Following Up: Still More (Health-Related) Evidence for a Prompt Restart

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CCP Virus, coronavirus, COVID 19, Im-Politic, mortality, opioids, poverty, public health, restart, suicide, Tim Mullaney, World War II, Wuhan virus

If you haven’t seen today’s new CCP Virus figures for the United States, you really need to take a look. Not only do they show (continuing) stunning declines in new cases and deaths nation-wide, they strongly reenforce my Saturday post arguments that the death toll from keeping the economy mainly closed longer than necessary (whatever your favorite definition) is pretty comparable to the toll being taken by the virus. So from a public health standpoint alone, as I emphasized, there’s at least a respectable argument for the fastest possible (again, insert your favorite definition) re-opening.

To recap, that previous post challenged one argument claiming that the numbers of Americans being lost each day to the CCP Virus (at the point that argument appeared, 2,763), was dwarfing even the daily deaths recorded during America’s major wars. The author, Tim Mullaney, was right – but vastly under-counted fatalities from various forms of economic privation. As I noted, these kinds of deaths are much harder to count and even estimate than virus-related deaths (although the latter pose big methodology problems, too). But any reasonable person would conclude that both kinds of death are substantial, and that the economy versus public health framework dominating the national debate was dangerously simplistic and even stupid.

Of course, a few days have passed since the 2,763 death rate was recorded (on April 15, as it turns out – and in fact, that day’s figure has now been revised down to 2,751 according to this Washington Post count – the source of all the virus deaths data used in this post). And those few days have seen jaw-dropping progress in reducing deaths. Indeed, today, they’re all the way down to 521.

So therefore, if by some miracle, the CCP Virus was wiped out today, and all further deaths prevented, the 42,384 total national fatalities reported during the 53-day period since the first virus victim was recorded on February 29 would come to 800 per day. A horrendous number to be sure. But it’s reasonable to assume that this favorable trend will continue – at least until some unknowably strong second or third waves come. Moreover, the progress has been so impressive that it’s unlikely to be significantly affected by any of the under-counting problems identified by some health data specialists.

If these assumptions are true, then the current daily virus death toll is still way above that of daily military deaths suffered during World War II (240). It’s also way above the latest figures we have for daily American suicides (132). But it’s not that far above the most recent (and so far unchallenged) estimate for daily deaths from poverty (685). And when you combine those two figures, you get 817 daily deaths – above the current daily virus toll.

Still skeptical – largely because not all the suicide deaths are economic-induced? Then check out the best daily suicide attempts number available – 3,836. At least some meaningful share of these surely resulted from economic despair, and the only reasons they didn’t become actual fatalities were either incompetence or some timely intervention or simple luck. They speak volumes about the power and mental health effects of economic despair. And while we’re on the topic of despair, don’t forget opioid overdoses, either. Many of them have been closely linked with economic stress, and the latest numbers show them running at 128 per day.

Finally – and a big shout-out to Facebook friend Clare Goldsberry for pointing this development out: Reports keep coming in that many significant medical problems are going untreated because of the CCP Virus drain on the healthcare system. Here’s just one example.

Do major uncertainties still surround all these numbers? You bet. But they leave two overriding points completely certain: Any economy restart over any time frame is going to kill a substantial number of Americans, and no one has any basis for claiming that the one will save significantly more lives than the other. If you read or listen to anyone coming down emphatically on one side or the other, I’d strongly advise you to turn the page, change the channel, or walk away.

Following Up: Why the Economy Shutdown vs Restart Debate is Still Idiotic

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CCP Virus, Centers for Disease Control and Prevention, coronavirus, COVID 19, drug abuse, Following Up, healthcare, Im-Politic, infant mortality, mortality, opioids, poverty, restart, suicide, Tim Mullaney, Trump, Wuhan virus

The heated debate over whether it’s more important to open the economy relatively quickly, or wait until the CCP Virus really is under control slogs on. And I mean slogs on, since once it became clear that the pandemic wasn’t going to be even close to a Black Death-like catastrophe, everyone with a working brain should have recognized that immense uncertainties are all around, and that both approaches therefore entail terrible risk.

