The Republican Health Plan: Die Faster. It’s Working

David would have more and more expert things to say about this, but I want to highlight a new report in The Lancet on trends in life expectancy.

There is a ton of material in the study, but the key takeaway is that over the next two decades the US will continue to lag its developed counterparts in achieving higher average life expectancy for its citizens.  Here’s the topline summary of some the results:

Globally, most independent drivers of health were forecast to improve by 2040, but 36 were forecast to worsen. As shown by the better health scenarios, greater progress might be possible, yet for some drivers such as high body-mass index (BMI), their toll will rise in the absence of intervention. We forecasted global life expectancy to increase by 4·4 years (95% UI 2·2 to 6·4) for men and 4·4 years (2·1 to 6·4) for women by 2040, but based on better and worse health scenarios, trajectories could range from a gain of 7·8 years (5·9 to 9·8) to a non-significant loss of 0·4 years (–2·8 to 2·2) for men, and an increase of 7·2 years (5·3 to 9·1) to essentially no change (0·1 years [–2·7 to 2·5]) for women. In 2040, Japan, Singapore, Spain, and Switzerland had a forecasted life expectancy exceeding 85 years for both sexes, and 59 countries including China were projected to surpass a life expectancy of 80 years by 2040.

Conspicuously absent from that list of 59 nations?

You guessed it:  the United States of America, which is predicted to come in at an average lifespan of 79.8 years, good for 64th in the league table of nations.  Compared with the average 4.4 years gain, the US is expected to add only 1.1 years to our collective expectations or hopes.  Given that piss-poor performance, the US will fall in longevity rankings from 43rd to 64th — the biggest drop in this study.

There are obvious caveats to all this, most important of which is that this is an exercise in model-based forecasting, and is thus subject to all the errors and uncertainties to which such complex predictive engines are heir.  But, of course, those errors apply to every nation under scrutiny, so I’m focusing more on the US’s relative performance than on the question of whether we’ll gain 1.1 years or 1.4.

The obvious question is why? Why do we already suck at this, and why is our predicament going to get worse.

Obvious, direct, mechanical causation is hard-to-impossible to determine, but the basic story is clear.  Republican policies are killing us. A CNN report on the study notes that the US

…currently has the lowest life expectancy among high-income countries. Life expectancy in the US has dropped in each of the past two years, according to annual reports by the National Center for Health Statistics, representing the first multi-year drop since 1962 and 1963. [all links in the original]

Gee.  I wonder what changed in the last two years.  And yeah, while I know correlation != cause, nibbling away at access to health care and increasing inequality are persuasive correlates of poor health outcomes.

And then there are specific scourges that can be identified:

An increase in drug-related deaths is believed to represent one factor in the stalling figures, with accidental drug overdoses causing 63,600 deaths in 2016. Furthermore, obesity in adults is at its highest rate ever in the country, according to the National Center for Health Statistics. Nearly four in every 10 adults and 18.5% of children in the US are obese, according to their research, while further research in February found a sharp increase in obesity rates in Americanchildren between the ages of 2 and 5.

More broadly: the overarching theme of GOP politics is to transfer wealth upwards and risk downwards.  Poor health outcomes and shorter (or less lengthened) life spans accompany more stress, less stability, poverty in general, poverty in old age and all the rest.  A GOP whose fundamental accomplishment is a tax scam that benefits meaningfully only those already rich does all that.  And we’re still waiting for the slashing of social insurance that will close the loop.  Life long college debt and houses sold to pay for nursing home care and all the other large ways and small that the paycheck to paycheck majority never gets to get ahead creates the financial and social context in which people die before their time.

The myth of post-war American capitalism was that the middle and working classes would, at long last, be able to accumulate capital and pass it on to their kids, thus powering a generation-over-generation gain in well being.  Republicans since Reagan have attacked that notion; it’s now on intensive care — and the public Republican intention to erode Medicare and Social Security would pretty much be the stake in its heart.

