
U.S. Life Expectancy Drops for Third Year in a Row (2018) - EL_Loco
https://www.smithsonianmag.com/smart-news/us-life-expectancy-drops-third-year-row-reflecting-rising-drug-overdose-suicide-rates-180970942/
======
cletus
The article says the drop is due to people in their 20s and 30s are dying but
why? The article states there is a big increase in overdose deaths but in
percentage terms. Is this significant? Are deaths from fentanyl up from 1,000
to 2,000 or 100,000 to 200,000?

I also didn't find the word "obesity" anywhere in this article and I have to
wonder how much this is a factor too.

As much as people might take this as "see how much life is better in [country
X]", you still see people desperate to come here. Even in the EU, legal and
illegal immigrants are much more likely to be headed to the UK and Germany.

I'm Australian but I've now lived in the US coming up on 9 years. The reason?
As a software engineer, you can squeeze what would be a lifetime of savings in
Australia into 10 years or less and that's hard to ignore.

The US is a pretty terrible place to live if you're poor however. And that
goes far beyond life expectancy (but it of course plays into it).

~~~
adventured
> The US is a pretty terrible place to live if you're poor however.

That's simply not true. The poor in the US have one of the world's most
expensive welfare states. It's the next ~20%-25% or so above the bottom 25%,
that have it worst. Those people don't get free access to healthcare because
they earn too much.

The US has a very advanced welfare state and safety net for the poor. The US
spends more of its economy on its welfare state than either Canada or
Australia, and is in the upper half of the OECD in that regard. The US welfare
state is also rapidly growing, whereas most other developed nations are seeing
their welfare states shrinking.

The US poverty and homelessness rates are both superior to Canada and France.
The US provides free healthcare for the bottom 25%, along with countless other
massive programs involving food and shelter for the poor.

~~~
dijit
You talk about absolute costs as if that means much.

Surely a conclusion can be reached where you’re spending more than any other
country, yet so inefficient at distributing the wealth that you’re spending,
or funnelling it into broken feedback loops that keep people in the welfare
system.

surely if that were the case then it doesn’t matter how much you’re spending
in absolute terms, you’d still not be enriching the lives of the poor or
helping social mobility.

~~~
rayiner
US social spending as a percentage of GDP (not absolute amounts) is about 18%,
about the same as Canada and Australia, a bit higher than the Netherlands or
Switzerland, and a smidge below the OECD average of 20%.

[https://data.oecd.org/socialexp/social-
spending.htm](https://data.oecd.org/socialexp/social-spending.htm)

~~~
dijit
I’m saying total spending doesn’t equate to effectiveness of spending. I too
can “spend” a lot of money on a boat by throwing suitcases of money into the
ocean, but it does nothing to improve the boat.

------
ilyaeck
Folks, the equation is quite simple: the US is a high-risk, high (financial)
reward society. Unlike the EU, it's optimized for the upside: you have many
opportunities to create wealth for yourself (and sometimes for others). The
EU, conversely, is optimized for the downside: you may not have too many
opportunities to climb high, but even if you are the bottom, life can still be
relatively comfortable. So, for the averaghe person, the European system is
likely (almost definitely) better. For risk-craving entrepreneurs, the US is
better (although some other places may have even more and bigger high-risk
opportunities nowadays). For you? You decide!

~~~
cultus
That's not actually true at all. The US has lower social mobility than most
wealthy European countries. Thus, there are actually fewer opportunities for
most people to create wealth for themselves compared to countries with more
equality. It's hard to start a business, if, like the vast majority of people,
you don't have a bunch of excess money sitting around.

[https://www.forbes.com/sites/aparnamathur/2018/07/16/the-
u-s...](https://www.forbes.com/sites/aparnamathur/2018/07/16/the-u-s-does-
poorly-on-yet-another-metric-of-economic-mobility/#1dab24b66a7b)

[https://www.economist.com/graphic-
detail/2018/02/14/american...](https://www.economist.com/graphic-
detail/2018/02/14/americans-overestimate-social-mobility-in-their-country)

~~~
nostrademons
Quintile graphs obscure absolute magnitudes. Most of the people that have a
realistic chance of making it into the upper income/wealth quintiles come from
relatively high social strata already (either within the U.S or, if they're an
immigrant, within their home countries), but they want that high percentile to
mean more in absolute terms.

In other words, if you come from the upper end of the distribution, income
inequality is a feature not a bug.

