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There’s a major irony in this question. Let’s take it step by step. In population terms, the US is still growing. It’s not as fast as some of the developing countries, but it’s doing rather better than many of the other developed countries. It’s an age phenomenon. In some countries like Japan, there will soon be population loss as the birth rate fails to keep pace with the deaths. More generally, the percentage of the population retired and not contributing to the tax system also means the cost of running each country will fall on a declining number of taxpayers when the medical costs of caring for an aging population are at their highest. Anyway, back to the irony: we used to have a high percentage of doctors per head of population. Governments used to ensure there were always enough doctors to build the health of our nation. As the Boomers worked their way through the education system, large numbers went into medicine and they have been keeping us going ever since. Except, along with all the other Boomers, most of these doctors are retiring and there are not enough coming through the medical schools to keep up the numbers. What makes this irony all the more sharp is the effect of the Affordable Care Act. This will bring millions more people into the healthcare system only to find there are not enough doctors to treat them.

The Association of American Medical Colleges estimates that, by 2020, we will be short about 90,000 doctors. As if his was not a serious enough problem, the reality is significantly worse in some states. If you are lucky enough to live in the northeastern states, there’s a good ratio of doctors per 100,000 population. Put the other way round, Mississippi has less than half the number of doctors practicing in Massachusetts. This reflects capitalism at work. There are more wealthy people to treat in Massachusetts. Doctors go where they can make the most money. Putting profit to one side, it’s always been more difficult to persuade doctors to work in rural states. As an example, Texas released 1,200 trained doctors from college last year. This is the second highest number of graduates in the US but Texas has one of the lowest numbers of doctors per head of population, i.e. assuming most newly qualified doctors stay in the state where they graduate, Texas is failing to train enough doctors. Were it not for the foreign-trained doctors, the shortage in Texas would be a crisis – another reason for allowing more immigration. Read the rest of this entry »

It’s at this point that Libertarians get all excited because this article is all about whether an interfering government should tell people how to live their lives. Think about the debate over criminalizing those who use soft drugs like cannabis. Victimless crimes, they shout. What we do in the privacy of our own homes is our affair. That’s why we’re all signed-up members of the NRA and will shoot to kill if threatened. Well, let’s add to the list of stuff that can kill you. Everyone has to know that smoking causes a range of cancers and other usually fatal diseases. So far, big government has refused to ban the sale of this lethal drug. It’s a major double standard. If smoking cannabis, even for medicinal purposes, is a crime in most states, why is nicotine treated differently when it kills rather more people?

Thinking back to the good old days of Eliot Ness and the Untouchables, Prohibition was not the greatest success. Indeed, the real statistics show that more alcohol per head was consumed during the period of the ban than before. So trying the same thing today is not going to produce better results. People will not be told to quit smoking or stop drinking to excess or to eat more healthy food or to exercise more. Even though, when you put all four factors together and show the catastrophic effect on health, the majority of Americans will resent being told – even though privately, they might admit it’s good advice. Read the rest of this entry »

Not that we want to come over allpessimistic, but this recession has been going on for a long time now andthere’s no real sign it’s going to come to an end anytime soon. Looking around,the property market is still in deep trouble. Foreclosures were slowed by therobo-signing problem, but banks are picking up the pace again. The unemploymentrate is stuck in the 9.5% area nationally. Locally, of course, it can be farworse, particularly among the young and the older workers. So what do you do ifthe worst happens and your job is suddenly on the line? Well, the first part ofthe answer is you negotiate to stay in work. Even though you may have to worklonger hours or take a cut, this is better than no money coming in. Other thanthat? Well, it all comes down to how careful you’ve been with your money.

Looking back, some of the moralists havedrawn on nature for models of how best to live. Some animals are reallyindustrious during the summer. This is the time of plenty but they run aroundlike there’s no tomorrow, collecting food and burying it or putting itsomewhere safe for the hard times during the winter. Others sit around gettingfat and, when the food runs out, they starve and die. Well, it’s the same withus humans. If you not only stay within your budgets, but save while the boomyears give you plenty, you’re well set-up when hardship comes. But if youborrowed heavily and never paid down your debts, you’re in trouble when the paychecks stop.

The big question should you be given apink slip is what happens to your health coverage. During all these happy yearsof security, there’s been no need to worry about the world of privateinsurance. Now, suddenly, you’re negotiating the final package of severancepay. If you’re lucky, your employer may offer some help in finding somewherenew to work and, while all this is going on, you need to research theConsolidated Omnibus Budget Reconciliation Act of 1985 (better known as COBRA). Read the rest of this entry »