Mankiw: Beyond Those Health Care Numbers

Greg Mankiw does his best to belittle the health care problem and sweep it under the rug:

Beyond those health care numbers, by N. Gregory Mankiw, Economic View, New York Times: Here are three true but misleading facts about health care that politicians and pundits in the United States love to use to frighten the public.

The United States has lower life expectancy and higher infant mortality than Canada, which has national health insurance. The differences are indeed significant. Life expectancy at birth is 2.6 years greater for Canadian men than for American men. Among women, Canadians outlive Americans by 2.3 years. Infant mortality in the United States is 6.8 per 1,000 live births, compared with only 5.3 in Canada.

These facts are often taken as evidence for the inadequacy of the U.S. health system. But a recent study by June and Dave O'Neill, economists at Baruch College, from whom these numbers come, shows that the difference in health outcomes has more to do with broader social forces.

For example, Americans are more likely than Canadians to die by accident or by homicide. For men in their 20s, mortality rates are more than 50 percent higher in the United States than in Canada, but the O'Neills show that accidents and homicides account for most of that gap. Maybe these differences have lessons for traffic laws and gun control, but they teach nothing about the U.S. system of health care.

Americans are also more likely to be obese, leading to heart disease and other medical problems. ... Research by the Harvard economists David Cutler, Ed Glaeser and Jesse Shapiro concludes that the growing obesity problem in the United States is largely attributable to its ability to supply high-calorie foods inexpensively.

Infant mortality rates also reflect broader social trends, including the prevalence of infants with low birth weight, which is correlated with teenage motherhood. Whatever its merits, a Canadian-style system of national health insurance is unlikely to change the sexual mores of American youths.

Some 47 million Americans do not have health insurance. This number from the Census Bureau is often cited as evidence that the health system is failing for many families. Yet ... the figure exaggerates the magnitude of the problem.

To start with, the 47 million includes about 10 million residents who are not U.S. citizens. Many are illegal immigrants. Even with national health insurance, they would probably not be covered.

The number also fails to take full account of Medicaid, the government's health program for the poor. For instance, it includes millions of the poor who are eligible for Medicaid but have not yet applied. These individuals ... could apply if they ever needed significant medical care. They are uninsured in name only.

The 47 million also includes many who could buy insurance but have not done so. The census reports that 18 million of the uninsured have an annual income of more than $50,000, which puts them in the top half of the income distribution. About a quarter of the uninsured have been offered employer-provided insurance but declined coverage.

Health costs are eating up an ever increasing share of Americans' incomes. ... But increasing expenditures could just as well be a symptom of success. The reason Americans spend more than their grandparents did is not waste, fraud and abuse, but advances in medical technology and growth in incomes. Medical science has consistently found new ways to extend and improve lives. Wonderful as they are, they do not come cheap.

Fortunately, incomes are growing, and it makes sense to spend this growing prosperity on better health. The rationality of this phenomenon is stressed in a recent article by the economists Charles Jones of the University of California and Robert Hall of Stanford. They ask, "As we grow older and richer, which is more valuable: a third car, yet another television, more clothing - or an extra year of life?"

Those looking at reform plans should be careful not to be fooled by statistics into thinking that problems are worse than they really are.

It's interesting and telling that he chooses to, for the most part, take a snapshot of a dynamic problem - where will the system be 10 or 20 years from now? - and use that snapshot rather than the expected pressures coming in the future to make his argument (and, while talking about misleading comparisons, he only considers the U.S. in relation to a single alternative, Canada, rather than to a broad array of alternatives that would give a fuller picture). He should also know that life expectancy from birth, which he is using in his arguments about different death rates for infants and the young, is not the only or even the best way to make life expectancy comparisons (as opposed, to say, the life expectancy at age 30, age 40, etc., i.e. given that you've already made it through the infant and young adult years). On obesity, it's correlated with being poor. Why might that be the case? Yeah, I know, they just don't have Greg's self-control. If they did, they'd be skinny and rich, just like him! I was surprised, too, at Greg's implication that Canadians are too backward to be able to "supply high-calorie foods inexpensively" like we can which is why they have less of a problem with obesity. And some of the arguments like blaming infant mortality on lack of morals rather than lack of access to health care - a key problem for the group he is targeting with his Malthusian moralizing - is a bit, um, surprising.

Anyway, you get the picture, it's bad morals (guns, births, eating too much, etc.), illegal aliens, people who make bad choices and don't buy insurance (more moralizing). Our people just aren't as moral as Canadians - we have too many people in certain groups so we look bad in comparison. It's not the failure of the system to deliver health care to these groups, nope, it's all those immoral people in the groups.

I assume the point in arguing that there is no problem is to undercut the case for reform. He wimps out and doesn't actually take a position on whether reform is needed or not, but why write this column if you are trying to encourage the process to move forward?

Why might he want to pretend there is no problem? Here's one answer from Clive Crook:

Why Democrats are winning on health care, by Clive Crook: This is from my latest column for National Journal...

The politics of the issue has moved a long way in the Democrats' favor. Public opinion has shifted, the polls say, in favor of universal coverage as a goal. Worries over the rising cost and availability of health insurance are a big part of the wider trend of rising economic anxiety. Americans' desire to see this problem fixed is greater now than it was in the early 1990s, when Hillary Rodham Clinton's previous health reform proposal was shot down.

At the same time, the Democrats -- and, above all, Clinton herself -- have radically altered their approach to the issue. Look at the way she pitches her plan on her campaign website. If you are happy with your existing health insurance arrangements, she insists, nothing will change. After the "Hillarycare" fiasco, that reassurance is crucial.

The Democrats' schemes all envisage an expanded government role -- as they must, if universal coverage is to be achieved -- but they are not single-payer "socialized medicine" plans. Moreover, that fact is obvious. The Republicans' insistence that these schemes amount to socialized medicine is implausible and smacks of desperation. The voters are not buying it. ...

Since the "socialized medicine" scare isn't working, I expect we'll see lots more columns trying to stop the movement toward universal coverage by minimizing the problem, and through other tactics.

Update: Brad DeLong adds more from Clive Crook:

Clive Crook on Health Care Reform, by Brad DeLong: He writes:

WEALTH OF NATIONS: Democrats Are Winning On Health Care (11/02/2007): Republican plans are cheaper... only because they are so much less ambitious.... None of these ideas -- not even McCain's, the best of the bunch -- frontally addresses the belief that the system is broken and, as a high national priority, needs far-reaching reform.

Do Americans really believe that reform is needed? They do, I think -- and if they do not, they should.... Lack of insurance is no longer partly a matter of choice (as in the case of the young and fit...), or else a problem only for the poor. Economic insecurity is on the rise for most Americans, not just for a static minority of poor people. People change jobs more often than they used to, whether they like it or not. And in the United States, when you change jobs you worry about your health insurance.

What if your next employer offers no coverage? What if a pre-existing condition makes an individual policy too expensive or altogether unavailable? The guarantee of universal coverage is something that almost all Americans, including those covered at present, would value and be willing to pay something for. And they know that every other rich country in the world provides it. As long as reform does not put them at an immediate disadvantage -- either by forcing them off plans they are happy with, or by pushing up their own taxes -- it is something they will vote for. The Democrats are offering reassurance on both points (more plausibly on the first than the second). They are on to something.

Update: See Dean Baker's "Further Behind Those Health Care Numbers." He explains why the 45 million uninsured figure may understate of the true problem, and he also looks at other statistics in more detail.

One more Update: Brad DeLong follows up with more questions on the numbers presented in the article (and he also has some questions about numbers that were not presented).

Comments

[howard]

mankiw was a complete cipher to me when he joined the bush administration, but based on what i know about him, he is a totally predictable, less than intellectually honest apologist for oligopolists and their fellow travellers. is it really possible that he's changed this much over time? or was he always this kind of quasi-propagandist, and economists just didn't want to acknowledge it?

[anne]

http://www.nytimes.com/2005/02/14/books/14bull.html?ex=1266123600&en=32440f7c34fc8b0e&ei=5090&partner=rssuserland

February 14, 2005

Between Truth and Lies, An Unprintable Ubiquity
By PETER EDIDIN

Harry G. Frankfurt, 76, is a moral philosopher of international reputation and a professor emeritus at Princeton. He is also the author of a book recently published by the Princeton University Press that is the first in the publishing house's distinguished history to carry a title most newspapers, including this one, would find unfit to print. The work is called "On Bull - - - - ."

The opening paragraph of the 67-page essay is a model of reason and composition, repeatedly disrupted by that single obscenity:

"One of the most salient features of our culture is that there is so much [bull]. Everyone knows this. Each of us contributes his share. But we tend to take the situation for granted. Most people are rather confident of their ability to recognize [bull] and to avoid being taken in by it. So the phenomenon has not aroused much deliberate concern, nor attracted much sustained inquiry."

The essay goes on to lament that lack of inquiry, despite the universality of the phenomenon. "Even the most basic and preliminary questions about [bull] remain, after all," Mr. Frankfurt writes, "not only unanswered but unasked."