Now we’re seeing the results, in years lost so that a Trump or Koch scion never has to ponder the indignity they might not begin life as a centimillionaire.

This will not end well.

Image: Rembrandt van Rijn or his circle, Head of an Old Man, c. 1629

36 replies
  1. 1
    Brachiator says:

    There is a ton of material in the study, but the key takeaway is that over the next two decades the US will continue to lag its developed counterparts in achieving higher average life expectancy for its citizens.

    But this is just part of the story. The number of people age 65 or older is getting significantly larger, and this has to be due to some degree to a higher standard of living.

    The year 2030 marks an important demographic turning point in U.S. history according to the U.S. Census Bureau’s 2017 National Population Projections. By 2030, all baby boomers will be older than age 65. This will expand the size of the older population so that 1 in every 5 residents will be retirement age.

    “The aging of baby boomers means that within just a couple decades, older people are projected to outnumber children for the first time in U.S. history,” said Jonathan Vespa, a demographer with the U.S. Census Bureau. “By 2035, there will be 78.0 million people 65 years and older compared to 76.7 million under the age of 18.”

    Older Americans are doing OK even with some bad habits. And there is some evidence to suggest that more affluent elders have better access to resources that give them a longevity advantage over other groups, so more detailed study of various demographic groups is warranted.

    And of course, women still have an edge over men when it comes to longevity. More could probably be learned from looking at this.

  2. 2
    Yutsano says:

    Okay the page comment numbers got a little wonky there for a bit.

    I’m sure the real take away is that if we had listened to the dirty librul hippies back in the day we might actually be better off. Hell if Theodore Roosevelt had gotten his system established no telling what it would look like today, especially after the Great Depression and the long regnum of his cousin.

  3. 3
    CarolDuhart2 says:

    One more thing: we’ve made real progress with some of our bad habits. When I was born, smoking was everywhere-even in hospitals which treated asthmatics and tuberculosis patients. When I first became an adult, one of the occupational therapy things I did was make ashtrays. Now I realize it’s been years since I’ve seen an ashtray anywhere, even for sale. Cigarettes was 75c per pack. Now they are at about $5-6 per pack, and god only knows what a carton costs these days, and where I see them there apparently aren’t any openly on the shelves. (Maybe you have to ask) We’ve made uneven progress on air pollution, but the sky no longer turns funny colors at night and I haven’t smelled the industrial smells I used to smell as a child. We’ve lowered emissions in our cars, and soon we won’t have any at all.
    Pot is slowly replacing alcohol in a lot of places, and even drinkers aren’t drinking as much anymore.
    We still have to go a long way towards safe and healthy sex, but if we can get sex education past the fundamentalists, and improve pre-and-post natal care……
    The future will look brighter…

  4. 4
    🇺🇸🌎 Goku (aka Amerikan Baka)  🗳🌷 says:

    The myth of post-war American capitalism was that the middle and working classes would, at long last, be able to accumulate capital and pass it on to their kids, thus powering a generation-over-generation gain in well being.

    Was it always a myth or did it actually exist and the GOP and it’s neoliberal policies have slowly destroyed it?

  5. 5
    Uncle Omar says:

    Social Security is saved! Now it can be turned over to the Masters of the Universe for further augmentation.

  6. 6
    sharl says:

    Meh. The important thing is that management and senior production staff at traditional major media are satisfied with their own medical coverage.

    Daniel Dale @ddale8

    If anyone still thinks Democrats don’t have a message focus in this election — they do, and it’s health care. New analysis finds it was mentioned in 61% of Democratic House ads between mid-September and mid-October: 2018: The Health Care Election

    David Dayen @ddayen

    I haven’t been out there as much as @daveweigel, but I’ve talked to a fair number of Congressional candidates, and I can’t think of one who hasn’t said “health care is the #1 issue.”

