Question: What is the world’s most widely used psychoactive drug?
Answer: Caffeine
In the U.S., caffeine is consumed mainly in the form of coffee, tea, and cola. But coffee dominates. Worldwide, humans consume over 10 million tons of coffee beans a year. Roughly 16% (1.62 million tons) is devoured by Americans. The daily intake of caffeine varies depending on type of beverage and brand as the chart below indicates.
On average, each American consumes approximately 164 mg of caffeine each day. That’s roughly 1 small cup of Dunkin or (3.5) 12-ounce Diet Cokes (Trump consumes at least 12 cans of Diet Coke a day).
Across the globe, daily consumption of caffeine is close to universal. Eight in 10 humans consume a caffeinated beverage daily. That makes this chemical substance the “most commonly consumed psychoactive substance globally.” Its popularity is related to its ability to deliver three useful physiological enhancements – wakefulness, motor performance, and cognition.
Chemically, caffeine is a close cousin of adenosine which is present in brain neurons. Adenosine builds up in synaptic connections between brain neurons. When it binds to special receptors, it activates neurons that promote sleepfulness. Ingested caffeine is water and lipid soluble, and therefore is able to traverse the blood-brain barrier. Once inside, its chemical structure mimics that of adenosine, and it occupies adenosine receptors because it shares the same approximate shape and size. When these receptors are occupied by caffeine, adenosine molecules are unable to activate the receptors. The net effect is wakefulness.
After a few weeks analyzing government spending and putting all of his calculations into Grok, the head of DOGE, Elon Musk, has made another decisive move in the attempt to save the government money. Speaking on the Joe Rogan show, Musk declared that his team had given Big Balls and Little Balls instructions to stop screwing around with the minor stuff like cutting off foreign aid saving the lives of children or getting all worked up about storing paper records in a mine, and to “go after the real money”. It turns out that means putting all US health care into a national health service and eliminating all private, non state-run health care.
He told Rogan, in between injections of what he claimed were vitamin supplements, that “the DOGE team realized that the British government spends about $7,500 per capita on health care, and the US government spends about $8,000”. After observers noticed a few puffs of smoke coming from Musk’s side of the room he went on to say, “that means our government can use the example of the Brits and cut spending by $500 a head and as an added bonus, private employers can stop wasting money on health care premiums”. When asked by Rogan if this new move was influenced by his desire to cut costs at his companies, Musk appeared to be unaware that he ran any companies.
Musk went on to say, “it’s incredible that we’ve been giving all these hospitals and health insurers government money and they’ve been sticking it in their hedge funds. Little Balls told me that he read a post from some blogger claiming that there’s over $500 billion sitting on the balance sheets of big hospitals and non-profit health plans. Now we have nationalized them all, that money can be put to better use.”
Rogan asked him how this would work and Musk said that all doctors, nurses and hospitals now worked for the Federal government and could just deliver care for free. “They’ll be paid British wages, and they’ll be happy–British people are still rich enough to be buying Teslas, no one else is! And if the line is too long, then people can fly to Scotland where they’ve got this socialized health care thing down pat. I understand President Trump has a special going at his hotel on that golf course, if you don’t mind looking at the windmills.”
When asked whether he supported Musk’s move, President Trump told the White House press corps that he wasn’t on the group call but that Don Jr had mentioned that Adderall was free in the UK, so it seemed like a good idea to both of them.
In unrelated news, Tesla also announced a stock buy-back in the amount of $500 billion.
“The recently announced limitation from the NIH on grants is an example that will significantly reduce essential funding for research at Emory.”
Gregory L. Fenes, President, Emory University
In 1900, the U.S. life expectancy was 47 years. Between maternal deaths in child birth and infectious disease, it is no wonder that cardiovascular disease (barely understood at the time) was an afterthought. But by 1930, as life expectancy approached 60 years, Americans stood up and took notice. They were dropping dead on softball fields of heart attacks.
