Politics & Policy

When It Comes to American Health, Culture Trumps Politics

A boy watches as window-washers work at Rady Children’s Hospital in California, U.S., May 30, 2017. (Mike Blake/Reuters)
D.C. can’t fix problems of the heart.

There are times when our partisan political debate feels like the modern, social-media-fueled version of Nero fiddling while Rome burns. Or perhaps the better analogy is to the proverbial “bread and circuses” designed to distract a population from its own misery.

I exaggerate, of course. But as we confront even the most significant policy debates of the modern era, one can’t help but think that we’re exacerbating the true challenges of American life rather than solving them. We are offering false hope of governmental solutions to crises of the heart and the soul. There are wounds that public policy can’t heal, even if some politicians will always have an incentive to pretend otherwise.

Consider two very interesting facts:

1. In 2015 — for the first time ever — the proportion of uninsured Americans dropped below 10 percent.

2. Also in 2015 — for the first time since 1993 — American life expectancy actually declined.

In other words, even as Obamacare was insuring more Americans than ever (after all, the law required people to buy insurance), Americans were living shorter lives. To be very, very clear, I know full well that correlation does not equal causation, and there is zero evidence — none — that Obamacare is in any way responsible for increases in American death rates. Honestly, it would be more comforting if Obamacare were responsible. In that case, we could just reform the law and save lives.

No, the reasons for the increase in death rates and decreases in life expectancy resist any clear governmental solution. Why? Because people are increasingly dying deaths of despair. Even as our ability to treat the classic deadly diseases increases, more Americans are committing suicide, overdosing on drugs, and drinking themselves to death.

According to a new study in JAMA: The Journal of the American Medical Association, examining American life expectancy from 2000 to 2015, various forms of self-harm eroded gains from better outcomes in treating, say, heart disease and cancer. Vox’s German Lopez described the findings this way:

In total, the researchers said decreased death rates related to heart disease, cancer, cerebrovascular diseases, diabetes, influenza and pneumonia, chronic lower respiratory diseases, and kidney disease contributed to a gain of about two years and three months in life expectancy from 2000 to 2015. But increases in drug overdoses, suicide, chronic liver disease and cirrhosis, and alcohol poisonings pushed down the overall gains.

In fact, drug overdoses alone decreased life-expectancy gains by more than three months. And it’s not a phenomenon that’s spread evenly across society. Look at this extraordinary chart, contrasting whites with and without college degrees:

If you read the books that I believe together constitute the essential trilogy of the American predicament — Charles Murray’s Coming Apart, Robert Putnam’s Our Kids, and J. D. Vance’s Hillbilly Elegy — or if you live in or close to any distressed American community, you know that the differences between college-educated and non-college-educated communities extend far beyond whether they’ve read Shakespeare.

Less-educated communities enjoy fewer economic opportunities in the information economy, their families are more fractured, and those that are predominantly white in particular attend church less. In some less-educated communities it’s unusual to see an intact, stable nuclear family, or it’s unusual to meet a mother who’s only had children within wedlock. As Putnam so vividly shows us in his book, this level of instability and stress has devastating long-term effects on children. Millions will repeat their parents’ mistakes.

Eventually, social problems reach a tipping point. You could drop a manufacturing plant into the middle of many distressed neighborhoods and you’d have a hard time finding reliable workers to staff the assembly line. When home life is chaotic and the bottle has been your main comfort, it is very difficult to suddenly show up and work hard every day, all year.

In this environment, politics often does more harm than good. Yes, better policies can improve life on the margins, but politicians dramatically overpromise, and when they overpromise they do two terrible things to our culture. First, they deceive Americans into believing that external, political forces are more powerful in American lives than individual choices. Second, they magnify American rage by failing to deliver on their impossible promises. And so angry, restless voters keep searching for a political savior who can never, ever give them what they truly need.

I’m not arguing that public policy is unimportant, but rather that American public discourse essentially majors in the minors and minors in the majors. We spend the bulk of our time and energy on policies that will have less impact on a human life than the decision of a mom and dad to stay together or join a church. Those decisions don’t just impact economic opportunity; they can mean the difference between illness and health, between life and death.

So, yes, let’s debate health care, but let’s not pretend politicians and policies are more powerful or important than reality dictates. Health so often follows culture, and the path to a healthy culture lies where it always has, with churches, volunteer groups, civic associations, and selfless families — with the “little platoons” that make America great. Repair those platoons, and you repair our culture. Politicians aren’t the key to national renewal; you are.


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