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U.S. Life Expectancy Falls Further (wsj.com)
209 points by Thorondor 83 days ago | hide | past | web | favorite | 266 comments



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I can think of a few other causes like sickness being a potentially bankrupting event so people don't go to a doctor when they should or too late.

This apparently is a risk, even if you have insurance because you are at the mercy of insurers not tossing you out over such whimsical reasons as pre-existing conditions or other bureaucratic tricks they use to kill their customers rather than getting them cured.

There are also these mafia extortion schemes that are completely legal where you have to pay through your nose for insurance in exchange for the privilege of not being charged tens of thousands of dollars for completely routine stuff like broken bones or other things that can and will go wrong for most people at some point. This is not a thing in most modern countries other than the US. Even many third world countries tend to get organized on this front to the best of their abilities.

Then there is the widespread obesity because of corn syrup being a heavily subsidized food ingredient (got to help those poor republican voting farmers). Also it seems there is a whole legislative game around shameless advertising on products where products that contain obscene amounts of corn syrup are advertised as "fat free" instead of "don eat this you stupid fat F*".

The reason for the drug overdoses is decades of shameless attempts by big pharma to coerce the US government on not cracking down on their quite successful attempts at selling heroine disguised as pain medication roughly at the same time when the war on drugs was a big thing. This too is much less of a thing outside of the US where pain medication tends to be very strictly regulated and not advertised every 10 minutes on TV.

In short, the above is the result of decades of misguided policies, failures to regulate, and greedy companies getting away with stuff they shouldn't get away with and lobbying successfully to get away with ever more.


> people don't go to a doctor when they should or too late

I saw this when travelling in the US for work. (I am Canadian). Striking up conversations in restaurants I met staff that worked while sick because they couldn't afford to take sick days, or worked with chronic conditions because they couldn't afford a visit to a doctor.

Even worse are the major chronic diseases from our lifestyle (hypertension, diabetes, etc). These are largely preventable or manageable with early care. But, if folks don't see their doctor then the severity of the disease grows until treatment becomes something major like surgery or an ER trip (both much more expensive than preventive care).

In short. Yes, the US healthcare system is broken. Interestingly one political party's solution is to blame a past president and continue to undermine what you have, while the other party is content with the existing for profit model.


> the US healthcare system is broken.

s/healthcare//


Yeah it's not just the healthcare system as that example shows. Imagine GP visits were free for that service worker. They still wouldn't go, because paid sick leave isn't mandated by law, so going still costs them money. And even if they do go, unpaid, they have no security in their employment as they can be terminated for any reason at all with no notice.


Many people are just too stubborn to go to the doctor. And many people go, knowing they can’t pay, because they’ll just never pay the bill and will dodge the bill collectors. Plenty of people receive free healthcare in the USA by virtue of never paying, but getting treated.

It’s the middle class who pays their huge bills. Insurance doesn’t cover why these days and deductibles are insanely high. The poor get treated and just skip out on the bill.


The "middle class" you're referring to is literally everyone who has insurance. This has nothing to do with income. Non-payment is not the cause of the high prices. The system is broken in a number of ways. Premiums are a crazy percent of income, putting them out of reach for people who don't have employer subsidized plans. Even then, those employer subsidized plans get more expensive and provide less with each re-enrollment. Here is a small personal example of someone who works in tech for a very large enterprise and is lucky to have the means to handle it: I went to the ER for an issue, admitted for 6 days with a myriad of tests to diagnose. The total bill for that was over $100k. Even though I went to one hospital nearly, $40k of those billings were "out of network" and I had no choice in the matter. I easily met my high deductible but, there were still random bills "not covered". That made my part nearly 10k. This open enrollment period, my employer has decided to drop all "out of network" support because only 10% of the workforce used it in the past. So, if I were to have an issue like this again, my part would be in the neighborhood of $50k for a few test and few days in a bed. That's a scary prospect for a lot of people. For some, letting a bill like that go to collections may be their only option.


Uh, despite what you have heard about the ACA (obamacare) it actually did do a number of good things. One of which is limit total yearly out of pocket. So if you have insurance (no matter how bad) your max out of pocket is capped.

For 2018 the individual limit was $7350,

https://obamacarefacts.com/health-insurance/out-of-pocket-ma...

Which granted is a _LOT_ if your making $30k a year, but its not the instant bankruptcy many people discovered themselves in after situations like yours where the out of pocket for "good insurance" could easily go over $100k for fairly limited hospital says.


Yeah, you're right, goddamn poor trying to be healthy when they can't afford it. Only people with money deserve health!

What's your proposed solution? Just murder the poor to balance the system? Which is, after all, what we already do, we just disguise it as "choice".


One of the problems is that it is expensive. More expensive than it has to be.


> And many people go, knowing they can’t pay, because they’ll just never pay the bill and will dodge the bill collectors.

Most providers (outside of ERs and the mandate for emergency stabilization therein, and some free clinics operated as charities) won't provide treatment without proof of insurance and any required co-payment upfront, or, for private pay clients upfront payment or fairly strong proof that payment will be collectible.


I think that's what he's saying - they go to the ER.


Yesh, but ERs are limited in services provided. The mandate they face with regard to service independent of payment is stabilization, not full-scope general medical service.


Going to the ER is a very common thing for many people. Even for cold and flu. So yes, they aren't getting general exams or long term care. They are getting immediate symptom based care in the most expensive way possible. This goes back to the issue mentioned above. People wait too long, go to the ER when it hurts but, it's too late.


There's another group of people like me. I have a good job, with good health benefits. I haven't been to the doctor for myself in probably a decade. I just don't like doctors.


> I just don't like doctors.

Why? They're there to keep you healthy. Yeah, sure it can be uncomfortable talking to a doctor about personal health issues, but it's better than waiting until it's too late and finding out that "if only you'd come sooner, we could have helped".


Our understanding of the human body is very rudimentary. Basically doctors are people who memorized a bunch of questionable info and try to guess what to do. Give people in that situation access to highly concentrated chemicals and extremely sharp objects (eg scalpels and syringes) and you really shouldn't expect much.

Like Feynman said though, if you are deathly ill in the jungle you would rather go see a witchdoctor than some random person. At least they will have some experience caring for the sick.


So do you stand by your words? Do you have a a Do Not Resuscitate order? Would you reject emergency surgery after being shot?


>"So do you stand by your words?" - Yes

>"Do you have a a Do Not Resuscitate order?" - No

>"Would you reject emergency surgery after being shot?" - No

I suspect the real problem here is with your reading comprehension though.


> They're there to keep you healthy.

This is probably the issue under contention. I don't like doctors either (or really the entire medical establishment). Some part of that is a belief that they aren't in fact there to keep you healthy. No I'm not trying to argue something like profit motives or whatever driving an unethical effort to make you dependent instead of healthy, or say doctors shouldn't exist, or that I wouldn't go to one if I thought I needed medical care, just that I don't like doctors or the systems and methods they operate under (some by force). nonbel unpacks one aspect of the dislike, The Elephant in the Brain unpacks another aspect (e.g. by the finding that people who receive free healthcare consume a lot more medicine but aren't any healthier, which wasn't actually surprising for me to hear!), and there are other aspects for my dislike too.


Mostly this. I think most doctors mean well but but when you go looking for problems that you are trained to find you usually find something, and medicine is so defensive these days due to malpractice litigation that nothing even slightly anomalous is ever ignored.


> medicine is so defensive these days due to malpractice litigation

Is there any evidence of this? I've seen malpractice litigation similarly cited as one of the reasons behind the the high cost of health care in the US (which is also frequently disputed [1])

[1] https://www.nytimes.com/2014/11/04/upshot/malpractice-reform...


They can do harm too. In my personal experience, they have caused much more harm than good. Not saying that for everyone, but ymmv with doctors.


My dad is dying from a 20 cm tumour right now. He has insurance but put up with the pain of a growing mass in his pancreas and stomach for months because he didn't like going to the doctor. Had we picked it up early, they could have operated and put him on immunotherapy.

Please, go to the doctor early and regularly. It's not worth it, trust me.


> "Had we picked it up early, they could have operated and put him on immunotherapy."

Your story could be helpful to others. According to the doctors:

1) What is the years survived estimate of this vs doing nothing in your fathers situation (age, stage, etc)?

2) What are the side effects (and in general the quality of life) after/during this treatment vs doing nothing?

Also, these should both be some sort of histograms or at least ranges.


My grandfather was born in the 1890's in what was then called Indian Territory (aka Oklahoma). He refused to go to the doctor for his entire life. He had a heart attack at ~70 and died a week later in the hospital. No procedures, drugs, waiting rooms, or paper work. I really admire that approach.



They never pay the bill, because they can't.

Do you understand how insanely expensive healthcare in this country is, especially if you're making minimum wage and have dependents?

What do you suggest they do instead? Die? Let their kids die?


It's not clear to me that @bluedino was arguing that people who can't pay for health care should go without. Instead, to me, the comments merely stated that such people can get access to health care. They can do this either by subsidized treatment, or by not paying the bill. We probably all agree that the US system has many flaws, but it is worthwhile to recognize the various routes to getting treatment.


First, if you're making miniumum wage, don't have kids.

If you do, you (or at least your kids) likely qualify for Medicaid, so you do get treatment. Often preferentially. I have been to providers who have a 6-8 week lead time on appointments for new private insurance patients, but Medicaid patients get in almost immediately.


Making minimum wage can happen years after having kids. I know a guy with two young kids who lost his job and is now making ~35% less. That’s not the kind of thing you can know ahead of time.


So part of your solution to healthcare is poor people not having kids? How do intend we accomplish that?


Not GP, but I read that more as "if you can't afford something, don't do that thing" coupled with "kids are not an exception to the previous recommendation".

It's not a matter of forcing that decision on people, but rather having the same expectation of personal choice and responsibility for that choice that we have for other health matters (exercise, diet, smoking, alcohol use).


Yes, well stated.


Yes. I think we need stronger education in middle school and high school as to what kids cost, and what they deserve in terms of a stable home and parenting, education, etc. And to not have kids until you are in a position to provide those things.

It's a biological drive so it's tough. But I think we could do better. We're too sensitve that we might be "poor shaming" or such nonsense to even discuss it these days.


> I think we need stronger education in middle school and high school as to what kids cost, and what they deserve in terms of a stable home and parenting, education, etc. And to not have kids until you are in a position to provide those things.

