We’re MUCH Better Off in 2026

Rose Colored Glasses; Man Bites Dog; If it Bleeds it Leads.

Politicians, journalists and influencers of all stripes emphasize the bad, the emotional and the unusual. This burdens us and our society. Allegedly, “it’s bad now, and it was MUCH better in the past”. This eternal NOSTALGIA is a big problem for our society today, leading many people to turn to populists, idealists, authoritarians and charlatans for salvation.

I will outline how much better the United States of America is TODAY than it was in the mid-1970’s. I graduated from high school with the class of 1974. I watched the emotionally mixed American bicentennial celebrations in 1976. I remember Jimmy Carter’s 1979 “malaise” speech in which he said that we, the people, needed to face our challenges directly, especially at a moral level. He was briefly cheered but then criticized for being too negative and pessimistic; an uninspiring leader!

Modern life in the USA is immeasurably better than it was in the 1970’s. It is certainly not perfect. The country has not achieved all that it could have or should have in the last half century. It still faces large global and moral challenges and wonders where it can possibly find the leadership, consensus and engagement to resolve them.

The sheer magnitude of changes in daily life across 50 years is difficult to describe but I hope that my outline will collectively communicate the great scale of improvements we have experienced and the resulting hope and expectation that the next 50 years will deliver the same kinds of positive growth. When we consider the last 50, 100 or 150 years of American life, we should be very optimistic.

Global Threats and Opportunities

  1. The Cold War ended in 1989, relieving the pressure of 4 decades of imminent nuclear destruction. This was a miracle. No war. No revolution. No territories seized. No leaders executed. A quiet end to the threat. The US managed the threat of nuclear terrorism. West Germany embraced East Germany. The European Union welcomed new members. The global economy thrived.
  2. The US established relations with China in 1979, beginning the country’s path to economic prosperity, trade and global influence. The growing trade between China and the world has acted to reduce the threat of conflicts while reducing the cost of goods for all.
  3. The US welcomed the growth of Japan plus the “four tigers” of Hong Kong, Singapore, South Korea, Taiwan, as Asian nations embraced the “Western consensus” of mixed market capitalism, global trade and liberal democracy.
  4. European nations also left behind histories of authoritarian governments or too much socialism to embrace the “Western consensus” and thicken ties through the European Union. Francis Fukuyama prematurely declared “the end of history” but the attractiveness of these successful choices was clear.
  5. The US joined international efforts to reduce tariffs and increase trade leading to a doubling of imports and exports as a share of GDP.
  6. The US adopted a less internationalist position after 9/11/2001, declaring a war on terror, defining the axis of evil, revoking treaty commitments, justifying preemptive war and invading Iraq without UN support. Even with this change, the US largely avoided major military conflicts and losses.
  7. Total immigration to the US grew during this period from 2.3% to 2.9% of the population per decade. Many immigrant groups successfully joined American society.
  8. The US welcomed foreign students to its universities. International tourists increased from 15 to 75 million per year.
  9. The US attempted to resolve the Middle East conflicts with some success, avoiding large scale wars.
  10. The US participated in talks to define and address the threat and impact of global warming. It has taken steps to reduce US carbon emissions.

Politics

  1. Presidents Ford and Carter helped to rebuild confidence in the government after Vietnam and Watergate.
  2. Ronald Reagan established “Conservatism” as a broad political philosophy for the Republican party.
  3. Bill Clinton repositioned Democrats more to the center on economics with his “third way” approach.
  4. Both parties increasingly used wedge issues and either/or choices to polarize parties and choices; although the share of independent voters has grown from 30 to 45%, with the rest evenly split between the two dominant parties.
  5. Perot, Buchannon, Palin and Trump provided social and economic populists with a choice.
  6. The country increasingly accepted racial minorities, women, gays, religious minorities, and immigrants; but the conflict between traditional and modern views was politicized as some could not tolerate the changes and others sought to embed the changes as universal human and legal rights accompanied by social pressures to comply with the dominant “tolerant” view.
  7. Federal government employment was reduced from 5 to 4 million in 50 years, while the population grew by 50%. After Reagan, “government” solutions were inherently suspect. Even Bill Clinton declared “the era of big government” is over.
  8. Total federal, state and local government activities grew a little faster than the economy, with the ratio of tax receipts to GDP inching up from 29% to 32%. The ongoing pressure to “cut spending, taxes and regulations” could not defeat the pressures to address social, political and economic issues and interests.
  9. The top marginal income tax rate was reduced from 70% in 1982 and has remained just under 40% since 1987. Neither party has proposed widespread tax increases.
  10. The Affordable Care Act was enacted in 2010, helping to bring the share of Americans without health insurance down from 20% in 1975 to 8% today.
  11. The US safety net/welfare system has remained intact during this period driving the supplemental poverty rate down from 20% to 15%, while the official poverty rate has declined by just 1%. The share of the elderly (65+) in poverty has fallen from 16% to 8%.

The Economy

  1. Real dollar GDP is 4 times larger at $24 trillion.
  2. US real per capita GDP has remained the highest of all major countries for a century. Continued leadership reflects a dynamically successful economy.
  3. Real per capita GDP has increased by 250% to $70,000.
  4. US fiscal and monetary policy has repeatedly been effective in taming the business cycle and recovering from shocks like the housing crisis and the pandemic.

US Business

  1. Industrial production, including energy, is up by 250%.
  2. The number of business establishments has doubled to 8.6M, providing ownership and employment opportunities in a more specialized, globally traded world.
  3. The number of franchise businesses has grown from 375,000 to 800,000+, employing more than 10 million people.
  4. The rate of new business formation and success increased throughout the period, with a new boost after the pandemic.
  5. Businesses responded to the 1970’s “Japanese invasion” and became strategically more focused, measured more effectively, focused on cost reduction, invested in R&D, and applied information technology and process improvement tools. Foreign and domestic competition led businesses to be more cost effective, improve product quality and offer products better tailored to diverse customer wants and needs.
  6. Firms experimented with factory robots by 1975. They now use 380,000 robots, adding 10% more annually.
  7. Auto production in the US has increased from 8 to 10 million units per year.
  8. Farms produce twice as much using 20% less land and 40% less labor.
  9. Businesses adapted to the world of greater international trade by growing or shrinking facilities, markets, products and product lines. They adapted to the new power of consumers and retailers and reduced power of manufacturers. They divested units and rejected the conglomerate model. They rejected vertical integration, learning to outsource all functions where they did not have a competitive advantage.
  10. Firms embraced more effective banking, equity and bond markets to fund their activities. They tapped global sources and private equity. They learned by use financial leverage to increase net earnings and acquire other less dynamic competitors.
  11. Firms changed organizational structures to have fewer layers, less positional power, more staff experts and the ability to use cross-functional (matrix) approaches to core operations, projects and joint ventures.

Education

  1. Preschool/Kindergarten enrollment up from 5 to 9 million. Nearly all part-time in 1975 and mostly full-time in 2025.
  2. High school graduation rate is up from 75% to 85%.
  3. Intelligence test scores have increased by more than 10 points.
  4. Share of young adults who have earned college degrees has doubled from 20% to 40%.
  5. Share of adults with college degrees has more than tripled from 12% to 38%.
  6. Share of young women with a college degree is up from 17% to 45%; shares for men up from 27% to 37%.
  7. Share of degrees in STEM disciplines has grown from 11% to 19%.
  8. Number of college students studying abroad is up by 5 times.
  9. Law school first-year enrollment remains at 40,000, while the population has grown by 50%.
  10. US holds 18 of top 30 global university spots.
  11. The number of annually earned doctorates has doubled.
  12. US accounts for 50% of Nobel prize winners, up from 40% in 1975.

Transportation

  1. 22% of new cars are electric. Self-driving cars are widely deployed.
  2. Fuel milage has doubled from 13 to 27 miles per gallon.
  3. New car defects have dropped by two-thirds.
  4. Air travel miles are up by 5 times.
  5. FedEx 2-pound overnight service was introduced in 1975 for $75. Service is widespread today at $55.
  6. Same day and next day delivery services are available today, making Amazon.com, grocery and restaurant deliveries common. Catalog mail order lead times were 6-8 weeks in 1975.

