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Thank you, Thomas Brown, for forwarding the question. I originally didn’t feel like answering but later on changed my mind.--------------If there is no God, all we have left is ontological naturalism.If ontological naturalism is an accurate understanding of reality, then there are certain predictions that necessarily follow. Some of these predictions can be tested for veracity. Naturalistic abiogenesis is one of those predictions.I’m not here to announce that no one has yet created life from scratch, since that’s already well known. I’m here to demonstrate in a simple way why naturalistic abiogenesis is 100% impossible.Keep in mind that I’m not saying chemists can’t eventually succeed in synthesizing life in the lab. (That would be intelligent abiogenesis, which is intelligent design). What I’m saying is that naturalistic abiogenesis, i.e. unaided Nature creating the first living thing, is 100% impossible. Let’s find out why. (spoiler: The simplicity of the reason may actually shock you)..Mindless prebiotic Nature has no goal in mind to create life.That’s basically it. The above statement is the summary of what obviates naturalistic abiogenesis.You don’t have to take my word for it. What I’ve written in bold above is not only obviously true, but also acknowledged by many scientists who actually care about reality. The below remark from Peter Ward is one good place to begin:Amazingly, one of the major criticisms of RNA life, one of the alternate life-forms introduced in the last chapter and the hypothesized last common ancestor of all DNA life, is that it probably did not exist because it would have been impossible to build RNA through natural chemical processes. Paul Davies notes: “As far as biochemists can see, it is a long and difficult road to produce efficient RNA replicators from scratch.... The conclusion has to be that without a trained organic chemist on hand to supervise, nature would be struggling to make RNA from a dilute soup under any plausible prebiotic condition.” Once RNA has been synthesized, the path toward life is open because RNA can eventually produce DNA. But how the first RNA came into existence—under what conditions and in what environments—became the central problem facing chemists. As Nobel laureate Christian de Duve notes in his book, there just seemed no way to see how RNA could come about naturally: “We must now face the chemical problems raised by the abiotic synthesis of an RNA molecule. These problems are far from trivial.” (emphases mine)--Peter Ward, Life as We Do Not Know It, page 67 (Viking Press, 2005).Or, as organic chemist Clemens Richert wrote in Nature Communications last year:Experimentalists in the field of prebiotic chemistry strive to re-enact what may have happened when life arose from inanimate material. How often human intervention was needed to obtain a specific result in their studies is worth reporting.When Diego Maradona was asked about having used his hand to score a goal in the quarter-finals of the 1986 soccer World Cup, he initially claimed that there had been divine intervention, and the term “Hand of God Goal” was coined.—There had been manual intervention, and there had been an understandable interest of the player not to admit it.—Organic chemists, if not all experimentalists in the field of prebiotic chemistry, are faced with a similar dilemma. We do our best to perform experiments that we believe re-enact possible steps of prebiotic evolution, but we know that we need to intervene manually to obtain meaningful results.Further, the ideal experiment does not involve any human intervention.For experiments aimed at demonstrating chemically more complex processes, such as multistep syntheses mimicking biochemical pathways or genetic replication, repeated interventions by the experimentalist have been necessary. Each step needs a specific chemical environment or set of conditions to occur in high yield. For example, an elimination reaction needs other conditions than an addition reaction, and assuming that both will occur simultaneously in the same solution is unrealistic.He also frankly said:Understandably, this has drawn the ire of those who feel that no or only minimal intervention is allowed for a process to be called prebiotically plausible. After all, it is not easy to see what replaced the flasks, pipettes and stir bars of a chemistry lab during prebiotic evolution, let alone the hands of the chemist who performed the manipulations. (And yes, most of us are not comfortable with the idea of divine intervention in this context.)Prebiotic chemistry and human interventionThe comment in parentheses is his.Whether divine intervention or human intervention, there’s a conscious entity doing the intervening. So even if our friends succeed, it demonstrates that intelligence and deliberate intent are needed to create a living thing. I'm glad this issue is explicitly acknowledged.Every (honest) OOL researcher on Earth will agree fully. It’s one thing for highly trained chemists to create RNA in a lab, but another thing entirely for unaided Nature to accomplish the same. Especially considering that Nature is not trying to make RNA, and has no intention of doing so. But, if the researcher is committed to Naturalism and atheism, then he has no choice but to maintain a strong (and unrealistic) faith that Nature did it anyway, even though he knows it’s not possible. One such researcher, Eugene Koonin, resorted to “an infinite multiverse” as a potential way out of this problem. (Supposedly, anything that can happen, WILL happen, in an infinite multiverse, and this would also include the chance origin of life: The cosmological model of eternal inflation and the transition from chance to biological evolution in the history of lifeThe above Koonin paper was from 2007, but in 2011 he had this to say:The origin of life is one of the hardest problems in all