The balance of the work tries, with the help of Wittgenstein, Pound, St. Augustine and the spy novelist Eric Ambler, among others, to ask some of the preliminary questions - to define the nature of a thing recognized by all but understood by none.

What is [bull], after all? Mr. Frankfurt points out it is neither fish nor fowl. Those who produce it certainly aren't honest, but neither are they liars, given that the liar and the honest man are linked in their common, if not identical, regard for the truth.

"It is impossible for someone to lie unless he thinks he knows the truth," Mr. Frankfurt writes. "A person who lies is thereby responding to the truth, and he is to that extent respectful of it."

The bull artist, on the other hand, cares nothing for truth or falsehood. The only thing that matters to him is "getting away with what he says," Mr. Frankfurt writes. An advertiser or a politician or talk show host given to [bull] "does not reject the authority of the truth, as the liar does, and oppose himself to it," he writes. "He pays no attention to it at all."

And this makes him, Mr. Frankfurt says, potentially more harmful than any liar, because any culture and he means this culture rife with [bull] is one in danger of rejecting "the possibility of knowing how things truly are." It follows that any form of political argument or intellectual analysis or commercial appeal is only as legitimate, and true, as it is persuasive. There is no other court of appeal.

The reader is left to imagine a culture in which institutions, leaders, events, ethics feel improvised and lacking in substance....

[anne]

http://www.gwinnettdailyonline.com/articleB5BD6D4417AF444DBD8F9770AA729B26.asp?printerFriendly=true

1986 - 2005

On Bull....
By Harry Frankfurt - Princeton University

One of the most salient features of our culture is that there is so much bull..... Everyone knows this. Each of us contributes his share. But we tend to take the situation for granted. Most people are rather confident of their ability to recognize bull.... and to avoid being taken in by it. So the phenomenon has not aroused much deliberate concern, nor attracted much sustained inquiry. In consequence, we have no clear understanding of what bull.... is, why there is so much of it, or what functions it serves. And we lack a conscientiously developed appreciation of what it means to us. In other words, we have no theory. I propose to begin the development of a theoretical understanding of bull...., mainly by providing some tentative and exploratory philosophical analysis. I shall not consider the rhetorical uses and misuses of bull..... My aim is simply to give a rough account of what bull.... is and how it differs from what it is not, or (putting it somewhat differently) to articulate, more or less sketchily, the structure of its concept. Any suggestion about what conditions are logically both necessary and sufficient for the constitution of bull.... is bound to be somewhat arbitrary. For one thing, the expression bull.... is often employed quite loosely -- simply as a generic term of abuse, with no very specific literal meaning. For another, the phenomenon itself is so vast and amorphous that no crisp and perspicuous analysis of its concept can avoid being procrustean. Nonetheless it should be possible to say something helpful, even though it is not likely to be decisive. Even the most basic and preliminary questions about bull.... remain, after all, not only unanswered but unasked. So far as I am aware, very little work has been done on this subject. I have not undertaken a survey of the literature, partly because I do not know how to go about it. To be sure, there is one quite obvious place to look -- the Oxford English Dictionary. The OED has an entry for bull.... in the supplementary volumes, and it also has entries for various pertinent uses of the word bull and for some related terms. I shall consider some of these entries in due course. I have not consulted dictionaries in languages other than English, because I do not know the words for bull.... or bull in any other language.

...

[Bruce Wilder]

Thanks, anne. Bull is exactly what Mankiw offers. I was going to just say that his critique was incoherent, but that hardly has the necessary force.

[Bruce Wilder]

Mankiw: "Wonderful as they are, they do not come cheap."

They come much, much cheaper, if health insurance is universal and health care is better organized by the government. Hello!

Mankiw: "Fortunately, incomes are growing, and it makes sense to spend this growing prosperity on better health."

Except there has been no sustained growth in real median individual incomes in 35 years! Almost all of the supposedly "real" growth in median wages, in the course of the Bush Administration, has been absorbed by the rising cost of health insurance.

The increasing share of U.S. incomes diverted into an ineffective health care system represent a source of declining real incomes! We spend increasing amounts, without a demonstrable benefit in health outcomes.

The Guiliani lie about prostate cancer rates illustrates that. The U.S. system detects a lot of indolent prostate cancer, and treats it, unnecessarily at great cost -- both financially and to patients who suffer through the tests and the care -- and, at the end of the day, we get exactly the same rate of death from prostate cancer.

[robertdfeinman]

The Puritan strain (which also contains most libertarians) wants to blame people for problems over which they have little or no control. This is coupled with an innate sense of superiority. The most ridiculous example being health care. Those in good health seem to blame those who aren't and can't envision that one day they may be in need of such social services. All it takes is one catastrophic illness coupled with a loss of job and then followed by a loss of insurance.

The other strain is a disdain for true democracy and a preference for an autocratic style of governance. Mankiw is a perfect example. First he remove postings from those who disagree with him, and then he bans comments altogether. Those with absolute certainty can never stand to have their ideology questioned. Robert Altemeyer has captured them in his latest online book.

I'd like to see how some of their attitudes hold up when they themselves become subject to misfortune.

[dissent]

Well, folks, now you see why Mankiw turned off comments on his blog.

He likes to bloviate about the moral defects of Americans, and how, by implication, they aren't good enough to deserve health insurance.

But he doesn't like to deal with the reactions of his fellow Americans. No messy upsets allowed!

I've noticed that right wing blogs are more likely to choose this approach.

[pgl]

I was going to suggest that NYTimes should have let the National Review run this Mankiw piece instead. But then I had to go to NRO's The Corner seeing Ponnunu on Social Security and Kudlow on the labor market. No - Greg's piece is not so dumb to deserve the dustbin of NRO. For reviews of those Corner pieces - see EconoSpeak and Angrybear.

[brian holt]

Mankiw can't see the forest through the trees. after reading his interpretations on why mortality rates are higher in the US, he goes on to list a bunch of reasons that most reasonable people would agree amount to an indictment of U.S. culture, which seems to be the very consequence of right wing policy:

"Americans are more likely than Canadians to die by accident or by homicide." Gee, why is this?

"that the growing obesity problem in the United States is largely attributable to its ability to supply high-calorie foods inexpensively." If this isn't evidence for the problem of supply side economics...

"unlikely to change the sexual mores of American youths"...actually, I think Mankiw means the sexual mores taught to our American youths....

[mrrunangun]

Very young [under 16]and very old [over 36]expectant mothers are considered to have high risk pregnancies in the hospital world. We want the doctors to refer such mothers to high-risk birth centers and not to try to deliver them in our small general hospital. There is no question that the USA has more such births than it used to. My children's junior high classes had half a dozen girls sitting out gym class for pregnancy 20 years ago-unheard of in my time there. Is there a location to check the assertion that the USA has more than its share of such pregnancies?
Prof. Thoma's point about various aged life expectancies to correct for cultural differences is a good one. Is there a location to check and compare life expectancy at ages 30, 40, 50, etc. in different countries? It would be nice to know the facts if any are available. If Prof. Mankiw has his facts right, his views deserve respect instead of derision. If not, he is spewing the bull.... and the contempt expressed above is deserved.

[pgl]

Brian - I think I'm beginning to see the "wisdom" of Rudy's health care ideas - that being take away the insurance of the poor. With no insurance, they'll decide to work out and eat better. Let them eat ricecakes! That's it!

[dale]

There is one social and moral determinant of health that many refuse to understand- Inequality. Read the works of the British social epidemiologists, Richard Wilkinson and Michael Marmot. They show how seemingly small differences in social economic status- in and of themselves- can lead to measurable differences in health, longevity and well-being.

I like to say that universal health insurance (single payer being my preference) is not only sound policy for ensuring the health of our citizens by getting folks in to see health care providers, but also, since it will decrease a significant measure of social-economic inequality, will, on that basis alone, save lives and make people more healthy.

[ilsm]

Mankiw: "Wonderful as they are, they do not come cheap."

Mankiw is obfuscating.

He should be worrying about all the wonderful outcomes not delivered by war machine weapons programs which do not come cheap.

If every weapon were judged on how its wonder performance were not net, there would be plenty of money for health care.

The folks who beat out the US in health outcomes spend less than a quarter portion of their GDP on war as the US.

From my study each weapon which is not needed, and required for a whim of some retired general marketing for the war profiteers costs US life expectancy.

Ike was wrong it costs more than some workers shirt.

[Mark]

As long as reform does not put them at an immediate disadvantage -- either by forcing them off plans they are happy with, or by pushing up their own taxes -- it is something they will vote for.

And that's exactly why it will never happen.

[pgl]

Tying Rudy's dishonesty, Lipitor monopoly power, and the Rudy-Mankiw health care plan all together at Angrybear - Let Them Eat Rice Cakes!

[Eye on the ball]

And that recent estimate of the number of Americans who die of cancer because of lack of access to health care was? And the number of bankruptcies due to illness was? And our system costs how much more for what it does deliver?

But let's not exaggerate the problem. It's a disaster without any exaggeration.