Remarkably, despite scientific advances, nearly 1 million Americans ( 931,578) died of heart disease in 2024. That is 28% of the 3,279,857 deaths last year.
The main cause of a heart attack, as every high school student knows today, is blockage of one or more of the three main coronary arteries – each 5 to 10 centimeters long and four millimeters wide. But at the turn of the century, experts didn’t have a clue. When James Herrick first suggested blockage of the coronaries as a cause of heart seizures in 1912, the suggestion was met with disbelief. Seven years later, in 1919, the clinical findings for “myocardial infarction” were associated with ECG abnormalities for the first time.
Scientists for some time had been aware of the anatomy of the human heart, but it wasn’t until 1929 that they actually were able to see it in action. That was when a 24-year old German medical intern in training named Werner Forssmann came up with the idea of threading a ureteral catheter through a vein in the arm into his heart.
His superiors refused permission for the experiment. But with junior accomplices, including an enamored nurse, and a radiologist in training, he secretly catheterized his own heart and injected dye revealing for the first time a live 4-chamber heart. Two decades would pass before Werner Forssmann’s “reckless action” was rewarded with the 1956 Nobel Prize in Medicine. But another two years would pass before the dynamic Mason Sones, Cleveland Clinic’s director of cardiovascular disease, successfully (if inadvertently) imaged the coronary arteries themselves without inducing a heart attack in his 26-year old patient with rheumatic heart disease.
But it was the American head of all Allied Forces in World War II, turned President of the United States, Dwight D.Eisenhower, who arguably had the greatest impact on the world focus on this “public enemy #1.” His seven heart attacks, in full public view, have been credited with increasing public awareness of the condition which finally claimed his life in1969.
Cardiac catheterization soon became a relatively standard affair. Not surprisingly, less than a decade later, on September 16, 1977, an East German physician, Andreas Gruntzig performed the first ballon angioplasty, but not without a bit of drama.
Dr. Gruntzig had moved to Zurich, Switzerland in pursuit of this new, non-invasive technique for opening blocked arteries. But first, he had to manufacture his own catheters. He tested them out on dogs in 1976, and excitedly shared his positive results in November that year at the 49th Scientific Session of the American Heart Association in Miami Beach.
He returned to Zurich that year expecting swift approval to perform the procedure on a human candidate. But a year later, the Switzerland Board had still not given him a green light to use his newly improved double lumen catheter. Instead he had been invited by Dr. Richard Myler at the San Francisco Heart Institute to perform the first ever balloon coronary artery angioplasty on an awake patient.
Gruntzig arrived in May, 1977, with equipment in hand. He was able to successfully dilate the arteries of several anesthetized patients who were undergoing open heart coronary bypass surgery. But sadly, after two weeks on hold there, no appropriate candidates had emerged for a minimally invasive balloon angioplasty in a non-anesthetized heart attack patient.
In the meantime, a 38-year-old insurance salesman, Adolf Bachmann, with severe coronary artery stenosis, angina, and ECG changes had surfaced in Zurich. With verbal assurances that he might proceed, Gruntzig returned again to Zurich. The landmark procedure at Zurich University Hospital went off without a hitch, and the rest is history.
American manufacturing is making a comeback. Driven by tariffs, supply chain instability, and shifting economic priorities, companies are reshoring production—reinvesting in U.S. labor and operations.
But there’s one major obstacle still standing in the way: the crushing cost of American healthcare.
For decades, U.S. employers have overpaid for healthcare without improving outcomes. Ballooning insurance premiums bloated administrative costs, and an opaque, middleman-driven system have left businesses with the highest healthcare costs in the world—twice as much as top global competitors.
If manufacturing is returning, shouldn’t we be demanding a more efficient and productive healthcare model to support it? The same industries that once offshored to escape labor costs must now confront the reality that the old way of buying healthcare is broken.
The Consolidated Appropriations Act (CAA) & The Growing Fiduciary Risk
The game has changed. The Consolidated Appropriations Act (CAA) of 2021 imposes strict new fiduciary requirements on employers that sponsor health plans. Companies can no longer blindly trust big insurance carriers or PBMs to act in their best interest.
