
Life expectancy in the U.S. is declining for middle-aged people of all groups - pseudolus
https://www.nytimes.com/2019/11/26/health/life-expectancy-rate-usa.html
======
claudeganon
> “The whole country is at a health disadvantage compared to other wealthy
> nations,” the study’s lead author, Dr. Steven Woolf of Virginia Commonwealth
> University, said. “We are losing people in the most productive period of
> their lives. Children are losing parents. Employers have a sicker work
> force.”

For profit healthcare in America is devouring its people and economy, full
stop. We can either have a society where half a million people go bankrupt
from medical debt each year, thousands die from treatable illnesses and lack
of access to medicines, while hospital CEOS and insurance execs walk away with
millions. Or, we can have one that excises their parasitism like the rest of
the developed world figured out was necessary decades ago.

~~~
zeveb
> For profit healthcare in America is devouring its people and economy, full
> stop. We can either have a society where half a million people go bankrupt
> from medical debt each year, thousands die from treatable illnesses or lack
> of access to medicines, while hospital CEOS and insurance execs walk away
> with millions, or we can have one that excises their parasitism like the
> rest of the developed world figured out was necessary decades ago.

The majority of the world still has, to my knowledge, for-profit health care:
Britain, Germany, France, Switzerland , Sweden and Italy all have at least
some form of private health care.

The United States _definitely_ have a problem with health care prices. It
doesn't appear from where I sit to be an issue with individual bad actors
(although of course they do exist) but rather structural. In part, the well-
intended federal and state attempts to improve things have backfired — as they
tend to do — and made things even more expensive (which reminds me of federal
student loans, another instance of well-meaning attempts to help the lesser-
off which somehow seem to benefit the upper middle classes most of all; cf.
also federally-subsidised mortgages).

~~~
rsynnott
> The majority of the world still has, to my knowledge, for-profit health
> care: Britain, Germany, France, Switzerland , Sweden and Italy all have at
> least some form of private health care.

While private health care exists in all of those countries, and in some of
them it's a significant part of the system, a lot of what exists isn't
actually _for-profit_.

For instance, in Ireland we have a dual public and private system (primary
care is private unless you're old, very young, or low income, private
hospitals exist as an option), but most of the private system is either
outright non-profit (most private hospitals, the statutory VHI health insurer)
or is heavily constrained by the existence of the non-profit portion and
regulation (private insurers have to compete with the VHI, and are not allowed
charge risk-based rates for most customers).

~~~
cookieswumchorr
in Germany, the actual doctors office that treats you may be a for-profit, but
they get the cash from your (mandatory) insurance, and the law regulates what
kind of treatment is essential and therefore included in the mandatory
healthcare plan. You can have a private healthcare plan that gets you extra
treatment, or pay yourself for it. But it's really Stuff you can live without.

another example, in Russia, you have _theoretically_ the same system, but the
level of treatment covered by the mandatory insurance is totally insufficient
by any reasonable modern standards, so you have to pay all the way. And it's
not about debt, it's often about not getting live-saving treatment before you
cash out.

------
mfer
> And while suicides, drug overdoses and alcoholism were the main causes

It looks like there is increasing mental health issues that aren't being
addressed. This seems to get blown past too quickly.

We tend to look at the medical side of things and the way the healthcare
system works. But, somethings have changed that caused the mental heath of
many to go down. Will changing the US to single payer or medicare for all
change the mental health problems? Given the research I've read it's highly
unlikely.

Can we please put more time into understanding and addressing the increasing
mental health problems? This is important for forums like this because studies
have repeatedly found we have a hand in it.

~~~
dota_fanatic
Don't you think these things are directly related?

A friend of mine had some minor mental health issues going into their 20s.
Lack of meaningful opportunity paired with obscenely expensive and
inaccessible healthcare helped drive those to become major health issues,
including drug addiction, due to intoxicating themselves to "help" distract
from their grim reality.