Energy

  1. The US faced energy crises in 1973 and 1979 that disrupted businesses, emptied filling stations and led to recessions.
  2. The US imported 35% of its petroleum products in the 1970’s. It is a net exporter today.
  3. Energy intensity, the ratio of energy used to GDP, has fallen by 60% since the 1970’s.
  4. LED bulbs last 10 times longer. Lithium-ion batteries last 4 times longer.
  5. Wind power is 10% of electricity generation. Solar is 10% of electricity generation. Solar is the lowest cost source today, accounting for two-thirds of new generating capacity added.
  6. Coal production is the same today as in 1975, down 50% from its 2007 peak. It is declining rapidly.

Environment

  1. Toxic air pollution measures are lower by 65-90%.
  2. The world resolved the threat to the ozone layer.
  3. Percentage of US homes in communities with treated wastewater has increased from 50% to 80%.
  4. State parks acreage has doubled. Federal parks acreage has tripled. Land trust additions are equal to the state parks area.
  5. Total US forest land area has increased from 750 to 800 million acres, while the US population has grown by 50%.
  6. Nesting pairs of American bald eagles have grown 100-fold, from 700 to 70,000.
  7. US (1976) and global (2014) birth rates are half of historical levels, reducing environmental demands.
  8. US is on track to reach 50% reduction in greenhouse gas emissions by 2030.

Health

  1. Life expectancy has increased from 73 to 78 years.
  2. Infant mortality rate has dropped by two-thirds.
  3. Smallpox has been eradicated. Polio remains eliminated. Other diseases close to zero.
  4. Smoking rate is two-thirds lower, down from 37% to 12% of adults.
  5. Death rates down: Strokes 67%. Cancer 25%. Flu/pneumonia 67%. Heart disease 50%+. Liver disease 25%.
  6. US governments, medical industry, businesses and people responded to the Covid-19 pandemic resulting in a death rate that was half of the 1917 Spanish flu. Novel vaccine development and flexible delivery resources limited the death toll.
  7. Abortion rates have fallen by 50% since 1980.
  8. Medical research continues to develop new science and solutions. Cloning and human genome mapping.
  9. In vitro fertilization births have grown from 0 to 100,000 per year.
  10. Modern anti-depression drugs (SSRI-Prozac) are much safer and more effective than their predecessors.
  11. Kidney dialysis extends lives for 550,000 today versus 25,000 in 1975.
  12. Americans have 40 million MRI scans done on 13,000 machines, up from zero.
  13. Laser eyer surgery has grown from an experimental procedure to 800,000 annually.
  14. 50,000 organs are transplanted each year, up from just a few experiments.

Safety

  1. Property crime rate is down by more than 50%. Violent crime rate is one-third lower.
  2. Both the workplace fatality and injury rates are down by two-thirds.
  3. Traffic fatalities per driven mile are three-fourths lower.
  4. Fire incidents have been cut in half while the population grew by half.
  5. Emergency medical services have grown from 2% to 90% of counties; employing 300,000 people, 50,000 ambulances and 1,300 helicopters.

Consumer

  1. Firms have offered consumers much wider options for products in all industries. A typical Walmart Supercenter has 125,000 different SKU’s.
  2. We enjoy year-round availability of most fruits and vegetables today rather than shopping by season.
  3. Clothing and durable goods prices have been cut by half.
  4. The average automobile is 13 years old versus 6, reflecting massive quality improvements.
  5. Car buyers can choose from 15 major manufacturers instead of just 4.
  6. Appliances in more homes: Washing machines (70-85%), dryers (45-82%), dish washers (28-54%), microwave ovens (4-95%). Refrigerators are 25% larger, half price and 75% more energy efficient.
  7. Median new home square footage has increased by half, from 1,500 to 2,200 square feet.
  8. Mortgage loan rates have declined from 8-14% to 4-7%. Real rates are just 2% today.
  9. Total debt service payments (home, car, credit card, student loan) as a percentage of disposable income have declined from 11% to 10%.
  10. Air-conditioned homes have grown from a hot 55% to a cool 95%.
  11. Away from home food spending has more than doubled from 28% to 59% of total food spending.
  12. Household consumption is up from 87% to 92% of disposable income. Savings is down from 13% to 8%.

Leisure

  1. Many television program options. Top 4 network share down from 90% to 30%. Recording and streaming options exist today.
  2. Cable or satellite TV access has grown from 14% to 100%.
  3. The number of feature films released each year has bloomed from 100 to 700.
  4. Music singles are effectively free today. They cost $7.50 each in current dollars in 1975. The transistor radio has been replaced with portable, wearable devices served by playlists, suggestions and feeds.
  5. Real consumer electronics prices have declined by 80-95%. A 21-25 inch color console was $2-3,000 in 1975 in current dollars. A 50-inch tv is available for $500 today.
  6. A 1982 IBM PC cost $10,000 in current dollars. For $2-3,000 today you get 1,000 times the processor speed, 10,000 times the memory and 100,000 times the storage space.
  7. Video rentals boomed in the 1980’s and 1990’s growing into a digital $100 billion industry.
  8. The $5 billion pinball machine sector evolved into the $50 billion handheld and online gaming industry.
  9. Virtual reality equipment is increasingly popular.
  10. Passports are held by half of US citizens, up from 5% in 1975.
  11. Following deregulation, the real price of air travel per mile has glided down by 40-60%.
  12. Hotel room capacity has doubled from 2.4 to 5.3 million.
  13. Pet food consumption has tripled.
  14. American wine production has increased from 250 to 700 million gallons, along with quality.
  15. American brewery count has increased from 150 to 7,000, along with quality.

Wealth

  1. Mutual funds, index funds and 401K’s offer investing to everyone. Percentage of stockholders has grown from 12% to 60%.
  2. The number of retirement plan participants has grown by 250%.
  3. Real dollar retirement plan assets have grown thirty-fold, from $1.6 to $48 trillion.
  4. Homeownership rate increased from 64% to peak of 69% before falling back to 66%.
  5. Family wealth more than doubled for those in the 1st-25th, 26th-50th, and 51st-90th percentiles between 1989 and 2022. Summary data for 1975 to 1989 is not readily available. Real home prices increased by 20% and the real dollar S&P 500 increased by 75% during this period, overall.

Labor

  1. Compounded labor productivity has increased by 150%, more than 2% per year!
  2. Manufacturing, administrative and farm jobs were reduced by 20% of the total during these 50 years. They were replaced by STEM/analysis, management and health care jobs.
  3. Prime age labor force participation increased from 74% to 84%.
  4. Typical unemployment rate declined from 6.5% to 5%.
  5. Share of self-employed workers increased from 9% to 11%.
  6. According to the Gallup Organization, the share of “engaged” workers has increased greatly in the last 20 years.
  7. Real median family income increased by 40% from 1984 to 2024.
  8. There are dozens of expert calculations of real incomes, adjusted for taxes, government benefits, charity, fringe benefits, hours, etc. Most show that 1975-1990 was flat and that 2000-20 showed modest increases.

Society

  1. The US continues to lead the world in charitable giving as a percentage of income, double the nearest country, Canada.
  2. US migration and population growth in the “Sunbelt” impacted local and national economies, politics and society. Texas (13-31M), California (21-39M) and Florida (8-23M) showed the greatest growth and national influence.
  3. Share of adults cohabiting has increased from 1% to 13%.
  4. Teen pregnancy rate has been cut in half.
  5. The share of married couples has declined from 83% to 67% of households.
  6. Parents now invest 20 hours per week caring for children, up from 12 hours in 1975.
  7. Same sex marriage was legalized by the US Supreme Court in 2015.
  8. Female labor force participation rate has increased from 46% to 57%.
  9. The female to male wage discount has been reduced from 35% to 10%.
  10. The number of congresswomen increased from 19 to 155 (7X).
  11. Women today have access to credit and credit cards in their own names.
  12. Black unemployment declined from 15% to 7%, with the excess above whites falling from 7% to 2%.
  13. Black poverty rate has declined from 30% to 18%.
  14. The Black to White income ratio has improved from 60% to 67%.
  15. The share of interracial marriages has increased from less than 1% to 10%.
  16. Percentage of Americans moving per year has declined from 20% to 12%. Interstate moves have declined from 3% to 2%.
  17. Robert Putnam’s “Bowling Alone” shows a 40% decrease in social participation during this time.
  18. Awareness, tolerance and support for “differences” is higher by an order of magnitude: races, nationality, immigration status, physical or mental disability, gender identity, mental health, autism, obesity, and personality.
  19. Hispanic Americans have increased from 6% to 20% of the population.
  20. The percentage of non-Christians, including religiously unaffiliated, has increased from 12% to 35% of the population.
  21. The share of 40-year-olds never married has increased from 6% to 25%.