If businesses fail to properly manage their healthcare spend, they are now liable for excessive costs, lack of transparency, and conflicts of interest.
🔴 This isn’t just theoretical—JP Morgan Chase is now facing a class-action lawsuit over how it managed its employee health plan, with board members named as defendants.
Employers have always scrutinized office supply costs, travel budgets, and vendor contracts—yet they’ve handed over healthcare procurement to third-party insurers with zero accountability.
Now, that lack of oversight is a legal risk.
Why Employers Need a Chief Health & Benefits Officer (CHBO)
Every major business function has an executive leader ensuring strategy, efficiency, and accountability:
CFOs manage financial health with precision.
COOs streamline operations for maximum productivity.
CIOs leverage technology to drive innovation.
So why do we continue to let third-party insurers and middlemen dictate healthcare purchasing without a dedicated executive overseeing the strategy?
Mark Cuban recently called for a new C-suite role: the Healthcare CEO (HCEO). A more appropriate and less confusing term may be the Chief Health & Benefits Officer (CHBO). This leader would act as a fiduciary to the company, ensuring that its health benefits strategy delivers better outcomes at lower costs—just like a CFO does with financial oversight.
News flash: America is not a very happy place these days.
No, I’m not talking about the current political divide (which is probably more accurately described as a chasm), at least not directly. I’m referring to the latest results from the World Happiness Report, which found that the U.S. has slid to 24th place in the world, its lowest position ever. We were 11th in 2011, the first such report.
Nordic countries scored the highest yet again, taking half of the top ten counties, with Finland repeating for the eighth year in a row as the happiest country. America’s nearest neighbors Mexico (10th) and Canada (18th) are happier places, tariffs or not.
The researchers declare: “Belief in the kindness of others is much more closely tied to happiness than previously thought.” They specifically cite the belief that others would return a lost wallet is a strong predictor of a country’s happiness, while noting that such returns are twice as likely as people believe them to be.
John F. Helliwell, an economist at the University of British Columbia, a founding editor of the World Happiness Report, said:
The wallet data are so convincing because they confirm that people are much happier living where they think people care about each other. The wallet dropping experiments confirm the reality of these perceptions, even if they are everywhere too pessimistic.
The U.S., as it turned out, ranked only 52nd in believing a stranger would return a lost wallet, and even only 25th that the police would. We were slightly more optimistic (17th) that our neighbors would.
Sharing meals with others is also strongly linked to happiness. “The extent to which you share meals is predictive of the social support you have, the pro-social behaviors you exhibit and the trust you have in others,” Jan-Emmanuel De Neve, a University of Oxford professor and an author of the report, told The New York Times.
Unfortunately, the number of people dining alone in the U.S. has increased 53% over the past two decades. According to the Ajinomoto Group, among American adults under 25, it has jumped 80%.
Young Americans are helped drive our dismal results generally. “The decline in the U.S. in 2024 was at least partly attributable to Americans younger than age 30 feeling worse about their lives,” Ilana Ron-Levey, managing director at Gallup, told CNN. “Today’s young people report feeling less supported by friends and family, less free to make life choices and less optimistic about their living standards.”
Eighteen percent (18%) of young U.S. adults (18-29) report not having anyone they feel close to, the highest of all the U.S. age groups, and those same young adults also have lower quality of connections than older U.S. respondents. The report speculates: “Although not definitive, this provides intriguing preliminary evidence that relatively low connection among young people might factor into low wellbeing among young Americans.”
In fact, if the U.S. was measured just by the happiness of our young adults, we wouldn’t even rank in the top 60 countries. “It is really disheartening to see this, and it links perfectly with the fact that it’s the well-being of youth in America that’s off a cliff, which is driving the drop in the rankings to a large extent,” Professor De Neve said.