------
EastLondonCoder
I think this has to do with the Great Recession. Prolonged economic insecurity
is associated with a poor mental health. And that is in turn associated with
self medication with things like alcohol and opioids.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4741013/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4741013/)

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4151244/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4151244/)

~~~
zaroth
That would be a quite a laggy effect at this point. The US has been having
it’s longest continuous period of economic growth ever.

~~~
danans
Growth on Wall Street isn't growth on main street, and huge corporate and big
investor profits (and associated cash hordes) haven't meant economic recovery
in the places and communities hardest hit by the opioid epidemic.

~~~
refurb
_Growth on Wall Street isn 't growth on main street_

Of course it is. Where do you think main streets pensions and 401k are
invested? Where do you think main street people work?

~~~
maximente
most equity is held by the richest americans, while others primarily depend on
wages which haven't risen in decades, basically.

also most people aren't employed by large business.

[https://www.pewresearch.org/fact-tank/2018/08/07/for-most-
us...](https://www.pewresearch.org/fact-tank/2018/08/07/for-most-us-workers-
real-wages-have-barely-budged-for-decades/)

[https://www.huffpost.com/entry/five-big-myths-about-
amer_b_8...](https://www.huffpost.com/entry/five-big-myths-about-
amer_b_866118)

~~~
refurb
Wages are only one part of compensation. Total compensation has increased
faster than inflation over the past decades.

~~~
fucking_tragedy
Health insurance costs have increased faster than inflation for decades and is
responsible for the total increase in compensation[1].

Workers are not getting more or better benefits. They're getting the same or
worse benefits, it's just that health insurance costs for the same plans
increase each year at a rate that vastly outpaces inflation.

[1] [https://si.wsj.net/public/resources/images/BF-
AU065A_INSUR_9...](https://si.wsj.net/public/resources/images/BF-
AU065A_INSUR_9U_20170919122105.jpg)

~~~
refurb
That's true, but it also contradicts the claim that compensation isn't going
up. Sure it's going towards ever more expensive healthcare, but it is going
up.

~~~
maximente
you seem to have both shifted the frame from wages to compensation then
defeated a non-existent claim about it, so that seems like a mighty straw man.

------
gingabriska
I see some people talking about Germany and France offering far better and
cheaper healthcare.

But can you afford to look only at Germany and France? They operate in a
broader framework of EU.

If you are going to compare services/living standards then must also directly
compare Romania or Bulgaria to the US because Germany and France are able to
provide cheap healthcare because their healthcare staff are willing to accept
lower prices and how does it work? By importing labor from cheaper European
countries. Presently, many doctors and nurses from Romania work in Germany
without them good luck being able to maintain "cheap" healthcare.

If you cut off Germany and France from rest of the EU, the healthcare cost
will likely shoot up far more than what it costs in US now.

There is downward pressure on wages in whole EU and this is why Europeans come
to states for better employment opportunities, and better pay which can and
does buy you better living standards if you are willing to spend the money you
make but it seems not many want to do that, they want free healthcare in
addition to taking large proportion of their wages home.

~~~
pcardoso
I am from Portugal, a country that has many people working in richer EU
countries, but I don't think this is true.

Romanian or Portuguese nurses and doctors working in France or Germany or any
other country will have the same wages as a french nurse or doctor. Or most of
the time at least.

My wife is a nurse and we did some research on this a few years ago.

~~~
therealdrag0
There is still the possibility of increased worker availability reducing
wages, you have less bargaining power if theres readily someone else to take
your place.

~~~
pradn
Medical workers coming in from other countries can suppress wages, but enough
to cause a significant price difference in cost of health care? We also don't
know the dynamic effects of a labor shortage. Maybe Germans would switch jobs
into the medical field and the wages won't rise that much?

~~~
gingabriska
German companies are bitching forever now that there are no workers available
for them. I read that in news every other week.

------
mrhappyunhappy
Lack of a stable career, terrible health insurance, high premiums, lack of
community involvement, isolation from people, increased screen time and media
consumption, hopelessness from always on sensational news, hopelessness in the
face of global catastrophe to be coming near you due to ever worsening climate
problem, student debt, not being able to afford a home, lack of healthy food
options, diet and exercise misinformation, overprescribed medication, always
on notifications never allowing you to relax, binge watching Netflix no time
for brain to relax, shortened sleep cycles disrupting circadian rhythm.