Computers

  1. Personal computer software and phone apps provide tools for email, calendars, word processing and spreadsheets to everyone today.
  2. Personal computers are in 95% of homes versus 0% in 1975.
  3. More than 90% of jobs today require computer skills.
  4. Home internet access is 92%.
  5. Digital cameras, music, videos, sound and storage make everything portable.
  6. Voice controlled devices and instant language translation.
  7. Today’s 10-day weather forecasts are as reliable as next day forecasts in 1975.
  8. Google search and artificial intelligence provide access to all of man’s writings and promise thought, itself.

Communications

  1. Internet structure and web browser provide access to everything and everyone.
  2. Smartphones integrate computing and communications. 90% ownership rate. Provides photo, filming and navigating capabilities.
  3. Mobile/cellular phone networks and wifi routers offer universal access to the internet and phones.
  4. Social media networks combine the input of many to build and use networks.
  5. Internet allows for open-source software and information creation.
  6. Video conferencing and internet enabled phone/video calls are common.
  7. Voice mail, answering machines, caller ID and 911 were invented.
  8. Digital books have grown to 25% market share.
  9. Annual first class mail per person increased from 240 to a peak of 360 in 2000 before falling to 130 today.
  10. Daily newspaper subscriptions have plunged from 60 to 20 million.
  11. Share of homes with landlines has fallen from 90% to 30%.
  12. A 3-minute long distance call in 1975 cost $8.70 in current dollars. An international Skye call today is 77 cents.

Summary

The world is a better, richer and safer place. Politics has evolved. The economy is 4 times larger. Businesses and education are more effective. Energy is cheaper. Transportation is better. The environment is much better. Health is much better. Safety is much better. The consumer is king. Leisure options and quality can’t even be compared with 1975. Wealth is up. Incomes are up. Society is digesting many large changes. The computer and communications revolutions have delivered miracles and promise more.

We face social, political and environmental challenges. We have more resources than ever before. Based on American history we should be very confident about solving our challenges.

Biden Presidency: Wins and Pinches

It’s time to evaluate the Biden presidency.

Economics

1 Reduced quarterly inflation rate (CPI) from peak 8.6% in 2Q, 2022 to 2.7% in 4Q, 2024.
2 Doubled the federal budget deficit from $0.75T to $1.5T per year.
3 Inflation grew to 9%, partly reflecting excess government spending initiated by the president.
4 Added 15M jobs; added jobs every month!!!!!!!
5 Cut the Black unemployment rate from 10.0% to 6.1%. Cut the Hispanic unemployment rate from 9.3% to 5.1%.
6 Increased per capita real disposable income by 5.6%.
7 Increased prime age labor force participation to near record 83.9%, last seen in 2001.
8 Reached pre-Covid employment in 28 months. Great Recession recovery took 3 times as long (77 months).
9 Real wages grew significantly in each year.
10 Record low unemployment rates quickly achieved and maintained after pandemic.
11 Reduced unemployment rate from starting 6.7% to 3.7% average for 2022-24. Pre-Covid 2017-19 was 4.0%.
12 Increased real GDP by $2.8T, 13.1% total, 3.2% annual. Trump pre-Covid gain was $1.7T, 2.8% annual.
13 Bloomberg reported a 26% increase in net household wealth between December 2020 and 2024.
14 Increased household wealth by 20%.
15 Recorded 24% increase in median home sales price from December 2020 to 2024.
16 Stockmarket value increased by 50% from December 2020 to 2024, building upon 50%+ rise in prior 4 years.

Outstanding economic results. The majority of inflation was due to pandemic and supply chain issues. Nonetheless, the growing budget deficits were an “own goal” that should have been avoided for economic and political reasons.

Governing

17 Appointed record number of federal judges, including record share of women and minority judges.
18 Postal Service Reform Act – reset reasonable debts, compensation and service levels.
19 Misevaluated and misresponded to declining personal health risks.
20 Democratic party exceeded expectations in 2022 midterm elections.
21 Negotiated spending limits in order to increase debt ceiling and avoid government shutdown.
22 Failed to overhaul Democratic party position as leaders of states and cities.
23 Failed to take advantage of the January 6, 2021 insurrection to remove Trump from politics.
24 Oversaw continued weakening of Democratic Party appeal to working class, minorities, men and independents.
25 Oversaw continued weakening of Democratic Party power, brand and results.
26 Promised to govern for all of the people but slipped into anti-MAGA politics.
27 Ran for second term and failed to withdraw in time for the party to field an effective platform and candidate.
28 Republicans were able to make DEI and wokeness a winning issue at all levels, without counter-leadership.
29 Unable to offer a new framework to reset politics outside of the win/lose polarization approach.
30 Increased IRS budget to reduce tax evasion and increase revenues.
31 Inflation Reduction Act – set minimum 15% corporate tax rate.
32 Electoral Count Reform Act – clarify presidential election processes.
33 Speech and legislation on threats to democracy, voting rights.
34 Support Voting Rights and Freedom to Vote legislation, enforced laws, opposed new state restrictions.
35 President and Democrats were unable to make progress on voting reforms despite opportunities.
36 American Rescue Plan – extra funding to cut child poverty in half.
37 Increased Pell Grant funding for lower income college attendees.
38 PACT Act – covers veterans exposure to toxic chemicals.
39 Provided new or lower cost internet access to 5M.
40 Provided student loan debt relief to 5 million borrowers.
41 American Rescue Plan – reduced medical insurance premiums

Some “good government” initiatives and results. Biden was unable to address the basic challenges of polarization, skepticism, social media, rule of law and personal integrity. He was elected as a “placeholder” to avoid Trump in 2020 and filled the “placeholder” role. He was unable to reframe the debates.

Public Health

42 Inflation Reduction Act – allows Medicare to negotiate top 10 drug prices,
43 Inflation Reduction Act – capped annual drug costs, reduces insurance costs
44 Negotiated agreement with pharmaceutical companies to reduce drug prices.
45 Doubled number enrolled in Affordable Health Care from 12M to 25M. 8% uninsured is record low.
46 Inflation Reduction Act – increases Affordable Care Act access to medical insurance.
47 American Rescue Plan – 500M covid vaccinations
48 American Rescue Plan – funding for individuals, businesses, governments and NFPs to survive pandemic.
49 Management of Covid-19 pandemic health care, communications and economic recovery strategy.
50 Failed to capitalize on his pandemic recovery and economic successes in the public eye.
51 Some pandemic decisions were overly restrictive, not based upon science, cost/benefit or value of freedoms.
52 Legislative, funding and regulatory changes to energize the Cancer Moonshot initiatives.
53 Rejoined the World Health Organization.

The pandemic mitigation and recovery should have been celebrated as a once in a century victory for the American people, science, business and government. And for the world! The results were amazing, if imperfect. Biden’s team was unable to stake out the high ground and frame the real results in this manner, allowing partisan politics to infect and undermine even this situation.

