April 3, 2023
By Paul Krugman
Paul ends with a sentiment that I don't think the GOP shares. I don't think the GOP feels that the government has any role in "keeping people from dying early".Last Friday the Medicare trustees released their latest report on the system’s finances, and it contained some unexpected good news: Expenditures are running below projections, and the Hospital Insurance Trust Fund won’t be exhausted as soon as previously predicted.
But one important reason for this financial improvement was grisly: Covid killed a substantial number of Medicare beneficiaries. And the victims were disproportionately seniors already suffering from severe — and expensive — health problems. “As a result, the surviving population had spending that was lower than average.”
Now, Covid killed a lot of people around the world, so wasn’t this just an act of God? Not exactly. You see, America experienced a bigger decline in life expectancy when Covid struck than any other wealthy country. Furthermore, while life expectancy recovered in many countries in 2021, here it continued to fall.
And America’s dismal Covid performance was part of a larger story. I don’t know how many Americans are aware that over the past four decades, our life expectancy has been lagging ever further that of other advanced nations — even nations whose economic performance has been poor by conventional measures. Italy, for example, has experienced a generation of economic stagnation, with basically no growth in real G.D.P. per capita since 2000, compared with a 29 percent rise here. Yet Italians can expect to live about five years longer than Americans, a gap that has widened even as the Italian economy flounders.
What explains the American way of death? A large part of the answer seems to be political.
One important clue is that the problem of premature death isn’t evenly distributed across the country. Life expectancy is hugely unequal across U.S. regions, with major coastal cities not looking much worse than Europe but the South and the eastern heartland doing far worse.
But wasn’t it always thus? No. Geographic health disparities have surged in recent decades. According to the U.S. mortality database, as recently as 1990, Ohio had slightly higher life expectancy than New York. Since then, New York’s life expectancy has risen rapidly, nearly converging with that of other rich countries, while Ohio’s has hardly risen at all and is now four years less than New York’s.
There has been considerable research into the causes of these growing disparities. A 2021 paper published in The Journal of Economic Perspectives examined various possible causes, like the increasing concentration of highly educated Americans (who tend to be healthier than those with less education) in states that are already highly educated and the widening per capita income gaps among states. The authors found that these factors can’t explain more than a small fraction of the growing mortality gap.
Instead, they argued, the best explanation lay in policy: “The most promising explanation for our findings involve efforts by high-income states to adopt specific health-improving policies and behaviors since at least the early 1990s. Over time, these efforts reduced mortality in high-income states more rapidly than in low-income states, leading to widening spatial disparities in health.”
That sounds right. But did high-income states adopt health-improving policies because they were rich and could afford to? Or was it because in 21st-century America, high-income states tend to be politically progressive and politics, rather than money per se, account for the difference?
There is, in fact, a strong correlation between how much a state’s life expectancy rose from 1990 to 2019 and its political lean, as measured by Joe Biden’s margin over Donald Trump in the 2020 election — a correlation slightly stronger, by my estimates, than the correlation with income.
There are several reasons to believe that America’s death trip is largely political rather than economic. One is the comparison with European nations, which have had much better health trends even when, as in Italy, their economies have performed badly.
Another is the fact that some of the poorest states in America, with the lowest life expectancy, are still refusing to expand Medicaid, even though the federal government would cover the bulk of the cost (and the failure to expand Medicaid is killing many hospitals). This suggests that they’re failing to improve health because they don’t want to, not because they can’t afford to.
Finally, since Covid struck, residents of Republican-leaning counties have been far less likely to get vaccinated and far more likely to die of it than residents of Democratic-leaning counties — even though vaccines are free.
All of this seems relevant to our current era of culture war, with many Republican politicians praising rural and red-state values while denigrating those of coastal elites. Gov. Ron DeSantis of Florida, for example, claims that although he grew up around Tampa Bay, he’s culturally a product of western Pennsylvania and northeastern Ohio. It’s worth noting, then, that the culture these politicians want all of America to emulate seems to have a problem with one of society’s most important functions: keeping people from dying early.
