Posts Tagged ‘healthcare’
“The first wealth is health”*…
As Angela J. Wyse and Bruce D. Meyer explain, lack of health insurance explains five to twenty percent of the mortality disparity between high- and low-income Americans…
We examine the causal effect of health insurance on mortality using the universe of low-income adults, a dataset of 37 million individuals identified by linking the 2010 Census to administrative tax data. Our methodology leverages state-level variation in the timing and adoption of Medicaid expansions under the Affordable Care Act (ACA) and earlier waivers and adheres to a preregistered analysis plan, a rarely used approach in observational studies in economics. We find that expansions increased Medicaid enrollment by 12 percentage points and reduced the mortality of the low-income adult population by 2.5 percent, suggesting a 21 percent reduction in the mortality hazard of new enrollees. Mortality reductions accrued not only to older age cohorts, but also to younger adults, who accounted for nearly half of life-years saved due to their longer remaining lifespans and large share of the low-income adult population. These expansions appear to be cost-effective, with direct budgetary costs of $5.4 million per life saved and $179,000 per life-year saved falling well below valuations commonly found in the literature. Our findings suggest that lack of health insurance explains about five to twenty percent of the mortality disparity between high- and low-income Americans. We contribute to a growing body of evidence that health insurance improves health and demonstrate that Medicaid’s life-saving effects extend across a broader swath of the low-income population than previously understood…
“Saved by Medicaid: New Evidence on Health Insurance and Mortality from the Universe of Low-Income Adults,” from @nber.org.
Congress, of course, just moved to cut Medicaid; as the wording in the “Big, Beautiful BIll” stands, 8-10 million Americans stand to have the their covergae terminated orr severely reduced.
But even as we agree that extending coverage– fixing the “demand side” problem– could save lives, we should note that we have some serious supply side problems to address: 80% of the country, insured or not, lacks adequate access to healthcare service; and there’s a large and growing shortage of healthcare professionals and workers (a problem aggravated by the Trump administration’s draconian crackdown on immigration). Technology offers some hope, but humans remain at the center of the issue.
* Ralph Waldo Emerson
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As we contemplate care, we might send insightful birthday greetings to Susan Lindquist; he was born on this date in 1949. A molecular biologist, she was a pioneer in the study of protein folding. She showed that alternate structural shapes of protein molecules could result in substantially different effects and demonstrated instances in fields as diverse as human diseases, evolution, and synthetic biomaterials designed to interact with biological systems. Her work laid the foundation for the development of AI-driven systems like Alpha-Fold that accelerate the discovery and development of new drugs and therapies.
“A world that is safe for mothers is safe for all”*…
There’s much discussion today of falling fertility rates and the prospect of a shrinking population. In her terrific newsletter, Your Local Epidemiologist, Katelyn Jetelina explores the (real) reasons why, and what can be done…
In the U.S.—and across much of the world—fertility rates are falling, and populations are projected to shrink.
The reasons people are worried vary. Some fear a loss of global influence or long-term human survival. Others approach the issue through religious, political, or ideological lenses—or just out of curiosity. Whatever the motivation, the question keeps coming up: What can we do?
In response, the new administration—guided in part by Project 2025—is considering financial incentives to encourage people to have more children. Ideas include education, like on menstrual cycles, or a “National Medal of Motherhood” to mothers with six or more children, as well as financial incentives like a $5,000 cash baby bonus or Fulbright scholarships reserved for mothers.
Globally, paying families to have children has yielded mixed results. In Russia, for example, payments ($10,000) have increased fertility rates by about 20%. However, in Canada during the 1970s, similar efforts yielded only a short-term increase.
So no—we don’t need to blindly throw spaghetti at the wall. We have the evidence: if we want people to have more children, we need to create a society that actually supports parents…
[Jetelina unpacks the dynamics at play: access to affordable health care, the lack of support for new parents, the cost of raising a child, the climate of fear of maternal mortality, and the dismantling of programs that support women…]
… People aren’t having fewer children because they don’t care about family, faith, or their future, or the future of this country. They’re having fewer because the system makes it too hard, too risky, and too expensive. A $5,000 payment is a drop in the bucket compared to what is required of families in this day and age.
