Two remarkable stories broke the same day last week: The mortality rate for white middle-aged American males actually increased by 134 per 100,000 between 1999 and 2014, a public health disaster of the same magnitude as the loss of life caused by HIV/AIDS. On the same day, we found that the increase in premiums for health insurance that North Carolinians can buy through the health insurance exchange is among the highest in the country.
It may be a coincidence that these stories appeared on the same day, but it is no coincidence that two are related to the same underlying social and economic forces. The authors of the mortality report, Angus Deaton (winner of the 2015 Nobel Prize in economics) and his wife Anne Case (also a Princeton economist), observed that the demographic that experienced this increase in deaths was between 45 and 54 years of age with a high school education or less. At the same time they were dying at higher rates, this population went through a period of economic distress, losing on average 19 percent of their household incomes. The major causes of their deaths were suicide, drug overdose and alcohol poisoning.
The economists noted that this same demographic – less-well-educated, white, middle-aged American males – reported more chronic pain and generally poorer health than their better educated counterparts. It is instructive that these same health conditions – risk of suicide, alcohol and drug abuse, chronic pain and poorer general health – have been observed in the CDC’s famous Adverse Childhood Experiences study of middle class adults who had been exposed to trauma or adversity in their childhoods.
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There is a story here. In the 1990s, average American families began to feel changes in the U.S. socioeconomic landscape. As a result of the corporate takeover of our political system, changes in tax policies increasingly benefited the rich at the expense of the rest of us. More of the economic value being produced by hard-working Americans was being sucked up by the corporate elite. The average family income of low- and middle-income Americans has been essentially stagnant for 30 years, while the income of the most well to do continues to rise to obscene heights.
Today in the United States, the son of a lower class father is less likely to rise in social class than the sons of lower class fathers in the “Old Europe” of Britain, Sweden and Germany.
Meanwhile, working men – men who in the past could have supported a family with a decent wage, who could have depended upon their children getting a decent public education, who had meaningful social connections to their neighborhoods and fellow workers through unions and other networks – lost those manufacturing jobs and with them the wages they were entitled to as the most productive workers in the world.
Thanks to NAFTA and other manifestations of globalization, those jobs and the respect that came with them disappeared. Instead, lower paying jobs in retail and service industries, with few to no health benefits, were what was left. The better jobs required more technical knowledge and skill than these graduates of high school 15 or 20 years earlier could summon. One needed to know how to run a computer, not a drill press.
What does this have to do with today’s insurance premiums in North Carolina? Everything. Social and economic policies have real consequences, and bad social policies have bad consequences. The pro-corporatist ideology that eviscerated our public schools and gave us a recycled political factotum for a university president, that redistributed the tax burden to those who can least afford it and eliminated the Earned Income Tax Credit for low income working families, that took away unemployment benefits from workers who through no fault of their own lost their jobs, that imposed new barriers between elderly, low-income and minority voters and the ballot box is the same ideology behind North Carolina’s refusal to participate in any way in the Affordable Care Act.
In the words of Wayne Goodwin, North Carolina’s insurance commissioner, “If we had a state-based (health insurance exchange) system, we would have had more companies competing. There would have been more leverage on my end as the Insurance commissioner and rates would have been lower,” Goodwin said. “If there had been Medicaid expansion, rates would have been lower.”
The global corporatist elite is in charge. They don’t understand, or don’t care, that their fancy theories are in fact hurting and killing ordinary working people. Although I share the same discomfort with business as usual that tea party sympathizers express, I disagree that too much government is the problem. On the contrary, we need more of that kind of government that represents and protects everyday people and provides the social, educational, economic and health supports that jobs in today’s economy do not.
We need our democracy back.
Jonathan Kotch, M.D., MPH, is research professor of Maternal and Child Health at the UNC Gillings School of Global Public Health.