoughts more commonly, men are four times as likely to die by suicide.Suicide rates for Native Americans are almost double the rates for other Americans.(Some good news: suicide rates for children aged 10 to 14 have declined by 18%, and for those between 15 and 24 by 9%, bringing suicide rates in those groups back to pre-pandemic levels.)What’s going on?Maybe the widespread anxiety and depression, along with the near record rate of suicide, should not be seen as personal disorders.Maybe they should be seen – in many cases – as rational responses to a society that’s becoming ever more disordered.After all, who’s not concerned by the rising costs of housing and the growing insecurity of jobs and incomes?Who (apart from Trump supporters) isn’t terrified by Trump’s attacks on democracy, and the possibility of another Trump presidency?Who doesn’t worry about mass shootings at their children’s or grandchildren’s schools?Who isn’t affected by the climate crisis?Add increasingly brutal racism. Mounting misogyny. Anti-abortion laws. Homophobia and transphobia. Attacks on Asian Americans, Hispanic Americans, Jews, Arab Americans and other minority groups. And the growing coarseness and ugliness of what we see and read in social media.Consider all this and it would almost be stranger if you weren’t anxious, stressed and often depressed.Studies show that women have nearly double the risk of depression as men. Black people also have higher stress levels – from 2014 to 2019, the suicide rate among Black Americans increased by 30%.Are women and Black people suffering from a “disorder”? Or are they responding to reality? Or both?White men without college degrees are particularly vulnerable to deaths from suicide, overdoses and alcoholic liver diseases, with contributions from the cardiovascular effects of rising obesity.Are they suffering from a “disorder”, or are they responding to a fundamental change in American society? Or both?In their book Deaths of Despair and the Future of Capitalism, economists Anne Case and Angus Deaton argue that “the deaths of despair among whites would not have happened, or would not have been so severe, without the destruction of the white working class … .”Part of the problem, they say, is that the less educated are often underpaid and disrespected, and feel that the system is rigged against them.skip past newsletter promotionafter newsletter promotionEven if we had far more mental health professionals, what would they do against these formidable foes? Prescribe more pills? If anything, Americans are probably already overmedicated.Don’t get me wrong. I’m not arguing against better access to mental health care. In fact, quite the opposite. Increased staffing and improved access to mental health care are very much needed.Mental health care is harder to find now than before the pandemic. About half of people in the US live in an area without a mental health professional, federal data shows, and some 8,500 more such professionals would be needed to fill the gap. Most people rely on family doctors for mental health care.Officials are trying to widen familiarity with a national suicide and crisis lifeline that last year received a nationwide number, 988.But in addition to providing more and better access to mental health care, and a suicide and crisis hotline, shouldn’t we try to make our society healthier?Americans experience the least economic security of the inhabitants of any advanced nation. A healthy society needs more job security and stronger safety nets.The distribution of income and wealth in the United States is the most unequal of any other advanced nation. A healthy society ensures that no one working full-time is poor, and levies high taxes on the wealthy to help pay for what society needs.Guns and assault weapons are easier to buy in the United States than in any other advanced nation. A healthy society bans assault weapons and makes it difficult to buy guns.A lower percentage of Americans has access to affordable medical care than in any other advanced nation. A healthy society keeps its people healthy.The United States puts more carbon dioxide into the air per capita than almost any other advanced nation. A healthy society better protects the environment.Big money plays a larger role in American politics than it does in almost any other advanced nation. A healthy society does not allow big money to buy politicians.Some American politicians – like Donald Trump – gain power by stirring up racism, xenophobia and homophobia. A healthy society does not elect these sorts of people.The list could be much longer, but you get the point. The anxiety disorders suffered by Americans are real, and they apparently are growing. But instead of regarding them solely as personal disorders, maybe we need to understand them at least partly as social disorders – and get to work remedying them as a society.Granted, it would be difficult to achieve any of these criteria for a healthy society.But without seeking to achieve them, no number of mental health professionals, and no amount of medications or hotlines, will be enough to substantially reduce the stress, anxiety, depression and suicidal thoughts that so many Americans are now experiencing.In the US, you can call or text the National Suicide Prevention Lifeline on 988, chat on 988lifeline.org or text HOME to 741741 to connect with a crisis counselor. In the UK and Ireland, Samaritans can be contacted on freephone 116 123, or email jo@samaritans.org or jo@samaritans.ie. In Australia, the crisis support service Lifeline is 13 11 14. Other international helplines can be found at befrienders.org
    Robert Reich, a former US secretary of labor, is a professor of public policy at the University of California, Berkeley, and the author of Saving Capitalism: For the Many, Not the Few and The Common Good. His newest book, The System: Who Rigged It, How We Fix It, is out now. He is a Guardian US columnist. His newsletter is at robertreich.substack.com More