One built-in complication, though, continues to muddy the waters. And even though decisive clarity can’t be gleaned from the available data, it’s worth pointing out: CCP Virus deaths are relatively easy to calculate – even if not perfectly identifiable, because single causes of death tend to be difficult and controversial to pinpoint for victims with important underlying health problems, and therefore different U.S. states have (not surprisingly) come up with different standards for counting them.

Deaths from a prolonged economic slump like the one into which America has been plunged are much harder to determine, and data are therefore more controversial. But no one should doubt that they’re noteworthy, and worth taking into account in any economy restart decisions.

As commonsensical as these observations sound, however, they continue being vigorously disputed, and one of the few such arguments I’ve seen that try to quantify relative rates of loss has come from economics journalist Tim Mullaney. Full disclosure: I’ve criticized Mullaney here before, finding him to be an extreme hater even by Never Trumper standards. But I hope you’ll trust me when I say I’m singling out his latest article simply because it makes the “restart later” argument in such data-dependent terms.

According to Mullaney, President Trump and other prominent conservatives are blowing the most deceitful smoke imaginable by insisting “You have to reopen the economy despite the ongoing Covid-19 pandemic, quickly, lest a wave of suicides, domestic battery and the like overwhelm even the death toll from coronavirus.”

His evidence? The CCP Virus daily U.S. death toll when he wrote his article (2,763) dwarfs the numbers of lives lost each day in the United States to economic-related causes (like many suicides), as well as the numbers lost daily during the nation’s wars. (As of yesterday, daily national CCP Virus deaths hit a much higher 4,591.) * SEE CORRECTION BELOW

The war comparisons are sobering – no doubt about it. But if you look at them realistically, so is what we know of the death toll from various forms of economic privation. For example, it’s true that “only” 132 Americans took their lives each day in 2018 (the last year for which statistics are available, as is the case with all the following numbers). And there’s no way to know how many were due to the victims’ economic circumstances. But it’s also true that, as of 2017, 1.4 million Americans tried and failed to commit suicide. There’s no way to know the reason for each one, but the daily figure comes to 3,865. Surely economics had something to do with many of them.

The clear implication: If not for circumstances unrelated to the economy, the numbers of  suicides and of economy-related suicides would be much higher. Therefore, economic-induced extreme despair is undoubtedly much more widespread than the actual suicide rates indicate. And they signal the presence of huge economy-related mental health problems. Further, given the stigma society still attaches to suicide, it’s fair to assume that the attempt numbers in particular are undercounted.

That same year, 192 Americans each day died of drug overdoses. Of these, 130 came from opioids – the category most likely influenced by worsening economic circumstances and prospects. And just as with suicides and attempted suicides, the numbers of overdose deaths are dwarfed by the attempted overdose numbers. The Centers for Disease Control and Prevention don’t provide absolute annual figures, but they do note that “For every drug overdose that results in death, there are many more nonfatal overdoses….” Chalk lots of them up to economic despair, too.

You can also learn a lot from estimates of annual lives lost to poverty as such. In 2011, a Columbia University study pegged them at 671 per day in 2000 – not a matter of thousands, but not bupkis, either. And here’s another poverty-related mortality statistic: In 2018, about 59 newborn American babies died each day. Were all due to poverty? Of course not. But they’re most heavily concentrated in racial and ethnic minority groups with the highest poverty rates, so that’s pretty revealing.

Infant mortality, moreover, points to another health and death rate reality that’s strongly affected by the state of a national economy: the state of its healthcare system.

Given America’s vast wealth and annual healthcare expenditures, and its continuing major healthcare problems, there’s no doubt that money is no panacea for better health and lower death rates. Structures of national healthcare systems matter critically. At the same time, does anyone seriously believe that the U.S. healthcare system is going to do a better job on mortality and other fronts the worse the economy fares and the longer the current downturn lasts?

