Tag Archives: Low Income

American health care: does it cause poor life-expectancy and high infant mortality?

Probably one of the best health care policy experts writing today is Avik Roy, who writes for Forbes magazine.

Here is his latest column, which I think is useful for helping us all get better at debating health care policy. (H/T Matt from Well Spent Journey)

Excerpt:

It’s one of the most oft-repeated justifications for socialized medicine: Americans spend more money than other developed countries on health care, but don’t live as long. If we would just hop on the European health-care bandwagon, we’d live longer and healthier lives. The only problem is it’s not true.

[…]If you really want to measure health outcomes, the best way to do it is at the point of medical intervention. If you have a heart attack, how long do you live in the U.S. vs. another country? If you’re diagnosed with breast cancer? In 2008, a group of investigators conducted a worldwide study of cancer survival rates, called CONCORD. They looked at 5-year survival rates for breast cancer, colon and rectal cancer, and prostate cancer. I compiled their data for the U.S., Canada, Australia, Japan, and western Europe. Guess who came out number one?

Here is the raw data:

Health care outcomes
Health care outcomes by country and type of treatment

Click here to see the larger graph.

So, what explains this?

The article continues:

Another point worth making is that people die for other reasons than health. For example, people die because of car accidents and violent crime. A few years back, Robert Ohsfeldt of Texas A&M and John Schneider of the University of Iowa asked the obvious question: what happens if you remove deaths from fatal injuries from the life expectancy tables? Among the 29 members of the OECD, the U.S. vaults from 19th place to…you guessed it…first. Japan, on the same adjustment, drops from first to ninth.

It’s great that the Japanese eat more sushi than we do, and that they settle their arguments more peaceably. But these things don’t have anything to do with socialized medicine.

Finally, U.S. life-expectancy statistics are skewed by the fact that the U.S. doesn’t have one health-care system, but three: Medicaid, Medicare, and private insurance. (A fourth, the Obamacare exchanges, is supposed to go into effect in 2014.) As I have noted in the past, health outcomes for those on government-sponsored insurance are worse than for those on private insurance.

To my knowledge, no one has attempted to segregate U.S. life-expectancy figures by insurance status. But based on the data we have, it’s highly likely that those on private insurance have the best life expectancy, with Medicare patients in the middle, and the uninsured and Medicaid at the bottom.

I know that my readers who like to dig deep into economics and policy will love the links at the bottom of the article:

For further reading on the topic of life expectancy, here are some recommendations. Harvard economist Greg Mankiw discusses some of the confounding factors with life expectancy statistics, citing this NBER study by June and Dave O’Neill comparing the U.S. and Canada. (Mankiw calls the misuse of U.S. life expectancy stats “schlocky.”) Chicago economist Gary Becker makes note of the CONCORD study in this blog post. In 2009, Sam Preston and Jessica Ho of the University of Pennsylvania published a lengthy analysis of life expectancy statistics, concluding that “the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system.”

The funniest thing I have found when talking to people from countries with socialized health care systems, like Canada and the UK, is that they are woefully uninformed about American health care. They literally do not know about free emergency room care, which is free for anyone regardless of insurance – including illegal aliens. They do not know about our expensive Medicaid program, which helps people who cannot afford health insurance. And our very very expensive Medicare program, which provides health care to the elderly – including prescription drugs. I get the feeling that foreign critics of American health care are getting their views from amateur documentaries produced by uneducated Hollywood propagandists, or maybe from TV shows on the Comedy Channel. They certainly are not getting their information from peer-reviewed studies by credentialed scholars from top universities, like the ones cited above.

I have literally spoken to Canadians who think that people in the USA without insurance do not get treatment and just die in the streets from stab wounds. They don’t know about the emergency room rule, or about charity care, or about Medicaid and Medicare. There is a lot of ignorance up there – wilful ignorance, in some cases. And keep in mind that the average Canadian household is paying over $11,000 a year for this substandard health care! They are paying more for less, and that’s not surprising since a large chunk of the taxes that are collected for health care go to overpaid unionized bureaucrats. Naturally, when their left-wing politicians need treatment, the first place they go is to the United States, where they pay out of pocket for the better health care. But that doesn’t stop them from denouncing American health care when they are talking to voters.

Higher infant mortality rates?

One of the other common arguments you hear from uninformed people outside the USA is the higher infant mortality rates argument.

