“Over the last 30 years, nearly every wealthy country in the world has made it much safer for people to have babies. Only one outlier has moved in the opposite direction: the United States, where the rate of people dying in childbirth continues, stubbornly and tragically, to rise. In 2021, 1,205 US women died from birth-related causes, up from 754 in 2019. Many of those deaths — a full 89 percent in one Georgia study — are potentially preventable with the proper care.”
“So why did U.S. life expectancy trends slow and then peak in 2014? And what, if anything, can policy makers and politicians realistically do to make increasing it a priority? As noted above, the big recent dip largely resulted from the COVID-19 pandemic. A 2023 Scientific Reports article “estimated that US life expectancy at birth dropped by 3.08 years due to the million COVID-19 deaths” between February 2020 and May 2022. But let’s set aside that steep post-2020 downtick in life expectancy resulting from nearly 1.2 million Americans dying of COVID-19 infections.
A 2020 study in Health Affairs chiefly attributed the 3.3-year increase in U.S. life expectancy between 1990 and 2015 to public health, better pharmaceuticals, and improvements in medical care. By public health, the authors meant such things as campaigns to reduce smoking, increase cancer screenings and seat belt usage, improve auto and traffic safety, and increase awareness of the danger of stomach sleep for infants. With respect to pharmaceuticals, they cited the significant reduction in cardiovascular diseases that resulted from the introduction of effective drugs to lower cholesterol and blood pressure.
So a big part of what propelled increases in U.S. life expectancy is the fact that the percentage of Americans who smoke has fallen from 43 percent in the 1970s to 16 percent now. Smoking is associated with higher risks of cardiovascular diseases and cancers, rates of which have been dropping for decades. In addition, the rising percentage of Americans who are college graduates correlated with increasing life expectancy.
However, since the 2004 peak, countervailing increases in the death rates from drug overdoses, firearms, traffic accidents, and diseases associated with obesity contributed to the flattening of U.S. life expectancy trends.
A 2021 comprehensive analysis of the recent stagnation and decline in U.S. life expectancy in the Annual Review of Public Health (ARPH) largely concurs, finding that “the proximate causes of the decline are increases in opioid overdose deaths, suicide, homicide, and Alzheimer’s disease.” Interestingly, the U.S. trend in Alzheimer’s disease prevalence has been downward since 2011. In addition, the ARPH review noted that “a slowdown in the long-term decline in mortality from cardiovascular diseases has also prevented life expectancy from improving further.” So enabling and persuading more properly diagnosed Americans to take blood pressure and cholesterol-lowering medications would likely boost overall life expectancy.”
“Many providers like Balay see an obvious link between rising congenital syphilis rates and sparse access to obstetric care (i.e., care for pregnant people, also called maternity or prenatal care). That’s largely because, historically, prenatal care is where syphilis transmission to a fetus has been interrupted. Testing is standard in prenatal care, and all but eight states require syphilis testing during pregnancy.
The problem is simple, as Balay explains. “There just is not enough obstetric care,” she said. And as prenatal care becomes increasingly scarce, so do opportunities to catch and treat syphilis.
Balay is not alone in thinking that scarcity helps explain what’s happening with congenital syphilis, especially among Indigenous Americans.
In a recent CDC report, 37 percent of US babies with syphilis were born to parents who didn’t get timely syphilis testing during pregnancy. But that number was higher, 47 percent, when the parents were American Indian. And most of those parents who didn’t get timely testing didn’t get any prenatal care at all.
In rural states, increasingly inadequate maternity care access is making intensified mother-to-child syphilis transmission all but inevitable. That puts Indigenous women and their newborns at especially high risk.”
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“One of the most promising solutions to South Dakota’s maternal care scarcity problem got a boost last year when the state’s voters approved an initiative to expand Medicaid beginning in early 2023. The expansion means more than 52,000 of the state’s residents are newly insured, which shifts the costs of their care from IHS to a better-funded federal program. It also means that hospitals caring for these patients will get paid more for the care they provide to the thousands of tribal residents newly covered by Medicaid. And most importantly to patients, expansion will make it more financially feasible to get the care they need.”
“A GOP experiment forcing low-income people to work to qualify for public health insurance benefits is stumbling in Georgia.
The state’s Republican governor, Brian Kemp, expected 31,000 Georgians to sign up in the first year of the program, which started in July. Through four months, only 1,800 people enrolled — and critics blame the paltry expansion on an overly complex program with too many hurdles for people to clear.”
“Mining companies offer good jobs with good benefits that can counterintuitively damage health care access. Health systems can grow dependent on those insurance plans to survive, and the benefits are in some cases so good that providers are reluctant to serve others in the community. It’s the consequence of a national health care system that feeds off employer-sponsored health insurance to turn a profit, and, as a result, warps itself to meet the needs of those who have it.
Six months of interviews with more than 90 patients, providers, retired miners, community leaders and health care experts across the U.S., including in three towns characteristic of the mining industry’s past, present and future — Williamson, West Virginia; Elko, Nevada; and White Sulphur Springs, Montana — reveal the breadth of these perils: retired and injured miners, and their families, struggling to get care; communities left with beleaguered or closed health facilities; and pricy hospital bills in towns where mines have driven up median incomes.”