[ScentOfViolets]

I would also suggest to Mr. Mankiw that gang shootings and teen pregnancies _are_ public health issues - just as smoking and drunk driving are now considered public health issues. I'm fairly certain that was C. Everett Koops view, at least.

[realpc]

Mankiw was just saying the 47 million uninsured figure is misleading, and it is. If it includes illegal immigrants and people eligible for Medicaid, then it greatly exaggerates the number of American citizens who are without health insurance. He does not say no reform is needed. Americans are very likely to be obese and that does shorten life. It's misleading to blame the shorter American lifespan on lack of health insurance, since that might not be the cause.

Our health care system has many problems, and there are no simple answers. We should at least try to be accurate with the numbers.

[anne]

Again, reading from the sample Blue Cross Blue Shield health insurace policy for Massachusetts. The cost is $595.52 a month for a single person, with another $400 deductible then co-pays for every service from routine screening tests on. That is $7,546 before insurance actually begins, and for flawed insurance at that.

The problem is as simple as spending a mere $7 billion a year to insure 3.8 million needy children when we are happily spending $200 billion on warring in and occupying Iraq. Greg Mankiw finds a Medicaid party for all, when just this summer the compassionate conservative Administration which Mankiw serves so well went as far as to cut assistance for disabled adults and children.

I know though, there is really no one who needs Medicaid and besides if they do they are immigrants who do not qualify in any event. Got to use more of my insurance. Got to.

[howard]

realpc, since you force us into this: the critique of the american health care system is that despite spending a great deal more than any other country on health care as a percentage of gdp, we do not have anywhere close to the best outcomes. in addition, a health-insurance system tied to your job limits job mobility; a system where "existing conditions" can disqualify you from coverage forces the rest of us to absorb the costs anyhow, only under sub-optimal conditions (i.e., on an "emergency" basis); and the fear of a medical-crisis induced bankruptcy is omnipresent in america.

in addition, of course, american corporations are at an enormous disadvantage carrying the health-care costs of current and former workers, something their global competition doesn't face.

yes, obesity is a problem and shortens lifespans, but no, it has absolutely nothing to do with the case of a national health insurance system and mankiw is either too stupid to know it or too dishonest to care.

which is why he's a propagandist, not an economist.

[anne]

"Infant mortality rates also reflect broader social trends, including the prevalence of infants with low birth weight, which is correlated with teenage motherhood. Whatever its merits, a Canadian-style system of national health insurance is unlikely to change the sexual mores of American youths."

Poof, no problem, because, well, poof. There is always an answer, and the answer i always no answer, but low birth weight infants is not a Greg Mankiw sort of problem anyway.

[anne]

"Research by the Harvard economists David Cutler, Ed Glaeser and Jesse Shapiro concludes that the growing obesity problem in the United States is largely attributable to its ability to supply high-calorie foods inexpensively."

Poof, no problem, poof. I imagine if we use Ed Glaeser's idea of segregating boys and girls we could solve this problem also since boys and girls together eat competitively. Poof.

[wjd123]

I admit it, I don't read Mankiw's blog. However I am aware that recently he turned of the ability to comment. After reading this article I went to his blog for the first time. I wanted to see if his New York Times' article was also carried there. It was. I also found some other interesting things about his blog. This for instance is his statement of why he created it:

I am a professor of economics at Harvard University, where I teach introductory economics (ec 10) among other courses. I use this blog to keep in touch with my current and former students. Teachers and students at other schools, as well as others interested in economic issues, are welcome to use this resource.--Mankiw

Since he no longer allows comments I looked for another way on his blog that his former students and teachers could keep in touch. There is none. Mankiw's blog is now a way for students to read about Mankiw's views. Unless keeping in touch is a one way street, I think Mankiw should rethink his purpose statement.

That aside, I also have to ask is Mankiw shirking his duty as a blog host by shutting off comments? Why should I have to get comments on Mankiw's piece on Mark Thoma's blog. Why are comments allowed here, but not on the blog of the person who wrote the controversial article. And why should Mark Thoma end up with the responsibility of maintenance for comments that should have been on Mankiw's blog. If Mankiw wants to stick to articles about conventional wisdom then not allowing comments isn't a biggy, but not if he wants to write controversial articles like this one on health care.

I found this nice comment about Mark Thoma's blog. The author was responding to an article by Dani Rodrik about the future of the econo-blogosphere. I posted this comment once before, but I think it's worth repeating.

And while I'm sure that there are prolific econobloggers who are not worth reading, I think they're probably in the minority. In my experience, most prolific econobloggers are worth reading. And while Greg Mankiw is a more famous economist, and has more readers, than Mark Thoma, the fact is that Thoma definitely has the better blog. If Thoma were to stop blogging tomorrow, the loss to the econoblogosphere would be much greater than if Mankiw or Becker-Posner or Freakonomics went dark.

http://www.portfolio.com/views/blogs/market-movers/2007/10/18/blogonomics-the-econoblogosphere-is-not-in-danger

[anne]

http://www.nytimes.com/2007/11/03/opinion/03herbert.html?ref=opinion

November 3, 2007

Worsening the Odds
By BOB HERBERT

Lonnie Lynam, a self-employed carpenter in Pipe Creek, Tex., specialized in spiral staircases. Friends thought of him as a maestro in a toolbelt, a whiz with a hammer and nails.

"His customers were always so pleased," his mother told me. "There was this one family, kind of higher class, and he built them one of those glass holders that you would see in a bar or a lounge, with the glasses hanging upside down in different sizes. It was awesome."

Lonnie had a following, a reputation. He was said to have a magic touch.

What he didn't have was health insurance.

So when the headaches came, he tried to ignore them. "We've had migraines in our family," said his mother, Betty Lynam, who is 67 and lives in Creston, Iowa. "So he thought that was what it was."

Lonnie's brother, Kelly, said: "He wasn't the type to complain. And since he didn't have insurance ..."

Kelly, 45, worked on different jobs with his brother. He was the one who rushed Lonnie to an emergency room one day last fall when the headaches became so severe that Lonnie couldn't stand up.

It would be great if there were something unusual about this story: A person without health insurance gets sick. The person holds off on going to the doctor because there's no way to pay the bill. The person is denied the full range of treatment because of the absence of insurance. The person dies.

Lonnie Lynam's headaches had been caused by cancerous tumors in his brain. During surgery, doctors discovered that the cancer had spread from other parts of his body.

Cancer is no longer the all-but-automatic death sentence that it once was. Extraordinary progress has been made in fighting the myriad forms of the disease.

But, as the American Cancer Society has recently been stressing, the health coverage crisis in the U.S. is a major drag on this fight.

"A woman without health insurance who gets a breast cancer diagnosis is at least 40 percent more likely to die," said John Seffrin, the cancer society's chief executive.

According to the cancer society: "Uninsured patients and those on Medicaid are much more likely than those with private health insurance to be diagnosed with cancer in its later stages, when it is more often fatal."

The uninsured (and underinsured) are also much less likely to get the most effective treatment after the diagnosis is made....

[anne]

"Here are three true but misleading facts about health care that politicians and pundits in the United States love to use to frighten the public."

Does this include the American Cancer Society? Not to worry though because for all the frightening, nothing has been done.

[save_the_rustbelt]

Mankiw lines up a bunch of facts, likely true, but lines them up to make in such a way as to create a distorted picture.

Even many of the Bush loonies think we need health care reform, just from another direction.

Off the top of my head it is difficult to think of many people of any influence who think the healthcare system is really swell. Mankiw is party of one.

says...

robertdfeinman said: ...I'd like to see how some of their attitudes hold up when they themselves become subject to misfortune...

This is one of the most frustrating parts of the whole neo conservative tribal dialogue-- if you are a member of the tribe, then you agree with the tribe and scorn those who are outside the tribe. In this case the tribe believes all the usual things having to do with wealth implying worth, poor people being lazy or stupid or manipulative, smart people being fully able to prepare and save for all future contingencies, and fianlly the worthiness of only those people who believe the same.

They have their tribal shibboleths, and to reinforce these they are repeated ad nauseam - a sort of economic gredo.

However, what is also part of the tribal belief structure is that sympathy and charity are for suckers, or can sometimes be a hobby of the wealthy. They believe that the less fortunate have made it a life strategy to hang around the hard-working neoconservatives, trying to arouse their nonexistent sympathies and tap them like maple trees. The job of the worthy/wealthy is to protect their sap.

By definition, if you are poor or have fallen on hard times is your own fault, and also it means you're not a member of the tribe.

So, if a member of the tribe falls on hard times they are automatically eliminated from the dialogue. If they open the eyes of charity and look around them, then too they are automatically eliminated from the dialogue.

Of course this is similar to the more strict and loony religious cults, which demand quite a lot of lip service from their adherents, and which routinely throw questioners or the needy overboard. However, a snapshot of the organization will show an extremely pure cross-section of believers.