Which brings up a related question: What’s likelier to happen first? Indeed, much likelier to happen first? The kinds of major economic and social policy reforms needed to alleviate American poverty significantly, or to cure what ails the healthcare system? Or finding anti-CCP Virus vaccine or cure? If you’re not sure, you just haven’t been paying attention.

Those wanting a substantial economy restart sooner rather than later can legitimately point out that the above economy-related mortality numbers overlap a great deal. And that’s true. Second and even third waves, as they warn, seem all too likely as well. But it’s also true that, when you add them all up, they’re significant, and at best can’t be too far away from the CCP Virus death figures in which much more confidence is justified.

How far away? Honestly, why should anyone care? They’re clearly close enough to warrant concern that, as Mullaney’s conservative targets contend, a prolonged mandated economic slump will exact terrible human health costs – and that the longer it lasts, the higher it will grow. It’s also crucial to remember that the CCPVirus death toll shows signs of trending down – however horrific it will ultimately be – and that absolutely no one who anyone’s listening to is urging a total national economy restart all at once. 

All of which reinforces conclusions I’ve been pushing since the CCP Virus became a genuine crisis: It confronts Americans will trade-offs as tragic as they are difficult to figure out, and that anyone arguing to the contrary is more interested in taking cheap, invariably partisan, shots than in finding solutions.

*CORRECTION.  The 4,591 U.S. deaths figure I reported here was not for April 17, but for April 16.  The April 17 figure was actually 3,856, and today’s figure is only 1,891.  Moreover, as explained here, “The spike in mid-April is due to New York City authorities adding probable cases to the city’s death tally.”  So this is the kind of correction that clearly works in favor of my argument, since these numbers indicate even more strongly that this still terrible daily figure is on the way down, and that any gap between it and comparable figures due to economically-induced mortality is even smaller than previously apparent.

(What’s Left of) Our Economy: More Crucial Details on the U.S. (and Heavily Female) White Die-Off

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2016 election, Angus Deaton, Anne Case, cities, coal, death rates, Donald Trump, health, Jobs, manufacturing, mortality, mortality crisis, Populism, rural areas, small towns, Trade, wages, whites, women, {What's Left of) Our Economy

Everyone should be grateful to the Washington Post for following up – in heart-breaking detail – on one of the most tragic and important stories of our time: the mounting mortality crisis among working- and middle-class middle-aged white Americans. At the same time, the Post‘s findings raise as many questions as they answer, significantly complicating the story – and the challenge of reversing these dismaying trends.

This white mortality crisis, you’ll recall, first broke into the news last fall, when Princeton University economists Angus Deaton (the latest Nobel prize winner) and Anne Case published a report solidly documenting the trend and linking it to growing economic insecurity combined with ever more paltry pension plans. Deaton and Case noted pointedly that, although other high-income countries, especially in Europe, had also experienced financial crises, productivity slowdowns, and widening inequality, the worsening white death rates in the United States, which provides fewer social and retirement protections, were unique. The authors also suggested that declining economic expectations hit white Americans’ psyches especially hard, and that non-whites, whose expectations were never as high to start with, found harder times easier to cope with.

As observers – like yours truly – noted, the implications for American politics seemed profound. In particular, I wrote, the Deaton-Case results indicated that outsider Republican presidential candidate Donald Trump was more on-target than even he suspected when he kept complaining that America was getting “killed” by job- and wage-killing trade policies. And in fact, a strong relationship between rising white mortality and resurgent U.S. populism was made clear by the Post last month, when it found a high correlation between concentrations of the mortality problem and support for Trump.

Today’s report, however, adds crucial details indicating that other factors may be at work as well. One such finding: that “the most extreme changes in mortality have occurred among white women….” Women, after all, haven’t suffered nearly as much manufacturing job loss as men – whether it stems from trade policy mistakes or other causes (like factory automation). At the same time, since so many women have entered the U.S. workforce in recent decades – as manufacturing employment has faced more trade and technology pressure – they could well be affected indirectly by industrial job loss, as laid off manufacturing workers had to start competing for jobs in service sectors where women were more numerous.

