In the name of the culture war, Republican states are impoverishing and killing their own citizens.
Do you want to live longer? Here’s one simple way: if you live in a Republican state, move.
I’m not being snarky. This is a dispassionate conclusion from the numbers.
Look at this chart of life expectancy by state. The data shows a striking trend: the top ten states with the longest life spans are bright blue. The bottom ten states with the shortest life spans are deep red. And this isn’t a small difference: the life-expectancy gap between the longest-lived state, Hawaii, and the shortest, Mississippi, is seven years! That’s the same magnitude as the difference in life expectancy between France and Syria.
Multiply this across hundreds of thousands of people, and imagine how many years of life are being squandered. Imagine how many people are missing out on a peaceful retirement and healthy old age. Imagine how many children have to grow up without parents. Imagine how many people die in the prime of their life, or suffer from chronic health problems for years before finally expiring.
This color-coded life expectancy isn’t due to chance. It’s a consequence of the laws and policies that prevail in red states versus blue states.
Death from a thousand cuts
There’s no single reason for this, but lots of different causes that add up. In states with fewer restrictions on tobacco, people smoke more and die of cancer more often. In states with fewer protections for workers, people are more likely to suffer from poverty, go uninsured, and die from treatable health problems. In states with weaker environmental laws, people die more often from diseases caused by pollution, like asthma, strokes and COPD. In states with weaker gun laws, more people die of homicide and suicide. In states with anti-vax governors and legislators, more people die of COVID. It’s an accumulation of death from a thousand cuts.
What does this look like at the level of individual lives? Here’s a story from Jonathan Metzl’s book Dying of Whiteness, about a man he calls Trevor:
…a forty-one-year-old uninsured Tennessean who drove a cab for twenty years until worsening pain in the upper-right part of his abdomen forced him to see a physician. Trevor learned that the pain resulted from an inflamed liver, the consequence of “years of hard partying” and the damaging effects of the hepatitis C virus. When I met him at a low-income housing facility outside Nashville, Trevor appeared yellow with jaundice and ambled with the help of an aluminum walker to alleviate the pain he felt in his stomach and legs.
Trevor could have gotten lifesaving drugs or an organ transplant, if only Tennessee had accepted federal Medicaid expansion. Because it didn’t, he was dying—slowly, painfully and without hope. However, he was fine with this:
Even on death’s doorstep, Trevor wasn’t angry. In fact, he staunchly supported the stance promoted by his elected officials. “Ain’t no way I would ever support Obamacare or sign up for it,” he told me. “I would rather die.” When I asked him why he felt this way even as he faced severe illness, he explained, “We don’t need any more government in our lives. And in any case, no way I want my tax dollars paying for Mexicans or welfare queens.”
It looks like this story from Idaho: a 29-year-old mother who died the day after Christmas, when her 2-year-old son reached into her purse, where she kept her handgun, and accidentally pulled the trigger and shot her in the head:
“My son is terrible,” Rutledge said. “He has a 2-year-old boy right now who doesn’t know where his mom is and he’ll have to explain why his mom isn’t coming home. And then, later on his life, as he questions it more, he’ll again have to explain what happened, so we’ll have to relive this several times over.”
…”They are painting Veronica as irresponsible, and that is not the case,” he said.“The inside story of how an Idaho toddler shot his mom at Wal-Mart.” Terrence McCoy, The Washington Post, 31 December 2014.
It looks like this study of IV drug addicts in West Virginia, illustrating the death toll of the opioid epidemic. “Scott”, a five-year heroin user, had this to say:
Q: Anything else you think we should know about heroin or related drugs in this part?“Hostility, compassion and role reversal in West Virginia’s long opioid overdose emergency.” Jeff Ondocsin, Sarah G. Mars, Mary Howe & Daniel Ciccarone, Harm Reduction Journal, 30 August 2021.
A: …I know that it’s killed a lot of people around here. I do know that. The majority of my graduating class, that never even used drugs when I was even in school, that even so much as smoked pot, are dead.[…] I graduated in 2007… probably when I go to my 20th year reunion—if I make it that long, hopefully—there are probably less than half of them.
The same pattern jumps out of other statistics. For example, a CDC chart of suicide by state shows blue states faring best, while the worst suicide epidemics afflict red states.
