Curbside Consult with Aaron Carroll Part 1: The lifespan among American retirees


let’s start with tell us who you are Aaron Carroll I’m Aaron Carroll I’m uh I’m a health services researcher and I’m a pediatrician I’m an associate professor of pediatrics at Indiana University School of Medicine and I should say that that you and I have been colleagues on the incidental economist and publishing together in the New England Journal of Medicine and and have been active in this game for a while how did you get started as as a sort of health policy commentator or blogger I think it started cuz uh mostly because I think I was doing radio first I’ve written a number of papers about physician views on on health care reform and so when healthcare reform became a bigger deal back in 2007 probably and when President Obama well then senator Obama I think went to talk to the AMA maybe he was president then some of my work came up and I started doing radio again because people were interested in how physicians would feel about health care reform and after doing that for a while people kept saying to me well why don’t you blog why don’t you actually write about this and I resisted it for a long time partially because writing at that time really wasn’t my gig and the idea of doing it every day just seemed daunting and I to be honest there’s a bit of a fear factor because when you start no one reads it and just getting your close personal friends to take a look is difficult and sometimes that’s more painful than oh yeah I don’t think most of my family story my blogs but I started doing it and I found that there was sort of a need for people that would sort of bring evidence or research or data to the discussion of health policy and at first I was doing it on my own blog which was called rational arguments and I’m sure I had no readers at the beginning and then when I started to finally track it with Google and you know I had in the tens and it was very accepting but I think a lot of the radio that I was doing started to get some traffic and then I actually started to pick up some pieces with from Austin frac who was the one who started the incidental economists and we would cite each other’s work periodically and then we actually talking about it and then one day he asked if I might be interested in joining then first I resisted because I’m not an economist and I’m you know I’m a health services research on a doctor and so while there I think is overlap of the work his seemed like a different sight and I wasn’t quite sure but his traffic I think at the time was was bigger than mine and it seemed like a natural fit and so we joined up god I think about a year after I started blogging so probably would have been about 2010 I think and then things started to really take off and we found that there’s again there’s just this need there’s this there’s this hunger for people who sort of are embedded in the research and willing to sort of examine the evidence and use rigorous methods but still give it a voice and so we like to say all the times like I have an opinion but my opinion is formed by data and evidence it’s not that I have a belief and I will go out and find data evidence to support that belief and so that’s really what we’ve tried to do obviously you’ve joined us since then and I think it’s it’s what we do but it’s it’s incredibly valuable and it’s it’s turned into an incredibly rewarding experience and there’s almost no aspect of my job that I enjoy more these days and it’s stunning to me given that writing at the beginning was such a chore and something I did not want to do that I do so much of it now one of the things that’s really striking about your blogging are the great graphs that you make I think that you are I guess I guess I guess as recline is ahead of you in terms of name recognition for graphs but you’re blah but you’re close behind I appreciate that we tried them all behind him and name recognition of nearly everything my favorite Erin graph I think was I think there’s two that I’m just going to note for readers one is there’s a fantastic graph which just shows changes in life expectancy above and below median income for male work once they once they reach reached retirement age and what’s really striking is almost the entire gain over the past three years and the life expectancy is basically in the top half of the income distribution and if you look at the people below that in the bottom half they’re basically they basically experienced almost no increase in life expectancy at all over that period which is really quiet if you want to know what the consequences of inequality in America that’s that’s really strike one how much did it go up in the in the top half I’ve forgotten at the moment I think about five years even that you know just not nearly as much as people will quote in sort of the lay media they’ll throw out numbers like 14 15 even 16 years and it life expect me at 65 has gone up but as you say it’s it’s almost entirely concentrated in the top half not even the top you know small percent the top half of us between the bottom half have barely gotten a year and to talk about taking away two years of their Medicare’s basically robbing them of a totally year it’s not compensating for any kind of growth moreover it’s very likely that there’s a lot of people in there who’ve had their life expectancy stay stable or go down it’s not that everybody in the bottom half is gone up here so it’s a very very regressive policy you know I think you’re writing about the utter stupidity of increasing the Medicare eligibility age had the real impact because it turns out it actually cost the health system money yeah it is people are not living longer to the extent that that most of us think and it’s really shifting costs onto individuals and states and employers away from the federal government in a way that really doesn’t address any of our problems except for the you know it does a little bit it helps a little bit for the federal you know the federal budget but only because it’s pushing off all these responsibilities on to other people who are less able to take it I feel like the only need that it fills is some sort of