Yves here. This interview highlights a key issue that deserves far more attention than it gets: that our longevity-obsessed squillionaire class are working against their own lifespans via their obscene levels of wealth. We have been writing from the very early days of this website how highly unequal societies impose a health cost even on the richest. This discussion does not include one issue, which is the stress created by high levels of stratification. If you are merely a high upper-middle class earner, losing your perch destroys pretty much all your social networks. You can’t afford to keep your kids in private school (meeting other parents is a big source of personal connections). You might have to sell your house and move. Even if not, you can no longer afford many of the same activities as your “friends,” such as belonging to clubs, going to big ticket charity event, taking ski holidays together.
So the need to hang on to your economic perch is acute and therefore stressful.
I had this happen personally to a lesser degree in the 1980s. I had a very splashy job as the head of mergers & acquisitions at Sumitomo Bank and then left. Both M&A and Japan were hot then. But even though I had been hired into the Japanese hierarchy, I knew I was ultimately a guest worker. But making a graceful exit was thwarted by the end of 1980s collapse in employment in M&A. Staffing levels across that field fell by 75%. The cuts were so deep that having been fired from a big firm was not seen as a badge of dishonor.
But when I wound up being a self-employed consultant (not a plan but it turned out colleagues kept calling me with projects and I realized two years later that I was consulting as opposed to back in fancy finance and might as well accept that), the difference in my social status was apparent. All sorts of nominal friend dropped me when I no longer at a prestigious firm. When I went to cocktail parties, I was at the bottom of the MBA status hierarchy. When I said I had my own consulting firm, most who’d met me for the first time sought to quickly find someone more valuable to talk to.
When I moved to Sydney in 2002, it was clearly more egalitarian than the US, as demonstrated among other things by the big spread in income and social/educational backgrounds of the regulars at the neighborhood pub. There I mentioned how many NYC professional contacts would not longer deal with me after I suffered a big status fall. I was told then that if anyone tried that sort of thing in Oz and word got around, they would be ostracized. Mateship, at least then, was a deeply held value. I have no idea if that is still true.
Part 2 of a two-part interview. Part 1 is here
By Lynn Parramore, Senior Research Analyst at the Institute for New Economic Thinking. Originally published at the Institute for New Economic Thinking website
When it comes to health in America, most people assume the rich are largely protected. Private hospitals, early screenings, and personal trainers may seem like a shield, but great wealth isn’t a magic cure. Even CEOs and their families face invisible forces that are cutting lives short.
Public health researcher Steven Woolf, professor of family medicine at Virginia Commonwealth University in Richmond, reminds us that problem isn’t just food or bad habits — it’s systemic. Where you live, how much you earn, and the policies shaping your community can all stack the odds against you. Americans – across demographics — are living shorter lives than people in other countries, even much poorer ones, buckling under the strain of a fragmented health system, rising costs, and environmental hazards that ravage everyone.
Woolf warns that the current administration’s policies could further strain our health so badly that a whole generation might face consequences approaching those of historical famines, like those in 20th century Russia.
The cure might not be in the latest medical breakthrough — or in artisanal raw milk. The real remedy could be economic: better wages, fairer policies, and structural changes that give all Americans a fighting chance at a longer, healthier life.
The Institute for New Economic Thinking spoke to Woolf about why fixing America’s health means reshaping the system that decides who lives, and who doesn’t, his concern with adolescent mental health, and why helping lower- and middle-income Americans afford basic needs and health care is key to the nation’s well-being.
LP: In the U.S., the wealthy can buy the best medical care, but does that truly insulate them from the public-health failures your research identifies, or do those systemic problems reach even the rich? After all, as Covid showed with Herman Cain’s death, money doesn’t stop a virus.
SW: You can still catch a virus, but even before the pandemic came along, we were publishing studies showing that rich Americans are dying earlier than rich people in other countries. So there’s something about America: even if you’re rich, you’re still being affected by the system. If you’re a CEO and you’re driving in your Porsche and have an accident, if the hospital they bring you to is struggling, you’re going to face the consequences of that when you roll into the emergency room.
LP: An emergency room that may be cost-cutting and understaffed thanks to private equity ownership.
SW: Yes. It’s also the diet you eat, the air you breathe: you’re not immune just because you’re rich. It’s definitely better for your health if you have more resources — people lower on the economic ladder are taking a much bigger hit. But even the wealthy are still being affected.
LP: You’ve been researching the state of mental health in America, which is contributing to our declining longevity outcomes. What’s concerning you most?
SW: There’s a real mental health crisis in America, especially among adolescents. Over the past year or so, I’ve been working on adolescent mental health, and we’re seeing huge increases in emergency department and hospital visits for depression, other mood disorders, self-harm, and suicide attempts. That really worries me — not only because we’re already failing to address the problem, but because, just recently, we’ve seen news that funding for SAMHSA, the government agency that supports mental health services, is being slashed by billions of dollars.
We’re rolling back some of the efforts the Biden administration had begun to address the mental health crisis, and that doesn’t bode well.
More broadly, when I was in public health school, we studied the Russian famine that had occurred decades earlier. We were able to look at studies that, after decades of data collection, showed just how severely the Russian famine affected people’s health.
Unfortunately, I think we’re going to see something similar here — decades of data documenting the long-term consequences of what’s happening now.
LP: Your research shows that life expectancy can vary dramatically depending on the state you live in, and that, overall, Americans have shorter lives than people in many other countries, including many you wouldn’t expect. Is the public even aware of this?
SW: I’m not too sure the average person is really aware of this — that the length of your life depends on what state you’re in. They may just think it’s the same for all Americans. I’m not sure how many people know about the U.S. health disadvantage, that Americans live shorter lives than people in other countries. I don’t know that that’s common knowledge.