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    A capitalist cheerleader wrote the US’s hottest new self-help book. Surprised? | Adam H Johnson and David Sirota

    As economic misery in the US persists, the country’s self-help industry has become a multibillion-dollar bonanza. If one reads enough of that industry’s happiness catechism – including its latest bestseller, Build the Life You Want – one realizes that all of the advice revolves around a core set of directives: focus on the self rather than the collective, redeploy hours to different priorities, spend less time at work, build deeper personal relationships – and, by implication, buy more self-help books.But if “time is money”, then in America’s survival-of-the-richest form of capitalism, time-intensive remedies are mostly for the affluent – that is, those with a big enough savings account to de-risk career changes; those with enough income to afford gym memberships, hobbies and excursions; those with enough paid leave and cash to enjoy the best vacations; those with enough resources to employ personal aides to do paperwork, chores and cleaning; those with enough workplace leverage to secure more hours off for introspection, friend time and outdoor adventures.Erasure of privilege disparity and presumption of wealth has turned most self-help products into a series of Stuart Smalley affirmations for the already and nearly comfortable. But while such class bias pervades the happiness industry, it is particularly egregious coming from the author of the aforementioned Build the Life You Want: Arthur Brooks, hardly a disinterested bystander in this epoch of economic anxiety and its attendant unhappiness.As the former $2.7m-a-year head of the American Enterprise Institute (AEI) – one of the country’s most prominent conservative thinktanks – Brooks spent a decade sowing the despair he now insists he is here to cure.Brooks’ career turn from let-them-eat-cake ideologue to I-feel-your-pain happiness prophet may seem bizarre. But he is walking the well-trodden – and lucrative – path from arsonist to firefighter. It is a trail previously blazed by financial crisis-era deregulators now platformed as credible economic experts, and by Iraq war proponents reimagined as leaders of a pro-democracy resistance.In Brooks’ case, he led an organization that repeatedly worked to help its billionaire and corporate donors prevent working-class Americans from securing the better standard of living, universal benefits and leisure time that undergird the countries consistently reporting the world’s highest levels of happiness.Citing a colleague’s book deriding Americans as “takers”, Brooks insisted the central crisis facing the nation is not a notoriously thin social safety net – but politicians who “offer one government benefit after another to our citizens”, complaining that this “has made a majority of Americans into net beneficiaries of the welfare state”.He declared war on “labor unions and state employees demanding that others pay for their early retirements, lifetime benefits, and lavish state pensions”. Under his leadership, the AEI railed against “entitlement” programs, tried to privatize and gut social security, opposed Medicaid expansion, opposed free college, opposed rent control and fought against free healthcare.Now, Brooks’ pivot to happiness guru is disseminating that political agenda via the soft agitprop of self-discovery and self-improvement. Along the way, Brooks is being boosted by (among others) the Atlantic, NPR and Oprah Winfrey (who is listed as co-author of the book, although in reality she only writes a handful of introductory paragraphs to each chapter) – together the most coveted media seals of approval for liberal readers whose purported ideals Brooks spent his career grinding into political dust, but who are now enriching him with $30 book purchases.On its face, Build the Life You Want offers a mix of reasonable – if banal – life advice, parables, reasonably clear distillations of complex philosophical and linguistic concepts, and synthesized academic research. The book engages in pop metaphysics that limits its ambition for the more science- and liberal-minded from the get-go, letting us know that achieving “happiness” – as some final stage of contentment – is impossible. But, Brooks insists, “we can be happier” in relative terms.“Unlike other books you may have read,” he tells us, “this one is not going to exhort you to pull yourself up by your bootstraps. This isn’t a book about willpower ​​– it’s about knowledge, and how to use it.”Which is all to say, this book is absolutely about how to pull yourself up by your bootstraps and follow concrete steps to self-contentment, but doing so with some reputable sociology and psychology studies as your guide rather than the quasi-fascist bromides about being an alpha dog one typically hears from the likes of Jordan Peterson. But the general motivational tone and reactionary political premises are the same.The book kicks off in earnest with a scrappy, can-do story of self-determination on the part of Brooks’ Spanish mother-in-law, “Albina”, who is used as a template for self-fulfillment.In the introduction, titled Albina’s Secret, we are told that, after years of living with an abusive husband and a fraught domestic life, “One day, when Albina was forty-five, something changed for her. For reasons that were not clear to her friends and family, her outlook on life seemed to shift. It’s not that she was suddenly less lonely, or that she mysteriously came into money, but for some reason, she stopped waiting for the world to change and took control of her life. The most obvious change she made was to enroll in college to become a teacher.”Brooks asserts that the primary change that propelled Albina toward midlife happiness was her shift from worrying about “the outside world” to looking inward.