A new study of mortality in 16 countries offers reasons why Americans are less healthy and die younger than people in other wealthy countries: We eat more poorly, get fatter and have less access to health care.
The 404-page report, done by the Institute of Medicine and the National Research Council also found that even though we are a so-called wealthy country, we have more people living in poverty.
In too many cases, out health care system contributes to that poverty.
We tallied up lower scores than these other nations on infant mortality, injury and homicide rates, teen pregnancy and sexually transmitted illnesses, HIV/AIDS, drug addiction, obesity and diabetes, heart disease, lung disease and disabilities.
So, what's the problem here?
Well, for one thing, out food supply is contaminated by chemicals and it's less nutritious than it could be because of our industrialized agriculture. 
Why is it that many glucose-intolerant people can eat wheat in Europe but not here? It's because they're not reacting to the glucose but to something else -- likely some chemical we're adding that Europeans are not.
 We add high fructose corn syrup to everything because it's cheaper than sugar, and our bodies do  know the difference, despite what the corn industry's ads say. High fructose corn syrup is metabolized differently, leaving our bodies unable to use insulin the way they should, leading to a higher likelihood of type 2 diabetes. Corn sugar also makes our bodies feel hungrier, leading to overeating and obesity. The "epidemic" of obesity and diabetes began in the 1970s, which is exactly when we started using so much high fructose corn syrup in our food.
Americans spend less on food as a portion of our income than any other wealthy nation, but we get what we pay for -- lousy nutrition. These contaminated, compromised foods are what's making us sick, but we continue to belly up to fast food counters and wolf down the crap they dish out. We continue to eat processed food because it's more "convenient."
The food industry is as powerful as Wall Street when it comes to fending off regulation, so we have to be smarter consumers. We have to buy locally from small farms whenever we can, organic, when we can't get local. Know our farmers. Most places have tailgate markets and farmer's markets now. There's really no reason to eat antibiotic- and hormone-laden meats. Yes, local, humanely raised meat is more expensive, but what is your health worth? Eat less meat.
Our food system is leaving us open to so many illnesses and millions of us are lacking full access to health care. We get  sick and fat and we either don't have insurance or our deductibles and co-pays are so high we can't get the care we need for our high blood pressure, high cholesterol and diabetes, so our condition gets worse until we have a heart attack or stroke, go into renal failure or lose a limb. Then we go deep into debt from the cost of crisis care. In right-to-work states, people lose their jobs because of illness, leaving them sick, in debt and uninsured.
Our poverty levels are only partly caused by health care costs, although that is a contributing factor. The real problem is that we are paid less than we were a generation or two ago. There has been a steady erosion of workers' wages and rights since 1980 as the power of unions has eroded. We work harder, make less and are less secure in our jobs than any time since the 1930s.  As poorer people, we are less able to afford decent nutrition and we have less access to quality health care. We live in less safe neighborhoods and we are exposed to more dangerous pathogens because of the lack of food regulation.
Our children are at higher risk of STDs and teen pregnancy because rather than teach them about safe sex, we pretend they won't become sexually active until their wedding nights and they wind up pregnant or worse. We pretend that talking to them will make them want to experiment so they begin to experiment anyway with little or no education.
Overall, we're a mess and the causes are easy to identify but difficult to fix with our current political polarization and the control huge corporations have over our government. 
We have to make the changes we can and lobby for changes at a higher level. We need real regulation of our food supply and real access to health care.

In 2009, the National Alliance on Mental Illness gave the United States a D in its overall efforts to provide care to people with mental illnesses. Things haven't improved much since then.
Suicide deaths in the military exceed combat deaths, but states continue to cut mental health services. More than half of the people in our jails have mental health issues. And although people with mental illnesses are not likely to harm others, if you give someone who can't reason ready access to guns, he or she is more likely to commit mayhem.
Still, "reform" efforts across the nation have eliminated hospital beds for people in crisis, Medicaid reimbursement rates are so low that most service providers can't afford to take on too many patients.
Starting in 2001, North Carolina began to "reform" its system "to offer consumers more choice." I cringe whenever I hear that phrase because it means privatization, and mental health care should never be left solely to the private sector.
People with severe and persistent mental illnesses need a lot of care, and they're not easy patients. If their illness is not well controlled, they might not even show up for appointments; they might stop taking their medications, in which case the illness will get worse.
