Life expectancy in America has declined for two years in a row

The US recovery looks decent in top-line aggregate terms, but the distributional aspects are quite bad. (And that was true of the recovery from the previous recession, as well.)

For broad social impacts, the distributional aspects are more significant than the top-line aggregates.

Update: found a nice heat map from NY Times; still the issue is there are no absolute numbers or the table that shows how the color gradient in the heat map progresses -- I get tall tales of year over year percentage increases but no absolute numbers to reference against. Is it really that hard to make a decent chart/graphic for this for a org like NYT?

Personally, to avoid being someone just criticizing but not offering my own ideas, here's my initial recipe at the moment based on what I've learned so far is (subject to change from new information, of course :) ). It actually includes all three:

* Government-mandated health insurance coverage at a certain useful minimum level. Insurance companies allowed to offer bettter plans as well, at higher prices. Keeping insurance coverage private reduces transitional shock to the system.

* Government subsidies based on income to make the minimum mandated coverage level attainable.

* Employer-sponsered plans are banned. Get rid of some corporate power imbalance vs small companies/individuals, and get hidden private subsidies out of the system.

* I'd try to take your (A) a bit further: the minimum-coverage plans could have some coverage gaps around self-inflicted conditions, and very little coverage for optional/purely cosmetic/not-necessary treatments. This may not be politically feasible - it could be seen as too cruel, or it could catch on with America's latent "personal responsibility" instincts; either way, I think it's the fairest place to treat as a first-line cost-control location for coverage. I need a second part, here, though, about making healthier options easier to come by for some, though.

* Completely agreed on banning drug B2C marketing. Let the drug's effectiveness sell itself to doctors, let that sell it to consumers.

* Beyond that, aggressively pro-research pricing and tax incentive policies, both for domestic drug companies and foreign ones - some of this might require policy discussions with other countries, but ultimately it's in everyone's interest if we get a bunch of research funded as in the long run, we'll make way more things treatable and have way more cheap drug options available. I think as long as we have a healthy market that we make sure rewards performance, not marketing we can keep the incentives in the right place.

* I think an annual physical is a good thing to include in the individual healthcare mandate as part of the insurance re-up process.

Obesity is a particularly tough one, though. Generally, populations that eat less (and less unhealthy simple-carb-based-stuff) and walk more appear to have less obesity, but politically this isn't a big winner, and would run into a lot of resistance if pitched as a "fixable by individual action" thing. And penalties for not meeting certain targets might be impossible - does anyone really want to put someone in jail for not paying a health fine for not getting healthier compared to the previous year? I don't, but if there's no teeth to it, how would it ever work?

Prescription opiates that lead to street drugs like heroin or illicitly-sourced ones after the prescription runs out, is my understanding. I don't know how the numbers break down in terms of initial exposure - how many bored desparate people were seeking a release, how many people got injured and then got hooked, etc...? But when we end up talking about drugs designed for 2,000lb elephants, it doesn't seem purely a problem of doctors/pharmacists, people are getting it from some unofficial sources.

Creating something new and teaching people the current state of the art are two separate things. And universities do both of them.

The things invented in Bell Labs in the 1950s are taught in universities today, but the researchers at Bell Labs had college degrees. It's a feedback loop.

> so how do we quantify e.g. how desperate we truly are for programmers?

Median salary is a very strong quantification, especially accounting for sub-specialization. It's possible we need more DBAs but not more web designers.

> I'm sure there's a middle ground between "the risk of training this person and them leaving is small enough compared to the potential return they'd give us since the field is so ripe" and "nah, we're totally good," but how do we find out where in that space we are?

They just don't benefit from it at all.

Suppose you pay $150,000 to train someone with the expectation that you'll pay them $50,000/year for five years and the training will allow them to do the work of an $80,000/year employee, so you'll break even (ignoring time value of money). Except that once they can do the work of an $80,000/year employee, they can immediately quit and get a job paying $80,000/year and you can't retain them by paying $50,000/year.

The alternative is to loan them the money, so if they leave they still have to pay you back for the training. But now you've just reinvented universities and student loans and companies don't get anything out of doing it in house that they wouldn't from hiring graduates from normal schools who borrow money from normal banks.

Companies know that they aren't any better at being a university than a university is and they aren't any better at being a bank than a bank is, so they don't try to be.