American Life Expectancy Drops
December 10, 2016 8:58 PM   Subscribe’s hard to deny that something truly dire has ensnared a large chunk of the country. In a country as big, complicated, and diverse as the United States, that “something” is actually a great many things, but I would argue they can be broadly summed up by one idea: what I call the “one-bad-break test.” ... In societies that function well, there are various safety nets in place to prevent a bad break from leading to a tailspin for particularly vulnerable victims. Compared to many other rich nations, the U.S. is not such a society — all too often, when vulnerable Americans encounter a bad break, there’s nothing underneath them to stop their slide. Instead, devastation follows, sometimes in the form of bankruptcy and addiction and death.
posted by Bella Donna (60 comments total) 61 users marked this as a favorite
We don’t know how bad the United States’ burgeoning mortality crisis is going to get. Russia provides a disturbing worst-case scenario. “Sometime in 1993, after several trips to Russia, I noticed something bizarre and disturbing: people kept dying,” wrote Masha Gessen in New York Review of Books in 2014. “I was used to losing friends to AIDS in the United States, but this was different. People in Russia were dying suddenly and violently, and their own friends and colleagues did not find these deaths shocking.” She went on to explain that “In the seventeen years between 1992 and 2009, the Russian population declined by almost seven million people, or nearly 5 percent — a rate of loss unheard of in Europe since World War II. Moreover, much of this appears to be caused by rising mortality,” with alcohol a prime culprit. This is what happens when the insides of a developed country begin to rot.

The United States isn’t Russia. Probably.

posted by T.D. Strange at 9:08 PM on December 10, 2016 [61 favorites]

This is the story of the last few years of my dad's life, and his early death. No safety net, and a run of bad luck, complicated by some probable mental illness. Going back generations the men in his family lived into their 90s, but he was 68 when he died last year.
posted by apricot at 9:21 PM on December 10, 2016 [12 favorites]

NPR: "There's not a better indicator of well-being than life expectancy. The fact that it's leveling off in the U.S. is a striking finding."
posted by kliuless at 9:48 PM on December 10, 2016 [6 favorites]

This is something that I think about quite a lot these days, as I progress further into middle age and see quite a few people around my age struggling.
posted by Halloween Jack at 9:53 PM on December 10, 2016 [7 favorites]

Oh apricot, I'm so sorry to hear that. For too many people, there is simply no safety net. And it's killing them.
posted by Bella Donna at 9:53 PM on December 10, 2016 [2 favorites]

I'd like every American to take a good look at figures like this and ask themselves if it's a coincidence that their children will be worse off than they are. It seems like the connection SHOULD be getting harder and harder to ignore, but the hegemons continue to offer the easy bait of brown skin, globalization, etc., and we've kept right on taking it.

My desperate hope is that the American people will finally start to understand that when you let a man like Donald Trump run the show and stock his cabinet with billionaires, Wall street executives, and oil company CEOs, the middle class does worse, not better.
posted by Vic Morrow's Personal Vietnam at 10:06 PM on December 10, 2016 [51 favorites]

Sadly, America hasn't ever had much of a safety net, so that doesn't really explain dropping life expectancies. Massive waves of opioid addiction are new though and seem to fit as an explanation. Unlike most problems, this one is pretty directly caused by government actions, and should be pretty easy to fix if our government can get its act together.
posted by miyabo at 10:06 PM on December 10, 2016 [3 favorites]

tldr: it's the rich people, stupid
posted by Vic Morrow's Personal Vietnam at 10:07 PM on December 10, 2016 [11 favorites]

Thanks Vic Morrow.

My personal favorite graph is this one. You have the 30 year period after WWII where productivity gains were shared with the people doing the actual production, and then the 40 year period after that where almost all productivity gains were captured by the 1%. And the graph makes it clear that if these gains had actually reached the working class, it would represent an approximate doubling of wages for most Americans. Which presumably would go a long way to avoiding an early death from bankruptcy, addiction, and despair.
posted by Balna Watya at 10:54 PM on December 10, 2016 [92 favorites]

And those countries with safety nets are having them eroded. In Australia you can see a doctor for free. In Joe Hockey's 2014 budget he proposed a $7 co-payment. That doesn't seem too onerous for most people, unless you have to see the doctor every week and you're on a pension. It was really unpopular and didn't pass.

Then Joe said something very revealing. In defense of his $7 doctor tax he said, laughing, 'That's as much as a cup of coffee'! I realised he's never had to buy a coffee. Some flunky just hands him one and it goes on the expense account. You could probably get $600 out of him if he broke the eggs in the supermarket parking lot. Except that would never happen because he wouldn't be there. He doesn't do the grocery shopping. He has a magic pantry that just fills itself. The Treasurer of Australia had no idea of what everyday staples actually cost.
posted by adept256 at 10:55 PM on December 10, 2016 [135 favorites]

Partners In Health, a medical charity active in Siberian prisons, Peruvian shantytowns, Haitian squatter settlements, and other places, has done good research on the dissuasive effects of copayments. For many people, even a small payment for doctor visits or medicines imposed a choice between getting healthcare and feeding their families. As a matter of human rights, PIH has always campaigned against fee-for-service, as institutionalizing inequality. I think they are right and I, personally, would have sent the National Guard to Oklahoma, Kansas and Texas to impose universal healthcare on an unwilling populace. Now see what we have: Republicans causing massive suffering and reaping the benefit of the outrage, because the victims are too effing misinformed to know whom to blame.
posted by homerica at 11:08 PM on December 10, 2016 [63 favorites]

My personal favorite graph is this one.