    John Whitehouse @existentialfish

    And yet, there literally has not been a single segment on health care on the nightly network news all year. Not a one. STUDY: Broadcast evening news shows have ignored health care in 2018
    The nightly news shows haven’t aired a single substantive segment about health care policy this year

    RedwoodGirl @RedwoodGirl

    I expect that all major national network TV reporters and producers all have great healthcare insurance and little experience with chronic or debilitating illness or going bankrupt from healthcare. I think they don’t believe it’s really a crisis. Or maybe they don’t care.

    David Frye @davidlfrye

    There was one on NPR’s All Things Considered tonight, and of course they managed to both-sides it. “On one hand, GOP has stopped running against Obamacare, on the other, Obamacare isn’t absolutely perfect, so: both sides.”

  7. 7
    geg6 says:

    @🇺🇸🌎 Goku (aka Amerikan Baka)  🗳🌷:

    All I know is I am going to be 60 in a month. I was born in1958, a later boomer. My parents had 6 kids. My dad was a union steelworker, my mom was a homemaker until her father died and she used proceeds from his home and insurance to go to college and then she was a newspaper reporter. All of us went to college with some help (and also our own borrowing) from our parents. When my parents had both passed, we each got a small but significant (for us) inheritance. Don’t know how many families like mine can do that now.

  8. 8
    zhena gogolia says:

    OT, WaPo says the Saudis have admitted that Khashoggi died in the consulate in Istanbul.

  9. 9
    Wag says:

    We’re number 64!
    We’re number 64!
    We’re number 64!

    Cool, said no one involved in health care in America

  10. 10
    Jay says:


    Cigarettes are no longer on the shelves for the same reason that razor blades and batteries are often in a locked cabinet.

    Rob a store for cash, and you might get a few bucks given how many transactions are credit cards, debit cards and e-wallets.

    Clean a store out of batteries, smokes and razor blades and you’ve got easily over $10k in product, that can easily be fenced at $0.35 to $0.50 on the dollar.

    During the Obama Presidency, median mortality rates in the US went from a decline started in the Smirky McChimpy Administration, to a slow rise.

    Note that the decline started 2 years ago.

    I wonder what happened two years ago?

  11. 11
    The Dangerman says:

    The Republican Health Plan: Die Faster . It’s From Working Two Jobs


    Browsed some concentration of wealth numbers; unless “they” want to live behind walls, with all sorts of security, this can’t continue forever.

    If you want to extend that to the caravan issue, go right ahead. Why do I get excited over 4000 refugees when there are 3000 counties in the US? OK, some counties have to take two. BFD.

  12. 12
    CarolDuhart2 says:

    Yes, @Jay: But the reason why they are so valuable is that they cost more-and people are smoking less. Hardly anyone bothered back when smokes were less than a dollar a pack, and there were more smokers. A memory for decades ago: I used to do market research calls with smoker surveys. The first one was a seasonal one where we got enough info cover a year-but the respondants were getting harder and harder to get as the years went by. I don’t even think they bother any more. Anti-drunk driving campaigns have inadvertently driven down the amount of alcohol consumption. “Two-fisted drinkers” and martini lunches have lost their luster these days.

    I think the slow rise the last 2 years has been the opioid epidemic. There’s a lot we could do with pain management if we did the research necessary. But profits from pain pills override better pain management approaches.

  13. 13
    Chris T. says:

    @Jay: The daily stress of living with the Orange Menace in control of the nukes takes its toll…

  14. 14
    Jay says:

    @🇺🇸🌎 Goku (aka Amerikan Baka)  🗳🌷:

    At the end of the Second World War, in the West, media income and wealth accrual gains exceed the average gains, and equaled or exceeded the top %5 gains.

    There’s lots of graphs out there that show that most of the productivity gains in Western Economies, until the ’70’s, accrued to the Poor and Middle Class.

    Reaganism, Thatcherism, Chicago School Economic’s however replaced Kenesism in the ’70’s with Trickle Down theory and since then, most productivity gains have accrued to Corporations and the 5%.

    Now the median Western family is one paycheck away from being broke.

