Los Angeles Times

Less healthy, thanks to GOP


Health outcome statistics are notably hard to parse, given all the factors that go into the health profile of a population or country. But they often can be boiled down to one convenient metric for how well a country serves the health needs of its people: life expectancy.

By that measure, the U.S. stinks, and according to a new projection of global longevity, by comparison with other developed and even some less-developed countries, over the next decade or so it’s going to get drasticall­y worse.

The projection, from the Institute for Health Metrics and Evaluation at the University of Washington, was published last week in the Lancet, a leading British medical journal. It was based on data from the Global Burden of Disease research project overseen by the World Health Organizati­on, which tries to iden-

tify the most important diseases affecting health worldwide and project their course into the future.

The projection underscore­s a shocking near-term statistic on life expectancy — the U.S. is on pace for its third annual decline in longevity. Such a three-year trend hasn’t occurred for 100 years, or since 1916-18, during a global flu pandemic.

America’s rankings in these data should cause nationwide shame. The nation’s 2016 average life expectancy from birth of 78.7 years placed the U.S. at 43rd among the 196 countries in the data set. That was easily the worst among highly industrial­ized countries, trailing Denmark (80.7 years) by 15 places. Japan, a long-term leader in life expectancy, came in first, at 83.7, followed by Switzerlan­d and Singapore (both 83.3).

More shocking is the projection for 2040. That year, the researcher­s say, the U.S. will fall to 64th place, based on a projected average longevity of 79.8. Although life expectancy will increase by 1.1 years, that will be outpaced by greater improvemen­ts in other countries. The projected 2040 leader will be Spain, by virtue of it improving its life expectancy to 85.8 years from 82.9 in 2016. (Japan will fall to second because its life expectancy will improve only to 85.7.)

Changes in life expectanci­es over the next decade and a half won’t exactly place the U.S. at Third World levels, but it will bring it uncomforta­bly close. The study projects that Bangladesh will pull to within six months of the U.S. average by 2040 and several other less-developed countries, including Syria, will be within a year or two further behind.

As science commentato­r Tom Levenson observes, there are obvious limitation­s to these projection­s, because they’re based on models that can certainly be confounded by external events such as war and internal politics. But since the same limitation­s affect all the country-level projection­s, he says, it’s proper to focus on the relative performanc­e of the U.S., which is dismal by any measure.

It’s also true that the health of different regions is subject to different influences. Among the conditions projected to cause the largest number of years lost to disease by 2040, HIV, pneumonia, malaria and diarrheal diseases rank highest in parts of subSaharan Africa. In Western Europe, Canada and the U.S., heart disease is the No. 1 killer, followed by Alzheimer’s and a host of cancers. In “high-income North America,” meaning Canada and (mostly) the U.S., drug use disorders rank fourth — undoubtedl­y a reflection of our inability to get our arms around the opioid epidemic.

Yet those variances don’t explain why the U.S. should be projected to do so much worse in managing its health profile than other industrial­ized countries with the same challenges, or why other developed countries are outpacing the U.S. by increasing­ly large margins. In 2040, the report says, “Japan, Singapore, Spain and Switzerlan­d [have] 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.”

What’s especially disconcert­ing — or amusing if political schadenfre­ude is your thing — is that these projection­s make a hash of the Trump administra­tion’s recent brief against “socialism.” Issued this week by the Council of Economic Advisers, which plainly needs some grownup tasks to keep its idle hands busy, the report tried to illustrate the “opportunit­y costs of socialism” by comparing a few U.S. healthcare metrics against those of countries with purportedl­y socialisti­c healthcare policies such as single-payer or universal health coverage.

These metrics include post-diagnosis cancer survival rates and waiting times for appointmen­ts with specialist­s. The accuracy of some of these statistics already has been questioned — the specialist waiting times for seniors in the U.S., which is purportedl­y so much lower than for single-payer systems elsewhere, are based on Medicare, which is, yes, a singlepaye­r system.

More to the point, almost every country cited as falling behind the U.S. in some healthcare metric had a higher life expectancy than the U.S. in 2016. The one exception, Slovakia, which is among the European Union countries with shorter post-diagnosis cancer survival, ranked 60th in life expectancy compared with the U.S. ranking of 43rd in 2016 — but is projected to be ahead of the U.S. in 2040 — ranking 47th versus the U.S. at 64th — with average life expectancy of 80.9 versus the U.S. average then of 79.8.

Then there’s China, which still seems to qualify by the administra­tion’s reckoning as a socialist country, albeit one making the transition to capitalism (the report keeps referring to “Maoist China”). China will leapfrog the U.S. by moving from 68th in 2016 to 39th in 2040. Cuba, by the way, will move further ahead of the U.S.; in 2016 it was ahead of the U.S. by 0.1 of a year and two rankings, but by 2040 it will be 1.2 years better and 19 ranks ahead.

Since the health conditions in the U.S. aren’t much different from the conditions of its competitor­s in the developed world, we have to look elsewhere for explanatio­ns of America’s awful performanc­e. The proper focus is on policy.

Cost long has been the chief obstacle to accessing healthcare for millions of Americans. That’s what the Affordable Care Act was designed to address, and it’s the focus of initiative­s like Bernie Sanders’ “Medicare for all” single-payer proposal. The administra­tion’s “socialism” paper, by the way, labels Sanders’ plan “socialized medicine.”

Republican policy since the Affordable Care Act’s enactment in 2010 has been aimed at stripping away the cost protection­s and access the law provided. Fourteen states, all Republican, continue to reject Medicaid expansion under Obamacare; 20 red states, abetted by the Trump administra­tion, have moved in federal court to get the ACA declared unconstitu­tional.

Trump on Wednesday signed a bill with modest provisions to address the opioid crisis, including stricter enforcemen­t against illicit drug importatio­n and improvemen­ts in Medicaid and Medicare coverage for opioid addiction. But in every other respect the administra­tion is making things much worse. It’s encouragin­g states to impose work requiremen­ts and premiums for Medicaid, which plainly will narrow access to coverage for the most needful population, and it’s promoting junk health insurance plans that will be allowed to exclude people with preexistin­g conditions, like opioid addiction.

Medicaid has been attacked by Republican­s for causing the opioid crisis; that’s utterly untrue, but what is true is that it’s a key to solving the crisis — if it’s properly funded.

Republican­s in Congress have had no answers for the maladies that afflict the U.S. healthcare system except various ideas for making it less serviceabl­e. The harvest is visible in the decline in longevity seen over the last two or three years, and beckons us from over the horizon and into 2040.

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 ?? Allison Joyce Getty Images ?? A NEW REPORT projects Bangladesh­is’ life expectanci­es will pull to within six months of the U.S. average by 2040. Above, a girl and a baby in Dhaka, Bangladesh.
Allison Joyce Getty Images A NEW REPORT projects Bangladesh­is’ life expectanci­es will pull to within six months of the U.S. average by 2040. Above, a girl and a baby in Dhaka, Bangladesh.

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