The graph shows non supervisory production worker productivity rises - take a common example, in automotive assembly, for simplicity, the production line used to be 50 workers in welding and 50 workers in trim final ... producing 300 cars per day. Say investors put up $5 mil to buy robots to fully automate the welding line for 3 years (at which point they need upgrading). Now the company only employs 50 workers in trim final and still produces 300 cars per day. By this measure, worker productivity has doubled from a macro point of view (which is what the graph shows), but from an individual point of view it's remained exactly the same - each worker in trim final produces the same amount of "work" as before.

The investors spent $5 mil to automate the line for 3 years, and saved $6 mil in wages, so they now pocket $1 in profits, not sharing it with the workers in trim final.

It's not clear that the 50 workers in trim final should get paid more because the welding line got automated, since they weren't the ones that invested the $5 mil to begin with, nor has their individual productivity increased even one bit...

In fact it's probably the other way around - with more automation, demand for labor falls, so wages fall further....

Basically, as its always been, capital produces profits, whether you leave it in fixed deposit and earn interest, or buy property and take rent, or invest in machines for automation in factories. The equilibrium state is all the wealth flowing to the top and this is actively counter-acted by redistributive policies from the government to force it back down: and you can see the impact of it working / not working over various periods where inequality grows larger.
posted by xdvesper at 11:20 PM on December 10, 2016 [39 favorites]

sic transit gloria mundi
posted by save alive nothing that breatheth at 11:27 PM on December 10, 2016 [2 favorites]

It's not a coincidence that the rot started after both parties embraced free trade and warmongering. Wow, what a nasty one two punch for the working class.
posted by Beholder at 1:51 AM on December 11, 2016 [8 favorites]

Yes this is me.

I can make enough money to live comfortably, and even to put away a little every month, if I'm careful. I don't have a family to support, which makes this much easier.

My comfort is entirely dependent on nothing going wrong, and when I am old--when things will certainly start going wrong, I will probably die at least in part due to lack of care. It is unlikely, at this point, that I will be able to amass enough capital to be secure.

This is the country my parents' generation made for me. Woo.
posted by Kutsuwamushi at 1:57 AM on December 11, 2016 [46 favorites]

If Democrats want a super majority, they need to embrace this slogan: Everyone Gets A Job.
posted by Beholder at 2:05 AM on December 11, 2016

2016 sux!
posted by spitbull at 3:18 AM on December 11, 2016 [1 favorite]

Wait beholder, was there a time of modern prosperity (so let's say since the 20th century started) when the US did not embrace militarism or free trade?
posted by spitbull at 3:20 AM on December 11, 2016 [5 favorites]

But what about the rich? Will the rich be ok?

Every morning I wake up in my drafty sub-$800-month-apartment to go to my less-than-minimum-wage service-industry job and as I get into my twelve-year-old 200K-miles car I think, "I sure hope the rich are ok today."
posted by BitterOldPunk at 3:40 AM on December 11, 2016 [68 favorites]

If Democrats want a super majority, they need to embrace this slogan: Everyone Gets A Job.

I don't think "Let's engage in the same bullshit dishonest demagoguery that the Republicans engage in" is a workable solution in the long term.

(Also, it's looking like if the Democrats want a super majority, all they really need to do is repair the election machine and make sure that the votes are counted honestly.)
posted by IAmUnaware at 4:02 AM on December 11, 2016 [7 favorites]

Those charts on the benefits of productivity don't take immigration, outsourcing and the female workforce into account. Many of the actual people who are the non-1% workforce that supplies American consumption today are, on average, paid a lot more than their demographic counterpart sof 40 years ago were, because they're earning US salaries and getting US public services, or at least are earning export-sector (relatively better) salaries in foreign countries, whereas their 40-years-ago counterparts were earning whatever the local demand of Mexico, India, China, etc., could pay them, or they were housewives.

So it is not at all surprising that with such a dramatic increase in supply of labor, that the price of labor would go down (or at least not rise) -- or that the brunt of that would fall on white men and black men, who are exactly the people who are facing all of this new competition.

By contrast, the 1% is about personal ownership of financial capital and about very high levels of educational attainment, and those things were already heavily globally competitive 40 years ago and also haven't been subject to as much incremental dilution by immigration or by the entrance of women into the workforce.
posted by MattD at 4:51 AM on December 11, 2016 [6 favorites]

It's the lack of meaningful self determination. Self determination, or having the stability and personal power to make goals and plans for the future and be able to reach them. Nowadays people who aren't economically disenfranchised will pick up their entire lives at a moment's notice and relocate and retrain themselves to chase work. Less formally educated and socially connected people and less competitively aggressive people and more easily trusting people are all getting their lunches eaten so often now, it's not as easy to maintain the illusion of having a meaningful say in the big picture choices that most affect our life circumstances. People just feel pushed around by all these big political and ideological shifts and fad popular movements that keep sweeping through the culture just long enough to disrupt everything but that never seem to hold influence long enough to lead to any new, stable foundation for a future.