International Relations

54 Created QUAD security relations with Australia, India and Japan.
55 Facilitated improved relations between Japan and South Korea.
56 Increased support from citizens and leaders in NATO nations to the US.
57 Recommitted the US to NATO, encouraged defense investments, welcomed Finland and Sweden.
58 Signed AUKUS deal with the United Kingdom and Australia for Indo-Pacific security.
59 Unable to renegotiate new bargain with allies to pay for US defense, police, trade, shipping, legal umbrella.
60 Was unable to delivered principle leadership for the liberal international model on trade and global affairs.
61 Failed to reset US-China relations despite shared interests in global commerce, climate, security and health.
62 Supported Trump’s anti-free trade and anti-China actions without proposing effective alternatives.
63 Reduced US reliance of Chinese imports by 10%, increased US exports to China by 15%.
64 US dollar increased in value by 15%.
65 US inbound foreign investment averaged twice as high from 2021-24 versus 2020.
66 US outperformed other nations in achieiving pre-Covid levels of GDP and employment.
67 US stocks increased in value by 50%, more than in other markets.
68 Supported the bipartisan 2024 immigration reform bill that was rejected by candidate Trump and Republicans
69 Failed to take emergency action to secure the US-Mexico border, protect and process immigrants.
70 Responsible for 3 years of 175,000 monthly migrant apprehensions versus 25,000 baseline.
71 Ended Afghanistan war within negotiated plan.
72 Protected the US from terrorist attacks, authorized surgical anti-terrorist attacks.
73 Recorded zero domestic deaths from international terrorist activities during 2021-24.
74 Support for Israel after Hamas attack, ceasefires, prisoner exchanges and hostage releases.
75 Afghanistan withdrawal was poorly planned and executed, costing lives, equipment and US stature.
76 Hamas attacked Israel, killing 1,200 citizens and taking 300 hostages, confident of Israel/US limits.
77 Israel invasion of Gaza has continued without resolution, highlighting the US’s lack of influence/leadership.
78 Economic, intelligence and military support to Ukraine, which has stopped Russia’s invasion progress.
79 US and allies imposed sanctions on Russia for Ukraine war.
80 Russia invaded Ukraine, confident that the US and allies would not respond effectively.
81 Russia’s invasion of Ukraine has continued, without effective opposition or a negotiated solution.

Biden was able to mend relations with our allies and improve the strength of these alliances and the global power of the US economy. His team fumbled the Afghanistan withdrawal, failed to prevent the Russian and Hamas invasions and was unable to drive these situations to better solutions. US power has been undermined by these failures. The spike in illegal immigrants also portrayed the US and the Biden administration as a weak protector of our essential interests.

Resources

82 Inflation Reduction Act – $369B clean/green energy investment incentives.
83 Invested in wind, solar, battery and electical vehicle technologies.
84 US increased position as world’s largest oil producer and LNG exporter.
85 Expanded the US portfolio of national monuments.
86 Invested $4B in superfund environmental cleanup.
87 Rejoined Paris Agreement to address climate change.
88 Infrastructure Investment and Jobs Act – $1.2T.
89 New investments in domestic manufacturing, adding 750,000 jobs.
90 CHIPS and Science Act – incentives for domestic semi-conductor production.
91 Executive order on Artificial Intelligence outlines potential risks.

Big wins in managing energy, infrastructure and the environment.

Social Issues

92 20% reduction in violent crime rate after pandemic increases.
93 Renewed the Violence Against Women Act.
94 Repositioned marijuana classified substance rating, reduced federal criminal enforcement.
95 Respect for Marriage Act – required states to recognize the decisions of other states.
96 Responded to Supreme Court reversal of Roe v. Wade with Executive Orders on reproductive health services.
97 Revised asylum seeker options, added green card options for spouses of US citizens.
98 Safer Communities Act – gun controls, screenings, red flags.

Some small wins for the left.

Wins and Pinches

3 wins for every pinch! A decent number of achievements for a one-term president in a very polarized age.

Overall

Public Health A

Economy A-

Resources B+

International C+

Social Issues C

Govern/Politics C-

Biden did an outstanding job on the “blocking and tackling” in a very difficult situation. He “treaded water” in the international arena. He did not advance liberal social causes effectively. He failed to effectively address the Trump/populist threat to our democracy. For this, the overall grade is a D. 😦

Left, Right and Center

Biden was a moderate. He only tilted far left on 4 of the 98 items. Student loan relief was for the university crowd. The failure to address border security administratively was due to minority and progressive politics. Doubling the budget deficit undercut 30 years of Democratic Party “fiscal discipline” following Clinton’s “third way”. Not trying to reposition Democratic politics as centrist, moderate, adult, opportunity, American, scientific, effective, growing, universal, creative, tolerant, professional, metropolitan, ecumenical, big tent, majority, community, emerging, aspirational, progressive, etc. for fear of displeasing the postmodernist crowd and/or special interests was a huge lost opportunity in a time that called for leadership.

His greatest success was in managing the pandemic threat and growing the economy. He managed crime and terrorists. He enhanced American global power. He was a moderate president, just like Obama and Clinton.

Trump

I’m not a fan of Trump. His first term delivered more results than expected, but his existential threat to our system was already very clear.

Modern History Index

257 items pulled from all arenas of life. Technology dominates, especially in the last century.

Grouping events into 40-year blocks shows 1940-79 as twice as dynamic as other eras.

1450 – 1779 20

1780 – 1819 12

1820 – 1859 16

1860 – 1899 31

1900 – 1939 47

1940 – 1979 99

1980 – 2025 32

Modern History: Biology and Life

1676 – Microscopic World

https://en.wikipedia.org/wiki/Antonie_van_Leeuwenhoek

1846 – Anesthesia / Modern Surgery

https://en.wikipedia.org/wiki/Anesthesia

https://en.wikipedia.org/wiki/Surgery

1859 – Darwin’s Theory of Evolution

https://en.wikipedia.org/wiki/On_the_Origin_of_Species

1865 – Germ Theory of Disease / Public Health

https://en.wikipedia.org/wiki/Germ_theory_of_disease

https://en.wikipedia.org/wiki/Louis_Pasteur

1896 – Psychoanalysis

https://en.wikipedia.org/wiki/Louis_Pasteur

1918 – Spanish Flu

https://en.wikipedia.org/wiki/Spanish_flu

1928 – Penicillin

https://en.wikipedia.org/wiki/Penicillin

1943 – Modern Drug Development

https://en.wikipedia.org/wiki/Streptomycin

1953 – Structure of DNA – Watson & Crick

https://en.wikipedia.org/wiki/History_of_molecular_biology

1956 – https://en.wikipedia.org/wiki/Chemotherapy

1959 – Horizontal Gene Transfer described as complement to evolution

https://en.wikipedia.org/wiki/Horizontal_gene_transfer

1959 – Modern Synthesis of Evolution and Genetics – Mayr

https://en.wikipedia.org/wiki/Modern_synthesis_(20th_century)

1960 – Oral Contraceptive Pill

https://en.wikipedia.org/wiki/Oral_contraceptive_pill

1961 – Antibiotic Resistant Bacteria – public health concern

https://en.wikipedia.org/wiki/Methicillin-resistant_Staphylococcus_aureus

https://en.wikipedia.org/wiki/Antimicrobial_resistance

1963 – Mood Altering Drugs (legal)

https://en.wikipedia.org/wiki/Diazepam

1965 – Medicare Program

https://en.wikipedia.org/wiki/Medicare_(United_States)

1965 – US Life Expectancy Reaches 70

https://www.ssa.gov/OACT/TR/TR02/lr5A3-h.html

1967 – Heart Transplant

https://en.wikipedia.org/wiki/Heart_transplantation

1970 – Magnetic Resonance Imaging Scanner

https://en.wikipedia.org/wiki/Magnetic_resonance_imaging

1973 – Biotechnology / Recombinant DNA

https://en.wikipedia.org/wiki/Recombinant_DNA

1978 – IVF conception

https://en.wikipedia.org/wiki/In_vitro_fertilisation

1980 – Smallpox Eradicated

https://en.wikipedia.org/wiki/Smallpox

1981 – HIV/AIDS new disease and treatments

https://en.wikipedia.org/wiki/HIV/AIDS

1996 – Cloned Mammal

https://en.wikipedia.org/wiki/Dolly_(sheep)

1997 – Global Warming

https://en.wikipedia.org/wiki/Kyoto_Protocol

2003 – Human Genome Project

https://en.wikipedia.org/wiki/Human_Genome_Project

2010 – Affordable Care Act

https://en.wikipedia.org/wiki/Affordable_Care_Act

2012 – Designer Genes Possible

https://en.wikipedia.org/wiki/CRISPR_gene_editing

2019 – Covid Pandemic

https://en.wikipedia.org/wiki/COVID-19_pandemic

Summary

Microbiology, DNA, biochemistry. Miracles.