I wonder what could possibly make people feel like shit and wanting to end it
all...

------
mrosett
I'm open the idea of various forms of drug legalization, but someone pointed
out that the opioid epidemic (which is behind the decline in life expectancy)
is arguably an experiment with legalizing heroin. The analogy isn't perfect,
but that gave me pause.

~~~
danans
Decriminalization (which is subtly different than legalization) of drugs isn't
in conflict with preventing addiction and abuse by treating these as health
problems, which is what they actually are.

The opioid epidemic was in significant part pushed forward by the unscrupulous
marketing of prescription opioid manufacturers, and further catalyzed by the
declining socioeconomic conditions in the areas most affected by the epidemic.

~~~
vonmoltke
> Decriminalization (which is subtly different than legalization) of drugs
> isn't in conflict with preventing addiction and abuse by treating these as
> health problems, which is what they actually are.

It is when you hold the belief that addiction is a moral failing. Most parts
of the US seem to be digging out from under that misconception, though.
Finishing it off for good could be the one good thing to come out of the
opioid epidemic.

~~~
atlasunshrugged
Yes, if there's any benefit to the current opioid crisis, it's that American
perceptions of addiction are changing as they see that anyone, not just
poor/minorities can be affected by addiction and that it's absolutely not a
moral failing

------
jwilbs
Two weeks, I had open heart surgery in my mid-20s in the US.

My main takeaway is this: those of us who work in tech or companies with
decent health insurance are extremely fortunate.

In total (knock on wood that this doesn’t go up), I spent around $10k out of
pocket.

This included more than surgery itself:

\- multiple ER visits because of my deteriorating valve

\- a LOT of dentist work (cleanings, fillings, wisdom teeth removal); these
things increase your risk of stroke/heart attack after heart surgery.

\- multiple visits with cardiologist and surgeon consultations

\- pre-operation

\- six days in the hospital recovering

To be honest, that’s a lot less than I expected to pay. However, I can’t help
but think of people in less fortunate positions that would 1) get fucked by
the bills if they had no insurance or 2) still go into debt despite having
insurance. When you really think about it, all options are ridiculous for an
operation that is literally do-or-die.

I’d also like to add a note on specialized vs ‘routine’ care here in the US.
Or my experience with it, anyway.

All specialized treatment I received (dentist, heart surgery, cardiologist)
was outstanding.

Routine cafe was awful, and ER visits were nothing short of ridiculous. I went
in with chest pain/shortness of breath (that I now know was very serious). I
waited for 6 hours. They gave me some blood work and an ekg and sent me on my
way. I went again the next week, because my symptoms were getting
progressively worse. Once again, I waited about 6 hours in the waiting room
before getting an ekg and some blood work. Both visits were a complete waste
of time. Luckily, I saw a cardiologist shortly after who gave me an
echocardiogram and identified the valve issue.

This (the shortness of breath, dentist visits, surgery) was all done within
the last two months. Were I in a less fortunate financial position, I probably
would have hesitated to even go to the cardiologist. Especially after having
thrown money at the ER for nothing.

It’s unfortunate how our healthcare system mirrors some sort of class-based
hierarchy: If you can afford it, great! Else, get fucked.

~~~
malvosenior
> _It’s unfortunate how our healthcare system mirrors some sort of class-based
> hierarchy: If you can afford it, great! Else, get fucked._

It's not widely known in the upper/upper middle classes but healthcare is more
or less free if you're poor in the US (even for major things like cancer
treatment). It's really the middle class that has it the worst as they don't
qualify for free health care.

Edit:

Some additional information to back up my assertion:

72.5 million people are covered by Medicaid:
[https://www.medicaid.gov/medicaid/eligibility/index.html](https://www.medicaid.gov/medicaid/eligibility/index.html)

The vast majority of medical services are available for free to Medicaid
members:
[https://www.medicaid.gov/medicaid/benefits/index.html](https://www.medicaid.gov/medicaid/benefits/index.html)

~~~
jwilbs
I was on Medicaid just a few years ago. It was definitely a lifesend, but the
network is very tiny and, as a result, scheduling visits with specialists (in
my experience, so anecdotally) took about three months.

I am very grateful I was not on Medicaid during the past few months. But I am
happy it’s an option.

