Markham's Behavioral Health

Americans' love affair with cars and the public health

From Gregg Easterbrook's book, The Progress Paradox:

"Today all but the bottom-most fraction of the impoverished in the Unite States do most of their routine traveling by car: 100 auto trips in the United States for every one trip on a bus or the subway, according to the American Public Transit Association."

I am 59 years old having been born at the end of 1945. My grandfather, Rufus, who died at age 94 was born in 1896. He was a farmer in North Bergen, NY. I remember him telling me that as a young man he took chickens to the public market in Rochester, NY about 20 miles a way this time of year, in January, in a horse drawn sleigh. I can't imagine such a thing. People are whining as I write this about a recent "storm" system that has come though our area dropping about 10 inches of snow and "travel advisories" are posted about unnecessary travel.

I just might go to Rochester, NY this afternoon because the sun is out, the roads have been plowed, and I can get to Rochester in my heated car in about 35 minutes on the interstate (it is 32 miles away).

I have riden the Park and Ride bus in my daily commute from Brockport to Rochester (22 miles), and I have ridden the train to New York City from Rochester a few times (360 miles), but I have driven hundreds of times to New York City, and thousands of times to Rochester, NY, and Buffalo, NY. We have become a nation of car drivers, dependent on a life style made possible by automobiles.

Easterbrook's continuing question is "has this made us any happier?"

Easterbrook points out in another place in his book, on page 72:

"Figures from the World Health Organization show that in 2000, the most recent year for which statistics are available, four times as many people globally died in traffic accidents than in any form of combat - 1.3 million traffic deaths versus 300,000 deaths from war. That car crashes currently pose a greater threat to the citizens of earth than combat is surely progress in the right direction."

In 2002 there were 42,815 deaths in highway crashes in the Unites States, 17,419, or 41 %, of which were alcohol related.

It makes me wonder whether we really need to be so concerned about terrorists? Terrorism can be a problem just as criminal activity is a problem in every society, but as a public health issue terrorism is small potatoes considering the carnage on our highways. The love affair of the American and his/her automobile comes with a pricetag of human life that apparently we are willing to accept for the advantages of mobility and independence.

Health Care costs as a proportion of GDP are great deal considering the quality of life

I love Gregg Easterbrook's book, The Progress Paradox. I have been commenting on my reading of it on this blog since December 18, 2004. It has been slow going because the book is so rich with interesting observations.

My last comments have been on the cost of health care in the US. Easterbrook has mentioned things like the fact that the primary reason for increasing costs of health care is not the actual costs of medical goods and services because they have been coming down, but rather because of the increase in utilization. In other words, more people are using more medical goods and services. He then observes that rather than complain, isn't this a good thing that people are living longer with higher quality of life than ever before in human history?

In this section, he is discussing the cost of health care in relation to the growth in the GDP.

"Yet if expense has to rise, health care seems the expense to pick. As the commentator, David Weissel has noted, rising medical share of GDP means that Americans bought 50 percent more health care per person in 2002 than they did in 1982. Isn't that good? We also built 19 percent more cars per person during the same period. Would we really have been better off with even more cars and less health care?"

I was listening to a wise person the other day who said that money can buy you two things: stuff or experience. It was his view that increasingly people are choosing to buy experience. Instead of working another 10 hours per week to buy another SUV they would rather have the time to play with their kids.

So, in thinking about the rising health care costs, we as Americans can decide if we will provide health care so that the average American can live another decade, another 10 years, or we all can have digital plasma TVs, or more jet fighters for the military. We can provide people with the experience of more life, or more stuff. Ratheyon and Haliburton may not be happy, but the 200,000 older Americans with new knees and new hips, so they can keep playing golf, will be.

Health care costs enhance quality of life. Is it worth it?

I am continuing my reading of Gregg Easterbrook's book, The Progress Paradox, and I am blown away by the points he makes.

He points out that American is the richest, healthiest country ever in the history of the world and wonders why we aren't happier.