Noni

[lonesome moderate]

Regarding "pre-existing conditions", does anyone here have a good feel for how this works out in practice, and how this is likely to work out in the future? I've heard the common horror-story anecdotes about people unable to get insurance because they weren't healthy enough, but (at least so far) I can offer myself as an opposing anecdote. It so happens that I suffered a birth defect that has always required fairly regular (and occasionally expensive) treatment, and which I've always known would lead to a delicate and expensive surgery. The surgery finally came this year, and my current employer's insurance company got stuck with a bill for several hundred thousand dollars. But I've never had a problem getting good insurance through any of my six employers (all Silicon Valley technology companies, no startups).

I don't have a clear idea about what kind of "pre-existing condition" makes people lose out on the health care lottery. Have I just been lucky? Or have the people in the anecdotes been remarkably unlucky? Or is this a problem that has started at the bottom and is now creeping up to the middle? Perhaps the fact that the big expense was more or less a one-time thing, with no further ongoing expenses, keeps me under the radar?

I suspect a big part of the problem for many people is that the whole system seems to work in such an opaque and random way. You don't really know if you should be worried about your insurance, and if you become convinced that yes, you should be worried, it's not necessarily clear what you should do.

[jacksmith]

The bottom line is that the British live longer than we do in America. And the average Briton was found to be in much better health than the best insured Americans. Sad... And British children are not dieing, and going extinct. Like all of the American children are. What do you have to say to that.

For the first time in the history of America. The life expectancy of today's children is less than that of their parents. This is catastrophic. And our infant mortality is equal to that of a third world country. Current U.S. adult life expectancy is down from #1 to #42. And dropping fast. These facts are what is known as EXTINCTION! indicators. These are the early signs of the final phase of the EXTINCTION of the American people.

You have to take the profit motive out of health care delivery. The profit motive does not work with health care. Or any other essential public service like police, and fire. The sooner everyone faces this truth. The sooner you will be able to adopt a real solution to the problem. The days of paying for health care out of pocket are at an end. Just like the mob days of paying for protection out of pocket came to an end.

HR 676 is the way to go. Single payer Universal National Health Care For All. Medicare for all. Accept no substitutes. The sooner you face this. The sooner you begin to heal the Cancer of private for profit medicine that is destroying this entire society. Other developed countries realized this years ago. It's a no-brainer now. See sickocure.org

Money, greed, and the profit motive has just decimated health care in America. And killed, and injured millions needlessly. Just for profit. But that is what large amounts of money, greed, and a lust for power always does. No one is immune from this corrupting power. The smart ones know this. And avoid letting them-self be put in compromising positions. But that is easier said. Than done. And very few succeed.

Most in the US go into medicine primarily to become wealthy. That is who the medical schools mostly choose. Most of the medical schools faculty are in bed with the drug companies, and others. And like the story of Dr. Faustus. They end up selling their soles. One compromise at a time. Until Lucifer owns them.

In medicine. Compromised care means. Injury, disability, and death. It's sad really. But HR 676 can fix this disgrace. Like it has in other developed countries. The only question is. How many more millions will be hurt, injured, and killed. And how many more of your children will die before their time. Before we fix this disgrace of private for profit health care in America.

I realize there will be a few people that have what they believe is good health care coverage. Who will want to opt out of a single payer system like HR 676. But let me remind you we rank # 37 in quality of health care for all. Down from #1. Never the less. A few opting out is not a problem. As long as all other Americans are automatically covered at birth through life. Unless they choose to opt out of HR 676. The government takes out 1.4% from your paycheck now for Medicare. All they have to do is substitute for HR 676 what they now take out of your paychecks for private health insurance. Remember, we already spend more on health care than any other country in the world. Right Now. We are being ripped off. And raped.

The SCHIP program is a desperately needed program for Americas children. But with the impending EXTINCTION of Americas children. And their current catastrophic health care condition. SCHIP needs to be extended to cover all of Americas children, immediately. Parents should have no hesitations, or financial worries about seeking medical care for their children. Whenever they have any concerns about their children's health. Especially in the richest country in the world. I would submit that any President, or politician that fails to do this for the children. Betrays their most solemn oath to protect the American people. Especially when you consider that all other developed countries have done this. And that we are the richest country in the world.

So get on it America. Get it done. You have been doing great over the past several months. Keep it up. And step it up. You have to force it, and take it. It's the right fight, and the right thing to do. Now is the time... Take no prisoners.

[Cyrille]

From a European perspective, it seems crazy to suggest that teenage pregnancies are not correlated to lack of healthcare.
Here, we do have kind of regular visits to a doctor (seeing as it is pretty much for free, we don't try to avoid them at any cost), and guess what, as you go through adolescence, this is a topic that gets mentioned. As are the various dangers associated (pregnancy is not the worst thing that can happen!) and how to prevent them. For free (or very cheap condoms). Without any parental agreement required.

A lot (really a lot) of European girls are under some birth control long before they are sexually active. Because you don't usually know when that'll happen -that's the beauty of the first time.

[Farrar Richardson]

Think of all those poor doctors who've sold their soles having to walk barefoot through the snow!

Sorry, jacksmith, I can never resist a bad pun. I agree with you entirely - also Cyrille

[Petter]

How the world works:

Progressives keep on doing mistakes, and conservatives refuse to correct them...

[anne]

Cyrille:

"From a European perspective, it seems crazy to suggest that teenage pregnancies are not correlated to lack of healthcare."

From any decent perspective.

There is a remarkably efficacious vaccine for cervical cancer, which is being given to all girls in Britain. The Governor of Texas asked that the vaccine be given to all girls in the state. Almost immediately there were complaints, seemingly focused on the idea that protecting girls from cervical cancer would encourage sexual activity, and the Texas legislature voted, all but 1, to set aside the Governor's order.

[anne]

http://www.medicalnewstoday.com/articles/86463.php

October 30, 2007

Nearly 1.8 Million U.S. Veterans Without Health Care Coverage *

In 2004, almost 1.8 million U.S. veterans and 3.8 million members of veterans' households were without health care coverage. Uninsured veterans and veterans' households accounted for 12.2 percent of uninsured Americans.

Researchers analyzed data from two national surveys, including the annual March Supplement to the Current Population Survey, to determine the number of uninsured veterans, trends in coverage and access to medical care. Among all veterans, 7.7 percent were uninsured, including 12.7 percent of those aged 64 or younger. The lack of health insurance among veterans seems to be worsening, with an increase of 300,000 uninsured veterans between 2000 and 2004.

"Like other uninsured adults, most uninsured veterans are low- to middle-income workers, who may be too poor to afford private coverage but are not poor enough to qualify for Medicaid or free VA [Veteran's Health Administration] care," the study's authors said. "We owe veterans care not because they can pay for it nor because they are heroes but - as their sacrifices remind us - because members of a society are obligated to serve and protect each other."

* http://www.pnhp.org/veterans_study/APHA_Veterans_galley.pdf

[anne]

"To start with, the 47 million includes about 10 million residents who are not U.S. citizens. Many are illegal immigrants."

We mention what we wish to mention, since the forthcoming study of veterans and veterans' houeholds lacking health is from Harvard researchers and has been written about in the Harvard Crimson and Boston Globe and Washington Post. "Many veterans are probably not illegal immigrants."

[ilsm]

Lonesome Moderate,

You appear, from my experience, to be in the "lucky employer provided insurance" class of health consumers.

There are covering federal and state laws for labor related job based insurances and the huge buying power of employer plans that make for a certain measure of taking on pre-existing conditions so you sell your services to the company for insurance you would otherwise not get.

Many self employed are denied or pay huge premiums for pre-existing conditions.

Although, the innovations in Massachussets may show a trend for leveling insurance for the self employed.

In a sense employer health insurance is a carrot keeping people in the big company labor pool who would otherwise be devising the next generation of the internet.

says...

Good and well said all, especially Noni and, well, not so much so Peter's Petter.

[dug]

" I also have to ask is Mankiw shirking his duty as a blog host by shutting off comments? "

I would say not. It is his prerogative to run his blog as he sees fit. Blogs are an invitation, not an obligation. Even so, it is our prerogative to draw what conclusions we want from his decision to delete past comments as well as prevent future ones. I don't think this was a technical necessity driven by the Blogger software.

To the topic at hand: even more private-sector oriented health care systems seem to result in better health outcomes than the USA's. Here in Switzerland, basic doctor/hospital insurance (Grundversicherung) is compulsory for all residents. The canton writes to you telling you so when you first move in. It is not allowed for the insurance companies to refuse you on the grounds of age or pre-existing conditions. A single person can get insurance for under CHF 400 a month (about $US 350). The most expensive plan I could find was CHF 600/month for a single person, and that provided worldwide coverage -- including in the United States -- in case you were injured or fell ill and required hospital treatment abroad.

Health care spending as a percent of GDP is second-highest in the OECD, and the private share is almost as high as in the US. But for that, we get a lot more doctors and nurses per 1000 residents, much lower infant mortality, top-5 life expectancy at birth, higher remaining life expectancy at 65 (which gets rid of Mankiw's objections about gang shootings etc).

