How the AHCA and Trump budget are addressing the decreased US life expectancy

Perhaps you saw a recent report from the CDC that the life expectancy for the US went down for the first time in decades.  The top seven causes of death for adults remained the same, although many of them became more common in 2016.

Let’s look at how president Trump’s proposed budget will address each of these conditions which are the seven top killers of American adults.

  1. Heart disease.  Heart disease causes 1 in 4 American deaths.  While it can strike persons of any age, it is most common in adults over 50.

While we have effective medications to treat heart disease, I have multiple patients who struggle to make ends meet every month.  When it’s a choice between medicine and food, my patients choose food.  These are hardworking men and women who have years before retirement, years before they will be eligible for the Medicare benefits they’ve been paying for their entire working lives.

How will the American Health Coverage Act (AHCA) affect those with heart disease?  First, it will substantially increase premiums for those whom heart disease is most likely to affect.  The AARP Policy Institute estimates that health insurance premiums will rise 13% for Americans ages 50-59, and 22% for 60-64 year olds.  For a 64 year old making $25,000, premiums are estimated to rise from $1,700/yr to $14,600/yr.  While sticker shock over that increase might not be enough to cause a heart attack, trying to cover the premiums might be enough to make the cost of life-saving medication out of reach.

2 and 3. Cancer and Chronic Lower Respiratory Disease (COPD and emphysema). While most cancer and COPD/emphysema is attributable to lifestyle causes (tobacco, diet and lack of exercise), as many as 10,000 cancer deaths a year are caused by exposure to environmental pollutants, like air pollution. 

Lung disease is one of the few causes of death that did not claim more lives than usual in 2016.  While most of that decrease in lung disease-related deaths is from decreases in smoking over the past twenty years, some of it is be attributable to the decrease in environmental pollutants.  Instead of capitalizing on the momentum of recent gains in air quality, this administration’s budget guts funding for the EPA whose regulation has been responsible for much of the improvement in our air quality.  Let’s give Beijing a run for its money.

4. Accidents and suicide.  Accidents (including overdoses) and suicides, especially among middle aged white men, were a major driver of the increased mortality in 2016.  Specifically, men aged 45-64 have had a 43% increase in suicide over the last 15 years.  Heroin overdoses have increased 20% from 2014-2015.

Despite the appalling increase in suicides and overdoses in the past few years, the AHCA removes the guarantees for equal mental health and substance abuse in the 31 states that expanded Medicaid coverage under the ACA.  But that only affects 19.7 million Americans suffering with substance abuse and more than 40 million American adults with mental health issues, so why should the AHCA provide care for them?

5. Stroke.  Stroke is another killer that is most common in adults over 50, although a third of hospitalizations for stroke occur in adults younger than 65.  According to the CDC, stroke costs the United States an estimated $33 billion each year in health care services, medicines to treat stroke, and missed days of work.  Stroke is a leading cause of serious long-term disability in the US.

The AHCA includes a provision to penalize anyone with a lapse of coverage (say, because of having to stop work because of a stroke) with a 30% surcharge on the cost of their policy.  Additionally, because of the high proportion of disability among stroke survivors, Medicare is a major insurance provider for stroke survivors.  The CBO estimates that the AHCA will make Medicare insolvent four years earlier than its current projected demise under Obamacare.  The AHCA is one more reason (in a long list) to pray you don’t have a stroke.

 6. Alzheimer’s Disease.  We should be okay on Alzheimer’s disease because we know the cause and have effective treatment for this disease that … wait, scratch that.  We don’t know how to prevent Alzheimer’s disease, nor do we have a single effective therapy to reverse the losses of Alzheimer’s disease or to stop its progress.

The Trump budget proposes a 20% cut in NIH funding, so don’t hold your breath on finding a cure any time soon for the 5 million Americans suffering from Alzheimer’s disease.

