“Socialism,”
writes Washington Post columnist
Kathleen Parker on February
9, “has always appealed to the young,
the cure for which isn’t age but responsibility. This usually comes in the form
of taxes and children, both of which involve working and sacrificing for the
benefit of others, the extent of which forms the axis upon which all politics
turns.” Parker is discussing the brouhaha around comments about the need
for women to support Hillary Clinton’s presidential bid, particularly those by
Gloria Steinem that young women are supporting Bernie Sanders because,
essentially, that’s where the boys are. Her logic seems a little contradictory
to me, because socialism is all about being part of a society that we are all
in together, where we work and sometimes sacrifice for the benefit of others.
Parker really means that we become more selfish, that the “others”
narrows from our whole society to that small group, presumably our nuclear
family, for whom we work and sacrifice. Of course, she is only talking about
some people. Some people never have children. Others of us realize that there
are benefits that we all want as a society – transportation and police and
schools and even a social safety net – that makes us more than willing to pay
our taxes. And a few people, very wealthy, accumulate much more money than they
or their children could ever use and pay very little in taxes. They, to be
sure, are big fans of the popular narrative endorsed by Parker: that the rest
of us need to buckle down and take care of our kids and not make a fuss and be
socialist and threaten their gravy train. And for sure keep paying taxes, so
that when they need to be bailed out the government has the funds.
It is a deeply flawed narrative, but it holds a lot of sway,
and is used to justify policies that have facilitated the greatest transfer of
wealth, from most of us to a few of them, in a century. More and more Americans
are on a treadmill, working harder and harder to discharge their responsibilities
to their families and pay their taxes, because their real wages are stagnant or
decreasing. Our economy increasingly is one where little is manufactured but we
all tithe to the kitty (or is it a lion?) of the financial services sector; its
“players” compete for that money taken from the rest of us (anyone seen “The
Big Short”?) and it bothers them not one bit. That it bothers a lot of young
people enough to support Senator Sanders (who Parker says “never outgrew his
own socialist-rebellious tendencies”) should make all of us happy and
optimistic, since what is happening now is not good for most individuals, their
families, America, or the world.
It’s also not good for a lot of people’s health. The New York Times’ Sabrina Tavernise
reports on February 12, 2016 that the “Disparity
in Life Spans of the Rich and the Poor Is Growing”. “Experts have long known that rich people generally live longer than
poor people,” she begins, but how much longer is increasing. This
was most recently demonstrated by a study conducted for the Brookings Institute
by Barry Bosworth, Gary Burtless, and Kan Zhang (“What
growing life expectancy gaps mean for the promise of Social Security”). Men
in the bottom 10% of income born in 1920 lived 6 years less than those in the
top 10%; for those born in 1950 it will be 14 years. For women the increase is
as great, from 4.7 to 13 years, and for women in the bottom 30%, life expectancy has actually decreased. This is not a good trend, and it is not limited
to the outliers in the top and bottom deciles. As illustrated by the
accompanying graph, the more you make the longer you can expect to live. Tavernise
makes clear that this is despite the advances that have occurred in medicine
and technology; indeed those have relatively little impact upon longevity or
health, despite the amount that we as a society spend upon them; most estimates
of the contribution of all medical care to health status are in the 10-15%
range. This is, nonetheless, where most of our health expenditures (now over
17% of GDP) are, and of course to the extent that they are of benefit to
individuals they are far more available to those who have more money. Per
Tavernise: “The Social Security
Administration found, for example, that life expectancy for the wealthiest
American men at age 60 was just below the rates in Iceland and Japan, two
countries where people live the longest. Americans in the bottom quarter of the
wage scale, however, ranked much further down — one notch above Poland and the
Czech Republic.”
The Times article quotes
the usual sources to tell us that lower income people are likely to have more
negative health behaviors, like smoking and prescription opioid use (but, somewhat
surprisingly, not that much more obesity – 37% in the lowest and 31% in the
highest income group). Health behaviors are important; they may be as
significant as medical care in determining our health. So is biology, our
individual genetics. But even smoking only accounted for a fifth to a third of
the difference.
The real causes of the difference in life expectancy are the
“social determinants of health” (SDH). These include having a place to live,
having enough to eat, having warmth in the winter, living in a neighborhood
with lower rates of both interpersonal (muggings, homicide) and institutional (environmental
pollution, lack of access to basic resources like stores, transportation,
sidewalks) violence. They also include the occupational risks accompanying many
lower-income jobs that involve physical labor and the toll it takes on the body
(and increase the probability of living with chronic pain and using opioids).
The SDH are tied to other risk behaviors, such as smoking. And, since
socioeconomic status is highly correlated with that of one’s family of origin,
people with higher incomes were likely to be born and raised in families with
higher incomes, which confers a lifelong health benefit. Of course, this negative
impact of SDH would be expected to be greatest in the lowest socioeconomic
groups, which it is, but above them surely people have those basic needs met?
Why are they living less long than the really rich?
A big part of the reason is misperception by the well-off,
which includes most policymakers, politicians, pundits, and even journalists of
how much money people make, and thus how many people are well-off. The median
household income in 2014 (US
Census Bureau report) was about $53,000. Half the households made less, and
half more. The bottom 80% of income earners account for about 50% of all
income, with the top 20% having the other 50% and the top 5% over 20%. An individual with an income of $100,000 is in
the top decile on that table, and so it is less surprising that folks making
less have some deficit in their health and life expectancy.
From the Times
article: “At the heart of the disparity, said Elizabeth H. Bradley, a professor
of public health at Yale, are economic and social inequities, ‘and those are
things that high-tech medicine cannot fix.’”. I have cited Bradley before (To
improve health the US must spend more on social services, December 18,
2011), and her point, that in the US we spend far more on medical care than
other social services, is still right on. We spend huge amounts on high-tech
and variably effective care that benefits a relatively small number of people
(and, disproportionately, those with higher income) and much less than other
OECD nations on other social services that actually improve health and life expectancy.
Oh, but those countries spending that money are those “social democracies” that
Bernie Sanders goes on about. You know, socialist. The ones where people are
healthier and live longer.