This is all from OECD data: http://www.oecd.org/document/16/0,3343,en_2649_37407_2085200_1_1_1_37407,00.html

The US system is just inefficient.

[anne]

http://www.latimes.com/business/la-fi-health23mar23,0,3345943,print.story?coll=la-home-headlines

March 23, 2007

Blue Cross Cancellations Called Illegal: The health insurer 'routinely' dropped the policies of pregnant or ill clients, an agency finds. The company disputes the charge.
By Lisa Girion - Los Angeles Times

Blue Cross of California "routinely" violated state law when it canceled individual health insurance coverage after policyholders got pregnant or sick, making no attempt to determine whether they did anything to merit such "harsh" treatment, according to a state investigation of practices that appear to be industrywide....

[anne]

http://www.boston.com/news/globe/editorial_opinion/oped/articles/2007/08/28/we_are_all_uninsured_now?mode=PF

August 28, 2007

We Are All Uninsured Now
By Laurence J. Kotlikoff - Boston Globe

BIG NUMBERS, like 45 million uninsured Americans, are hard to grasp. But that number came home to me at a recent conference. The keynote speaker was former Supreme Court justice Sandra Day O'Connor. Her topic was our healthcare system, and her message was personal and anguished.

The gist was that even she lives in constant fear of major uninsured health bills. Not her own -- those of her son. He can't afford insurance because his son -- her grandchild -- has a preexisting condition....

[lonesome moderate]

ilsm - thanks, you make a lot of sense. I wasn't aware that there are laws that limit the ability of employer plans to do the same thing. Of course it is much harder to get insurance on your own, and insurance companies seem to be much more aggressive about defining preexisting conditions for people who are trying to do that.

This suggests that we can expect demand for some kind of national health system to crystallize the next time we have a significant recession, which of course we haven't for sixteen years. Until then, it seems likely that people like Mankiw, backed by massive corporate funding, will be able to continue to make more-or-less plausible counterarguments.

[anne]

http://www.nytimes.com/2007/10/12/opinion/12krugman.html?hp

October 12, 2007

Sliming Graeme Frost
By PAUL KRUGMAN

Two weeks ago, the Democratic response to President Bush's weekly radio address was delivered by a 12-year-old, Graeme Frost. Graeme, who along with his sister received severe brain injuries in a 2004 car crash and continues to need physical therapy, is a beneficiary of the State Children's Health Insurance Program. Mr. Bush has vetoed a bipartisan bill that would have expanded that program to cover millions of children who would otherwise have been uninsured.

What followed should serve as a teaching moment.

First, some background. The Frosts and their four children are exactly the kind of people S-chip was intended to help: working Americans who can't afford private health insurance.

The parents have a combined income of about $45,000, and don't receive health insurance from employers. When they looked into buying insurance on their own before the accident, they found that it would cost $1,200 a month — a prohibitive sum given their income. After the accident, when their children needed expensive care, they couldn't get insurance at any price....

[anne]

For a couple, no children, Massachusetts Blue Cross Blue Shield health care coverage with deductible and before co-payments costs $15,092 for the year or $1,257 a month.

[howard]

lonesome moderate, since no one directly answered your question, let me say that by and large (and yes, you're right that randomness does come into this) if you are insured through a "pool" (such as a corporate health-care plan), pre-existing conditions aren't generally that big a problem.

however, only 60% of american workers are currently covered, and that number is declining.

so if you're not in a pool and left to fend for yourself in the individual health-insurance market, pre-existing conditions becomes a major issue.

[howard]

lonesome moderate, since no one directly answered your question, let me say that by and large (and yes, you're right that randomness does come into this) if you are insured through a "pool" (such as a corporate health-care plan), pre-existing conditions aren't generally that big a problem.

however, only 60% of american workers are currently covered, and that number is declining.

so if you're not in a pool and left to fend for yourself in the individual health-insurance market, pre-existing conditions becomes a major issue.

[save_the_rustbelt]

morning parable:

Bill Gates take 9 homeless guys into a bar to buy them a drink.

Greg Mankiw stops by, calculates the average net worth of the 10 men as $5 billion each, calls George Bush and tells him the economy is doing great, and that we need more income tax cuts and some regressive gasoline taxes.

Thus endeth the lesson.

[realpc]

"american corporations are at an enormous disadvantage carrying the health-care costs of current and former workers"

Ok, so that means corporations are not running the Republican party, right?

"obesity is a problem and shortens lifespans, but no, it has absolutely nothing to do with the case of a national health insurance system"

The point is that health outcomes depend more on lifestyle than on access to medical treatments. The point is that the 47 million figure is misleading, not that healthcare in American is perfect.

[realpc]

"Cancer is no longer the all-but-automatic death sentence that it once was. Extraordinary progress has been made in fighting the myriad forms of the disease."

That is NOT TRUE Anne. The NYT has some nerve stating such an utter lie.

Look it up. Almost no progress at all has been made in curing advanced cancer.

[realpc]

"Even many of the Bush loonies think we need health care reform, just from another direction."

Mankiw said we need health care reform. He just doesn't like the misleading numbers.

[howard]

realpc, your comment about corporations is inane.

and your response to the issue at hand - whether national health insurance - is emptyheaded and heads towards the inane, given that lifestyle choices cannot obviate genetically driven outcomes.

and your comment about cancer is inane.

do you have anything of use to add to the discussion, or do you think that mankiw has quite beautifully summed up the case for the status quo, which apparently is what he lives to do?

[realpc]

And reform doesn't necessarily mean putting the government in charge of health care. There are many problems, many different kinds of problems, with health care in America. The price of a relatively simple emergency room visit, for example, can be over $1,000. Prices have become so high that everyone must have insurance.

And we don't have any choice about what kind of insurance we want, if covered by an employer. Everyone gets the same deal.

There are all kinds of problems. And the non-holistic philosophy of most MDs is not the least of them. And the ridiculous propaganda from the medical industry has people convinced there has been progress in treating cancer. And MDs give patients harmful drugs when all they need is to improve their lifestyle.

Democrats are correct in saying there are problems, but they are usually wrong about what the problems are and how to solve them.

[Cyrille]

Well, quite similarly, lifestyle is HUGELY influenced by access to healthcare.
With regular visits to the doctor, you learn a lot about what you could do to improve your lifestyle. And since people don't change everything in one go, it's far better to have regular visits to your GP than to read a book one day.
Of course, it gets even clearer when it's about specifics (ie, not just whether burgers are healthy, but whether this particular type of exercise is good for YOU, which food YOU should not eat, and so on... There, nothing beats actual access to health care).

Somehow, we drunkard smoker sexually obsessed French (OK, I did give you some stereotype there) manage to have a more healthy lifestyle, fewer teenage pregnancies, people made aware that they should relax on the meat... it sure isn't coming from a culture of strict sobriety.

[evagrius]

Can someone tell Mr. Mankiw that, at least in California, full-time working adults are usually not eligible for Medicaid? Parents of children eligible for Medicaid are not themselves eligible for Medicaid unless a deprivation, linked to the child, is present. That deprivation has to be temporary incapacity to work, ( work injury), disability, ( verified by Social Security), unemployment, ( provided they are eligible for unemployment benefits), or being a separated ,divorced custodial parent of the child. A full time working married couple will not be eligible at all for Medicaid.
Further, there's an asset limit of $2000 for a single individual or $3000 for a married couple, ( with about $150 extra for each child). Assets don't include a home or one automobile but do include all other assets including 401K plans, bonds,stocks, savings, etc;.

There are programs that don't consider assets but they are limited to pregnant women and children. Even then, income limits geared to the FPL are in effect.

I really wish these writers would look up the eligibility rules, available on-line, before making idiotic assertions regarding Medicaid.

[anne]

Evagrius, please continue to repeat the criteria for Medicaid when relevant, and simply add an appropriate reference when possible. Repeating is important, in the midst of intended absurdity. Reference, when possible, is always important for refutation.

What does "FPL" represent?

RealPC, I can set oen all sorts of data on progress in treating cancer. But, if you are going to refute the often made case for progress then there must at least be a carefully set down alternative case with specific references.

[anne]

When I set down the cost of Blue Cross Blue Shield insurance for Massachustes or Connecticut or Rhode Island, I am actually reading from the policies I have asked for. A beginning cost of $15,092 a year for a couple, as on my desk, is just scary. While the limits to Medicaid coverage or to veterans coverage as I only now understand is scarier. I did not know there are important limits to veterans health insurance, but I do now. *

* http://www.washingtonpost.com/wp-dyn/content/article/2007/10/30/AR2007103001316_pf.html

[anne]

There is a wonderful anti-war, anti-Vietnam war, song by Arlo Guthrie called "Alice's Restaurant" that was made a film. Part of the song describes draftees acting crazily to avoid the draft, which is really being sane but that is another matter. I would guess that the first thing an otherwise healthy soldier needs to do on leaving service is to act crazily enough to be considered sufficiently disabled for to assure veterans insurance. We need another song.

[nemo]

"That is NOT TRUE Anne. The NYT has some nerve stating such an utter lie.

