Live Long and Prosper

But unless you are already wealthy or in a fabulous job, probably not so much in a red state. If the only two things you can’t avoid are death and taxes, seems that when it comes to life expectancy, in a red state, you can get one a lot sooner than the other… and since you are probably not making that much anyway, taxes don’t matter much. Is this a bias against red states that some good old fake news cannot fix, or are there hard numbers to back this up? Even without the “inequality multiplier” of the novel coronavirus pandemic, which has saddled those with the least with the greatest risk and the greatest burden.

When the Affordable Care Act (ACA aka Obamacare) offered states the ability to expand their Medicaid coverage for low income citizens, most red states declined. Most blue states accepted, and the larger ones even embellished the coverage offered under the Federal statute. It was 19 red states, joined by the Trump administration, that filed a lawsuit to kill the ACA completely, a case now pending before the US Supreme Court. As red states rapidly repealed pollution controls with encouragement from the President (who cut the EPA to the bone), laws and regulations that kept toxins out of the air, rivers, streams, aquifers, lakes and seas, pollution-related ailments skyrocketed. Too many guns, a strong gun culture, also is a negative indicator for life expectancy.

Unemployment from rust belt obsolete industries and resource extraction sectors exploded well before the pandemic. Opioid addiction rates mirrored in regions most impacted by that dislocation. Red states often have lax work safety rules or spotty enforcement practices. People of color still struggled so much more in red states, a serious factor that impacted both their mental state and their physical health. Conspiracy theories kept people in need of medical treatment away from doctors, even when they could afford them, and when the virus hit, the association between having solid health insurance and having a job ripped millions away from those much-touted company health insurance policies.

Indeed, as Noam N. Levey writing for the August 4^th Los Angeles Times reports, there is a “deepening the divide between red and blue states, according to a new study on links between life expectancy and state policy… The report, published Tuesday [8/4] in the health policy journal Milbank Quarterly, finds that states where residents live longest, including California, tend to have much more stringent environmental laws, tougher tobacco and firearms regulations and more protections for workers, minorities and LGBTQ residents… Since the mid-1980s, the gap among U.S. states in how long their residents live has widened, reversing decades of progress toward greater equality.

“One group of states, mostly in the Northeast and the West, have seen average life expectancies rise relatively steadily, placing them on par with the wealthiest nations of Western Europe. Those states tend to have more stringent regulations… By contrast, the life expectancy in states with more conservative health, labor and social policies — concentrated in the South and Appalachia — have stagnated in recent decades, according to the study, which adds to growing research on health and political disparities between states.

“California has among the highest average life expectancies in the country, at 81.3 years. It also had the most liberal policies in the nation in 2014, the most recent year the study analyzed, according to the system the authors developed to rank states… ‘It’s disheartening to see another example of a missed opportunity by policymakers,’ said David Radley, senior scientist at the nonprofit Commonwealth Fund who studies differences in state health policies and the effects on people’s health. Radley was not involved in Milbank report.

“The new report may help shape efforts to rethink government policy in the wake of the coronavirus pandemic, which has exposed deep structural weaknesses in the U.S. as well as yawning gaps in many state safety nets… ‘The overarching conclusion is clear: States that have invested in their populations’ social and economic well-being by enacting more liberal policies over time tend to be the same states that have made considerable gains in life expectancy,’ the study’s authors wrote.

“Even before the current public health crisis, life expectancy in the U.S. had been declining, setting America apart from most other wealthy nations. That decline has fueled tough questions about domestic policy.” There’s no direct proof of any one practice that causes the decline in health in underregulated red states, but the statistical correlations are overwhelmingly clear. Poverty and ill-conceived state policies that place wealthy interests over individual well-being didn’t matter as much as half a century ago. Dietary habits, bad all over this country, are particularly worse in red states as well and have gotten worse of late. Obesity kills. It all adds up.

“Through the 1960s and 1970s, for example, state life expectancies generally converged… That trend began to reverse in the mid-1980s, around the same time that a conservative movement, led by President Reagan and mirrored in many state capitols, became ascendant.

“The gap between states accelerated further after 2010, when sweeping Republican victories in state elections shifted policies further to the right in many places… By 2017, residents of the state with the highest life expectancy — Hawaii — were living on average seven years longer than residents of the state with the lowest life expectancy — Mississippi.

“By contrast, the gap between the best- and worst-performing states in 1984 was less than five years… The gap is not only about policy: States where people live longer tend to be wealthier and have better educated populations, for example… ‘States like Connecticut are investing in their population, investing in schools, setting an economic floor for their workers, discouraging behaviors like smoking that kill people,’ [Syracuse University sociologist Jennifer Karas Montez, the lead author of the new study] explained. ‘You have other states like Mississippi and Oklahoma that aren’t doing any of this.’

“In Connecticut, whose policies have become steadily more liberal over the last half century, life expectancy increased 5.8 years between 1980 and 2017 to 80.7 years… In Oklahoma, which has become markedly more conservative, life expectancy increased only 2.2 years over the same period, reaching 75.8 years in 2017.” LA Times. As Republican leaders, state and federal, press to reopen the economy at warp speed, explaining away the rising infection and mortality rates –with minimal attention paid to wearing masks and social distancing and telling us that we cannot afford to extend “rich” unemployment benefits – we are going to lose a lot more Americans. That a disproportionate number of those infected and killed come from Trump’s own stronghold of red states should make everyone, even from blue states, ashamed. We are all Americans. We deserve better.

            I’m Peter Dekom, and we are the only truly modern developed country on earth with this extraordinary failure to extend healthcare to and promote health for all Americans as a basic right and a national priority above all else.