Here’s an article by Stanford University professor Scott Atlas to explain why the argument fails.

Excerpt:

Virtually every national and international agency involved in statistical assessments of health status, health care, and economic development uses the infant-mortality rate — the number of infants per 1,000 live births who die before reaching the age of one — as a fundamental indicator. America’s high infant-mortality rate has been repeatedly put forth as evidence “proving” the substandard performance of the U.S. health-care system.

[…]n a 2008 study, Joy Lawn estimated that a full three-fourths of the world’s neonatal deaths are counted only through highly unreliable five-yearly retrospective household surveys, instead of being reported at the time by hospitals and health-care professionals, as in the United States. Moreover, the most premature babies — those with the highest likelihood of dying — are the least likely to be recorded in infant and neonatal mortality statistics in other countries. Compounding that difficulty, in other countries the underreporting is greatest for deaths that occur very soon after birth.

[…]The United States strictly adheres to the WHO definition of live birth (any infant “irrespective of the duration of the pregnancy, which . . . breathes or shows any other evidence of life . . . whether or not the umbilical cord has been cut or the placenta is attached”) and uses a strictly implemented linked birth and infant-death data set. On the contrary, many other nations, including highly developed countries in Western Europe, use far less strict definitions, all of which underreport the live births of more fragile infants who soon die. As a consequence, they falsely report more favorable neonatal- and infant-mortality rates.

[…]Neonatal deaths are mainly associated with prematurity and low birth weight. Therefore the fact that the percentage of preterm births in the U.S. is far higher than that in all other OECD countries — 65 percent higher than in Britain, and more than double the rate in Ireland, Finland, and Greece — further undermines the validity of neonatal-mortality comparisons.

You can listen to a podcast with Dr. Atlas here, from the Library of Economics web site.

If you want to read more about how American health care compares with health care in socialized systems, read this article by Stanford University professor of medicine Dr. Scott Atlas. And you can get his book “In Excellent Health: Setting the Record Straight on America’s Health Care” from Amazon.

Romney wins CNN debate against Obama and biased moderator Candy Crowley

Romney brought up the Obama administrations lies about Benghazi as well as the Fast and Furious gun-running to Mexican drug cartels to seal the victory. Although the Democrat moderator lied about Obama calling Benghazi an act of terror, it wasn’t enough to save Obama from Mitt’s constant repetition of the horrible performance of the economy under the socialist Barack Obama.

Romney narrowly won, but it could have been better if he had pressed the attack on the security failures in Benghazi with more facts. He pulled his punches there, and he had no reason to.

There are two stories to this debate. First, the CNN moderator lied to protect Obama about his Benghazi security failure:

CNN correspondent and second presidential debate moderator Candy Crowley disgraced herself tonight, repeatedly intervening to save a floundering President Obama and showing why many Americans were rightfully suspicious of her ability to moderate a presidential debate fairly.

Her most outrageous act tonight was her incorrect seconding of Obama’s statement that he declared the Libya terrorist attacks to be “terror.” While Obama did indeed use the word, this is not what he meant by it. Instead, he was simply referring to “acts of terror.” There was no mention of Al Qaeda or any of its affiliates with respect to the actual attack on the U.S. embassy in Benghazi.

Here is the full Obama statement in reference to “terror” in Libya.

“No acts of terror will ever shake the resolve of this great nation, alter that character, or eclipse the light of the values that we stand for. Today we mourn four more Americans who represent the very best of the United States of America. We will not waver in our commitment to see that justice is done for this terrible act. And make no mistake, justice will be done.”

Perusing the full Obama speech reveals that the president and Crowley misstated the facts…

She has now admitted that Romney was correct about Benghazi.

Second, the CNN moderator cut off all discussion of Obama’s Fast and Furious gun-smuggling to drug cartels, after asking a planted question about “assault weapons”:

As I reported earlier, the topic of Operation Fast and Furious came up at tonight’s presidential debate in New York. During Mitt Romney’s remarks on the deadly subject, President Obama sat in the background where he smirked and at one point, laughed.

[The] debate moderator Candy Crowley quickly changed the subject away from Operation Fast and Furious and when she was done speaking, President Obama failed to address the issue. After the debate in the media spin room, the Obama campaign wasn’t interested in discussing the details either.

[…]Fast and Furious has damaged the relationship between Mexico and the United States, not to mention, it’s laughable to hear President Obama talk about gun control when his own Justice Department armed Mexican cartels with thousands of AK-47 style weapons.