And he tells us why what we have done so far in Medicare Advantage and explains that it doesn’t work because we haven’t got the clinical data easily available via API. (Those in the know knew he was going to say that!). He also thinks that commercial payers may yet be the saviors of ACOs and Medicare Advantage by buying bundled care from providers and making it necessary for them to access the data across the board, and then change overall behavior. And Aneesh is quite optimistic about the new Admin and its MAHA stance. Matthew Holt
This piece is different from the typical “health-care industry” topics covered in this forum.
My Sunday morning routine usually involves getting a cup of coffee and downloading the most recent editions of magazines on my iPad.
The cover of the February 13 edition of Time magazine immediately caught my attention because the title read “OUR CANCER MYSTERY. WHY IT’S NOW STRIKING US SO YOUNG’’. Four people are on the cover: their names, cancer types, and age at diagnosis displayed. 18 to 40. I imagine that the majority of readers might describe their expressions as neutral and composed, their posture calm.
But I see what exists below the restrained surfaces. Something I am all too familiar with. Disbelief. Worry, Bewilderment. Uncertainty. Sadness.
Although overdue, a major news magazine had finally put it out there, front and center. A call to action.
On September 14, 2017, I was standing in a hospital room in Boston, when my previously healthy son, Patrick, then 29, received the shocking news that he probably had stage 4 colorectal cancer, which further tests confirmed. That grave diagnosis came with a bleak 14 percent relative 5-year survival rate. Like the cognitive simulation of Schrödinger’s cat, my beloved son’s life now lay in a sealed box, with a hammer hovering over a flask of toxin. Would it fall, smash the vial, and kill my son? I could only be an observer. I desperately wanted to be the one in the box instead of him.
Fatherhood and medicine are integral to my identity. Throughout the three years during which he received superb care at Dana Farber Cancer Institute, in Boston, I had to be his father first, offering emotional support with love and hope. The physician adviser part was a secondary role.
Despite his indomitable spirit, positivity and best efforts, Patrick took his last breath on September 6, 2020, in his childhood home, Although relieved that his suffering was over, I was caught in immense sorrow, not yet realizing that eventually acceptance would slowly weave itself through the grief, and I would gain a nuanced understanding of “before and after.’’
As I mentioned in my 12/6/2024 piece in this forum, I hadn’t thought very much about early-onset cancer during many of the years that I was in clinical practice and as a physician executive.( I had categorized my experience with bladder cancer at 49 as an anomaly.) But that has changed in the past few years, during which the rising incidence of cancer in younger adults has been, first, in the scientific and medical literature and then sporadically in the broad national news, especially since the summer of 2023. But millions of people still have no idea that this is happening.
Writing is how I express myself best, so in early 2020, I started writing to help myself navigate what was happening to Patrick. As the global phenomenon of early-onset cancers expanded, I felt compelled to tell my son’s inspirational story and raise awareness of early-onset cancer and the need to dramatically expand screening for it. Over three years, I wrote a book titled RESERVATIONS for NINE: A DOCTOR’S FAMILY CONFRONTS CANCER, published earlier this month and timed to CRC Awareness Month. A labor of love and grief, it’s a book about family, love, loss, science and spirituality. Craig Melvin, NBC’s TODAY Show co-anchor, graciously wrote the foreword. Three months after my son passed away, Craig lost his 43-year-old brother to the same disease.
Many books have been written about cancer. From a patient undergoing treatment, to a family member or other caregiver, to a doctor treating a patient, to a researcher looking to change the trajectory of those being diagnosed and treated. But this one is unique. Part memoir and tribute, interspersed with journal entries by my son and others in my family. Part medical saga, the book aims to educate the public about the dangerous global rise in early-onset cancers, and to help provide a roadmap by example of loved ones going through cancer battles, and a call to action to the medical community to get ahead of this crisis.
My son’s life shouldn’t be defined by cancer, but, rather, how he responded to it. Most inspirational was how he became a strong public advocate of screening and funding for cancer research.
I hope that readers of THCB can find the time to share the messages of this book with family, friends and colleagues.