    * the difference between median and average is best explained by the Bill Gates joke.

    Bill Gates walks into a bar full of Construction Workers, and suddenly, on average, everybody is a Billionaire.

    The median wealth in the bar however, doesn’t change. 64 guys with $750 to their name and 1 mega-Billionaire.

  15. 15
    🇺🇸🌎 Goku (aka Amerikan Baka)  🗳🌷 says:

    @The Dangerman:

    I think it’s such a bullshit issue about the caravans. We’re partly responsible for the mess in Central America and we need to take these people in. And you’re right the current situation won’t last forever.

  16. 16
    p.a. says:

    @🇺🇸🌎 Goku (aka Amerikan Baka)  🗳🌷: No, the New Deal and GI Bill did work*, but the fact that the rest of the developed world at that time was devastated by WW2 gave a bit of a boost to American (economic) Exceptionalism that would naturally be eroded as Western Europe rebuilt.

    * White people

  17. 17
    Yutsano says:

    @p.a.: Part of the reasons for the start of the Civil Rights movement is precisely because those gains weren’t trickling down to minorities. And the minorities had been fighting just as much if not more in World War II and Korea.

  18. 18
    Chris T. says:

    @p.a.: Some studies (waves hands vigorously here) say that the developed-world wreckage played a relatively minor (maybe up to 25-30% or so, which is significant but not dominant) part in the growth of the USA middle class. But it’s likely the 70-90% marginal tax rate that helped the most.

  19. 19
    Jay says:


    Smokes here are $12.33 a pack. When I started smoking, $2.45 a pack. Funny what 45 years of inflation does to the cost of a product.

    The Bank of Canada inflation calculator says they should cost only $11.45.

    Smokes are kept in drawers here, cartons in locked cabinets, for the same reason you have to pay first before pumping gas.

    There arn’t a lot of highly profitable, easily fungible items, almost as good as cash, to steal in our cashless societies for anybody who doesn’t use a pen or a computer.

    Gas an go was becoming so profitable that people were fitting extra tanks into trucks and RV’s so they could steal $600 worth rather than $150.

    There’s also a reason why cigarettes are shipped in unmarked semi’s with armed guards. The minor price differences between Provinces because of taxes, as much a $2, is profitable enough for cigarette smuggling to be an Organized Crime.

  20. 20
    gene108 says:

    @🇺🇸🌎 Goku (aka Amerikan Baka)  🗳🌷:

    Post WW2 prosperity existed. When I was growing up in the 1980’s, there was a lot of nostalgia for the 1950’s and pre-hippie 1960’s, because a single earner could support a family by working in a factory or construction, buy a home in the ‘burbs, and have some money left over. Even a high school drop out could get a middle class job at a factory.

    Then inflation and stagflation hit in the 1970’s and people started getting stretched on what they could afford. American companies started losing market share to foreign competitors like Honda, Sony, BMW, etc. and stuff was showing up on the shelves saying “Made in Japan” or “Made in Taiwan”.

    Stagflation had the VSP’s totally freaked out because what should work, based on their understanding of economics, wasn’t working.

    And this helped open the door to Supply Side Economics, because who knows, the other stuff wasn’t working, so give this a try.

    What Reagan did that really hurt the average person, was green light a lot of aggressive M&A activity. It wasn’t enough to just run a profitable company, with a healthy balance sheet, that took care of its employees. You had to maximize earnings or corporate raiders would buy out your company.

    And thus the era of downsizing and slashing benefits that created incentives for people to remain loyal, such as eliminating pensions, began.

  21. 21
    CarolDuhart2 says:

    @Jay: $64 a carton before taxes.And yes, inflation has something to do with the price increase,but if people were still smoking the way they did when I was a kid, the tobacco companies would have a whole line of very cheap cigs composed of the tobacco they would otherwise reject-like cheap booze made of stuff that better distillers and wineries wouldn’t sell. Also there are a lot of tobacco farmers who are learning how to grow other things.

