At the beginning of this month, federal health researchers reported that life expectancy in the United States in 2021 declined steeply for the second year in a row. At 76, it’s three years lower than it was in 2019. We now rank roughly 50th in the world, behind every other rich country and, it appears, lower than China. It’s an astounding and depressing development.
The biggest driver of what the Financial Times’ Edward Luce recently called “America’s death crisis” is, of course, the Covid epidemic, which has claimed over a million lives in the United States since 2020. But Covid, in and of itself is not the sole source of this decline. For one thing, the US has had substantially higher mortality from Covid than its wealthy peers because of underlying problems that also explain why we’ve not rebounded from a bad 2020, as they have. Health experts and demographers have long pointed to a variety of factors to explain why the United States does so poorly at keeping people alive. The so-called “U.S. health disadvantage” encompasses a number of intertwined pathologies contributing to our death crisis. These include expensive and often inaccessible health care, endemic chronic diseases, including diabetes, lack of exercise and poor diets driving high rates of obesity, in part the result of lack of access to good, nutritious food in many places and a level of violence unknown in other wealthy countries. So-called “deaths of despair,” charted in depth by the economists Angus Deaton and Anne Case and including fatalities from alcoholism, drug overdoses and suicide had been spiking for years. Those were all exacerbated by the epidemic, which also found fertile ground in a population especially susceptible to serious illness and mortality from the coronavirus.
Like so much else, our health disadvantage is the result of a series of collective choices we’ve made about what to prioritize and what to ignore. Expanding health care access over the past decade, primarily through the Affordable Care Act, has been a slog. Both the obstructionism of the GOP and a political system that powerful interests leverage to their advantage have resulted in a fragmented health safety net that delivers in highly inequitable ways. Those forces are transmitted through a political culture that regards the specter of “socialized medicine” as anathema. In so doing, we cut off our noses to spite our collective face. As the political scientist James Morone once put it, though Americans profess to abhor “rationing” in health care, “few health care systems anywhere are as heavily rationed as America's. [Indeed}, the first procedure in any health care setting is the inevitable ‘wallet biopsy.’”
Drilling down from those top line numbers, the death crisis has been especially dire for Native Americans and Alaska Natives. The new data show that life expectancy for that group is now a shocking 65 years, an estimated decline of six years since the start of the pandemic. Sixty-five years is the ballpark life expectancy for middle-of-the-pack countries in Africa, including Gabon, Botswana and Eritrea. And Black Americans’ life expectancy, which itself declined by three years, is now 71.5, on a par with places like Moldova, the poorest country in Europe.
Luce expressed shock that, given this extraordinary new data, it’s barely made a ripple in our political debates. But it never does. We argue vociferously over health care, to be sure. But one feature of our collective political myopia is that, except in the most simplistic and jingoistic ways, we never seriously consider why we lag behind other rich countries in such a critical area. The new life expectancy figures and the mere blip it created on our political radar is illustrative of that larger phenomenon.
In light of this new data, I’ve found it even more annoying than usual to watch Republicans bleat on social media about how dangerous and degraded “blue” cities are. For one thing, though there has been a jump in crime in cities since 2020, there has been, as my friend Tom Schaller and others keep noting, a similar or greater spike in rural areas. And the same “pro-life” forces that are so eager to point out how nasty, brutish and short life is in “Democrat” parts of the country, overlook a highly inconvenient fact. Namely, that if you look at life expectancy by state, the differences between blue and red ones is staggering. Mississippi has the lowest life expectancy in the union, at under 72 years. California’s, by contrast, clocks in at 79. For some perspective, the gap between California and Mississippi is the same as that between the US and Venezuela in 2019. West Virginia is the only other state with a life expectancy under 73 years. While there are some red states, like Idaho, with high life expectancy, the overall pattern is unmistakable - red states do worse than blue states in this most basic measure of well-being.
Demography experts will tell you that the factors contributing to life expectancy are multiple and complex. And I’m really not bringing up the red state/blue state divide here to score political points. But we face a multi-front disaster in this country, in the form of, first a flatlining, and then a sharp decline in an indicator whose increase is supposed to be the hallmark of affluent countries. The above-noted intertwined pathologies have rendered our political system ill-equipped to deal with the crisis. So, while Democrats mostly fight a series of rearguard actions to try to fortify our expensive but wanting safety net, Republicans respond with endless variations on the theme of “I know you are, but what am I.”
Meanwhile, large numbers of Americans are dying needlessly.
(I wrote an earlier plaint about this kind of “American exceptionalism,” here).
Thanks, I have thought about this, too. It does puzzle me that no Democrat seems to leverage this information when Democrats are accused of trying to be like the socialist European countries. My reply would be, "Would you rather have a life expectancy that is 3-4 years longer? Would you like the security of knowing if you have a catastrophic illness, you won't spend the rest of your life being in debt if you get treated?" And it's no coincidence. Most of the 12 GOP states refusing to expand Medicaid are in the Bottom half of life expectancy and none in the Top 15. They also have the highest maternal mortality rates, even if that number isn't high. And it's been widely reported that Trump counties in all states had in general the highest COVID-death rates. Bottom line is that GOP policies outside abortion are never as pro-life as Democratic policies. I don't think Republicans have a death wish, even if many of them would rather die than yield on their perceived liberties. But if it's a matter of ignorance, I doubt that educating them would change the political map much.