The stunning success of vaccines in America, in one chart

“Measles, mumps, and polio are supposed to be diseases of the past. In the early to mid-20th century, scientists developed vaccines that effectively eliminated the risk of anyone getting sick or dying from illnesses that had killed millions over millennia of human history.
Vaccines, alongside sanitized water and antibiotics, have marked the epoch of modern medicine. The US was at the cutting edge of eliminating these diseases, which helped propel life expectancy and economic growth in the postwar era.”

“As long-accepted, lifesaving public health measures increasingly become politically polarized, routine vaccination rates are rapidly declining in much of the US. In the 2019–2020 school year, three states had less than 90 percent of K–12 students vaccinated against measles, mumps, and rubella. By the 2023–2024 school year, 14 states had fallen below that threshold. The number of states with more than 95 percent of schoolchildren vaccinated — the preferred level of coverage to prevent outbreaks — dropped from 20 to 11 during that same period.

It is no surprise then that the number of US measles cases more than quadrupled from 2023 to 2024. Nobody has died of measles in the US since 2015, but if vaccination rates continue to decline, this highly contagious disease (one person can infect more than a dozen other people) will spread with increasing ease, which raises the risk that American kids could die.

We know how to prevent that. We’ve had remarkably safe, effective shots for decades. We just need to keep using them.”

https://www.vox.com/future-perfect/386215/trump-rfk-jr-vaccines-health-measles-chart

Why is US health care like this?

” In most rich countries, people don’t have to worry about sifting through a dozen different health plans — and they don’t live in fear of losing their health care after losing a job, and they receive more affordable, higher-quality care than Americans do. The paradox of the world’s wealthiest nation having one of the weakest health systems among developed nations has long been a vexing policy problem — without an easy solution.”

“American health insurance, as we think of it today, started to take shape in the 1920s, as the medical profession was being standardized and modern hospitals were being built. Some employers started offering payments for hospital-based services as a perk for their workers. Companies had large groups of employees, some in good health and some in bad, to spread the risk and make the finances work much like modern-day insurance does.
This system soon became entrenched enough that President Franklin D. Roosevelt bypassed plans to include national health insurance as part of the New Deal. Then came World War II, along with government-mandated wage controls for employees in the private sector to keep the war machine moving. Barred from offering raises to motivate their workers, companies started pumping up their health benefits — and the government agreed to exempt those benefits both from wage controls and taxes.

By the 1950s, employer-sponsored insurance had become popular among those who received it and progressive labor unions urged the government to make the tax exemption permanent. Congress agreed, enshrining in 1954 the subsidy for company health plans in federal law. Doctors and hospitals, whose industry was growing into the leviathan that it is today, became accustomed to working with private insurers rather than with the government directly.

Today, these work-based health plans still cover roughly half of all Americans.”

“The problem with the employer-based system was it left out too many people because they didn’t work or didn’t have a job that offered health insurance. To start filling in the gaps, in 1965, Congress created Medicare and Medicaid to cover two of the biggest groups of people who lacked coverage: seniors and people in poverty.

After that expansion, we had a system that covered most Americans — which made it hard to change, because people feared losing what they had.

Those fears, supported by the medical industry’s campaign against “socialized medicine,” doomed the health care overhauls proposed by presidents Richard Nixon and Bill Clinton that would have consolidated most Americans into a national insurance scheme. Certain tendencies in American culture — consumerism and trust in private markets — made it easier to persuade the public that they’d lose under a government-run health plan.

Meanwhile, the US health care system still had obvious holes. Rather than threaten the status quo, policymakers added new patches.

CHIP was approved in the 1990s, covering children of working-class families whose incomes were not low enough to get Medicaid. (Their parents, however, were often left without any coverage at all.) The 2010 Affordable Care Act, also known as Obamacare, was designed to fill that gap by covering people who didn’t receive health insurance through their jobs but didn’t qualify for Medicaid.

Yet even after a half-dozen rounds of incremental health reform over five decades, about one in 12 people in the US lack health coverage and Americans are much more likely than people in other developed nations to say they skip medical care because of the cost.”

“Other countries built their health care systems more deliberately.

After World War II, the United Kingdom sought to extend medical security to all its citizens, creating the National Health Service; many other European governments followed suit.