Also muddying the picture is the big (and overlapping) rural-urban white health divide found by the Post (with “rural” including “small-town America”). In important ways, this geography of the white mortality crisis is consistent with the trade and manufacturing-centered interpretation. As is known by anyone who has traveled extensively around the “rust belt” or the American South, lots of factories have been and still are located in small towns and semi-rural areas, in part because land is cheap.

And reinforcement for this view is found on this map accompanying the Post article.

So many of the orange-brown and dark grey areas in the map on left — which signify counties and regions with the fastest rising white female mortality rates — are places like southern Michigan (think “auto industry”), northern Ohio (autos, steel, and industrial machinery), northwestern Indiana (steel), north central and western New York State (industrial machinery, heating and cooling equipment, railroad equipment, steel), and the Carolinas (where the plunge in textile and furniture jobs hasn’t nearly been offset by newer – often foreign – investments in sectors like aerospace, automotive, appliances, and electronics assembly). (The map on the right shows counties and region where white female mortality is falling.)

Nonetheless, so many of the biggest orange-brown stretches are regions dominated by other parts of the economy. Clearly, the coal industry’s woes bear lots of blame for the mortality crisis in Kentucky, southern Ohio, and West Virginia. And Nebraska, the eastern half of Utah, and the western half of Kansas have never been manufacturing strongholds (though Wichita has long been a major aerospace center).

The variety of local and regional economies involved shouldn’t be surprising. Anything as big as a mortality crisis in such a large segment of the population is bound to have multiple causes – and to resist talking-point-deep explanations and slapdash remedies. But that doesn’t mean the mainstreams of the two major parties shouldn’t be addressing the rapidly deteriorating health of so many Americans much more comprehensively and energetically.

 

Im-Politic: Evidence that Trump is Right. American Trade Policies Literally are Killing Us

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2016 elections, Angus Deaton, Anne Case, Donald Trump, faith-based voters, families, H1B visas, Im-Politic, Immigration, middle class, mortality, Nobel prize, Princeton University, Republicans, Rick Santorum, Trade, working class

Republican presidential candidate Donald Trump has drawn a lot of scorn from the Mainstream Media and the nation’s political chattering class by insisting that countries like China, Mexico, and Japan are “killing” America on trade. The vast majority of them know nothing about U.S. trade policy, and those with a smidgeon of familiarity with the subject don’t take seriously the idea (drawn straight from conventional economics) that growing trade deficits subtract from America’s growth and employment levels.

But last week, the nation received stunning news that Trump literally may be right, along with new insights into why a White House aspirant blasting U.S. trade (and immigration) policies in the harshest possible terms has gained such traction despite a personal style and background that are highly unconventional in elective politics – to put it mildly.

A new study claiming that middle-aged American whites have recently been dying at much higher rates than their counterparts in other high-income countries also points to a strategy through which Trump can dramatically improve his standing with the religious conservative voters who still view him with such skepticism, but who wield major clout in early caucus state Iowa, and early primary state South Carolina.

The study was co-authored by no less than Angus Deaton, the Princeton University professor who just won the Nobel prize for economics, and his wife Anne Case, also a noted Princeton economist. It purports to show that, between 1999 and 2013, there has been “a marked increase in the all-cause mortality of middle-aged white non-Hispanic men and women in the United States between 1999 and 2013.”

Moreover, according to Deaton and Case, “This change reversed decades of progress in mortality and was unique to the United States; no other rich country saw a similar turnaround.” And just as intriguingly, this trend in mid-life mortality, which marked a major reversal from an overall decline in death rates for Americans aged 45 and older, “was confined to white non-Hispanics.”