Look it up. Almost no progress at all has been made in curing advanced cancer."

You're having trouble with your reading comprehension. The NYT article says nothing about curing advanced cancer, for which indeed little progress has been made.

The article says that progress has been made treating many forms of cancer. But that progress has happened in treatment of cancer when it is detected early. It doesn't get detected early if people avoid going to a doctor because they lack medical insurance.

The lack of medical insurance directly undermines early detection, and helps ensure a death sentence. That is clearly what that article is about.

[anne]

Nemo is right in describing just why the American Cancer Society is stressing the need for universal health insurance in bettering prospective cancer treatment.

[anne]

http://delong.typepad.com/sdj/2007/11/mark-thoma-is-u.html

November 4, 2007

Mark Thoma Is Unhappy with Greg Mankiw...
By Brad DeLong

Mark understates things.

Does Canada lack an ability to supply high-calorie foods inexpensively?

Low-birthweight babies are due to the failure to push prenatal care as well as to teenage motherhood, which is itself more the result of a failure to push birth control information and technologies than the "sexual mores of American youths."

The millions of the poor who are eligible but not enrolled in Medicaid will be signed up when they show up at the emergency room, but they are not getting the care that might keep them from winding up at the emergency room.

But the thing that should have led the article to be sent back for a rewrite is a very relevant fact that is somehow omitted. In 2003 the U.S. spent $5711 per capita on health care, while Canada spent $2998 http://www.oecd.org/health/healthdata; it's not just that the U.S. has worth health status outcomes than Canada; it's that we proportionally spend $800 billion a year more than Canada does, and yet in aggregate and overall have less than nothing to show from it.

Readers should not be fooled by the omission of relevant statistics into thinking that problems are not as serious as they really are.

Somebody in the New York Times editorial staff should have questioned this before they ran it. Shame on them.

[Steve J.]

Mankiw argues that Americans greater tendency to die by accident or homicide accounts for most of the difference but that doesn't seem to account for the difference in life expectancy for older persons. Given that one makes it to the age bracket 65-69, Canadians still live longer:
19.6 years more versus 18.7 for Americans.

http://radamisto.blogspot.com/2007/10/life-expectancy-from-age-65-69.html

[anne]

Brad DeLong:

But the thing that should have led the article to be sent back for a rewrite is a very relevant fact that is somehow omitted. In 2003 the U.S. spent $5711 per capita on health care, while Canada spent $2998 http://www.oecd.org/health/healthdata; it's not just that the U.S. has worse health status outcomes than Canada; it's that we proportionally spend $800 billion a year more than Canada does, and yet in aggregate and overall have less than nothing to show from it.

Greg Mankiw:

Health costs are eating up an ever increasing share of Americans' incomes. ... But increasing expenditures could just as well be a symptom of success.

[However increasing America expenditures for health care are not a symptom of relative system success or of absolute success for tens of millions of middle and low income Americans.]

[realpc]

There has been no progress in treating cancer. The progress is in early detection technology. So early cancer that might have resolved spontaneously is counted as a cure in the statistics. And survival times automatically lengthen as detection becomes earlier. So more patients survive 5 years and are counted as cures -- but it's only because their cancer was discovered earlier!

It's all a myth! We don't know if cancer survival has improved or not. And if it has improved, it's much less than what the ACS's propaganda has misled you to believe.

[anne]

Understand what it is for physician-teachers at Harvard to find former soldiers coming to them for treatment and not having insurance, but the physicians were as surprised as I am. I thought all veterans at least were health protected. But, we were wrong and research showed the number of veterans lacking insurance is 2 million and rising. What then of the likes of a mere daughter of Georgia parents who have low incomes and no insurance and whose diabetic daughter is removed from SCHIP though qualifying?

I am not interested in lower accidental death rates in Canada in this context. Not at all.

[anne]

"There has been no progress in treating cancer."

I suggest evidence, since I can easily offer and have easily offered evidence of just the reverse. I suggest evidence.

[anne]

Steve J:

"Mankiw argues that Americans greater tendency to die by accident or homicide accounts for most of the difference but that doesn't seem to account for the difference in life expectancy for older persons. Given that if one makes it to the age bracket 65-69, Canadians still live longer: 19.6 years more versus 18.7 for Americans."

Thank you so much. This is confronting precisely the sort of deceptive comment made by the President and assistant Attorney General in charge of protecting voting rights that African Americans or Latinos have shorter life spans than Anglos. Older African American live about as Long as Anglos, and Latinos actually live longer.

[anne]

There are important class and ethnic and gender undertones to Greg Mankiw's arguments about lifespans and early pregnancy, that make attention to health care provision disparities all the more important, not less important. Resource discrimination governing a fundamental right does not make for social health or morality.

[baileyman]

I'm just curious, among professional economists, does anyone really take Mankiw seriously?

[Jay]

$5,000 per capita ain't too bad. It's an old N.Y. Times article, but just a few years back the state of New York was spending $10,000 per Medicaid patient!
http://www.nytimes.com/2005/07/18/nyregion/18medicaid.html?pagewanted=1&_r=1

[Ken Houghton]

Hmm. I've been trying to find data to support the Cutler, Glaeser, and Shapiro argument (it seems intuitive; increasing the price difference between quality, healthy food and junk food will increase the level of obesity), but the closest I could find is Cutler, Glaeser, and Rosen (NBER 13013):

Despite substantial increases in obesity
in the past three decades, the overall population risk profile is healthier now than it was formerly.
For the population aged 25-74, the 10 year probability of death fell from 9.8 percent in 1971-75 to
8.4 percent in 1999-2002. Among the population aged 55-74, the 10 year risk of death fell from 25.7
percent to 21.7 percent. The largest contributors to these changes were the reduction in smoking and
better control of blood pressure. Increased obesity increased risk, but not by as large a quantitative
amount.

[Barry]

"A lot (really a lot) of European girls are under some birth control long before they are sexually active. Because you don't usually know when that'll happen -that's the beauty of the first time."

Posted by: Cyrille

Of course, Mankiw thinks that differing rates of teenage pregnancy are due to differing sexual mores. And he's right, but in the opposite direction. Where one assumes that a teenage girl will be sexually active, and acts accordingly, there are fewer teenage pregnancies. Where one assumes virginity until marriage, and inacts accordingly, there are more teenage pregnancies.

[evagrius]

Anne;

"What does "FPL" represent?"

Sorry. I thought "everyone" knows that "FPL" is the Federal Poverty Level.

An added note to Medicaid. If, say, an elderly person, ( who are eligible if 65 or over) or disabled person, ( receiving Social Security Disability), obtains Medicaid, ( having passed the asset test of having less than $2000 or $3000 depending on marital status), they may receive Medicaid with what is known as "share-of-cost", ( SOC).

The SOC is based on whatever income the single individual has over $600/ month or $934 for a married couple.

Naturally, this is quite under the current FPL ($851 single/ $1141 married).

Clinton, in one of his last administrative acts, allowed the establishment of the Aged and Disabled FPL program which made it possible for singles and married couples under a certain income limit to have zero SOC. The 2007 limits are $1081 for a single and $1502 for a couple.
( This is only in California- other states may have different income limits).

However, if the income is above those limits, the SOC is calculated based on the $600/ month maintenance need.

You can see the complexity of the California program on this single sheet, the Medi-Cal Budget Calculation Chart;

http://www.dhs.ca.gov/mcs/mcpd/meb/ACLs/PDFs/ACWDLs/2007ACLs/10thru19/c07-17.pdf

Now...can anybody argue that this is a logical and simple program?

[malcolm]

As far as I can see, Mankiw fails the test of imagination.
If his family income were $50,000 a year, he could "afford"
health insurance in the sense that it would be feasible for him to purchase it. I remember when I was a poor student in graduate school and I complained how I couldn't
afford an Anne Tyler novel -- my general equilibrium teacher told me that I certainly could afforfd the book;I had simply chosen not to buy it. I have never forgot wanting to tell him that he was abusing his power over me and that he was a jerk.

[realpc]

"There has been no progress in treating cancer."

"I suggest evidence, since I can easily offer and have easily offered evidence of just the reverse. I suggest evidence."

Anne, what evidence did you offer easily? I would really like to see it. I have searched and searched and found that it's a bunch of misleading numbers and propaganda. They primarily want to sell the chemotherapy.

[anne]

http://www.who.int/whosis/database/core/core_select.cfm

Using the World Health Organization to focus on healthy life expectancy, which is a WHO classification, the data from birth seem revealing for girls. Assuming American girls are less likely to be killed in criminal or accidental circumstances, then we find longevity significantly less for American girls than girls in developed country on country. I need to graph this, but I do not notice a single developed country with a lower healthy life expectancy for girls.

[anne]

Assuming then that the problem with America is not that girls generally grow up to travel in packs of ax murderers or wander competitively naked through winter snow fields, then I would suggest that a relatively and markedly low health life expectancy for our girls might be attributed to some problems in health care even if the problems are related to miserable food.

Cuba, by the way, shows up remarkably well in health category on category.