Our Hamilton County: 40 Weekend Hikes

https://www.arcofappalachia.org/highlands-nature-sanctuary/

Hamilton County is in the middle of the Wisconsin glaciated till plains region. The nearby landscape is relatively flat and contains a limited number of state parks, forests or nature preserves. Yet, for the weekend hiker willing to drive 1-3 hours away, the hiking options are unlimited. The 3-hour radius extends far into Ohio, Michigan, Illinois and Kentucky. Think of Chicago, Bloomington, IL, Champaign-Urbana, IL, Vandalia, IL, Terre Haute, Evansville, Owensboro, KY, Louisville, Elizabethtown, KY, Frakfort, Lexington, Cincinnati, Hillsboro, OH, Columbus, Dayton, Fort Wayne, Findlay, OH, Toledo, Coldwater, MI, Kalamazoo, South Bend, and South Haven, MI.

A 3-hour driving radius covers 100,000 square miles and 200 counties. Indiana is the 38th largest state with 36,000 square miles, so we cover almost 3 Indiana’s. This is equal to the combined land area of Michigan and Ohio or the combined land area of Illinois and Kentucky! Indianapolis is deemed the “Crossroads of America” due to its central location and direct access to national highways in all 8 directions away from the city. Chicago, Peoria, St. Louis, Evansville, Louisville, Cincinnati, Columbus and Lansing. US 31 provides a ninth limited access highway north to South Bend and Grand Rapids. The abundance of highways offers 3-hour access up to 210 miles away.

During the pandemic I hiked in all 200 counties within 3 hours of Hamilton County. I summarized the top 40 hikes in 3 blog posts based upon distance away and an extra one for honorable mentions. Let’s organize them below based upon their primary attraction for hikers.

Forests (6)

Hoosier National Forest / Pioneer Mothers Memorial Forest (121 S)

Great Seal State Park (205 SE) Ohio

Morgan-Monroe State Forest (61 S)

Jackson-Washington State Forest (93 S)

John James Audubon State Park (196 SW) Kentucky

Lawrence Woods State Nature Preserve (184 NE) Ohio

https://www.fs.usda.gov/detailfull/hoosier/about-forest/?cid=fsbdev3_017499

https://www.greatsealstatepark.com/

https://www.in.gov/dnr/forestry/properties/morgan-monroe-state-forest/

https://stateparks.com/jackson-washington_state_forest_in_indiana.html

https://parks.ky.gov/parks/find-a-park/john-james-audubon-state-park-7815

https://ohiodnr.gov/go-and-do/plan-a-visit/find-a-property/lawrence-woods-state-nature-preserve

Hills and Streams (6)

Spring Mill State Park (90 S)

Clifton Gorge State Nature Preserve (144 E) Ohio

Cedar Line Nature Preserve (151 SE) Kentucky

McCloud Nature Park (40 W)

Versailles State Park (75 SE)

Portland Arch Nature Preserve (80 W)

https://ohiodnr.gov/go-and-do/plan-a-visit/find-a-property/clifton-gorge-state-nature-preserve

https://pendletoncounty.ky.gov/Pages/CedarLineNaturePreserve.aspx

https://www.visithendrickscounty.com/listings/mccloud-nature-park/186/

https://www.in.gov/dnr/state-parks/parks-lakes/versailles-state-park/

https://www.nature.org/en-us/get-involved/how-to-help/places-we-protect/portland-arch-1/

Waterfalls (6)

Clifty Falls State Park (90 SE)

Charleston Falls Preserve (122 E) Ohio

Cove Spring Park (186 SE) Kentucky

Highlands Nature Sanctuary (196 SE) Ohio

Hoosier National Forest – Yellow Birch Ravine (142 S)

Williamsport Falls (83 NW)

https://www.miamicountyparks.com/parks/charleston

https://www.frankfort.ky.gov/751/Cove-Spring-Park

https://www.arcofappalachia.org/highlands-nature-sanctuary

https://www.hoosierhiking.com/the-blog/yellow-birch-ravine-nature-preserve

https://en.wikipedia.org/wiki/Williamsport_Falls

Rivers (4)

Devou Park (138 SE) Ohio

Harmonie State Park (206 SW)

Battelle Darby Creek Metro Reserve (175 E) Ohio

Providence Metro Park (186 NE) Ohio

https://www.exploredevoupark.org/

https://www.in.gov/dnr/state-parks/parks-lakes/harmonie-state-park/

https://metroparkstoledo.com/explore-your-parks/providence-metropark/

Lakes (2)

Patoka Lake (142 S)

Pokagon State Park (158 NE)

https://www.in.gov/dnr/state-parks/parks-lakes/patoka-lake/

Prairie/Flatlands (5)

Hooper Branch Savannah (125 NW) Illinois

Kickapoo State Recreation Area (100 NW) Illinois

Midewin National Tallgrass Prairie (176 NW) Illinois

Ouabache State Park (110 NE)

Pumpkinvine Trail (150 N)

https://dnr.illinois.gov/inpc/area.area3iroquoishooperbranchsavanna.html

https://dnr.illinois.gov/parks/park.kickapoo.html

https://www.fs.usda.gov/midewin

https://www.in.gov/dnr/state-parks/parks-lakes/ouabache-state-park/

Nature Preserves/Small Gems (5)

Ott Biological Preserve (205 NE) Michigan

Spicer Lake (143 N)

Gallagher Fen Nature Preserve (147 E) Ohio

France Park (80 N)

Calli Nature Preserve (70 SE)

https://www.calhouncountymi.gov/departments/parks/ott_biological_preserve.php

http://www.sjcparks.org/591/Spicer-Lake

https://ohiodnr.gov/go-and-do/plan-a-visit/find-a-property/gallagher-fen-state-nature-preserve

https://www.co.cass.in.us/departments/e-i/france-park/home

Arboretums (6)

Allerton Park (150 W) Illinois

Gabis Arboretum (146 NW)

Bernheim Arboretum and Forest (157 S) Kentucky

Boone County Arboretum (130 SE) Ohio

Yew Dell Botanical Garden (144 S) Kentucky

Pyramid Hill Sculpture Park (115 SE) Ohio

https://bcarboretum.org/

https://www.pyramidhill.org/

Our Hamilton County: Cost of Living

https://www.firstib.com/about-us/new-headquarters/

Metro Indy Cost of Living is 7% Below Average

https://www.stats.indiana.edu/about/coli.asp

https://www.bankrate.com/real-estate/cost-of-living-calculator/

In general, Hamilton County’s costs are similar to those of the Indy metro area. It’s 357,000 residents account for just 17% (1 in 6) of the formal Indy metro area’s 2,075,000.

Solid county level data is not available for all areas, but limited comparisons helped to identify goods and services that might differ between Hamilton County and the Indy average.

https://www.bestplaces.net/cost_of_living/county/indiana/hamilton

https://www.epi.org/resources/budget/?gclid=Cj0KCQjwxuCnBhDLARIsAB-cq1rnk521GaWh6Evp4LUs2TaA2Tgx_oufafn9ywPIV32tpToZ0f0FVpwaAhnMEALw_wcB

Housing

Hamilton County’s housing is 8% more expensive than the national average rather than 15-17% lower as seen in metro Indianapolis. The housing stock is also newer, larger and higher quality. The full housing price difference would increase the total cost of living measure by 7%. Considering one-half being due to age/quality and one-half due to prices adds 3.5% to 93.1% to yield a revised 96.6% cost of living ratio.

https://www.towncharts.com/Indiana/Housing/Marion-County-IN-Housing-data.html

https://www.towncharts.com/Indiana/Housing/Hamilton-County-IN-Housing-data.html

The median Marion County house was built in 1971. The median Hamilton County house was built in 2000.

