Our guests this week are Lena Makaroun, MD, a research fellow at the VA Pudget Sound, and Sei Lee, MD, Associate Professor of Medicine at UCSF and frequent co-host on this podcast. They recently wrote a paper in JAMA Internal Medicine on wealth disparities in the US and England, and implications for mortality and disability. Major take home points: “It’s not that great to be rich, but it really sucks to be poor.” Those in the bottom quintile of wealth had the greatest difference in disability and mortality (ie worse). Differences between those in the highest quintile of wealth and the next highest were relatively minor in comparison. “Rather than saying universal healthcare doesn't help, I would just say it's not enough.” Worse disability and mortality with lower wealth were observed in the US and England, both before and after age 65. Does this mean National Health Service isn’t working? The authors expected to find less difference in England where universal coverage is, well universal, and not just after age 65 in the US (Medicare). The authors give thoughtful responses.