~~~
AlexTWithBeard
_scheduling visits with specialists (in my experience, so anecdotally) took
about three months._

From my own experience, that's approximately what it takes to schedule a
specialist visit in the UK.

Unless (surprise!) you have a private insurance.

------
bluedino
I was expecting the cause to be obesity - just imagine how much healthcare
costs would go down if the 40% of Americans who are obese, weren’t.

I’d imagine life expectancy would go up a bit too.

~~~
abstractbarista
Free or reduced cost stuff is all the rage these days. Yet we refuse to look
in the mirror, where at least a partial explanation for the costs may be
found. Quite unfortunate.

~~~
atlasunshrugged
There are some other interesting tweaks that can be done as well, sin taxes on
things like sugar, tobacco, and booze are all likely to have major impacts on
increasing the overall life expectancy

------
examancer
We continue paying more for demonstrably worse care and outcomes than our
global peers.

Single payer needs to happen, now. Medicare for All.

~~~
refurb
You do realize that Medicare Part D is entirely run by private companies and
thus is no "single payer".

~~~
vonmoltke
That's true, but it only covers prescription drugs. The rest of the system is
single-payer.

Not that we _need_ single-payer, just more controls on costs and benefits.
Germany and Switzerland do fine without single-payer.

~~~
refurb
Medicare Advantage includes Parts A,B,D and are run by private insurers as
well.

It just irks me when people call for "Medicare for all", but clearly don't
understand what Medicare actually is.

~~~
robbintt
Not accurate. Part A and B are paid directly to medicare.

~~~
refurb
Part C plans offer Part A and B through private insurers.

------
mr_tristan
Has there been comparison of urban to rural areas with this? Are young people
in rural areas dying faster than urban areas?

I found this from 2017: [https://www.cdc.gov/media/releases/2017/p1019-rural-
overdose...](https://www.cdc.gov/media/releases/2017/p1019-rural-overdose-
deaths.html)

My sense is that rural areas are harder to change, and probably far more prone
to monopolies from service providers. The combination of higher costs of
monopoly with higher rates of drug use might lead to more deaths.

Or, in another way, in the US, is being poor in a rural area
better/worse/similar to being homeless in an urban one?

~~~
Frost1x
Unless I'm missing a parent reference you're referring to, the article
explicitly mentioned this:

>In terms of deaths from suicide, Bernstein writes that there is a huge
disparity between urban and rural Americans. The suicide rate amongst urban
residents is 11.1 per 100,000 people, as opposed to rural residents’ 20 per
100,000.

~~~
mr_tristan
I'm just wondering if there's ways to link the timelines of the main article
(last 3 years) and the rural vs urban comparison (which was from 2017, but
cites data much earlier)

------
mighty_bander
Glad to live in Canada. As of 2016, life expectancy was nearly four years
ahead of the US, and trending in the right direction.

~~~
refurb
Huh?

 _" Life expectancy in Canada has stopped increasing for the first time in
more than four decades, due largely to soaring overdose deaths in the Western
provinces."_[1]

[1][https://www.theglobeandmail.com/canada/british-
columbia/arti...](https://www.theglobeandmail.com/canada/british-
columbia/article-overdose-crises-lowering-life-expectancy-statistics-canada/)

~~~
mighty_bander
My bad, there's a drop two years after the source I looked at. Seems like the
problem is international. So I guess the question is: what can we do about it?

------
myth_buster
[Nit] Show me 4 embedded ads but not a single chart when talking about trends.
Also 2018.

~~~
disabled
This is a good starting point. This is all open access, and funded through the
Bill and Melinda Gates Foundation. This is done at the University of
Washington Medical School, which is basically "as good as it gets" for a
public medical school in the US. UW also has solid allied health departments.
Their statistics department (even outside of the realm of health) is solid
too: [http://www.healthdata.org/us-
health/publications](http://www.healthdata.org/us-health/publications)

------
chabes
Interesting quotes from the article:

> Speaking with NPR, disease prevention expert William Dietz of George
> Washington University stressed the links between overdoses and suicides.
> Both may occur amongst people “less connected to each other in communities”
> and are tied to a “sense of hopelessness, which in turn could lead to an
> increase in rates of suicide and certainly addictive behaviors.”

> McHugh echoes Dietz, concluding, “There's a tremendous amount of overlap
> between the two that isn't talked about nearly enough.”

------
11thEarlOfMar
Meanwhile, I was informed yesterday that my health insurance premium is going
up by 12%.