That's mostly value indoctrination (both the what they deserve part and the “do not do X if you cannot do Y” part fairly directly,and also the “what they cost” if it focuses on what a preferred approach costs rather than the costs of a spectrum of choices), not education.

> It's a biological drive so it's tough

It's also an economic choice, which is why birthrate declines with strength of social safety nets.

(Which is also why strengthening the social safety net is probably a better approach than trying to shame people into not reproducing.)


shameless advertising on products where products that contain obscene amounts of corn syrup are advertised as "fat free"

Ah, yes. In the US, Twizzlers are a "Low fat snack": https://www.hersheys.com/twizzlers/en_us/products/twizzlers-...

In Canada, just candy: https://www.hersheys.com/twizzlers/en_ca/products/twizzlers-...


In my teens (90s) I knew an overweight girl who would eat hersheys chocolate syrup straight from the bottle as a "dieting" snack. Her understanding was that it was fat-free, hence non-fattening.

It's sad how much this misunderstanding of fat being fattening has permeated the US population to this day. All the false/misleading information in product advertising has definitely played a significant role, it should be made illegal and enforced with stiff fines.


Twizzlers are a low fat snack. That is 100% true.


It's also 100% misleading. I know people on HN love to be technically correct, but come on buddy...


Belgium here.

Do you want understand the cause behind the healthcare faillure in the US ?

Just take a look at the chart of the halthcare sector index of US Stock Market.

If I remember well, healthcare was once considered as defensive sector in bear market... Now, it beats, by far, even the financial sector in bull market.


Because wealthy aging boomers spend more on speculative anti-aging fads in a bull market.


Also because the us healthcare market is for profit and they have managed to blocked market reforms.


Lots of sectors of the economy are for profit, but they follow the S&P instead of leading it. Healthcare used to be a follower too. Now it's a leader.


Government regulates and manipulates health care to such a degree that its hard to even suggest a free market is anywhere close to what is observed.


So why do the countries with even more heavily regulated "socialist" healthcare (most other developed countries) deliver the same quality at half the price?

To front-run the complaints, "same quality" does depend on specifics. The USA really does lead the world in breast cancer and diabetes treatment. It is in the middle or back of the pack at nearly everything else, though, including cost, which is >double, even for treatments without quality to match. Most people would not pay >double for this if they had a choice.


> So why do the countries with even more heavily regulated "socialist" healthcare (most other developed countries) deliver the same quality at half the price?

They don't. They offer different services at lower overall cost. Cancer survival rates are the highest in the U.S., mostly because people don't like to die, and the U.S. is (by and large) stinking rich. Here in Ontario, I got a double ear infection (from swimming in lake Erie a few days before symptoms started), and was prescribed a combination eardrop. I'm under 25, and do not have private supplemental insurance, but I expected something like this to be covered by OHIP+; turns out they decide not to cover it unless you've been experiencing symptoms for almost a full month.

I ended up paying (it wasn't so bad, honestly) out of pocket for it, since my jaw was almost completely seized up at that point.

Now, you expect something like this to be covered, but these particular drops (I guess the doctor assumed I had supplemental insurance, or knew I would prefer this product [it worked very well and was easy to administer]) are not covered except as a last resort.

In the U.S. system, the majority of people pay for the privilege of at least partial coverage of more convenient/effective (but more expensive) medical products and services. The U.S. market produces high demand for medical products and services, and by-and-large has more disposable income, so prices can be higher.


It's not just healthcare, and it's not just the US. Dig deeper, look at the ex-Nazi bank called B.I.S. See how much Tether they printed in 2009.


> people don't go to a doctor when they should or too late.

Absolutely, I saw this when working in the US at age 23 (I'm Australian)

A good friend separated his shoulder while snowboarding and couldn't afford the surgery, so did nothing. To me this was staggering, and I had no idea people in "good" countries lived like that. Growing up in Australia this is unheard of.

His shoulder is still screwed, 15 years later.


>his too is much less of a thing outside of the US where pain medication tends to be very strictly regulated and not advertised every 10 minutes on TV.

I've never seen a commercial for a pain medication or opioid, they're usually for some heart/skin condition, ED, STD treatment, or something related to aging.


https://www.smithsonianmag.com/science-nature/how-advertisin...

This paints a bit of a different picture ... I imagine somebody cracked down on this more recently.


I meant within the last fifty years and on TV.


> Then there is the widespread obesity because of corn syrup being a heavily subsidized food ingredient

You forgot to mention that the US Gov't also subsides the other side via food stamps, which poor folks use to purchase corn syrup and cheap grain foods, further exasperating the obesity epidemic. It's true insanity.


There aren’t many differences between the food purchases of SNAP and non-SNAP households[0]. While Food Stamp recipients are more likely to be obese, there is not a strong correlation between that obesity and the food stamps [1].

[0]https://www.jacobinmag.com/2017/01/food-stamps-snap-welfare-... [1]https://www.theatlantic.com/health/archive/2017/05/the-messy...


It gets more insane. I've also seen that in some places they instituted a "sugar-tax" but the federal government intervened and made an exception for people paying with food stamps: https://www.chicagotribune.com/business/ct-soda-tax-food-sta...


"... which poor folks use to purchase corn syrup and cheap grain foods ..."

This is true. It is truly insane that public food benefits can be used to buy soft drinks, sugar cereals and candy:

"Soft drinks, candy, cookies, snack crackers, and ice cream are food items and are therefore eligible items"[1]

[1] https://www.fns.usda.gov/snap/eligible-food-items


It doesn't seem insane to me, just a reflection of the reality that people sometimes buy unhealthy foods - for both legit and frivolous reasons.

Sometimes your kid will only eat sugary cereals for breakfast, because children can be fussy eaters. Or maybe you want to kick back with a can of Coke after a hard day at work (or need the caffeine to wake up for work in the morning, and coffee is too expensive). Or you want some Snickers bars to take on the train or bus to snack on. Policing what kind of food people spend their food stamps on seems like a pointless waste of time and government resources to me.


Let me guess...American? Because coming from outside, the way you pile sugar into everything (including breakfast) is just insane and aa little stomach churning.

Obviously it's a bit nurture on both our parts, but sugar for breakfast is crazy, as is being taught that things like soda or snickers should ever be eaten except for in exceptional/celebratory circumstances.

One needs to be taught that those food stuffs are acceptable and gain a palette for them, because foreigners find your food sickly sweet. Clearly this is a policy/cultural thing...


Guessed wrong! I do live in the US at present, however.

> Obviously it's a bit nurture on both our parts, but sugar for breakfast is crazy, as is being taught that things like soda or snickers should ever be eaten except for in exceptional/celebratory circumstances.

There's always a gap between how things should be done and how they are actually done. I personally don't eat sugary cereals, or drink soda. I like sweets and candy and I'll admit it's a struggle to control sometimes, especially when I'm stressed out. I won't judge someone in far worse circumstances than I for indulging in sugar - it might be the only good thing in their life. And I don't approve of government resources being spent on checking what kind of food people eat - you can get far more bang for your buck elsewhere.


> Sometimes your kid will only eat sugary cereals for breakfast

Present healthy food. Vary it day over day in case they really do have some strong dislike for something. If they don't eat it, they weren't very hungry. They will eat cereal every time you give it to them, no matter how hungry they are, which is part of the problem. Do not feed them crap because "that's all they'll eat".


I don't have children. I have friends who have children. I don't know if you have children. I have seen that children can be stubborn in their eating habits - I know I was.

Low-income parents may be hesitant to introduce new, healthy foods to kids because if the kid doesn't like it, it's time and money wasted (assuming the parent can't finish it). They're more likely to buy something the kid is sure to eat.

> If they don't eat it, they weren't very hungry

That's what I think to myself also whenever I see a parent running after a child trying to feed them. But parents can't seem to find peace unless the child finishes their meal. I've also heard children get cranky because they're hungry, but don't eat because they haven't learned that it will make them feel better. Being in that situation as a parent seems horrible. I'm willing to believe that stressed out low-income parents would rather that the kid eats anything, even crap, than face a meltdown.

> Do not feed them crap because "that's all they'll eat".

If I ever have children, this is my plan. But I have also heard that plans don't survive contact with the enemy...


Yeah, I've got three of the little buggers. Thanks for keeping it civil, I could have been less blunt in my initial response.

I'm a little sensitive to this one because my wife and several of my friends are teachers and I gather it's really, really common for even fairly well-off kids' breakfast, every day, to be a couple pop-tarts. Which is a dessert, and isn't even on the healthier end of that category. As long as that continues to be as normal as it is, our obesity epidemic's going no-where.

Definitely don't blame low-income folks for doing what they need to do to get through the day, and yeah, food waste can really suck when you're not handing your kids hyper-palatable food for every meal, with the extra kick in the teeth that the hyper-palatable stuff's often easier to prepare. I mostly just weep for the future when I hear about the clearly-middle-class-or-higher folks doing that, or see them feeding their kids snacks (almost always crackers or similar) in the store to keep them docile, or whatever.

> If I ever have children, this is my plan. But I have also heard that plans don't survive contact with the enemy...

It's for sure harder to do it right. Snacks do shut them up, and in that weeks-to-months period when they just won't STFU at the store damn it, you do wanna just shove some crackers in their face so they'll quit making a scene. But if you do you'll have to keep doing it and then you're the parent with the six-year-old still snacking in the store. They will eat crap for any meal at all, or between meals, because it's crap and tastes freakin' amazing. That's the point of it. You just gotta suppress fear of judgement and keep in mind that the (medical) pros say skipping or picking at 50-60% of meals is totally normal for kids, and they will not starve themselves into ill health just because green beans don't trigger the same primal OMG-I-need-more-of-this responses as Doritos do.

The only place this is hard for us is with the grandparents. OMG there's no stopping them short of just cutting them off, which is too harsh for us to stomach. So much junk food. But that's how they eat too—they just don't get it, and that kind of deep cultural difficulty with food is why it's such a pain to do things right on an individual level. And school-provided lunches are pretty bad. The ones around here, at least, are clearly designed to shove as many calories as possible into the poorer kids, damn the nutrition and good eating habits.


The government ought to be in the business of making sugary drinks and snacks subject to the general market (I.e., through eliminating subsidies for corn and refined sugars) and not trying to become experts in what should and should not be in poor people’s shopping carts. Restrictions like that only lead to people selling their benefits at a loss for cash to get what they want.