[anne]

Also, before we are told that the American problem is Latino immigration, as we are so often told all our problems are about Latino immigration, Latino life expectancy is comparable to or better than Anglo life expectancy.

[anne]

http://krugman.blogs.nytimes.com/2007/11/05/pooh-poohing-health-care-problems/

November 5, 2007

Pooh-Poohing Health Care Problems
By Paul Krugman

People have asked me what I think of Greg Mankiw's piece in the Times. I'll outsource the criticism to Mark Thoma, Brad DeLong and Dean Baker.

I'd add that the Democratic nominee for president has to hope that Greg's line is the basis of the GOP campaign — there's nothing like saying "Hey, what's the fuss? Being uninsured or underinsured is no big deal" to make you seem completely out of touch with the real concerns, sometimes bordering on terror, that people have about health care.

[anne]

http://www.who.int/whosis/database/core/core_select.cfm

Simply look at the WHO health characteristics for remarkably poor Cuba and easily understand why American students compete for places medical school openings in Cuba and why Michael Moore brought several American patients for treatment in Cuba for which Moore was ridiculed by film critics.

[anne]

http://www.epi.org/printer.cfm?id=2818&content_type=1&nice_name=webfeatures_snapshots_20071031

October 31, 2007

Immigration Not Driving the Erosion of Health Insurance
By Heidi Shierholz

The number of people in the United States without any type of health insurance continued its steady climb in 2006, to 47 million uninsured. The share of the population without health coverage has grown over 2 percentage points since 2000, from 13.7% in 2000 to 15.8% in 2006.

Some analysts have argued that this increase is driven by the fact that there are more immigrants living in the United States, and that immigrants are less likely than native-born people to have health insurance. While both of these facts are true (the share of the foreign-born population increased 1.2 percentage points from 2000 to 2006, and the share of immigrants without health insurance was 20 percentage points higher over this period than that of native-born people), these facts are not driving the overall decline in coverage.

For one thing, the percent uninsured increased over this period at roughly the same rate among the native-born (up 1.8 percentage points) and immigrants (up 2.0 percentage points). Furthermore, if the percent of immigrants in the population had remained unchanged from 2000, the overall uninsured share still would have increased by 1.9 percentage points. Given that the actual increase was 2.1 percentage points, this means that only 0.2 percentage points (or less than one-tenth) of the increase of the uninsured can be attributed to immigration. The conclusion is clear: immigration is not the driving force behind the continued erosion of health insurance in this country.

[nemo]

"There has been no progress in treating cancer. The progress is in early detection technology. So early cancer that might have resolved spontaneously is counted as a cure in the statistics. ... It's all a myth! We don't know if cancer survival has improved or not. ..."

You really just make things up, don't you? Or is there some propaganda site where you get this stuff?

For some cancers, there are problems with early detection, because there is either little to be done with early detection, or because there are too many false positives. But those are well known problems.

For many other extremely common cancers, such as breast cancer, colon cancer, bladder cancer, early detection really is coupled with statistically proven effective treatments.

This is especially true with colon cancer. But detection is not cheap -- on the order of $2,000 to $5,000 for the colonoscopy George Bush just had. Colon cancer is so common, so deadly, and and so easy to treat if detected early, it is strongly recommended that everyone over 50 have a colonoscopy every 5 years -- every 3 years if they have already detected and removed non-benign polyps.

But obviously very few people can pay that kind of money every 3 to 5 years without insurance. So it really does come down to lack of insurance leading to lack of preventive medicine leading to needless early death.

[Ted]

American medecine is just a scam to take all your money before you die. I have been strugggling with ear pain for 4 years that is so crippling I lost my job, house, insurance and was forced to live off my 401K because over 6 different doctors said 'get over it', 'there is nothing we can do for inner ear problems' or 'its migraines-see a neurologist' all the while I am pointing out a swollen side of my face from outer ear to inner tonsil (twice the size of the 'normal' right side. No blood tests, x-rays or nuthin. Because of this my boss said see a shrink, miss one more day and your fired. By quitting to get severence and with no dr ok I lost any right to claim any benefits and lawyers said Dr must diagnose before we can help. The system is designed to deny benefits and kick you out. Drs treat based on liability, what their HMO covers, what kickbacks come from pharma, and lastly what is most profitable. This is why we are #1 in costs and 32 to 60th in quality in world studies. If only I could get treatment so I could work but my life is ruined so will the drs be soon.

[Tom W]

Anne claims that the LOWEST cost for health insurance in Massachusetts from blue cross is $15k/yr for a couple. Yikes! It surprised me, because I paid for blue cross recently (albeit in California) and the price was less than $800 per year. And that price hasn't increased much; when I go to the bc website now, I find that the price has increased to about $900 per year. The most expensive plan they offer for an individual in CA is less than $3000 per year. Anyone can verify this by visiting http://bluecrossca.com and applying online to see their prices.

On the other hand, if I look at prices for Massachusetts, then I find they're about 5 times higher than in California. Yikes! Obviously, Massachusetts needs the state to intervene in health care. Except...Massachusetts is where the state has ALREADY intervened in health care. Apparently, state mandates haven't reduced prices there.

Remind me again why Massachusetts is a model for the rest of the nation.

Someone else mentioned that colonoscopies cost $5000. Here in CA they appear to cost $500, which still seems a bit pricey since a colonoscopy involves little more than shoving a camera up your ass and having a gastro doc analyze the pics. But I suppose docs make good money, and deservedly so. So they charge a lot. But $5000 for perhaps 2 hours of a gastroenterologist's time seems excessive. Is that the price in Massachusetts?

Personally, I live in California where the state interferes much less, and I find the prices of health insurance plans and health services to be quite affordable. I spend less on health insurance than on car insurance.

[anne]

The precise cost for single person Blue Cross Blue Shield coverage is $595.52 a month or $7146.24 for a year, plus a $400 deductible. Also, I find the cost similar for Massachusetts or Rhode Island or Connecticut.

I have no Internet reference, but I am even now looking at a plan cost sheet.

I suggest checking the California Blue Cross Blue Shield cost carefully, for I have trouble understanding such a supposed difference.

[anne]

"Personally, I live in California where the state interferes much less, and I find the prices of health insurance plans and health services to be quite affordable. I spend less on health insurance than on car insurance."

I find no evidence this could be so.

[realpc]

"You really just make things up, don't you?"

No Nemo, it's true. The numbers are misleading and that's a fact anyone can see, if they care to be a little skeptical.

Let's say a type of cancer normally kills in about 10 years. One patient is diagnosed at the fourth year, and another is diagnosed at the sixth year. So, with no treatment at all, the first patient is likely to die in 6 years, and the second patient is likely to die in 4 years. The first patient is counted as cured (survived more than 5 years).

Even if both patients receive exactly the same treatment, one will be counted as cured and the other as a fatality.

So that is one reason we can't be at all sure what the cancer cure rates mean.

Another problem is that the body often fights off cancer on its own, without any treatment, especially at very early stages. But all these "cures" are attributed to the treatment. The treatment may have done nothing at all. You would have to compare patients receiving treatment to patients receiving no treatment, to see how often early stage cancer resolves spontaneously. And of course that experiment can't be done.

These two problems are never mentioned in cancer statistics. Victory is proclaimed because cure rates and survival times have increased. No one knows if it's because of the treatments or not, but everyone assumes that it is.

This is a very simple and obvious statistical problem. You can see that I didn't make it up, because it's obviously true. It's just that everyone desperately hopes that cancer is being conquered. So they ignore the fact that we just can't tell from the data how much progress has been made, or if there has been any progress at all.

[anne]

Please, please, please either give scientists credit for studying theoretical and applied statistics and trying to use the tools correctly snd being reviewed by other scientists on use of the tools, or study a little medical research methodology and applied statistics.

[Patricia Shannon]

Right, scientists and doctors are all brilliant, all-knowing saints who are never influenced by the people who pay them. That's the reason we never find out that the results of drug tests have been hidden or falsified. Yeah, sure. Scientists are human beings.

[anne]

Yes; scientists or physicians are horrible terrible rotten and we have made no medical progress this hunfred years beyond learning how to use aspirin. I understand, but am thankful for the explanation.

[realpc]

Scientists and physicians are mere mortals. There has been medical progress -- the technological progress has been wonderful. Improvements have been made in surgical and diagnostic technology, in pain management, and in curing bacterial infections.

But very little progress has been made in understanding or curing some of the most deadly diseases, including AIDS and cancer. And most chronic diseases are still a mystery.

Anne, you can idolize MDs if you want, but in reality they have very limited knowledge. If we point this out, that does not mean we're saying they are all horrible and rotten. You know that.

[Icarus]

Real PC...

"Scientists and physicians are mere mortals. There has been medical progress -- the technological progress has been wonderful. "

See, I think there's a problem here, with such adulation. "Science" has also created the very situation it cures. Approvals of chemicals in our food are a byproduct of "science". Approval of toxins in our air, approval of all sorts of things which constitute 'modern life'.

