Fisher: There was a report last week from the National Center for Health Statistics that showed the life expectancy in America is actually declining ― the only Western, industrialized country in the world where that’s happening. And it’s happening among white men, white women and black men alike, and it’s happening despite the decline in the death rate from cancer and despite a decline in smoking. When you see that, what does it say to you about the quality and availability of health care in this country?

Cassidy: First, we were told that people were dying because they didn’t have health insurance. Now we have record numbers of people insured and our mortality rate has increased and life expectancy has decreased.

Fisher: So, we should have less health care?

Cassidy: No, but I think it kind of gives lie to the fact that somehow we’re going to enter into a wonderful new world once Obamacare was implemented. And I say that not with joy. I say that with kind of ― those are my patients. Those are working families who now have been unemployed.

Proverbs said, “The people have no hope, they despair.” And in their despair, the suicide rates among white men and white women who are middle-aged and above is at all-time highs. The opioid epidemic is incredible. The metabolic syndrome ― if you will, another form of addiction, a cohort addiction, if you will ― is also kind of limiting life. I think it’s incredibly sad. We need our economy going again.

Going back to how I started ― maybe, I think, I mentioned this earlier ― there are employers who responded to the employer mandate by reducing the hours of their lower-paid workers from 40 hours a week to 30 hours a week to escape the mandate. And folks say, “Oh, no, it didn’t happen.” Yes it did. First, we look at in my office, look what the the Federal Reserve of New York did. Not if you look at all workers. Of course it doesn’t apply to a CEO or an engineer. It applies to that lowest quintile. Those people who are already paid the least because those are the folks whom a mandated benefit substantially increases their wage. Therefore, it was decreased. Example after example.

Those folks can no longer have a living wage. I think it’s easy to imagine those folks in despair, those folks perhaps going on disability, those folks perhaps becoming addicted to opiates. I can go on, but it’s easy to imagine. Again, these are patients ― for 30 years I had patients like this who were addicted in the kind of scenario I described. I think we have to give them hope. We have to give them hope.

Fisher: Well, along the lines of that comment, there was a fascinating analysis last week of the election that showed that Donald Trump performed better than Mitt Romney had four years ago in many places, but he compared best of all to the Republican nominee from four years ago in those counties that have the highest drug, alcohol and suicide mortality rates, and that sounds awfully like a mandate to attack the heroin and opioid abuse problems that ravage so many American communities. So what do you see the incoming administration doing on that front to make a real difference?

Cassidy: It doesn’t surprise me. Going back to my practice ― kind of a working-class practice. And if you listen to them, if you hear what they’re saying, but also if you look at the statistics. Statistics are that when employment decreases, the number of people on disability goes up, and as the disability population goes up, you end up with a kind of ― you’re permanently unemployed. And statistic after statistics, it’s an inverse relationship. Employment goes down, lagging but going up concomitantly would be the number of people on disability. Those folks want hope.

When the people have no vision, they despair, and they want a vision of America that will give them their lives back. Good jobs, good benefits, a job to go to, every morning kissing their wife or their husband goodbye, dropping your kids off. And now they stay at home with nothing to do. We need an economy that works for them again.