of science, but it is also one of the most important. Origin-of-life research has evolved into a lively, interdisciplinary field, but other scientists often view it with skepticism and even derision. This attitude is understandable and, in a sense, perhaps justified, given the “dirty” rarely mentioned secret: Despite many interesting results to its credit, when judged by the straightforward criterion of reaching (or even approaching) the ultimate goal, the origin of life field is a failure – we still do not have even a plausible coherent model, let alone a validated scenario, for the emergence of life on Earth. Certainly, this is due not to a lack of experimental and theoretical effort, but to the extraordinary intrinsic difficulty and complexity of the problem. A succession of exceedingly unlikely steps is essential for the origin of life, from the synthesis and accumulation of nucleotides to the origin of translation; through the multiplication of probabilities, these make the final outcome seem almost like a miracle.– Eugene V. Koonin, The Logic of Chance: The Nature and Origin of Biological Evolution (Upper Saddle River, NJ: FT Press, 2011), p.391“Almost like a miracle” is a frank admission of what OOL entails. Nevertheless, in the same book, he continued to cling to the multiverse hypothesis as a guaranteed solution to the problems involved with OOL.Here’s the summary of Koonin’s argument, in his own words:Simply put, the probability of the realization of any scenario permitted by the conservation laws in an infinite universe (and, of course, in the multiverse) is, exactly, one....Thus, spontaneous emergence of complex systems that would have to be considered virtually impossible in a finite universe becomes not only possible but inevitable under MWO [Many Worlds in One]So as long as matter or energy aren’t created or destroyed (conservation), then anything can, and will, happen... in some universe somewhere within the multiverse. Including naturalistic abiogenesis.Koonin says:Indeed, in an infinite multiverse with a finite number of histories, there is no chance that we live in the best of all possible worlds. There is an infinite number of worlds that are incomparably better, even those where Elvis is still alive in 2007 as wryly noticed by Garriga and Vilenkin.According to Koonin (and some Many Worlds physicists who agree with him), in some universe somewhere right now, there’s a guy who’s a practicing neurosurgeon, a janitor, and the lead actor in a recent blockbuster movie—simultaneously. He owns 271 cars, and is married to his high school sweetheart (who happens to be a princess from a tribe of highly-advanced super-beings). Their son adopted a pet chimpanzee named Wilson, while their twin daughters are ballistic missile experts in the local galactic army.No, this isn’t a hypothetical story I just made up. These things are actually going on right now as we speak, in some universe somewhere, according to Koonin. The pet chimp is also very clever, and has learned how to fly a helicopter, among other things.Koonin isn't a physicist, but he should know better. A mathematical hypothesis in cosmology doesn’t automatically translate to the real world. His proposal also ignores the simple fact that an infinite multiverse is still mindless Nature, so we haven't escaped the issue of deliberate or intentional creation of life. A mindless prebiotic multiverse doesn't wake up in the morning and say “Well, I have to be off to work now, I have to continue this process of inventing life, this process I started x amount of years ago.”... Any universe still has to deliberately invent life. Koonin himself estimated the probability of a minimal replication-translation machinery arising by chance to be less than [math]10^{^{-1018}}[/math], if we don’t invoke multiple universes. But even this slightly-above-zero odds is still too generous. Think about a trained monkey trying to synthesize life in a chemistry lab. What are the odds of him succeeding?? Exactly. But even the monkey has a better chance than a prebiotic Nature which has no goal or purpose whatsoever.In any case, simply postulating an infinite multiverse in attempt to overcome the problem does not help—He doesn’t put forth any mechanism whereby life could be naturally synthesized, but just makes the bold assertion that it must certainly happen given a multiverse. One of the reviewers of Koonin's paper complained about this very issue:In this paper we have neither any mechanism or constraints for the translation system, nor prior observations on which to base our probability measures. We have only a conjectured sample space, and no systematic mechanism of coarse-graining the relevant measures. This leads to a rather strange outcome where we might as well assert that all observed biological order emerged in one step, including the complete evolutionary history of life. This is equally as possible as the emergence of an RNA polymer, and eye or an atom. Notice that these are all equally possible, namely, certain, in an infinite multi-verseAny one universe still has to go through the steps required to deliberately create life even if we multiply universes “infinitely”. The impossible odds of a prebiotic Nature creating life hasn’t changed.Another factor that is usually seen as a possible helper for abiogenesis is Time. If Nature has (m/b)illions of years to work with, she should be able to eventually get the right combination to the safe, right? No, not at all. That would be akin to claiming a blind engineer could invent a BMW, or a Model-T Ford, given billions of years to live and try. It’s clear why time isn’t the problem. The blind engineer actually has better odds in this analogy than Nature does, since he at least knows what he’s attempting to accomplish.The origin of encoded genetic information is also assumed to have just happened miraculously under the multiverse scenario. Information here isn’t