“She switched,” Brooks tells us, from “wishing others were different, to working on the one person she could control: herself.”Personal responsibility is a hallmark of the self-help genre, and Brooks’ breezy title has this convention in spades. In his telling, changing “the outside world” as a pathway to peace and happiness is a fool’s errand. Like virtually all self-help books, we are told the road to self-satisfaction is found within – not with our circumstances, but how we respond to our circumstances.This is a convention of the capitalist self-help genre for one obvious reason: it requires nothing in the “outside world” to change. And once one gets into the messiness of “changing the outside world”, one ventures into political theory. This is uncomfortable and can’t be put into an earth-toned 700-page book that rich Atlantic subscribers will want to buy.Albina’s solution, Brooks tells us, wasn’t to find her local underground socialist party or union headquarters and join a political movement to combat the Franco regime, or to try to materially improve the lot of other women sharing her gender-based suffering – it was to ignore “the outside world” and instead focus on a career shift and a switch in attitude.Like a lot of self-help advice, this works on a micro scale. Surely, it’s too great an ask to demand a middle-aged mother in an economically precarious situation join the fight against the Franco regime. But Brooks is constitutionally uninterested in the forces of patriarchy and capitalism that co-authored the misery – not because they’re irrelevant to his self-help brand of anti-politics, but because of it.Self-help makes grand claims about human progress, it offers advice to the masses on how they can improve their lot – it is inherently political by its nature. But Brooks does not tell us that we can be empowered by making demands of the powerful, or joining a union or a political movement, but – how else – by buying his book.This is Brooks’ big trick: his happiness recommendations presume a society that can and will never change from the one he helped craft in Washington.In today’s AEI-sculpted America, millions are deprived of the building blocks of happiness such as guaranteed healthcare, free higher education, paid family leave, workplace empowerment, retirement security and a host of other social democratic pillars that sustain the world’s happiest societies. Unwilling to allow for the possibility that such conditions can or should change in the United States, Brooks nonetheless presents happiness as an achievable self-centric project inside the dystopia he helped create.Build the Life You Want follows Brooks’ first foray into the happiness industry – a book called From Strength to Strength that is about “finding success, happiness, and deep purpose in the second half of life”.That monograph argues that because of the way humans’ brains change, one’s professional decline begins much earlier than we expect. The book suggests that workers in midlife should therefore move into work roles that require less cognitive innovation (fluid intelligence) and more teaching of acquired wisdom (crystallized intelligence).It is an important finding that might prompt a broader discussion of policies that could account for this inevitability – retraining programs, funding for midlife career education, universal portable benefits that allow for job switches and earlier retirement ages. But ever the conservative ideologue, Brooks eschews all that, instead channeling the old conservative trope that failing to change professional trajectory – or being demoralized by the work treadmill – is just a mental flaw in one’s personal outlook.“Satisfaction comes not from chasing bigger and bigger things, but paying attention to smaller and smaller things,” he writes, in a call for a mass change of attitude.What prevents necessary career shifts that might lead to happiness, Brooks asserts, is “self-objectification, workaholism, and most of all success addiction that chain us to our declining fluid intelligence curve.”“What do I want to do with my time this week to cultivate the relationships that will result in that end scenario?” Brooks says he asks himself in order to imagine an existence of stronger personal bonds. “I might make the decision to leave work on time, leave my work at the office, get home for dinner, and watch a movie after dinner with my family.”In this dreamscape, most Americans get to choose when they work, and under what conditions. Nowhere in Brooks’ world of lanyards does he consider that Americans working ever-longer hours and ever-more jobs may have less to do with career ambition than with simply trying to earn enough to pay the ever-increasing bills – bills that fund the ballooning profits of the kind of donors who can pay Brooks’ upwards of $125,000 speaking fee or write six-figure checks to outfits like the AEI.This same ideology carries into Build the Life You Want, where Brooks repeatedly hints at a deeper theme of overwork and soul-sucking labor, but avoids the obvious indicators and instead moves on to sell his brand of self-analysis – with little consideration of systemic problems.Recapping researchers documenting how humans are usually good at categorizing their own positive associations, Brooks notes that “activities that were most negative and least positive were commuting and spending time with one’s boss”.He caps this off with a joke: “Obviously, then, it’s definitely best not to commute with your boss.” It’s clear that people’s least favorite activities are related to working dreary, miserable jobs.Does this prompt Brooks to apologize for leading the fight against proposals for government-sponsored healthcare that could end the employer-based system and free Americans to search for more fulfilling jobs without fear of losing access to medical services?No, it’s the subject of a wisecrack and he moves on.This isn’t to say the book is uninterested in “careers” – it very much is. It just doesn’t care much for jobs, or the masses who occupy work for work’s sake, to stave off starvation and homelessness – what novelist Ursula K Le Guin called kleggich, or “drudgery”, work that the vast majority of people do day in and day out for survival.The target demographic for Brooks is the aggressively middle and upper class, so what matters is how “happy” the job makes them rather than whether the worker has carpal tunnel syndrome or is subject to sexual harassment, precarity and a host of problems that affect anyone who can’t afford the luxury of lifehacking their happiness as Brooks prescribes.In its characteristically fawning profile of Brooks as “part social scientist, part self-help coach, part motivational speaker, and part spiritual guru”, Politico recently cast his journey as a departure from politics and ideology.