Reducing food deserts, increasing healthy food programs for children, and eliminating market distorting subsidies are less paternalistic and more effective.


The amount of money we just gave Jeff Bezos for putting a headquarters near his new house would fund the entire US food stamp program for a week or two, or if you prefer depth instead of breadth, would fund food stamps for hundreds of thousands of people for the rest of their lives.


And with the returns from that money "we just gave" Bezos, we can fund many times that. And if "we" don't get that return? Bezos doesn't get that money.

The winning localities and companies offered $2 billion in rebates to amazon over 10 years, conditional upon job and revenue targets that guarantee the localities and companies are getting multiple times the rebate amount. https://en.wikipedia.org/wiki/Amazon_HQ2

Marketwatch put the local economic contribution at up to $17 billion per year (not per 10 years like the $2 billion). https://www.marketwatch.com/story/amazons-hq2-could-bring-lo...

Sounds like an amazing ROI.

My only question is, how can I give Bezos money for that kind of guaranteed return?


To be fair, it's much easier to separate "food" from "not food" than to have to qualify whether any particular product is "good" or "junk" food.

Can you imagine the additional bureaucracy needed to classify (and enforce) the use of food stamps on a more granular level?


They seem to do just fine with the WIC program. Make food stamps just like WIC.


Or just give people cash and let them make their own decisions.


Are you arguing that poor people would live longer if they had less money for food?


No, of course not! Just pointing out the craziness of how the system actually works.


How do food stamps add to the craziness if they're not making things worse for the recipients?


They give the recipients the ability to get unhealthy food at the cost of the US taxpayer. This causes multiple issues that affect all taxpaying Americans in addition to the cost of the food subsidy, including adding to the cost of providing healthcare (pushing up premiums, etc).


It seems counterintuitive that having unhealthy food increases healthcare costs over not having enough food. How does that work? Is it because they don't live long enough to accumulate medical expenses? That still doesn't sound like a net win for taxpayers.


> shameless advertising on products where products that contain obscene amounts of corn syrup are advertised as "fat free"

And there are "low carb" products that contain an obscene amount of fat.

If people can't count calories, that's their tough luck. It's not rocket science.


In my experience, high fat isnt an issue since it makes you feel full... as long as you also aren't eating a lot ( > 20-100 g/day) of carbs. The real problem is they started pairing sugar and corn syrup and grains in general with high fat food.


> high fat isnt an issue since it makes you feel full

High fiber carbs and protein make you feel full too.

> The real problem is they started pairing sugar and corn syrup and grains in general with high fat food.

aka: calorie dense foods. Also, it's the type of grains they use - low fiber, high GI - not grains in general.

Individual bodies' responses to fat/carb ratios, while different, are marginal, and orders of magnitude less important than total calorie consumption - especially when overeating.

If you're eating 3,000 more calories a day than me, it really doesn't matter that your body, for example, stores 10% more fat from carbs than mine does.


You will just have to try a low carb diet for a week or so to experience the reduced "hunger". It is quite amazing to learn that half the feelings of hunger you feel are due to carbohydrate addiction. You may also experience withdrawal symptoms very similar to those of quitting smoking.


> It's not rocket science.

Yet there’s no reliable research that proves how all of that works in most people nor how the situation can be solved at large scale. I think it’s a way harder problem than flying rockets.


Eat fewer and burn more calories. It's a simple recipe that is supported by the bulk of scientific research.

Educating people, modifying their behavior, and increasing their willpower and persistence is what's difficult - that's a sociological problem and I agree, a hard one. The actual physical mechanism is simple.


> The actual physical mechanism is simple

Sure. Running faster is also just increasing the power to weight ratio.

You are technically right, but nobody doubts the high level physics of it, it’s the biology part that is complex.

Even leaving aside socio-economic factors and pure behavior issues, it’s not just a “throw things in and you can predict what goes out”. Knowing how different bodies manage food intake, food processing and retention, then come up with a calory burning budget is damn hard. We’re not pipes, a lot of things happen in the body.

I know it’s so much more comfortable to think it’s simple, but I think we need the courage to accept it’s not as straightforward as motivational poster would want us to believe.


I thought preexisting conditions was eliminated by the ACA? Also corn syrup is not the real culprit. It is just overeating in general. Portion sizes are huge in the US compared to the EU.


The issue with corn syrup is mostly that it made it cheap for producers to load up their food with it. And most people like sweet food, so they eat more and buy more.

Corn syrup isn't really any better or worse for you than cane sugar, it's just a lot cheaper.


Preexisting conditions are still a thing if you cannot afford normal health insurance because you are self-employed and have to scrape by on short-term health insurance. It sucks.


The decline is mostly the product of an increase in drug overdose deaths and suicides (likely also related to drug abuse[1]). Cancer mortality is continuing to decline which is nice to hear:

"Earlier this century, the steady and robust decline in heart-disease deaths more than offset the rising number from drugs and suicide, Dr. Anderson said. Now, “those declines aren’t there anymore,” he said, and the drug and suicide deaths account for many years of life lost because they occur mostly in young to middle-aged adults.

While progress against deaths from heart disease has stalled, cancer deaths—the nation’s No. 2 killer—are continuing a steady decline that began in the 1990s, Dr. Anderson said. “That’s kind of our saving grace,” he said. “Without those declines, we’d see a much bigger drop in life expectancy.”

Drug-overdose deaths skyrocketed between 2015 and 2017, particularly for adults between ages 25 and 54. The main culprit was fentanyl and other synthetic opioids that became pervasive in illicit drug supplies in the U.S. around that time.

Deaths from synthetic opioids rose 45% in 2017, while the death rate from heroin, which had risen sharply after 2010, was flat."

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499285/


> The decline is mostly the product of an increase in drug overdose and suicides

The US is pretty much also the only country where suicides are increasing.


Are there other countries where the news media is as hell-bent on stoking the fires of craziness and painting the world as a horrible, horrible place full only of strife and despair?


The big change relatively recently is that suicides in rural areas are now far higher than urban. Have you been to a rural area in the US recently? Most have been completely hollowed out - there is no hope in a lot of these places. The despair there is real.


Can you be more specific than just 'rural'? I've been through middle Illinois, Iowa, Nebraska and Kansas and those areas seem mostly fine to me. Is it because rural farming is still ok but other rural like appalachia or rural Montana isn't doing well? Specifically where is hollowed out?


I took a road trip through the Northern states, WI, MN, SD, WY, it was truly depressing. Some of these towns were just shells, no interesting businesses, tiny run down houses, shuttered buildings, the only buildings that were open were the post office and a couple diners or gas stations. I don't consider that mostly fine, it was sad.


I think OP was probably referring to the 'dead Main Streets' and 'neighborhood near the plant that closed is totally struggling' phenomenon. I've been around the same areas and see seriously struggling places. When I was growing up, the Main Street was a little better but still bad, but the new strip mall stores/outlets/Walmart out by the highway were doing great. Now, the stores around the Walmart aren't even alive.


I've seen what they described in Texas, Virginia, Utah, etc. I suspect that it is like this throughout much of the southern United States. People are born in places that cannot provide them an adequate living, and then they are too poor to leave. It's a pretty hopeless situation to become trapped in.


Basically a lot of the "rust belt" areas like Ohio, Kentucky, large swaths of Pennsylvania, parts of Virginia, etc., and also rural areas of southern states that were always below average or poor are now downright destitute.


India


Has a declining suicide rate. The rate is higher than that of the US, but improving, while the rate in the US is getting worse.


The question was about the media, not the suicide rate.


I suspect it's because we hate poor people and think any form of welfare is "Russian Communist Socialism"

When it comes to spending on social welfare, the U.S. is at the low end of the spectrum relative to Western Europe. For example, only 18.8 percent of the U.S. GDP is spent on social welfare, while most of the OECD nations spend at least 25 percent of their GDP. Our rates of suicide are increasing while their rates fall.

of course it's way more complicated and nuanced than my one example.

edit - no? is this wrong?


not sure exactly why you're being downvoted, but you probably should justify why "percent of GDP spent on social welfare" is the relevant comparison here. the US is in the top quartile of OECD countries for GDP per capita, and has over twice the GDP per capita of the lowest quartile countries. if they spent the same percentage of GDP as the other countries, they would be spending vastly more per citizen.


Suicide rates in several other developed nations are either higher or compable to the US. Things must be really, really bad in Belgium, Finland and Iceland eh (you know, just three of the nicest countries on Earth). How could Sweden, France and Australia be anywhere near the US rate?

Suicide rates in order per 100k: South Korea 20.2, Belgium 15.7, Japan 14.3, Finland 13.8, US 13.3, Iceland 13.3, France 12.1, Sweden 11.7, Australia 11.7, New Zealand 11.6, Switzerland 11.3, Ireland 10.9, Canada 10.4, Norway 10.1

Others in Europe: Russia 26, Lithuania 25.7, Belarus 21.4, Ukraine 18.5, Latvia 17.2, Estonia 14.4, Hungary 13.6, Moldova 13.4, Poland 13.4, Slovenia 13.3, Austria 11.4

Why are Europeans killing themselves at such high rates?


I think it is rate of change which has people concerned. The rate of suicide in the US is up 25% in the last 15 years.


> The US is pretty much also the only country where suicides are increasing

So the initial assertion was not compelling.

> it is rate of change which has people concerned.

Do you have any source about people being concerned (what people?) for the new goalpost?


Note that the majority of the mentioned countries are relatively small. The rates in the largest ones - that is Germany, France, UK, Italy and Spain - covering more than half of the European population - are much lower than in the US.

The elephant(s) in the room is(are) of course Russia and within the EU - Poland(population: 38mln) - but in these cases the explanation as to why it happens is pretty obvious.


One possible explanation is that Europeans are not killing themselves at significantly higher rates but that coroners in the US are less likely to classify a death as a suicide relative to coroners in Europe. There are a lot of cultural taboos in place. Again, however, this is just supposition.


Belgium has decriminalized euthanasia, maybe that plays a role...


Should euthanasia be included in suicide rates though?

Honest question, I really dont know.

Having a terminal illness at age 90 and being clinically depressed at age 18 are very different things (obviously).


Weirdly in Belgium this appears to be specific to the Walloon west of the country.

All the other European ones you mention other than Finland (where the suicide rate is believed to be linked to being dark for half the year) are Eastern european former communist states. There's still a lag in healthcare modernisation there.