“It’s a vital issue. The President promised to run one of the most transparent and open administration in history. That’s not the case in fact literally today the Justice Department filed suit trying to get out access to records thrown out of court. The President is so upside down on Fast and Furious. He’s never directly addressed the question. He was asked specifically by Univision and he said he would get to the bottom of it but nobody has been held accountable and they haven’t provided the documents to Congress,” Rep. Jason Chaffetz, who sits on the House Oversight Committee, told Townhall. “I’m glad to see Mitt Romney mentioned it and actually talked about it in a proactive way as something that was wrong on every facet.”

Here are some of the other key points about tonight’s debate:

It’s worse to be raised by a single mother than a married couple, even if you’re not poor

Here’s one of my favorite sociologists W. Bradford Wilcox writing about single motherhood in the left-leaning Slate.

Excerpt:

Take two contemporary social problems: teenage pregnancy and the incarceration of young males. Research by Sara McLanahan at Princeton University suggests that boys are significantly more likely to end up in jail or prison by the time they turn 30 if they are raised by a single mother. Specifically, McLanahan and a colleague found that boys raised in a single-parent household were more than twice as likely to be incarcerated, compared with boys raised in an intact, married home, even after controlling for differences in parental income, education, race, and ethnicity. Research on young men suggests they are less likely to engage in delinquent or illegal behavior when they have the affection, attention, and monitoring of their own mother and father.

But daughters depend on dads as well. One study by Bruce Ellis of the University of Arizona found that about one-third of girls whose fathers left the home before they turned 6 ended up pregnant as teenagers, compared with just 5 percent of girls whose fathers were there throughout their childhood. This dramatic divide was narrowed a bit when Ellis controlled for parents’ socioeconomic background—but only by a few percentage points. The research on this topic suggests that girls raised by single mothers are less likely to be supervised, more likely to engage in early sex, and to end up pregnant compared with girls raised by their own married parents.

It’s true that poorer families are more likely to be headed by single mothers. But even factoring out class shows a clear difference. Research by the Economic Mobility Project at Pew suggests that children from intact families are also more likely to rise up the income ladder if they were raised in a low-income family, and less likely to fall into poverty if they were raised in a wealthy family. For instance, according to Pew’s analysis, 54 percent of today’s young adults who grew up in an intact two-parent home in the top-third of household income have remained in the top-third as adults, compared with just 37 percent of today’s young adults who grew up in a wealthy (top-third) but divorced family.

Why is this? Single mothers, even from wealthier families, have less time. They are less likely to be able to monitor their kids. They do not have a partner who can relieve them when they are tired or frustrated or angry with their kids. This isn’t just a question of taking kids to the array of pampered extracurricular activities that many affluent, two-parent families turn to; it’s about the ways in which two sets of hands, ears, and eyes generally make parenting easier.

I think that people who think that it is hatred and bigotry to say that there should be rules around marriage and sex understand the reasons for these moral boundaries. We are trying to protect the children, and so we have boundaries about who can have sex and who can get married. Children need a mother and a father, and we need to promote and celebrate that as marriage, and not anything else. We should be rewarding people for getting married and staying married.

Related posts

Low-income households spend 9% of their money on lotteries and gambling

J Warner Wallace of Please Convince Me tweeted this story from the Atlantic.

Excerpt:

The Mega Millions jackpot makes this the week to talk about lottery economics, so here’s a whopper: Households earning less than $13,000 a year spend a shocking 9% of their money on lottery tickets, Henry Blodget relays from a PBS report.* Are they clueless? Are they desperate? Are they economical? Maybe, probably, and possibly.

For the desperately poor, lotteries perform a role not unlike the obverse of insurance. Rather than pay a small sum of money in exchange for the guarantee of protection that you’ll need in the future, you pay a small sum of money in exchange for the small probability that you’ll win money to help your lot right away. It is, for lack of a better term, a kind of aspirational insurance.

So often, everyone acts as if low-income people are necessarily more virtuous than other for earn more, such that we should automatically redistribute wealth from frugal people to wasteful people. Instead of redistributing wealth, though, maybe we should be redistributing character and wisdom and restraint. Maybe the reason that the poor are poor is because although they have every advantage living in the prosperous west, that they just make poor decisions.

