Thank you once again for an excellent article on Chicago’s choices and efforts to increase social investment.

It seems Chicago’s dilemma is a core American problem. The anomaly is electing a courageous mayor willing to open the discussion of American priorities.

You highlight the history of ignoring the social determinants of health and crime. The ability of wealthy oligarchs to control politics to assure austerity funding for social investment, while fighting any taxation which might threaten their wealth, privilege, or impunity while directing funding to the mechanisms of social control: surveillance, increasingly militarized policing, and massive incarceration.

This is not a system designed to assure the wellbeing of the whole public. It is a system of Social Murder.

It is a system designed explicitly to avoid investing in the social determinants of health and crime which guarantees health, education, social harms including unnecessary suffering and death to whole segments of society. Not coincidentally, poor, vulnerable, and people of color.

Unless this reality is called out, I fear the new mayor will continue to struggle in a system heavily rigged against the people. He may gain small concessions, but that is the well worn strategy of cooption.

It is time for Chicagoans to be offered a real choice: the status quo of Social Murder, or a real change to a society build on Social Benefit. Benefit the few, or the many?

We are at the proverbial Einstein insanity moment: Continuing to do what is not working expecting different results. Or change our paradigm to benefit society as a whole first. Start by investing in the social determinants of health and crime. We can do better.

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Most of the analyses of social versus health spending are not very good.

U.S. problem is that health spending does crowd out everything else.

It's five times our defense spending, something that 10 out of 9 health care reporters don't know.

And we're not talking only about high health spending on low-income people. It's high health spending on most of us who actually get care.

The cause of this problem is simple ANARCHY in health care. Anarchy is what we are left with when we don't have either a competitive free market in health care (unattainable) or competent government action in health care.

No one in U.S. health care is accountable for anything that happens outside the building where they work. Only one state even has a list of the ERs and hospitals needed to care for people who are sick or injured. And no entity is accountable for doing anything real to address the primary care crisis, the LTC crisis, the soaring out-of-pocket crisis, or any of the others.

The $4.7 trillion we will, together, spend on health care should make it the easiest problem to solve in the U.S.

But let's not pretend that better prevention will cut health costs. We should prevent all the illnesses and injuries we can. But prevention has a 100 percent failure rate. That's when we need medical security for all Americans--confidence we'll get effective, quick, and kind care without any worry about the bill.

Focusing on the "social determinants of life" today just let's health care off the hook.

With half of health spending wasted, and with health care sponging up an added $200-$250 billion each year, we'll never have money to address social determinants until we get health care costs under control.

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