A half-century later, another wealthy island nation made the same choice. Taiwan, building a modern democracy after decades of authoritarian rule, scrapped a fractured, inequitable health system to set up a national insurance program that would cover everyone. It was a proclamation of solidarity after a tumultuous military dictatorship had come to an end.

Not all countries have opted for a single government program, but their systems are still simpler than America’s and cover the entire population. In 2006, the Netherlands opted to trade a dysfunctional two-tiered insurance system for a universal program that relied on private coverage but was nevertheless designed to insure everybody. The uninsured rate there today is less than 1 percent (some people opt out).

But the US? We’ve never paused to build a fairer, simpler, uniform health system.”

https://www.vox.com/explain-it-to-me/375082/us-health-insurance-plans-medicare-medicaid

Trump’s health care plan exposes the truth about his “populism”

“Vance’s sunny rhetoric here disguises his plan’s inegalitarian moral priorities.
It is true that the young and healthy have different medical needs than the old and sick. And before the Affordable Care Act’s regulations, the former could sometimes procure cheaper insurance tailored to their (currently) limited needs.

But this came at a social cost. Insurers were able to offer cheap health coverage to those who barely needed it by screening out those with preexisting conditions. In Vance’s terminology, they constructed low-risk pools: By only including people who were unlikely to require expensive treatments in their plans, they could profitably provide low-premium insurance to the young and well.

Meanwhile, sick and/or older Americans on the individual insurance market either went without coverage or were forced to pay dramatically higher premiums in order to cover the high cost of their care. Some state governments tried to defray this cost somewhat by subsidizing high-risk pools. But enrollees still paid much higher premiums than the typical market rate, and their coverage often excluded the treatments they needed most.

The Affordable Care Act effectively forced the healthy to subsidize the sick. It required insurers to include those with preexisting conditions in their plans and cover all medically necessary procedures. To guarantee that insurers could still turn a profit and that coverage remained (at least somewhat) affordable for all, the government provided consumers with insurance subsidies.

The upshot of all this was that coverage became a little more expensive for some healthy people, while growing much cheaper for the old and seriously ill.”

“Vance’s vision for health care policy helps clarify the character of the right’s burgeoning “populism.” On trade and immigration, Vance’s ideology may prize a nationalistic conception of the common good above free markets. But on most economic questions, its iconoclastic rhetoric belies its fealty to conservative orthodoxy — and thus, to “the ruling class” whom Vance loves to deride.

As Trump’s running mate, Vance is campaigning on tax cuts for corporations and the wealthy and deregulation for health insurers. The rest of Trump’s economic agenda is rather hazy. But if his first term is any guide, it would also involve curtailing workers’ collective bargaining rights, reducing workplace safety standards, and attempting to throw millions off of Medicaid. Vance has not seen fit to criticize any aspect of this record.”

“For Vance, deregulating insurance markets at the expense of the vulnerable is not neoliberal or anti-populist. But arguing that politicians should not spread incendiary lies about immigrants is.”

https://www.vox.com/politics/372635/trump-health-care-plan-vance-preexisting-conditions

Should We Blame Fauci for the COVID Pandemic?

“Prior to COVID-19, Fauci had long supported funding pandemic research that other scientists found risky, if not downright dangerous.
In 2005, as NIAID director, he praised researchers who’d used a grant from his agency to resurrect the virus that had caused the Spanish flu pandemic. Better understanding that virus would help prevent future diseases, he argued. “The certain benefits to be obtained by a robust and responsible research agenda aimed at developing the means to detect, prevent and treat [future pandemics] far outweigh any theoretical risks,” he said in an October 2005 statement co-authored with then–CDC Director Julie Gerberding.

This wasn’t a universal opinion at the NIAID. The agency’s chief scientist described this approach to pandemic prevention as “looking for a gas leak with a lighted match.”

Fauci would continue to praise and fund this kind of research. In 2011, researchers at the University of Wisconsin and at Erasmus University Medical Center in the Netherlands managed to manipulate the virus H5N1 (which had been responsible for a 2004 bird flu epidemic in Asia) to transmit between mammals, a “gain of function” for a virus that had heretofore only been able to pass from infected birds to humans. One of the researchers involved in the work would say the enhanced pathogen they’d created was “very, very bad news” and “probably one of the most dangerous viruses you can make.” Fauci was more sanguine, telling The New York Times that “there is always a risk. But I believe the benefits are greater than the risks.””