“Brooks has undergone one of the more unusual professional transformations that Washington has witnessed in recent decades,” the Beltway news outlet wrote. “His most recent transformation also represents a type of retreat – away from a conservative movement that once held him up as a model of its future.”Brooks himself leans into this assertion, arguing that “I’m not a player in the conservative movement” and adding that his career in the conservative movement “is just not relevant – this stuff isn’t relevant anymore”.But Brooks’ professional trek is less a “transformation” – and less shocking – if one considers that his happiness books are ideological manifestos shrouded in the veil of social science. His new literature is the kind of academia-flavored politics that has long been the central product – and sleight of hand – of the almost $70m thinktank that Brooks ran for a decade. (The AEI still lists Brooks as one of its scholars.)From its origin, the AEI has depicted itself as a staid, nonpartisan, quasi-academic institution, even though it has always been a lobbying front for rightwing forces – a one-stop shop where corporate America can advance its ideological and political interests under the auspices of academic research and policy-shaping.Though not mentioned in the AEI’s official history, President Harry Truman shut down the organization in 1949 because it was illegally operating as a lobbying front for the railroad industry. It falsely called itself an “educational association” while sharing a physical address with a rail lobby. Though the AEI’s donors remain anonymous to this day (a practice frowned upon in the non-profit world for obvious reasons), the donors that have been revealed through reporting include fossil fuel extractors, labor abusers, opioid pushers, dictators, weapons makers and big tech giants – all of which have an interest in shaping US political discourse, under the guise of seemingly nonpartisan empiricism.The bulk of Build the Life You Want is harmless enough, synthesizing sociological and psychological theories and studies from the past 50 years or so, from personality sorting questionnaires to scientifically suspect, but persistently popular, reliance on brain activity research. But Brooks then weaponizes that research and scholarship to create ideological storylines.The book stresses the importance of “earned success”, which is Brooks’ personal conservative spin on “learned helplessness” – a concept popularized in the 1970s by Martin Seligman, the so-called “father of positive psychology”.“Earned success instead gives you a sense of accomplishment and professional efficacy,” Brooks writes. “The best way to enjoy earned success is to find ways to get better at your job, whether that leads to promotions and higher pay or not.”Hard work for its own sake will make us happier is a storyline that couldn’t have been better articulated by AEI scholars, who insinuate that Americans’ big problem is their alleged lack of work ethic, not the rapaciousness of the thinktank’s donors.Paraphrasing – or rather, misreading – Viktor Frankl, the author of the 1946 Holocaust memoir and social psychology text Man’s Search for Meaning, Brooks writes that “the common strategy of trying to eliminate suffering from life to get happier is futile and mistaken; we must instead look for the why of life to make pain an opportunity for growth.”Later, building off Frankl’s works, Brooks repeats a major theme of the book: circumstances aren’t what matter, our response to them is.“You can’t choose your feelings,” Brooks tells us. “But you can choose your reaction to your feelings. What [Frankl] was saying is … If someone you love gets sick, you will be afraid, but you can choose how you express this fear, and how it affects your life.”But if a loved one is sick, the most significant way one can choose how it “affects your life” is if said loved one has quality, inexpensive healthcare – something Brooks spent more than 10 years working to make sure the poor can’t have. What would the average person rather have in the face of an earth-shattering family illness: a squishy life guideline to managing emotions or quality healthcare?Obviously the latter, but for Brooks, only the former is on offer.This “tough it out” ethos is consistent with Brooks’ decades of advocating the evisceration of programs designed to help the poor survive – all to extend “happiness” and prosperity to the masses.“It is a simple fact that the United States is becoming an entitlement state,” he wrote in a 2012 Wall Street Journal op-ed that depicted social security, welfare programs and disability benefits as “impoverishing the lives of the growing millions dependent on unearned resources”.