Thank you, Matthew and THCB for providing this forum to present my story.
George Beauregard, DO is an Internal Medicine physician whose experience includes 20+ years of clinical practice as well as leading organizations strategic and clinical initiatives
Four days after emergency surgery and barely able to walk, Heather Sherman flew from Chicago to Washington for first-day-of-work onboarding at the Agency for Healthcare Research and Quality. Fourteen months later, Sherman suddenly became one of the thousands of federal employees summarily dismissed by a weekend email telling them they were “not fit for future employment.”
The trauma of that abrupt ending in mid-February — giving her just a few hours before all access was shut off — still lingers. “This was my dream job,” Sherman told me.
If Sherman were an air traffic controller or nuclear materials expert, her work keeping the public safe would be obvious. But as a mid-level employee with a technical role at a little-known agency in the mammoth Department of Health and Human Services, her curt dismissal and that of an undisclosed number of AHRQ colleagues prompted not even a ripple of news coverage.
Yet what a New York Times editorial decried as a “haphazard demolition campaign” by the Elon Musk-led Department of Government Efficiency, one that is undermining “the safety and welfare of the American people,” applies to agencies like AHRQ and low-profile jobs like Sherman’s just as much as to more high-profile positions.
In complex systems, of which healthcare is surely one, carelessness has consequences.
(Disclosure: I’ve known Sherman for years, and while I serve on AHRQ’s National Advisory Council, I have no inside information. All opinions are my own.)
For Sherman, with two master’s degrees and a Ph.D., the anodyne title of health scientist administrator masks a beyond-the-data devotion to patient safety. A 2023 report by the President’s Council of Advisors on Science and Technology declared patient safety “an urgent national public health issue.” In truth, the urgency is embraced mostly by a small number of individuals determined to drastically reduce the estimated 160,000 Americans perishing each year from preventable medical errors in hospitals.
That death toll is a conservative estimate by the Leapfrog Group. Food and Drug Administration administrator-designate Martin Makary has called medical error “the third-leading cause of death” and estimated a death toll of more than 250,000 Americans.
Saving Lives and Money
Even if the focus is only fiscal — leaving aside the human impact — medical care that causes unintended harm is inefficient and costs money. The potential savings are large: an in-depth examination of medical records by the HHS Office of the Inspector General found that a shocking one-quarter of Medicare patients suffer some level of harm during a hospital stay.
It’s that “inefficiency,” human as well as financial, that Sherman wanted to attack at AHRQ. She proposed an initiative enabling hospitals nationwide to collaborate within a legal framework that promotes candor by protecting their interactions from being discoverable in a malpractice lawsuit. That structure is known as a “patient safety organization,” established by Congress through bipartisan legislation in 2005. The process of ongoing collaboration is known as a “learning health system.”
Sherman recalls reaching out to everyone she knew whose organization was affiliated with a PSO and asking what they needed to meet today’s challenges. “The almost unanimous answer was, ‘We want a place to find solutions, a place to share solutions,’” Sherman said. “‘We want to know what to do.’”
“Any kind of systemic prevention of problems saves money,” she added.
To be effective, however, collaborative problem-solving on a large scale requires more than just setting up Zoom calls and sharing documents. It quickly gets technical; e.g., ensuring that all participants classify and report an adverse event in the same way.
“Classification is the key,” Sherman said. “It’s like a box of different-colored Lego pieces in different sizes. Each Lego is a data element. Everybody has to understand what it means in order to use it.”
Along with her technical expertise, Sherman also brought a determination to expand what information was collected and how it was used; for instance, by bringing in patient and family input. “The law was not meant to exclude reporting of problems by anyone who wasn’t a clinician,” Sherman said. She also planned to utilize qualitative data “to tell a story. You learn a lot more about the nuances of error in the qualitative data.”
To accomplish those ambitious goals, Sherman began seeking buy-in from AHRQ leadership while also planning a national kick-off conference for May. Then, awakening on Saturday morning, Feb. 15, and turning on the TV news, she heard a White House correspondent report that government departments were firing “probationary employees.” Soon afterwards, the dreaded email popped up in her inbox from the HHS personnel office.
