Wednesday, September 26, 2012

The Americans Who Are Now Dying Earlier

Perhaps the most shocking sign of America's deep problems is the decline in life expectancy now taking place in hundreds of its counties, primarily among less educated women.

This has been in the news in the last few days, but as far as I know it first appeared in the literature over a year ago:

“Falling behind: life expectancy in US counties from 2000 to 2007 in an international context”
Sandeep C Kulkarni, Alison Levin-Rector, Majid Ezzati and Christopher JL Murray
Population Health Metrics 2011, 9:16 

As the Los Angeles Times reported then:
"In 737 U.S. counties out of more than 3,000, life expectancies for women declined between 1997 and 2007. For life expectancy to decline in a developed nation is rare. Setbacks on this scale have not been seen in the U.S. since the Spanish influenza epidemic of 1918, according to demographers.

The backsliding for women began before 1997, but researchers found it had accelerated in the last decade. Only 227 counties saw women's life expectancy decline between 1987 and 1997, according to the study.

The worst-performing counties were clustered primarily in Appalachia, the Deep South and the lower Midwest. In those places, women died as much as a year younger in 2007 than women did a decade earlier. Life expectancy for women slipped 2 1/2 years in Madison County, Miss., which recorded the biggest regression."
To my mind -- as a self-employed, middle-aged American with pre-existing conditions, who has great difficulty getting the health care I need -- this is the most worrisome trend in the country. I wish it would get asked about at the Presidential debates -- but, since the Big Media moderators all have big incomes and great health benefits, I doubt very much that it will. Let's face it -- few people care, and Mitt Romney is the least of them. (Even Barack Obama doesn't dare venture into the poorer parts of the country.)

As Harold Meyerson writes in the Washington Post:
The market is not just redistributing income in the United States, then. It is redistributing life.

21 comments:

libertard said...

David, see the discussion in the comments here:

http://marginalrevolution.com/marginalrevolution/2012/09/some-life-expectancies-are-shrinking.html

The world is more complicated than you'd like to think, and every bad thing isn't so easily blamed on evil Republicans

charlesH said...

Here is an interesting PBS read/view on the subject.

Money & Medicine

"Money & Medicine investigates the dangers the nation faces from runaway health care spending as well as the dangers patients face from over-diagnosis and over-treatment. In addition to illuminating the waste and overtreatment that pervade our medical system, Money & Medicine explores promising ways to reduce health care expenditures and improve the overall quality of medical care. "

"The trillion-dollar question is how can we reduce unnecessary medical spending so that we can afford to provide affordable, high quality health care to all Americans? A number of recent studies estimate that a third of all health care expenditures are unnecessary and that eliminating wasteful spending would save over 800 billion dollars a year. Since every dollar of so-called unnecessary spending is a dollar of income to a health care provider, reigning in health care spending is much more easily said than done. However, Money & Medicine adopts a unique approach to addressing this pressing medical, ethical, and financial challenge. The film was shot at two world-renowned hospitals - UCLA Medical Center in Los Angeles and Intermountain Medical Center in Utah. The dramatic doctor/patient stories the film captures at these two hospitals illustrate the powerful forces driving excessive medical care as well as proven strategies that can reduce unnecessary medical spending, such as improving the coordination of patient care, facilitating shared patient decision-making, and practicing evidence-based medicine.

Public Policy Productions, Inc.
Kurt Thompson receiving proton beam therapy for prostate cancer.
At both hospitals, Money & Medicine exposes the painful end-of-life treatment choices made by patients and their families, ranging from very aggressive interventions in the ICU to palliative care at home. The film also investigates the controversy surrounding diagnostic testing and screening as well as the shocking treatment variations among patients receiving a variety of elective procedures."

http://www.pbs.org/programs/money-medicine/

charlesH said...

delete photo caption from above "Kurt Thompson receiving proton beam therapy for prostate cancer."

cut and paste typo

charlesH said...

"To my mind -- as a self-employed, middle-aged American with pre-existing conditions, who has great difficulty getting the health care I need -- this is the most worrisome trend in the country."

You are aware of Oregon's FMIP program?

You are aware but it costs too much?

What?

FMIP seems similar to what my wife uses in Utah.

http://www.oregon.gov/oha/OPHP/OMIP/pages/apply_omip.aspx#are_you_eligible_for_omip_fmip_coverage_

David Appell said...

Charles, it's not just FMIP's relatively high premiums, it's the 30% copay for everything. Everything.

As a Tea Partier, how do you justify your wife utilizing this government subsidy?

charlesH said...

"As a Tea Partier, how do you justify your wife utilizing this government subsidy?"

a) I'm not a Tea Partier. I'm sympathetic to many of their views but I'm more conservative/libertarian.

b) We are in the prepaid pool.

"Utah’s Comprehensive Health Insurance Pool (HIPUtah) is specifically designed to provide health coverage for people with serious medical conditions. HIPUtah also serves as the state’s Health Insurance Portability and Accountability Act alternative, which is required by the Federal government."

"HIPAA portability requires states to guarantee that a person can obtain an individual policy if that person
is no longer eligible to be covered under an employer group policy, regardless of health condition. Utah
complies with this requirement in two ways: (1) HIPUtah accepts all HIPAA eligibles regardless of
health condition; and (2) state law guarantees an individual policy available through the private market if
the person is healthy in accordance with SB 60 as demonstrated below."

I paid insurance premiums for 30yrs (before my wife had diabetes) and continued paying HIP after I retired. Now that my wife needs help we are entitled to the coverage we have maintained continuously for 30+yrs.

c) I also will begin collecting SS in about 6mo having paid more than my share for 30+yrs.

