The post-Obama era red state wave across the Midwest and South over the last decade has turned back decades of progress for tens of millions of Americans, including life expectancy numbers that are plummeting like rocks in the ocean, and there's no better example of how Republicans are killing their own constituents than Ohio.
Americans are more likely to die before age 65 than residents of similar nations, despite living in a country that spends substantially more per person on health care than its peers.
Many of those early deaths can be traced to decisions made years ago by local and state lawmakers over whether to implement cigarette taxes, invest in public health or tighten seat-belt regulations, among other policies, an examination by The Washington Post found. States’ politics — and their resulting policies — are shaving years off American lives.
Ashtabula, Ohio’s problems stand out compared with two nearby counties — Erie, Pa., and Chautauqua, N.Y. All three communities, which ring picturesque Lake Erie and are a short drive from each other, have struggled economically in recent decades as industrial jobs withered — conditions that contribute toward rising midlife mortality, research shows. None is a success story when it comes to health. But Ashtabula residents are much more likely to die young, especially from smoking, diabetes-related complications or motor vehicle accidents, than people living in its sister counties in Pennsylvania and New York, states that have adopted more stringent public health measures.
That pattern held true during the coronavirus pandemic, when Ashtabula residents died of covid at far higher rates than people in Chautauqua and Erie.
The differences around Lake Erie reflect a steady national shift in how public health decisions are being made and who’s making them.
State lawmakers gained autonomy over how to spend federal safety net dollars following Republican President Ronald Reagan’s push to empower the states in the 1980s. Those investments began to diverge sharply along red and blue lines, with conservative lawmakers often balking at public health initiatives they said cost too much or overstepped. Today, people in the South and Midwest, regions largely controlled by Republican state legislators, have increasingly higher chances of dying prematurely compared with those in the more Democratic Northeast and West, according to The Post’s analysis of death rates.
The differences in state policies directly correlate to those years lost, said Jennifer Karas Montez, director of the Center for Aging and Policy Studies at Syracuse University and author of several papers that describe the connection between politics and life expectancy.
Ohio sticks out — for all the wrong reasons. Roughly 1 in 5 Ohioans will die before they turn 65, according to Montez’s analysis using the state’s 2019 death rates. The state, whose legislature has been increasingly dominated by Republicans, has plummeted nationally when it comes to life expectancy rates, moving from middle of the pack to the bottom fifth of states during the last 50 years, The Post found. Ohioans have a similar life expectancy to residents of Slovakia and Ecuador, relatively poor countries.
Like other hard-hit Midwestern counties, Ashtabula has seen a rise in what are known as “deaths of despair” — drug overdoses, alcoholism and suicides — prompting federal and state attention in recent years. But here, as well as in most counties across the United States, those types of deaths are far outnumbered by deaths caused by cardiovascular disease, diabetes, smoking-related cancers and other health issues for residents between 35 and 64 years old, The Post found. Between 2015 and 2019, nearly five times as many Ashtabula residents in their prime died of chronic medical conditions as died of overdoses, suicide and all other external causes combined, according to The Post analysis of the Centers for Disease Control and Prevention’s death records.
Public health officials say Ohio could save lives by adopting measures such as a higher tobacco tax or stricter seat-belt rules, initiatives supported by Gov. Mike DeWine, a Republican generally friendly to their cause.
“I told the legislature, ‘I’m going to ask you to invest in things where you’re not going to see the results during your term in office and I’m not going to see it during my term in office,’” DeWine said in an interview in the governor’s mansion.
But those proposals have repeatedly stalled in a state legislature controlled by Republicans for 27 of the past 29 years and whose leaders show little inclination to move aggressively now.
DeWine has a “nanny state” mentality, said Ohio state Rep. Bill Seitz, the state House majority floor leader and fellow Republican who has helped block tobacco tax increases amid aggressive lobbying by industry interests. The 68-year-old Seitz, who smoked for 50 years before developing kidney cancer and having a kidney removed this summer, said he’s unmoved by his own brush with the health system — even if it led him to finally kick the habit.
“I’m not going to turn into a smoke Nazi just because I used to smoke and I don’t anymore,” Seitz said.
When I say that Republicans would kill their own constituents if it meant "owning the libs" this is what I mean. All my life America has been a country where the chief factor in your life expectancy has been the zip code where you grew up. Republicans are just making it worse for entire states.
They're literally killing us, folks.
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