I should say that RFK Jr. has actually been talking a lot about the U.S. health disadvantage. It’s just that the narrative is reframed as a way of defending the agenda that he wants to defend.
LP: You and Secretary Kennedy share the goal of making America healthy again. But in his view, that means things like fewer vaccinations.
SW: Yes, and drinking raw milk and a few other things like that. In the spirit of fairness, I should point out that people like me get criticized on conservative sites — academics, experts, the “elite,” and so on. One common critique I see when I publish is: if this guy is such an expert, why is our health getting worse? Our life expectancy is declining, so clearly the experts don’t know what they’re talking about. The argument is that we need a new approach.
I get that narrative, but it’s like the barn burning down and not letting the fire engine work. People in my field have been tracking this for years, warning about the trends, and calling for policy changes that have largely been ignored. Because those policies weren’t implemented, our health outcomes have only gotten worse.
LP: What’s a policy that you think could really help if Secretary Kennedy were to get on board with it and implement it?
SW: Well, here’s the thing: the most important policy changes that could improve health outcomes don’t come out of HHS.
Even before Trump returned to the White House, economic policies were widening the gap, leaving the middle class and lower-income Americans behind while concentrating wealth among a rich upper class. Meanwhile, median wages and household income were flat or even declining for a large sector of the American households.
Then an administration comes in and ratchets that up with regressive tax policies, further concentrating wealth and tightening the economic squeeze on American families.
With prices and inflation rising, wages not keeping up, and health care costs climbing due to the failure to maintain ACA subsidies, these economic pressures are, in my view, seriously undermining families’ ability to take care of their health or access care.
If I could do just one thing, it would be to change economic policy to support the middle class and lower-income Americans—promote growth for them and let corporate America ease up a bit on profit-making so families can regain their footing.
How do we get wages up so that people can earn a livable wage and not have to have multiple jobs in order to pay their bills? How do we control prices?
There’s a temporary need for social welfare; unemployment assistance and other programs to help people get through tough times. But some structural solutions are outside of government: for example, companies can decide to pay their workers a livable wage, sometimes because state law requires a minimum wage, to help all employees afford living expenses.
If that means upper management takes a smaller salary, so be it. The focus is on the well-being of workers and their families. Arguing that employers should change wage policy is different than saying, “tax the rich.” Taxes do become important if state government or local governments don’t have the money to pay for social programs, but that’s a different issue than urging CEOs to do right by their workers.
LP: How high on the list is universal health care? How much difference would it make?
SW: It’s high on the list because many of these diseases—diabetes, heart disease, and other chronic illnesses—are affected by policies that could serve as preventive measures. Once people get sick, the lack of universal health care means they can’t always afford the medications they need. High copays force choices between medicine and basic needs like food, creating morbidity and mortality rates that patients in England, France, or Italy don’t face.
LP: Navigating our health system is stressful – dealing with the bewildering labyrinth of claims, changing or insufficient networks, medical debt. That constant strain surely fuels America’s mental health crisis.
SW. Yes, and the fragmentation — the fact that you have to fill out multiple forms, the fact that one practice doesn’t know what the other practice knows, and so forth. It all leads to lapses in care. It leads to medical errors. Quality of care suffers as well. People experience complications that wouldn’t experience under a streamlined system. And yes, all that creates stress that impacts health.
LP: What are you concentrating on in your research going forward?
SW: I’m trying to refocus attention on an issue I was studying before the pandemic: rising mortality rates among young and middle-aged Americans. That’s really what was driving the flatlining of life expectancy in the U.S. even before COVID. And that same age group was hit disproportionately hard by the pandemic.
People of the same age in other high-income countries didn’t end up in the hospital or die at the same rates. Now that COVID is waning and numbers are returning to normal, the pre-pandemic trend hasn’t stopped—we’re still seeing those mortality rates rise for non-COVID conditions.
Part of my goal is to document this from a research standpoint, but also to raise public awareness: Americans are now less likely to reach 65 than before. The chances of surviving to retirement age are shrinking.
LP: A lot of people blame pandemic factors like isolation from remote work or school for some the struggles young and middle-aged Americans have faced. How much of the story is about that?
SW: I think there definitely were adverse consequences of the lockdowns, and also the economic factors, people’s livelihoods taking a hit during the shutdowns.
In retrospect, there probably were some elements of it that were not effective. In fairness, we were trying to make decisions with inadequate information and trying to use the best available judgment. But I still think a lot of those policies were exactly the right thing to do — if you didn’t want people to die.
LP: It’s not great doing schoolwork alone over Zoom, but the bigger issue is getting sick yourself and potentially having long-term consequences — or having family get sick or even die.
SW: Yes exactly. Memories fade very quickly. We quickly forget, the experience of suddenly getting short of breath and within 24 hours, you’re struggling to stay alive. That was the virus we were dealing with. In that context, having to do your homework on Zoom is an adverse impact, but if it keeps your grandma from dying, it might be worth it.
It was a novel virus —that will happen again when there’s another novel virus — and by definition, that means we don’t have experience with it, so we don’t know how it works. You have to make some decisions in the absence of knowing that. So some of what the CDC was recommending was based on an educated guess of what would be effective. I think a lot of lessons were learned about the tone of the communication from public health agencies. I think there was too much condescension and talking in a dismissive way to the public that I think should be avoided in the future. A lot of trust in public health eroded during the pandemic because of that.
I think in the future, there needs to be a more respectful tone and more transparency about what we know, what we don’t know, that kind of thing. But what people saw was how the scientific method works in real time. You have theories, you test them, you discover, oh, that theory is wrong. And you continue to investigate until you get it right.