just the physical nucleobases, or even their sophisticated ordering alone, but the ribosome’s understanding of the language, and their ability to decode and use those instructions to build the specified proteins. And then we have multiple regulatory genes in addition, which are all information networks. I could employ many quotes here concerning what information is, but I like how Hubert Yockey put it in this simple statement:The meaning, if any, of words, that is, a sequence of letters, is arbitrary. It is determined by the natural language and is not a property of the letters or their arrangement ... For example, "O singe fort!" has no meaning as a sentence in English, although each is an English word, yet in German it means, "O sing on!" and in French it means "O strong monkey". Like all messages, the life message is non-material but has an information content measurable in bits and bytes.-- Hubert Yockey, "Information in Bits and Bytes," BioEssays, 17: 85 (1995).Or as evolutionary biologist George C. Williams once pointed out:Evolutionary biologists have failed to realize that they work with two more or less incommensurable domains: that of information and that of matter. I address this problem in my 1992 book, Natural Selection: Domains, Levels, and Challenges. These two domains will never be brought together in any kind of the sense usually implied by the term "reductionism." You can speak of galaxies and particles of dust in the same terms, because they both have mass and charge and length and width. You can't do that with information and matter. Information doesn't have mass or charge or length in millimeters. Likewise, matter doesn't have bytes. You can't measure so much gold in so many bytes. It doesn't have redundancy, or fidelity, or any of the other descriptors we apply to information. This dearth of shared descriptors makes matter and information two separate domains of existence, which have to be discussed separately, in their own terms. The gene is a package of information, not an object. The pattern of base pairs in a DNA molecule specifies the gene. But the DNA molecule is the medium, it's not the message. Maintaining this distinction between the medium and the message is absolutely indispensable to clarity of thought about evolution.—G.C. Williams, "A Package of Information," in J. Brockman ed., The Third Culture: Beyond the Scientific Revolution, p.43 (Simon & Schuster, 1995).Or, as chemistry professor Michael Polanyi already noted way back in 1958, in his book Personal Knowledge:Information in the DNA could no more be reduced to the chemicals than could the ideas in a book be reduced to the ink and paper: something beyond physics and chemistry is encoded in DNA.Here's an excerpt from a 2013 paper, where the authors acknowledge that the genetic code cannot possibly have a naturalistic origin:It has been repeatedly proposed to expand the scope for SETI, and one of the suggested alternatives to radio is the biological media. Genomic DNA is already used on Earth to store non-biological information. Though smaller in capacity, but stronger in noise immunity is the genetic code. The code is a flexible mapping between codons and amino acids, and this flexibility allows modifying the code artificially. But once fixed, the code might stay unchanged over cosmological timescales; in fact, it is the most durable construct known. Therefore it represents an exceptionally reliable storage for an intelligent signature, if that conforms to biological and thermodynamic requirements. As the actual scenario for the origin of terrestrial life is far from being settled, the proposal that it might have been seeded intentionally cannot be ruled out. A statistically strong intelligent-like “signal” in the genetic code is then a testable consequence of such scenario. Here we show that the terrestrial code displays a thorough precision-type orderliness matching the criteria to be considered an informational signal. Simple arrangements of the code reveal an ensemble of arithmetical and ideographical patterns of the same symbolic language. Accurate and systematic, these underlying patterns appear as a product of precision logic and nontrivial computing rather than of stochastic processes (the null hypothesis that they are due to chance coupled with presumable evolutionary pathways is rejected with P-value < [math]10^{^{-13}}[/math]). The patterns are profound to the extent that the code mapping itself is uniquely deduced from their algebraic representation. The signal displays readily recognizable hallmarks of artificiality, among which are the symbol of zero, the privileged decimal syntax and semantical symmetries. Besides, extraction of the signal involves logically straightforward but abstract operations, making the patterns essentially irreducible to any natural origin. Plausible ways of embedding the signal into the code and possible interpretation of its content are discussed. Overall, while the code is nearly optimized biologically, its limited capacity is used extremely efficiently to pass non-biological information. (emphases mine)The “Wow! signal” of the terrestrial genetic codeLater on in the full article, we find their conclusion concerning the code’s origin:Whatever the actual reason behind the decimal system in the code, it appears that it was invented outside the solar system already several billion years ago.Well, they earlier ruled out a naturalistic origin by chemical evolution, so we’re left to wonder who “invented” the code. They’re proposing ETs in their paper (per SETI), but this doesn’t save Naturalism as we’ll see a little later.There’s actually a US$10million challenge out there still ongoing, for anyone who can demonstrate a set of coded information that didn’t originate from a mind, i.e., that can be spontaneously generated by Nature. The judges include well-respected biologists George Church and Denis Noble, and the Royal Society has also gotten involved recently. Below is a 2-minute summary video and the official website followingArtificial Intelligence + Origin of Life Prize, $10 Million USD | HeroX.