Absolutely I think it would have been different had they had access to general
preventative healthcare from the start so they could get routine dental,
physical, etc. Would they be cured of their mental health problems? Probably
not. Would the effects have been less destructive? Yeah, I would bet on it.

~~~
mfer
> Don't you think these things are directly related?

From what I've read there isn't a strong relation between them. Some of it is
obvious. The system has been roughly the same for many years but the change
happened to mental health anyway.

As I start to read studies on it I learn there are other factors affecting
mental health.

The people who study these things are predominantly saying it's related. Why
should we think it is?

------
spiderfarmer
The lack of empathy and solidarity is only growing in the U.S. so this problem
won’t be solved any time soon.

~~~
nextstep
I have a more optimistic view. Bernie Sanders’ campaign explicitly asks people
if they are willing to fight for people they don’t know, and his campaign has
the largest donor base and the biggest rallies.

~~~
WhompingWindows
I love Bernie and I voted for him in the 2016 primary... that said, I won't be
voting for him in 2020. He's not indicative of some great revolution, of some
kumbaya moment...Sanders is going to get less than 20% of the vote in the
primary and, as a socialist, he is hated and a non-starter for 30% of the
populace who rabidly support Trump.

Bernie, Biden, Trump: We do not need elderly presidents. 80 year olds are
scientifically proven to be cognitively declined relative to younger
individuals. They are much more likely to die in office, more likely to have
memory issues, slower to comprehend new things, and are just much more out of
touch with the average citizen.

So, while I laud Bernie's character, I don't think a 77 year old man being
preferred by less than 20% of one half of the electorate is cause for
optimism.