But what really links the Deaton and Case findings to economic developments are the data they present shedding light on the causes of increasing mortality among this white cohort – which they themselves argue reveals the connection. Their summary is worth quoting in full:

“This increase for whites was largely accounted for by increasing death rates from drug and alcohol poisonings, suicide, and chronic liver diseases and cirrhosis. Although all education groups saw increases in mortality from suicide and poisonings, and an overall increase in external cause mortality, those with less education saw the most marked increases. Rising midlife mortality rates of white non-Hispanics were paralleled by increases in midlife morbidity. Self-reported declines in health, mental health, and ability to conduct activities of daily living, and increases in chronic pain and inability to work, as well as clinically measured deteriorations in liver function, all point to growing distress in this population.”

The authors continue:

“Although the epidemic of pain, suicide, and drug overdoses preceded the financial crisis, ties to economic insecurity are possible. After the productivity slowdown in the early 1970s, and with widening income inequality, many of the baby-boom generation are the first to find, in midlife, that they will not be better off than were their parents. Growth in real median earnings has been slow for this group, especially those with only a high school education. However, the productivity slowdown is common to many rich countries, some of which have seen even slower growth in median earnings than the United States, yet none have had the same mortality experience.”

As Deaton and Case explain it, American workers’ feelings of economic insecurity are so much greater than those of their European counterparts mainly because their retirement arrangements are so much shakier. Most American employers who still provide pension plans have moved to the defined contribution model – “with associated stock market risk.” In Europe, by contrast, most employers still offer defined benefit plans.

I have no doubt that the authors have identified a big piece of the problem. But here’s another, and one that’s directly related to the Trump campaign: Whereas recent U.S. presidents from both major parties have pushed a long string of trade deals that have encouraged American businesses to offshore massive numbers of high wage industrial jobs, Europe’s governments have worked much harder to keep that employment – and the underlying production – at home.

As made clear in my book on globalization, The Race to the Bottom, the resulting job loss and wage stagnation (and often declines) have rippled throughout the entire American middle and working class. And although it’s eminently reasonable to believe that the U.S. economy has significantly outperformed the Europeans for many years, these death rate data indicate that this outperformance has been scarcely relevant to the most important test of a successful society by far – improving the lives of the great majority of its people.

And here’s another Trump-ian tie-in overlooked by Deaton and Case. European governments obviously have been as eager as the U.S. government to admit huge numbers of immigrants from very low-wage countries into their economies. But where European and U.S. immigration policies differ significantly entails their openness to immigrants with relatively high levels of skills and education. In other words, there’s nothing in Europe remotely like the American H-1B program, which has fostered major immigration-related job displacement (and therefore wage decreases) in white collar occupations that were supposed to be immune to competition from much cheaper foreign workers. More generally, this kind of offshore outsourcing has hit a wide variety of jobs in the professions in addition to technology positions.

So this is nothing less than a golden opportunity for Trump – both with the downwardly mobile whites in general who have flocked to him not only in great numbers but on a sustained basis so far, and with the so-called evangelicals who represent so much of the Republican primary electorate. For the causes of rising white mortality described by Deaton and Case are inarguably both causes of family break-up – especially divorce – and symptoms of the strains placed on families by economic angst.

Of course, faith-focused voters have long blamed the weakening of the traditional American family overwhelmingly on the rise of more permissive social and cultural values since the 1960s. But some U.S. politicians – notably pundit and former Republican presidential candidate Pat Buchanan, and former Pennsylvania Senator Rick Santorum, who has run this year and in 2012, have made the connection with economic forces. And the Eaton-Case study gives Trump the kind of ammunition that Buchanan – who, unlike Santorum, went after U.S. trade policy – never had. Moreover, Trump has the kinds of communications skills both to capitalize on the new data, and to present it in exciting and fresh-sounding – not to mention somewhat sensationalistic – ways.

The Deaton-Case findings aren’t accepted by everyone. But whose are? More important, in politics, it’s all too easy to make persuasive claims that have no credible sources. Making claims that come from supremely credible sources can be even more effective – including by blunting lots of Mainstream Media and chattering class scorn. So I’m really looking forward to Trump’s next appearance on “Meet the Press” or some similar brain-dead national media outlet, when he tells the moderator, “Our trade and immigration policies are literally killing us! And you don’t have to take my word for it!”