…Most of us don’t actually know, much less appreciate, the number of things that need to be done in order to arrive at the “simplest” prokaryotic cell. Even if you assume a pre-cellular self-replicator, you still have to arrive at the prokaryotic cell eventually. Prebiotic Nature has no goal or aim or plan to create a cell. The fact that highly trained, highly intelligent chemists still can’t do it, speaks volumes. Lay naturalists and even some with degrees think all that’s needed is lots of time, then Nature will eventually produce a living cell.Here’s a link that describes the magnitude of what we’re dealing with, and what a prebiotic Nature has to accomplish without even having any intention or goal or desire or aim or plan to accomplish it: Animadversions of a Synthetic ChemistIncase you find yourself wondering why he spent so much time talking about nanocars before getting into biomolecular systems, here’s the punchline:Carbohydrates are the backbones of nucleotides, which in turn are needed for DNA and RNA. Carbohydrates also serve as recognition sites for cells to communicate with each other, and as food sources for living systems. The difficulties involved in carrying out carbohydrate synthesis in a prebiotic environment parallel those found in making nanovehicles.AND:Designing nanocars is child’s play in comparison to the complexity involved in the synthesis of proteins, enzymes, DNA, RNA, and polysaccharides, let alone their assembly into complex functional macroscopic systems.Later on in the article:When reading the protocols for the suggested prebiotic-like precursors, one is struck by the high-level sophistication, expert synthetic prowess, and remarkable ingenuity of the researchers.The sheer amount of intellectual effort that goes into OOL research is more than impressive. And we still can’t pull it off. But a mindless prebiotic Nature with no intention of creating a cell somehow did it.Consider the ingredients needed to make basic candy (skittles in this case):Now consider just a miniscule piece of a skittle:Would Nature alone be able to synthesize and assemble the ingredients needed to make a tiny piece of a skittle? Not in ten billion years! But many adults believe Nature somehow synthesized and assembled everything that’s needed to make a living, metabolizing, self-replicating cell. Prebiotic Nature has as much desire to make a cell as it does a piece of skittle candy. i.e., None.--------.ExtraterrestrialsIf we claim ETs seeded the first life on Earth, as our SETI friends propose, we must keep in mind that the ETs are still natural beings if we hold to ontological naturalism. Thus, we have to explain how Nature produced the first ETs. As Richard Dawkins said:[Intelligent design] could come about in the following way. It could be that at some earlier time, somewhere in the universe, a civilization evolved by probably some kind of Darwinian means to a very, very high level of technology and designed a form of life that they seeded onto, perhaps this planet. Now that is a possibility, and an intriguing possibility. And I suppose it’s possible you might find evidence for that if you look at the details of biochemistry and molecular biology. You might find a signature of some sort of designer, and that designer could well be a higher intelligence from elsewhere in the universe. But that higher intelligence would itself have had to have come about by some explicable or ultimately explicable process. It couldn’t have just jumped into existence spontaneously.AND:Whether we ever get to know them or not, there are very probably alien civilizations that are superhuman, to the point of being god-like in ways that exceed anything a theologian could possibly imagine. Their technical achievements would seem as supernatural to us as ours would seem to a Dark Age peasant transported to the twenty-first century…In what sense would they be superhuman but not supernatural? In a very important sense…the crucial difference between gods and god-like extraterrestrials lies not in their properties but in their provenance. Entities that are complex enough to be intelligent are products of an evolutionary process. No matter how god-like they may seem when we encounter them, they didn’t start that way…They probably owe their existence to a (perhaps unfamiliar) version of Darwinian evolution.Gods, Aliens, Mormons and Richard Dawkins’ New AtheismSo saying ETs put the first life on Earth still keeps us inside the box of Naturalism. Nature still has to create and evolve the ETs, so the OOL problem remains.Then there’s at least one scientist in peer-reviewed publication who also thinks panspermia by ETs isn’t a good enough proposal, due to the obvious reality that natural chemistry has no intent to create life. He concedes “supernatural intervention or intelligence” (aka God), or that cellular life has existed from eternity:Cause of Cambrian Explosion - Terrestrial or Cosmic?It's a long paper. If you care to see the below quote from the article, scroll down halfway through, it’s under ‘Appendix A. Origins of life and scientific alternatives to the H-W cosmic panspermia?’. For the PDF version it’s on page 17.Yes that’s an actual suggestion from last year in a peer-reviewed secular scientific paper. Either God did it, or self-replicating microbes have always existed.The difference between the two proposals is thatGod is a single eternally-existing entity. This is logically consistent and plausible, and even a metaphysical necessity to avoid an infinite regress of causesOn the other hand, eternally-replicating microbes means that abiogenesis never happened, i.e., there was no ‘first ever microbe’. This leads us to not only an infinite regression, but also an infinity of countable objects, which is a logical absurdity since you can always add 1 more item to the presumed infinity (and adding 1 more is precisely what takes place whenever a microbe replicates). There are abstract infinities in math, but not a physical infinity of real, countable objects (see here for example if interested: Infinity is Not Real.