Our system in North Carolina imploded. People were dying on the streets -- literally. And the state General Assembly is still looking to make more cuts. 
The system is changing from a fee-for-service to block grants, which will total less than what was being spent. The money just isn't adequate, as our local management agency here in Asheville learned from experience.
So now, instead of reviewing cases every year, it is done every three months, which means four times the paperwork and four times the likelihood that a person's care will be reduced or terminated. Fewer care providers are willing to do this increased and unpaid work.
Instead of being an hour, sessions are now 45 minutes. You can still bill for an hour, but you will be reimbursed for only 45 minutes of your time.
More people are falling through the cracks and then turning up in jail or dead.
When NAMI revisited its national report card in 2011, the advocacy nonprofit found more cutbacks in states' systems.
The Affordable Care Act contains some strong advocacy for people with mental illnesses, including a mandate that insurance companies cover psychiatric care at the same level they do every other specialty. You can't charge a $50 copay for an endocrinologist and $75 for a psychiatrist. You can't allow 52 visits to a gastroenterologist but only 12 to a psychiatrist.
That's great for people who have insurance, but people with severe and persistent mental illness aren't likely to be able to hold down a job, and our health insurance in this country is tied to employment. Even after the Affordable Care Act takes full effect in 2014, most of us still will get our health insurance through our employers.
So, people with mental illnesses are left to fend for themselves. Some will have access to disability, but if they have been able to work for any length of time, they will only be eligible for SSD, which means they might lose Medicaid and not have access to Medicare for two years.
Some have sporadic employment and so will not be eligible for Medicaid, especially in states that refuse to expand Medicaid.
None of this makes any sense to me. It's so much more cost effective -- not to mention humane -- to treat this chronic illness properly.
But there still are people who believe we can all control our own brain chemistry and that someone with a mental illness is somehow morally deficient.
Many evangelical Christians believe people can and should pray the illness away, even though they would never say the same thing about asthma.
We as a society are punishing people for an illness over which they have no control, and it's costing us billions in lost productivity, in criminal justice dollars and

Dear Gov. McCrory,
I didn't vote for you, partly because I didn't believe you were a moderate Republican. You can prove me wrong.
Soon now, you will announce whether North Carolina will expand Medicaid to about a half-million people in the state. The action won't cost the state a dime in the first three years, and then we'll pay just 10 percent of the cost each year after that.
I urge you to stand up to people who for ideological reasons alone would allow 500,000 people to be denied basic health care.
People who make less than 133 percent of the federal poverty level can't afford even the most basic care, so they don't get checkups and they can't manage chronic illnesses. 
So, let's look at the logic here. If we deny them care, we will pay a whole lot more down the road as people show up in the emergency room in renal failure or with a massive stroke or heart attack, or with cancer that has progressed beyond the point of any hope for a cure.
People who don't have access to care are much sicker by the time anything is done for them, and by then it may be too late to save their lives.
That's what happened to my son, Governor. He couldn't get insurance because a birth defect was a pre-existing condition, and without it, he couldn't get the screening tests he needed. He got sick and he got sicker and was finally admitted to the hospital weighing just 110 pounds (he was 6 feet tall). He was so sick it took them five days to stabilize him, and his cancer was stage 3. He had to leave his wife to get Medicaid, and his chemo cost about $600,000. That's just the chemo, not the two surgeries, the radiation, the other medications and the loss of his tax revenues. So, by cheaping out on his care, we probably spent more than $1 million.
My son would be an attorney now, making decent money and paying his fair share in taxes.
Multiply that by 500,000 people, and I'm just talking about the financial cost. 
How about the emotional cost? How about the cost to our souls as human beings?
Have you ever lost a child, especially one who shouldn't have died? I wished my own heart would stop when his did, and many days I still do.
You have the chance to save thousands of lives of people in this state. I know your buddy, Art Pope, is advising  you to let those poor people fend for themselves, but I hold out hope that you have more character and compassion than that.
Make no mistake about it, Governor, we are talking about letting people die just to make a political point.
If that isn't evil, what is?

Several states have chosen to opt out of the expansion of Medicaid, and it is not in the best interests of their people or their health care businesses, especially hospitals.