~~~
SolaceQuantum
Who do you recommend, since you like the policies but not the candidate it
appears?

~~~
WhompingWindows
For the primary: I don't know, to be honest. I really don't want to vote for
anyone so elderly, you can see with Trump and Biden that their cognitive
capability to form words and give good speeches is pretty lack luster.

For the general: Whoever is not Trump, they are all superior in myriad
ways...the only Dem who isn't superior to Trump is Marianne Williamson,
because she's just as qualified and sensible as Trump.

------
Empact
Key quotes for me:

> Dr. Woolf said one of the findings showed that the excess deaths were highly
> concentrated geographically, with fully a third of them in just four states:
> Ohio, Pennsylvania, Kentucky and Indiana.

> “What’s not lost on us is what is going on in those states,” he said. “The
> history of when this health trend started happens to coincide with when
> these economic shifts began — the loss of manufacturing jobs and closure of
> steel mills and auto plants.”

> The increased deaths from drug overdoses reflected increased rates of
> addiction to opioids. But they have also risen because of changes in the
> drug supply in the East and Midwest. Over the last decade, the synthetic
> drug known as fentanyl has been mixed into heroin — or in some places has
> replaced it. That has made the drug supply more deadly, since it is
> difficult for users to know the dose they are taking.

> Life expectancy in the coastal metro areas — both east and west — has
> improved at roughly the same rate as in Canada.

These together point to me to local crises: people in hard times due to
economic shifts turning to drugs, etc, as an outlet.

There are many ways to improve the lot of these people, but being blind to the
cause does not help them. Also let’s be clear about the scale of the problem:

> While the total number of excess deaths — meaning the number of deaths that
> would not have happened if the mortality rate had continued to improve — is
> small, at 33,000

For context, total overdose deaths are ~70,000/year.
[https://www.cdc.gov/drugoverdose/index.html](https://www.cdc.gov/drugoverdose/index.html)

------
fma
Anyone who has followed presidential candidate Andrew Yang knows this. This is
why he wants the "American Scorecard" which consists with indicators including
life expectancy, suicide rate, drug overdose rate...rather than things like
GDP, unemployment.

The country is not healthy. Until we put these numbers in the forefront, we
will keep trying to just increase GDP at the cost of people's lives.

------
higeyuki
How happy are you? Truly, ask yourself. Think back and think of how things
have drastically changed in society.

This is telling of a world that cares more and more about the "economy" then
they do people. With little to no focus on living and so much emphasis on
"success," "Business," and "economy."

Work with little pay, a buy in club for access to healthcare and no work/life
balance in many jobs. It does not surprise me even the smallest amount. Health
insurance (at least in the states) is more like a Costco membership. It just
gives you access to healthcare.

Healthcare profits have been in decline so I don't think it is about the "for
profit" system as much as it is other things in our environment
(work/natural.) I think this is more telling of how our culture chooses to
live and has structured the work environment.

[https://www.wsj.com/articles/u-s-hospital-profits-fall-as-
la...](https://www.wsj.com/articles/u-s-hospital-profits-fall-as-labor-costs-
grow-and-patient-mix-shifts-1524495601)

------
Balgair
The CDC report gives a much better view of these findings [0]. I would really
suggest reading the report. It is not jargony and takes maybe 15 minutes to
zip through. They really put a lot of time into making it accessible and it
shows.

In reading that report some things that I noticed are [1]:

Pg. 8: Alzheimer's Disease caused deaths for both males and females increased
a fair bit! And for males, Unintentional Deaths also increased recently. Note
that the Y-axis is in a LOG scale; any movement upwards is a lot.

Pg. 10: Yeah, Juul and the like really are hurting children. Grades 2 & 3
Obesity are increasing too. Both are not good.

Pg. 11: Asthma in black children has gone up a fair amount.

Pg. 14: West Coast and Virginian essential vaccination is under 2/3 babies (3
years or younger). That is WELL below herd immunity. New England, Deep South,
and Plains states are above 3/4.

Pg. 21: Ages 15-44 have seen an uptick in mortality. Note: The y-axis is in
LOG scale, so it's been a fair bit of an uptick.

Pg. 22: A big uptick in infant mortality due to unintentional injuries.

Pg. 23: ... Jesus ... a huge increase in child suicide rates and an increase
in teen homicide and suicide rates. Note: The y-axis is in LOG scale.

Pg. 24: HIV deaths are WAY down (!), unintentional injuries and liver
cirrhosis are up.

Pg. 25: Alzheimer's deaths in the elderly are up a fair amount.

pg. 26: Holy shit ... overdose rates are just ... wow ...

pg. 27: Appalachia and New England ... good Lord ... I mean, you hear things
about it all, but wow.

pg. 29: Cirrhosis deaths in middle aged men are really climbing. The booze, it
ain't good.

BTW here's the scihub link for the JAMA article that the NYT is talking about:
[https://scihub.bban.top/https://jamanetwork.com/journals/jam...](https://scihub.bban.top/https://jamanetwork.com/journals/jama/article-
abstract/2756187)

[0]
[https://www.cdc.gov/nchs/hus/index.htm](https://www.cdc.gov/nchs/hus/index.htm)

[1] this is mostly a summary that I posted here 38 days ago when the report
first dropped. Seriously, just read the CDC report!

~~~
TurkishPoptart
When you say: >Note: The y-axis is in LOG scale What does this mean?

~~~
throwanem
It runs by orders of magnitude, e.g. 1, 10, 100, 1000...

------
izzydata
The way things are going in the US are unsustainable and I'm not even talking
about the impending climate problems. What is going to give out first and how
long will it take?

~~~
shantly
If we don't fix healthcare costs it'll be that in 5-15 years, just looking at
the increases in costs year over year. It's strangling the economy.

After that we very likely have a (lack of) retirement crisis coming in, I
reckon, 15-30 years. I'd guess there'll be a concurrent falling off of
generational passing-on of wealth (inheritance) that'll compound the issue and
ensure it lasts much of the rest of the century. This'll be _way_ worse if all
we've managed to do with health care costs is hold them at their already-too-
high levels, rather than lower them.

The worst risk is that crises aren't always blamed on the right people/issues,
and sometimes end up causing scary shifts in the politics of a state (watch as
I carefully avoid Godwinning the thread)—I suspect the mobility of wealth and
how much money is in the hands of effectively stateless corporations will make
any such occurrence rather more _interesting_ than it has been in the past in
the US, e.g. the Great Depression, as incentives for various actors may not be
aligned the same ways they have been. One hopes the phrase "feeding frenzy"
won't apply, but it seems possible.