------
drinane
Anecdotal Comments < Hard Evidence. US is indeed in relative decline.

------
conanbatt
The writing is on the wall: the US has to fix is healthcare system.

------
whiddershins
Quick googling shows suicide deaths increasing 24% over 15 years, to 45,000 in
2014.

I heard an interview on Sam Harris’ podcast where the contention was teenage
suicide rates are dramatically increasing.

Overdose deaths are at around 70,000 for 2017.

Overdose deaths and suicide are very connected, insofar as they can be traced
to a feeling of hopelessness or meaninglessness.

Alcoholics are at a very high risk for suicide, for example.

There may be many other related causes of death: homicides, car crashes, and
other destructive behaviors can still be viewed through a lens of lack of self
worth or hope.

I think it is a huge mistake to treat it as a priori that economic factors
drive this situation.

You can argue that even though we are all materially much more well off than
100 years ago, the awareness of relative status still has a profound
psychological impact.

But I think looking at possible non-economic factors relating to
psychological, philosophical, and spiritual health might provide alternate
hypothesis that could help. I think policy makers and pundits avoid that
because it seems much harder to address those issues via policy.

To me, though, the data implies a widespread crisis in sense of meaning.

~~~
khuey
US population is up 15% over those same 15 years. The increase in suicides is
a lot less dramatic when normalized per-capita.

------
beenBoutIT
Even in a country where people were well educated, the average life expectancy
rising beyond some point wouldn't be a good thing. No idea where that optimum
average life expectancy is, but it's entirely possible that we exceeded it and
the drop noted here is actually a positive thing.

~~~
jedharris
What is your rationale for capping average life expectancy? I hope not some
reasoning based on costs due to old age since that is not a logical
consequence. Advances leading to increased life expectancy could also lead to
healthier / more productive old age.

~~~
beenBoutIT
Not capping life expectancy artificially and not artificially working to
extend it for everyone. The world got along fine from 1800-1900 with the world
average life expectancy existing at less than 50, but there's no guarantee of
the same being true at a global average of 100. IRL everyone alive now exists
in a tenuous situation where one of the key constraints is Earth's finite
resources. Everyone can't have everything everywhere at the same time while
living to 100 unless the population stays artificially low.

*[https://ourworldindata.org/life-expectancy](https://ourworldindata.org/life-expectancy)

------
disabled
If you live in the US and plan on staying alive in the long run, then you
better spend a lot of time consulting HealthData.org--and analyzing the data
there--to fit your particular situation.

The third leading cause of death--or at least what is believed to be the third
leading cause of death--is preventable medical errors:
[https://www.npr.org/sections/health-
shots/2016/05/03/4766361...](https://www.npr.org/sections/health-
shots/2016/05/03/476636183/death-certificates-undercount-toll-of-medical-
errors)

Let's not even get in to how much health care actually costs in the US. But,
if you want a completely solid read on that matter, get the book CASINO
HEALTHCARE via Amazon. You will not be disappointed.

That being said, both me and my fraternal twin brother turned 30 a month ago.
Unlike for most people, turning 30, together with my brother, was a very
special milestone that I never expected to reach in life.

I have 2 rare autoimmune neurological diseases, that affect my peripheral
nervous system (with one of them being very rare, with only case reports and
cohorts published in the medical literature...and it was discovered relatively
recently in the medical world...in the past 20 years via NIH research grants
to physician-scientists) plus type 1 diabetes. It is all connected, but that
is another story for another time.

The US health care system is unequipped to properly deal with people who have
rare diseases. 6-7% of the general population has a rare disease, so having
one, diagnosed or not, is actually common, and is even more common than the
prevalence of ADHD in adults! This too is another story for another time, but
I ended up self diagnosing the very rare one correctly, even though in my case
the whole situation is beyond confounding, even compared to others with the
same very rare condition that I have.

The issue is that for people with rare disease, the situation can be
desperate, dismal, and even hopeless. In the case of rare disease, the social
support structures in place within a society are literally just as important
as the medical aspects of care.

We really do need highly specific plans and approaches for, rare diseases in
general, for dealing with our unique situations. Compared the the United
States, the European Union excels at this, and is the only world superpower
that has a practical, pragmatic, and winning approach on the matter. For
access to orphan drugs, Germany is the clear winner worldwide. For societal
supports, Norway (which is not part of the EU but it is kind of part of the EU
for the purposes here) is phenomenal and no other country compares, worldwide.
Their government has extremely well developed programs, offices, and "medical
homes" (go to contacts that are teams that coordinate all care) for rare
disease patients, and for them only.

Remember, our situations are unique and different compared to other more
common chronic illnesses, whether you want to believe this or not.

In fact, probably the biggest threat to my well being as somebody with rare
disease: a government that does not reform, regulation wise, with the rapidly
changing pace of technology. (And yes, all technology in general needs to be
regulated, to varying degrees, whether you want to agree or not.)

Sorry to go off on a tangent. If I told the whole story, which would take
quite awhile, you would be shocked, amazed, stunned, and impressed, all at the
same time. I have cheated death many times, and I really shouldn't be alive.
Both my doctors and I very much are aware of that. I certainly do not know why
I am here, however I have purpose and I have meaning in my life.

I would love to go into more specifics, but I cannot without effectively
writing a novel here.

The point is, on my 30th birthday, I came to the realization that I basically
have to go to the EU (I am a dual US|EU citizen) to not only stay alive in the
long term, but to potentially avoid having to suffer profoundly for the rest
of my life. I cannot go in to the specifics here, though. But, trust me, the
US health care system is not equipped to deal with rare disease properly, at
all.

So, instead of celebrating the remarkable accomplishment of my 30th birthday
with my best friend (I really shouldn't be alive), I was realizing that I had
to leave the US for good, to stay alive. I cannot go in to specifics here, but
this is not an exaggeration at all. It was profoundly sad for me, because I
have to leave my family, who mostly live int he US, and basically start a new
life.

------
Someone1234
I moved from the EU to the US...

Toddler had a seizure (first and last ever). Called 911. $1300 for a 1.5 mile
(per Google Maps) ambulance ride to the hospital plus a $300 bill just towards
"medical care" for the ride (none actually given).

Then $800 for the ER, and a seperate $400 bill for the doctor (who sent us
home after telling us to come back if more occurred but otherwise give child's
tylenol and go see the child's pediatrician on Monday).

Did I mention that both the ambulance company and the hospital have a local
monopoly? There's no price competition, no choice to be made, nor could there
be in a medical emergency.

The problem with all of these is: If it happened again, I'm genuinely going to
think "is this an emergency enough to justify a $2K medical bill?" That
shouldn't be how medical treatment is decided.

The whole "capitalism will solve it" thing just isn't working. I cannot shop
around for medical care, I cannot see prices, and insurance is $1300/month for
essentially no benefit (except to turn prices from bonkers to incredibly
high).

