You're blaming the declining life expectancy on more people receiving health insurance.

Sound logic there.

Posted by dahsdebater on 6/15/2020 11:03:00 AM (view original):
Here are the data in chart form. I actually posted them in the other thread I linked, so I was shocked when you tried to refer to CDC mortality data to defend the ACA. I already know what these data show. To make it more glaringly obvious, zoom in the dates from the 70s or 80s to present.

Off the top of my head I'd bet environmental regulations, acts such as seat belt laws, and the opioid crisis has more to do with life expectancies in the 70s, 80s, and today than the ACA.

Here are the facts:

1) The US had increased life expectancy >1 year every decade from 1900-1910
2) Global indices of first-world countries indicate that the rest of the world is continuing to experience the same slow but steady increase in survival we've seen since the '70s (see, for example, this). And the US lags behind most other developed nations. So you can't argue we're bumping into some natural limit.

What changed in this country in this decade?

We managed to increase life expectancy in the 30s. This decade has seen solid overall economic growth, coupled to a decline in survival for the first time in the CDC dataset. It is very clear - if the objective of healthcare is fundamentally to keep people alive, the ACA is an abject failure.

I, also, do not see any data that directly implicates the ACA for any decrease in the US mortality/life expectancy estimate.
It defies logic to think that MORE insured leads to more death.
That's kind of absurd when taken in any other context.

It is logical to conclude that the drop in "expectancy" is a result of some other factor(s).
The opioid crisis is a good guess.
Also, I think at some point, I think the rising number HAS to reach an apex due to the ever increasing numbers of baby boomers who (are exactly WHO has lived longer, and) are now reaching advanced ages and are going to start dying at large numbers, many of them UNDER that apex (78.?) number.
Heck, I have to last over a decade to make the number myself.
I consider that doubtful.
Of course, I never expected to make 50.
Thanks to the ACA I made 60!

Bush lied people died

I just honestly find it shocking how many millions of people are still trying to defend the ACA on its own merits. The data speak for themselves.

If you want to make the argument that the ACA is important as a stepping stone to something that actually works, that can make sense. It's objectively true that most of the best healthcare systems in the world (as measured by things that actually matter, keeping people healthy and keeping people alive) are publicly-funded. The only real exception is Switzerland, which has a healthcare system more similar to what we have now, but they spend more on healthcare than most of the single-payer systems, so even that isn't the best role model. So sure... ACA as a waypoint, fine. But for itself? Ridiculous. This is even more true when you start looking into the academic studies indicating that declines in life expectancy are largely coming from the bottom quartile of Americans by wealth; the richest 25% are continuing to live longer and longer as they always have. The ACA changed virtually nothing for them.

The opioid crisis, rise in suicides, and liver disease (brought on by alcohlism and obesity) account for the declining life expectancy in America. Quick Google search showed me that.

Which of these is because of more people getting health care insurance?

Posted by laramiebob on 6/15/2020 11:37:00 AM (view original):
I, also, do not see any data that directly implicates the ACA for any decrease in the US mortality/life expectancy estimate.
It defies logic to think that MORE insured leads to more death.
That's kind of absurd when taken in any other context.

It is logical to conclude that the drop in "expectancy" is a result of some other factor(s).
The opioid crisis is a good guess.
Also, I think at some point, I think the rising number HAS to reach an apex due to the ever increasing numbers of baby boomers who (are exactly WHO has lived longer, and) are now reaching advanced ages and are going to start dying at large numbers, many of them UNDER that apex (78.?) number.
Heck, I have to last over a decade to make the number myself.
I consider that doubtful.
Of course, I never expected to make 50.
Thanks to the ACA I made 60!

Its an absurd logical leap.

"The NFL has never been more popular, so clearly Christian McCaffrery is better than Barry Sanders." Same thing.

I see your point, Dahs, but I don't think you can compare life expectancy to when the ACA was passed and automatically assume it was a failure. You have no idea what the numbers would look like had the ACA not been passed. I need you to give me an actual study that would control for other factors. Otherwise, this is all speculation.

Is it not possible that without the ACA, life expectancy would have dropped even more? You can't just carry data from previous decades over to a new one and assume that every trend will hold forever.

Even then, I'm not sure how any of this is a negative argument against the ACA. It got more people healthcare. That's undeniable. If getting more people healthcare hurt life expectancy, that's a flaw with the way America does healthcare. Either way, the ACA is a net positive. Like I said earlier, if we need to fix how we do healthcare, a good starting point is to actually get people insured.

Tang, you brought up Occam's Razor the other day.

I think it's clear it applies here.

The US had the largest overhaul in healthcare policy in its history in 2010.
US trends in life expectancy fundamentally changed in 2010.
Healthcare is the #1 driver of life expectancy.

Obviously you can't prove what would have happened, although I could argue that what happened to the wealthiest Americans might be the best indicator. But I think the burden of proof is clearly on the people denying that the statistics slapping us in the face should be trusted, not on the guy who thinks they should.

The opioid crisis, rise in suicides, and liver disease (brought on by alcohlism and obesity) account for the declining life expectancy in America. Quick Google search showed me that.

Which of these is because of more people getting health care insurance?

Alcoholism peaked in the 70s.
Suicides peaked in the 90s.
Prescription drug abuse is easily linked to low-income people getting insurance coupled with shorter visits to vet pain complaints.

Dahs - can you explain your theory for why the ACA caused a reduction in life expectancy?

Bob used himself as a personal anecdote to defend the ACA. I could do something similar to illustrate another way it could contribute to declining healthcare standards.

The ACA put my parents' small private medical practice out of business. They saw ~50-60% as many patients per day as PCPs working for the big providers. Various provisos of the ACA made it impossible for them to continue to make money practicing medicine the way they wanted to practice medicine. This was not a big tragedy for them. My dad was 70 (maybe 69? I think 70) at the time they closed, and he'd had an opportunity he'd been wanting to take for a while to go preach in Germany. So just to be clear, nobody in the family is bitter about this. But it is illustrative of a general point that the general public may not be aware of - Federally-subsidized insurance programs (historically Medicare and Medicaid) reimburse at very low levels, typically substantially lower than private insurance plans. They can get away with this because the Federal government is the biggest single negotiator, the elderly comprise a large portion of the patient population, and while some docs have refused Medicare patients it was always difficult to fill your appointments without them. But the point is... you get paid less for a visit with a patient on Federally-subsidized insurance than you do on a visit with a patient on private insurance. This now also applies to most ACA-subsidized plans. This means that overall average reimbursement is down. In order to remain profitable, healthcare providers have to reduce visit time. I don't know of any aggregated statistics proving this to be true, but it is anecdotally true.

Anyone old enough to do this exercise, think about this. How long did you spend on an average doctor's visit in 1990? In 2005? How about now?

You want to talk about preventative care? What form of preventative care is more valuable than talking to your doctor? The very person best trained to put together different things you say and actually diagnose you?

Posted by tangplay on 6/15/2020 12:15:00 PM (view original):
Dahs - can you explain your theory for why the ACA caused a reduction in life expectancy?

I don't need to. The data support my position. You need very good reasons to reject the obvious hypothesis, not to accept it.