Taxes

Indiana local taxes average 9.3% of income versus 10.2% nationally. This 10% savings on a 10% cost factor reduces the overall cost of living measure back down to 95.6%. State sales and income taxes do not vary by county. Hamilton County’s property and income taxes are lower than its large population peer group in Indiana.

Food Prices

Historically, Indianapolis has been a competitive grocery market. Kroger has a leading market share. Cub Foods and Marsh have left the market, but Meijer’s, Trader Joe’s, Whole Foods, Fresh Thyme, Fresh Market and Market District now compete with the others.

https://www.indystar.com/story/money/2014/03/22/grocery-store-wars-indianapolis-shoppers-profit-foodie-fight/6715177/

https://www.axios.com/local/indianapolis/2023/05/02/indianapolis-grocery-stores-kroger

5% of low-income Hamilton County residents do not live near a grocery store, versus 6% nationwide. The supply of grocery stores is adequate.

https://www.countyhealthrankings.org/explore-health-rankings/indiana/hamilton?year=2023

Hamilton County’s retail sales per capita figure is 14% above the national average, despite the very high concentration of retail stores in Marion County along 82nd/86th Street. The county is well served by retailers of all kinds.

https://www.census.gov/quickfacts/fact/table/US/SBO001217

https://www.census.gov/quickfacts/fact/table/US,marioncountyindiana,hamiltoncountyindiana,hendrickscountyindiana,johnsoncountyindiana,hancockcountyindiana/HSG860221

Food away from home makes up almost 5% of the consumer price index. No restaurant food index is publicly available. However, the Big Mac price in Hamilton County is $4.59 versus the $4.39 national average price, a 5% premium. If this applied to all restaurant prices, the overall cost of living index would be 0.3 higher, 95.9. The average Indiana Big Mac price was just $4.11.

https://worldpopulationreview.com/state-rankings/big-mac-index-by-state

https://pantryandlarder.com/mccheapest

The Economic Policy Institute provides “modest income” food prices that are 19% higher in Hamilton County than in Marion County. Given the proximity of the counties and the long-standing coverage of “food deserts” in Indianapolis contrasted with nearly none in Hamilton County, this indicator is suspect.

https://www.epi.org/resources/budget/?gclid=Cj0KCQjwxuCnBhDLARIsAB-cq1rnk521GaWh6Evp4LUs2TaA2Tgx_oufafn9ywPIV32tpToZ0f0FVpwaAhnMEALw_wcB

Health Care

Hamilton County has 1.8 hospital beds compared with the national average of 1.9 and the Indiana average of 3.3. It has 1.5 primary care physicians versus 1.0 nationally and 1.3 in Indiana. 10% of Hamilton County households have medical bills in collections compared with 17% nationally and 19% in Indiana. Access to health care is adequate.

https://www.usnews.com/news/healthiest-communities/indiana/hamilton-county

The Best Places website uses a simple index of a standard hospital bed night, a doctor’s visit and a dentist’s visit indicating that Hamilton County health care costs are equal to the national average (100).

https://www.bestplaces.net/cost_of_living/county/indiana/hamilton

A Rand Corporation study indicates that Indy metro hospital rates are 25% higher than the national average. This is driving Indiana statehouse political battles with claims and counterclaims. Professional services fees were 25% below the national average.

https://www.rand.org/pubs/research_reports/RRA1144-1.html

https://www.wfyi.org/news/articles/why-are-indianas-health-care-costs-so-high

Although health care is as much as 18% of GDP in the US, the share in the consumer price index is only 5%. If Hamilton County consumer costs are the same as the nation, this would increase the cost-of-living index by 0.6 points to 96.5.

Utilities

Best Places pegs Hamilton County’s utility costs at 93 rather than 107.

Indiana natural gas prices are more than 20% below the 50 state median.

https://www.chooseenergy.com/data-center/natural-gas-rates-by-state/

Indiana and Hamilton County electricity prices are 10% below the national average.

https://www.eia.gov/electricity/monthly/epm_table_grapher.php?t=epmt_5_6_a

https://www.electricitylocal.com/states/indiana/noblesville/

https://www.energysage.com/local-data/electricity-cost/in/

Local utilities are probably at least 10% lower than in the summary statistics, so the COL index should be reduced by 0.9 points based on their share of spending, reducing the index to 95.6.

Transportation

Indiana used car prices are the lowest in the nation, 11% below the average.

https://www.iseecars.com/used-car-buying-by-state-study

Indy fuel prices match the US average.

https://www.axios.com/local/indianapolis/2023/08/11/gas-prices-down-below-average

Indiana auto insurance rates are 40% less than the national average. Hamilton County rates are a little lower.

https://www.bankrate.com/insurance/homeowners-insurance/states/#home-insurance-rates-by-state

https://www.policygenius.com/homeowners-insurance/home-insurance-rates-by-zip-code/

The US Census Quick Facts tool reports that Hamilton County’s average commute time is the same as the country’s.

The 94 score may be high, but no specific change is indicated.

Other Goods and Services

Home insurance prices for Indiana and Hamilton County are variously reported as 10% below, equal to and 10% above the national average.

https://www.bankrate.com/insurance/homeowners-insurance/states/#home-insurance-rates-by-state

https://www.policygenius.com/homeowners-insurance/home-insurance-rates-by-zip-code/

https://www.insurance.com/home-and-renters-insurance/home-insurance-basics/average-homeowners-insurance-rates-by-state

Indiana’s state university tuition rates match the US average.

https://www.collegetuitioncompare.com/state/

Indiana has very high childcare prices.

The Economic Policy Institute and Indiana Family and Social Services Administration indicate that Hamilton County childcare costs are 13% higher than in Marion. Because childcare accounts for just 0.6% of spending, no adjustment is indicated.

https://www.epi.org/resources/budget/?gclid=Cj0KCQjwxuCnBhDLARIsAB-cq1rnk521GaWh6Evp4LUs2TaA2Tgx_oufafn9ywPIV32tpToZ0f0FVpwaAhnMEALw_wcB

https://www.in.gov/fssa/carefinder/provider-reimbursements/

Summary: Hamilton County Costs are 4% Lower than the National Average

County level housing, health care and grocery costs added more than 4% while lower taxes and utility costs subtracted almost 2% for a final score of 95.6, more than 4% below the national average.

Our Hamilton County: Healthy Behavior

https://www.practicematch.com/employer/iu-health-north-hospital/48077/

Healthy Behaviors

For each measure, we’ll list the Hamilton County rate, the Indiana rate and a letter grade primarily comparing Hamilton County with the Indiana average but also considering the national average.

Annual flu vaccinations: 64% vs 54%, A.

Infants with recommended immunizations: 66% vs 67%, C.

Mothers receiving pre-natal care in first trimester: 84% vs 72%, A.

Mammography screenings: 47% vs 39%, A.

Adults with recent preventive care visit: 78% vs 75%, B.

Adults reporting excessive drinking: 18% vs 18%, C.

Alcohol impaired driving deaths: 24% vs 19% (US avg is 27%), C.

Adult smoking: 11% vs 20% (US avg is 16%), A.

Preventable hospital stays (by outpatient services) per 100K Medicare enrollees: 1,850 vs 3,174, A.

Adults without leisure-time physical activity: 17% vs 26% (US avg is 22%), A.

Adult obesity: 29% vs 37% (US avg is 32%), B.

Adult diabetes rate: 8% vs 11% (US avg is 9%), B.

Diabetes deaths per 100K: 12 vs 30, A.

Heart disease prevalence: 4.4% vs 6.0%, A.

Heart disease hospitalizations per 1K Medicare beneficiaries: 48 vs 62 (US avg is 57), A.

Sexually transmitted disease (chlamydia) cases per 100K: 216 vs 480, A.

Existing HIV cases per 100K: 82 vs 193, A.

Some medical experts dispute classifying measures (above and below) as being strongly related to individual behaviors or as social indicators. They are grouped as conventionally done by others reporting on public health.