Almost everybody's got access to cheap filler entertainment and junk food. But that's not what gives people a sense of having a meaningful life. A society that actively frustrates the ability of its people to set long term goals and make life plans and feel hopeful about achieving them--whether it's due to cultural factors, social breakdown, or political failure--is a society that feels powerless. Addiction, suicide, risk taking behavior are all behaviors commonly thought to be driven by social alienation and a psychological urge to reassert control in the most direct ways possible over one's own body and self (tragically, with the result typically being even more loss of real, practical power in the long term, because there's a tension between long term and short term personal freedom we don't always acknowledge or consider very carefully). These problems represent very common maladaptive but very normal human behaviors for coping with feeling powerless, given the statistical evidence. That also explains why we're getting so nasty with each other--the crabs in a bucket effect because there's so little practical power to go around, we scrabble and sell each other out over tiny scraps of it.
posted by saulgoodman at 5:10 AM on December 11, 2016 [37 favorites]

"The statistics hint at an underlying level of increasing misery."—Jerri-Lynn Scofield, US Life Expectancy Declines in 2015: Unintentional Injuries Rise, Naked Capitalism (9 December 2016).
posted by Sonny Jim at 5:44 AM on December 11, 2016 [3 favorites]

If Democrats want a super majority, they need to embrace this slogan: Everyone Gets A Job.

Even if they were able to deliver such a thing, it would not solve the problem at hand. Because of the way our health-care delivery system is broken, A Job does not pay your copay, or your deductible. Many of The Jobs do not pay for time taken off from work to deal with a health problem. Let's be realistic; if you give everyone A Job, most of them are not going to be Living-Wage Jobs, they're going to be Working-Poor Jobs that don't change the equations of doom in the least. In fact, lots of the people now going into free fall already have Jobs, at least initially.

Fix the god-damned health care system by going to single-payer. Then maybe those crappy jobs would actually help some people.
posted by Kirth Gerson at 5:45 AM on December 11, 2016 [43 favorites]

Wherever this trend goes, what we’re seeing is the end result of decades of slow-burn economic decline and decay, with no end in sight. You can only make it hard for people to work and pay rent and buy necessities and live so long, you can only have them living right on the brink of bad-break ruin for so long, before there will be serious consequences. And we’re seeing those serious consequences in every new set of shocking mortality statistics.

How are these statistics shocking? This piece reminds of Baudrillard's assertion that America is the last primitive society.

Europeans often ask the difference between America and Europe – especially between England and America, for as the latter was the spawn of the former, it would be easy to assume they are the same.

It is unclear how an educated American writer can be shocked by this data, given the photographs of homeless encampments in Silicon Valley and the stories of people dying from bankruptcy. If life in America is solely predicated on economic activity and economic viability, how can anyone be surprised that lifespans shorten as vast swaths of the population become less economically viable?

No, that cannot be shocking, nor should it be surprising. In fact, it should be recognised in some manner, for that is the very way the American system was designed to function. In Europe (Western Europe), I generally explain, there is a top and a bottom. One can rise, to a degree, and one can fall, to some degrees, however the social states set up after WWII provide deep and rich social safety nets. The benefit is that there is no bottom to fall out of, the cost is that safety net is paid for by taxation, which caps upward social mobility. There are fewer homeless and destitute. There are fewer Jay Z's, Steve Jobs, and Mark Cubans.

There is ample discussion about the number of new millionaires minted each year in the United States, or billionaires. Yet rarely is there a discussion about the number of people that fall homeless each year or go bankrupt. Further, record numbers of people incarcerated, and those people live shorter lives.

The American system is designed not to take care of needs of the people, rather it is designed to provide people with the economic opportunity to take care of their own needs. If they cannot do that, it is designed to purge them from the formal system and let them fend for themselves on the streets. There is perhaps no greater example of this than skid row in Los Angeles. Right next to some of the finest medical institutions in the world, is a population of people that suffer from afflictions seen in the developing world. They do not receive care or treatment because they do not deserve care or treatment. In fact, they have not earned it.

If American mortality is reversing, that is a sign that an increasing number of people are no longer economically viable, and therefore their lifespans become shorter. Like income and wealth inequality, we now see lifespan inequality. Far from those statistics being shocking, they should be expected, given the structure of the American systems. The financial crisis was never resolved, instead we adapted to it – and we adapted by further concentrating wealth. Reading this article makes it look like we now have two social systems. The obvious system for those that are economically viable and productive, and the hidden system for those that are not.

The shocking statistics might be the gap between those two. Economically productive Americans are no doubt living longer than ever, and I would imagine that economically unproductive Americans started seeing decreased lifespans long ago. One can imagine that the the gains of the former – some people living many years longer – are balanced with the losses of the latter – many people living gradually a few years shorter.