> "Drug-overdose deaths skyrocketed between 2015 and 2017, particularly for adults between ages 25 and 54. The main culprit was fentanyl and other synthetic opioids that became pervasive in illicit drug supplies in the U.S. around that time."

CDC wonder[1] has data from 1999-2016, when I plotted the appropriate ICD-10 codes[2] I found this is a misleading way of describing the data: https://i.ibb.co/N9Fqmxd/CDCmort.png

You can clearly see that deaths attributed to these codes in those age groups have been increasing since well before 2015, basically since the data became available.

[1] https://wonder.cdc.gov/mcd-icd10.html

[2] https://news.ycombinator.com/item?id=18561136


The opioid epidemic is an amazing example of human psychology and the power of a visual. More people die from it every year than Vietnam, yet there's been no large public outcry to resolve the situation because it isn't right in your face like a 9/11 or pearl harbor. Even ignoring the human impact and just going to economics, those lost lives will cost the US billions in lost productivity over time, yet nobody really cares.

Honestly, somebody should make a Kony2012 style video about it. It was a sham but I can still remember how viral that thing went, because it hit all the buttons of human psychology.


Someone replied to you with an ignorant comment that was deleted. I'm copy/pasting it here anyway because they are spewing common misconceptions that need to be squashed.

> The US has 330 million people. Do we really care if a bunch self-select out of the gene pool?

While some people do choose to use drugs with their own free will, this epidemic isn't about that. Many people getting addicted have been initially prescribed the pain killers by a doctor for medical reasons and then got addicted. They didn't use recreationally.

It's thanks to these ignorant comments that make them fearful of seeking help with the addiction.

The was on drugs and the stigma it brings continues it's devastation...

> The only way I would care is if I found out that a foreign power was behind this, i.e. getting people addicted to deadly substances in order to undermine our country. If it's just jackass flunkies doing it because they're jackass flunkies, then I'm just glad they aren't on the highways.

It's not a foreign power, it's our own pharmaceutical companies attacking our citizens.

From lobbying against medical marijuana as an alternative pain killer to pushing false information on doctors and patients about the addictive nature of their drugs.

But pharmaceutical companies don't fit your typical stereotype of a villain and they flood our politics with cash, so they are getting away with murder.

Finally, people regurgitating the garbage like "self-select out of the gene pool" are also a major part of the problem. How someone got addicted to drugs shouldn't be important. Whether It was due to recreational use or by a prescription, they need help and should not be ostracized.

Our public funds should go to recovery centers, not law enforcement for victimless drug use.

There are plenty of laws on the books to arrest someone who harms another, whether on drugs or not. We don't need laws specifically for drug use. Those people need medical help, not jail.

edit: typos


I hate pharma companies too, and think they definitely were a part of the gateway to addiction, but you should read more about how the overdoses are occurring.

As another user pointed out below: > "Drug-overdose deaths skyrocketed between 2015 and 2017, particularly for adults between ages 25 and 54. The main culprit was fentanyl and other synthetic opioids that became pervasive in illicit drug supplies in the U.S. around that time."

> "Deaths from synthetic opioids rose 45% in 2017, while the death rate from heroin, which had risen sharply after 2010, was flat."

Also: https://www.theguardian.com/society/2016/may/10/fentanyl-dru...

Synthetic opioid overdoses: https://www.drugabuse.gov/related-topics/trends-statistics/i...

People end up ingesting shit they don't even know about that's in their drugs (like chinese fentanyl) and then accidentally OD. It's still bad to overprescribe drugs, and this shows more legalization/regulation of drugs would be better to not have supplies randomly cut with whatever products some dealer has laying around.


You're missing the link. Here's the chain of events for this epidemic.

1. Doctors over prescribe opioids and poorly monitor patient addiction.

2. Eventually, doctor cuts off patient.

3. Addicted patients turn to street drugs, like Chinese fentanyl.

4. Street drugs have unreliable dosage and ingredients, making it easy to accidentally overdose.


> It's thanks to these ignorant comments that make them fearful of seeking help with the addiction.

I'm not sure the comments are made out of ignorance as much as desperation.

Imagine an audience member telling a DJ: "Hey, I liked your stuff. But I kept hearing a bunch of pops and clicks in the music. Was there something wrong with your system?"

And the DJ says, "No, my system was just discarding the samples that self-selected to miss realtime deadlines. Good riddance, I say!"

We need a name for this fallacy: perhaps the "Unsampling Fallacy?" That is, morally attacking samples in an attempt to characterize the very system for which you were supposed to analyze those samples to gain insights into it.

It's glaring with the DSP example but insidious when it's humans being sampled.


Seems their comment is gone too. I’d love to have been given the chance to downvote them.

To me this all boils down to what you’re saying, but I’d like to just add mention that i think the bigger disease in the US that enables situations like this is the acceptance of misinformation. As you pointed out, many many many of these cases are started by a medically issued prescription, and it kills multiple times more people than recent wars or terrorist related acts, yet anyone who drives action here is often labeled as “helping junkies that don’t deserve help”.

In the very near future when climate change has destroyed our way of life, and one of the few nations that was capable of doing something is finally and certifiably recognized as having sat by and done nothing, i hope the world takes note. These are the kinds of acts of neglect that make Nero famous, and while i don’t want their names remember, i do want the world to move on from the US being seen as the worlds police and freedom fighters. If Kama is real, the US should be concerned, and as someone that is a close neighbour, it terrifying to think how that will flow on to impact the rest of us.


> i think the bigger disease in the US that enables situations like this is the acceptance of misinformation.

It's amazing how many Americans are actually proud of their ignorance.


> It's amazing how many Americans are actually proud of their ignorance.

It's also amazing how many Europeans think they're somehow different.


You can still see the comment if you go to your settings and set "showdead" to yes. I'm guessing it was flag-killed for being inflammatory?

But to take it seriously, what fraction of opioid deaths started from a prescription?


>"In the very near future when climate change has destroyed out planet"

Maybe people are killing themselves because they are addicted to the fear porn spread by mainstream/social media regarding "climate change". I don't mean this as a joke, I was addicted to financial/economic fear porn for a bit and it did have a negative effect on my outlook.


Climate change is on track to cause catastrophic damage in the next few decades AND there is no indication of anything being seriously done about this. In other words, a train is barrelling and, crucially, there are no signs of anyone intending to stop it. Yeah, I think it's justified to be scared.


I believe the parent's point was not about the veracity of climate change, but rather the impact of constant exposure to fear.

Herbert's quip that "Fear is the mind killer" is apt.

Research (has hit the HN front page several times) bears out the fact that constant exposure to stress decreases IQ.

Ergo, the first step to most effectively combating anything is to accept it, but NOT give in to fear and despair.

Climate change is real. We are not doing enough to counteract it. But we can.


There was just a recent discussion here about this and every time I asked for sources and then checked that is not what was found in the primary sources. The catastrophic outlook is created by a few people and amplified by the media as clickbait, not any sort of scientific consensus or track record of successful predictions.

You can go through my recent post history to find it.


While our media does abuse fear as a way of getting attention, the opioid epidemic has direct lines to pharmaceutical companies.

People dying from their addiction aren't killing themselves, they are struggling to survive.


Economic collapse and climate change are very different. Climate change news does not evoke the emotion of fear, but rather emotions of disappointment, lament, and anger.


If you think the economic system is scammy, but most people just won't listen, you will experience the exact same emotions you list. So I have to disagree.


The main "fear porn" here that I think relates, and it's more of a tangent than any direct connection, is the propaganda associated with the War On Drugs, just as a comparison to the realities of the opioid epidemic. Some of the issues that were associated with various illegal drug epidemics were legitimate (particularly addictive substances that had the potential to destroy your health like heroin and cocaine), but the propaganda ended up being a moral panic implemented for sometimes questionable (possibly tribalism oriented) reasons, where a few substances (some of them, like cannabis, being relatively harmless) ended up getting demonized, a way-too-high amount of Americans got arrested for trifles as a result, and so forth. Ironically a large portion of the drugs in this epidemic were not in this much demonized category.

Back on topic, the "messaging" here that directly relates, as far as the opioid epidemic goes, is the opposite: the lax regulation of the marketing for prescription drugs. Purdue Pharmaceutical was allowed to engage in a lot of aggressive marketing courting physicians with plenty of symposiums and swag. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2622774/) The marketing hugely downplayed the addiction potential of Oxycontin, over-promoting the use cases and underplaying risk. (Along the way you get some IMHO absurd swag like an Oxycontin-sponsored 50s swing music compilation -- https://www.reddit.com/r/SwingDancing/comments/593xof/til_th... -- I mean, what?) This helped contribute to the opioid over-prescription problem.

Sober, fact based analysis -- present in neither of the above scenarios -- unfortunately is in short supply these days.

Personally, I haven't seen the sort of aggressive marketing you see in America for prescription drugs in any other country -- at least, I don't recall seeing the sort of direct-to-consumer prescription ads anywhere else, (I was able to find articles that said DTCA is quite restricted in Europe --https://www.pharmafield.co.uk/in_depth/pharmaceutical-direct...). I think pharmacy-to-physician marketing is still allowed in most places, but the above shows that work needs to be done to ensure that this marketing also is sober and fact based. Even physicians can be persuaded by "marketing swag". (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623540/)


Not that I consider the "war on drugs" to be valid in any way, but I haven't seen anything involved with it that is in the same category as the genre of "news" I am talking about:

https://www.urbandictionary.com/define.php?term=Fear%20Porn

https://www.urbandictionary.com/define.php?term=doom+porn


Have you been living under a rock or is my definition of large public outcry vastly different? I hear about this more than I hear about climate change issues (but not as much as about gun violence, which causes far fewer deaths in the US).

But what causes far greater deaths than even opioids, is avoidable medical errors. It's quite difficult to stop a highly addictive class of drugs which is backed by big business (legal or illegal). But that many avoidable medical errors in 2018, despite the high barriers to become a doctor?

Maybe we shouldn't be treating this opioid problem so gravely after all. The more serious, more deadly, more costly problem of avoidable medical errors could be even the root cause of the addiction epidemic.

I spent the better part of my adult life as an addict, and yet not one doctor out of the many that I saw acknowledged or noticed. Furthermore, on the occasions I did muster enough courage to ask them if the drugs were causing harm (three different non-opioid drugs at different periods of my life), I was shrugged off, the doctors saying that my symptoms do not match up, or otherwise downplaying the situation. I needed hard evidence that what I was doing was actually harming me or I saw no incentive to quit. By the time one does enough chronic use to be at risk of death, I imagine the addiction and habit is far too strong to easily break. So I'm of the opinion that the root cause is with the medical profession's apparent limitations.

