Chicken Or Egg: People In Trump States Have Lower Life Expectancies

Trump states have lower life expectancy. Is that because they embrace Trumpist policies that make them more likely to die sooner than normal people? Or is it the deleterious impact of those policies that cause them to embrace Trumpism in the first place? Monday, Paul Krugman took a closer look: America's Red State Death Trip. Pointing out a Tom Edsall piece that showed "red and blue voters live in different economies," Krugman's point is that "the political divide is also, increasingly, an economic divide [and] that red and blue voters don’t just live differently, they also die differently."

About the living part: Democratic-leaning areas used to look similar to Republican-leaning areas in terms of productivity, income and education. But they have been rapidly diverging, with blue areas getting more productive, richer and better educated. In the close presidential election of 2000, counties that supported Al Gore over George W. Bush accounted for only a little over half the nation’s economic output. In the close election of 2016, counties that supported Hillary Clinton accounted for 64 percent of output, almost twice the share of Trump country.

The thing is, the red-blue divide isn’t just about money. It’s also, increasingly, a matter of life and death.

Back in the Bush years I used to encounter people who insisted that the United States had the world’s longest life expectancy. They hadn’t looked at the data, they just assumed that America was No. 1 on everything. Even then it wasn’t true: U.S. life expectancy has been below that of other advanced countries for a long time.

The death gap has, however, widened considerably in recent years as a result of increased mortality among working-age Americans. This rise in mortality has, in turn, been largely a result of rising “deaths of despair”: drug overdoses, suicides and alcohol. And the rise in these deaths has led to declining overall life expectancy for the past few years.

What I haven’t seen emphasized is the divergence in life expectancy within the United States and its close correlation with political orientation. True, a recent Times article on the phenomenon noted that life expectancy in coastal metropolitan areas is still rising about as fast as life expectancy in other advanced countries. But the regional divide goes deeper than that.

A 2018 article in the Journal of the American Medical Association looked at changes in health and life expectancy in U.S. states between 1990 and 2016. The divergence among states is striking. And as I said, it’s closely correlated with political orientation.

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.

Is this all about deaths of despair in the eastern heartland? No. Consider our four most populous states. In 1990, Texas and Florida had higher life expectancy than New York and almost matched California; today, they’re far behind.

What explains the divergence? Public policy certainly plays some role, especially in recent years, as blue states expanded Medicaid and drastically reduced the number of uninsured, while most red states didn’t. The growing gap in educational levels has also surely played a role: Better-educated people tend to be healthier than the less educated.

Beyond that, there has been a striking divergence in behavior and lifestyle that must be affecting mortality. For example, the prevalence of obesity has soared all across America since 1990, but obesity rates are significantly higher in red states.

One thing that’s clear, however, is that the facts are utterly inconsistent with the conservative diagnosis of what ails America.

Conservative figures like William Barr, the attorney general, look at rising mortality in America and attribute it to the collapse of traditional values-- a collapse they attribute, in turn, to the evil machinations of “militant secularists.” The secularist assault on traditional values, Barr claims, lies behind “soaring suicide rates,” rising violence and “a deadly drug epidemic.”

But European nations, which are far more secularist than we are, haven’t seen a comparable rise in deaths of despair and an American-style decline in life expectancy. And even within America these evils are concentrated in states that voted for Trump, and have largely bypassed the more secular blue states.

So something bad is definitely happening to American society. But the conservative diagnosis of that problem is wrong-- dead wrong.

Americans born in 2017 can expect, on the average, to live to be 78.6 years old. But in bright blue states, people will live longer and in the reddest states with the stupidest people, people will die earlier First the 10 states with the highest life expectancy:

• Hawaii- 81.5
• California- 80.9
• New York- 80.8
• Minnesota- 80.7
• Connecticut- 80.6
• New Jersey- 80.5
• Colorado- 79.9
• Massachusetts- 79.9
• Vermont- 79.9
• Washington- 79.9

Those states are all "blue" and Trump lost them all, some in landslides. In Hawaii, California, and New York, the 3 states with the highest life expectancy Trump only received, respectively, 30.03%, 31.62% and 36.52% of the vote. Now let's look at the ten states with the lowest life expectancy:

• Mississippi- 74.5 (same as Vietnam)
• West Virginia- 74.8
• Alabama- 74.9
• Kentucky- 75
• Arkansas- 75.4
• Louisiana- 75.4
• Oklahoma- 75.4
• Tennessee- 76
• South Carolina- 76.2
• Ohio- 76.6

These wretched states, filled with people who make poor choices about everything in life, from what they eat to whom they vote for, all went for Trump in 2016, many by landslides. The three sickest states-- Mississippi, West Virginia and Alabama-- gave Trump, respectively 57.94%, 68.50% and 62.08% landslide victories. Moral of the story: if you vote for Trump-- and for Republicans-- you will die before your time and so will your children. You want change? Forget Trump and his lies... vote Bernie Sanders; he's offering what you want and need.

Ian Welsh asks what you plan to do with the "toy" that is your life -- and how your choice may impact other lives

PRINCESS IDEA: The world is but a broken toy,
its pleasure hollow — false its joy.
Unreal its loveliest hue, alas!
Its pains alone are true, alas!
Its pains alone are true.
HILARION: The world is ev'rything you say.
The world we think has had its day.
Its merriment is slow, alas!
We've tried it, and we know, alas!
We've tried it and we know.
ALL: Unreal its loveliest hue,
its pains alone are true --
PRINCESS IDA: Alas!
ALL: The world is but a broken toy,
its pleasure hollow — false its joy.
Unreal its loveliest hue, alas!
Its pains alone are true, alas!
Its pains alone are true.
FLORIAN: Unreal its loveliest hue.
HILARION, CYRIL, and FLORIAN: Unreal its loveliest hue.
ALL: Unreal its loveliest hue, alas!
Its pains alone are true, alas!
Its pains alone are true.

Ellizabeth Harwood (s), Princess Ida; Phiip Potter (t), Prince Hilarion; David Palmer (t), Cyril; Jeffrey Skitch (b), Florian; Royal Philharmonic Orchestra, Sir Malcolm Sargent, cond. Decca, recorded May 1965

Victoria Sladen (s), Princess Ida; Thomas Round (t), Prince Hilarion; Leonard Osborn (t), Cyril; Jeffrey Skitch (b), Florian; New Symphony Orchestra of London, Isidore Godfrey, cond. Decca, recorded Oct.-Dec. 1954

Muriel Dickson (s), Princess Ida; Derek Oldham (t), Prince Hilarion; Charles Goulding (t), Cyril; Geoge Baker (b), Florian; D'Oyly Carte Opera Company, Malcolm Sargent, cond. EMI, recorded Oct. 27, 1932 (digital transfer by F. Reeder)

by Ken

True to his word since his fund-raising drive, when he encouraged readers who appreciate what he has to say to contribute or subscribe, Ian Welsh has been producing a steady stream of posts -- mixing observations long and short on current developments with the larger-perspective commentaries and reflections he's been primed to share. If you haven't been keeping up, I encourage you to visit the site and rummage around the archive (and, if you enjoy what you see, to contribute or subscribe).

Obviously in the category of "larger-perspective commentaries and reflections" is Thursday's "Life Is a Toy, Not a Game," which has been rattling around my head. If it winds up rattling around yours, I apologize, but, well, that's life.

First we need to grasp this idea that "life" is a "toy," with which any number of "games" can be devised. I'm not going to try to paraphrase Ian's discussion of the point, which would in addition take a good measure of the fun out of it. Instead let's jump to --


A CLASSIC LIFE-GAME CHOICE (AND ITS
WIDER EFFECTS): SUBURBAN LIVING

Ian looks in toy-and-game terms at a game choice that should be familiar to us, after setting forth a basic principle about such choices: "[T]he choice of what games societies support is largely non-rational, and based on esthetic, moral and ethical choices, along with pure power considerations."