------
readarticle
“In the northeast and midwest” should be appended to the title.

California experienced negative growth. Texas, Georgia, Florida, Oregon,
Washington “0-5% growth”.

 _Dr. Woolf said one of the findings showed that the excess deaths were highly
concentrated geographically, with fully a third of them in just four states:
Ohio, Pennsylvania, Kentucky and Indiana._

—

 _“I’m not sure the dramatic, ‘there’s something desperately wrong with the
entire country’ narrative is entirely accurate,” Dr. Harper said. “Certain
groups, such as Hispanics and Asians, are doing O.K. It’s not like the entire
country is being subsumed by a single social phenomenon that can explain all
of this. There are a lot of moving parts.”_

------
m463
I don't think people realize the increased mortality of being on the upper end
of the (literal) scale.

Here's a journal article:

[https://journals.plos.org/plosmedicine/article?id=10.1371/jo...](https://journals.plos.org/plosmedicine/article?id=10.1371/jo..).

but to summarize BMI vs years lost:

    
    
      BMI    40-45   45-50   50-55   55-60
      men    -6.5    -10.8   -10.6   -17.0
      women  -6.9     -9.1   -10.3   -13.1

------
nickthemagicman
It's unregulated capitalism. Jobs are dead end unless you have advanced
degrees which eliminates a huge portion of the country. Most jobs require you
to be sedentary in office and work long hours. 70% of the country is living
paycheck to paycheck. The healthcare industry is profiting massively at the
expense of the population. Politicians have been purchased by big biz so this
will not change. It's just going to get worse.

------
TurkishPoptart
Is there something us devs with money to throw around can do to, well, not
fix, but alleviate the insurance gap? Perhaps there could be a large pool we
could pay into, that people could spend solely on necessary medical care.

~~~
jhloa2
Are you proposing a secondary level of insurance for a failing primary
insurance system? Won't that just make it worse?

------
droithomme
Everyone's got their own opinion about what is to blame for this, I'll toss
mine in.

I see a lot of people with stress and despair related problems such as high
blood pressure, heart disease, obesity, alcoholism, drug use. Diet can be an
issue as well but diet problems on these come from stress management tactics,
it's not the diet that's the root cause here.

Currently a major source of stress is the general political atmosphere of
endemic bullshit, violence, fake news, lies, shout downs, cancel culture,
cover ups, self dealing, and all this on both sides. And if you say both sides
both sides jump down your throat trying to bullying you into agreeing with
them their side whatever it is is perfect and the other side are literal
demons who need to exterminated. By not agreeing only one side is at fault,
then you as well are labeled a demon worthy of extirpation as well. Choose
sides or be cast into hell. But choosing either side is to buy into a
delusion.

Another cause of poor health has been mentioned: the health care system really
is shit for most people. My insurance runs over $20,000 a year for a really
crappy policy that doesn't cover anything since everyone is out of network or
there's a copay that is _more_ than the cash price, meaning I just pretend I
don't have insurance to save money. Any hospital emergency I can be assured
that either the plan doesn't cover the hospital at all or doesn't cover the
people working there. In network coverage for anything involving more than one
person doesn't exist. And although many doctors are good people and competent
a lot more are money grubbing and incompetent, having practices managed or
advised by MBAs with maximum profit as the sole motive. Specialists are
particularly hard to get ahold of and charge absurd amounts compared to
literally every other country in the world.

How to fix any of these? None of it is ever going to get fixed. The deep state
is not just a government thing, it also extends to medicine, teaching, police,
and other professions which have invisible networks that will thwart any
attempt at reform or improvement to protect their own positions and
lifestyles. Trying to fix it is a waste of time that only leads to being made
a target of attacks, and introducing massive stress into your life. One might
as well try to fix communism from inside Stalin's Soviet Union. You'll only be
disappeared or end up dead. Best instead to figure out ways to have as little
to do with the system as possible, and undermine it whenever you have the
opportunity, hoping it will eventually collapse. The only way out is collapse
at this point. Some cars are so far gone they can't be fixed. Likewise with
houses. I've seen people try to restore an old farmhouse or victorian with a
rotted foundation and floors and spend hundreds of thousands of dollars ending
up with a crappy house with poor energy efficiency and little resale value.
They are broke and stressed out and just spent a decade exposing themselves to
black mold and sometimes things like asbestos. They could instead have
demolished it and built a full size replica using modern efficient methods for
a tiny fraction of what they spent "fixing" it. Why did they pursue
restoration instead? Because they bought the rotted house for what they
thought was a bargain and ignored its long term costs, and also they "fell in
love" with it through simple familiarity and comfort of knowing it was theirs.
Tearing something down or throwing it out and starting over again is the only
way out of things that are far too rotted and broken to be worth fixing.
Political and economic systems, houses, cars, and relationships all fall under
this rule.