“The good news is that we have a golden opportunity to rein in entitlements,” he said, invoking Washington-speak for reducing social security benefits, which the AEI has proposed. “By reforming entitlements and the tax system instead of extracting more money with higher tax rates, the economy could be reoriented away from unearned transfers to earned wages. This would make the economy fairer and sounder. And in the process it could build a happier country for ourselves and our children.”If it seems deeply cynical to use pop psychology and pop morality of “earning” money and creating “happiness” to argue for lowering taxes for the rich and cutting social programs for the poor, that’s because it is.Brooks now insists he is no longer manufacturing such political opinion, but his old austerity activism shines through in his happiness literature.The most explicit example is in his book From Strength to Strength. As part of a passage headlined “The benefits of weakness, pain, and loss”, Brooks cites Frankl to suggest that a world of hardship may actually be desirable, because people “could find the meaning of their lives, and personal growth, in all kinds of suffering”.Perhaps this explains why Brooks’ new iteration as a happiness guru includes no mea culpa for his past career explicitly advocating for the austerity that sows so much desperation. If suffering is a catalyst for personal growth, then why should he offer contrition?The mystery, then, isn’t why he is so unapologetic and still on this trajectory (answer: it is lucrative). The most vexing question is: why are so many liberals falling for this act?This is a man who is deeply uninterested in – and, indeed, actively hostile to – creating the conditions that allow anyone who isn’t in his class status the capacity to be safe and secure, much less happy, and he is now one of the country’s most prominent gurus for finding “happiness”.For the better part of a decade, Brooks hired and curated the careers of documented racists like Charles Murray, climate denialists like Mark Perry and ”replacement theory” advocates such as JD Vance. Now he’s doing a calm, professorial routine about how we all need to take a practical, science-driven path to being happier?This should be a scandal, but Brooks frames it in the right Atlantic-ese, so most just nod along.For a book about a life well lived, Build the Life You Want is remarkably short on objective discussions of ethics or virtue. All moral content exists entirely inside the head of the reader or the authors’ examples of happy people (what makes you feel inspired, what our subject found fulfilling), with zero discussion about what is objectively virtuous or what can be done as a community rather than as an individual – fitting for a career funded by ExxonMobil, the Koch brothers and heirs to the Walmart fortune.Ultimately, this is where all of these class-flattening, middlebrow self-help discussions of happiness fall apart: they treat “happiness” as the center of the moral universe rather than virtue, which is to say, the politics of maximizing others’ happiness over one’s own in a systematic way, rather than as one-off instances of bourgeois charity.But, of course, serial killers are “happy” murdering, Charles Koch is “happy” extracting profit from low-wage workers, and Saudi dictators are “happy” hosting cocaine-fueled yacht parties and buying soccer teams. So what? Being happy is not inherently good or bad. What matters is building systems of justice, welfare and safety that allow the maximum number of people to be secure and healthy.If granting the average working person rights to a universal basic standard of living ends up creating more happiness, then all the better.But without such foundational rights – rights Brooks has spent his career opposing – what is “happiness” if not an abstract privilege of those who can afford it?
    Adam H Johnson is the co-host of the podcast Citations Needed and a writer for the Substack newsletter The Column
    David Sirota is a Guardian US columnist and an award-winning investigative journalist. He is an editor-at-large at Jacobin and the founder of the Lever. He served as Bernie Sanders’ presidential campaign speechwriter
    A version of this article first appeared in the Lever More

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    Our primary healthcare system is a mess. We have a plan to fix it | Bernie Sanders

    The bad news is that the US healthcare system is broken and dysfunctional. We spend twice as much per capita as almost any other country, nearly $13,000 per year, while 85 million Americans remain uninsured or underinsured. In addition, our health outcomes are often worse. In terms of life expectancy, for example, we live far shorter lives than the people of many other industrialized nations.The system is failing ordinary Americans. On the other hand, the insurance and drug companies that dominate it have sky-high profits and their CEOs receive exorbitant compensation packages. The thousands of lobbyists those companies have on Capitol Hill are also doing very well.It’s time for a change.As disastrous as our overall healthcare system is, our primary care system is even worse. Tens of millions of Americans live in communities where they cannot find a doctor or dentist, even when they have insurance, while others have to wait months to get seen. Despite spending a huge amount of money on healthcare, the United States doesn’t have enough doctors, dentists, nurses, mental health practitioners, pharmacists or home healthcare workers. And that workforce shortage is getting worse.Most countries spend between 10% and 15% of their healthcare budgets on primary care. Canada spends 13%, Germany spends 15%, Spain spends 17% and Australia spends 18%. We spend less than 7%.In other words, instead of investing in disease prevention and enabling people to gain easy and timely access to the medical care they need, we spend heavily on expensive hospital and tertiary care. Our “system” is there big time when people end up in the hospital. We just don’t do much to keep them from going there.Every major medical organization agrees that our investment in primary healthcare is woefully inadequate. They understand that focusing on disease prevention and providing Americans with a medical home will not only saves lives and ease human suffering, but save money. Providing primary care to all is not only good public policy, it is cost-effective.The major backbone of our current primary care system, especially for low- and moderate-income Americans, is the Federally Qualified Community Health Center program. Today, 30 million men, women and children receive