The Affordable Care Act cuts the amount of money hospitals receive to compensate them for the care they provide to people who can't pay. The logic was that the expansion of insurance coverage, especially the expansion of Medicaid, would cut down on the amount of uncompensated care hospitals need to give.
But the Supreme Court threw a wrench into that plan when it decided that states don't have to expand Medicaid. Several states have said they won't expand Medicaid, but the law still provides for cuts to the money the federal government pays to hospitals for uncompensated care.
Although some are calling for an increase in federal money for hospitals in those states that refuse to expand Medicare, others are saying the states that refuse to cover more people under Medicaid shouldn't be rewarded -- especially because the expansion costs states nothing for the first three years and then the costs to the state rise to 10 percent of the total cost of the expansion. In other words, federal money is already available to these states and if they choose not to take it, that's their problem; the government shouldn't reward them with money from somewhere else. Here is the solution. Get on board or not, but those are your only choices.
When Medicaid was enacted in 1965, few states wanted anything to do with it. But eventually, all 50 states saw the advantages of a centralized system to care for people in need.
Those states that refuse to get on board will face a lot of pressure from hospitals, which will be less able to care for the poor, and probably from voters who don't understand why people in their state can't get care when it doesn't cost the
Let me start by saying I'm tired of the politicization of life-and-death issues in this country. Twenty children and seven adults are dead in Newtown, Conn., and people are screaming about politics. 
It's political because lobbyists pay billions to make it so.
We can't talk about gun safety without being political. I noticed the same thing during the health reform debate. 
I know what it is to lose a child who shouldn't have died and I'm trying to wrap my heart around all of those families in Connecticut. I at least got to say goodbye to my child. 
This is a tragedy beyond my ability to even comprehend. I have spent much of the time since hearing the news praying for healing that I know will never really come completely. Losing a child is not something you ever get over.
This is about people's lives, and gun manufacturers have made it Republican vs. Democrat. They have many of us believing that guns are perfectly safe; it's people who are dangerous.
Well, it's people with guns who are dangerous. Not all of them, mind you, but enough of them to cause havoc every few weeks.
This is not a simple problem with a simple solution. This is not just about guns, although guns certainly play a huge part.
I see this as a three-pronged problem:
  • The ease with which people can get guns and ammunition;
  • The lack of diagnosis and treatment for mental illnesses;
  • Our country's love affair with violence.
This is a public health issue and an education issue. The gun lobby has too much power and it has billions of dollars driving that power. A lot of the talking points I'm hearing come from those dollars.
  • We shouldn't regulate guns because then only criminals will have them.
  • We should put guns in the hands of more people so they can shoot back.
  • We should honor the victims by not discussing gun laws.
  • Guns don't kill; people do.
  • Only crazy people go on rampages so we all need guns to protect ourselves from them.
  • People will find other ways to kill if we take away their guns.

And on and on ...
Without going into all the anti-gun rhetoric, let me just say 20 children and seven adults were killed yesterday. Three people died in a mall in Oregon less than a week ago. The bodies are piling up and we're still arguing instead of talking.
We as a nation regulate cars more than we do guns -- we require a licence that has to be renewed periodically. We have more laws regulating the manufacture of teddy bears than we do guns.
It's well past time to have some sensible regulation of guns, including banning of assault weapons and background checks of everyone who wants to buy a gun -- even at a gun show.
The reason so many "nut cases" go on killing sprees is because they have a chronic illness that gets worse when it isn't treated, and we keep cutting funds for mental health. People with serious mental illnesses don't often have insurance because they can't hold a job and our access to care is tied to employment. In addition, most insurance policies don't cover much mental health care, although that will change in 2014, thanks to the Affordable Care Act.
I have watched as our mental health system in North Carolina has imploded because of state "reform," which privatized much of the system. Add to that the defunding of the system in recent years and you have a disaster. 
So, people with severe and persistent mental illnesses don't get the treatment they need, and their illnesses get worse, just like any untreated chronic illness.
Until we address this problem, we will continue to see "nut cases" with guns going on shooting rampages -- unless, of course, we make it more difficult for them to get guns.
We can demand improvement in our mental health system, and we will see it if enough of us demand it. Call your legislators and let them know you won't back down.