Social Indicators

Emergency room injury visits per 10K: 532 vs 850, A.

Injury deaths per 100K: 43 vs 85 (US avg is 76), A.

Drug overdose deaths per 100K: 12 vs 28 (US avg is 23), A.

Opioid ER visits per 100K: 31 vs 75, A.

Deaths of despair per 100K: 31 vs 53, A.

Teen births per 1K females: 4 vs 17, A.

Births, mother smoked during pregnancy: 1% vs 11%, A.

Infant deaths per 1K live births: 4.7 vs 6.7 (US avg is 5.4), B.

Deaths per 100K under age 18: 30 vs 60 (US avg is 50), A.

Children in single parent households: 13% vs 25%, A.

Disconnected ages 16-19, not working or in school: 5% vs 6% (US avg is 7%), B.

Juvenile arrests per 1K: 8 vs 19, A.

Summary

Hamilton County earns summary A grades for both behaviors and social indicators. US News & World Report rates Hamilton County as 8th best nationally of the counties it tracks. County Health Rankings lists it as the healthiest county in Indiana. 

http://indianaindicators.org/dash/overview.aspx

https://www.usnews.com/news/healthiest-communities/indiana/hamilton-county

https://www.countyhealthrankings.org/explore-health-rankings/indiana/hamilton?year=2023

https://nccd.cdc.gov/DHDSPAtlas/Reports.aspx

https://www.hamiltoncounty.in.gov/254/Health-Department

Our Hamilton County: Health Resources and Outcomes

https://www.structurepoint.com/engineering-and-infrastructure/project/riverview-health-westfield-hospital

Health Resources

For each measure, we’ll list the Hamilton County rate, the Indiana rate and a letter grade primarily comparing Hamilton County with the Indiana average but also considering the national average.

Primary care physicians per 100K: 140 vs 67, A+.

Hospital beds per 1,000: 1.8 vs 3.3, (US avg is 1.9), B.

Population per “other” (nurse practitioner) primary care providers: 920 vs 830, C-.

Population per mental health care provider: 580 vs 530 (US avg is 340): D.

Population per dentist: 1,350 vs 1,700 (US avg is 1,380), B.

Access to park or physical recreation facilities: 90% vs 77%, A-.

Uninsured adults: 5% vs 10%, A+.

Food insecurity: 7% vs 11%, A.

Limited access to healthy foods: 5% vs 9% (US avg is 6%), B.

Health Outcomes

Life expectancy: 81.6 vs 76.5 (US avg is 78.5), A.

Deaths per 100K: 710 vs 965, A+.

Premature deaths per 100K: 215 vs 420, A+.

Reporting poor or fair health: 9% vs 15%, A.

Poor physical health days per month: 2.5 vs 3.3 (US avg is 3.0), B.

Poor physical health one-half of the time: 7% vs 10%, A.

Low birth weight: 7% vs 8%, B.

Arthritis hospitalizations per 10K: 33 vs 33, C.

Hip fractures per 10K aged 65+: 56 vs 62, B.

New lung cancer cases per 100K: 46 vs 72, A+.

Total cancer rate per 100K: 442 vs 457, C+.

Total cancer death rate per 100K: 126 vs 163 (US avg is 144), A-.

Mental Health

Poor mental health days per month: 3.9 vs 4.9, A.

Frequent mental distress: 13% vs 16%, B+.

Medicare beneficiaries with depression: 20% vs 21% (US avg is 18%), C-.

Insufficient sleep: 27% vs 36%, A.

Suicide deaths per 100K: 9 vs 15, A+.

Summary

Subjectively, health resources combine for a solid B+ or A-. Health outcomes are clearly rated A. Mental health is A. US News & World Report rates Hamilton County as 8th best nationally of the counties it tracks. County Health Rankings lists it as the healthiest county in Indiana. Hamilton County operates Riverview Health. Its health department effectively managed several rounds of covid vaccines.

https://www.countyhealthrankings.org/explore-health-rankings/indiana/hamilton?year=2023

https://www.usnews.com/news/healthiest-communities/indiana/hamilton-county

http://indianaindicators.org/dash/overview.aspx

https://www.hamiltoncounty.in.gov/254/Health-Department

Mostly Good News Since the 2008 Great Recession

https://content.time.com/time/specials/2007/article/0,28804,1733748_1733756_1735278,00.html

Real, after inflation, Gross Domestic Product is up by one-third, despite the pandemic. That’s 2% annually, despite the Great Recession and the pandemic. The US economy is very solid.

A 21% increase in per capita income during this time. Quite solid and constant growth.

Inflation averaged a bit less than 2% before the pandemic, spiked to 8%, and has since declined to 4%. Experts disagree on whether it will return to 2% soon.

Gas prices are the most obvious component of inflation. They are largely driven by global supply and demand. Prices today are the same as in 2011-14, despite the general inflation increase of more than 20% since then.

Despite the pandemic, US unemployment is at a 50 year low!

Job seekers today encounter 3 times as many job openings.

Core age labor force participation has snapped back after the pandemic.

Investment values have doubled.

The number of millionaires and billionaires in the US has continued to increase.

Personal savings rates rose from 6% to 9% before the pandemic, shot up and fell back down to just 4% recently.

Housing values have doubled since the Great Recession.

Mortgage rates averaged 4% after the Great Recession, dropped to 3% and then increased to 6%+ as the Federal Reserve raised interest rates.

US exports have nearly doubled in 14 years.

Despite the Trump tariffs, which Biden has maintained, imports have also nearly doubled.

Despite historically slower growth rates, higher budget deficits and looser monetary policies, the US dollar is more highly valued today than in 2008.

Foreign countries still see the US as a positive ally, despite their concerns during the Trump era.

Obama returned the budget deficit to a “reasonable” 3% by 2016. Trump expanded it to 5% and then 15% as the pandemic struck. Biden drove some recovery to 5% by 2022, but has not driven further reductions.

US coal production is in a long-term decline.

Natural gas production has nearly doubled in 14 years.

Net farm income has been significantly above the base for 6 of the last 14 years, despite lavish Trump farm subsidies.

Manufacturing employment has continued to rise slowly in the last 14 years against the headwinds of international competition.

It’s difficult to put the pandemic in perspective, but here we see a 2-year reduction in expected lifespans. Opioid deaths and so-called “deaths of despair”, alcohol, drugs, suicide, also play a role.

Birth rates continue to drift lower as seen in all regions of the world.

The number of retirees has increased by more than 50%.

Retiree incomes are up by one-third, matching inflation.

Prospective retirees have doubled their cumulative savings.

The abortion rate has continued to fall in the last 30 years.

Church attendance has dropped from 40% to 30%.

Summary

The US economy recovered slowly after the Great Recession and then very quickly after the pandemic. Real, after inflation, output and per capita output increased. The labor market became very tight. Asset prices (investments and housing) rose for intrinsic and monetary reasons. The US remained a competitive international producer. The federal budget deficit was better at the end of the Obama period but worse for Trump and Biden. The pandemic reduced life expectancy and households had fewer children. Successful retirements grew and will grow. Social trends continue, uninterrupted by political positioning and policies.

Perceptions of the country and the economy are increasingly shaped by partisan political party views. Nonetheless, the US economy continues to grow and thrive.

Good News: Emergency Medical Services (EMS) Today (1972-2022)

Positive Media Coverage

https://www.imdb.com/search/keyword/?keywords=medical-drama

Since the pioneering 1972 drama Emergency! there have been dozens of TV shows highlighting the critical role of emergency medical services (EMS) personnel.

https://www.imdb.com/search/keyword/?keywords=medical-drama

Vehicles

Modern Emergency Medical Services (EMS) vehicles today are designed to help EMS medical professionals provide world class care. They now meet national standards (1974, 1990) for space, equipment, supplies and client care. These vehicles are stocked with supplies and equipment to meet all typical emergency care needs.

https://www.nremt.org/about/history

Air Medical Services

Helicopter based emergency services started in 1974 in Baltimore, Jacksonville, Pittsburgh, Seattle and Denver leveraging the equipment and pilot experiences of the Vietnam War. Emergency helicopters are staffed with qualified personnel and equipment to handle the most extreme situations. Emergency personnel are staged across the country to respond to emergency situations.