high-quality primary healthcare at community health centers in 14,000 neighborhoods located in every state in America. Many of these centers also provide dental care, mental health counseling and low-cost prescription drugs.According to a recent study by an expert at the Kaiser Permanente School of Medicine, community health centers saved Medicare and Medicaid $25bn in 2021 alone.In fact, research has shown that it is about $2,300 less expensive for a Medicaid patient to receive care from a community health center than at a private clinic and it is roughly $1,200 less expensive for a Medicare patient to receive care at a community health center than at an outpatient clinic.At a time when millions of Americans have no option but to go to an emergency room for their basic healthcare needs, it turns out that an emergency room visit is about 10 times more expensive than going to a community health center.One thing is certain. We cannot address the primary healthcare crisis unless we also address the major shortages that we have in our healthcare workforce. According to the most recent estimates, over the next decade our country faces a shortage of over 120,000 doctors – including a major shortage of primary care doctors.The nursing shortage may even be worse. Over the next two years alone it is estimated that we will need between 200,000 and 450,000 more nurses.We also have a shortage of some 100,000 dentists in America.And, despite the very serious mental health crisis we are facing, there is a massive shortage of mental health service providers – psychiatrists, psychologists, social workers, counselors, addiction specialists and many more.For many years members of Congress have talked about these crises. Now is the time to act. As chairman of the US Senate health, education, labor and pensions (Help) committee I am working hard to pass bipartisan legislation which will transform our primary healthcare system so that every American, no matter where they live or what their income might be, can get the care they need when they need it.If we increased funding for primary care by $130bn over five years, through a combination of increased federal funding and the elimination of some of the enormous waste and bureaucracy in the current healthcare system, we could double the number of people using community health centers and come close to providing primary healthcare to every person in America.Further, an investment of $40bn over five years could substantially increase the number of doctors, nurses, dentists and mental health care providers we desperately need.Is this $170bn, five-year investment in our primary care system and healthcare workforce a lot of money?Yes. It is. But let’s be clear. This $34bn annual investment to improve our healthcare system would amount to less than half of the increase that Congress provided to the Pentagon last year alone.In my view, healthcare is a human right. The legislation that I am proposing would go a long way towards accomplishing that goal.
    Bernie Sanders is a US senator and chairman of the health, education, labor and pensions committee. He represents the state of Vermont, and is the longest-serving independent in the history of Congress More

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    To protect abortion access, the FDA should decline to enforce a mifepristone ban | David S Cohen, Greer Donley and Rachel Rebouché

    On Friday, the nation faced dueling decisions from federal judges regarding the first drug in a medication abortion: mifepristone. A judge in Texas ruled that the Food and Drug Administration (FDA) likely improperly approved the drug, putting mifepristone’s approval on hold while the case plays out (though this order won’t take effect until late Friday this week). Minutes later, a judge in Washington state ruled that the FDA could not change the status quo regarding mifepristone’s availability.In response to these two cases and two other less-publicized cases involving the FDA and medication abortion, the agency needs to chart a course consistent with its mission to protect patient health and to follow the evidence. As the Biden administration has stated, protecting medication abortion is a public health imperative now that states can ban all abortion outright. If the agency does not respond to these conflicting rulings in a manner tailored to provide the greatest access possible to medication abortion, it will be telling of Biden’s commitment to reproductive justice.Though the case in Texas has garnered enormous attention, it is not the only case thrusting the FDA into the center of the abortion debate. The others have the opposite goal of improving access to the drug. The litigation in Washington state, not widely discussed until Friday, centered around the FDA’s special and onerous regulation of medication abortion. Eighteen state attorneys general sued the FDA arguing that the agency’s overregulation is not justified by the statute or the drug’s safety and must be lifted. If successful on appeal, this would ensure mifepristone is treated like other prescription drugs – prescribed through any provider and accessible at any pharmacy.Plaintiffs in two other cases are pushing even further, trying to use the FDA’s special regulation of mifepristone to argue that a state cannot ban or overregulate the drug. These lawsuits, filed respectively by the generic manufacturer of mifepristone in West Virginia and a physician in North Carolina, might restore access to medication abortion across the country. The plaintiffs argue that federal approval of mifepristone trumps state abortion laws, essentially forcing all states to allow medication abortion as regulated by the FDA.The FDA is caught in the crosshairs. Though the agency prides itself on scientific independence and seeks to avoid the appearance of partisanship, any reaction the agency has to these cases – even a decision not to act – will appear political to one side. Nonetheless, the FDA must push forward to ensure access to this