“In 2014, there was a series of embarrassing safety lapses at U.S. government labs, highlighting this risk.

Dozens of CDC employees were potentially exposed to live anthrax samples shipped by mistake to labs not equipped to handle them. At another CDC lab, a less dangerous version of bird flu was accidentally contaminated with deadly H5N1. Vials of smallpox capable of infecting people were stashed in a cabinet at an NIH lab, where they’d apparently been sitting for decades. None of these incidents were direct results of gain-of-function research. But they heightened the concern that researchers working to enhance deadly pathogens might do so in unsafe settings.”

“In 2021, Fauci said the NIH “has not ever and does not now fund gain-of-function research in the Wuhan Institute of Virology.” That wasn’t true. What EcoHealth was doing in Wuhan clearly met the widely understood definition of gain-of-function research.

In his June 2024 testimony, Fauci dodged accusations that he lied by saying that while EcoHealth’s work might have met a generic definition of gain-of-function research, it didn’t meet the precise definition established in the P3CO framework.

Fauci said that every time he mentioned gain-of-function research, “the definition that I use is not my personal definition; it is a codified, regulatory and operative definition.” That definition, he said, “had nothing to do with me.”

On the contrary, regulatory definitions had quite a bit to do with Fauci. They were designed with the expectation that he and his fellow public health bureaucrats would use discretion and good judgment when making decisions. The relevant regulatory language included lots of “likelys and highlys and reasonably anticipated,” says Gerald Epstein, a former director at the White House Office of Science and Technology Policy who wrote the P3CO policy. “These words are inherently subjective. You can’t not be. You’ve got to be making judgment calls on something that does not yet exist.” Those subjective definitions gave Fauci and his NIAID underlings considerable room to decide what research required additional review.”

“We probably won’t ever definitively discover the origins of COVID-19.”

“Chinese officials obstructed any investigation into the Wuhan Institute of Virology. In September 2019, the Associated Press reported, the institute took its database of viruses offline. It also hasn’t made public lab notebooks and other materials that might shed light on exactly what kinds of work it was doing in the lead-up to the pandemic. In late 2019, the Chinese government also exterminated animals and disinfected the Wuhan wet market. If COVID did leap from animal to human in the Wuhan market, as many natural origin proponents argue, that evidence is gone.

What we’re left with is studying the structure of the SARS-CoV-2 virus itself and whatever information can be gleaned from the U.S.-funded research that went on at Wuhan leading up to the pandemic.

On both fronts, Fauci, his underlings at the NIAID, and NIAID-funded scientists involved with work at Wuhan have worked to conceal information and discredit notions that COVID might have leaked from a lab.

In late January 2020, Fauci’s aides flagged the NIAID’s support of EcoHealth’s Wuhan research in emails to their boss. A few weeks later, Fauci and Daszak would go on Newt Gingrich’s podcast to dismiss the idea that COVID-19 came from the Wuhan lab, calling such arguments “conspiracy theories.”

Both men also worked to shape the discourse behind the scenes away from any focus on a lab leak. Daszak organized a group letter of scientists in The Lancet, the U.K.’s top medical journal, declaring that they “stand together to strongly condemn conspiracy theories suggesting that COVID-19 does not have a natural origin.” Daszak did not disclose his relationship to the Wuhan lab when organizing this letter; The Lancet’s editor would eventually concede that this was improper.

In testimony to the House coronavirus subcommittee in May 2024, Daszak would claim the “conspiracy theories” mentioned in the Lancet letter referred only to such wild early pandemic notions that COVID had pieces of HIV or snake DNA inserted into it. He said a word limit prevented him from being more precise.

Fauci, meanwhile, would help corral virologists into publishing the widely cited “proximal origin” paper in early 2020. In the paper, the authors flatly declared that “we do not believe any type of laboratory-leak scenario is plausible.”

Yet troves of private messages and emails released by the House subcommittee’s investigation show that the authors privately expressed far more openness to a lab leak theory.

