Red State Death Spiral

We’ve watched as so many red states have worked hard to stab the Affordable Car Act (aka Obamacare or the ACA) in the heart, particularly in refusing to expand Medicaid to those for whom medical care is virtually non-existent. The same red states, like West Virginia, Kentucky and Oklahoma where teacher strikes and protests have hit recently and where teacher pay is literally half the pay levels of blue states like New York and California, with the worst performing public educational systems in the entire country.

This right wing movement is willing to support tax cuts for the rich – note that lovely reduction in the federal corporate rate from 35% to 21% has not created any significant new jobs; about 90% of the savings these companies received from this cut has instead gone into dividends for shareholders and stock buybacks – but damned be the little folk who need healthcare and rely on public education for their children.

When it comes to healthcare, the entire American healthcare system is designed for those who can afford to pay for it. Special interests have insured that we have the highest cost prescription drugs on earth and that our exclusion of various forms of medical ailments from coverage options plus the dwindling availability of affordable healthcare – as the Trump administration, particularly in willing red states, picks apart even the most functional aspects of the ACA – put a particularly nasty strain on those who can afford it the least.

Simply, we think we are a modern country with the best of everything, but are so from that standard. Our infrastructure is in ghastly shape (a recent trip to China showed me what modern infrastructure looks like!!), our educational performance measured by objective global parameters continues to plunge (from first to 19^th), and our life expectancy averages place us in 43^rd place! We should be ashamed. But it is the red states that drag down our national averages the most.

The Los Angeles Times (April 17^th) fills in the blanks and looks at a summary of Americans’ vital signs published in early April in the Journal of the American Medical Association: “The report is the work of dozens of U.S. public health scholars who are part of an international consortium known as the Global Burden of Disease group. It found that mortality rates in the U.S. have declined nearly 22% over 26 years, from 745 deaths per 100,000 people in 1990 to 578 deaths per 100,000 people in 2016… But those figures obscure substantial geographical variability in Americans’ health and quality of life. And the improvements could readily be swept away by dark clouds on the horizon.

“In 2016, an American’s average life expectancy at birth ranged from a high of 81.3 years in Hawaii to a low of 74.7 years in Mississippi. If each state were a country, the authors of the report said, Hawaii would be tied with Ireland, ranking 20th worldwide. Mississippi, meanwhile, would tie with Kuwait, ranking 76th in the world.

“California’s life expectancy at birth was also among the highest in the nation, coming in second at 80.9 years. Other states with a life expectancy above 80 were Connecticut, Minnesota, New York, Massachusetts, Colorado, New Jersey and Washington.

“Hovering at the bottom alongside Mississippi were West Virginia, Alabama, Louisiana, Oklahoma, Kentucky and Arkansas. In none of those states did the average life expectancy at birth reach 76 years… The geographic disparities ‘leave the United States far from being united,’ wrote Dr. Howard K. Koh of Harvard University and Anand K. Parekh , chief medical advisor of the Washington-based Bipartisan Policy Center, in a JAMA editorial that accompanied the report. ‘Despite notable improvements in some outcomes, the U.S. disease burden is shared unequally.’

“One key measure captured states’ unequal levels of health most dramatically: trends in deaths among people 20 to 55… Some 31 states and the District of Columbia saw this rate of such early death fall between 1990 and 2016. That includes 15 states — led by New York, California and Illinois — where the rate dropped by more than 10%... But in 21 states, the mortality rate among 20- to 55-year-olds increased. In five states — Kentucky, Oklahoma, New Mexico, West Virginia and Wyoming — it rose by more than 10%.

“Heart disease and lung cancer were the No. 1 and No. 2 killers of Americans in 2016, just as they were in 1990. That’s despite real progress over the last 20 years: Lower smoking rates and more widespread use of treatments to reduce cholesterol and high blood pressure have led to a 33% decline in deaths due to cardiovascular disease for people of all ages.

“Self-harm, opioid use disorders and alcohol-related liver diseases all zoomed up the cause-of-death chart. These scourges appeared to drive many of the increases in early deaths seen in states such as West Virginia.

“Motor vehicle crashes, meanwhile, dropped from the third-most common cause of death in 1990 to the eighth position in 2016… Driven by rising rates of obesity, poor diet and insufficient exercise, diseases such as colorectal cancer and diabetes became the fifth- and eighth-most prolific killers of Americans, respectively. And osteoarthritis and diabetes leapfrogged a wide range of conditions to become more important causes of Americans’ disability.

“Healthcare costs linked to diabetes ate up close to 5% of all U.S. spending on healthcare, the study said. That diabetes-related bill was 6.1% higher in 2013 than it was in 1996.

“Meanwhile, two perennial complaints — back pain and depression — remained the leading causes of disability among Americans…In a country where mental healthcare is disorganized, stigmatized and inaccessible to most, 10 million U.S. adults live with a serious mental condition, and more than 7 million people younger than 18 experience a serious emotional disturbance.

“All told, three risk factors claimed the highest toll in terms of years lived with a disability in 2016. Tobacco consumption loomed largest in 32 states. Excess weight was the leading cause of disability in 10 states (including California). And in eight states and the District of Columbia, alcohol and drug use contributed most heavily to residents’ disabilities.

“The authors of the new report note with alarm that though tobacco use is waning in the United States, rates of obesity and metabolic problems such as high fasting glucose are ‘steadily increasing.’ That’s despite an uptick in physical activity, which was, alas, ‘not enough to control weight gain.’”

Just about all the leading indicators of ill-health are higher in red states when compared with blue states; red state healthcare coverage and educational standards are among the lowest in the land, particularly in those states where agriculture and resource extraction are the prevailing industries. Hard to believe that that the slogan in these states remains “America First”… but I guess in reading the fine print, it really reads, “Rich Americans First and Screw the Rest.”

I’m Peter Dekom, and I wonder what it would be like to have a federal government that actually puts “people first,” but that may be a very long time coming.