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““Doctors want these big reimbursements from the very rich insurance policies that the gold mine provides. They don’t want the pennies they receive from Medicare,” said Jan Brizee, former ombudsman for the Nevada Office for Consumer Health Assistance representing Elko and other rural counties. “So you have somebody who’s retired after 25 or 30 years, and now they have nothing, having to travel out of town to get even primary care, let alone a specialist.”
Not all mining communities experience these problems, and similar issues exist in towns dependent on other industries with good benefits, like manufacturing. But mining communities face unique obstacles compared with other one-company towns — including remoteness and challenging geography — that make it difficult to attract other businesses that would diversify their health insurance landscape.
Miners also tend to be in worse health than their counterparts with other manual labor jobs, with higher rates of poor sleep and heart disease.”
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“Medicaid expansion and extra federal funding to support rural health centers and hospitals have helped in some towns. But providers bemoan stingy state Medicaid reimbursement rates that aren’t enough to pay the bills, paltry federal funding to support primary care and hospital designations that don’t meet the needs of all facilities.
For the most part, these solutions have inadequately addressed the systemic failures of employer-based health systems in these communities.”
“Experts say the public’s disinterest in the latest Covid shots is likely a combination of poor messaging from authorities, a diminishing fear about a virus that three years ago was wholly unknown, and the political polarization of the pandemic itself. But whatever the reasons, that vaccine ambivalence still poses a health threat.
Elderly people and very young infants continue to have a higher chance than the rest of the population that they will be hospitalized with Covid-19. Vaccination rates have fallen off for the former group, who are also most likely to die from an infection, and they were never strong to begin with for the latter”
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“The known unknowns for the future, which could spur another round of investment and interest in updated Covid-19 vaccines, are biological. The virus has been evolving and will continue to evolve and could, in theory, reach a point where the current vaccines are ineffectual.
The other question mark is inside of us. The reason many people still enjoy protection from serious illness is because our body’s T-cells are familiar with the virus and can activate when they detect it. They may not be able to stop an infection entirely (that is the role of antibodies, which are quicker to fade) but they can stamp out the virus before a person becomes too sick.
What we don’t know today is how long our T cells’ memory will last, and how durable that immunity really is. The only way to find out is for more time to pass.”
“Universal health care remains an unrealized dream for the United States. But in some parts of the country, the dream has drawn closer to a reality in the 13 years since the Affordable Care Act passed.
Overall, the number of uninsured Americans has fallen from 46.5 million in 2010, the year President Barack Obama signed his signature health care law, to about 26 million today. The US health system still has plenty of flaws — beyond the 8 percent of the population who are uninsured, far higher than in peer countries, many of the people who technically have health insurance still find it difficult to cover their share of their medical bills. Nevertheless, more people enjoy some financial protection against health care expenses than in any previous period in US history.
The country is inching toward universal coverage. If everybody who qualified for either the ACA’s financial assistance or its Medicaid expansion were successfully enrolled in the program, we would get closer still: More than half of the uninsured are technically eligible for government health care aid.
Particularly in the last few years, it has been the states, using the tools made available by them by the ACA, that have been chipping away most aggressively at the number of uninsured.
Today, 10 states have an uninsured rate below 5 percent — not quite universal coverage, but getting close. Other states may be hovering around the national average, but that still represents a dramatic improvement from the pre-ACA reality: In New Mexico, for instance, 23 percent of its population was uninsured in 2010; now just 8 percent is.
Their success indicates that, even without another major federal health care reform effort, it is possible to reduce the number of uninsured in the United States. If states are more aggressive about using all of the tools available to them under the ACA, the country could continue to bring down the number of uninsured people within its borders.
The law gave states discretion to build upon its basic structure. Many received approval from the federal government to create programs that lower premiums; some also offer state subsidies in addition to the federal assistance to reduce the cost of coverage, including for people who are not eligible for federal aid, such as undocumented immigrants. A few states are even offering new state-run health plans that will compete with private offerings.”
“Research has shown that people will skip necessary care if they have even a small cost to pay, and recent surveys find one in three Americans say they have postponed medical treatment in the last year due to the cost.”
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“The Perry Undem survey, which polled nearly 2,700 Americans on behalf of the American Cancer Society’s Cancer Action Network, the Leukemia and Lymphoma Society, and RIP Medical Debt, also detected widespread struggles to afford health care. About 7 in 10 people say they have received a medical bill that they could not afford, it found, and more than 60 percent of Americans said they had made some kind of sacrifice — delaying care, skipping appointments, changing the food they buy at the grocery store, etc. — in order to afford health care in the past two years.”
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“About 40 percent of people said they were always or frequently unsure how much their medical services would cost after they received care, according to the Perry Undem survey; another 30 percent said they were uncertain about the costs at least some of the time. Nearly two-thirds of US patients said they were at least sometimes unsure how much their insurance plan would cover after being treated.”
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“About 6 in 10 Americans said they had experienced a problem using their health insurance in the past year, according to KFF.”