7. Diabetes and chronic kidney disease (CKD).  28.9 million Americans live with diabetes, and the disease disproportionately affects ethnic minorities.  Diabetes and hypertension, both chronic diseases, are the top two causes of chronic kidney disease (CKD).  Both diabetes and CKD are major contributors to heart attack and stroke risk, but appropriate treatment for diabetes and hypertension can delay- or prevent altogether-  many cases of CKD.

The US has a shocking disparity between rural and urban care for chronic diseases including diabetes, hypertension and CKD.  While Medicaid expansion under Obamacare sought to increase access to care in rural areas, nearly two-thirds of people without insurance lived in states that did not choose to expand Medicaid. Likewise, according to the Kaiser Family Foundation, only 51% of rural workers had employer-sponsored health insurance, as opposed to 57% in urban areas.  The combination of these two factors leaves 14% of the rural population (as opposed to 9% of the urban population) without access to affordable insurance coverage, and this is despite the ACA.

Here is a map of the states that expanded their Medicaid coverage under the ACA (blue states expanded Medicaid; orange states did not).  Thanks, Kaiser Family Foundation for the map.

Since 2010, 80 rural hospitals have closed in the US.  The National Rural Health Association estimates that by 2020, 25% of rural hospitals will have closed. Closing a hospital not only affects the health of that community and its surrounding area, but often eliminates the one of the largest employers in that region, throwing hundreds of people out of work.  For kicks, let’s look at the map of where rural hospitals have closed since 2010 (courtesy of Rural Health Research Program and Slide Share):

Rural Hospital Closures*: 57 Closures from January 2010-Present August 24, 2015 6 August 24, 2015 Created using SmartDraw®

I’m no geography genius, but there seems to be a lot of overlap between the orange parts of the top map (no Medicaid expansion) and the dots on the lower map (closed rural hospitals).

The AHCA makes no effort to address these disparities in care, or to improve the survival chances of rural hospitals.  A market-based health care exchange leaves out rural markets.  If Congress is so determined to improve the ACA, they should at least make some effort to improve the one real defect in the ACA, which is the persistent lack of rural health care access, especially in areas where Medicaid was not expanded under the ACA.

I give Congress and the Trump budget proposal and F on health care so far.  Empty words have their place (obviously, since that’s how the 2016 election was won) but when it comes to the health of our country, gutting recent gains in health care access under Medicaid expansion and removing the budget for disease research is all bad.

Seven Quick Takes: may the force be with you

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One. Yesterday I took the children to the Denver Art Museum. When they were younger, the Art Museum was one of their favorite places to hang out, but now that they’re big, they don’t think they have time. So sad to be sixteen and have seen it all…
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Two. I dragged them anyway (Come with me, young padawan…) And as soon as we stepped in the members’ line—before we’d even seen the door to the exhibit—they all started bouncing around, getting excited about it.

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Three. The exhibit itself was fantastic. Everything was there: the Jedi robes, all the different light sabers, draughtsman renderings, the clippings that inspired Princess Amidala’s robes, all sorts of Greeblies, Han and Chewbacca, Darth Vader, and yes, the metal bikini. (Sorry, no photo.)
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Four. I skipped a few of the prequel movies (true confessions), so Amidala’s gazillions of costumes were all new to me. But they were so exquisite in the fabric and the detail.
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Five. Yoda and I had a chat. Love Yoda, I do.
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Six. The DAM has a room dedicated to hands-on art. It rotates with whatever the special exhibit is at the time, so right now it’s a costume-designing room. The girls loved it; the boys walked over to the bookstore instead.
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Seven. We don’t do field trips as frequently as we did when they were younger, but they’re worth it when we do—this one especially so. Even just for the “Mom, thanks for making me come,” a certain teenager whispered in my ear.

Go check out Kelly for more quick takes!

And for more on how to make your local art museum accessible to your kids, you can read here or here.

Daybook 3.6.16

Outside my window: hail. We had a stunningly beautiful weekend with blue skies and warm sun, but this morning the light was greeny-yellow and made me think TORNADO. I don’t think I’ve ever seen hail this early in the spring. Especially since it’s technically still winter.

