August 25, 2020
Despair Grips Lower-Paid White Workers
Long before COVID-19 upended our world, the lives of lower-paid, less-educated workers had already been coming apart.
“It’s the other epidemic, but it’s an epidemic that’s been occurring under the radar for a long time,” Anne Case said in her keynote address for the annual meeting of the Retirement and Disability Research Consortium, which was held online early this month.
Case, a Princeton University economist, was referring to the findings from her seminal work on the deterioration in financial well-being and rising death rates among white, non-Hispanics without a bachelor’s degree. Case, along with her husband, Angus Deaton, also at Princeton, have just published a book on their research, “Deaths of Despair and the Future of Capitalism.”
The deaths of despair they refer to are due to drug addiction, liver disease from alcoholism, and suicide. In writing this book, they are shining a spotlight on a phenomenon affecting people who no longer have a voice, in part because labor unions, once powerful advocates, have declined.
In 2018, some 158,000 white adults of all ages without a college degree died from addiction, alcoholism and suicide, according to Case and Deaton’s research – more than double the number in 1992 and on par with COVID-19 deaths to date.
But the death rate is just the tip of an iceberg of woe that includes an increase in physical pain, declining mental health, and a loss of a sense of self, Case said.
One disturbing trend is the relatively recent phenomenon of rising suicides among white women without a bachelor’s degree. Although suicides among their male counterparts are still much higher, women’s suicides in recent years have been increasing at roughly the same pace.
What is at the root of this despair? Case provides economic explanations, including a long-term decline in men’s wages and in the percentage who are employed. However, economics is inadequate to explain the despair. …Learn More
May 26, 2020
How COVID-19 Spreads in Nursing Homes
The coronavirus has pulled back the curtain on longstanding problems in nursing homes. In 2014, the Inspector General for the U.S. Department of Health and Human Services had reported that more than one in five seniors in skilled nursing facilities experienced “adverse events.” These included poor medical care, patient neglect, and inadequate infection control, which frequently sent residents to the hospital.
Now, some nursing homes have become COVID-19 hotspots. This has contributed to disproportionate numbers of deaths among people over age 70, who may also have weakened immune systems that make them more susceptible to the virus or underlying medical conditions that increase their mortality rate.
Anthony Chicotel, a staff attorney with California Advocates for Nursing Home Reform, discussed what he’s seen in nursing homes in the months since the pandemic began.
Briefly, Tony, name the big three underlying problems you feel caused the virus to spread.
Chicotel: No. 1 is chronic understaffing to meet the needs of the residents and to perform all the basic functions required every day. No. 2 would be a tolerance for poor infection control practices. This flows from No. 1 because good infection control requires time, and it’s one of the things that gets cut when you’re pressed for time. No. 3 might be the practice of staff working in multiple facilities. Because they are often low-paid, it’s not unusual for them to work for two different companies that do nursing home care, or they might also work for an assisted living provider. This cross-pollination contributes to the spread of the virus among facilities. We’ve also learned that most of the staff who had the coronavirus have been asymptomatic.
The problems in nursing homes are not new?
Chicotel: I think we should’ve anticipated this. Coronavirus has brought all this out into the open but the Centers for Disease Control cites a a pre-pandemic study that found that up to 388,000 nursing home residents die each year resulting from poor control of infections such as Methicillin-resistant bacteria (MRSA) and urinary tract and respiratory infections. We’ve just accepted this staggering breakdown of infection control for a long time. I’m an advocate, and it wasn’t something I really focused on either. It’s been begging to be addressed in a significant way for some time.
Talk about infection control. In this pandemic, everyone is aware that hand washing is critical to stopping the virus. You cited a report by the Centers for Medicare and Medicaid Services (CMS) that 36 percent of long-term care facilities do not comply with hand-washing protocols and 25 percent do not comply with protocols for personal protective equipment (PPE). …Learn More
April 7, 2020
Our Parents Were Healthier at Ages 54-60
Baby boomers aren’t as healthy as their parents were at the same age.