It's often very hard to get medical help in general until something is plain and obvious, highly common, or literally killing you, with the evidence needing to show up on examination or test. This is something that I could be vastly improved with AI doctors and open access to anonymized health data. But given how much of a fight the taxi cab driver union puts up (with self driving cars and even Uber), I won't hold my breath for the AMA to get behind the idea.


People have gone to a lot of effort to convince their fellow Americans that those that die from opioids deserve it. I'm sure some will turn up in this thread.


"Deserve" is going overboard, but there's certainly a moral difference between something that happens due to one's own choices, vs. something that happens because it was compelled.

It's reasonable have more sympathy for a conscripted soldier killed in a foreign war he had no desire to fight in than an opioid addict that died from a result of choosing to do drugs.


You're perpetuating a myth that drug use is all about personal choice. Many addicts started with prescription opioids, recommended by their doctor, and only moved to more dangerous options once their doctor's supply was extinguished. Doctors themselves over-prescribed these to attack pain, meanwhile they were being lied to by pharma about the addictiveness of opioids. On top of that, you have fentanyl being added to heroin to increase its potency, and also vastly increase the mortality rate.

Finally, it may be hard for those of us who were never addicted to opioids to understand. It no longer becomes a simple choice when your body is extremely sick if you don't get your dose. This is one reason why a drug addict might steal from those they love, their illness is literally the most important physical sensation at any moment, overcoming familial and societal norms. It's a scourge and illness, not merely a choice.


It's not going overboard. I've heard more than one person refer to it as Darwin at work or "they deserved it for being weak"


Of course, someone could be both. Veterans have elevated risks of both drug use (often related to injuries) and suicide due to PTSD.

https://centerstone.org/news-events/news/opioid-crisis-impac...

The permanent war has long term casualties.


I actually don't think that those people really have any significant voice at all, let alone the ability to persuade anyone. Sympathy for the victims of the opioid crisis is one of the few things that spans the political divide; the right sees the outsize devastation it has on their rural constintuencies and the left wants to expand healthcare and decriminalize drugs. The only people I can imagine saying "they deserve it!!" are befuddled leftover Cold Warriors who still see Nancy Reagan every time they close their eyes, or else just transparent trolls who get off on inciting others. Sadly, it just so happens that those same people are in control of the government.


> those lost lives will cost the US billions in lost productivity over time

It's so strange how prevalent it has become in the past few years to talk of human beings in terms of productivity. Growing up in the 90s, all the talk was about how we were mindless consumers. Now, all I hear is people talking of others and themselves as producers and productivity. How they feel about themselves and their worth depends on whether they had a 'productive day'. What does that really even mean? It's amazing how quickly the vernacular changes.

Never in a million years would I have ever thought of someone dying and juxtaposing that with productivity. Why even bring it up? Are we here just to produce for society or the wealthy or the government? 20 years ago, would we have been upset at all the consumers or consumption being lost through suicide and death? We are talking of others and ourselves like farmers talk about produce and livestock. Maybe that's what modern society has reduced us to. Livestock that needs to produce.


Reporting on productivity change is a reasonable way to quantify the social impact of a phenomenon, which allows people to compare it in scale to other issues, and prioritize scarce resources accordingly. Of course it's imperfect, and data is lost compared to a qualitative assessment of individual lives. But can you think of a consistently better quantitative measurement? Longevity?

We've recently seen a lot of coverage of the forecast that climate change could cause a 10% reduction in GDP by 2100. Your objections apply to this measure equally. But by quantifying the magnitude we can compare it to things like the cost of remediation.

Quantifying an effect also has the benefit of exposing the estimate to more effective refutation. The more numerate debate we subject policy preferences to, the stronger they'll be.


This seems like a prevailing attitude, but I think it is based on a debunked thought processes.

People used to think that heroin or other substances were inherently addictive in and of themselves. This was because of experiments on mice in Skinner boxes. But that is not how addiction works. Addiction is, in great measure, the result of animals being unhappy and trying to do something about it.

This has been proven both in humans and in mice. Mice, and humans, generally don't get addicted when they have good things to do.

To focus on the opioid side of our social dysfunction is just as useless as focusing on any other SYMPTOM of dysfunction.

When I hear people talking about how horrible the epidemic is, I can't stop helping thinking of a flu analogy:

This sniffling epidemic is really terrible. We should ban sniffling because sniffling people suffer, we need to protect them* if they sniffle. But let's not worry about people washing their hands... that's unrelated.

* Generally implied is that by protecting people it means putting people in cages if they disobey our social commands.


I heard an interesting podcast about how the pain scale used in hospitals and clinics is directly responsible for the opioid crisis, and it was intentionally designed to sell pain killers. You know the sheet you get when you visit a doctor that asks “how severe is your pain on a scale of 1-10”?

The well intentioned scientist (June Dahl) who championed the widespread adoption of the pain scale recalls that when she was giving talks about it and it started to get a little traction, the pharma industry started pouring money into her campaign. At the time she thought it was just unbiased grant money without an agenda, but she later realized the intent was to sell more drugs.

https://www.gimletmedia.com/science-vs/opioids-how-america-g...


I think it's the same issue as the prison population being so enormous. When someone does crime/drugs the country collectively just thinks that these people did it to themselves.

I've heard people casually refer to criminals/addicts as animals, it's ridiculous.


Yes that's sad. But consider: what would you call someone who injected strangers with noxious drugs and enjoyed their torment? An animal? Is it so big a leap to think the same, when they're doing it to themselves?


No, no person is a animal and it's misguided and inappropriate to make the comparison.

People who behave cruelly aren't animals, they're people who behave cruelly and we should seek to minimize/stop their cruelty and ability to inflict it.

Drug users, willing or no, also aren't animals. Drug users who want to stop should be given all the tools necessary to kick their habits. Drug users who don't want to stop should be given the tools necessary to reduce the harm to themselves and to society.

Anything else is barbaric.


Technically, we are animals.


We're not discussing taxonomy, so this is completely irrelevant.


Yes, it's a major leap and the fact that you can't see it is concerning.

If you are enjoying someone else's tourment, especially after you inflicted that tourment onto them, then you are a psychopath.

People who take drugs aren't taking it for the hangover, they are taking it for the high. If you remove the tormenting hangover, 100% of users would be fine with that.

You should seek psychiatric help and I'd be happy if my tax dollars were used to help you with your mental problems.


Ha! Just playing devil's advocate, to help folks understand the alarm with which some folks see drug abuse.

I actually work in helping abusers control their addiction. I have all the access to mental health services I need, thanks.


What would you call someone who compelled strangers to buy low-quality things they don't need? What would you call someone who tricked children into getting addicted to mobile games? What would you call someone who knowingly buys products manufactured under poor labor conditions? What do you call someone who willingly eats meat produced in cruel environments?

You can play this game all day. This isn't the point. They're all people — they have families, wants and needs, they dream at night. They're all just trying to get by one way or another. They're no more discardable than you or me.


This "I'm not arguing this, but it could be argued" is such a waste of time.

If you say it's "not so big a leap", make the argument? After all it doesn't matter if a leap is big or not, that's always related to the gap it needs to cross. If argument holds and you end up on the other side, it wasn't so big a leap. But it's pointless to talk how a leap is feasible instead of simply making it, leaving that as some sort of exercise for the reader.

I guess it would be actually two arguments, 1.) calling sociopaths animals 2.) the equating of injecting others with something for the purpose of torturing them with injecting oneself with drugs, for the reasons and purposes people actually do that.

Not sure how you would funnel the wide variety of reasons people end up addicted to drugs into something that could be compared with a single situation and motivation like that hypothetical torturer, but then again you haven't made the argument yet, so maybe you know something I overlooked.


Your premise seems to be that all death should evoke equal concern. I think people being forced by threat of violence to commit violence against another group of people and dying during it is far worse than someone chosing of their own volition to use a recreation drug and making a mistake with their own life.

I'd bet many people share my differentiation. I don't think it's primarily a 'visual' difference.


Some blame needs to rest on the shoulders of the CDC, even the AMA[1] has come out against the guidelines the CDC put up over two years ago that others have used as guidance, incorrectly. The CDC needs to clarify the guidelines or just flat out back off so that those in pain and prescribed pain medication can get it. Far too often the guidelines are being used by non Doctors to deny needed medication

https://www.painnewsnetwork.org/stories/2018/11/14/ama-calls...


More people die from it every year than Vietnam

[Kind of off-topic] I'm guessing you mean by 'than Vietnam', 'than Americans died in the Vietnam war"? (Well I think so. Apologies if not.) That's a pretty macabre unit. Can you imagine how a Vietnamese person would feel reading that? Maybe in Vietnam they say 'More people die from [something] every year than America' - meaning what they call the American War[0]. Wouldn't that sound super-weird. That's something like how what you said sounds to me. Only for them it would mean 1-3 million.

[0] or the Resistance War Against America.

edit: Downvoter, care to explain how I can improve my comment? Thanks.


I'm downvoting because you are getting offended for others (I'm assuming you are not Vietnamese). Avoiding common expressions because you are trying to guess that someone might be offended is going too far in caring and politeness.

ps. You could also use car deaths per year (somewhat similar number) but then anyone who has lost relatives in car accidents might get offended by using these macabre numbers.


They are just using synecdoche. From the context of the comment and the shared culture of the audience people can understand what they are talking about. It's no different than how people in America know that if you talk about changes in government policy after "nine eleven" you mean the terrorist attacks not the sports car.


You're being pedantic for the sake of outrage.


>You're being pedantic for the sake of outrage.

Eh no.

Imagine you're sitting in Canada and say "The opiod epidemic kills more people annually than WW II", and then when confronted, you say "Of course I mean Canadian lives in WW II!"

Americans may only see 55000 deaths in Vietnam. The rest of the world (and HN is international in audience) sees a lot more.


Possibly a better way to put it is to simply point out that the war caused something like 1.3-4.2 million deaths.

A similar bit of misfocus shows up in comments about the Holocaust, which technically refers to the 6 million Jewish dead rather than the estimated 17 million total.


[flagged]


Please don't be a jerk on HN, regardless of how wrong someone is or you think they are.