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In the garden: I watered the trees this weekend. I’ve been on crocus watch for ten days, and yesterday they hit their glory. I love crocuses. Spring bulbs remind me of the mystery.
Last week:
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Yesterday:
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It’s still too soon to pull all the leaf-mulch off the perennials, but I’m hoping to put carrots and some spinach in the square foot gardens this week.

In the school room: we are hoping to make it to the Denver Art Museum’s Star Wars Costumes exhibit. It’s supposed to be excellent. I’ll let you know.

Friday is the end of our third quarter of school, which has me thinking about pulling it all together: reviewing, reflecting on the essentials during these last nine weeks.

In the kitchen: We had pancakes and sausage for Shrove Tuesday last week, and then fasted over the weekend (with a few meals between Tuesday and Friday night.)  This week is busy.  We’re all going in different directions with long hospital hours (Sam), tutoring (Jonah), swim practice (Owen), dance rehearsals (Moriah), and gymnastic (Phoebe).  It’s lots of driving during the hours I would like to be in the kitchen, so there will be lots of prepare-ahead but low-key cooking right before dinner.  Pot roast with kale and blueberry salad, chicken-coconut-lime soup and homemade bread, crock pot carnitas tacos, and vegetable frittatas, and brined pork chops with wild rice and broccoli.

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On my reading shelf: I have a few titles queued up to read, including Learning to Swim by Sara J. Henry and Bitter Medicine by Sara Paretsky, but they may have to wait until spring break. No free time right now.

On my mind: I have my Family Practice board exam next month, so much of my “free” time is going toward studying. It’s once every ten years, which seems like a long time, but every time it rolls around, it catches me off guard. Not already?

Grateful: for this year’s 30 hour famine, which we completed over the weekend. This was the first year all six of us have fasted together. It was a great way to begin Lent.  Every year it blows me away how much our lives revolve around food.  More on this to come.

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Also, we had a spontaneous trip to the movies last night to see the Lego Batman Movie. I couldn’t say I want to see any of the previews, but I laughed all the way through Batman. No spoilers here, but it somehow succeeded in simultaneously being deep and making DC child appropriate.

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Praying for: so many dear friends in the middle of huge (and hard!) transitions. The persecuted (the list is growing longer here). The hungry, both here and around the world.  Refugees and immigrants. Truth and wisdom for our government. The press.  My boards: for the discipline to study and the ability to update my knowledge. Jonah’s National History Day this weekend. Mandy, Ruth, Judy, Mick, Christine, Mary, Anne, Clare.

 

7QT: Can we take the rest of the month off?

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One: Our run of warm, dry winter days has ended.  Last Sunday, I saw these flowers coming up.  Today, our emerging tulips are frozen and buried.

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Two: It’s February, which means everything feels like a slog. Why is that?

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Three: We’ve been shaking up our school subjects in little ways, like multiplying with sugar cubes and writing poetry with magnets, but there’s only so much I can do to lighten the load for my high schooler.

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Four: last week I registered him for the ACT, the SAT subject test and 2 AP exams. (Between his exams and my Boards, this spring is going to be full of bubbles.) It took me three hours just to register him, and I speak the language. I can’t imagine trying to negotiate this in a second language, or without experience.

Product DetailsFive: Meanwhile, we’re still plodding away on all our reading.  We listened to The Tale of Despereaux: Being the Story of a Mouse, a Princess, Some Soup and a Spool of Thread (Kate DiCamillo) on the way to ski last week. It falls in the category of Good Books that Are Saving My Life Right Now.  Neither of the girls remembered it from the last time we read it.  The audiobook is fantastic; the story (and storytelling) are truly wonderful.

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Six: The children have played that digital piano into the ground.  Two notes are malfunctioning, so it sounds just like a broken hammer on an actual piano.  Owen still plays it three or four hours a day.

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Seven: We made it up to ski again, this time for an entire day. Phoebe did her first terrain park. I did not ski the box with them.