~~~
elamje
I agree that is outrageous. The problem is that people think it is capitalism.
When there is no price transparency, there is no capitalism, period.

Hopefully the US is on the way to government healthcare, but for now it would
be great to just achieve price transparency so people can shop around.

Without price there is no competition. Without competition there is no
capitalism.

~~~
hangonhn
Kenneth Arrow did a great analysis on efficient markets and the US healthcare
industry. Basically it doesn't work the way it works in most free markets
because of information asymmetry (he got the Nobel for it). Even if you had
price transparency, you aren't in a position to decide what treatment to buy
because you're not the doctor and don't have the necessary knowledge to make
that decision. The whole process is misaligned because the recipient is not
knowledgable enough to make the decision, the decision maker (doctor) is not
the payor, and the actual payor (insurance) is often neither of those.
Efficient markets require certain preconditions to be met to work. It's true
in many situations but there are some well known edge cases.

~~~
Ididntdothis
I think you are right but I still think two steps would make the system much
saner:

\- Price transparency

\- One price for the same service. The practice of charging $500 to the
insurance but $10000 to the uninsured needs to stop. Maybe it's fine to vary
by a few percent but there is no other market where the same product costs 20x
more depending on who pays. If the excuse is that this is to compensate for
non payers then let's pay for this from a separate pot.

~~~
SolaceQuantum
None of this addresses the point- even if you have price transparency and one
price for the same service, you are not educated enough to select services you
need. Doubly so if an emergency happens.

~~~
Ididntdothis
There are plenty of situations where you know what you need and you could shop
for prices if it was possible to get any reliable prices. At a minimum
transparency would make it obvious to the public how crazy the pricing
practices are.