Drug overdose and abuse seem to me to be a symptom of something way more troubling. I can't help but feel like there is a sense of uselessness felt by and toward a large population in the US and rather than lift them up we are letting them be snuffed out.


> Drug overdose and abuse seem to me to be a symptom of something way more troubling.

A general feeling of disconnectedness? Perhaps some existential dread in there. The United States (by and large) used to be lashed to religious moorings, which provided some sense of purpose and moral grounding, as well as fending off pesky questions like "what happens to me when I die?"

The statistics that claim the US is still largely religious are hallow. People wear labels of their religion as a means to exclude or silently signal 'better-than-you', when the purpose and message of those religions has nothing to do with that.

I don't mean to say lack of religion is the primary cause of our opioid epidemic, rather a significant contributing factor.

I would venture a guess that things like easy access and over-prescription also play a role.


Something else to consider: In many oriental countries such as Japan and China, people used to live with minimal influences from religions. There are buddhism presence here and there, but buddhism itself is very non intrusive than abrahamic religions.

I lived in northern Europe for a couple of years and it seems to me northern/western Europe is also much less religious than US, without a opioid epidemic.


I'm honestly shocked how American doctors seem to give out opioid prescriptions for any illness or pain. I've not once heard from somebody here (Germany) that was prescribed opioids by their dentist after a surgery. They usually tell you to take some tylenol and rest at home, I've never heard of somebody getting opioid for that. But I've heard it mentioned multiple times regarding american dentists.

There surely are more examples where the docs seem to be a lot less careful about giving out these drugs. Also I think, and that's not only regarding the US, but all of the world, people should be getting way more education about what these drugs are, what they cause, how they should be taken and how you should stop taking them / what risks it bears if you don't.


> People should be getting way more education about what these drugs are, what they cause, how they should be taken and how you should stop taking them / what risks it bears if you don't.

My experience is that it's too complicated for people. My parents can just about understand don't take more than 8 paracetamol/tylenol per day, or don't take advil if you've got high blood pressure, but any more complex than that and they just can't really understand it.

They can't (or don't want to) understand that certain antibiotics mix poorly with alcohol (Don't drink on antibioitics) or that some painkillers are _not_ suitable for hangovers (headache == tylenol). They don't understand how statistics of side effects work (10% of people have one or more of the following side effects means "It won't happen to me"), or that some supplements can interfere with medication (warfarin and St Johns wort), and that this is bad, even though they're not medicines.


>The statistics that claim the US is still largely religious are hallow. People wear labels of their religion as a means to exclude or silently signal 'better-than-you', when the purpose and message of those religions has nothing to do with that.

Among people younger than about 60 or so I've noticed the reverse being far more true. People don't broadcast how religious they are. People are much more likely to broadcast things like what you're saying which is fairly insulting. You're message basically boils down to "most people who believe they are religious are just in it for the virtue signaling and therefore are doing religion wrong" which is pretty insulting to anyone even remotely religions.

I personally don't think religion has a large effect on opioid use or suicide but if it does have one it's a positive one. Nobody ever got hooked on drugs or attempted suicide because their life was fulfilling and on a track to get better. People do drugs and kill themselves because they are in despair and feel like there is no way out of their situation. If anything religion would act as a positive outlet for those feelings.


> I personally don't think religion has a large effect on opioid use or suicide but if it does have one it's a positive one.

That was my point.

As for insulting people, that isn't my intent. I have only my own observations to go on, and I don't know other people's situations or story, especially religion. My personal experience has been rather shallow. No one asks hard questions, no one talks about God unless they're forced into it, especially at church.

Part of my (rather sad) interpretation of my experiences is that I have questions that are hard, that no one wants to answer. And I'm not able to ask those questions and get a useful answer. So, my interpretation is stained.


> Part of my (rather sad) interpretation of my experiences is that I have questions that are hard, that no one wants to answer. And I'm not able to ask those questions and get a useful answer.

That's unfortunate. However, there are people who are not at all afraid of the hard questions.

I see from your profile that you're at UW Madison. As it happens, I know such a person there. (He's almost certainly going to become my son in law.) If you want someone to deal seriously with the hard questions, contact me at mikestimpson (at) yahoo (dot) com.


What do you mean by hard questions? Does it include things like "what happens after we die?"?

I think those questions are best answered by religion, but religion is being attacked, or at the very least, excluded in most thought-provoking venues.

Take for example the school that reject have Chick-fil-A on campus because of its (Chick-fil-A's) religious leanings[0]. Or the fact discussing religion on this very website is generally frowned upon - though that seems to be a reaction to people's recent animosity towards religion.

[0] https://abcnews.go.com/US/wireStory/school-blocks-chick-fil-...

----

That said, I think religion can have a very real effect on opioid use/suicide, depending on the religion. See for example Utah, where the opiod rates, suicide rates and pornography rates are above average. I think that's a result of a complex interplay of factors. I think the gist of what's going on is that the "mormon" culture has squashed many visible vices - smoking, alcohol consumption and physical infidelity. Combine that with a streak of being judgmental / people trying to fit in (TGF, not in all places), and you get an over expression of harder to see negative effects: pornography consumption (though maybe Utahns just pay more for it... being more honest about it?), opioid use, and depression leading to suicide.

----

With all that said, (disclaimer: I'm a member) I think the Church of Jesus Christ of Latter-Day Saints has plenty of missionaries who love to talk about (and answer) the hard questions (if I'm interpreting your post right). And I'm willing to talk about them too (my username as a gmail account). I'm not sure the answers will be satisfactory to you, but I've found them useful.


> Take for example the school that reject have Chick-fil-A on campus because of its (Chick-fil-A's) religious leanings[0]. Or the fact discussing religion on this very website is generally frowned upon - though that seems to be a reaction to people's recent animosity towards religion.

That article you linked seems to suggest that the school doesn't like Chick-fil-A's leanings towards gay rights. Do you tie gay rights into a religious ideals?

Is it animosity towards religion, or is it animosity towards anti-gay forces? I for one have certainly met militant atheists, so I'm not going to pretend that militant atheism doesn't exist, but they're a very small minority of people.

Most atheists I've seen are willing to listen to me talk to them about religion. They're curious, growing up with a life without religion, and they are interested in what growing up in a religious family is like. But where the line is drawn is when rights of others are trampled upon.


Interesting. I did not realize the history behind Chick-fil-A. I stand corrected - that was a poor example. The extent of my knowledge there was the christian underpinnings of Chick-fil-A's founder and the statements made in the article.


Yeah, I'll again say that I've 100% met militant atheists before and they're quite an annoying bunch. But...

> The extent of my knowledge there was the christian underpinnings of Chick-fil-A's founder and the statements made in the article.

In the majority of these cases, people usually don't care about religion, as much as political views. IE: They may be pro-choice (while religious are typically pro-life), and that's what they're really annoyed about.

Or in this case, the Chick-Fil-A situation is 100% a gay rights issue more so than anything else.

Even the "Satanic Temple" is really just a bunch of trolls / a political group who are mostly concerned about separation of church-and-state issues. The "Satanic Temple" just uses the same tactics as right-wingnuts do: "Trigger the snowflakes". In any case, the entire strategy is to try to make the other side look bad by trolling and acting worse. I severely doubt that anyone in the Satanic Temple actually worships Satan, they seem to be atheists / secularists for the most part.

------------

Again, militant atheists who look down upon religion certainly exist. But they aren't commonly in major positions of power in my experience. So I'm always weary when any group blames things as a "War on Christians".


CFA was not blocked for its religious leanings, but "based on the company's record widely perceived to be in opposition to the LGBTQ community".


>used to be lashed to religious moorings, which provided some sense of purpose and moral grounding, as well as fending off pesky questions like "what happens to me when I die?"

I don't buy this for a second. There is a notable, consistent correlation with economic viability (lack thereof) and perceived/real economic inequality and the negative effects these have on a population. Drug use, mental illness, even infant mortality.

This is what is happening. People don't have good jobs, they don't have a good education (and in some cases their education doesn't net anything), and they don't have a "purpose." You don't need to invoke whimsical images of non-sense to guess at why people feel useless and/or are seeking drugs.

* https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2652881/

* https://www.equalitytrust.org.uk/drug-abuse

* https://www.equalitytrust.org.uk/mental-health

We are actively wasting multiple nations' resources and people's own personal lives over absurd policies and to cater to a very tiny portion of the population who is already rich beyond anyone's dreams.


> and they don't have a "purpose."

I guess I didn't state my case clearly. My point was (in part) that religion can provide purpose if people lean into it the right way, and that having a purpose can stave off the desire to be numb - emotionally and physically.


>My point was (in part) that religion can provide purpose if people lean into it the right way

There isn't evidence that being involved in a religion alleviates or negates any of the effects/correlations that were presented earlier.

It might seem reasonable to suggest that religion gives people purpose, but again, it actually doesn't really affect what we're talking about. There are extremely religious communities who have extremely high drug use and mental issues per capita. There are extremely religious communities who do not have those issues in the same significant manner. The main factor setting them apart is the economic environment.

The only things (relevant to the current discussion and context) that help out with these issues tends to be economic stability and viability.


> uselessness

Also see anomie [1]

[1] https://en.wikipedia.org/wiki/Anomie


Never heard of this but it definitely resonates.


as someone who often feels useless (more like impotent rage most times) I can totally see why some people chose the path they chose.


Just you wait until all the jobs are automated and most people only have arts or person to person services as potential.


I think you're reading too much into the epidemic. Availability and over-prescription is the primary cause. People aren't prescribed opiates for depression for instance, but the over-accessibility to opiates allows for illegal use to take place more easily.


Note that if you are in the demographic of well educated and high income Americans, your life expectancy is still quite high and you should assume you will live to your 90s when planning for retirement!

The decrease in life expectancy observed is being largely driven by people on the middle to lower portion of the income spectrum. It's very unfortunate that it is happening and so many people are struggling. Hopefully our country can come up with solutions to help out people who are struggling with addiction and poor health.

But, it's important to remember that if you are not in that demographic, you are still likely to live a very long life and need to plan for that.


The article is about the trend - not the absolute numbers


A lot of premature deaths are not just a direct result of suicide or drug abuse, but a deeper result of despair and isolation. Improved healthcare would help, but I feel like it's a cultural issue as well.

