[qgin]

It’s not about the victory or loss of either party. It’s saying there are two Americas developing simultaneously and people in each have different health outcomes.

Are the parties causative? Or are they just the labels that we have to describe the two groups currently? We don’t know.

[commandlinefan]

> Are the parties causative?

Or is it the other way around? Commenters occasionally often point out the "red states" are the biggest recipients of welfare in spite of being the ones that vote most against it. To me, it seems that the most likely explanation for this is that the voters there see the negative effects of welfare and the ones who are voting for it are insulated most from the unintended consequences. It could just as easily be that the voters who see the most death are voting for the party they most feel will enact policies that will lead to less of it.

[timr]

Before looking for cause, you always look for plausible co-variates. Here, there are a ton: red counties tend to be rural. Rural places have huge problems with health care access, obesity, addiction, poverty, and many other issues that predict poor health outcome.

[kibwen]

The study takes ruralness into account, shown in this graph: https://www.bmj.com/content/bmj/377/bmj-2021-069308/F4.mediu...

[timr]

That doesn't "take it into account"...it just plots them, based on which presidential candidate the county voted for. And by looking at the plot, it's clear that age-adjusted mortality rates are almost perfectly aligned for rural democratic and republican areas until 2009, when they drop suddenly for the democratic areas. Then they both continue tracking in parallel. Why is that? Can't tell. Sure is suspicious. Could it be that a bunch of counties flipped in 2008?

I skimmed this paper to see if the authors did any of the facepalm-obvious things you'd do to control for covariates if you were serious about doing an observational analysis (e.g. multi-factor regression), but saw nothing. They're literally just looking at differences in slopes in the lines:

> Trends in mortality were examined to identify changes in slope using Joinpoint Regression Program version 4.8.0.1, which models consecutive linear segments on a log scale, connected by joinpoints, and can measure when slopes of annual percentage change (APC) undergo a statistically significant change

This is a...well, let's just call it non-conventional...analysis method.

[orwin]

> Rural places have huge problems with health care access, obesity, addiction, poverty, and many other issues that predict poor health outcome.

So, yes, probably, but. I went in a rural area in West Virginia for some personal reasons. And i mean rural. One hours and a half from Charleston, and half an hour of the nearest town (population: 728). I think i met all the democrat voters there(four dozen or so :P). Mountain guides, kayak/raft guides, musicians(a lot), old hippies living off the land, a lily farmer, a lot of organic farmers too (And the first goat farmer who convinced me than US cheese is at least as good as french/italian goat cheese). Some of them without running water, almost half of them off grid. I think the "fatest" one was barely over my weight, so between 27 and 29 BMI. I also went to the organic farmer market in Hungtington (Clearly not republican leaning, as the sticker against mountain top mining, pro-unions and "Freedom Industries = Lexycon, protect our water" could show) and to a city music festival (were i met all those communist hippies again). Frankly, the overall health and shape of those people, i thought i was back in europe.

Poverty and health care access, yes. Addiction: not that much. Some are alcoholics, i think i met one meth user, but no one tried to sell to us, and their social life is way too full to have time for this shit. Obesity: clearly not. Less than in Paris.

Also, these people were clearly aware of the Elk river incident (it was four years after, still had banners and stickers warning about water quality) and did flush/replace their pipes, and could very well be the only ones who did.

[Spivak]

That would only explain a point in time state of affairs but not why they observed the effect widen along party lines. Their theory was that blue areas expanded medicare and red areas didn't but there could be others.

[heavyset_go]

Medicaid was expanded to cover those with low incomes in some states, not Medicare.

[TMWNN]

>Commenters occasionally often point out the "red states" are the biggest recipients of welfare in spite of being the ones that vote most against it.

Usually framed as "blue states are paying for the red states' welfare". But this isn't true.

First, the state of California does not pay a cent to another state or to the federal government. It is residents of California that pay federal taxes, which in turn provide funding and services to states and individuals.

Second, the Rockefeller Institute (<https://rockinst.org/issue-areas/fiscal-analysis/balance-of-...>) shows that, as of 2018 (the last time I checked this data; I see that 2019 is now available), the 10 states at the bottom of the per capita list—that is, the states that benefit from the most federal spending per person compared to how much each person pays in federal taxes—are

2016/2020 Hillary/Biden-voting states: VA, NM, MD, HI, 1/2 of ME

2016/2020 Trump-voting states: KY, AK, AL, WV, MS, 1/2 of ME

It's not so much "blue states" as per the above-mentioned claim, but taxpayers of four very wealthy Northeast states (the Tri-State area plus Massachusetts) that account for the vast bulk of citizens paying more than they receive from the federal government. After them come CO, NE, UT, and MN, of which half voted for Hillary/Biden and half for Trump. All other states, including CA, are net beneficiaries of the taxpayers in the top eight (and, again, really, it's the top four).

[fullshark]

The end of the piece makes it pretty explicit what the point is actually: authors believe democratic policies are better and should be pushed to republican regions. They then go on to talk out of both sides of their mouth on this front, that "health care shouldn't be enmeshed with politics" but hoping that politicians will "listen" to them.

[yuriks]

What people mean when they say that is that someone's opinion on evidence-based policies shouldn't be intertwined with their allegiance to a particular party. The entire point of politics is determining policy, and policy has an effect on the outcomes the doctors that wrote the article want to improve.

[fullshark]

In any case authors are clearly making a political argument and implying if not explicitly making a causation argument here, not merely describing the state of the world.

[fzeroracer]

The state of the world is the result of politics. You can't talk about one without talking about the other. Like the Texas energy grid being a disaster is the result of conservative deregulation and privatization. Merely describing the state means you're simply describing the effect and not the cause.

[bitwize]

That's because of the two political parties, one is by far more prone to ratfucking. The authors are saying "get the ratfucking out of health care".