Or if you look at maternal mortality, blue states have lower rates and red states have higher. There are some outliers—blue New Jersey fares surprisingly poorly—but the overall pattern is impossible to deny. Now that the courts have taken away protections for abortion, red states are already setting about cutting off women’s access to all kinds of health care, so this gap is going to widen dramatically.
Blue states prop up red states
If you look at a list of states by GDP and sort by values per capita, the same pattern emerges yet again. The top five richest states are New York, Massachusetts, Washington, California and Connecticut. Because GDP is an average, this isn’t necessarily a measure of equality, but it is a measure of productivity and economic strength.
If free-market dogmas were correct, then the reddest states, with the least regulation, the weakest unions, and the fewest worker protections (i.e., the most “freedom“), should top the list. They should be oases of prosperity, thriving at the expense of overregulated blue states. Instead, the opposite holds true.
If you drill down to the county level, the gap becomes even more dramatic. According to an analysis by the Brookings Institution, the counties that voted for Joe Biden in 2020 make up 70% of America’s GDP. The American economy is a world powerhouse, and almost all of its strength and wealth comes from diverse, liberal, well-educated blue states and cities.
In fact, the only reason that red states aren’t even worse off is because of huge, ongoing economic transfers from blue states, in the form of programs like Medicare and Social Security Disability. It’s actually blue states that are the productive “makers”—they pay more in federal taxes than they get back in federal spending—whereas the red states are the “takers” that are propped up by these transfer payments.
Deaths of despair
This wealth gap matters to more than just living standards. It can literally be deadly.
States with underfunded schools, decaying infrastructure, and uneducated workforces—in short, states that refuse to invest in the future—are bleeding jobs. Chronic unemployment produces feelings of hopelessness, meaninglessness, and the loss of dignity that comes from being unable to provide. To cope with this psychic damage, people turn to self-destructive behaviors. They die at higher rates from all causes, especially suicide, drug overdoses, and alcoholism. Researchers call these “deaths of despair“:
Brian Alexander’s recent account of a hospital in Bryan, a small town in Ohio’s northeast corner, offers a glimpse into how destructive anomie can be. Particularly noteworthy is Alexander’s discussions of Keith Swihart, who experiences the worst outcomes from uncontrolled diabetes, including blindness and amputation; his wife, Stephanie, dead at age 46 from cervical cancer; and several of his friends who kill themselves by handgun, rifle, rope, or overdosing on fentanyl and amphetamines.
These deaths aren’t a natural disaster. Nor are they an impersonal working out of historical forces, for which no one bears the blame. They happen because red-state voters and legislators choose to pursue culture-war issues at the expense of their own health and lives.
Red states refused to set up Obamacare exchanges and turned down Medicaid expansion even when it was virtually free. (They even scrapped their own state-level health plans when the conservative mood turned against universal health care.) This led to dozens of rural hospitals closing down, resulting in hemorrhaging jobs and health care becoming harder or impossible to get for people who don’t live in big cities.
Red states have gutted public-school budgets in the name of lowering taxes. This leads to brain drain: an exodus of the smartest, best-educated people, weakening the economy. Big tech companies and other cash-flush employers have passed over red enclaves like Kansas City, because there wouldn’t be enough educated workers to hire.
Red states fought tooth and nail against COVID lockdowns, masking and vaccine mandates, even banning private entities from having their own vaccine requirements. This predictably led to the virus running wild, disabling and killing people who didn’t need to die.
When you consider the bigger pattern, it looks like the United States isn’t one country. It’s more like two countries forced to live together under one roof.
Neither red nor blue states are free from legislative gridlock, pollution, crime, poverty, racism, unaffordable housing, and other social ills. However, there’s one side that’s at least trying to better its people’s lives, while the other is either ignoring these evils or actively making them worse.
The conclusion is clear: if you want to be richer, to be healthier, and to live longer, you should move to a blue state that protects voting rights, workers’ rights, women’s rights, immigrants’ rights. What other yardstick could there be to measure the success of a state, if not the health and life span of its people?
Of course, “just move” isn’t a one-size-fits-all solution. Not everyone can afford to pack up and move. Even for those of us who can, uprooting your life is a major disruption, not to be taken lightly. But I’m saying those who have the means should seriously consider it. The evidence is clear: Living in a red state is hazardous to your health.