critical drug.Starting with the two cases just decided, the agency can comply with both by announcing that it will exercise enforcement discretion. Enforcement discretion allows the agency to provide safe harbor for technical violations of law. So even if mifepristone becomes an unapproved drug per the Texas order, the agency could announce that it would not pursue action against the entities that market or dispense the drug to maintain the status quo as required by the Washington case.This would not require the agency to “ignore” the Texas order, as some have suggested. Rather, enforcement discretion is a normal part of the FDA’s operation and only relevant if the drug becomes unapproved as ordered. The FDA could exercise this discretion without being ordered to by the Washington court, but the Washington case provides enormous political cover for the agency to use this discretion.Repercussions for patient and public health could result from the FDA failing to clearly exercise its enforcement discretion. Clinicians may turn to a different medication abortion regimen that does not include mifepristone and is outside of current FDA regulation. Though alternative regimens will be vital to maintaining abortion access if mifepristone becomes inaccessible, they are slightly less effective and, more importantly, will upend what has been the uniform, established protocol for a medication abortion in the United States for over two decades. Relatedly, confusion is sure to reign after the Texas decision unless the FDA speaks in a clear and timely voice. Already, certain abortion providers have indicated that they will continue to dispense mifepristone regardless of the order in Texas unless the FDA tells them they cannot.As requested by plaintiffs in the Washington case, the FDA could also start the process to remove the unnecessary barriers to accessing mifepristone, which every relevant medical organization agrees are not medically necessary. These barriers make abortion less accessible without any benefit for patient safety. Though the FDA has repealed parts of these unduly restrictive rules over the last decade, the FDA should abandon the remaining restrictions, which are also contradicted by the best evidence. These policies do not make the agency seem evenhanded; they make it seem unscientific. The agency should not wait for the Washington court to order this – it should start the process now.In the pre-emption cases, the FDA could help the effort to restore access to early abortion in states with abortion bans by embracing the theory that the federal agency’s regulation of medication abortion trumps state law. The Department of Justice has already signaled its agreement, but the FDA has been silent. The FDA has spent decades assessing the risks and benefits of medication abortion, examining and re-examining the evidence even decades after its approval in 2000. States should not be able to override that authority and create a public health crisis by banning a safe and effective medication.The agency, however, has appeared unwilling to remove the remaining unnecessary barriers to mifepristone or support pre-emption at this juncture. Indeed, it has said nothing about pre-emption and is opposing the attorneys general in the Washington case – a fact that may surprise people who think the Biden administration is doing all it can to support abortion access. Given the current public health crisis, the FDA must be bolder in its support of reproductive healthcare.Try as it might, the FDA cannot escape the abortion debate. Instead of trying to play both sides, the agency must act now by following the science and protecting the public’s health to the best of its ability. Protecting access to safe abortion is the way to do that.
    David S Cohen, a law professor at Drexel University, is a co-author of Obstacle Course: The Everyday Struggle to Get an Abortion in America, a board member of the Abortion Care Network and a consulting attorney with the Women’s Law Project
    Greer Donley is a law professor at the University of Pittsburgh and a board member of the Women’s Law Project
    Rachel Rebouché is the dean of the Temple University Beasley School of Law and a faculty fellow at the Center for Public Health Law Research More

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    If you have a miscarriage in Republican America, your health is now at risk | Moira Donegan

    If you have a miscarriage in Republican America, your health is now at riskMoira DoneganThe supreme court’s decision to overturn Roe has created a vast new public health crisis, as abortion bans complicate once-standard care for pregnant women The worst-case scenarios arrived with alarming speed. In the weeks since the US supreme court’s decision in Dobbs v Jackson Women’s Health, the case that overturned Roe v Wade and eliminated the constitutional right to an abortion, American women have faced a radical reordering of their lives. A right essential to their dignity and self-determination has been stripped away after nearly 50 years – and with it, the gains women have made in professional, political and social life are newly and gravely endangered. But in addition to this moral and civic crisis, the supreme court’s decision has also created a vast and acute new public health crisis, as abortion bans complicate once-standard care for pregnant women – and place the health of even those who are not pregnant into new and arbitrary danger.From natural birth to caesarean: women must be given unbiased information | Kara ThompsonRead moreTopicsUS politicsOpinionAbortionWomen’s healthHealthHealth policyRepublicanscommentReuse this content More

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    Joe Biden challenges Americans to 'mask up' for first 100 days – video

    Joe Biden has urged Americans to wear face masks for 99 days as part of a challenge for his first 100 days in office during a speech on Thursday in which he unveiled his administrations’s national Covid strategy.