I generally end my conversations with Europeans in the following way.

Imagine you had universal heath-care, a society free from weapons, and strong education systems. You also have a small house, one car for two people, and food is relatively expensive. The basic needs of most people are taken care of, few people are homeless, and there are low incidences of violent crime.

Would you trade away health-care and eduction and legalise weapons, if it meant you could have a larger house, another car, and cheaper food? If it mean that people were on their own, many were homeless, and there was a culture of violent crime?

Unsurprisingly, most seem to desire a society with moderate incomes, less material possessions, with better education systems and higher levels of general safety. Because the latter sounds like a developing country. Privatised services. Weapons on the street. Weak education systems. Some have large houses, some are homeless...

The most shocking part of that article is that anyone is shocked by it...
America is, in concrete form, the traumatic consequence of European dreams. America is the original version of modernity, the weightless paradise of liberation from the past. Europe is the dubbed or subtitled version. What is only thought in Europe becomes reality in America. It is we who imagine that everything culminates in transcendence, and that nothing exists that hasn’t been conceptualized. Americans are not interested in conceptualizing reality but in materializing ideas.

Americans inhabit true fiction by giving it the form of reality, while we are condemned to the imaginary and to nostalgia for the future. We anticipate reality by imagining it or flee from it by idealizing it. Americans merely radically implement everything we think about, from mass egalitarianism to individualism to freedom to fantasy. In so doing, “utopia achieved” has transformed into the anti-utopia of unreason, weightlessness, value neutralism, indifference, the indeterminacy of language, and the death of culture.
posted by nickrussell at 5:50 AM on December 11, 2016 [66 favorites]

My wife and I are basically one disaster away from financial implosion. Unfortunately, that "one disaster" could easily be our twenty-something son, who is struggling with a low-wage job that provides the absolute worst healthcare coverage I've ever seen. Did you know that, as long as a company provides at least one health policy, no matter how expensive, that meets ACA requirements, they can also provide lower-cost plans that don't meet ACA requirements? And, of course, if they're paying their people diddly, they're going to have to opt for the lower-cost, non-compliant, plans, because the compliant plan will eat a third their paychecks.

Given that the next Congress has the ACA, Social Security, Medicare, and Medicaid firmly in their sights for "reform," I expect this will get a whole lot worse before there's any hope of it getting better.
posted by Thorzdad at 6:19 AM on December 11, 2016 [12 favorites]

Everyone Gets A Job.

I'm open to trying a lot of things, but I'm possessed of a dark suspicion about human nature that tells me this phrase won't work. That suspicion tells me this election was partly won because of a significant part of the electorate that deeply believes everyone isn't worthy of respect or a job. It's like the fundamental attribution error engraved on the heart; having "everyone" invoked means that the people who should be punished and ground upon won't be properly punished and ground upon. If only we had someone who will do that.

There's a dark genius to #MAGA, maybe particularly as a counterpoint to "Stronger together" and "I'm with her." "America" can be the shining city on the hill, or it can be a dog whistle. It can be "everyday Americans" that *you* know deserve a break, unlike the welfare queens.

We can't talk about "everyone." Everyone includes The Undeserving. The lazy. The immigrants who came here to take the promise of this land from those who've rightfully inhabited it. And of course, this is why we have to aggressively fight safety nets and make sure these people aren't protected from a bad break, otherwise we'll be mooched off of and all be made weak and subservient.

So if we want "Everyone Gets A Job," we have to translate it:

"America Works, America Wins."

There's the intimation of the "if," the conditional, the perhaps harsh but ultimately just world. There's "America" as code for either America's ultimate promise of the tired and poor... or for "real Americans."

This all assumes that the battle is still won or lost on winning elections by persuasion. No one should give up on that idea yet, and I hope everyone's figuring out what they can do to gear up and work hard on that. But it's also worth seriously considering what needs to be done if there are any more signs we're past that point.
posted by weston at 6:24 AM on December 11, 2016 [20 favorites]

Thank you, Ronald Reagan. Thank you, Milton Friedman.

Because Personal Responsibility above all. Because Not Encouraging Bad Lifestyle Choices. Because hypothetical welfare queens in gold Cadillacs.
posted by acb at 6:28 AM on December 11, 2016 [7 favorites]

"America Works" was House of Cards...
posted by Coda Tronca at 6:29 AM on December 11, 2016 [2 favorites]

I have similar discussions with Europeans to nickrussell's here in Paris. So very many people view the USA as a sort of wish fulfillment utopia. Interestingly, the French don't so much care about big houses, but they do love the idea of huge salaries. Income-related class lines are pretty compressed here: minimum wage now gets you about 1200 euros/net a month, or 14K/year. But with that comes essentially free healthcare, higher education, highly-subsidized continued education, certification programs for existing skills that can be entirely reimbursed (say you got your degree in literature but want to have a cert that says you have the equivalent of a BA in computer science, for instance), subsidized daycare, subsidized housing, et cetera and so forth. Now, living on minimum wage certainly isn't fun or easy, but you can in fact survive in a warm home with food on the table and be in good health. You start hitting a middle-class income at about 25-30K/year, higher middle class at around 40-50K, and above 50K you're doing pretty damn well for yourself. And those are roughly Parisian salaries; in smaller places you can live a great life at 40-45K.