If the government wants to be part of the solution, it shouldn’t just throw out incentives. It should invest in the foundation: affordable care, parental leave, safe childbirth, and supportive systems.
Let’s focus on what matters: building a society where families can thrive. If we do that, everything else—including birth rates—may just follow…
It’s not rocket science: “Birth rates are falling. But solutions are focused on the wrong thing,” from @kkjetelina.bsky.social.
(Image at top: source)
* Abhijit Naskar (@naskarism.bsky.social)
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As noodle on nativity, we might spare a thought for Edouard Van Beneden; he died on this date in 1910. An embryologist, cytologist and marine biologist, he made discoveries concerning fertilization in sex cells and chromosome numbers in body cells. His studies (of the roundworm Ascaris) showed that sexual fertilization results from the union of two different cell half-nuclei. Thus a new single cell is created with its number of chromosomes derived as one-half from the male sperm and the other half from the female egg. Van Beneden also determined that the chromosome number is constant for every body cell of a species. His theory of embryo formation in mammals became a standard scientific principle.
“The greatest wealth is health”*…
On the state of healthcare around the world, three charts…
* Virgil
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As we contemplate care, we might send revealing birthday greetings to Leopold Auenbrugger; he was born on this date in 1722. A physician, he devised the diagnostic technique of percussion (the art of striking a surface part of the body with short, sharp taps to diagnose the condition of the parts beneath the sound)– by which he could estimate the amount of fluid in a patient’s chest and the size of his/her heart.
Auenbrugger was simply applying an approach he’d learned as boy, tapping his father’s wine casks to determine how full they were. After seven years of clinical investigation, he published the method in Inventum Novum (1761), though his technique did not gain recognition and acceptance until years after his death. When a translator republished the work in French (1808) the method gained acceptance around the world, and through time (to the present) as a fundamental diagnostic procedure… for which Auenbrugger is considered one of the fathers of modern medicine.
“Old ways of thinking die hard, particularly when they were weaned by legally enforced monopolies”*…
According to the US Bureau of Labor Statistics, from 2000 to present, prices in the hospital industry have grown faster than prices in any other sector of the US economy. The $1.3 trillion US hospital sector accounts for 6% of US GDP, nearly a third of all health care spending (which is materially higher as a share of GDP in the U.S. than in any other country). The average price for an inpatient hospital stay is $25,000.
A new working paper from the NBER assesses the impact of these rising costs. From its abstract:
We analyze the economic consequences of rising health care prices in the US. Using exposure to price increases caused by horizontal hospital mergers as an instrument, we show that rising prices raise the cost of labor by increasing employer-sponsored health insurance premiums. A 1% increase in health care prices lowers both payroll and employment at firms outside the health sector by approximately 0.4%. At the county level, a 1% increase in health care prices reduces per capita labor income by 0.27%, increases flows into unemployment by approximately 0.1 percentage points (1%), lowers federal income tax receipts by 0.4%, and increases unemployment insurance payments by 2.5%. The increases in unemployment we observe are concentrated among workers earning between $20,000 and $100,000 annually. Finally, we estimate that a 1% increase in health care prices leads to a 1 per 100,000 population (2.7%) increase in deaths from suicides and overdoses. This implies that approximately 1 in 140 of the individuals who become fully separated from the labor market after health care prices increase die from a suicide or drug overdose.
– NBER WORKING PAPER SERIES- WHO PAYS FOR RISING HEALTH CARE PRICES? EVIDENCE FROM HOSPITAL MERGERS
Four of the authors of that paper looked more deeply into the issue, exploring why those costs are rising; they identified consolidation in the hospital sector– 90% of hospital markets are now highly concentrated, according to the thresholds set by the FTC and the U.S. Department of Justice– as a key culprit:
The study, conducted in collaboration with researchers at Harvard University, Yale University, and the University of Wisconsin-Madison, found that of 1,164 mergers among the nation’s approximately 5,000 acute-care hospitals that occurred in the United States from 2000 to 2020, the Federal Trade Commission (FTC), which is tasked with preserving competition, challenged only 13 of them — an enforcement rate of about 1%.