Finally, we have a love affair with violence in this country. We adore it. It's in our movies, on TV and in the games we play. The military uses violent video games as a recruiting tool -- go to the Army's web site and play for free.
Every year, the special effects in our entertainment get more grisly and realistic and the violence more graphic because it takes more to shock us. We've become desensitized to it, and there's some good scientific research to back that up.
I do not advocate censorship, but I do think parents should try to protect their children from it. If we don't buy the violent video games or go to the grisly movies, they won't be profitable so they won't be made. 
We are the ones who drive the market.
We are the ones who can make change.
Now is the time -- before the pain of this loss of innocent life diminishes.
While our hearts are still broken, let's honor the victims by being the force of change needed to prevent another massacre.

As happens most days, I got a call this morning from someone who needs health care information. She recently lost one son to cancer and another son is ill, was recently injured and now needs rehabilitation services.
Because this son only recently got SSI disability, he has to wait two years for Medicare to kick in. Because he has a 401K savings plan from when he was able to work, he isn't eligible for Medicaid. He was planning to buy a small mobile home with that money, but now he has to spend it down -- even though he can't withdraw it without paying a penalty because he isn't of age yet.
There is no reason to make people who get disability wait two years for health coverage; the reason they get disability is because they can't work, and in this country, health coverage is tied to work.
This is not an unusual situation; thousands of people are caught up in this gap every year. Many lose their savings and their homes and some die. Four years ago I interviewed a family caught in this gap and they received four calls from the bank during the two hours I was there. The woman told me they were getting eight to ten calls every day. Their power had been turned off once and the woman couldn't find a dentist who would take care of her infected teeth, which were damaged by the drugs she was taking for another condition and causing her a great deal of pain.
She had nowhere to turn.
The same is true of this family I spoke with this morning. If they can't pay for the bed in rehab, the man will be sent home, where there is no one to care for him properly.
If someone has Medicaid before getting disability, they often lose eligibility for Medicaid when they begin receiving disability checks because the $400 or $600 a month they get puts them over the income threshold in their state. In Texas, someone making just 12 percent of the poverty level can be kicked off Medicaid. And a single male adult isn't eligible, no matter what.
Congress could fix this easily by making anyone on disability eligible for Medicare immediately instead of making them wait two years.
If states expand Medicaid to over anyone with an income less than 133 percent of the federal poverty level, people won't lose eligibility for Medicaid so easily. But a number of states have said they won't expand Medicaid even though they won't have to pay a cent for it for three years and in the long run will only pay 10 percent of the cost. 
Only Congress can change this, but they haven't been inclined to do so. It seems they haven't been inclined to do much to help people in need in recent years.
It seems to me this family has been through enough, but there are those who would call them moochers because they need help because of circumstances beyond their control

The Kansas City Star just completed a yearlong investigation of the beef industry, and it's worth reading if you care about what you and your family are eating.
The industry was reformed somewhat a century ago after Upton Sinclair's book, "The Jungle" was published in 1906. Although the writing style is dated, the book is worth reading because government regulation seem to have regressed back to that time.
The problems are different today, though, and it makes the meat much more dangerous.
Beef cattle are pumped full of antibiotics, which make the bacteria that survive extremely virulent. Plus, the antibiotic we ingest with our burgers makes those very drugs less effective when we really need them, increasing the number of antibiotic-resistant infections. When these cows' manure is used to fertilize crops, bacteria in the soil can strengthen and become resistant to antibiotics. The Star details the story of children in Joplin, Mo., getting antibiotic-resistant infections following the tornado there because dirt with resistant bacteria got into their wounds.
But animals that have no infections are still being pumped full of antibiotics and there aren't likely to be laws against it any time soon, thanks to the lobbying power of the beef and pharmaceutical industries.
Cattle also are given beta blockers to make them grow faster and fatter, and the residual amounts of the drugs we get with our meat can cause cardiovascular problems. They're also given growth hormones, which cause them to grow faster, but also are found in the meat we eat.
The way cattle are kept before being slaughtered is nothing short of revolting. They stand in feedlots, shoulder-to-shoulder, sometimes knee-deep in their own feces, eating things cows were never meant to eat, including corn and ground up bone meal from other cows.