In 2020, there were more than 1,600 helicopters and 700 fixed wing aircraft participating in emergency medical services in the US, making more than 200,000 responses to service requests.

https://www.hmpgloballearningnetwork.com/site/emsworld/article/1223054/air-medical-services-then-and-now

Emergency Medical Profession

The National Registry of Emergency Medical Technicians (NREMT) was established in 1970. This organization has driven the development of a true profession.

https://www.nremt.org/about/history

In 1975 the AMA recognized emergency medicine as a physician specialization and recognized paramedics as allied health professionals. Prior to this time, the training, skills, employers, supervision, equipment and medical protocols of the emerging profession were so varied that initial efforts to define and enhance the professional identity and roles of paramedics and EMTs were often opposed by physicians, nurses, lawyers and hospital administrators. In the 1970’s states began to pass legislation that defined the legal roles which paramedics and EMTs could play without concern for lawsuits from their customers. Specialized emergency physician training was also developed during the 1970’s highlighting the role of paramedics, immediate care, transport care, triage issues, communications and the emergency room admitting and medical services. Emergency medical dispatching programs started in the 1980’s. Military paramedics/EMTs adopted national standards in 1986, aligning the two groups. Paramedic manager standards for training have been defined for most states.

Paramedics and EMTs are regulated at the state level. Definitions of roles, titles, allowable drugs/procedures, supervision requirements, certifications, examinations, renewals and education programs varied widely in the 1970’s. The role of national certification as an option or requirement grew throughout the 1980’s and 1990’s. Today, differences between states remain, but most states (45+) largely conform to recommended national standards for all dimensions.

While most people think of paramedics and EMT’s as specialized staff or extra skills held by first responders, the profession now includes military personnel, dispatchers, air staff, emergency room, jail, blood bank, medical labs, education and interhospital transportation roles. This increased breadth of experiences has helped the profession to improve the content of its services, education, certification and allowable procedures.

https://en.wikipedia.org/wiki/Paramedics_in_the_United_States

Professional Certification

As states defined various paramedic and EMT legal roles, they created state professional certification agencies. The first national EMT exam was administered in 1971 to 1,500 applicants. By 1984 one-half of states required the national exam for certification. By 2005, 46 states recognized or used the standardized national exams.

The national exams incorporated American Heart Association standards in 1986. Major national standards changes were implemented in 1994-95 to include 2 decades of lessons learned, a systems approach to paramedic/EMT roles and a dual focus on theory and practice.

A single national organization (NREMT) sets national standards and reviews those states and programs which adopt them. Certification standards are defined for 5 typical levels in each state and at the national level. A majority of states simply adopt the national standards and almost all accept candidates who met the national standards rather than specific state standards. The “level” of skills, training and experience in states that do not adopt the national standards are generally comparable, with a few exceptions. A national standard curriculum is available which is aligned with the testing requirements. Candidates are evaluated on theory and practice, individual diagnosis/treatment and situation/scenario evaluation. Certification requires a period of field internships. A majority of firefighters earn some level of EMT certification. Almost all states recognize certifications from other states. The national agency accredits training programs and agencies.

https://www.emsmemorial.org/ems-history

https://indianahealth.care/history-of-ems

https://wvde.state.wv.us/abe/Public%20Service%20Personnel/HistoryofEMS.html

Professional Education

Ambulance staff training was first defined in the late 1960’s. The first EMT curriculum was nationally recognized in 1969. Prior to this time, ambulance staff had basic first aid training. National training standards were set in 1973 together with the emerging certification exams. A full national paramedic curriculum was released in 1977. A comprehensive “emergency care” manual was published in 1979. Early training was largely done by individual hospitals in urban areas. Training soon moved to universities and community colleges where it is focused today. While associates and bachelor’s degrees are not required for most paramedic/EMT licenses, they are now commonplace. The number and variety of procedures provided by paramedics and EMTs has grown throughout the period. As emergency room physicians became commonplace and their confidence in EMS staff increased, they supported this growth in “standing procedures” to be taken without physician coordination. With increased experience, documentation, best practices and scientifically based standards improved. The medical profession adopted a “systems approach” to health care beginning in the 1990’s and EMS staff have adopted this approach.

Cardiac Care

Prior to 1972, CPR training was defined and more broadly offered in the US. Portable defibrillators were invented but not broadly available. Emergency cardiac treatment programs were rare.

In the 1970’s heart resuscitation guidelines were published, more portable defibrillators were available and related EMT training began.

Cardiac care has been a key curriculum and certification exam component for paramedics/EMTs since the 1980’s.

The American Red Cross introduced defibrillator training into its first aid course in 1999.

The easier to use AED defibrillator was approved for sale in 2004 and is now widely placed in many communities and millions have been trained to use them.

Pediatric Care

Pediatric care was upgraded in the 1984 curriculum and exam standards for EMS staff. Specialized pediatric care hospitals were clearly established.

Emergency Rooms

Hospitals invested in emergency room space, equipment and staff after 1975 when emergency room physicians became a specialty. In 1983 Level 1 trauma centers and pediatric critical care centers were defined and began to be implemented. Disaster resource centers were defined in 2004. Stroke centers were defined in 2009. While these specialty care centers were defined, a wide variety of immediate care centers were established in many areas, providing additional options for EMS services.

Medical Protocols

EMS professionals have benefitted from the global “process revolution” of the 1980’s. Health care professionals view each patient and situation within a “process framework”. This has allowed paramedics and EMTs to increase the variety and depth of first response diagnosis and treatment which they can legally and effectively provide. Evidence based medical standards replaced the previous “trial and error” standards in the 1990’s. Standard operating procedures were defined for most situations. This allowed EMS staff to act immediately without emergency physician approval in more situations. “Standing field treatment protocols” were widely defined and adopted in 1997 clarifying the roles of paramedics/EMTs. EMS standards were further revised in 2000 using the “medical systems” approach. Standardized EMS data recording and sharing began in 2000 and has expanded since then, allowing improved systems, evidence and medical based changes to accumulate. States generally approve both procedure and medical treatment options for individuals holding each level of EMT/paramedic certification.

Communications

In 1972, police and fire vehicles had basic special purpose radio communications and dispatchers as did taxi fleets. Improved medical dispatching skills accompanied the growth of EMS resources. Revised EMS radio communication standards were adopted in 1973. EMS staff benefitted from the expansion of cellular phone services. 911 emergency call services began in 1968 and expanded nationally throughout the 1970’s. Dedicated EMS to hospital communications as increasingly adopted in the 1990’s. Video services were added after 2000.

Funding

In 1966 a National Academy of Sciences study titled “Accidental Death and Disability” highlighted the comparatively high casualty rates of domestic vehicle accident victims versus those with war injuries! Thousands of Americans were disabled, mistreated and died each year versus the standard treatment offered by the military in combat zones. Congress responded by moving lead responsibility for EMS from the US DOT to US HEW in 1972. 5 demonstration EMS programs were funded in 1972. Further federal investments were made in the 1970’s. However, by 1980, Congress and the president decided that states should manage and fund this component of the health care system.

EMS Professional Skills

Today, when you dial 911 in an emergency, you can expect a nationally certified, trained and supervised team to quickly arrive and provide a high-quality level of services.

Assessment of incident, accident, patient situation.

Compliance with standard care protocols and escalation to physicians.

Triage in mass casualty situations.

Safe movement and extraction of patients from accident situations.

First aid treatment.

Intravenous fluid administration.

ECG, EKG administration and defibrillation (manual and electric).

Intubation.

Drug administration.

Acute asthma treatment.

Heart rhythm assessment and rate correction.

Spinal immobilization.

Transportation to the best next level care facility.

One Million EMS Professionals!

There are 1 million certified emergency medical system (EMS) personnel in the US today, up from basically ZERO in 1972. One-fourth are highly skilled paramedics. A little more than one-half are certified EMTs.

https://www.nremt.org/maps

About one-half of the total were certified at the national level.

Pre-1972