My grandfather died in his early 70's a few years ago. By any other measure, he should have lived well into his 80's. He had a comfortable middle-class life and was quite healthy when he was younger. But he spent the last decades of his life in rural Maryland with very little social contact. My family rarely visited him. For reasons I'm still unsure, my dad didn't talk to him for almost 2 decades. His physical and mental health really disintegrated.

My wife is from India, and I'm convinced that this sort of thing is more rare there. There is a strong, almost sacred connection between family members. If your parent is sick or unwell, you bring them into your house and take care of them. No questions asked. For the most part, the culture in (white, middle-class) America looks at things very differently, and I'm not really sure what the solution could be.


And subtract 5.5 for Native Americans https://www.ihs.gov/newsroom/factsheets/disparities/

Native Americans on reservations have free health care from IHS https://www.ihs.gov/ https://www.ihs.gov/forpatients/faq/


This seems like a case of temporary circumstances and statistical creating a doomsday picture. The temporary circumstances seem to be the suicide rate brought on by the still recovering economy and glib life prospects. Partly related to this is a new deadly drug that is gaining popularity.

Add to this the statistical factors like the anti smoking and healthy living campaigns hitting their peak effect a few decades after improvents in modern science hit their peak effectiveness.

To me, it seems like life exectancy will improve again as the economy improves and governments find ways to fight fentynal.

Improving life expectancy maked great advancements in healthcare and sanitaion and lifestyle in the past. As these improvements seem to have peaked I dont know that life expectany is still a good indicator of progress in rich nations


> To me, it seems like life exectancy will improve again as the economy improves and governments find ways to fight fentynal.

I find this exceedingly difficult to believe in the rural areas of the US. The current expansion is almost the longest on record, going on since 2009. The structural forces that have hollowed out the economies of rural areas (widening inequality, e-commerce, globalization, etc.) are only increasing, not decreasing. The drug overdoses may be caused by powerful opiates like fentanyl, but the drug use is mainly a symptom, not cause, of despair.


[flagged]


Please don't take HN threads into nationalistic flamewar.


If China can stop fentanyl from pouring out of their country, why can't the US stop it from pouring in?


I suspect that if a different country started producing fentanyl on the scale that China does, but offered it at a 10% reduced price, we would purchase the drug from that country instead.

then the blame would shift from China to the new country.

maybe instead of blaming others, we should fix ourselves. stop buying cheap dangerous drugs and decriminalize the drugs we do have


I haven't read anything yet on the source of the fentanyl, do you have a worthwhile link?


It's relatively well known that if there's a chemical you want, there are several factories in China that will make it and ship it to you.

Anabolic Steroids are one example, Fentanyl is another, I'm sure there are many more.

For example I wouldn't be surprised if there's a black market for agricultural chemicals that are banned in the US but you can get them from China.



> This seems like a case of temporary circumstances and statistical creating a doomsday picture.

It's definitely intellectual fraud. This is a life expectancy projection for babies born in 2017 and it's assuming the opioid overdoses (the recent scale of which didn't exist ten years ago) continue unabated for seven or eight more decades.


It’s remarkable how much of the article narrates a tale of opioids and suicide, whereas the obvious elephant in the room seems the be the poor, or lack thereof of a public health care system.


Um, the article specifically mentioned that

>the drug and suicide deaths account for many years of life lost because they occur mostly in young to middle-aged adults.

Hence their large effect on life expectancy.

Of course healthcare effects life expectancy but the net effect on overall life expectancy has been small because half-assed legislation has ensured that recent gains for the poor and sick have come at the expense of the middle class and healthy.


See my post here: https://news.ycombinator.com/item?id=18561136

Depending on how the data breaks down that could just be a narrative they are pushing for whatever reason. The "overdoses" include poisoning by pretty much any drug.


More money is spent on public healthcare in the US than private healthcare.


I dont disagree that public healthcare would improve life expectancy but it wouldn't cause a decrease in life expectancy as healthcare is not any less accessible today than in the past


Citation needed, if only because of the increased expense.

Also, public heath care plays a massive role in opioids treatment and suicide prevention, at least in developed countries.

What seems to be clear is, unless the issue if acknowledged, the US will continue to slide literally to developing countries life expectancy levels.


I wonder if I should be concerned. If I simply avoid opioids and suicide, I'm safe?


It depends. Do you attend a high school in America?


Is this a reference to shooting deaths? If so, you should be aware that there are ~100 mass shooting deaths a year despite the sensational coverage they get in the media. America does have many more gun deaths than other countries, but the majority of those deaths are suicides and a majority of the homicides are in high crime areas. This is a problem that we can address, but mass shootings, though tragic and terrifying, are not a large public health issue.


The intentional murder rate in the US is around an order of magnitude bigger than in most countries in Western Europe, Australia or Canada. If you think that’s not an issue, I guess I must disagree.


I do think that's an issue, and I said it's one we can address. It's separate from the issue of mass shootings in schools, which is what I was commenting about.


Can someone explain the link of the lowered life expectancy to flu and pneumonia? I thought that these were deceases that were only fatal for people with compromised immunity.


No, they are not. They are likely to be much more dangerous for those groups, but the flu or pneumonia can kill anyone.

Some strains of the flu are believed to be more deadly to the "strong" patients, due to a phenomena known as "cytokine storm" - where the strong immune system response directly contributes to death.


The 1918 flu strain was unusual in that it was more effective in killing previously healthy adults because it stimulated an immune system overreaction. So having a weakened immune system when exposed to this H1N1 strain actually increased survivability.


The 1918 flu was exceptional in that aspirin recently became a generic drug and the recommendation was to soak the patient in it. The symptoms of aspirin poisoning are similar to those of pneumonia (the main cause of death via flu).

>"In February 1919…Edward's fever kept getting higher and higher…aspirin…was given to him by the 1/2-handful over and over…Edward sweated through his mattress…Dr.…could not save his patient.

[...]

A confluence of events created a “perfect storm” for widespread salicylate toxicity. The loss of Bayer's patent on aspirin in February 1917 allowed many manufacturers into the lucrative aspirin market. Official recommendations for aspirin therapy at toxic doses were preceded by ignorance of the unusual nonlinear kinetics of salicylate (unknown until the 1960s), which predispose to accumulation and toxicity; tins and bottles that contained no warnings and few instructions; and fear of “Spanish” influenza, an illness that had been spreading like wildfire." https://academic.oup.com/cid/article/49/9/1405/301441


Flu and especially pneumonia can be deadly to anyone just a lot less likely. Since the seasonal flu variate in intensity appended with off-season flu's added to the death rate from this kind of diseases. Just a hypotheses though, nothing concrete.


If you get the flu as a healthy adult, you're statistically likely to be fine, but you absolutely may die, especially with some of the nastier strains.


I'd guess that drug addicts having compromised immune systems are increasing deaths from these.


Wow, maybe (not being sarcastic) eating a monocultured food diet and living as sedate humans in sterile environments has a bigger effect on our immune systems than we'd like. This must have been measured? Compare immunity in farmers vs office workers or some such?


I'd have thought, if anything, that a farmer living in a rural environment saw less exposure to (human) diseases than an office worker in an urban environment. They have far less exposure to _people_, after all, and people are generally the main carriers.

Also, basically no-one works in a sterile environment. There's a reason that so many places have hand sanitiser dispensers.


I think you underestimate the amount of bad health environments there are in cities (anecdotal evidence only). I would not call most cities or working environments anywhere close to sterile.


To be honest, nobody is talking about very deadly exposure to pesticides in farmers populations. There actually have been papers published on that. While living outside a big city might be on average better for you, being a farmer is probably not.


Right; nobody was talking about that.


Nor anything close to a spoonful of soil on the bank of a pond outside a city?


Actually: lots of people bring a lot of diseases with them, so it you judge by germs, I would argue a city with buses, train stations, airports and harbors would be worse than any soil outside of it. Though it says nothing about food, can't argue there. Though (from experience) "farmers" tend not to be too broad in their nutritional uptake and eat mostly the same where I come from as people in the cities. Might be different in the states though.


Its immunity before you're exposed that at issue. How did you grow up? What routine exposures did you experience?

I grew up muddy and dirty, eating anything I found in nature that was mostly edible (apples, ground cherries, berries, chewing bark and grass), as well as organic beef and pork (before we knew what that meant) and garden vegetables. That was closer to historical experience.


I’ve been re-reading the foundation series by Asimov lately. Without spoiling the plot, one common theme in the book is the decline of empire. It’s uncomforably germane.


I would like to see this correlated to access to "health care", which need not necessarily translate to improved health.

From personal experience, I have a strong suspicion that much of this "care" is actually harming people. In particular I am concerned about over-prescription of anti-pain/anxiety/depressant medications and incorrect dietary modifications (eg, to eat a low-fat/salt/cholesterol diet).

EDIT:

Very roughly, there is a link to "obamacare". From TFA:

>"The U.S. has lost three-tenths of a year in life expectancy since 2014, a stunning reversal for a developed nation, and lags far behind other wealthy nations."

>"The ACA's major provisions came into force in 2014. By 2016, the uninsured share of the population had roughly halved, with estimates ranging from 20 to 24 million additional people covered during 2016." https://en.wikipedia.org/wiki/Patient_Protection_and_Afforda...


The psychiatrist David Healy wrote an awesome, but poorly titled book called Pharmageddon just on this point. By some estimates up to 500K people a year are killed due to bad interaction with the medical system. Per a Johns Hopkins report they estimate around 180K. Its worth noting this is not just medical errors which are incredibly frequent, but much of it is due to side effects of correctly prescribed drugs.


Thanks, not sure if I would read an entire book on it though. What source of data does he use?


(On edit: below comment is retracted. At least for 2015 to 2016, the decline is not attributable to Simpson's paradox. See Table 4 in the CDC report linked below.)

This is either incompetence or maliciousness on behalf of the CDC, WSJ, or both. Life expectancy in the US is falling, but it's only falling due to Simpson's Paradox [1].

The CDC's own data [2] shows life expectancy increasing for all genders and races except black men, which decreased marginally over the last few years.

The primary reason life expectancy is falling is due to changes in the racial composition of the population, not because of opioids or suicide.

[1]: https://en.wikipedia.org/wiki/Simpson%27s_paradox

[2]: https://www.cdc.gov/nchs/data/nvsr/nvsr67/nvsr67_05.pdf (see Figure 5)


From the document you posted:

since 1990. • In 2016 compared with 2015, life expectancy decreased for non-Hispanic white males (0.2 year), non-Hispanic black males (0.4), non-Hispanic black females (0.2), Hispanic males (0.2), and Hispanic females (0.1). Life expectancy for non-Hispanic white females remained unchanged

So, no, it's not just Simpson's paradox.