So imagine all the wild dreams that go through French people's heads when they hear there are people in SF earning 70-90K. That's Mercedes-buying, golf-playing, champagne-drinking, massive apartment in a chic Paris suburb-having over here. La classe.

Every single time, I have to tell these bright-eyed, eager people that the USA is not a dream. First and foremost, we have to pay for our healthcare. Now, I will say one thing: men are the worst offenders in thinking they can get away without healthcare. Women comprehend the issues a lot more quickly. Men I have to break out examples like "what happens if you're in a car accident?" because god forbid I suggest they might fall or get sick. Women don't need any examples, our bodies generally give us at least one, often accompanied by complications, at regular intervals. Gender differences aside, the only thing that gets through to them are the numbers and this key distinction: in the US, health insurance is an insurance it is not healthcare. You don't pay several hundred a month for free care, you pay several hundred a month so that when you go to a doctor or the ER, it won't cost as much as it would if you didn't have that insurance. You will still have to pay anywhere from 30-50 dollars for a GP to several hundred, possibly several hundred thousand, out of pocket. I have to repeat that bit several times before Europeans finally blanche and go silent in shock.

I do not know why this surprises anyone either. I left the States 20 years ago for several reasons and healthcare was a huge one. I, a woman, made the right choice without knowing it at the time: a year after I left was when I had a burst ovarian cyst that started internal bleeding that would have killed me within a dozen hours if I hadn't gone to a nearby hospital in Finland. Being as I was just out of school at the time? Had that happened to me in the States, I would not have gone to the hospital. Simply because I'd have known I couldn't afford it, so why take the chance on the stabbing pain? It was probably nothing. I walked to the Helsinki Women's Hospital because it was a few blocks away and figured, eh, it's free, at least this way I'll know what's going on. I was operated on a couple hours later. They saved my life. I paid the equivalent of 50 euros out of pocket for surgery under general anesthesia and an overnight stay.

I would have been a statistic in those early deaths had I been in the States.
posted by fraula at 7:15 AM on December 11, 2016 [152 favorites]

Has anyone done a regional analysis of this? If I recall correctly, the paper from last year about rising white mortality suggested that it was pretty regionally specific: it was working-class white people, but it was specifically working-class white people who didn't live in major metropolitan areas. Is that the case here as well?
posted by ArbitraryAndCapricious at 7:17 AM on December 11, 2016 [1 favorite]

Many of the actual people who are the non-1% workforce that supplies American consumption today are, on average, paid a lot more than their demographic counterpart sof 40 years ago were, because they're earning US salaries and getting US public services, or at least are earning export-sector (relatively better) salaries in foreign countries, whereas their 40-years-ago counterparts were earning whatever the local demand of Mexico, India, China, etc., could pay them, or they were housewives.

Understandably, though, workers in the U.S. tend to think about their wages, not those of the global workforce supplying American consumption.

So from the perspective of a U.S. worker, the above seems to be contradicted directly by available statistics regarding real wage growth.

More broadly, what gains there were in wage growth across the last 36 years were modest:
From 1980 to 2007, hourly compensation and weekly wages grew side by side. Compensation grew 1.5 percent per year, and weekly wages 1.2 percent, with the gap substantially explained by the continued growth of non-wage compensation. However, median weekly earnings from the Current Population Survey (CPS) rose only 0.7 percent per year. The most likely reason for the large gap between average and median wages is that the productivity, and thus wages, of high earners grew significantly faster than average during the 1980s.
The above is from a Heritage Foundation report arguing that wage growth has been "typical" historically once the measures are corrected for (i.e., not conflating changes in average household income with wage changes), but CPI figures for inflation provide some context for this. The yearly inflation figure is generally at or well *above* the 1.5% or 1.7% figure one gets from measuring "real wage growth."

The net effect is that wage growth compared to inflation indicates a decrease in purchasing power, which is more reflective of the lived experience of wage earners in the U.S.

Absent some form of engineered redistribution (0), the alternatives that remain are an artificial restriction of the labor supply, which will invariably result in depriving some group of people of economic opportunity (1); massive spikes in consumer prices (in the short term, anyway) (2); a massive reduction in the average U.S. resident's standard of living (which will also take place only in the short term (3); or the end/radical transformation (same difference) of the U.S. version of the mixed economy or the current global economy as it currently stands (4).

This year, people have voted for a combination of 1 (on purpose) and some version of (2) and/or (3) (unwittingly). In the longer run some version of 4) seems unavoidable, because 0) is somehow unthinkable to most voters and elites and options (1) through (3) are holding actions, and politically indefensible ones at that.