    Biden signed an executive order to mandate face coverings during interstate travel and within federal buildings as he noted the US coronavirus death toll is higher than that from the second world war. More

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    PM channels his inner John Wayne in vaccine metaphor meltdown | John Crace

    Shortly before 5pm in the UK, president-elect Joe Biden gave a press conference. The results of the trials were very promising, he said, but there was still a long way to go before a vaccination programme could be rolled out nationwide. So it was now more important than ever not to let your guard down and to carry on wearing masks. It was coherent, informative and in less than five minutes Biden had told Americans just about everything they needed to know.
    Boris Johnson likes to do things rather differently. Almost to the second after Biden had finished speaking, the prime minister stepped out into the Downing Street briefing room, flanked by the deputy chief medical officer, Jonathan Van-Tam, and Brigadier Joe Fossey, dressed in full camo gear that had the reverse effect of drawing attention to himself. A new form of anti-camo perhaps.
    After a few introductions, Boris went on one of his long rambles. He didn’t really have anything to say that couldn’t have been wrapped up in minutes but he considers a press conference not to have taken place unless he’s wasted the best part of an hour of everyone’s time.
    Perhaps it was the excitement of having a real life soldier standing next to him, but Johnson’s explanation of the new vaccination was relayed in a series of metaphors straight out of the movie Stagecoach. The arrows were in the quiver! The cavalry was on its way, the toot of the bugle – Michael Gove’s presumably – was getting louder but still some way off. Having a prime minister who manages to trivialise something really important is getting extremely draining and it’s hard not to zone out within moments of him starting a sentence. So much for the great communicator.
    Next up was the brigadier who is in charge of the mass testing in Liverpool and looked uncomfortable throughout. “Two thousand troops have answered the call,” he said, making it sound as if the soldiers had had some say in their deployment rather than been told they were off to Liverpool for the next four weeks.
    He then pulled out a piece of plastic from his pocket. “You know what a swab is,” he continued. “Well this is the lateral flow that gives you a result within an hour.” And that was all he had to say. He didn’t seem at all sure what the lateral flow actually was or how it worked but then he was only following orders. If he’d had his way, he’d have saved the taxpayer a return train ticket from Liverpool to London.
    There was no slideshow this time – obviously No 10 has started to wonder if they are more trouble than they are worth after recent events – so Van-Tam was left to ad lib on the vaccine trial. Even though he had no more information than Boris, so all he could do was repeat the fact that it was exciting but we shouldn’t get carried away just yet. Try to think of it as a penalty shootout, he said – Boris’s crap analogies are as contagious as the coronavirus. We’ve scored the first goal, so we know the keeper can be beaten, but there was a long way to go before the match was won. No one seemed to have told Van-Tam that the expectation in a shootout was that the penalty-taker would score.
    Things carried on in much the same vein when questions came in from the media. The brigadier tried to make himself as inconspicuous as possible – merging into the background was part of his SAS training – and so the only other thing he had to offer was that he was just on day four of his deployment so it was hard to tell whether things were going well or badly. Van-Tam desperately hunted around for new ways of saying the vaccination trials were still at an early stage, but things were looking more hopeful for next year.
    Try to think of yourself as being on a railway station on a wet and windy night, he said, doing his best to channel his inner Fat Controller. You could see the lights of the train two miles away. Then the train pulled into the station and you didn’t know if the door was going to open. Next you couldn’t even be sure of whether there would be enough seats for everyone. The UK had only ordered enough vaccine for about a third of the population, so unless more doses came online most people were going to miss out. It didn’t sound quite as hopeful as he had suggested. But maybe that’s just the way he tells them.
    Boris, meanwhile, just looked relieved to only get one question on the US presidential election. And that wasn’t even on if he had spoken to the president-elect – he hadn’t as Biden has been too busy taking calls from Micronesia – or if he had any reaction to being called a “shape-shifting creep” by a former adviser to Barack Obama. The Democrats still haven’t forgiven Boris for his remarks about Obama’s part-Kenyan ancestry giving him a dislike of the British empire.
    “I congratulate the president-elect,” said Johnson, sidestepping a suggestion he give Donald Trump a call to persuade him to throw in the towel. The US and the UK had had a close relationship in the past and no doubt would do so in the future. He had nothing to say on Brexit. Rather he chose to accentuate the shared climate change objectives of Cop27. Or Cop26 as the rest of the world knows it. More