One of the paper’s authors, Scripps Research evolutionary biologist Kristian Andersen, privately rated a lab leak as “highly likely.” But Andersen had a pending $8.9 million grant application with the NIAID as the paper was drafted. That grant was later approved. In an email, one of the paper’s authors, Edward Holmes, references “pressure from on high” during the drafting process.

The authors of the proximal origin paper say they merely had their minds changed while drafting the paper. They were just following the scientific method.”

“Fauci’s best defense is that he ran a sprawling agency that doled out billions of dollars in grants. Even the most detail-obsessed administrator couldn’t possibly keep track of every single program and project. And U.S. officials had limited control over what happened in the distant, opaque Wuhan lab.

But even if that’s true, it’s an admission of administrative negligence, since the oversight protocols weren’t followed. It also implies a dramatic failure of the risky research that Fauci championed for pandemic prevention. As Ridley says, the pandemic “occurred with the very viruses that there was the most attention paid to, in the very area where there was the most research going on, where there was the biggest program looking for potential pandemic pathogens, and yet they failed to see this one coming.” At a minimum, gain-of-function research didn’t protect the public from the pandemic.

Meanwhile, the more direct case against Fauci is strong: Not only was he an ardent supporter of research widely believed to be risky, but he manipulated bureaucratic protocols in order to avoid scrutiny of that research, then responded evasively when called to account for his actions. At least one of the programs born out of Fauci’s risky research crusade was pursuing exactly the type of viral enhancements that were present in COVID-19, and that research was conducted at the Wuhan virology lab in the very same city where the virus originated. Lab leak proponents cite the virus’s transmissibility as evidence for a Wuhan leak: After all, EcoHealth was trying to create pathogens primed to spread rapidly in humans.

The evidence is not fully conclusive. But it seems reasonably likely that Fauci pushed for what his peers repeatedly said was dangerous research, that some of that dangerous research produced a deadly viral pathogen that escaped the lab, and that Fauci helped cover up evidence and arguments for its origins.”

https://reason.com/2024/09/14/faucis-pandemic/

Free medical school won’t solve the doctor shortage

“The US does have significantly fewer doctors per capita than some other wealthy nations, such as Germany and Sweden. But America’s physician-to-patient ratio is actually about the same as other developed countries — Canada, the United Kingdom, Japan, France — that still generally rank better on measures of health care quality than the US does. So aggregate numbers alone are not enough to explain the access problems that patients face, and experts disagree over whether we need to boost the overall supply of providers in the short term.
The bigger problem is misallocation in the US physician workforce, Coffman told me last year. We know that we don’t have enough doctors in certain important specialties: primary care, obstetrics, and psychiatry, for example. We also don’t have nearly enough providers in a broad swath of specialties practicing in rural and other low-income communities. Between 2010 and 2017, while large urban counties added 10 doctors per 100,000 people on average, rural counties lost three. As a result, metro regions had 125 doctors per 100,00 patients, while rural areas had 60.

America is littered with doctor deserts, areas where there are not enough primary care providers, much less specialists or hospital-level services. The federal government estimates that 80 percent of rural Americans live in medically underserved communities.

In the long term, the US will undoubtedly need more doctors in rural and urban areas alike. Groups like the Association of American Medical Colleges continue to project long-term workforce shortages, as boomer-generation doctors reach retirement age and the population of seniors requiring medical care swells.”

https://www.vox.com/future-perfect/361620/bloomberg-johns-hopkins-free-medical-school-doctor-shortage

Pregnancy in America is starting to feel like a crime

“Imagine you’re eight months pregnant, and you wake up in the middle of the night to a bolt of pain across your belly.
Terrified you might be losing your pregnancy, you rush to the emergency room — only to be told that no one there will care for you, because they’re worried they could be accused of participating in an abortion. The staff tells you to drive to another hospital, but that will take hours, by which time, it might be too late.

Such frightening experiences are growing more common in the wake of the Supreme Court’s 2022 Dobbs v. Jackson Women’s Health decision, as doctors and other medical staff, fearful of the far-reaching effects of state abortion bans, are simply refusing to treat pregnant people at all.

It’s part of what some reproductive health activists see as a disturbing progression from bans on abortion to a climate of suspicion around all pregnant patients. “People are increasingly scared even to be pregnant,” said Elizabeth Ling, senior helpline counsel at the reproductive justice legal group If/When/How.