Historically, (4) happens after a while if you have (1), (2), or (3) for too long. And this why every serious thinker about political economy from Hayek to Marx ends up arguing for some form of direct payment to citizens that is not linked directly to labor participation, whether through UBI, progressive taxation regimes, or forcible redistribution. In other words, they return (0) or (4).
posted by kewb at 7:24 AM on December 11, 2016 [12 favorites]

I will probably live longer than my dad (50) because i did not start smoking at 12 like he did. Will I make it as far as my mom (68)? Since the election I've been wondering that a lot. I'm probably healthier but if I lost my insurance and got sick, or Republicans take away my Medicaid/Medicare/SS as promised, maybe not. And my kiddo, well I just can't stand to really think about it. All I can think to do is offing myself if that's the only way not to burden him. Cheerful stuff.
posted by emjaybee at 7:35 AM on December 11, 2016 [1 favorite]

It's worth noting that a huge part of the drop in mortality is linked to heroin overdoses, which the article discusses. There's another element of this, though: we know some effective ways to help people recover from heroin, and many heroin addicts actually do have some access to treatment, even if it happens to be court-mandated. The problem is, many treatment programs refuse to use methadone, suboxone, or vivitrol in their recovery programs, preferring instead 12-step varieties or amorphous abstinence counseling, for reasons that have never been entirely clear to me, but which I suspect have to do with notions of what is a deserving way to recover from addiction, and what are "appropriate" ways to spend government or foundation money. And this cannot be overstated: the refusal of available treatment providers to use the pharmaceutical resources available to them is causing, at least in part, the overdose rates, as many deaths result from ineffective or temporary treatment, followed by addicts finishing the program, and then using at the previous quantities again at a much lower tolerance.

Here's a really good article discussing this phenomenon in Kentucky, which is where I am based, and a state in which the white working class and poor have been hit HARD by heroin.
posted by likeatoaster at 7:38 AM on December 11, 2016 [25 favorites]

It's worth nothing, though, that the mortality rate for black men went up in 2015, and that's not likely to be heroin. It's not clear to me what caused the increase in mortality for black men, but the heroin epidemic seems mostly to be hitting white Americans.

The biggest jump in mortality was among white women, followed by white men and then black men. Everyone else is pretty much stagnant. Of course, black men had higher mortality to start out with.
posted by ArbitraryAndCapricious at 7:48 AM on December 11, 2016

Calling it a "bad break" seems really disingenuous.

It isn't a bad break when all the cards are stacked against you, when the massive force of an industrialized nation is telling you to work or starve, and if you can't work, well too bad. Oh, by the way, don't get sick, then really too bad. Thems the breaks.
posted by Sphinx at 7:53 AM on December 11, 2016 [8 favorites]

So much of this is a solved problem. Healthcare and direct income redistribution. Free education and a job guarantee even if it requires 'make work'.

But it's precisely because the solutions are known that the 1% and capital class knows exactly how to turn the captured machinery of the state around to prevent it. And our system of legal bribery, denial and dilution of the franchise, captured or de facto state run media, and two-tiered, paid-for justice is designed to preserve inequality at every level, not reduce it.
posted by T.D. Strange at 7:59 AM on December 11, 2016 [15 favorites]

we know some effective ways to help people recover from heroin, and many heroin addicts actually do have some access to treatment, even if it happens to be court-mandated. The problem is, many treatment programs refuse to use methadone, suboxone, or vivitrol in their recovery programs, preferring instead 12-step varieties or amorphous abstinence counseling, for reasons that have never been entirely clear to me, but which I suspect have to do with notions of what is a deserving way to recover from addiction, and what are "appropriate" ways to spend government or foundation money. And this cannot be overstated: the refusal of available treatment providers to use the pharmaceutical resources available to them is causing, at least in part, the overdose rates, as many deaths result from ineffective or temporary treatment, followed by addicts finishing the program, and then using at the previous quantities again at a much lower tolerance.

speaking as a recovering addict: one of the surest ways to perpetuate addiction is to have nothing else to look forward to, nothing else to give you hope, no way out of the mess you're in. once you've ground people down long enough, made them understand that nothing they do will actually improve their situation, they will start to turn to whatever offers temporary relief.

and make no mistake, it's not illusory relief -- it's very real. the only thing is, it's the kind of relief that doesn't actually help my circumstances; it makes them worse. by the end of my drinking/using, my life was a wreck that I felt I couldn't escape from -- but at least when I was drunk/high, I didn't have to THINK so much about all the problems I didn't know how to solve in the first place.
posted by Vic Morrow's Personal Vietnam at 8:42 AM on December 11, 2016 [27 favorites]

Neoliberalism, Market Fundamentalism, whatever you want to call it: this is what it does.
posted by Ray Walston, Luck Dragon at 8:51 AM on December 11, 2016 [3 favorites]

I would respectfully posit that the self-determination thing that saulgoodman identifies is pretty easily demolished by the Just World Fallacy taken from Philosophy 101. E.g. This world is not Just, nor is it fair, no do your efforts, largely correspond to outcomes.

It would be just super peachy keen if they did but due to those nasty system externalties-- they don't.