~~~
apta
I'm not sure it's politics as much as a deeper underlying cause. A lot of
today's salaries are just not sustainable to live and retire off of anymore.
You read stories about how several decades ago, a man working at a gas station
was able to afford a house, car, and support his wife and children. Today, you
have people in their 30s who are still in debt, and whose salaries are barely
able to sustain them. They end up having to work 2 or even 3 jobs if they have
a family to support.

Combine this with a consumer heavy society, where people seem unable to
control their impulses, and this is not a good result.

~~~
Ididntdothis
" A lot of today's salaries are just not sustainable to live and retire off of
anymore. You read stories about how several decades ago, a man working at a
gas station was able to afford a house, car, and support his wife and
children."

I just moved into a new place and had a painter do the walls. He started
working at Safeway with 17, retired at 52 with a pension, has 2 houses and
raised 2 kids. that sounds almost impossible these days.

------
anovikov
Maybe it's fracking?

------
jstewartmobile
I think US healthcare is poisoning people. Every office-dweller is on proton-
pump inhibitors, SSRIs, or both. In most cases, the PPIs are there to treat
people who have wrecked their GI tracts by popping ibuprofen once or twice a
day. Every older person is also on statins. Then there's the oxycontin
dominance in the red states.

People constantly going to the doctor over side-effects and dosage level
adjustments. Doctors just see them as walking wallets, and prescribe a new
pill to cover the old side-effects with new ones.

Your liver and your kidneys can only take so much--see the dialysis centers
popping up all over the place...

~~~
volkl48
No, people are poisoning themselves.

~40% of the US population is obese and in total, ~72% of the US population is
overweight (including those classified as obese).

Every doctor I know would prefer you to eat and move/exercise appropriately
rather than prescribing you drugs. That's the preferred treatment and would
prevent many of those issues.(especially when you also include other basics of
a healthy lifestyle, like sleeping enough and not abusing substances).

However, as is obvious, most people are unwilling to actually do what's
required for that. So doctors are left with trying to mitigate symptoms or
reduce harm without being able to tackle the cause.

\----------

It will be interesting to see what happens in the coming decades elsewhere in
the world, as most of the rest of the world is rapidly catching up to the
unfortunate "norms" of US weight problems.

I suspect you will see the prevalence of many of those ailments rising
elsewhere in tandem.

~~~
jstewartmobile
No, medicine is. If "healthcare" didn't offer alternatives to getting your
shit together, people would either get their shit together, or die.

From past life expectancy stats, the former happened more than the latter.

Also, recent US life expectancy decline can be accounted for, _entirely_ , by
prescription opioid epidemic.

iatrogenics

~~~
ntsplnkv2
People do die. Most complications due to unhealthy lifestyles are causing
people to die earlier and more often, or live frustrating lives.

The alternatives really aren't that great. Yea, prick your finger every day
and regulate your sugar so you don't die or get sick. Fun.

The reality is, food is designed to be addicting to sell more food, just like
everything else in our capitalist society.