“We all knew it was coming,” Sherman said. “We just didn’t know when.”
A Legal Loophole
“Probationary employee” has a different meaning for federal employees than for private-sector ones. In the private sector a probationary period might last a few months, but an employee can typically still be fired “at will” any time afterwards, barring protections related to union membership or illegal discrimination. In federal employment, in contrast, the probationary period before civil service job protections kick in can last one, two or even three years, depending on various factors, and the probationary period can start over even for long-time employees if they’re promoted or switch agencies. Sherman was hired on a two-year probationary period.
Even probationary employees, however, can be fired only for certain reasons. Hence the careful language of the DOGE-driven form letter signed by HHS Chief Human Capital Officer (Acting) Jeffery Anoka that informed Sherman she’d not met “the burden to demonstrate why it is in the public interest” for the government to finalize her appointment. It continued, “your ability, knowledge and skills do not fit the Agency’s current needs, and your performance has not been adequate.”
Excerpt from letter sent to probationary federal employees
“I was very calm that day,” remembered Sherman. “The next day I was a mess.” Questions of what would happen to her work, as well as compensation for unused sick leave and time off, remain unresolved; senior AHRQ managers are also in the dark. “Nobody knows anything, and there’s no guidance,” she said. “I am disheartened and disappointed.”
At the Centers for Medicare & Medicaid Services, a senior manager named Jeff Grant pushed back hard in a letter to Anoka posted on LinkedIn after 82 employees in his group were told they were “not fit for continued employment.” Grant began by announcing he was immediately retiring after 41 years of federal service, emphasizing later that he had served with equal dedication both Republican and Democratic administrations. Grant went on to refute accusations of incompetence by saying the fired workers had not only passed a series of formal reviews with high marks, but the interview process, one in which he was personally involved, allowed CMS to select “truly the best of the best” out of hundreds of resumes.
Moreover, Grant pointedly noted, many of those fired at his Center for Consumer Information and Insurance Oversight were set to work on writing and implementing a new rule announced as a Trump administration priority. That rule, “is projected to save billions in program dollars,” he wrote, “which is the ultimate in government efficiency.”
A Plea For Public Service
On an even more personal note, an “open letter to America from career federal civil servants,” written anonymously to avoid retaliation, poignantly reminded the public, “We are your neighbors, friends and family. … Most of us heeded a call to serve because we love this country and what it represents as much as you and wanted to give back. The hard work we do, we do on your behalf.”
That declaration resonates with Sherman, who said she’s long yearned to work for AHRQ, a small-budget agency with the big-mission task of helping make U.S. medical care better and safer.
“I never wanted to leave AHRQ,” Sherman said. “I wanted to be in this department, in this job, for the rest of my life. I didn’t go into this profession to be rich. I went into this profession to make a difference in people’s lives.”
The “chainsaw” approach favored by Musk continues: the administration has ordered every federal agency to turn in a plan for even more drastic cuts by March 13. The impact of two federal juges’ orders reversing some probationary employee layoffs remains to be seen, particularly since they are being appealed. For Sherman, meanwhile, there are two poignant codas to her career situation. DOGE, the force behind her firing, has been criticized for acting with both joyful cruelty and dubious legal authority. As it happens, Sherman’s undergraduate major was in judicial morality and constitutional democracy.
Meanwhile, although Sherman almost immediately lost all job-related access, her last official day on the AHRQ payroll was March 14. This year, that’s the next-to-last day of Patient Safety Awareness Week.
Michael L. Millenson is president of Health Quality Advisors & a regular THCB Contributor. This piece was previously in Forbes
When most Americans undergo surgery, they expect to recover quickly and return to their normal lives. Few realize that something as routine as a shoulder surgery, a hernia repair, or a mastectomy can mark the beginning of a life-altering opioid addiction. This often-overlooked connection between routine medical care and opioid dependence demands urgent attention.