As Science (big Science) creates the landscape for our lifestyle, it also researches 'cures'.

If we applaud 'science' for the cures, we must also take acount of its contributory negligence. And, we don't. We have a blind spot to the effects of big science, which leads to what cultural critic Ashis Nandy calls the "split legitimacy" of science. (See "Traditions, Tyranny, and Utopias")

[Karl K]

What an astonishing bunch of leftist claptrap infects these comments! Mankiw makes arguments.. and all you intellectual hooligans can do is make ad hominem attacks. Pathetic.

Please, please, PLEASE keep it up. Show the American people your delusional notions, your Bush Derangment Syndrome, your teeth gritting, head exploding, fist pounding anger.

This just in, ladies and gentlemen. The Canadian system of universal health care sucks with long waiting lines and suboptimal outcomes. The British system of universal health care sucks with long waiting lines and suboptimal outcomes. The French system of universal health is going broke.

What you don't understand is that Mankiw's FACTS -- you know, the DATA -- are indisputable.

FACT 1. Life expectancy is lower in the United States than Canada NOT because our health system is inherently worse, but because of social factors.

FACT 2. We do NOT have 47 million people uninsured. Anyone who utters that number -- like, say, presidential candidates that many of the idiot commentators on here would vote for -- are engaging in demagoguery.

FACT 3. Most of those who comment on here LIKE demagogues.

Keep it up folks. Please. Let the American people know how silly and deranged you really are.

[realpc]

Icarus,

I was NOT adulating science. I was explaining to Anne the serious limitations of our medical science. I was admitting that there has been great technological progress. If I don't say that, inevitably someone accuses me of being anti-science. I am not anti-science, but I don't idolize science either.

[cl-Oregon Girl]

For life expectancies, go here
http://www.cdc.gov/nchs/fastats/lifexpec.htm

[Patricia Shannon]

Karl K
I won't bore regulars by repeating a bunch of details of my own and others experience, but I have been driving for more than two years while legally blind in one eye with a cataract, because of lack of health insurance. I was luckily able to get a good enough paying job a couple of years ago (with 7 months out of work in between) to save up enough for a cataract operation. Just in time, because my other eye is now on the boundary of being legal to drive in my state. You don't know what you're talking about, and you will cling to your beliefs no matter the evidence.

[Patricia Shannon]

Icarus,

Is the world going to end today? We agree on something :)

[John Wright]

Lots of great debate here, I posted a response on my blog which I will paste here for the record:

In Gregory Mankiw's Beyond Those Healthcare Numbers ( http://www.nytimes.com/2007/11/04/business/04view.html?ex=1351828800&en=7ebf86b6773f35bd&ei=5090&partner=rssuserland&emc=rss ), he writes that the dangerous arguments in the health care debate are the ones that are true but don't mean what people think they mean. His article shows however that most common health care statistics and arguments that point the finger at a lack of an effective health care system in America, of which he only addresses the 3 he chose, are indeed true when seen as part of a comprehensive picture of our failed health care system. The dangerous arguments on the other hand are arguments like his that ignore their power.

The first fact Mankiw reviews is that Americans die sooner and have higher infant mortality rates on average than Canadians, who have national health insurance. Mankiw states that the lower American life expectancy could be due in large part to the fact that Americans are more likely to die by homicide or accident. He then blatantly asserts that any life expectancy comparisons between the U.S. and Canada must then have nothing to do with health care. In reality, lower life expectancy in the US is probably due to many factors of which poorer health care could indeed be an important one and Mankiw makes a logical fallacy to rule it out altogether based only on a study of another potential contributing cause, homicide rates. Mankiw then states that Americans also might die on average sooner because we happen to be so obese because we are so good at high calorie food production. This is his most disturbing argument in the article because Mankiw is essentially stating that our poor health, in this case obesity, has nothing to with our health care system. He does this by asking us to believe that while our poor health is the source of many disturbing statistics, these statistics prove nothing about our health care system. This is exactly the convoluted reasoning about health care that Mankiw purports to debunk in his article. The truth is that there are many complex reasons for the rise of obesity in America and the rest of the world, including availability of cheap high calorie foods, and the solution is also going to need to be equally complex. Part of this solution is preventive health care, something Mankiw can't seem to fathom as being essential to this debate. A preventive health care system does things such as reward doctors who succeed in getting their patients to make healthy lifestyle such as quitting smoking or losing weight. There are many other parts of a possible solution against obesity, including a comprehensive government led program against it , building our city infrastructures with plenty of active spaces, food education programs for adults that teach adults how to cook and eat healthy, starting children out with a healthy and active lifestyle in our daycares and schools (including physical education), and voluntary and involuntary corporate responsibility for public health. Whatever the solutions, you cannot argue that on the one hand obesity in America is not related to our health care system but is on the hand the cause of poor health leading to lower life expectancy. Our health care system is meant to the be one of the foundations of health and life in this country and should help to keep our citizens fit, active, and with world class age spans. It should hence serve an important role in reducing our obesity and increasing our life expectancy.

Mankiw analyzes the infant mortality rate in a similarly over simplistic and irresponsible fashion. He argues that the U.S. has higher infant mortality rates than many other countries not because of a worse health care system but because our young people have less sexual mores. This is ridiculous, American young people are no less or more interested in sexual activity than young people of other counties. However, young teenage mothers do lack the same level of access to basic sex education as those in other countries, our pregnancy and abortion clinics are regulated to rather second class Planned Parenthood centers, there is no free STD testing at normal clinics and there is a host of other infra-structural problems such the as lack of affordable higher education options for young people in this country. The truth is that our health care problems are part of a larger more systemic problem of a lack of a infrastructure of care, health, and basic services in this country. Infant mortality rates in this country must be treated as part of a larger problem that requires bold, consistent systematic solutions, something that Mankiw ignores.

Next Mankiw takes up his second misleading, in his opinion, statistic about health care, the fact that 47 millions Americans are without it. He argues that 17 million of them can really afford it, it's their fault for not having health care insurance, as they make on average over $50,000 a year per household. Millions of others in that 47 million are eligible for Medicaid or are illegal immigrants. Mankiw argues that just because these people aren't taking advantage of the options open to them doesn't mean we should change the health care system that is working for the rest of us. Again this is a 1/2 baked argument that ignores larger issues. Many uninsured Americans who have annual household incomes of more than $50,000 have multiple children to pay for, are in massive consumer debt, and are not educated about the importance of health care, again a culture of health issue. Illegal immigrants is largly a moniker for migrant workers who deserve some basic level of health care on top of a safe and legal way to work in this country, another basic infrastructural problem in this country. As far as Medicaid is concerned, there are a confusing set of health care options open to people including the SCHIP program that many people don't understand and vary from state to state. Finally, Mankiw's argument, and that of presidential candidates like Mit Romney who he advises, that the health care system as a whole is not broken for the rest of us is assuming something that our rising obesity, heart problems, health care costs, number of disputes with insurance companies over coverage of basic procedures and operations, and many other problems that paint a broad picture, greatly dispute. But whatever the number of uninsured Americans, there are two more important questions. One, what does it say about our health insurance system that we can't design a basic level of health insurance for every American that is easy to use everywhere and understand? And two, what is the number of unhealthy Americans who could through a preventive system have been kept healthy? Again this is not just an issue about lack of health insurance, this is an issue about the lack of a culture of health in this country, a far more basic problem.

Finally, Mankiw writes that a third misleading health care argument is that since Americans spend a relatively large amount of their income on health care expenses we should reform the system. Contrary to being an argument for reform, Mankiw argues that it shows that Americans value health care so much we are willing to spend lots of our income on it. I agree with Mankiw in that I believe we should value health care enough to spend a substantial amount of our income on it, whether by taxes, or otherwise. But right now we are spending our money on a failed system, or even more accurate no system, and this is a bad investment. We are not investing in a health care system that works for every American and that can be delivered efficiently, comprehensively, and most important effectively. We are going to spend a lot more money without such a system that would prevent many larger health problems. If Americans don't at least become less obese, have better hearts, become more healthy eaters, have a lower incidence of cancer and infant mortality with a greater life expectancy than we don't have the world class, low cost system this great country deserves and that Americans can count on and value.

I envision creating a health care system that every American regardless of income can trust and value and that is as basic and comprehensive and available as water, the Internet, or our public schools. I believe a publicly available health care service, designed to be radically preventive, and delivered through a variety of public/private ways, could easily provide up to 70 or 80 percent of health care services in this country. More specialized and innovative private services could be built and delivered on top of it. I am also in favor of a comprehensive national health care bill of rights that will do for how we value health in this country what the civil rights legislation did to help Americans value the rights of all members of our society. We show what we value as the foundations of our society by what we give to every member of society, fund with our taxes, and manage through our civic institutions. But whatever the solution to build such a foundation of health care for this country, Mankiw proposes none. He like many others continues to treat health care statistics in a isolated way, instead of as part of the debate about how to create a comprehensive culture of health in this country.

says...

yo mama

[Joans Weight Loss Story]

Hey,
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with kind regards,
Joan