"We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defense, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America."
So says our founding document, but it's interpretation is up for...err, interpretation.
For example, we know Christians often take the position of 'tough love." For example, when arguing against homosexuality, they argue that they hate the sin - and they "just love the sinner so much that they want to save them from their evil ways, so that's why it should be illegal..." Or, they are fond of talking about how loving God was when he Flooded the world, massacred the Midianites, etc. It was Righteous Love!
They seem to continue this line of thought that says, "Hey, if you want to smoke and drink yourself to death. That's your Freedom!" And, "Hey, if you don't want to pay $2000 per month for Health Insurance, and you get cancer, that's on you! Tough love!"
Krugman's article is what has been fairly widely understood: The Right Wong doesn't care if people live or die, they just want to be left alone to make money any way they see fit - Caveat Emptor. They want deregulation to allow banks to take wild risks because "you should have done your homework, or kept your money under your mattress." They want freedom to sell supplements without having to tell people what's in them because "hey, you should have done your research". They don't want licenses for guns or child care workers because "hey, the reason you got shot, or your kid got raped is because you didn't do your research."
IMO, the Right is trying to remove themselves from any responsibility for anything in society - until it comes to religion. Then suddenly, they want everyone to comply. They want the Ten Commandments, Creation, the Bible, etc. taught in school, because they think that is how we will have a better society. They think if everyone becomes Christian, we'll have a wonderful society. It's a pipedream, and one of those pipedreams that because it has no chance of ever happening, and with no other plan in place, it becomes detrimental to society.
So, I understand they think it's about "individual responsibility", but what they don't see is that it is individual responsibility when those individuals come together to form a collective solution in the form of a corporation or government.
Delegating, for example, meat inspection to the government is wildly successful. We don't have people dying of bad meat, or disease because the USDA inspects meat packing plants and farms.
Delegating responsibility to the police, EMT's, schools, day care, health care, is, in fact, individuals taking responsibility by letting others focus on the problem, rather than thinking each individual can actually learn everything they need to know about those topics.
We've all known that Red States are poorer, more ignorant, more religious, die of Covid more, less scientifically literate, etc. This was all their choice. They wanted to vote for Right Wing policies because - like they think more guns will stop shootings - they think more freedom will al make them happy and rich.
Meanwhile, as they become poorer, sicker and sadder, they will blame it on the Libs. After all, these Southern States have had generations of Right Wing rule - so like the gun problem (when we have the most guns per capita already) - when do they expect their de-regulation, anti-government policies to start working for them?
They're (literally) dying to know.
1. What do you think is the main reason for the widening disparity in life expectancy between different regions in the US?
2. Is the Covid pandemic responsible for the decline in life expectancy in the US, or are there other underlying factors at play?
3. Should the government have a role in ensuring that people live longer, healthier lives? Why or why not?
4. What policies could be implemented to improve life expectancy and overall health in the US?
5. Why do you think some of the poorest states in the US are refusing to expand Medicaid?
6. Is there a political or cultural factor that explains the correlation between political leanings and life expectancy in the US?
7. Do you think that access to healthcare is a basic human right? Why or why not?
8.Should healthcare be a for-profit industry, or should it be provided by the government?
9. Are there any specific policies or practices in other countries that the US should adopt to improve its health outcomes?
10. Should the government take action to encourage people to get vaccinated? If so, what measures should be implemented?
11. Should healthcare professionals be required to get vaccinated against Covid?
12. What is the role of education in improving health outcomes?
13. Should the government be responsible for educating people about healthy lifestyles and disease prevention?
14. How can we address the underlying socioeconomic factors that contribute to poor health outcomes, such as poverty and lack of education?
15. What do you think is the most effective way to reduce health disparities between different regions and socioeconomic groups in the US?