How Physicians and Hospitals Sustain the Opioid Epidemic
For decades, the pharmaceutical industry has shaped medical education, ingraining the belief that opioids are the best first-line treatment for acute pain. As a result, American physicians prescribe opioids at dramatically higher rates than their counterparts in other countries. A recent study in Annals of Surgery found that after three common surgeries, 91% of U.S. patients were prescribed opioids, compared to just 5% of the global patients.
Hospitals and health systems have also played a significant role in perpetuating opioid dependence. Opioids have long been a convenient and cost-effective solution for acute pain management, readily available and inexpensive to administer. However, the financial incentives for hospitals extend far beyond the initial prescription. The short-term complications of opioid use—such as nausea, constipation, urinary retention, and hyperalgesia—require additional treatments, increasing hospital revenue. Long-term complications, including dependence, overdose, and addiction, further drive profitability through repeat admissions, extended care, and emergency visits. In effect, hospitals and health systems have become financially reliant on opioid-based care, benefiting from both the immediate and prolonged consequences of opioid prescribing.
A study from the University of Michigan/IBM Watson revealed that a single opioid prescription after elective surgery increased healthcare costs by an average of $5,680 per patient per year across all payer types, including Medicare, Medicaid, and commercial insurance. This widespread cost increase affects insurance premiums, employer healthcare spending, and state and federal budgets. Notably, this estimate does not even account for the long-term costs of addiction treatment, which can be 2-16X that cost per patient per year.
The Devastating Impact of Routine Opioid Prescriptions
Each year, over 60 million surgeries are performed in the U.S., leading to the prescription of 45 million new opioid prescriptions per year. But the real crisis lies in what happens next: nearly 10% of all surgical patients remain on opioids long after their recovery should be complete. That means 2-4 million Americans every year are still using opioids beyond 90 days post-surgery.
A recent report from Moody’s Analytics, by chief economist Mark Zandi, had an eye-opening fact: the top 10% of earners in the U.S. – those who make $250,000 or more – now account for just shy (49.7%) of half of consumer spending. If that strikes you as unusual, you’re right. It is a record since at least 1989. Thirty years ago the comparable percentage was 36%.
“The finances of the well-to-do have never been better, their spending never stronger and the economy never more dependent on that group,” wrote Dr. Zandi. He added: “Wealthier households are financially more secure and thus more able and willing to spend their income. That is, they save less than they would otherwise.”
The rest of us are struggling to hold our own against inflation, not always successfully. It’s why companies like Costco and Walmart are trying to target upscale shoppers, while “value” oriented firms like Big Lots, Family Dollar, or Kohl’s are closing stores or even declaring bankruptcy.
This extreme bifurcation, of course, made me think of healthcare, where – as is famously known – half of all spending is attributable to only 5% of patients. In case you’d forgotten, in healthcare, half the population accounts for 97% of all spending, so the other half accounts for a measly 3%.
Now, you might say, neither of those is surprising: rich people spend more, and sicker people cost more. But somehow neither of those seems right to me.
The answer to a politics ofscarcity is a politics of abundance, a politics that asks what it is that people really need and then organizes government to make sure there is enough of it.
Mr. Klein didn’t coin the phrase “politics of abundance,” but he and Derek Thompson did just write a book on the topic (Abundance) that discusses their thoughts at more length. I have not read the book, but I saw a quote from it that I quite liked: “What is scarce that should be abundant? What is hard to build that should be easy?”
Despite all these shortages or would-be shortages, of course, we manage to spend way more than other countries on healthcare. One can only imagine how much we might be spending if there were no shortages. I take that back: I’m not sure I can imagine.
In the category of things that are scarce that should be abundant, and/or things that are hard to build that should be easy, I’d probably put housing at the top but healthcare as a close second. The trouble is, when we pour more money into healthcare, as we are wont to do, we don’t seem to fill any of our many shortages, much less improve the quality of care or outcomes.
