ACA repeal and Medicare reform may increase the suicide rate among middle age and older Americans.
While for years, suicide has been considered as a major threat among children and those of college age, the two age groups with the highest rate of suicide are
- 45 to 64 year olds, followed by
- those age 85 and older.
Those most prone to suicide are non-Hispanic white and Native American males.
Suicide rates are lowest in highly urban states with strong social service support systems: e.g., New York, New Jersey and California.
The highest rates are in largely rural states, in the Plains and the South. These states tend to have low spending on social services and lax gun laws.
- The two states with the highest rates are Montana and Wyoming.
- Half of all suicides are by gun. Men prefer guns; women prefer poison or drug overdose.
While these states have lower costs of living, they also have lower household incomes.
The explanation for suicides is largely inferential and anecdotal. No one to my knowledge goes around collecting suicide notes to tabulate causes.
Statistical inference points to economics, partly because that’s the data available, as per the quote from Professor Putnam, below.
“This is part of the larger emerging pattern of evidence of the links between poverty, hopelessness and health,” said Robert D. Putnam, a professor of public policy at Harvard and the author of “Our Kids,” an investigation of new class divisions in America.
Anecdotal evidence also points to the role of finances in suicide decisions. Some of us know people who have shot themselves on receiving a cancer diagnosis when they have no medical insurance to cover the cost of treatment.
- When the patient is unable to afford treatment and has only slight chance of recovery, suicide may just make sense.
- Some may do this to keep their spouse from financial ruin.
Adding to this, statistical inference also suggests that states that make it easier to file for bankruptcy have lower suicide rates. California, for example, leads in bankruptcy filings but has a very low suicide rate.
What does the ACA repeal have to do with this?
- Access to doctors was designed to encourage screening and early detection of disease, when the illness is less obvious or painful, more easily treatable and less costly to treat.
- Removal of access is going to mean that more disease is caught at later stages, with patients having fewer options, pain, less likelihood of success and higher costs that may be unaffordable. Repeal will put more people in this impossible position. What do you expect them to do?
- American Foundation for Suicide Prevention, “Suicide Statistics.” https://afsp.org/about-suicide/suicide-statistics/
- CDC, “Suicide — Facts at a Glance,” 2015
- Curtin SC, Warner M, Hedegaard H. “Suicide rates for females and males by
race and ethnicity: United States, 1999 and 2014.” NCHS Health E-Stat. National Center for Health Statistics. April 2016.
- Debt.org, “Bankruptcy Statistics,” https://www.debt.org/bankruptcy/statistics/
- Tavernise, Sabrina, “U.S. Suicide Rate Surges to a 30-Year High,” The New York Times, 22 April 2016. https://www.nytimes.com/2016/04/22/health/us-suicide-rate-surges-to-a-30-year-high.html?_r=0