This sobering finding comes out of a RAND study that took a series of snapshots over a 24-year period of the health status of Americans when they were between the ages of 54 and 60.
The researchers found that overall health has deteriorated in this age group, and they identified the specific conditions that are getting worse, including diabetes, pain levels, and difficulty performing routine daily activities.
Obesity is an overarching problem: the share of people in this age group with class II obesity, which puts them at very high risk of diabetes, tripled to 15 percent between 1992 and 2016.
In addition to declining health, the study for the Retirement and Disability Research Consortium uncovered strong evidence of growing health disparities among 54 to 60-year-olds: the poorest people are getting sicker faster than people with more wealth.
The increase in women’s pain levels has been starkest over the past 24 years. The wealthiest women have seen an increase of 6 percentage points in the share experiencing moderate to severe pain from conditions like joint or back pain. But the poorest women saw a 21-point leap. The disparity for men was also large: up 7 points for the wealthiest men versus 15 points for the poorest men.
The bottom line: today’s 54 to 60-year-olds are not as healthy as their parents were, and the study suggests that the disparities between rich and poor will continue to grow.
To read this study, authored by Peter Hudomiet, Michael D. Hurd, and Susann Rohwedder, see “Trends in Health and Mortality in the United States.”Learn More
January 23, 2020
Medicaid Expansion has Saved Lives
The recent rise in Americans’ death rates is a crisis for the lowest-earning men. They are dying about 15 years younger than the highest-earners due to everything from obesity to opioids. Women with the lowest earnings are living 10 years less.
But healthcare policy is doing what it’s supposed to in the states that expanded their Medicaid coverage to more low-income people under the Affordable Care Act (ACA): helping to stem the tide by making low-income people healthier.
An analysis by the Center for Poverty Research at the University of California, Davis, found that death rates have declined in the states that chose to expand Medicaid coverage. The study focused on people between ages 55 and 64 – not quite old enough to enroll in Medicare.
Medicaid has “saved lives in the states where [expansion] occurred,” UC-Davis researchers found. They estimated that 15,600 more lives would have been saved nationwide if every state had covered more of their low-income residents.
This is one of many studies that takes advantage of the ability to compare what is happening to residents’ well-being in states that expanded their Medicaid programs with the states that did not. Progress has come on many fronts.
In expansion states, rural hospitals, which are struggling nationwide, have had more success in keeping their doors open. By covering more adults, more low-income children have been brought into the program, which one study found reduces their applications for federal disability benefits as adults. And low-income residents’ precarious finances improved in states where Medicaid expansion reduced their healthcare costs. …Learn More
October 10, 2019
What’s Driving the Longevity Gap
The decline in U.S. life expectancy is unlike anything we’ve seen
Bombshell headlines like this popped up in major news outlets last November after the government reported that life expectancy in 2017 fell for the third year in a row.
This is a troubling break from the steady improvements in lifespans since 1900, which were powered by a combination of medical breakthroughs and healthcare policy. Early in the 20th century, antibiotics dramatically increased infant lifespans. Later, new treatments like statins and stents, as well as expanded access to healthcare through Medicare and Medicaid, increased life expectancy across the age range.
But there’s another story behind this story: life expectancy very much depends on where one falls on the economic ladder.
Between 1979 and 2011 – prior to the very recent fall in longevity – the increase in lifespans was much larger for more educated, higher-earning Americans than the gains for people with less education and lower incomes, according to a study by the Center for Retirement Research (CRR).
Smoking is an important factor in this socioeconomic divide. The decline in smoking and cardiovascular disease greatly contributed to rising longevity in the latter half of the 20th century. But while all Americans are smoking less today, those in lower socioeconomic groups still smoke much more. Today, one in four of them is a smoker, compared with just one smoker for every 10 people who attended college, the CRR found.
Looking ahead, education will remain a clear dividing line, and life expectancy will continue to depend crucially on the future prevalence and impact of smoking, as well as obesity, CRR predicted. …Learn More