-----ConclusionFor decades, highly trained experts have been striving to create life from scratch, using the abiotic raw materials found in nature. They are yet to succeed, due to a number of well-identified ‘chicken and egg’ paradoxes, and other known problems. Even if they did eventually succeed somehow, that would only demonstrate that a high level of intelligent input is needed to create biological life; which is what intelligent design says. Nature has zero intent to invent life from abiotic molecules. This explicitly makes naturalistic abiogenesis a nonstarter. Proposing an infinite multiverse where “anything that can happen will happen” is an unsubstantiated assertion with no empirical evidence whatsoever, and doesn’t offer a mechanism for abiogenesis or even address the issue that Nature has no intent to create life. The suggestion that microbial life has always existed and self-replicated is a logical absurdity, since there can be no such thing as an infinity of real objects, or an infinite regress of causes.Thus in the question of God vs Naturalism (which isn’t a false dichotomy since pantheism, multiverse, etc all fall under Naturalism), one of the two options can be safely eliminated.

I do not think that conservatives are convinced that affordable health care for all is not feasible. I think they want to maintain a big business for profit at the expense of the American people’s health . There is a vast network of very rich corporations , pharmaceuticals , hospitals and doctors who profit enormously from the present system of healthcare in the US. I will use a summary of the study done at Yale University and Published in the Lancet medical journal to emphasize my point.SummaryAlthough health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care. Efforts are ongoing to repeal the Affordable Care Act which would exacerbate health-care inequities. By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services. Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to single-payer health care would provide the greatest relief to lower-income households. Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1·73 million life-years every year compared with the status quo.• View related content for this articleThis article is available free of charge.Simply log in to access the full article, or register for free if you do not yet have a username and password.1.Collins SR Gunja MZ Doty MMHow well does health coverage protect consumers from costs? Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2016.http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2017/oct/collins_underinsured_biennial_ib.pdfDate: Oct 11, 2017Date accessed: March 27, 2019View in ArticleGoogle Scholar2.United States Census BureauAnnual estimates of the resident population for selected age groups by sex for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010 to July 1, 2017 2017 population estimates.https://factfinder.census.gov/bkmk/table/1.0/en/PEP/2017/PEPAGESEXWe're sorry but this website doesn't work properly without JavaScript enabled. Please enable it to continue.https://factfinder.census.gov/bkmk/table/1.0/en/PEP/2017/PEPAGESEXDate: Feb 18, 2018Date accessed: July 3, 2018View in ArticleGoogle Scholar3.Auter ZU.S. uninsured rate steady at 12·2% in fourth quarter of 2017.U.S. Uninsured Rate Steady at 12.2% in Fourth Quarter of 2017The uninsured rate among U.S. adults held steady at 12.2% in the fourth quarter of 2017, but is up 1.3 points since the end of 2016.https://news.gallup.com/poll/225383/uninsured-rate-steady-fourth-quarter-2017.aspxDate: Jan 16, 2018Date accessed: July 3, 2018View in ArticleGoogle Scholar4.Fiedler M Adler LHow will the Graham-Cassidy proposal affect the number of people with health insurance coverage?.How will the Graham-Cassidy proposal affect the number of people with health insurance coverage?Matthew Fiedler and Loren Adler estimate that the Graham-Cassidy legislation would reduce the number of people with insurance coverage by around 22 million each year during the 2020 through 2026 period.https://www.brookings.edu/research/how-will-the-graham-cassidy-proposal-affect-the-number-of-people-with-health-insurance-coverage/Date: Sept 22, 2017Date accessed: March 27, 2019View in ArticleGoogle Scholar5.Organisation for Economic Co-operation DevelopmentOECD Health Statistics 2015.OECD Health StatisticsThis dataset includes comparative tables analysing various health care resources such as total health and social employment, physicians by age, gender, categories, midwives, nurses, caring personnel, personal care workers, dentists, pharmacists, physiotherapists, hospital employment, graduates, remuneration of health professionals, hospitals, health equipment, hospital beds, medical technology with their respective subsets. The statistics are expressed in different units of measure such as number of persons, salaried, self-employed, per population.https://www.oecd-ilibrary.org/social-issues-migration-health/data/oecd-health-statistics_health-data-enDate: 2015Date accessed: March 27, 2019View in ArticleGoogle Scholar6.Centers for Medicare and Medicaid ServicesNHE Fact Sheet.NHE Fact Sheet | CMSHistorical NHE, 2019: NHE grew 4.6% to $3.8 trillion in 2019, or $11,582 per person, and accounted for 17.7% of Gross Domestic Product (GDP). Medicare spending grew 6.7% to $799.4 billion in 2019, or 21 percent of total NHE. Medicaid spending grew 2.9% to $613.5 billion in 2019, or 16 percent of total NHE. Private health insurance spending grew 3.7% to $1,195.1 billion in 2019, or 31 percent of total NHE. Out of pocket spending grew 4.6% to $406.5 billion in 2019, or 11 percent of total NHE. Hospital expenditures grew 6.2% to $1,192.0 billion in 2019, faster than the 4.2% growth in 2018. Physician and clinical services expenditures grew 4.6% to $772.1 billion in 2019, a faster growth than the 4.0% in 2018. Prescription drug spending increased 5.7% to $369.7 billion in 2019, faster than the 3.8% growth in 2018. The largest shares of total health spending were sponsored by the federal government (29.0 percent) and the households (28.4 percent).   