Reduced U.S. Life Expectancy Tied with For-Profit Health Insurance System Failure

Interview with Dr. James G. Kahn, professor at the Institute for Health Policy Studies at the University of California, San Francisco, conducted by Scott Harris

The average life expectancy of Americans has fallen over the past two years, the sharpest two-year decline in nearly 100 years according to the National Center for Health Statistics.  The decline in longevity is linked with the over 1 million deaths caused by the ongoing coronavirus pandemic, but other factors played an important role as well.  Those factors, according to the report include: a rise in deaths from opioid overdoses, heart disease, chronic liver disease and cirrhosis.  

According to research in 2021, the average American could expect to live until the age of 76, a loss of almost three years since 2019, when Americans could expect to live, on average, nearly 79 years.  The decrease in life expectancy has impacted Native American and Alaska Native communities hardest, with average life expectancy shortened by four years in 2020 alone.  While other wealthy nations experienced high mortality rates at the beginning of the pandemic in 2020, most had recovered a year later due to high vaccination rates, the adoption of social distancing and the wearing of masks.

Between The Lines’ Scott Harris spoke with Dr. James G. Kahn, professor at the Institute for Health Policy Studies at the University of California at San Francisco, who assesses the recent report on life expectancy decline and how that decrease in longevity is related in part to the failure of America’s privatized, for-profit health insurance system. Dr. Kahn is also editor of Health Justice Monitor.

DR. JAMES KAHN: The falling of life expectancy is, in fact, largely a function of how we did in the COVID pandemic. And there were two major problems there. One is our public health response was delayed and inadequate. If you compare our response to other countries around the world, we didn’t keep as good track of what was going on and our interventions were not as as clear and effective as they could have been. Certainly mask wearing and vaccinations made a huge difference, but it took a long time to get those going.

The other critical thing to remember is that we now have very good evidence, which colleagues and I published recently, that lack of insurance, which of course is very common in the United States, contributes hugely to the COVID death toll. It increased the death toll by about a third compared to a situation where everyone had insurance.

That’s well over 350,000 extra deaths from COVID due to lack of insurance. So that is definitely a big part of it.

Another thing you mentioned, which is a serious issue, is the ongoing and growing epidemic of opioid use and abuse and associated with that — particularly with fentanyl now playing such a big role in that — is an increase in overdose rates. This and some related problems can be thought of, unfortunately, as deaths of despair. These are people who are using drugs, who are struggling to deal with issues in their lives, one of which is the fact that health insurance is becoming less and less effective as a way to help people get health care. The deductible, the amount that people need to spend at the beginning of the year before the insurance even kicks in now is often $2,000 to $5,000.

So a middle-income family, someone with a health problem, maybe it’s COVID, maybe it’s something else. They may be very reluctant to go seek medical care because they perceive correctly that the payment is coming out of their own pocket. Their insurance is not going to help them. That, of course, leads not only to worry and despair, but also leads to a decrease in medical care. And that’s another contributing factor to the rising mortality that we’ve seen recently.

SCOTT HARRIS: Dr. Kahn, there have been many public opinion polls which reveal the real unhappiness and anger that many people in this country have about our health care system, our for-profit health insurance system. And there have been politicians and groups advocating for single-payer health insurance. And you, yourself, of course, have been active in that. But it seems we haven’t made a lot of progress towards adopting a universal health care system such as exists in most other wealthy nations in the world.

What hope do you have that we can break this deadlock that has been bought and paid for by the health insurance industry and Big Pharma that has prevented any progress in moving to a system where people’s health won’t be exchanged for large profits?

DR. JAMES KAHN: Well, I’m not a prognosticator on political movements. I do think about the fact that the challenges in health care are coming to a head. They’re getting worse and worse as private insurers have a bigger and bigger role in the health care system. As you pointed out, dissatisfaction with our health care system — including financial and health problems — is growing.

Public support for single-payer, when you ask the question fairly, is inching up. It’s about two-thirds. Now, if you ask a fair question like, “Do you want the government to pay for your health care if that meant that you’d have to pay new taxes, but all your premiums and cost-sharing would go away?” If you ask it in a fair way like that, you get about two-thirds saying yes. That’s a pretty good number in Congress.

The single-payer bill with lead author Rep. Pramila Jayapal has 120 co-sponsors now. That’s not enough to win, but it’s a lot more than it used to be. So there are movements in the right direction and I always hold out hope that there will be a recognition of the crisis and then a response to that where we actually do something to solve the problem.

The other thing I want to relate to that is our crisis in democracy, small “d”, as you and your listeners I’m sure know very well. We are facing some significant crises around polarization and about the narrative perpetrated by the new GOP that there is something unfair about the system. And we face some real challenges in fighting that off.

And I think the fight to preserve democracy and the fight for single-payer are closely linked. If you think about it, the kinds of advances that single-payer would bring, such as equity, such as liberty to choose doctors. If you run down the list of democratic principles, single-payer is infinitely more supportive of those principles than is the the current fractured and troubled health care system.

So I’m hoping that we see the salvation of democracy and the salvation of our health care as being part of the same fight.

Find more information on Health Justice Monitor at

Listen to Scott Harris’ in-depth interview with Dr. James Kahn (19:02) and see more articles and opinion pieces in the Related Links section of this page.

For the best listening experience and to never miss an episode, subscribe to Between The Lines on your favorite podcast app or platform: Apple PodcastsSpotifyStitcherGoogle PodcastsAmazon MusicTunein + AlexaCastboxOvercastPodfriendiHeartRadioCastroPocket Casts,  RSS Feed

Subscribe to our Weekly Summary