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December 5, 2019

Red Death, Blue Health?

Josef Stalin is reputed to have said: “The death of one man is a tragedy. The death of millions is a statistic.”

Josef Stalin is reputed to have said: “The death of one man is a tragedy. The death of millions is a statistic.” In the hands of New York Times columnist Paul Krugman, the deaths of thousands can be a partisan bludgeon.

A number of scholars have pondered the recent rise in deaths of despair — those attributed to alcoholism, suicide and drug overdoses. Krugman sees a chance to make a crude red state/blue state comparison.

“I looked at states that voted for Donald Trump versus states that voted for Clinton in 2016, and calculated average life expectancy weighted by their 2016 population. In 1990, today’s red and blue states had almost the same life expectancy. Since then, however, life expectancy in Clinton states has risen more or less in line with other advanced countries, compared with almost no gain in Trump country. At this point, blue-state residents can expect to live more than four years longer than their red-state counterparts.”

So, vote Democrat, live four years longer?

Krugman muses that many blue states expanded Medicaid and that obesity tends to be higher in red states. Residents of blue states also have higher levels of education. That’s about the sum of his analysis, but it’s enough for him to declare that the “conservative” diagnosis of what has gone wrong in America, i.e. that the decline of traditional values has had negative effects, is “dead wrong.”

“Sentence first, verdict afterward” said the Red Queen. Comparing red states and blue states this way is facile.

First, it’s essential to stress that the decline in life expectancy is a nationwide phenomenon that hits all ethnic groups and both sexes. Of the states with the worst statistics — West Virginia, Ohio, New Hampshire, Maine and Vermont — three are blue states, one is red, and one is purple.

It seems dubious to assume that Medicaid expansion, which happened mostly within the past five years, could have had such a dramatic effect in so short a time. Some of the states that expanded Medicaid, like Louisiana and Alaska, have some of the highest rates of premature deaths. Only 14 states have not expanded Medicaid, and they are disproportionately poorer states in the Deep South.

We do know that these “deaths of despair” as Princeton’s Anne Case and Angus Deaton dubbed them, are the result of behaviors. Unlike in poorer countries, where impure drinking water or infectious disease takes a large toll, our premature deaths arise from drug addiction, alcohol abuse and suicide.

Suicide is on the rise, not just among middle-aged and older Americans, but among the young as well. Between 2007 and 2017, youth suicide increased by 56%, and suicide attempts quadrupled. The prime suspect here is social media. Instagram, Snapchat, Twitter and their competitors can induce anxiety and depression among teenagers eager for peer approval. Many spend most of their waking hours unnaturally attached to screens, which deliver pleasure but also bullying and belittling. A high school teacher noted that the cafeteria used to be the noisiest room in the school. No longer. It’s now a tableau of darting fingers and uneasy eyes.

Maybe social media is not the problem. It’s probably too soon to know. Human behavior is complicated. Some states have more guns than others (which contributes to suicide deaths). Some have more access to Fentanyl.

There is no debate in the literature that the decline of two-parent families is associated with poorer outcomes for children (though divorce sometimes makes adults happier). And there is emerging evidence that loneliness — another effect of family breakdown — has become more of a public health problem than obesity. Men raised in fatherless homes are more prone to joblessness, drug addiction and a range of other troubles than those raised by two parents. They are also more vulnerable and damaged than their sisters who are raised in the same circumstances.

Here’s the twist, and the part Krugman completely missed: Many of the people in blue states who are keeping the life expectancy figures up are actually living in a traditional way, even if they vote Democrat. The college-educated upper-third in America follows bourgeois virtues. They get an education, get a job, get married and have children, in that order. The blue states are full of them. New Mexico and Alabama, not so much.

So it’s Krugman’s partisan point scoring, not the “conservative diagnosis,” that’s dead wrong.


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