Meanwhile, the researchers show that the FTC, using standard screening tools available to the agency during that period, could have flagged 20% of the mergers — 238 transactions — as likely to cause reduced competition and increase prices…
Unchallenged hospital mergers should have had minimal effects on competition and prices if the FTC were optimally targeting enforcement, the researchers noted. However, using data on the prices that hospitals negotiate with private insurers, the researchers found that mergers the FTC could have challenged as predictably anti-competitive between 2010 and 2015 eventually led to price increases of 5% or more.
The researchers estimate that the 53 hospital mergers that occurred on average annually from 2010 to 2015 raised health spending on the privately insured by $204 million in the following year alone. Putting this spending increase in context, the researchers note that the FTC’s average annual budget and antitrust enforcement budget between 2010 and 2015 were $315 and $136 million, respectively…
The study found that mergers in rural regions and areas with lower incomes and higher rates of poverty generated larger average price increases, often in outpatient services. The researchers suggest this occurred because those regions — compared with higher income, urban settings—have fewer free-standing clinics that offer surgical and imaging services that compete against hospitals in the outpatient market…
Consolidation in Hospital Sector Leading to Higher Health Care Costs
As Cory Doctorow succinctly observes…
The health system is a perfect example of how monopolization drives more monopolization, and how that comes to harm the public and workers. Health consolidation began with pharma mergers, that led to pharma companies gouging hospitals. Hospitals, in turn, engaged in a nonstop orgy of mergers, which created regional monopolies that could resist the pricing power of monopoly pharma – and screw insurers. That kicked off consolidation in insurance, which is why most Americans have a “choice” of between one and three private insurers – and why health workers’ monopoly employers have eroded their wages and working conditions.
How consolidation in the hospital sector is increasing healthcare prices and creating even steeper costs more broadly in the economy. @nberpubs @AEAjournals @doctorow
* Mitch Kapor
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As we measure our blood pressure, we might send concerned birthday greetings to Janette Sherman; she was born on this date in 1930. A physician, toxicologist, author, and activist. She researched pesticides, nuclear radiation, birth defects, breast cancer, and illnesses caused by toxins in homes and was a pioneer in the field of occupational and environmental health.
Dr. Sherman served as a medical-legal expert witness in more than 5,000 workers’ compensation claims and served as an expert witness for residents in communities affected by environmental hazards, most famously the Love Canal neighborhood of Niagara Falls, N.Y. Her medical-legal files, among the largest collections of their kind in the United States, are preserved at the National Library of Medicine at the National Institutes of Health in Bethesda, Md.
“Poverty is the worst form of violence”*…
Two economic historians, Peter A. Coclanis and Louis M. Kyriakoudes, on why about 20% of counties in the U.S. South are marked by “persistent poverty”…
For a brief moment in the summer of 2023, the surprise No. 1 song “Rich Men North of Richmond” focused the country’s attention on a region that often gets overlooked in discussions of the U.S. economy. Although the U.S. media sometimes pays attention to the rural South — often concentrating on guns, religion and opioid overdoses — it has too often neglected the broad scope and root causes of the region’s current problems.
As economic historians based in North Carolina and Tennessee, we want a fuller version of the story to be told. Various parts of the rural South are struggling, but here we want to focus on the forlorn areas that the U.S. Department of Agriculture refers to as “rural manufacturing counties” — places where manufacturing is, or traditionally was, the main economic activity.
You can find such counties in every Southern state, although they were historically clustered in Alabama, Georgia, North and South Carolina, and Tennessee. And they are suffering terribly.
First, let’s back up. One might be tempted to ask: Are things really that bad? Hasn’t the Sun Belt been booming? But in fact, by a range of economic indicators — personal income per capita and the proportion of the population living in poverty, for starters – large parts of the South, and particularly the rural South, are struggling.
Gross domestic product per capita in the region has been stuck at about 90% of the national average for decades, with average income even lower in rural areas. About 1 in 5 counties in the South is marked by “persistent poverty” — a poverty rate that has stayed above 20% for three decades running. Indeed, fully 80% of all persistently poor counties in the U.S. are in the South.
Persistent poverty is, of course, linked to a host of other problems. The South’s rural counties are marked by low levels of educational attainment, measured both by high school and college graduation rates. Meanwhile, labor-force participation rates in the South are far lower than in the nation as a whole.
Unsurprisingly, these issues stifle economic growth.
