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Dying too young – David Ruccio

Four Horsemen of the Apocalypse by Tristan Eaton (Source: Flickr cc)

The following article by Prof David Ruccio appeared in RWER blogs on 2 Dec 2019. It highlights the impact of economic pressures and inequality on the overall health and longevity of most members of society,

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If there ever was an argument in support of Medicare for All it’s this: despite spending more on health care than any other country, the United States has seen increasing mortality and falling life expectancy for people aged 25 to 64, who should be in the prime of their lives.

A new report published in the Journal of the American Medical Association [1] paints a bleak picture: the average life expectancy in the United States, which had increased for most of the past 60 years, has actually fallen for 3 consec- utive years. But this is not just a recent trend. The U.S. life expectancy began to lose pace with other countries in the 1980s and, by 1998, had declined to a level below the average life expectancy among OECD countries. While the life expectancy within these countries has continued to increase, American life expectancy stopped increasing in 2010 and has been actually decreasing since 2014.*

The recent reduction in life expectancy within the U.S. was largely related to increases in all-cause mortality among young and middle-aged adults, rather than for other groups (infants, children, and the elderly) for whom mortality rates have declined. For individuals aged 25 to 64 years all-cause mortality rates were in decline in 2000, reached a nadir in 2010, and increased thereafter.

But the roots of the crisis in U.S. life expectancy go back further in time. Midlife mortality rates for a variety of specific causes (e.g., drug overdoses and hypertensive diseases) began increasing earlier. But they weren’t reflected in all-cause mortality trends because they were offset by large, simultaneous reductions in mortality from ischemic heart disease, cancer, HIV infection, motor vehicle injuries, and other leading causes of death.

However, increases in cause-specific mortality rates before 2010 slowed the rate at which all-cause mortality fell (and life expectancy rose), and event- ually culminated in a reversal. The end result was that all-cause mortality rose after 2010 (and life expectancy fell after 2014).

The authors of the report make it clear that the deficiencies in the healthcare system explain increased mortality for at least some conditions.

“ Although the US health care system excels on certain measures, countries with higher life expectancy outperform the United States in providing universal access to health care, removing costs as a barrier to care, care coordination, and amenable mortality. “

Radically transforming the way healthcare is financed, such as is proposed in the U.S. Medicare for All Act of 2017 Health Insurance Program, would go a long way to reversing the decline in life expectancy in the United States. It would eliminate the financial barriers to decent healthcare, providing everyone with access to hospitalization, primary and preventative services, prescription drugs, and other services (such as oral health, audiology, and vision services), and so on.

But, we have to admit, universal health insurance is not by itself going to solve the problem in the United States. One reason, of course, is that one cause of the decrease in life expectancy is the surge in drug overdose deaths that began in the 1990s, which came out of the private, profit-seeking U.S. health- care industry itself.**

The increasing mortality and falling life expectancy among young and middle- aged Americans were exacerbated by other dimensions of U.S. capitalism. We know, for example, that, since the late 1970s, income inequality widened, surpassing levels in other countries, concurrent with the deepening U.S. health crisis.

Moreover, those most vulnerable to the new economy (e.g., adults with limited education and younger men) experien- ced the largest increases in death rates as did those who worked in areas that suffered economic dislocation, such as rural U.S. areas and also the industrial Midwest. While the authors admit that the causal links have not been firmly established, they observe that “Socio-economic pressures and unstable employment can explain some of the observed increases in mortality spanning multiple causes of death.”

It’s not just a matter of absolute income or net worth. According to the report, the causes of economic despair may be more “nuanced”, arising from “perceptions and frustrated expectations” within the American working population. What- ever hope was tied in with the American Dream has been undermined as economic inequality reached obscene levels and intergenerational mobility declined.

