Thursday, October 27, 2022

The politics of health policy

A paper published in PLOS ONE, U.S. state policy contexts and mortality of working-age adults, results in this USA Today article: "More Americans die younger in states with conservative policies, study finds". 

What is the factual situation that the PLOS ONE paper sets out?
Americans die younger than people in most other high-income countries. With a life expectancy of 78.8 years in 2019, Americans died 5.7 years earlier than people in Japan, the global leader; 3.3 years earlier than their northern neighbors in Canada; and 2.5 years before their closest geopolitical allies in the United Kingdom. Shockingly, U.S. life expectancy falls between two middle-income countries—Cuba and Albania. 
Within the United States, life expectancy differs markedly across geographic areas such as states and counties. In 2019, it ranged from 74.4 years in Mississippi to 80.9 years in Hawaii. U.S. life expectancy has stagnated, largely because of higher mortality among adults 25–64 years of age. According to a comparison of U.S. life expectancy to the average of 16 other high-income countries in 2006–2008, deaths before age 50 accounted for 67% of the shortfall among U.S. men and 41% among women. 
Mortality rates provide another sobering picture of the early deaths among so many individuals in the United States. Based on rates from 2019, for every 100 babies born in the United States, two will not survive to their 30th birthday, six will not reach age 50, and 16 will die before they can enjoy retirement at age 65. Like life expectancy at birth, differences across states in mortality rates among adults ages 25–64 are striking.
In the PLOS ONE paper but not mentioned in the USA Today article are things like this:
Fig 4 demonstrates that, for women and men and across all lag times, lower working-age mortality from alcohol-induced causes was associated with more liberal labor policies and more conservative marijuana policies.
and
We examined four counterfactual scenarios in which all policy domains in all states were set to the maximum liberal score of 1 (Scenario 1) or the maximum conservative score of 0 (Scenario 2); the maximum liberal score of 1 applied to all domains except marijuana and health and welfare, which were set to 0 and 0.5, respectively, because conservative marijuana policies were associated with lower all-cause mortality, and no association was observed for the health and welfare score (Scenario 3, “Hybrid”); and domains trending in conservative or liberal direction were set respectively to their 0 and 1 extremes (Scenario 4,”Status Quo”).
Scenario 1 is "all liberal" and Scenario 3 includes conservative marijuana policy "because conservative marijuana policies were associated with lower all-cause mortality". These are the results:
In their simulation for 2019, Scenario 1 results in 86,181 fewer age-adjusted deaths among women and 84,949 fewer deaths among men, for a total of 171,030 lives saved. Scenario 3 results in 92,057 fewer deaths among women and 109,393 fewer deaths among men, for a total of 201,450 lives saved. So adopting liberal policies for essentially everything but marijuana results in 201,450 - 171,030 lives saved = 30,420. 

That is, the cost of liberal marijuana policy is 30K lives per annum.
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Now, suppose this above was well-settled science, with widespread validation of the results. How would this inform policy advocacy of the two political parties? 

Among the Republicans of today, there is no regard for science, and driven purely by partisan concerns, they would ignore all of this. 

More interesting are the Democrats, who are much more reality-driven, but who also have a strong faction in favor of liberalizing marijuana. Will they give up their pot dreams in favor of lives? Or will they argue that those 30K lives per annum is an acceptable cost to pay for whatever benefits marijuana liberalization provides (e.g., maybe less incarceration, or some measure of social justice)?