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Now they want to know when they can ski without me. Just because I wouldn’t ski the box! So rude.  Soon they’re going to be asking me to drop them at the gondola.

Go check out Kelly for more Quick Takes.

What’s Saving My Life Right Now

Upon the inspiration of Anne Bogel, this is a reflection on what’s saving my life right now.

Midday walks.

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Sometimes we borrow our neighbor’s dog. Sometimes we hit a nature preserve (no dogs allowed.) Sometimes we just walk, but it’s always worth the effort.

Good books.

The children and I are reading Swallowdale by Arthur Ransome and Greenglass House by Kate Mitford. I am re-re-re-reading Dorothy Sayers’s Gaudy Night. (Sam just read it for the first time.)

Honestly, I’m not up for a challenge right now. I need something I know ends well. Suggestions?

Colorful food.

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This week I made Run Fast, Eat Slow’s Runner’s High Peanut Sauce, and we poured it over bowls of rice, grilled chicken and diced vegetables. Yum.

Prayer.

My friend Lori introduced me to the app Pray As You Go. It’s a lovely 11-12 minutes of contemplative music, Scripture, meditation on the Word, and prayer.

Also, because I’m not playing music in church right now, I am free to seek prayer from our prayer ministers during communion. And I do. Every week.

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What’s saving your life right now?

7QT: STEM at home

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Alas… those were the days, when all I had to do was grow bacteria in the kitchen…

One: It began like any other home science experiment: we had almost all the pieces needed, and I figured I could use the substitutions in the teacher’s manual without a problem. (That might have been my first mistake.)

We started with a 9-V battery and some wire. And a metal Allen wrench.

The goal: build an electromagnet.

Two: We followed the directions, taping the wire to both ends of the 9-V battery and coiling it around the wrench. But it wouldn’t magnetize.

Three: I’m so tired of science experiments that don’t work. It’s happened so many times that the kids were ready to give up, as one does, but I was having nothing of that.

I knew the battery was working, because once we connected the circuit, the battery got hot. But the Allen wrench wouldn’t pick up any of the paper clips. So I pushed the kids a little harder: what could the problem be?

We came up with a list:

  1. maybe the paper clips aren’t the right kind of metal
  2. the Allen wrench was too big
  3. the Allen wrench was the wrong metal
  4. perhaps we need more coils of wire around the wrench
  5. the battery wasn’t powerful enough

Four: We substituted out the wire. No change.

Five: We tested a different magnet on the paperclips. The fridge magnet picked up paper clips like… well, as it does.

Which left the battery.

Six: I happened to have this 12-V battery lying around.

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I believe this is the key to having successful science and engineering experiences at home: have a bunch of stuff lying around. It’s impossible to have a clutter-free house and a successful home science environment. The battery may or may not have been part of our old security system, we aren’t sure. But anyway, there it was, just sitting on top of the freezer. So I connected it.

The first time I tried to wrap the wire around the battery terminals, it blew sparks and I felt the charge from my fingers all the way down to my ankle. Whoa. Okay, the battery worked.

The kids were all for stopping at that point, but I was going to show them how science requires perseverance! And as Thomas Edison said, ‘I have not failed. I’ve just found 10000 ways that won’t work.” We were going to keep trying.

Seven: The second time, I used alligator clips to connect the wire to the battery. When I clipped the wire to the negative terminal, there was a small fire, the alligator clip melted, and all the children screamed.

If I’d been a good homeschool mom, I would have taken a picture.  Instead, I unclipped it and smothered the fire.  We went back to the 9-V battery and a smaller screwdriver for the Allen wrench.

Success! Not only did we pick up a bunch of paperclips (this is meaningful work here!), my children developed a healthy fear of perseverance. When Sam asked them what they learned that day, they said, “We learned it’s not safe to do science experiments with Mommy.”

I’m counting this one as a win. And because the battery can’t be thrown away in the regular trash, it will still be hanging around my house until I need it the next time.

How’s STEM education going at your house?

Be sure to check out Kelly’s site for more Quick Takes!