Moreover, these potential causes are probably not independent and may, together and in complex ways, shape mortality patterns: “ major contributors like smoking, drug abuse, and obesogenic diets are shaped by environmental conditions, psychological distress, and socio-economic status. The economic pressures that force patients to forego medical care can also induce much stress and unhealthy coping behaviors and can fracture communities. “

U.S. citizens are confronted, then, with an enormous problem: an economic system that, especially in recent decades, has caused mortality to rise and life expectancy to fall among young and middle-age workers; a private healthcare system that has both been inadequate to the task of caring for these people and in, the case of certain classes of pharmaceutical drugs, made the problem worse; and a system of health insurance that has left millions of people without access to healthcare.

Medicare for All therefore represents a real solution to one dimension of the problem — but not to the other two.

Unless and until the U.S. economic system (including the way healthcare is provided) is radically transformed, U.S. citizens will continue to die much too young.

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*According to the report, life expectancy began to advance more slowly during the 1980s and plateaued in 2011. U.S. life expectancy peaked in 2014 and subsequently decreased significantly for 3 consecutive years, reaching 78.6 years in 2017.

**It started with the introduction of Oxy-Contin in 1996; followed by increased heroin use, often by patients who had become addicted to the prescription opioids; and then was subsequently aggravated by the emergence of potent synthetic opioids, which triggered a large post-2013 increase in overdose deaths.

Source: Real World Econ Rev, 2 Dec 2019

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Patrick Newman

Even in the UK, the trend of increased life expectancy has flatlined and in certain deprived parts of the country, it is actually falling. This is strongly correlated to the policy of austerity implemented since 2010 which leads to increasing underfunding of both the National Health Service and social care.


Yup: but in order to change the economic system based on ‘growth’ in order to provide ever more ‘wealth’ for the 1% to capture and sterilise so the economy can’t use it to provide for everyone’s needs, you first have to kick the parties out of Congress and the Judiciary.

George Washington accurately predicted what would happen if parties were allowed to capture the democratic system, yet still money talked and the people let their new republic be captured just like all others. The political party stranglehold is now so complete that everyone assumes it is the only way to run a country, and almost nobody is pointing out that the nation is currently effectively committing suicide because the Founding Fathers did not think to specifically outlaw political parties in the Constitution.

And so their ‘failsafe’ idea of having three equal branches of government has been easily circumvented by the parties capturing all three, and so locking themselves into eternal virtual civil war for all time, unless the nation is able to come to its senses and amends the Constitution to write the parties out and get a proper Congress of thinking men who are capable of making rational and unbiased decisions, and of ejecting the criminals among their number when necessary, as was the original intent.

John deChadenedes

There are, of course, many strong arguments for having Medicare-For-All, and no good arguments opposing such a plan. For economists, who tend not to be persuaded by arguments like, “It’s the right thing to do!” or “People have the right to good healthcare regardless of income”, even the purely economic arguments are on the side of Medicare- For-All.

Paying twice as much as do people in other industrialized countries, for worse outcomes, violates the principles of free markets. Incredibly high overhead costs violates the principles of efficiency. Very high medical prescription costs, with no real competition, violates the principle that rich white people should not be prevented from becoming ever richer, no matter how they choose to do it.

Millions of people dying younger and sicker than is necessary or desirable violates yet another principle.

Ken Zimmerman

I guess it depends on the priorities that are chosen. Classical and neoclassical economists oppose solutions, particularly those from the government that make everyone in a society better off. In these solutions they see great damage being done to the “natural” mechanisms of the economy which support people over the long term. Medicare-for-all would improve health care for everyone in the U.S. quickly. Perhaps in as little as two to three years. According to these economists it would also destroy the mechanisms of market competition and pricing that are the heart of what they think assures that services like health care will be widely available at afford-able prices (for some) over the long term. It’s just not a trade-off that should be made. Immediate satisfaction in exchange for long term failure.

This “lesson” has been effectively pass- ed on to many Americans. Particularly the part about government programs failing and hurting people. So, between the opposition of mainstream economists and the fear of many Americans of government programs like Medicare-for- all, such programs don’t have enough public support and particularly money to become the law of the land. Changing this requires we first change in a wide- spread way basic American assumptions, and secondly have the resources to explain the program to all Americans in ways they can comprehend.

Dr David Ruccio is an Economics Professor at the University of Notre Dame, Indiana, and is editor of the journal Rethinking Marxism.

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