You're correct. I edited the parent.


That's not my takeaway from Figure 5. The curve for "Non-Hispanic white male" seems to be dipping downward since 2014, and "non-Hispanic white female" appears to either also be decreasing or at best flatlining.


Looking at Fig. 5 you can clearly see that peak life expectancy for Non Hispanic white males occurs around 2010 then flatlines and finally heads down.


Not sure why you are getting downvoted. It is certainly possible this is just an artifact of changing demographics, or even adoption of ICD-10. It could even be that birth records are becoming more reliable than in the past so people are not overstating their age as much (eg, to collect social security).


How does that compare to other countries with changing racial composition? What has happened to black men to cause their life expectancy to fall?


A sharp rise in police killing unarmed black men, I'd wager.


AFAIK, there's been a sharp rise in people who aren't black noticing that, not a sharp rise in the underlying phenomenon.


"Life expectancy for Americans fell again last year, despite growing recognition of the problems driving the decline and federal and local funds invested in stemming them."

If lack of awareness isn't the problem, then what is? What drives people to end their lives? Is it the way we live our lives? The people around us and our inner demons telling us it's the only way to stop the pain? And would projects involving life extension work and make them not go through their plan of taking their own lives?


Measuring life expectancy from birth is more a measure of infant mortality.

The data on life expectancy from 5 years old is remarkably consistent... mid to upper 70's.

It's even more consistent when one looks at life expectancy from 21 years.

I do not have links to the charts showing this. But, last time I checked, I was quite surprised at how a sensational story about life-expectancy from birth loses much of its significance when one disregards the deaths that occur in the first 5 years of life.


My little brother killed himself last month.

My cousin OD'ed on heroin in 2016. My old classmate, 2 weeks after him - same church for the funeral.

One of my best friends killed himself in 2015.


I am so very sorry for your losses.


As with many problems in the U.S., income and wealth inequality are largely to blame: https://www.vox.com/science-and-health/2018/1/9/16860994/lif...


Stress, cancer, inactivity, obesity, diabetes, prescription and street drug abuse... doesn't surprise me unfortunately :(


Nicotine, Valium, Vicodin, Marijuana, Ecstasy, and Alcohol ....C-c-c-cocaine

https://www.youtube.com/watch?v=bAXPUN2z2CE


Visit the rural parts of the US and you'll see that see-destructive behaviors are way too common. There's no hope right now for half the country. Whatever wealth they had has been mined out.


I think we've reached the point of diminishing marginal returns to health care spending. That means when we spend more money on healthcare as a percent of GDP, life expectancy starts to fall. We are already at 16% of GDP spent on healthcare. That's double the amount that any other country spends on healthcare. We also have worse life expectancy vs. countries that spend much less as a percent of GDP than we do.

One of the most disturbing trends in American healthcare, IMHO, is that the suicide rate has been steadily rising since 2000. It's now back to where it was in the 1980s before SSRIs.


US healthcare outcomes in most areas aren't actually particularly good, though (iirc, it does reasonably well on cancer, but is under par on most other stuff). The US healthcare system is expensive because it's inefficient.


I would argue that it's expensive because it is private and unregulated.

The amount of anger the healthcare system can cause in the US is unbelievable. Example, I had a surgery that was pre-approved. Then, I received a bill for $20k. I called the insurance and they said the company wanted to charge them to much and they could not come to an agreement, therefore, they are not paying. So, I call the surgery place and told them there is no way I am paying that bill.

I kept getting bills for 4-5 years, till they settled with insurance company and send me a bill for $500. At that point, I decided just not to pay it, because it angered me so much.

Doctors are under pressure now too. There is pressure to see many patients in a day. Push drugs, vaccinations and so on. It is terrible for everyone involved except companies who benefit financially from it.


> I would argue that it's expensive because it is private and unregulated.

Oh, sure, that's likely what makes it inefficient.


Empirically, the US health care market is both the most privatized and the most inefficient.

http://voices.washingtonpost.com/ezra-klein/2010/01/america_...

https://www.eurekalert.org/pub_releases/2011-08/cu-ups080211...


That's an odd causal link to draw. For all we know, the increase in healthcare spending is what has caused the life expectancy to fall less than it otherwise would have.


I doubt it helps that anything medical related costs so much more in the US than it does anywhere else for no real reason.


It's not how much you spend, it's what you get for it.


The United States is a unique outlier due to its special healthcare structure: https://ourworldindata.org/the-link-between-life-expectancy-...

I think a better conclusion would be that life expectancy can be hardly increased with further spending in the current healthcare system.


You want a clear sign that the U.S. is failing? Here's one.

It's the short, statistical version of a thousand thousand tragic individual tales.


How is the obesity epidemic not affecting deaths?

I remember clearly nurses saying hospitals are full of elderly and obese people.


Is there any indication as to whether life expectancy has fallen for all income groups? Are there any income related discrepancies?


Rich people's life expectancy is increasing just fine, it's the poorer people that are having trouble.

Source: https://jamanetwork.com/journals/jama/article-abstract/25135...


Article:

Life expectancy for Americans fell again last year, despite growing recognition of the problems driving the decline and federal and local funds invested in stemming them.

Data the Centers for Disease Control and Prevention released on Thursday show life expectancy fell by one-tenth of a year, to 78.6 years, pushed down by the sharpest annual increase in suicides in nearly a decade and a continued rise in deaths from powerful opioid drugs like fentanyl. Influenza, pneumonia and diabetes also factored into last year’s increase.

Economists and public-health experts consider life expectancy to be an important measure of a nation’s prosperity. The 2017 data paint a dark picture of health and well-being in the U.S., reflecting the effects of addiction and despair, particularly among young and middle-aged adults, as well as diseases plaguing an aging population and people with lower access to health care.

“The continuation of this trend is a warning for all of us that our country has not found a way of addressing the profound needs of the people who are dying,” said Eric Caine, professor of psychiatry and director of the Injury Control Research Center for Suicide Prevention at the University of Rochester Medical Center. “While the economy may be recovering at the macro level, it’s very uncertain whether it’s affecting the lives of these people.”

The U.S. has lost three-tenths of a year in life expectancy since 2014, a stunning reversal for a developed nation, and lags far behind other wealthy nations.

Life expectancy is 84.1 years in Japan and 83.7 years in Switzerland, first and second in the most-recent ranking by the Organization for Economic Cooperation and Development. The U.S. ranks 29th.

“It’s significant,” Bob Anderson, chief of the mortality-statistics branch of the CDC’s National Center for Health Statistics, said in an interview. “It doesn’t seem like a lot, but in terms of human cost you’ve got a lot of life that’s not being lived.”

White men and women fared the worst, along with black men, all of whom experienced increases in death rates. Death rates rose in particular for adults ages 25 to 44, and suicide rates are highest among people in the nation’s most rural areas. On the other hand, deaths declined for black and Hispanic women, and remained the same for Hispanic men.

“These sobering statistics are a wakeup call that we are losing too many Americans, too early and too often, to conditions that are preventable,” said CDC Director Robert Redfield.

As drug and suicide mortality has risen, deaths from heart disease, the nation’s leading killer, went down only slightly, failing to offset the increases in mortality from other causes and prolonging another worrisome trend. A decadeslong decline in deaths from heart disease—brought about by antismoking and other public-health campaigns, along with medications to control blood pressure and cholesterol—has stalled in recent years, with heart-disease deaths even increasing slightly in 2015.

Earlier this century, the steady and robust decline in heart-disease deaths more than offset the rising number from drugs and suicide, Dr. Anderson said. Now, “those declines aren’t there anymore,” he said, and the drug and suicide deaths account for many years of life lost because they occur mostly in young to middle-aged adults.

While progress against deaths from heart disease has stalled, cancer deaths—the nation’s No. 2 killer—are continuing a steady decline that began in the 1990s, Dr. Anderson said. “That’s kind of our saving grace,” he said. “Without those declines, we’d see a much bigger drop in life expectancy.”

Drug-overdose deaths skyrocketed between 2015 and 2017, particularly for adults between ages 25 and 54. The main culprit was fentanyl and other synthetic opioids that became pervasive in illicit drug supplies in the U.S. around that time.

Deaths from synthetic opioids rose 45% in 2017, while the death rate from heroin, which had risen sharply after 2010, was flat.

Methamphetamine and cocaine use is on the rise in the U.S., but deaths from those drugs weren’t broken out from the total. Those statistics will be released in mid-December, in a separate report, said Holly Hedegaard, a medical epidemiologist at the CDC and lead author of the reports released Thursday on drug overdoses and suicide.

There is some hope the decline in life expectancy won’t be prolonged. The rise in drug-overdose deaths was slower in 2017 than the previous year. Total overdose deaths for the preceding 12 months dropped slightly between late last year and April, though they remain high.

“We may have reached a peak in regards to the drug-overdose epidemic,” Dr. Anderson said. “I’m hopeful, given what we’ve seen in recent months.“ But, he cautioned, “This might just be a lull.”

More federal and local resources have been devoted to the opioid crisis. States began accessing nearly $1 billion in federal grants in 2017 to combat the opioid crisis. In addition, opioid prescriptions are monitored more tightly, and medication to reverse opioid overdoses has become more available, among other factors possibly behind the tentative improvement.

Suicides rose 3.7% in 2017, accelerating an increase in rates since 1999, the CDC said. The gap in deaths by suicide widened starkly between cities and the most rural areas between 1999 and 2017, the data show. The rate is now far higher in rural areas. “There’s a much wider spread,” Dr. Hedegaard said.

“This is extremely discouraging,” Christine Moutier, chief medical officer of the American Foundation for Suicide Prevention, said of the suicide-rate increase. Studies show that traumas such as economic difficulties or natural disasters, along with access to lethal means including guns and opioid drugs, and lack of access to care can affect suicide rates, she said. More accurate recording of deaths may also have added to the numbers, she said.

Scientific understanding of suicide and its risk factors is improving, Dr. Moutier said, and new prevention programs are being implemented. But their effects have yet to be felt, because they haven’t been scaled up yet, she said.

“The science is growing tremendously,” she said. “We now have answers about how to prevent suicide.”


USA #1! You can't kill yourself as good as we can!

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