  22. 22
    Brachiator says:

    @Chris T.:

    The effective tax rate was much lower than the marginal tax rate, and there is not much to indicate that the country was more awash with federal revenues than later. But there were rising incomes (aided no doubt by unions) and more wealth accumulation by those who rose into the middle class.

  23. 23
    🇺🇸🌎 Goku (aka Amerikan Baka)  🗳🌷 says:

    That about tracks with what I’ve read about it. It all started to erode in the 70s as the previous poltical regime that had existed since FDR’s first election began to fray.

  24. 24
    Jay says:


    $12.33 here are the cheap smokes, not a premium brand. A carton is $123.30, as it contains 10 packs.

    92.86% of the cost increase of a pack of smokes is due to inflation.

    We have health and wellness taxes on smokes in Canada for a long time.

    They have not kept pace with inflation.

    If Federal and Provincial Taxes had kept pace with inflation, in BC a pack would cost $17.78.

  25. 25
    MisterForkbeard says:

    @sharl: I mean, the key takeaway here is that Democrats have a consistent message that people care about – and that the media just refuses to acknowledge that or cover it.

  26. 26
    geg6 says:

    @🇺🇸🌎 Goku (aka Amerikan Baka)  🗳🌷:

    You want a good book on the decline of the prosperity of the blue collar middle class, find “When the Wolf Finally Came: the Decline and Fall of the American Steel Industry.” Great book that shows how stupid and greedy the MOUs are, the decline of unions and the end of the blue collar middle class in our neck of the woods. It focuses on the Pittsburgh area steel industry, but could be a lot of the big unionized industries during those times. One of the tales it tells is what happened to the J&L/LTV plant in Aliquippa, the mill where my grandfathers, father and a brother worked. It’s a sad and infuriating book, but very well written and quite a good read if you are interested in how it all fell apart.

  27. 27
    sharl says:

    @MisterForkbeard: Exactly. I hope/assume that Dem campaign managers have long learned that trad media ain’t their friends, and they need to bring top form to their ground games. From what I’ve been reading – and despite being inherently a glass-half-empty kinda guy – I like what I’ve been seeing on that score.

    I just keep getting mad (unproductively so) at the two-faced nature of media orgs, whose reporting sides don’t cover this stuff, while their pundits make up shit about what Dems are doing wrong. I’m happy to beat up on (fellow) Dems when I think they deserve it, but imo they’re doing what they need to here.

    I dunno. This kind of “news” programming must be keeping media owners and/or advertisers satisfied I guess; at least that’s the only explanation I can come up with.

  28. 28
    Jay says:

    @🇺🇸🌎 Goku (aka Amerikan Baka)  🗳🌷:

    It wasn’t just the Political Regime.

    Chicago School Economics hit everywhere.

    Investors were previously happy with stock gains of 10% -15%, often paid in dividends or the dividends rolled over through the Corporation or a Holding Company into more shares.

    Then Investor’s wanted 30% – $35%, and for many Corporations, that required cutting payroll, wages, benifits and cutting expansion and reinvestment.

    Then regulations changed and the Vulture Capitalists like Steve Meuchin arrived. Leveraged buyouts of “under performing” Corporations, allowed Board takeovers. This lead to legalized “looting”. Companies that were seeing annual 10% -15% gains, were suddenly making obsence gains.

    Various ways to do this were carried out. Pension funds, held to pay pensions were stripped out, ( Federal Laws now allowed it), were turned back into cash and reported as profit. So what if it became a ponzi scheme where instead of the Pension being paid by money set aside by Employee’s and the Company, and instead by current Employee and Company contributions.

    Real Estate Holdings were sold off, then rented back, often to and from a company controlled by the Vultures. Ditto for production equiptment, vehicle fleets, service centers and other Divisions.

    Crony Capitalism preyed on this as well. In the ’50’s, Boards were generally Independent, focused on the welfare of the Company. CEO’s made 58% more annually than their median Employee’s.

