The US healthcare system hurts poor Americans. It’s about to get worse | US healthcare

There is a strange disconnect in the public health debate in the United States. Come January, millions of Americans could abandon their health insurance as premiums soar following the Trump administration’s decision to end federal subsidies that helped some 20 million people afford insurance on Obamacare marketplaces.

Earlier this year, Republicans in Congress agreed to cut more than $850 billion from the 10-year budgets for Medicaid, the Low-Income Health Insurance Program and the CHIP Children’s Health Insurance Program to finance some tax cuts. Given U.S. fiscal rules, this reduction means that an additional $500 billion in funding for Medicare is at risk.

Meanwhile, in a part of the United States far from these concerns, wealthy people are pouring money into startups that study how to prolong life: some $12.5 billion over the past 25 years, according to the Wall Street Journal.

OpenAI’s Sam Altman has invested $180 million in Retro Biosciences, which hopes to reprogram aging cells. Tech billionaires like former Google CEO Eric Schmidt and Vinod Khosla of Sun Microsystems have invested hundreds of millions in NewLimit, which attempts to reverse cellular aging. Meta’s Mark Zuckerberg revamped his philanthropic foundation a few weeks ago to focus on the intersection of biology and AI to cure all diseases.

A quick look at the health status of Americans will show you that this combination of priorities is not ideal. The average life expectancy in the United States in 2023 was shorter than it was in 2010. It fell far below not only the lifespan of people in the rich countries of the European Union, Japan or Canada. Average life expectancy at birth in the United States is now shorter than in Albania, the Czech Republic, Chile and Panama. That’s four years less than the average life expectancy in Puerto Rico.

This is despite Americans’ enormous, unprecedented spending on health care – inflated by a large, profit-driven, private medical industry that charges patients and their insurers an arm and a leg every time they come into contact with the system, whether or not the procedure benefits their health.

Like the deep and worrying poverty of the United States, its excessive mortality is not due to a technical deficit or an economic constraint. It’s a choice. The United States is not just rich. It is probably better than any other country in the world at inventing cutting-edge drugs and therapies. What is terrible is ensuring that its residents, even the poorest, have access to the basic elements of a healthy life – from decent jobs and mundane amenities like clean water to access to health insurance.

American death and misery are intimately linked. From the nation’s addiction to fentanyl to obesity and widespread suicides, the deadliest diseases often don’t require sophisticated health technologies. It is the social contract that must be established.

The short lives of Americans are not breaking news. Concerned scientists have been trying to draw attention to them for years. In 2013, the National Institutes of Health released a massive study titled “Health in the United States in International Perspective: Shorter Lives, Poorer Health,” in which a group of experts worked to identify the reasons why Americans were dying younger than other countries.

The study made recommendations, mainly on opportunities to learn from other countries. What has Washington done about it? Well, Republicans have been trying to repeal the Affordable Care Act for years. Then there were these cuts to Medicaid. And there’s this new delayed vaccination schedule, courtesy of Health Secretary Robert F Kennedy Jr.

People who invest in futuristic life extensions don’t die young. Inequalities in life expectancy are more pronounced in the United States than in all other high-income countries. Research conducted a decade ago by researchers at Harvard, MIT, McKinsey and the U.S. Treasury found that the richest 1 percent of American men lived 14.6 years longer than the poorest 1 percent. For women, the gap was 10.1 years. Additionally, the longevity gap between Americans in the richest 5% and those in the poorest 5% widened by more than two years between 2001 and 2014.

Among the array of diseases that are killing Americans at higher rates, from infant mortality to opioid overdoses, Americans’ disproportionate poverty plays a critical role in explaining their deficits. Research by economists at Brown University, Dartmouth College and the University of Southern California found that babies born to wealthy American mothers died at about the same rate as babies born to affluent European mothers. Disproportionate infant mortality in the United States was almost entirely attributable to the children of poor people.

There is a long list of reasons why Americans are dying younger: high infant and maternal mortality and disproportionate rates of suicide and homicide — not surprising given the ubiquity of guns in American society. There are car accidents – probably due to Americans driving more – and lung disease due to disproportionate smoking rates between the 1940s and 1980s. There is obesity. And there are what economists Angus Deaton and Anne Case call “deaths of despair,” which these days typically occur following a fentanyl overdose.

Yet the most important factor explaining America’s exceptionally short lifespan is that no one really cares about preventing poor and marginalized Americans from dying. Washington is too busy giving tax cuts to the rich, so maybe they could invest in fighting cell aging.