The private business share of health spending accounted for 19.1 percent of total health care spending, state and local governments accounted for 16.1 percent, and other private revenues accounted for 7.5 percent. For further detail see NHE Tables in downloads below. Projected NHE, 2019-2028: National health spending is projected to grow at an average annual rate of 5.4 percent for 2019-28 and to reach $6.2 trillion by 2028. Because national health expenditures are projected to grow 1.1 percentage points faster than gross domestic product per year on average over 2019–28, the health share of the economy is projected to rise from 17.7 percent in 2018 to 19.7 percent in 2028. Price growth for medical goods and services (as measured by the personal health care deflator) is projected to accelerate, averaging 2.4 percent per year for 2019–28, partly reflecting faster expected growth in health sector wages. Among major payers, Medicare is expected to experience the fastest spending growth (7.6 percent per year over 2019-28), largely as a result of having the highest projected enrollment growth. The insured share of the population is expected to fall from 90.6 percent in 2018 to 89.4 percent by 2028. For further detail see NHE projections 2019-2028 in downloads below. NHE by Age Group and Gender, Selected Years 2002, 2004, 2006, 2008, 2010, 2012, and 2014: Per person personal health care spending for the 65 and older population was $19,098 in 2014, over 5 times higher than spending per child ($3,749) and almost 3 times the spending per working-age person ($7,153). In 2014, children accounted for approximately 24 percent of the population and about 11 percent of all PHC spending. The working-age group comprised the majority of spending and population in 2014, almost 54 percent and over 61 percent respectively. The elderly were the smallest population group, nearly 15 percent of the population, and accounted for approximately 34 percent of all spending in 2014. 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Between 2016 and 2017, the number of people with health insurance coverage increased by 2.3 million, up to 294.6 million. • In 2017, private health insurance coverage continued to be more prevalent than government coverage, at 67.2 percent and 37.7 percent, respectively. Of the subtypes of health insurance coverage, employer-based insurance was the most common, covering 56.0 percent of the population for some or all of the calendar year, followed by Medicaid (19.3 percent), Medicare (17.2 percent), direct-purchase coverage (16.0 percent), and military coverage (4.8 percent). • Between 2016 and 2017, the rate of Medicare coverage increased by 0.6 percentage points to cover 17.2 percent of people for part or all of 2017 (up from 16.7 percent in 2016). • The military coverage rate increased by 0.2 percentage points to 4.8 percent during this time. Coverage rates for employment-based coverage, direct-purchase coverage, and Medicaid did not statistically change between 2016 and 2017. • In 2017, the percentage of uninsured children under age 19 (5.4 percent) was not statistically different from the percentage in 2016. • For children under age 19 in poverty, the uninsured rate (7.8 percent) was higher than for children not in poverty (4.9 percent). • Between 2016 and 2017, the uninsured rate did not statistically change for any race or Hispanic origin group. • In 2017, non-Hispanic Whites had the lowest uninsured rate among race and Hispanic-origin groups (6.3 percent). The uninsured rates for Blacks and Asians were 10.6 percent and 7.3 percent, respectively. Hispanics had the highest uninsured rate (16.1 percent). • Between 2016 and 2017, the percentage of people without health insurance coverage at the time of interview decreased in three states and increased in 14 states.https://www.census.gov/library/publications/2018/demo/p60-264.htmlDate: Sept 12, 2018Date accessed: January 14, 2020View in ArticleGoogle Scholar56.Duron VP Monaghan SF Connolly MD et al.Undiagnosed medical comorbidities in the uninsured: a significant predictor of mortality following trauma.J Trauma Acute Care Surg. 2012; 73: 1093-1098View in ArticleScopus (31)PubMedCrossrefGoogle Scholar57.Lopez-Gonzalez L Pickens GT Washington R Weiss AJCharacteristics of medicaid and uninsured hospitalizations, 2012.Characteristics of Medicaid and Uninsured Hospitalizations, 2012 #182Location of patients' residence Place of residence is based on the urban-rural classification scheme for U.S. counties developed by the National Center for Health Statistics (NCHS). For this Statistical Brief, we collapsed the NCHS categories into either urban or rural according to the following: Urban: Large Central Metropolitan: includes metropolitan areas with 1 million or more residents Large Fringe Metropolitan: includes counties of metropolitan areas with 1 million or more residents Medium and Small Metropolitan: includes areas with 50,000 to 999,999 residents. Rural: Micropolitan and Noncore: includes nonmetropolitan counties (i.e., counties with no town greater than 50,000 residents). Median community-level income Median community-level income is the median household income of the patient's ZIP Code of residence. The cut-offs for the quartile designation are determined using ZIP Code demographic data obtained from the Nielsen Company. The income quartile is missing for patients who are homeless or