Understanding the Deadly Trip of Republican States – 04/04/2023 – Paul Krugman

Last Friday (31), Medicare advisors released their latest report on the system’s finances, containing some unexpected good news: expenses are below projections and the Hospital Insurance Trust Fund will not deplete as soon as it was predicted. .

One important reason for this financial improvement, however, is dire: Covid has killed a substantial number of Medicare beneficiaries. And the victims were disproportionately elderly people who already suffered from serious – and costly – health problems. “As a result, the surviving population had below-average expenditures.”

But Covid has killed many people around the world, so wasn’t it just an act of God? Not exactly. You see, the United States has experienced a greater decline in life expectancy because of Covid than any other wealthy country. Furthermore, while life expectancy recovered in many countries in 2021, here it continued to fall.

And Covid’s dismal US performance was part of a larger story. I don’t know how many Americans are aware that, over the past four decades, our life expectancy has been steadily decreasing relative to other advanced nations — even nations whose economic performance has been poor by conventional measures. Italy, for example, has gone through a generation of economic stagnation, with basically no growth in real per capita GDP since 2000, compared to a 29% increase in the US. However, Italians can expect to live about five years longer than Americans, a gap that has widened even as Italy’s economy struggles.

What explains the American way of dying? Much of the answer appears to be political.

One important clue is that the problem of premature death is not evenly distributed across the country. Life expectancy is wildly uneven across regions of the US, with major coastal cities not looking much worse than Europe, but the south and inland east faring much worse.

But wasn’t it always like that? No. Geographical health disparities have increased in recent decades. According to the US Mortality Database, in 1990 Ohio had a slightly higher life expectancy than New York. Since then, life expectancy in New York has increased rapidly, almost converging with that of other rich countries, while life expectancy in Ohio has barely increased and is now four years less than New York.

There has been considerable research into the causes of these growing disparities. A 2021 article published in The Journal of Economic Perspectives examined several possible causes, such as the growing concentration of highly educated Americans (who tend to be healthier than those with less education) in states that are already highly educated and the rise differences in per capita income between states. The authors found that these factors only explain a small fraction of the growing mortality gap.

Rather, they argued, the best explanation lies in policy: “The most promising explanation for our findings involves efforts by high-income states to adopt specific health-improving policies and behaviors since at least the early 1990s. At the same time, these efforts reduced mortality in high-income states faster than in low-income states, leading to increased spatial disparities in health.”

That feels right. But did high-income states adopt health-improving policies because they were rich and could afford it? Or was it because in 21st-century America high-income states tend to be politically progressive and politics, not money itself, explains the difference?

There is, in fact, a strong correlation between how much a state’s life expectancy has increased from 1990 to 2019 and its political leanings, as measured by Joe Biden’s margin over Donald Trump in the 2020 election—a slightly stronger correlation, by the my estimates, than the correlation with income.

There are several reasons to believe that America’s deadly trip is largely political rather than economic. One is the comparison with European countries, which have had much better health trends even when, as in Italy, their economies have performed poorly.

Another is the fact that some of America’s poorest states, with the lowest life expectancy, still refuse to expand Medicaid, even though the federal government covers most of the cost (and the failure to expand Medicaid is eliminating many hospitals). This suggests they are failing to improve their health because they don’t want to, not because they can’t afford it.

Finally, since the Covid strike, residents of Republican-leaning counties are much less likely to be vaccinated and much more likely to die than residents of Democratic-leaning counties — even though vaccines are free.

All of this seems relevant to our current culture war era, with many Republican politicians praising rural and red state values. [republicanos] while denigrating those of the coastal elites. Governor Ron DeSantis of Florida, for example, claims that although he grew up in Tampa Bay, he is culturally a product of western Pennsylvania and northeastern Ohio. It’s worth noting, then, that the culture these politicians want all of America to emulate seems to have a problem with one of society’s most important functions: preventing people from dying early.

Translated by Luiz Roberto M. Gonçalves

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