The new machines used to tenderize the meat push dangerous pathogens (including e. Coli) into the middle of the meat, which is less likely to be cooked to a high enough temperature to kill the bacteria. The same is true of ground beef. 
To combat this, some of the meat -- the stuff once deemed unusable -- is processed with ammonia. The resulting mush, called pink slime, is added to ground beef. Almost every frozen ground beef patty in America contains some of this slop.
Regulations in this country are so lax that if federal inspectors find bacteria in meat, they can't even force a recall -- recalls are voluntary. Fortunately, meat processors still have to worry about adverse publicity, so they do recall bad meat.
The retailer Costco has more rigorous inspection criteria than the US government, although even its inspections don't find every bad batch of meat. According the the Star, Costco officials boast that, until recently, they did more E. coli testing in the company’s lab than the US Department of Agriculture does nationwide at all other beef plants combined.
In fact, Costco officials boast that, until recently, they did more E. coli testing in the company’s lab than the USDA does nationwide at all other beef plants combined.
And it's not just the beef industry that's troubling; pork and chicken share many of the same problems.
The solution is to buy pasture-fed beef, pork and chicken, and buy it from local producers. Meat that's pasture-fed is lower in saturated fat and cholesterol, so it's healthier, and it's tastier. It's more expensive, but you get what you pay for. It probably won't hurt you to eat less meat.

I had an e-mail from a surgeon this morning from a physician who said he wanted some help getting the word out that any woman who has had a mastectomy is covered by insurance for breast reconstruction. The insurance company can't turn you down.
I know people don't know their rights under the Affordable Care Act, but this law was passed 14 years ago. I looked it up.
Nearly 300,000 people (mostly women, but a few men as well) face breast cancer every year. A generation ago, women routinely got a radical mastectomy with their diagnosis. You signed the permission before the biopsy, so you woke up minus a breast and a whole lot of muscle tissue if the pathology lab found cancer. There was no discussion because doctors offered no alternative to this body-mangling surgery.
Studies found that the survival rate was just as good when only the breast was removed, and that just removing the tumor and some surrounding tissue was also adequate in many cases.
Women lobbied to be given the choice of lumpectomy or simple mastectomy. Doctors, mostly male at the time, resisted, but women didn't back down.
Fewer women today get mastectomies, but it is indicated in many cases, and these women can have reconstruction, either at the time of mastectomy or later. Either way, insurance companies must cover the procedure.
Not all women want to have reconstruction, and no one should have it done without getting all the information available. This document by the American Cancer Society is a good place to start gathering information:
Your decision will depend on your age, the stage of your cancer, whether you have enough extra tissue to construct the new breast (very thin women sometimes don't have enough), even whether you smoke.
Each case is unique. However, if you and your surgeon decide breast reconstruction is best for you, insurance coverage (IF you are insured) is not an issue. It's covered.

One of the things Bob Costas talked about in his 90-second commentary Sunday was whether possible brain damage caused by football head injuries was partly responsible for Jovan Belcher's uncontrollable rage.A new study published in the medical journal, "Brain," shows that contact sport athletes like boxers and football players are more likely to develop chronic traumatic encephalopathy (CTE), a progressive degenerative disease of the brain found in athletes who suffered injuries to the head. Symptoms include memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, and, eventually, progressive dementia. (Read more about the study at http://www.medicaldaily.com/articles/13390/20121205/study-shows-former-football-players-suffered-brain.htm#03CHcX6u4pXeBQwP.99).The study, by researchers at Boston University School of Medicine, looked at the donated brains of professional athletes, war veterans, and others likely to suffer head injuries, found evidence of CTE, which occurs "as a consequence of repetitive mild traumatic brain injury."
They found evidence of CTE in professional along with college and high school football players, as well as in hockey players, boxers, and a wrestler -- and the families of the deceased reported troublesome and irregular behavior leading up to their deaths, including memory loss and personality changes.
Throw a handgun into that mix and you have real trouble.
Until recently, football players were sent back into the game if they said they were OK. With endorphins coursing through a player's system, he might not realize he's not OK, and a mild concussion could go undiagnosed and untreated. When that happens a few times, it can add up to CTE, and the symptoms might not appear for years.
Costas expanded on his commentary last night on The Last Word with Lawrence O'Donnell, talking about the mixture of possible brain damage and guns.