Bankers in the Western world were a net negative through 00s but they had the power and were valued deeply enough by certain parts of society that they were bailed out for a cost of trillions. Suburbs are economically unproductive, pure consumption to a degree that shames monastics and hermits, yet US society is largely set up as a giant subsidy for the suburban lifestyle, because Americans value having a house with a yard away from a lot of other people, surrounded by a bunch of other houses very similar to there’s inhabited by people very much like them, generally far from any productive activity.

That’s an esthetic choice: it’s a choice about what the good life is, “the good life is living in suburbs, therefore we will subsidize suburbs massively, because that’s how we want to live”.

That subsidy is a direct drain on all the people who look at suburbs and hate them, and don’t want to live in them. Living in suburbs requires economic relationships, embedded in law and custom, which are coercive and unequal.

“You win if you buy a big house in the suburbs, have 2 cars and 2 kids and die comfortably.”

That’s a game statement.

Ian has a lot more to say about this distinction between life-as-toy and the games people play, and brings in SimCity as an example of a toy that can be used to play just about any sort of game the player wishes. "Winning" or "losing" at SimCity has no meaning except what meaning you give it. Just as with life.

Who wins life? If you die with the most power or money, did you win? If you did the most good, do you win? If you enjoyed yourself the most? Made great art? Raised great kids? Went fishing as often as you wanted?

"Humans set up games all the time," Ian says. Capitalism is one, democracy another. Not surprisingly, then, "Different societies love different games."

Each game favors a certain type of person: the men and women who rise to the top of the capitalism game have almost no qualities in common with those who rise to the top of the renunciate game [favored by "the truly faithful" in medieval monasteries], and almost nothing in common with the scholar-bureaucrats who ran the Chinese empire so often. Different qualities and different development were rewarded.

WE GET TO CHOOSE OUR OWN LIFE-GAME,
BUT THE CHOICE ISN'T ENTIRELY FREE

Personally, this is the point in Ian's essay which has resonated most for me, because it's a lesson it took me a hellishly long time to learn, and by the time I did, I didn't see a whole lot that could be done about it.

None of this alters the fact that life is a toy, like a ball or SimCity. You can add rules to it, and enforce those rules with sanctions, but ultimately each person decides their own win conditions. One of the decisions is whether to play one of the approved games, of course, and many people don’t realize they can opt out of much of those games.

A society’s level of coercion is easily measured when thought of in these terms: how hard is it to opt out of the socially mandated games; or at least how onerous are the requirements of those games? Will you die? Go hungry? Just not get as much approval? How many different games are there, and how easy is it to move between them, so that you can find a way of playing with your toy that isn’t obnoxious to you, and is at least somewhat socially approved. It’s hard, today, for example, to be a monastic or a hermit; society in the West isn’t set up for it: people won’t feed you. In Thailand, on the other hand, it’s pretty easy. People not involved in the monastic or hermit life think those lives are valuable and are willing to support them.

It's possible that way back when somebody tried to make me understand how much trouble you can be setting yourself up for if you choose not to play your life as one of the conventionally accepted games. Thinking back, I kind of realize that actually most of the people I encountered were doing everything in their power to make me understand this, and I didn't get it, or didn't believe them, maybe because they didn't come right out and put it in such bald terms. I'm not sure what I could have done in any case, though, since it was pretty clear that I would both hate and be no good at any of the "games" I saw in the toy store of life.


FINALLY WE GET TO THE PAYOFF
OF THE TOY-AND-GAME MODEL

"Now some people have probably been offended by me calling life a toy," says Ian --

because we think of toys as trivial and disposable and we like to think that lives aren’t, even though we certainly very often act as if other people’s lives are disposable. But the word communicates that life is something you decide what you’re going to do with. Life always ends: there are no immortals—so what enjoyment or satisfaction are you going to get out of your toy before you no longer are able to play with it?

And, perhaps, what sort of society do you want to live in, so that you can get the most out of that toy? And do you care if others are able to use their toys as they want, or not?

There’s no bedrock here, there’s no ultimate source of authority. Unless you believe in God, there is no system of reason which can logically prove that we should be kind or cruel, want money or not want it, be hermits or epicures; or anything else.

So, what are you going to do with your life, your toy, and how are you going to help, or hinder, others in their enjoyment of their toy?

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