We have prepaid for everything we are or plan to get.

charlesH said...

Did you watch PBS "Money & Medicine"?

Thoughts?

David Appell said...

> Did you watch PBS "Money & Medicine"?

No -- I don't have a television.

David Appell said...

So your "entitled" -- your wife's medical coverage is an entitlement, something your owed?

That's what you're saying? That you're one of 47% that Romney disdains?

charlesH said...

"So your "entitled" -- your wife's medical coverage is an entitlement, something your owed?

That's what you're saying? That you're one of 47% that Romney disdains?"

If you buy auto insurance and you have an accident you are covered (if you are current on your premiums). If you buy health insurance and then you get sick you are covered (if you are current on your premiums).

It's not rocket science David.

"Insurance is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for payment. An insurer, or insurance carrier, is a company selling the insurance; the insured, or policyholder, is the person or entity buying the insurance policy. The amount to be charged for a certain amount of insurance coverage is called the premium. Risk management, the practice of appraising and controlling risk, has evolved as a discrete field of study and practice."

"The transaction involves the insured assuming a guaranteed and known relatively small loss in the form of payment to the insurer in exchange for the insurer's promise to compensate (indemnify) the insured in the case of a financial (personal) loss. The insured receives a contract, called the insurance policy, which details the conditions and circumstances under which the insured will be financially compensated."

http://en.wikipedia.org/wiki/Insurance

charlesH said...

"Did you watch PBS "Money & Medicine"?

No -- I don't have a television."


You can watch it online here. Tell me what you think.

http://www.pbs.org/programs/money-medicine/

David Appell said...

But your wife would not be covered without a government program.... So which government programs are undesirable? Only those that don't benefit you?

charlesH said...

"But your wife would not be covered without a government program.... So which government programs are undesirable? Only those that don't benefit you?"

The insurance industry is highly regulated by the states. This is true for auto, home, health etc. Insurers are required to maintain sufficient reserves to pay off claims etc. They also cannot drop you to avoid paying a claim. Since most people purchase insurance through their employment, all of the states have some kind of program to allow one to continue paying premiums to maintain coverage on an individual basis.

I think what you want for health care is not really insurance but a simple government subsidy. Why doesn't the state of Oregon pay for free health care for all Oregonians? Oregon is a pretty liberal state. Why not show the rest of the country how it would work?

Did you watch the PBS video?

charlesH said...

"Charles, it's not just FMIP's relatively high premiums, it's the 30% copay for everything. Everything."

Again, it seems you want free health care. You want your neighbors to pay for your healthcare. You are highly educated with a PhD in physics and you want your less capable neighbors to pay for all of your healthcare. You don't even want to pay 30%.

We maintain our insurance by paying high premiums with a very high deductible. It certainly is not free for us.

David Appell said...

Charles, you clearly avoided my question. Your wife would not have health insurance without a government program, because no private insurer will cover her at an affordable rate.

Obviously, this is a government program you approve of -- because, it seems, you benefit from it.

But you are opposed to many other government programs that benefit others. I smell the stink of your hypocrisy.

charlesH said...

"Charles, you clearly avoided my question. Your wife would not have health insurance without a government program, because no private insurer will cover her at an affordable rate.

Obviously, this is a government program you approve of -- because, it seems, you benefit from it.

But you are opposed to many other government programs that benefit others. I smell the stink of your hypocrisy."

Both you and my wife benefit from a government program. We paid handsomely to be admitted while you get admitted for free. Nevertheless, I'm not complaining about the programs (thus I'm not a hypocrite)although others may. I'm complaining about your attitude toward contributing at least a portion to your own health care.

My wife benefits from a government program that provides continued coverage after work related coverage is not available. We purchased insurance when she was healthy and have maintained the coverage for 30yrs. She now pays >$12,000 per year for the "privilege" of continued coverage.

You have a program available to you in Oregon that will pay 70% of your care even though you did not (apparently) purchase insurance when you were healthy and then maintain it. You are like the guy who wants to be able to purchase auto insurance after the accident. You state provides you a means to purchase auto insurance after the accident and you have the chutzpah to complain that the coverage is only 70% not 100%.

charlesH said...

"Did you watch PBS "Money & Medicine"?

No -- I don't have a television."


You can watch it online here. Tell me what you think.

http://www.pbs.org/programs/money-medicine/

David Appell said...

> Again, it seems you want free
> health care.

Stop putting words in my mouth, Charles.

I want the ability to buy health care at an affordable rate, over the course of my entire lifetime. That happens in dozens of advanced countries -- except the US. Is that so difficult for you to understand?

David Appell said...

Don't worry, Charles -- I spend plenty on my health care, since I buy it for cash (which means I pay far more than those with insurance).

In the last 12 months, 13.6% of my before-tax income went to medical expenses, and 9.0% of my total expenses, with no a penny of government support except the usual tax deductions (on an income that doesn't warrant many of them).

So stuff your sanctimony. And tell us how much you and your wife are benefiting via government largess -- at a time when you bitch about having to pay anything for anyone else.

David Appell said...

By the way, Charles: do you have a mortgage? If so, how much of it has been paid for by taxpayers?

David Appell said...

CharlesH wrote:
>> You have a program available to you in Oregon that will pay 70% <<

This is absolute bullshit, Charles. Stop it.

It is a program that costs about $8,000/yr before it pays a dime for anything.

Do you seriously not understand that?

After $8K, it pays for 70%. So people who do not get the benefit of government assistance (and all those ordinary workers who work for companies get a large benefit of about $1250/yr) have to make a gamble -- pay now, or perhaps pay later.