I agree about emergency situations.

~~~
SolaceQuantum
If I go for routine bloodwork do I know exactly what bloodwork to order for,
or the codes to request? Do I know when to discern between MRI, Xray, or
ultrasound diagnostic? I find this hard to believe.

~~~
Ididntdothis
Often your doctor tells you what tests they want and then you go to some
center where they perform the tests. It's pretty predictable in many cases.

~~~
SolaceQuantum
_" Often your doctor tells you what tests they want"_

This is the exact point- you do not have the education to shop because you
don't even know what you need to be shopping for.

------
tanin
Might be off-topic, but in general, US is very harsh on poor people.

Apart from healthcare, Two more things that are harsh on people that don't
have money (like students) are:

1\. You need a car, which costs thousands of dollars (depending on how much
reliability you need). Then, if your car breaks down and you're poor, you're
really fucked.

2\. Eating out is a big expense (e.g. tip makes it worse). It's ridiculous
that eating out every day in a month could cost as much as a round-trip flight
to Thailand. You could also buy a macbook with that money.

Back, in Thailand, when I was a college student, my allowance was $15 USD a
week, and I ate out pretty much every meal. Most of semi-poor/average-income
people in Thailand eat out. Granted, the food safety standard is way worse.
But I'd still prefer that than spending time doing the cooking myself.

~~~
s_y_n_t_a_x
If you live in a city, a car is much less needed, anywhere else, you're
correct, it's a big expense. When I was poor my car always caused me money
troubles. Insurance, tags, gas, breakdowns. If any of that goes out you pay
more in fines.

Eating out is a luxury. It's much much cheaper to buy groceries. Groceries are
cheaper in the US than any country I've been to, including Thailand. I didn't
try to eat natively though (bought cheese/beef/milk imported from Australia)

When we eat out it's usually fast food or pick-up, we don't like eating in
public. It's between $15-30 for both of us. Thailand it was cut in half, but
we used Grab to deliver it to us. Japan we spend upwards of $50 for half the
portions.

You're comparing being poor in US vs Thailand. I'm sure you know the standard
of poor is very different. Being poor in the US would be middleclass living at
least in Thailand.

tl;dr I disagree, being poor in America is a much more pleasant experience
than being poor in many other countries.

~~~
tanin
> Eating out is a luxury.

This would be one difference. In Thailand, we eat out to fill our stomach. We
usually don't consider it a luxury. We also don't care much about services.

If anything, I am a bit annoyed about the high-touch service here.

> It's between $15-30 for both of us. Thailand it was cut in half

Half is still too expensive for Thais. A dish in an average air-conditioned
mall (e.g. Tesco Lotus) would cost $1-$2 USD per dish. These dishes taste
great as well.

> tl;dr I disagree, being poor in America is a much more pleasant experience
> than being poor in many other countries.

I agree with this statement.

However, this pushes toward the all-or-nothing situation. You either have good
experience or are screwed. There's nothing in between.

Restaurants having high safety standard is great. But then there's no cheaper
restaurant. Then, poor folks have to spend time cooking, which is gonna waste
time and taste worse.

One of my tidbits that illustrates the different quality of life between US
and Thailand is that: I live in US for 6 years now, and I've never seen a
cockroach here. In Thailand, I'd see one on the first day I arrive. This
happens even if I stay in a high-end condo.

~~~
s_y_n_t_a_x
> This would be one difference. In Thailand, we eat out to fill our stomach.
> We usually don't consider it a luxury. We also don't care much about
> services.

Wages are higher in America, so the getting service is going to be more
expensive. However, food is very very very cheap compared to most countries.
So yeah, it may not be a luxury in Thailand, but eating out is a luxury in the
US because you're not paying for the food, you're paying for the service. Fast
food is an option though if you really don't want to cook, but some people
don't like that.

I actually prefer home cooked meals, I think they taste better, but I'm lucky
that my wife loves to cook. When I was single I was content heating up food.
Food was the last thing I was worried about at the lowest point in my life. I
ate corn dogs nearly every day because it took a minute to cook and a minute
to eat and I could buy a 50 pack for next to nothing.

