Genealogy and ACA

[no_hypocrisy]

I've done some serious research into my father's side of the family, going back to the mid-nineteenth century.

My latest takeaway is how young my father's aunts were when they passed away in the Twenties and Thirties: mid-fifties; sixty, tops. OTOH, the brother of my father's mother lived to his early nineties, partly because he was wealthy and could afford the best medical care.

Please note the years when they died were BEFORE the New Deal, Social Security. With mortality rates like that, middle age was old age back in the day.

I've also been able find online many of their death certificates with the cause of death recorded. Most were heart disease that could have been treated with a doctor.

With the potential repeal of the ACA, do we really want to return to the "Good old days" when you weren't expected to live beyond your mid-fifties?

[Igel]

1. Those "good old days" were 2009.

Average life expectancy in 2009 was "mid-fifties"? Try 20 years higher.

It's not the first thing like this I've seen. On a dozen issues, "if X is repealed it'll be just like it was some outrageous number of years ago," even if regulation or law X is only 3 years old. You'd think that life was truly horrendous in the US in 2010 and 2011. It was trivially different for most people than it is today, and much of the difference is just because unemployment's declined.

Heck, I heard one person say that if DAPA is overturned it'll be just like it was in the '40s when the braceros were chucked out of the US and their wages never forwarded to them. Except that DAPA never actually took effect, so in December 2016 it was like DAPA was overturned.

The New Deal didn't do much for health. What did more for health were things like antibiotics, vaccines, and controlled drug tests. Even into the 1890s calomel was routinely prescribed for a number of ailments. That's HgCl2, mercuric chloride. Even causes of death are sometimes a mystery on old death certificates--no autopsy, no routine doctor's care, it was really best guess in most cases.

Even in the 1600s (and 600s, for that matter) there were people who lived to an old age. Many of the world's "superlivers," those that get to 100 or more, are in rural areas with little medical care. A lot of the wealthy ate, drank, and screwed themselves into relatively early graves. Remember, the wealthy had crystal and indoor plumbing, both of which were really excellent sources of lead contamination. Even in Roman times, the wealthy did foolish things, like sweetening their wine and dried fruit with lead sugar--lead (II) acetate. With wealth comes indolence and luxuries that aren't good for people. With poverty comes malnutrition and worse sanitation, which can lead to greater death from infectious diseases. It's a trade off.

One reason that we have such an emphasis on sewers in the last 150 years or so is because of some Brit who was trying to figure out why some areas of London had higher death rates than others during some epidemic. He happened to look at a map of sewers in London and realized that where you had sewers you had a lower death rate. Now, you may think, "Ah, sewers were for the wealthy." Except that they were old, very old, some Roman but mostly just to help avoid flooding--almost all of them were near the Thames, the oldest part of the city. Of course, all the high-class areas were farther away from the Thames. The Thames were near the docks, where workers and poor people lived in crowded conditions. The inference from that--the poor people had a lower incidence of death from that disease than the wealthy.

Life's never as simple as we think.

[no_hypocrisy]

3. Clarification

I meant that in the 1920s and 30s, life expectancy ranged between mid-fifties and the sixties.

[greatauntoftriplets]

2. Three of my four grandparents likely could have been saved by antibiotics.

As a result, they died at ages 36, 42 and 59. The one grandmother who was alive during my childhood died at 73 following a stroke. New medical techniques since her death might well have made a difference.

Yet, one great-grandfather lived to 96.

To some extent, it's the luck of the draw. Still, I agree with your theory that there are likely to be more deaths at younger ages then has been common in recent years.

Just sad.

[MichMary]

4. "Heart disease"

can mean many, many different things, and a lot of them were not treatable at that time. There were no artificial heart valves, bp meds, cholesterol meds, etc., etc., etc. Whatever surgeries were available were primitive and very risky. There were no antibiotics to treat endocarditis. I could go on.

It is extremely naive to think that those conditions "could have been treated with a doctor." Furthermore, you have no way of knowing whether they ever did/didn't seek treatment. At that time there were alternatives to payment (such as bartering) that we don't have access to today.

Your ancestor who had money probably also had extremely good luck and/or good genes. My two paternal aunts both died in their 50's, one in 1980, the other in 1986. One of them had the best insurance available at the time--low cost, no deductible, no co-pay. Her condition wouldn't have had a good outcome regardless of what treatment she would have had.

I would also be willing to bet that the astronomical deductibles that people have to pay under the ACA prevent people from seeking medical care, in many cases.

[frazzled]

5. They didn't have treatments for heart disease in the 1920s and 30s

No coronary bypass surgery, no calcium channel blockers, no diagnostic tools even (or just the beginning of rudimentary ones). A lot of our grandparents died earlier, even into the 1970s and 80s, because today's medical treatments for their conditions didn't exist. Yes, there's a correlation between poverty and mortality, but also there's a genetic component, and the factor of medical advances. And while it's true that lack of access to medical treatment is a death warrant, it doesn't make sense to go back to mortality rates in the 1920s and 30s to explain that.

[csziggy]

6. We are already seeing an increase in maternal and infant mortality

In some of my ancestral families I see a very high infant mortality rate which is often accompanied by maternal deaths. It was not unusual for there to be three or four children who died at birth or shortly after, then the death of the mother with another child.

Now the rates are back up in the US - though not for the same reasons in the past. These are deaths that preventative health care could reduce. Unfortunately that does not seem to be in the near future for our country.

Maternal Mortality Rate in U.S. Rises, Defying Global Trend, Study Finds
By SABRINA TAVERNISE
SEPT. 21, 2016

WASHINGTON — One of the biggest worldwide public health triumphs in recent years has been maternal mortality. Global death rates fell by more than a third from 2000 to 2015. The United States, however, is one of the few countries in the world that have gone against the grain, new data show. Its maternal mortality rate has risen despite improvements in health care and an overwhelming global trend in the other direction.

<SNIP>

Most people imagine maternal mortality as 19th-century-style deaths such as hemorrhage in childbirth or death from eclampsia, a condition involving high blood pressure. Those types of deaths still happen, but their rate has not changed much.

Instead, the increase in recent years has been driven by heart problems and other chronic medical conditions, like diabetes, which has increased sharply in the population. Researchers have theorized that an increase in obesity — particularly acute among poor black women, who have much higher rates of maternal mortality than whites — may be contributing to the problem.

“The really scary thing to us is all the deaths from cardiovascular disease and heart failure,” said Dr. William Callaghan, who runs the Maternal and Infant Health Branch in the Division of Reproductive Health at the Centers for Disease Control and Prevention. “It’s a quarter of all deaths. There were almost none in the remote past.”
https://www.nytimes.com/2016/09/22/health/maternal-mortality.html