Tag Archives: blue states

OK, Let’s Talk About Mental Health

It’s so predictable. And maddening. After each horrific mass shooting, Republicans pandering to the NRA insist that the problem isn’t guns–it’s mental health.

The most obvious response is equally predictable (albeit far more intellectually honest):  these attacks are vanishingly rare in countries where there are similar proportions of  mentally ill citizens but far fewer guns.

Mental health professionals will also point out that the great majority of people diagnosed with a mental health problem are not violent, so pointing to an undifferentiated “mental health” crisis is simply an effort to distract from the role played by virtually unrestricted gun ownership.

I personally agree with a New Republic headline:“The Main Mental Health Issue in This Country Is in the Republican Party.”

That said, I also agree that, overall, America does a very poor job of diagnosing and treating mental illness. So if we were to ignore the immense hypocrisy of the Republicans who only respond to these massacres by advocating an increase in resources devoted to mental health, we might welcome their sudden attention to that scarcity and their apparently heartfelt efforts to address it. (Snark alert: If you believe those efforts are really heartfelt, I have some swampland in Florida to sell you…)

The linked article from the New Republic looked at the existing patchwork of state funding for mental health diagnosis and treatment.

Before you click, just hazard a guess: Of the top 10 states, how many are red? Likewise, how many of the bottom 10 are red? And where do you imagine Texas ranks?

If you don’t feel like floating down that rabbit hole, I’ll save you the trouble. The top 10 states are: Maine, Pennsylvania, Arizona, New York, New Jersey, New Hampshire, Montana, Vermont, California, Maryland. One red state in the bunch (yes, Arizona is borderline, but it went Democratic in 2020). The bottom 10, from forty-first to fiftieth, are: Florida, Wyoming, North Dakota, Delaware, Louisiana, Oklahoma, Kentucky, Idaho, West Virginia, Arkansas. One blue state.

And Texas—where that lying death cultist of a governor vows to attack the scourge of mental illness with a zeal unmatched since Wayne LaPierre took his last trip to Zegna—just misses the bottom 10, in fortieth place. I doubt I even need to point out (although for the record I will) that Greg Abbott and the state’s Republicans have been cutting mental health funding, by more than $200 million over the last two years.

The article noted that there has been one –and only one–major expansion of mental health spending and insurance coverage in recent American history–and it was part of the Affordable Care Act., aka Obamacare. According to a Commonwealth Fund report, the ACA’s impact on the country’s mental health has been salutary, particularly in states that accepted Medicaid funding.

And we all know how the GOP has reacted to that particular expansion of access to healthcare, including mental healthcare.

The GOP then spent years trying to repeal and “replace” it. Trump also wanted it repealed. So the sole major expansion of mental health coverage in this century was contained in a bill whose passage every Republican in Washington opposed and on which most Republican governors have refused to participate in the state-level implementation. Come to think of it, probably the sole reason the red state of Montana ranks in the top 10 on mental health spending is that the state took the Medicaid expansion money under former Democratic Governor Steve Bullock.

Republicans are not going to expand mental health funding. Mental health care is for sissies and liberals. The only thing they’re going to expand is access to guns. We know this because recent history tells us so. Last week in Vox, Zack Beauchamp posted a shocking but not surprising report on academic studies of legislative responses at the state level to mass shootings. The finding? The norm in this country has been that mass shootings have been used by state legislatures and governors as an excuse to loosen gun laws, not tighten them. This is our country.

We have a mental health problem, all right– but it’s primarily among Republican legislators.

 

Red States, Blue States…And Death Rates

The other day, during a political discussion (these days, pretty much every discussion gets political) my youngest son wondered aloud whether it had been a mistake to win the Civil War. The red states of the South have been an economic drag on the blue states for a long time–they send significantly fewer dollars to Washington than they receive courtesy of blue state largesse.

My son was being flip, but his characterization of Red and Blue states wasn’t far off. As Paul Krugman wrote in a recent column in the New York Times, “the political divide is also, increasingly, an economic divide.”

Democratic-leaning areas used to look similar to Republican-leaning areas in terms of productivity, income and education. But they have been rapidly diverging, with blue areas getting more productive, richer and better educated. In the close presidential election of 2000, counties that supported Al Gore over George W. Bush accounted for only a little over half the nation’s economic output. In the close election of 2016, counties that supported Hillary Clinton accounted for 64 percent of output, almost twice the share of Trump country.

Evidently, however, we don’t just live in different economies–lately, we also die differently.

Back in the Bush years I used to encounter people who insisted that the United States had the world’s longest life expectancy. They hadn’t looked at the data, they just assumed that America was No. 1 on everything. Even then it wasn’t true: U.S. life expectancy has been below that of other advanced countries for a long time.

The death gap has, however, widened considerably in recent years as a result of increased mortality among working-age Americans. This rise in mortality has, in turn, been largely a result of rising “deaths of despair”: drug overdoses, suicides and alcohol. And the rise in these deaths has led to declining overall life expectancy for the past few years.

What I haven’t seen emphasized is the divergence in life expectancy within the United States and its close correlation with political orientation. True, a recent Times article on the phenomenon noted that life expectancy in coastal metropolitan areas is still rising about as fast as life expectancy in other advanced countries. But the regional divide goes deeper than that.

It turns out that the “death divide” Krugman is addressing is closely correlated with political orientation.

I looked at states that voted for Donald Trump versus states that voted for Clinton in 2016, and calculated average life expectancy weighted by their 2016 population. In 1990, today’s red and blue states had almost the same life expectancy. Since then, however, life expectancy in Clinton states has risen more or less in line with other advanced countries, compared with almost no gain in Trump country. At this point, blue-state residents can expect to live more than four years longer than their red-state counterparts.

There are a number of possible explanations: blue states expanded Medicaid while most red states didn’t, for example. The gap in educational levels is probably implicated as well; better-educated people tend to be healthier than the less educated, for a number of reasons.

Krugman also notes differences in behavior and lifestyle that affect mortality. (Although obesity has dramatically increased all across America, obesity rates are significantly higher in red states.)

Krugman references–and debunks–conservative explanations for the death divide:

Conservative figures like William Barr, the attorney general, look at rising mortality in America and attribute it to the collapse of traditional values — a collapse they attribute, in turn, to the evil machinations of “militant secularists.” The secularist assault on traditional values, Barr claims, lies behind “soaring suicide rates,” rising violence and “a deadly drug epidemic.”

But European nations, which are far more secularist than we are, haven’t seen a comparable rise in deaths of despair and an American-style decline in life expectancy. And even within America these evils are concentrated in states that voted for Trump, and have largely bypassed the more secular blue states.

Although he doesn’t mention it, I’d also be interested in seeing a comparison of gun deaths in Red and Blue states.

Actually, conservatives like Barr inadvertently make a point: culture and values matter. Just not the way they think.