Black economist Walter Williams explains:

Avoiding long-term poverty is not rocket science. First, graduate from high school. Second, get married before you have children, and stay married. Third, work at any kind of job, even one that starts out paying the minimum wage. And, finally, avoid engaging in criminal behavior. If you graduate from high school today with a B or C average, in most places in our country there’s a low-cost or financially assisted post-high-school education program available to increase your skills.

Most jobs start with wages higher than the minimum wage, which is currently $5.15. A man and his wife, even earning the minimum wage, would earn $21,000 annually. According to the Bureau of Census, in 2003, the poverty threshold for one person was $9,393, for a two-person household it was $12,015, and for a family of four it was $18,810. Taking a minimum-wage job is no great shakes, but it produces an income higher than the Bureau of Census’ poverty threshold. Plus, having a job in the first place increases one’s prospects for a better job.

In fact, the number one cause of poverty is the decision by individual people not to marry before having children. That’s not caused by “corporate greed” or other bogeymen. It’s an uncoerced decisiojn that each person makes. If anyone is causing poverty, it’s the anti-marriage left which subsidizes and glamorizes single motherhood by choice and divorce.

Instead of making poverty more comfortable so that the poor can continue to make bad decisions, maybe we should be encouraging them to do the things that will life them out of poverty. Let’s pay the poor to finish school, get married, stay married, get a job, and wait before having children. And let’s support them by giving them school choice and other freedoms that allow them to escape the underperforming public schools. Fixing poverty doesn’t just mean handing people money – there are deeper issues.

What I also like about this story is that it was tweeted by a Christian apologist. Arguing about philosophy and science and history is good, but if we aren’t concerned about issues like abortion, marriage, poverty and freedom, then that’s not a good sign. Wallace should be commended for his concern for the poor.

Evaluating common criticisms of American health care

Here is a must-read article from my friend Matt Palumbo at the American Thinker. It’s extremely high quality. (I removed the links in my excerpt – but he linked all the sources in his post)

Excerpt:

The oft-cited “46 million uninsured” is breathtakingly easy to break down to size.  Keep in mind that there is overlap in the following statistics, as many people listed in them belong to multiple categories.  Around 10 million of the uninsured aren’t even citizens.  Another 8 million are aged 18-24, which is the group least prone to medical problems.  The average salary of a person in this age group is $31,790, so affording health care would not be a problem.  Seventeen million of the uninsured make over $50,000 a year, and within that group, 8 million make over $75,000.  These people are usually referred to as the “voluntarily uninsured.”  Another large group of these 46 million are uninsured in name only, as they are eligible for government programs that they haven’t signed up for.  Estimates on how large this group is vary, the range being from 5.4 million as estimated by the Kaiser Family Foundation to as large as one third of all the uninsured, as estimated by BlueCross BlueShield.  The number of people without care because they cannot afford it is around 6 million — still a large number, but a fraction of 46 million, and no reason to restructure the entire health care system.

Then comes the issue of lifespan.  Of all attempts to discredit the American system, lifespan has been the worst.  Although lifespan gives a good indicator of a nation’s health at a glance, it does have its problems under analysis.  We get a strange paradox when examining two statistics: life expectancy and cancer survival rates.  Estimates vary on how we rank exactly; the World Fact Book showing that we rank as poorly as 50th worldwide.  Even the best estimates in our favor place us far behind most developed nations.  Despite this, the United States excels at cancer survival.  Of the 16 most common cancers, the United States has the highest survival rate for 13 of them.  Overall, the five-year cancer survival rate for men in the States is 66.3%, and 47.3% in Europe.  Women have an advantage too, with a survival rate of 62.9% in the States, and 55.8% in Europe.  So that said, how is it that our system takes better care of us, and doesn’t grant added lifespan to boot?  Quite simply, the lifespan measurement commonly cited doesn’t factor in many variables which shorten lifespan, many of which medical care cannot prevent.  Among these factors are murders, suicides, obesity, and accidents.

He looks at the uninsured number, the infant mortality rate, and other interesting things in the article, showing how the statistics that impugn the US health care system have been misused. There are some good articles linked, like this post from Commentary magazine by Scott Atlas, entitled “The Worst Study Ever?”. Atlas is the same guy who listed out how the US health care system compares to others, which I blogged about before.

You can check out Matt’s blog “The Conscience of a Young Conservative“. Not sure how scalable that blog name is. Because of the “young” part, not because of the conscience or conservative part.