------
ilikehurdles
Leaving your 20s and 30s with a career you enjoy, basic benefits such as
health insurance, retirement funding, and paid time off, and the ability to
afford a reasonably sized home without falling into tremendous amounts of debt
seems less and less likely each year. I have a lot of family who have moved
from the EU to the US and back to the EU, I have also lived there myself, and
I'm intimately familiar with their day-to-day. If the average American knew
what the benefits and lifestyle are like for a middle-class German family, all
those totally disconnected accolades about job and GDP growth that our
oligarchs like to shower upon us would do nothing to prevent work strikes and
riots in the streets.

~~~
himeexcelanta
I’ll probably get downvoted for this, but a strong argument can be made that
the European welfare state has only been made possible due to massive US
defense subsidies and economic stimulus during the post WWII/Cold War. This
doesn’t mean that the US has a good excuse for relatively poor domestic social
services vis a vi many European states, but let’s also be real about what
allows Germany, France, etc to provide “free” healthcare and other social
subsidies.

In the particular case of Germany, defense spending is only 1.2% (this stat is
easily found via google). I’d rather have Pax Americana (which arguably is in
decline) over the past 70 years providing stability in Europe, helping to lift
hundreds of millions of East Asians out of agrarian subsistence, etc than
slightly cheaper healthcare. Although, tell that fact to someone who receives
huge, opaque medical bills for simple procedures in the US and they probably
wouldn’t take too kindly to that line of reasoning...

~~~
Someone1234
What's the strong argument?

Germany spends 11.14% of GDP on healthcare or 442B. The US by contrast spends
17.07% of GDP on healthcare or 3498B. Therefore the US spends more and still
lacks a comparable system.

Additionally the amount Germany saves by under-spending on defensive wouldn't
offset the cost of the wealthfare state for example if Germany spent 3% (the
US spends 3.5% on defense) of its GDP on defense instead of the current 1.2%
they go from spending 47B to 119B. That extra 72B is less than 17% of their
total healthcare costs, which again, are much lower than the US'.

This whole argument is a US Conservative talking point that has little to no
basis in fact. When you look at the underlying data, it simply doesn't hold
up, the cost of medical care and defense are orders of magnitude different and
the US's system is so inefficient, even with the savings after decreasing
defense spending from 3.5% of GDP to 1.2% (extra 472B/year) it wouldn't
function well.

~~~
himeexcelanta
I’m not arguing that the US healthcare system is more efficient (it definitely
isn’t). I’m arguing the political and economic conditions present in post-91,
EU-integrated, unified Germany were only made possible in part by constant
military and political deterrence provided in part by US defense spending. US
military power also increased the politician and diplomatic leverage of the
West during the Cold War (the most obvious example being NATO).

~~~
thatfrenchguy
That’s quite BS knowing France has a much better healthcare system compared to
the US and also can nuke any country to death. Defense spending and healthcare
are clearly unrelated.

~~~
gingabriska
I read somewhere France still has colonies somewhere in Africa.

------
tntn
HN title is not good. Original title is "U.S. Life Expectancy Drops for Third
Year in a Row, Reflecting Rising Drug Overdoses, Suicides."

The comparison is between the last three years and 1915-1918, but the Spanish
flu was just getting going in 1918.

EDIT: folks just arriving, the HN title has changed since I commented. It
previously said "worst trend since Spanish flu," or something.

~~~
spanxx
> Spanish flu of 1918

It was not Spanish. It's origins come from the battlefields of WWI.

~~~
tntn
Next you're probably going to tell me about French fries, right?

~~~
simonh
Freedom Fries

------
jimbob45
“Higher suicide rates in rural areas are due to nearly 60 percent of rural
homes having a gun versus less than half of homes in urban areas,”
psychiatrist and behavioral scientist Keith Humphreys of Stanford University
says. “Having easily available lethal means is a big risk factor for suicide.”

Pretty bold claim there. Seems like you could run a pretty big study just
based off that one hypothesis.

~~~
hobs
Your comment comes off as if people hadn't thought to do this before.

The center for disease control is legally prohibited from doing so thanks due
to lobbying from the National Rifle Association -
[https://en.wikipedia.org/wiki/Dickey_Amendment](https://en.wikipedia.org/wiki/Dickey_Amendment)

~~~
treyfitty
Not quite true, and as the link you posted highlights, they are prohibited in
using tax funds to advocate for or against gun control. They’re empowered to
do studies, but they must not use tax dollars earmarked for specific
initiatives.

~~~
Loughla
If I'm not mistaken, the federal government in all of its forms has chosen to
call even studying gun violence as a step in the process of advocating for or
against gun control. I feel like NPR did a story about that last year, but I
can't find anything about it. Am I imagining this happened.