Men who play football at the pro level tend to be strong and aggressive to begin with. Throw in a handgun and a little CTE and you have an extremely volatile mix.
Of course, National Rifle Association president, Wayne LaPierre said during a radio broadcast that Belcher's girlfriend should have had a gun to protect herself, and he thought Bob Costas' comments were disgusting.
Right, Wayne. There's a real solution: more firearms. And God forbid anyone should talk about any kind of regulation of firearms. 
Handguns have become a national public health issue, and so have brain injuries from sports, although no one wants to talk about that. We Americans are so obsessed with sports that we ignore what the players sacrifice to entertain us. We immerse ourselves in statistics, standings and fantasy leagues and forget about the human cost.
Football and hockey players as young as high school level show signs of damage from repeated blows to the head.
I like football. I enjoy watching it. But I think something has to change. Already, the NFL is looking more closely at head injuries and not allowing players to go right back into the game.
But by the time players get to the NFL, some have suffered enough head injuries already to develop CTE regardless of NFL rules. We need to look at changes in the game for the youngest players and follow through to high school and college. Teenagers take risks as part of their growing-up process. They don't think long-term. It's up to the adults in their lives to make sure their risks don't lead to permanent damage. 

An article in Sunday's New York Times reminded me that even with the Affordable Care Act, our system has some pretty serious problems, and one of the worst is the cost of medications. 
The pharmaceutical companies here have free rein when it comes to setting prices on their products. Unlike other countries, we don't cap their profits because the companies claim they won't be able to do research and development of new drugs.
Thing is, they're not doing nearly as much R&D as they did in the past. Their biggest research projects are based on finding a new angle on older drugs before their patents expire. It's about making as much and spending as little as they can get away with.
Look at what happened when the cholesterol-lowering drug Lipitor's patent expired. The company offered the name-brand drug at the same price as the generic to keep people buying Lipitor and not the generic. That's $4 a month for many consumers and Pfizer, the manufacturer, is still making money on it. Before it went off patent, the average cost was $160 per month. 
Insurance companies covered Lipitor as a "tier 2" drug. Tier 1 drugs are usually generics and co-pays might be $10 or $15. Tier 2 drugs are ones that are on the insurance companies' formularies, and they might cost the consumer $25 to $30; tier 3 drugs are generally the newer and more expensive drugs and might cost $75, $80 or more.
When I took Ambien after Mike died, it cost me $85 for a three-month supply, but only if I ordered through the mail; otherwise it was $85 per month. As soon as it went generic, it was $15 for a 3-month supply, and it came from a different manufacturer. I could get it now for $4 a month at my grocery store pharmacy.
What Pfizer did was make the name brand's price competitive with the generic to try and keep market share.
In Sunday's New York Times, Frank Lalli wrote about trying to find out what his cancer drug would cost in the new year, when his insurance plan changes its prescription coverage plan. The drug, Revlimid, which is manufactured by Celgene, retails for $524 a pill, or $132,000 a year.
Lalli didn't know how much of that would be covered by his insurance plan, so he set out to find an answer.
It took him more than a week of calling his insurance provider, the human resources department at his former employer, the drug company and Medicare before he got an answer, which he demanded be in writing because he wasn't certain he could trust it.
My question is this: How much does it cost Celgene to make Revlimid? How much of a profit does its manufacturer make?
All too often, the profit is completely unreasonable.
When Mike needed chemo, he applied for Medicaid, the government plan for low-income people. He discovered he would have to leave his wife to get it. He applied for disability, hoping he would still be able to live on his own and not have to move back in with me. He was denied twice before he was put on the waiting list for a hearing.
In the end, the pharmaceutical companies were paid more than $500,000 for his chemo drugs. He got nothing; his first disability check came nine days after he died. Obviously, we put profit before human life in this society.
The drugs we take are sold at a fraction of the cost in other countries and the pharmaceutical companies are still making money, but those companies have made sure it's illegal for us to buy drugs from Canada. The excuse was that you never know what you're getting if you buy from elsewhere. But those drugs coming from Canada were made here in the United States; it's illegal to re-import them because the pharmaceutical companies want to protect the obscene profits they make from the prices they're allowed to charge here.
It's time to stand up to Big Pharma and regulate its prices. That alone would put a big dent in the rising costs of health care.