I think a fairly easy example would be my family's rise and fall through the US class system, using my Dad (a very self-determination kind of guy) as an example.

1970 -- Truck Driver
1980 -- Concrete Truck Driver
1985 -- Concrete Salesman
1990 -- VP of Sales
2000 -- Regional VP
2003 -- CEO
2005 -- Terminated in a hostile takeover. Mandated liquidation of defined benefit pension.
2008 -- Mother acquires breast cancer
2010 -- Family holdings lost due to paying for illness
2015 -- Family bankrupt, house loss. Father lives on social security, is ill.

I'll leave the present out, but is grim. So what parts of this are self-actualized, right? What parts are 'Just?'
posted by mrdaneri at 9:12 AM on December 11, 2016 [42 favorites]

The US is still infected with a particularly virulent version of Calvinism. Simply put we are taught early on that the righteous get rewarded and the unvirtuous get punished. So if you get a bad break it's apparently your own damned fault.

Combined with other essential myths like the idea that the American dream that you can just pull yourself up by the bootstraps and that your children are guaranteed to have more prosperity than your generation and you have a toxic mess.

I think we are only beginning to deconstruct our own mythology and it's negative consequences.
posted by vuron at 9:35 AM on December 11, 2016 [16 favorites]

I just started reading 'Methland' after a recommendation on here, only to read today that the new opioid nightmare is Fentanyl, 50 times stronger than heroin and apparently what killed Prince.
posted by Coda Tronca at 10:06 AM on December 11, 2016 [3 favorites]

Yeah, but that's not purely an accident. Nobody can ever achieve perfect self determination, but the structure and values and shared commitments of a society can provide an environment that either promotes or discourages varying levels and degrees of the limited potential there is for meaningful self determination. It is possible to have a social order that encourages and supports our ability to form stable communities and have meaningful lives in which good faith, positive efforts do lead to gains and a sense of progression and hope for the future in life.
posted by saulgoodman at 10:20 AM on December 11, 2016 [3 favorites]

This is a sincere question born of an incomplete understanding of how statistics work - but: was there a need for the study to take the aging of the Baby Boomer generation into account, and if so, did they? Or might that have had some impact on the outcome of this study?
posted by EmpressCallipygos at 10:34 AM on December 11, 2016

Pretty irrelevant when you're talking about life expectancy.
posted by Kirth Gerson at 10:38 AM on December 11, 2016

Life expectancy is based off of averages, and once you hit a large enough population, the size doesn't matter. It actually doesn't take that many people to get consistent averages.
More importantly, other nations are not seeing this decline.

Healthcare is a nightmare, chronic diseases are on this rise, addiction is rampant , mental health isn't treated and paying for care is pretty impossible.
posted by AlexiaSky at 10:41 AM on December 11, 2016 [1 favorite]

The RAND study [consider the source] on excess Russian mortality after 1992-1993 is relevant; Consider the return of diptheria from essentially 0 deaths in the 1970's to 424 in 1993. This is the sort of thing I think we're committed towards, from both an economic and policy perspective in the US.
posted by mrdaneri at 11:02 AM on December 11, 2016 [2 favorites]

Pretty irrelevant when you're talking about life expectancy.

It can matter if you're talking about life expectancy of age cohorts, or aggregating up from age cohorts.
posted by ROU_Xenophobe at 11:32 AM on December 11, 2016 [1 favorite]

Reports of life expectancy statistics in the general media almost always refer to period life expectancy.

Period life expectancy is a hypothetical statistic constructed from age-specific death rates at a particular point in time. It is the average length of life for persons who would hypothetically live their entire lives given the age-specific death rates in effect at that point in time.

So when demographers say life expectancy fell from one year to the next, they're really saying that age-specific death rates (or some subset of them) went up from one year to the next.

By contrast, cohort life expectancy measures the average length of life for a given cohort (e.g., Baby Boomers). It can't be calculated with certainty until the entire cohort has died off. To estimate it for a cohort that hasn't died off, you'd have to forecast the death rates the still-living members of that cohort will experience in the future.

(Source: I'm a demographer.)
posted by mikeand1 at 1:11 PM on December 11, 2016 [19 favorites]

mikeand1 (or anyone else): So do you happen to know why, when looking at current life expectancy by age here, the US is ranked around 30th for life expectancy for ages below 60 and above 90, but is around 15th for ages 70-80? Is it just due to that cohort continuing to be the beneficiaries of a world-topping healthy childhood, or is it instead due to some current knack in the US for keeping old folks alive today?
posted by chortly at 6:44 PM on December 11, 2016

...or is it instead due to some current knack in the US for keeping old folks alive today?

posted by Thorzdad at 6:55 PM on December 11, 2016 [1 favorite]

"So do you happen to know why, when looking at current life expectancy by age here, the US is ranked around 30th for life expectancy for ages below 60 and above 90, but is around 15th for ages 70-80?"

Life expectancy at birth is heavily influenced by infant mortality. The U.S. has a comparatively high infant mortality rate, as compared with most developed countries. That puts a huge crimp in our life expectancy numbers.