Our health insurance premiums continue to go up. I just got my notice last week that my plan is going up 17% this year.

My employees are complaining that their contribution has gone up as much as $40.00 per month for a single plan.

Why is health care going up? Easterbrook says that it is not so much the price of goods and services as it is the utilization.

There are basically two things that drive health care: the number of benefits covered, and the number of people using the benefits. If people want a plan with comprehensive and complete coverage such as dental, eye care, chiropractic, drug, etc. they are going to pay for it. If more people start using the benefits such as drug benefits, then the costs go up too.

Easterbrook uses just one example: knee replacements. We're not talking hips, elbows, back surgeries, etc. just knees.

"Some 200,000 knee replacements were performed in the United States in 2001, at the average cost of $26,000. That's $5.2 billion in health care spending just for artificial knees, a category of treatment that did not exist a generation ago. Medicare will provide artificial knees at taxpayer expense to patients in their eighties who do not have that much longer to live. As available health care technology increases and society feels everyone should have access to the best care under all circumstances, we should expect health care spending to rise even if the prices of individual goods and services are declining. The essential result is that most people are better off." p. 14

Do you want your 67 year old mother or father, or grandmother or grandfather, to get that knee replaced that will increase the quality of life significantly for the next 10 -20 years? I would guess that you probably do. Is it worth another $40.00 per month to you? Perhaps joint replacements should not be a covered benefit and only those that have $26,000.00 to pay for it themselves should get it.

Grandpa will have to decide if he wants a new knee or a new Ford next year.

Of course then poor people and people on fixed incomes will have to endure pain, hobble, and give up opportunities for mobility and increased vigor.

On the other hand, we are spending over $13.1 Billion PER MONTH on the war in the Iraq which would pay for a lot of knees.

Would Americans rather spend their tax dollars on war or improve the quality of life? Our current administration seems more hell bent on war.

Living large in the U.S. of A.

I am continuing my reading of Gregg Easterbrook's book, The Paradox of Progress, and continue to find out amazing things about our American way of life that I was not aware of before. For example, did you know that since 1995 Americans have purchased more than 3 million all terrain vehicles, which are used almost exclusively for recreation, and continue to buy about 750,000 per year?

According to the 2000 United States census, almost 23% of American households had incomes of at least $75,000.00 per year. Easterbrook points out that in terms of "work hours", of important goods and services, only health care and college education cost more than they did in the 1950s.

Most Americans are rich beyond their wildest dreams only two generations ago. The middle class now lives like the upper class then with air conditioning in their homes, eating out 3 or 4 times per week, taking vacations in resort areas in the U.S. and abroad, owning a couple of homes, multiple cars, recreational vehicles, with the best health care in the world.

Most of us have come to take all this for granted even if we are up to debt to our eyeballs. So why aren't we more happy? Or are you happy with all this stuff?

Mother Teresa made a comment one time that Americans are the richest country on earth when it comes to money and material things, but the poorest when it comes to love. Whatever did she mean? And is she right?

I am reminded of the cynical but witty statement that money can't buy you happiness, but it helps.

What causes poverty?

What causes poverty? Statistics show that if you don't want to be poor you need to do three things.

"Former Clinton advisor William Galston sums up the matter this way: you need only do three things in this country to avoid poverty—finish high school, marry before having a child, and marry after the age of 20. Only 8 percent of the families who do this are poor; 79 percent of those who fail to do this are poor."

I first found this quote in Gregg Easterbrook's book, "The Progess of Paradox". He quotes James Q. Wilson who made the statement above in his essay, "Why We Don't Marry" which appeared in the Winter, 2002 issue of the City Journal and which you can access by clicking on the link below.

Link: City Journal Winter 2002 | Why We Don’t Marry by James Q. Wilson.

Americans spend more on watercraft in one year than the GDP of North Korea. What's up with that?

"Today a leading problem with your dream house by the water is that so many other people also own vacation homes and own powerboats or jet skis - in 2001, Americans spent $25 billion, more than the GDP of North Korea, on recreational watercraft - that the tranquility may be shattered by piston roar." (The GDP of North Korea was estimated at 22 billion.)