Meanwhile, financial institutions have fled the region: The South as a whole lost 62% of its banks between 1980 and 2020, with the decline sharpest in rural areas. At the same time, local hospitals and medical facilities have been shuttering, while funding for everything from emergency services to wellness programs has been cut.
Relatedly, the rural South is ground zero for poor health in the U.S., with life expectancy far lower than the national average. So-called “deaths of despair” such as suicides and accidental overdoses are common, and rates of obesity, diabetes, hypertension, heart disease and stroke are high – much higher than in rural areas in other parts of the U.S. and in the U.S. as a whole…
Although some people think that these areas have forever been in crisis, this isn’t the case. While the South’s agricultural sector had fallen into long-term decline in the decades following the Civil War — essentially collapsing by the Great Depression — the onset of World War II led to an impressive economic growth spurt.
War-related jobs opening up in urban areas pulled labor out of rural areas, leading to a long-delayed push to mechanize agriculture. Workers rendered redundant by such technology came to constitute a large pool of cheap labor that industrialists seized upon to deploy in low-wage processing and assembly operations, generally in rural areas and small towns.
Such operations surged between 1945 and the early 1980s, playing a huge role in the region’s economic rise. However humble they may have been, in the South — as in China since the late 1970s — the shift out of a backward agricultural sector into low-wage, low-skill manufacturing was an opportunity for significant productivity and efficiency gains.
This helped the South steadily catch up to national norms in terms of per-capita income: to 75% by 1950, 80% by the mid-1960s, over 85% by 1970, and to almost 90% by the early 1980s…
By the early 1980s, however, the gains made possible by the shift out of agriculture began to play themselves out. The growth of the rural manufacturing sector slowed, and the South’s convergence upon national per capita income norms stopped, remaining stuck at about 90% from then on.
Two factors were largely responsible: new technologies, which reduced the number of workers needed in manufacturing, and globalization, which greatly increased competition. This latter point became increasingly important, since the South, a low-cost manufacturing region in the U.S., is a high-cost manufacturing region when compared to, say, Mexico.
Like Mike Campbell’s bankruptcy in Hemingway’s “The Sun Also Rises,” the rural South’s collapse came gradually, then suddenly: gradually during the 1980s and 1990s, and suddenly after China’s entry into the World Trade Organization in December 2001…
A sobering read: “Poor men south of Richmond? Why much of the rural South is in economic crisis.”
* Mahatma Gandhi
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As we dive into the dynamics of development, we might recall that it was on this date in 1718 that the famous pirate Edward Teach– better known as Blackbeard– was killed off the coast of North Carolina.
Edward Teach, also known as Blackbeard, is killed off North Carolina’s Outer Banks during a bloody battle with a British navy force sent from Virginia.
Believed to be a native of England, Edward Teach likely began his pirating career in 1713, when he became a crewman aboard a Caribbean sloop commanded by pirate Benjamin Hornigold. In 1717, after Hornigold accepted an offer of general amnesty by the British crown and retired as a pirate, Teach took over a captured 26-gun French merchantman, increased its armament to 40 guns, and renamed it the Queen Anne’s Revenge.
During the next six months, the Queen Anne’s Revenge served as the flagship of a pirate fleet featuring up to four vessels and more than 200 men. Teach became the most infamous pirate of his day, winning the popular name of Blackbeard for his long, dark beard, which he was said to light on fire during battles to intimidate his enemies. Blackbeard’s pirate forces terrorized the Caribbean and the southern coast of North America and were notorious for their cruelty.
In May 1718, the Queen Anne’s Revenge and another vessel were shipwrecked, forcing Blackbeard to desert a third ship and most of his men because of a lack of supplies. With the single remaining ship, Blackbeard sailed to Bath in North Carolina and met with Governor Charles Eden. Eden agreed to pardon Blackbeard in exchange for a share of his sizable booty.
At the request of North Carolina planters, Governor Alexander Spotswood of Virginia dispatched a British naval force under Lieutenant Robert Maynard to North Carolina to deal with Blackbeard. On November 22, Blackbeard’s forces were defeated and he was killed in a bloody battle of Ocracoke Island. Legend has it that Blackbeard, who captured more than 30 ships in his brief pirating career, received five musket-ball wounds and 20 sword lacerations before dying…
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