As for the other ages -- I'm not sure that website is entirely reliable. I would note also that estimating mortality rates at ages of 90+ can be tricky.

(I should add that I'm more of a former demographer; I work in a different field today, and haven't done research on mortality rates for a few years.)
posted by mikeand1 at 8:10 PM on December 11, 2016 [1 favorite]

Oxyana: Tucked in the Appalachian mountains of Southern West Virginia, Oceana, is a small, once thriving coal-mining town that has fallen victim to the fast spreading scourge of prescription painkiller Oxycontin. As the coal industry slowly declined and times got tough, a black market for the drug sprung up and along with it a rash of prostitution, theft and murder. Soon its own residents had nicknamed the town Oxyana and it began to live up to its reputation as abuse, addiction and overdoses became commonplace.
posted by PenDevil at 10:53 PM on December 11, 2016 [3 favorites]

Yeah, already been through the "bad break" situation. Not going into details because it's beyond fucked up, but one thing that resonates in this thread is that when you're in a really bad situation, even the slightest impediment to making some progress or getting help can prevent you getting help at all. The post above about Partners in Health and their research into copayments being dissuasive rings true: parallel to that, if getting welfare is dependent on providing last year's tax return and you're already sleeping on friends' couches and your tax is done by a family accountant when the family is overseas... Even a minor bureaucratic impediment can be too much when your week's mental and emotional energy is expended on "don't go insane and try to survive."

That said, all this shit happened in Australia where there is a social safety net, even if it's often too difficult to access. That probably made the difference between the situation being recoverable and not. I look at the US healthcare system in complete horror now - it really does seem predicated on everything in your life going smoothly.

Also worth noting that there's probably some key factors in how recoverable these situations are. Age is one - much harder to start over when you're 65 and have to deal with ageism when looking for work. Another is how much the society stigmatises addiction and how easy it is to access treatment. Also importantly, people don't have unlimited emotional capacity to deal with trauma. If this is the second or third time a bad break has fucked everything up for you, it's probably exponentially harder to deal with than the first. (Consequently I'll go to lengths to never go through that again - woe to whoever might cost me a job or destabilise my life in the slightest from here on out.)
posted by iffthen at 10:59 PM on December 11, 2016

Age is one - much harder to start over when you're 65 and have to deal with ageism when looking for work.

Ageism starts a lot earlier than 65, believe me. It starts rearing it's head as you near 50, and goes into full, horrible bloom as you cross that mark.
posted by Thorzdad at 4:58 AM on December 12, 2016 [4 favorites]


That's the question, though. For those of us under 60, it would be a silver lining to the terrible life expectancies in the US if, should we make it to 65, from that point on we have one of the better life expectancies. But that would be so only if this is an actual age effect (eg, due to medicare) rather than a cohort effect that will be gone (along with so much else of the boomer legacy) by the time we reach that age. The fact that the rankings fall back towards 30th after 80 or so may suggest that is in fact due to a cohort effect rather than better healthcare for the old, but on the other hand, as mikeand1 suggests, it's probably pretty hard to estimate life expectancies for 85 and up (eg, note that many of the highest-ranking countries are in Central America for some reason). But whether or not the oldest rankings are right, it does seem to be systematically the case that from birth to 60 or so, the US ranks consistently around 30th, and then seems to move up the rankings for a few decades of age for some reason. I certainly hope it's due to Medicare!
posted by chortly at 5:52 PM on December 12, 2016

Chortly, based on my experiences with both my mother and my father-in-law over the past couple of years, I think the fall after 80 is an expression of the fact that the 80s and 90s is pretty much when the efforts of medical science to keep people alive start to fail. Even Medicare coverage can't keep someone alive forever. Eventually, despite everyone's best efforts, the body simply begins to fail, and the 80s and 90s are when it happens. Up until that point, though, Medicare is a godsend to older Americans, given the increasing parade of maladies that plague them as they age.

It will be (sadly) informative, if the next Congress is successful in gutting Medicare, to see if that uptick in life expectancy ends up declining to match everyone else. Or, maybe even drops below the line. Suicide is one of the fastest growing causes of death among the elderly. Without the safety net of Medicare, I could see that becoming more of a factor. I know that's a morbid thing to say, but...
posted by Thorzdad at 12:13 PM on December 13, 2016

Chortly, based on my experiences with both my mother and my father-in-law over the past couple of years, I think the fall after 80 is an expression of the fact that the 80s and 90s is pretty much when the efforts of medical science to keep people alive start to fail. Even Medicare coverage can't keep someone alive forever.

That's definitely true. But I was noting the relative rank of the US compared to other countries, rather than the absolute life expectancy decline. I doubt the relative rankings at 85 or 90 are very meaningful in any case, so the big question, apparently unresolved, is whether Medicare is what boosts US's relative ranking after 65 or so, or whether it's just a cohort effect. My pessimistic guess is that in 20 years, when those in their 40s enter their 60s, their life-expectancy rank will remain in the 30s rather than rising to the teens, given how terrible the health of this generation currently is. But I guess we'll find out...
posted by chortly at 10:53 AM on December 16, 2016

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