foreign. Payer Payer is the expected primary payer for the hospital stay. To make coding uniform across all HCUP data sources, payer combines detailed categories into general groups: Medicare: includes patients covered by fee-for-service and managed care Medicare Medicaid: includes patients covered by fee-for-service and managed care Medicaid Private Insurance: includes Blue Cross, commercial carriers, and private health maintenance organizations (HMOs) and preferred provider organizations (PPOs) Uninsured: includes an insurance status of self-pay and no charge Other: includes Worker's Compensation, TRICARE/CHAMPUS, CHAMPVA, Title V, and other government programs Hospital stays billed to the State Children's Health Insurance Program (SCHIP) may be classified as Medicaid, Private Insurance, or Other, depending on the structure of the State program. Because most State data do not identify patients in SCHIP specifically, it is not possible to present this information separately. When more than one payer is listed for a hospital discharge, the first-listed payer is used. Patients covered by both Medicare and Medicaid with Medicare listed as the primary payer were excluded from this analysis. About HCUP The Healthcare Cost and Utilization Project (HCUP, pronounced "H-Cup") is a family of databases and related software tools and products developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ). HCUP databases bring together the data collection efforts of State data organizations, hospital associations, private data organizations, and the Federal government to create a national information resource of encounter-level data (HCUP Partners). HCUP includes the largest collection of longitudinal hospital care data in the United States, with all-payer, encounter-level information beginning in 1988. 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It considers how countries have used available health care resources to reduce the overall burden of CVD and diabetes, and it focuses on the variation in OECD health systems’ ability to convert health care inputs (such as expenditure) into health gains.https://read.oecd-ilibrary.org/social-issues-migration-health/cardiovascular-disease-and-diabetes-policies-for-better-health-and-quality-of-care_9789264233010-enDate: June 17, 2015Date accessed: July 2, 2019View in ArticleGoogle Scholar75.Thomas K Ornstein CAmid opioid crisis, insurers restrict pricey, less addictive painkillers.Amid Opioid Crisis, Insurers Restrict Pricey, Less Addictive Painkillers (Published 2017)Drug companies and doctors have been accused of fueling the opioid crisis, but some question whether insurers have played a role, too.https://www.nytimes.com/2017/09/17/health/opioid-painkillers-insurance-companies.htmlDate: Sept 17, 2017Date accessed: December 1, 2019View in ArticleGoogle Scholar76.Amos OWhy opioids are such an American problem.BBC, Oct 25, 2017Why opioids are such an American problemPeople in America take more opioids - such as morphine and codeine - than in any other country. 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Most of the original guidance remains the same, but limited changes have been made as a result of: (1) the Supreme Court's decision in US Airways, Inc. v. Barnett, 535 U.S., 122 S. Ct. 1516 (2002), and (2) the Commission's issuance of new regulations under section 501 of the Rehabilitation Act. The major changes in response to the Barnett decision are found on pages 4-5, 44-45, and 61-62. In addition, minor changes were made to certain footnotes and the Instructions for Investigators as a result of the Barnett decision and the new section 501 regulations. EFFECTIVE DATE: Upon receipt. EXPIRATION DATE: As an exception to EEOC Order 205.001, Appendix B, Attachment 4, . a(5), this Notice will remain in effect until rescinded or superseded. ORIGINATOR: ADA Division, Office of Legal Counsel. INSTRUCTIONS: File after Section 902 of Volume II of the Compliance Manual. Enforcement Guidance: Reasonable Accommodation and Undue Hardship Under the Americans with Disabilities Act Table of Contents INTRODUCTION GENERAL PRINCIPLES REQUESTING REASONABLE ACCOMMODATION REASONABLE ACCOMMODATION AND JOB APPLICANTS REASONABLE ACCOMMODATION RELATED TO THE BENEFITS AND PRIVILEGES OF EMPLOYMENT TYPES OF REASONABLE ACCOMMODATIONS RELATED TO JOB PERFORMANCE JOB RESTRUCTURING LEAVE MODIFIED OR PART-TIME SCHEDULE MODIFIED WORKPLACE POLICIES REASSIGNMENT OTHER REASONABLE ACCOMMODATION ISSUES UNDUE HARDSHIP ISSUES BURDENS OF PROOF INSTRUCTIONS FOR INVESTIGATORS APPENDIX: RESOURCES FOR LOCATING REASONABLE ACCOMMODATIONS INDEX This Enforcement Guidance clarifies the rights and responsibilities of employers and individuals with disabilities regarding reasonable accommodation and undue hardship. Title I of the ADA requires an employer to provide reasonable accommodation to qualified individuals with disabilities who are employees or applicants for employment, except when such accommodation would cause an undue hardship. This Guidance sets forth an employer's legal obligations regarding reasonable accommodation; however, employers may provide more than the law requires. This Guidance examines what "reasonable accommodation" means and who is entitled to receive it. The Guidance addresses what constitutes a request for reasonable accommodation, the form and substance of the request, and an employer's ability to ask questions and seek documentation after a request has been made. The Guidance discusses reasonable accommodations applicable to the hiring process and to the benefits and privileges of employment. The Guidance also covers different types of reasonable accommodations related to job performance, including job restructuring, leave, modified or part-time schedules, modified workplace policies, and reassighttps://www.eeoc.gov/policy/docs/accommodation.html#leaveDate: 2002Date accessed: January 6, 2020View in ArticleGoogle Scholar82.Blinder V Eberle C Patil S Gany FM Bradley CJWomen with breast cancer who work for accommodating employers more likely to retain jobs after treatment.Health Aff. 2017; 36: 274-281View in ArticleScopus (41)CrossrefGoogle Scholar83.Aizer AA Falit B Mendu ML et al.Cancer-specific outcomes among young adults without health insurance.J Clin Oncol. 