deep-seated desire among some sense of the population that we have to take Medicare away I mean it’s a on if there’s or just cut it I mean just make it less or no objective reason because there’s there’s plenty of debates that we could have of ways to trim Medicare spending but there’s not one that just seems so silly I just can’t I can’t even find another word for it it just makes no sense and in any way it potentially could harm people’s health it costs people twice as much as we save it it’s regressive it’s not compensating for any kind of life expectancy increase and so almost any way you look at it it just doesn’t make sense it’ll be some ways to cut Medicare you can make some argument for it that’s based in in rationale and you can discuss the trade-offs of it but that one just doesn’t but I think it gets back to your point my my favorite charts are the ones that that just basically dispel deep-seated means or beliefs if he thinks because people know to be true I mean just people just inherently believe we’re living so much longer than we were 30 years ago that we have to we have to extend or raise the Medicare eligibility age and that’s just not true one of my favorite charts still and there’s two of them which actually very similar but one of them is just sort of where I just made a pie chart of the number of Canadians that come to the United now when I say I think that one I think was I think it was the daily dishes chart of the year like a year or two ago can that was a big deal again when I’m a little blogger at the time um but you know the number of Canadians who come here is just barely seeable on a chart and yet everybody seems to believe they know someone who came here and in the same way another of my favorites is the same thing it’s it shows the actual dollar savings that we can probably see in the health care system from tort reform which again is almost unseeable it’s this thin line that you can drag out of the pie chart but everybody just knows malpractice system is why health care cost so much in the United States and it’s just not the way to solve it well one of the problems we have is I mean it comes down to some of the work that Danny Kahneman and people like that have done on the psychology of decision making there are there are genuine and real vivid examples of people coming from Canada some of those have been exaggerated in the retelling but there’s real examples there’s real examples of ridiculous malpractice settlements there’s real examples of all sorts of stuff that are just not very common at all and so if in fact my in my own work and I do a lot of work in violence prevention you know people are terrified that a homicidal stranger is going to come in their house and kill them yeah that if you actually look at all the cases of homicides in the United States where the motive is listed as burglary it turns out there’s a hundred in the United States of course the whole United States in the year so it’s not zero there’s enough to you can imagine it’s a great story on cable TV about it that’s genuinely scary in Chicago that was one you know in any year and so people are and when you think about the risks of suicide and of accident and and of someone getting hold of that gun and doing something terrible with it if the reason you’re having that gun is the fear that some stranger is just gonna kick your door in and you’ve got to have that gun there to find out it’s just a really really rare risk but it’s a very vivid and scary risk and so people think it’s more common but your point is so good and I can’t I’m I have to bring up even an anecdote to discuss this because I’m curious to get your opinion of it but we’ve been my daughter is uh about six and a half she’s in first grade and after the recent shooting the school felt this intense need to discuss this with the students including my daughter he’s a first grader and they’ve even done drills on what to do and in the past week she’s she can’t go to sleep she’s cries every night because she’s scared a man’s gonna come through the window and shoot her because this is what and I’m just why do we even tell kids is some sort of baffled about this because again the actual likelihood of this happening is zero I mean it’s just infinitesimal you know it’s certainly there are some people who should be talking about this advice about it and think sure the things we might do that that would make our kids safer and but but let’s not put it on the first graders to Ted Oh crisis response but I see if this is almost I feel like how it gets started if just like now she’s panicked about this now she believes this is something that’s very likely to occur um and it strikes me that this is how it starts the anecdote is so powerful and I see this in adults as well and we see it in all kinds of things where you know people just because they think it’s possible I remember when Plan B was was a big issue and they were talking about adolescents could get a hold of it and and you know that the likelihood that they could they could take it and then they could overdose so there could be a problem and and people kept saying it’ll be right there next to the batteries and I I remember going to the the FDA the FDA it was the poison control website more people died of battery inches then of you know many drugs and I’m like terms up batteries are far more dangerous than when planned means it’s you know but we just we buy into this fear or this this this sort of inflating the the anecdote or the individual thing and we lose sight of just the perspective of how dangerous is what I could do this all day but I remember when SARS everybody was panic they were gonna die SARS but no one talks about flu which kills of course tens of thousands of people every year and you know but but SARS killed zero it’s just we we can’t seem to focus on the things that are we’re all are we’re gonna have a nonprofit that gives you organization we’re all gonna meet at Burger King and talk about how frightened we are about the power lines that are over yeah you know that are gonna be put in over our house you know and right it is in what can you do

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