The fall of Roe has led to an ever-widening net of criminalization that can ensnare doctors, nurses, and pregnant people alike, leading to devastating consequences for patients’ health, experts say.

Complaints of pregnant women turned away from emergency rooms doubled in the months after Dobbs, the Associated Press reported earlier this year.”

“The Dobbs decision has created an environment in which people experiencing miscarriage are treated as criminals or crimes waiting to happen, advocates say — or sometimes both.

In October 2023, an Ohio woman named Brittany Watts visited a hospital, 21 weeks pregnant and bleeding. Doctors determined that her water had broken early and her fetus would not survive, but since her pregnancy was approaching the point at which Ohio bans abortions, a hospital ethics panel kept her waiting for eight hours while they debated what to do. She eventually returned home, miscarried, tried to dispose of the fetal remains herself, and was charged with felony abuse of a corpse.

The charges were ultimately dropped, but experts say her case is part of a larger pattern.”

https://www.vox.com/health/356512/pregnancy-america-crime-dobbs-justice

How dangerous is it really to have a baby in America?

“Even if the CDC data isn’t perfect, many scholars agree that far too many people are dying during and after childbirth in the United States.
We have many sources of information about maternal mortality, said Laurie Zephyrin, a senior vice president for advancing health equity at the Commonwealth Fund. The CDC’s National Center for Health Statistics releases the numbers that have been most debated recently, but the agency also has a Pregnancy Mortality Surveillance System that employs medical epidemiologists to comb through death records from pregnancy up to a year after birth. Meanwhile, state and local maternal mortality review committees also independently investigate maternal deaths. “All three of these ways of collecting data are showing that we have a problem in this country,” Zephyrin said.

We can also understand US maternal health better by putting it an international context. Comparing maternal mortality across countries can be complex, for some of the same reasons it’s complicated to count maternal deaths within the US. Some countries use a pregnancy checkbox like the one added in the US while others do not, leading to concerns that other nations may be underreporting maternal deaths, making the US look worse by comparison.

However, we know that the US lags behind other countries when it comes to policies proven to improve maternal (and overall) health. Among wealthy countries, the US is the only one without universal health care, said Munira Gunja, a senior researcher with the Commonwealth Fund’s International Program in Health Policy and Practice Innovations. It’s also the only one without federally mandated paid parental leave, and it’s the only country that doesn’t provide home visits and other comprehensive postpartum care, instead often limiting birthing people to a lone doctor’s appointment six weeks after birth. “The US is a clear outlier, particularly when it comes to postpartum support,” Gunja said.

Meanwhile, everyone involved in the debate over counting maternal deaths agrees that Black birthing people are dying at a disproportionately high rate. That disparity shows up whether you use the CDC’s method or Joseph’s, and it’s indicative of bigger problems within the US health care system, experts say. Black Americans in general have a lower life expectancy than white Americans, and Black babies are more likely to be stillborn or die in infancy. “This is across the board, not just in maternal health,” said Angela D. Aina, co-founder and executive director of the Black Mamas Matter Alliance.

Some have argued that the language of “crisis” is unproductive, frightening pregnant people and prospective parents and clouding the search for solutions. “The constant drumbeat that maternal mortality is ‘commonplace’ and that pregnancy is ‘deadly’ doesn’t empower me with information to make my own decisions,” Jerusalem Demsas writes at the Atlantic. “It just stresses me out.”

Reasonable people can disagree over what constitutes a crisis and over the best way to measure how often Americans experience the tragic situation in which a person who is already sick dies from their illness after giving birth.

But experts do not disagree on the basic premise that too many pregnant and birthing people are dying in America, that many of their deaths are preventable, and that we already know some of the reforms — from paid leave to better prenatal and postpartum care — that would save their lives.”

https://www.vox.com/health/356794/pregnancy-health-maternal-mortality-pregnant-cdc

Pig kidney transplants are cool. They shouldn’t be necessary.

“Humans could, if we wanted to, end the kidney shortage right now without any assistance from our porcine friends.”

“There are more than enough human beings walking around with spare kidneys who could donate them to strangers in need. They simply choose not to.”

https://www.vox.com/future-perfect/24117935/pig-kidney-transplant-mass-general-donation