2014; 32: 2025-2030View in ArticleScopus (83)PubMedCrossrefGoogle Scholar84.Substance Abuse and Mental Health Services AdministrationBehavioral health trends in the United States: results from the 2014 national survey on drug use and health.https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdfDate: Sept 10, 2015Date accessed: March 27, 2019View in ArticleGoogle Scholar85.National Institute of Mental HealthMental Illness.NIMH " Mental IllnessMental Illness Mental illnesses are common in the United States. Nearly one in five U.S. adults live with a mental illness (51.5 million in 2019). Mental illnesses include many different conditions that vary in degree of severity, ranging from mild to moderate to severe. Two broad categories can be used to describe these conditions: Any Mental Illness (AMI) and Serious Mental Illness (SMI). AMI encompasses all recognized mental illnesses. SMI is a smaller and more severe subset of AMI. Additional information on mental illnesses can be found on the NIMH Health Topics Pages . Definitions The data presented here are from the 2019 National Survey on Drug Use and Health (NSDUH) by the Substance Abuse and Mental Health Services Administration (SAMHSA). For inclusion in NSDUH prevalence estimates, mental illnesses include those that are diagnosable currently or within the past year; of sufficient duration to meet diagnostic criteria specified within the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV); and, exclude developmental and substance use disorders. Any Mental Illness Any mental illness (AMI) is defined as a mental, behavioral, or emotional disorder. AMI can vary in impact, ranging from no impairment to mild, moderate, and even severe impairment (e.g., individuals with serious mental illness as defined below). Serious Mental Illness Serious mental illness (SMI) is defined as a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities. The burden of mental illnesses is particularly concentrated among those who experience disability due to SMI. Prevalence of Any Mental Illness (AMI) Figure 1 shows the past year prevalence of AMI among U.S. adults. In 2019, there were an estimated 51.5 million adults aged 18 or older in the United States with AMI. This number represented 20.6% of all U.S. adults. The prevalence of AMI was higher among females (24.5%) than males (16.3%). Young adults aged 18-25 years had the highest prevalence of AMI (29.4%) compared to adults aged 26-49 years (25.0%) and aged 50 and older (14.1%). The prevalence of AMI was highest among the adults reporting two or more races (31.7%), followed by White adults (22.2%). The prevalence of AMI was lowest among Asian adults (14.4%). Figure 1 Past Year Prevalence of Any Mental Illness Among U.S. Adults (2019) Demographic Percent Overall 20.6 Sex Female 24.5 Male 16.3 Age 18-25 29.4 26-49 25.0 50+ 14.0 Race/Ethnicity Hispanic or Latino* 18.0 White 22.2 Black or African American 17.3 Asian 14.4 NH/OPI 16.6 AI/AN 18.7 2 or More 31.7 *Persons of Hispanic origin may be of any race; all other racial/ethnic groups are non-Hispanic. NH/OPI = Native Hawaiian / Other Pacific Islander | AI/AN = American Indian / Alaskan Native Mental Health Services — AMI Figure 2 presents data on mental health services received within the past year by U.S. adults aged 18 or olhttps://www.nimh.nih.gov/health/statistics/mental-illness.shtmlDate: Nov, 2017Date accessed: June 8, 2018View in ArticleGoogle Scholar86.Firth J Kirzinger A Brodie MKaiser Health Tracking Poll: April 2016.Kaiser Health Tracking Poll: April 2016 - Substance Abuse and Mental HealthThe April Kaiser Health Tracking Poll examines public opinion on the severity of health problems in the U.S. and takes a closer look at attitudes towards current health problems; including access t…https://www.kff.org/report-section/kaiser-health-tracking-poll-april-2016-substance-abuse-and-mental-health/Date: April 28, 2016Date accessed: March 27, 2019View in ArticleGoogle Scholar87.National Alliance on Mental Illness (NAMI)A Long Road Ahead: Achieving True Parity in Mental Health and Substance Use Care.NAMI, 2015https://www.nami.org/about-nami/publications-reports/public-policy-reports/a-long-road-ahead/2015-alongroadahead.pdfDate accessed: January 6, 2020View in ArticleGoogle ScholarUncited References64.Sommers BD Long SK Baicker KChanges in mortality after Massachusetts health care reform: a quasi-experimental study.Ann Intern Med. 2014; 160: 585-593Scopus (128)PubMedCrossrefGoogle Scholar65.Sommers BDState medicaid expansions and mortality, revisited: a cost-benefit analysis.Am J Health Econ. 2017; 3: 392-421Scopus (30)CrossrefGoogle Scholar66.Kronick RHealth insurance coverage and mortality revisited.Health Serv Res. 2009; 44: 1211-1231Scopus (38)PubMedCrossrefGoogle Scholar67.Franks PHealth insurance and mortality. Evidence from a national cohort.JAMA. 1993; 270: 737-741Scopus (259)PubMedCrossrefGoogle Scholar68.Sorlie PD Johnson NJ Backlund E Bradham DDMortality in the uninsured compared with that in persons with public and private health insurance.Arch Intern Med. 1994; 154: 2409-2416PubMedCrossrefGoogle ScholarArticle InfoPublication HistoryPublished: 15 February 2020IdentificationDOI: Improving the prognosis of health care in the USACopyright© 2020 Elsevier Ltd. All rights reserved.ScienceDirectAccess this article on ScienceDirectLinked ArticlesThe effect of Medicare for All on rural hospitals – Authors' replyFull-Text PDFThe effect of Medicare for All on rural hospitalsFull-Text PDFRelated Specialty CollectionsThis article can be found in the following collections:Public Health