    Boards became stacked with fellow Grifters. CEO salaries, benifits and stock options exploded across the Board. I sit on your Board and I approve this looting. You sit on my Board and approve my looting.

    Sears is a case in point. So is Toy’s R Us. But they are old stories.

    Vast fortunes can be make by taking over a solid 10% -15% company, then using crony capitalism to vastly inflate CEO compensation, run short term asset stripping operations, report it as profit, issue new shares and stock splits to deflate stock prices as the stock climbs, now that the company is +35% profitable year after year, while the CEO and Board sell off their shares and options at peak prices.

    You can however, only do it so long, but if you get out before the crash, your “reputation” is Golden, and there’s always another Company out there.

    Basically, the unfettered Capitalism introduced in the 1980’s, started “eating it’s own children” to accrue more money to the 5%. But there’s lot’s and lot’s of children, even if they are not infinite.

  29. 29
    Jay says:


    Yup, double yup.

  30. 30
    Jay says:


    Democrats, given how the MSM keeps chasing after Still Dead Briebart’s Balls, will never “control the narrative”, they will never be able to “stick to the message”, because that’s not the Game the media plays.

    What Democrat’s can do, is control the message and narrative amongst Democratic Party voters and allies.

    Sadly, of late I have seen a fair number of Top 10,000 Lefty Blog’s go chasing after Still Dead Briebart’s Ball’s memes like Warren’s genetics, Oprah for President, Top 5 Ways Democrats can make 49 votes against Rapey K larger than 51.

    Pisses me off.

  31. 31
    Jay says:


    The House of Sawed:

    “The Saudi government acknowledged early Saturday that journalist Jamal Khashoggi was killed while visiting the Saudi consulate in Istanbul, saying he died during a fist fight.

    The announcement, which came in a tweet from the Saudi foreign ministry, said that an initial investigation by the government’s general prosecutor found that Khashoggi been in discussions with people inside the consulate when a quarrel broke out, escalating to a fatal fist fight.”


  32. 32
    CarolDuhart2 says:

    @MisterForkbeard: Yes, because other than local news, the media has trouble with issues. Issues require experts, and the national press finds issues, and th experts on those, boring.

    Another thing: they hate the fact that Dems aren’t in disarray at all. There are no real fights between factions anymore.

  33. 33
    Jay says:


    The only problem the MSM has with “issues”, is like facts, they have a strong Liberal bias.

  34. 34
    Mart says:

    Clearly the decreased life expectancy it is not the fault of Republican policy, it is those damn Obamacare death panels!

  35. 35
    Ruckus says:

    We have made obvious progress over the last 60 yrs. No doubt about that. What is not quite as obvious is that we are making progress at a much slower rate than other industrialized/wealthy countries. And republicans are doing their damnedest to go backwards at an alarming rate. Those 60 yrs? They want to get rid of all the advancements of that time for everyone not rich enough to own their own healthcare system or at least a reasonable part of it.
    How many of us are old and need that healthcare system more than ever? My hand is raised. How many of us are doing OK but not in any way wealthy and can afford a republican healthcare system? My hand is raised.

  36. 36
    Msb says:

    @ Brachiator
    Over 65s’ larger share of the population is largely the result of decreased birth rates after the Boomers.

    The US is falling behind because the countries in the lead are doing active health promotion for their whole populations (as well as trying to avoid increasing wealth inequality and to reduce poverty, which are also bad for health). The US largely leaves health promotion to the individual, which works great for well educated, financially secure populations and badly for those that aren’t. Obvious target issues for the US are diet/exercise/obesity as well as food insecurity, the opioid epidemic and especially perinatal health care. US maternal and infant death rates are scandalously high for a developed country, large because (surprise, surprise) deaths among the poor and minorities. Countries that are serious about maternal health have rates as low as 4 deaths per 100,000. The UK is at about 12 and the US about 24 and rising, when maternal deaths are falling in every other country, owing to efforts to achieve the MDGs and SDGs. Shameful.

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