      Easterbrook, page 6

13% of home purchases in U.S. in 2000 are second homes

As much as we hear about homelessness in the U.S., it is interesting to note that in 2000, 13% of home purchases in the U.S. were of second homes. These second homes are usually vacation homes.

     Gregg Easterbrook, page 6, The Progress Paradox

Fly in communities where you keep a plane in your garage.

Did you know that there are fly in communities built around runways for small planes where you can taxi up to your house and park your plane in the garage? Think I'm kidding? Check out Spruce Creek near Daytona Beech, Florida by clicking on the link below.

"Life's good and you can live it - in the perfect condo with the perfect location.  This upscale home offers complete privacy in the living quarters, with only one common connecting wall located in the hangar.  For the golf, tennis or swim enthusiasts, just stroll across the tree lined lane to the Country Club, where you can enjoy their delectable menu. The condo is quite versitile offering 2 or 3 bedrooms and two baths while the 44'2" X 38'8" AIR CONDITIONED hangar features a second story office and one and a half baths with their own separate A/C.  The extras and upgrades are numerous in this lovely home with crown moldings, sun tunnels, custom window treatments and the list goes on.. Come see for yourself how good life is at Hawks Nest in Spruce Creek Fly-In.

$550,000"

I found this out when I was reading Gregg Easterbrook's book, The Progress Paradox wherein he discusses this phenomenon on page 5. He mentions another such housing development called Pecan Plantations outside of Fort Worth, Texas.

What has this got to do with behavioral health? It has me wondering whether people who live these lifestyles are happier that someone who lives in a 30 year old mobile home he bought for $3,000.00 and drives a 97 Ford Escort with 149,658 miles on it like me?

If you won 20 million dollars in a lottery would you want to live like this? I am curious.

Link: On Final for Home.

Fly out for dinner

 

Gregg Easterbroom in his book, The Paradox of Progress, describes the One Hundred Dollar Hamburger organization. Easterbrook says

"Nearly a thousand fly-in restaurants are open for business in America today, according to an organization called Hundred Dollar Hamburger. (Small private planes cost around $100 an hour to operate.) Most are simply eateries adjacent to general aviation airports, but an increasing number, like McGehee's, have become fly-in in the complete sense. The advent of such reastaurants is exciting to the owners of small planes, many of whom learned to fly as a challenge, or in response to the romance of the air, then discover that they crave destinations for the kind of one-hour hops that make for recrational aviation. Just imagine trying to explain to the indigent of the developing world that one provlem experienced by Americans is finding something to do with their personal aircraft!" P.4

As a Social Worker I travel in the wrong crowds. I see people every day who worry if their food stamps will last till the end of the month or whether they will have to beg food at the local food pantry. So I marvel at the One Hundred Dollar hamburger which feeds most of the people I work with for a couple of weeks maybe three, sometimes four.

Link: The One Hundred Dollar Hamburger.

The Progress Paradox : How Life Gets Better While People Feel Worse, the book

I am reading The Progress Paradox by Gregg Easterbook and I invite you to read along with me. I will be reporting periodically on what Easterbrook has to say. I think it will be an interesting read. I am taken with the book because he writes and documents stuff that I have always wondered about like "How come as we get richer, more and more people seem unhappy?"

In the introduction, Easterbrook reviews indicators of how life in the US has gotten better over the last four generations and then finishes the introduction by saying,

"But even if the arrow of progress points toward an even better life, unhappiness persists and is wholly real regardless of whether our recent forbearers might find it unbelievable that anyone could be unhappy in an air conditioned house with a refrigerator crammed with food and ambulances on call.

We live in a favored age yet do not feel favored. What does this paradox tell us about ourselves and our future?"

Stay tuned because I will share more of my reading and thoughts as I go along,

Link: Amazon.com: Books: The Progress Paradox : How Life Gets Better While People Feel Worse.