Birther Myth

by Don Boudreaux on March 29, 2011

in Data, Health, Myths and Fallacies

Here’s the Heritage Foundation’s Robert Book on different methods of defining infant mortality (from a letter in the March 30th Wall Street Journal):

Your editorial “The March of Health Progress” (March 25) correctly celebrates the increase in life expectancy, decrease in infant mortality and decreasing death rates from most of the leading fatal diseases in the latest annual summary of mortality data from the Centers for Disease Control and Prevention.

However, a closer look at the data reveals an even rosier picture. Increased access to fertility treatments has resulted in more multiple births and a higher average maternal age. These factors result in more high-risk pregnancies and would be expected to increase infant mortality—yet infant mortality has declined more than enough to offset these increased risks.

Those who argue that the U.S. lags behind some other countries in infant mortality fail to take into account national differences in definitions of live birth. The U.S. complies with the World Health Organization standard, which requires registration of a live birth whenever an infant shows any sign of life outside the womb, regardless of birth weight, size or duration of gestation. Many countries restrict registration to cases in which these measures exceed certain limits, such as a birth weight of 500 to 1,000 grams, a crown-to-heel length of 25 to 35 centimeters, 22 to 28 weeks of gestation, or survival for a minimum amount of time. Since small and pre-term babies are more likely to die, standards that exclude these cases artificially decrease a country’s infant mortality rate, making its health-care system seem better than it really is. Yet U.S. infant mortality rates are competitive, despite a much more broad definition of live birth.

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{ 83 comments }

Emerson White March 29, 2011 at 10:55 pm

Fantastic news!

vikingvista March 29, 2011 at 11:37 pm

In addition, comparisons have been made between premature infant survival rates in the US compared to Canada. US survival rates are higher. Neonatal care in the US is unsurpassed, and you will probably not find neonatalogists anywhere in the world who would say that US neonatal medicine is inferior. If infant mortality is higher in the US, it is in spite of superior neonatal health care.

Also, compared to many European nations, the US has a sizable population of young women who don’t seek perinatal care, even when it is offered for free.

Methinks1776 March 30, 2011 at 12:06 am

Also in comparison to European countries, we have far more women who undergo fertility treatments (we can afford it). Fertility treatment is more likely to result in multiple fetuses and multiple fetuses almost always lead to premature birth – often very premature. So, the U.S. leads Europe in preemies.

Preemies, of course, have a higher mortality rate. A 500 gram preemie’s probability of survival is something like 50%.

An interesting read:
http://whqlibdoc.who.int/publications/2007/9789241596145_eng.pdf

Steve_0 March 30, 2011 at 1:45 am

Just an anecdote: My good friend Anna was born weighing exactly one pound. She was cared for and survived, requiring a donated cornea. She just published her first AP-wire story this month.

Don Boudreaux March 30, 2011 at 7:22 am

I love hearing of such happy occurrences! Thanks! And best of luck to Anna at the start of her career.

Ike March 31, 2011 at 6:07 am

I shudder to think of what will happen when her editor assigns her the first “Health Care In America is Inferior” story.

Superheater March 30, 2011 at 8:28 am

“Also, compared to many European nations, the US has a sizable population of young women who don’t seek perinatal care, even when it is offered for free.”

Having been a state Medicaid/Medicare auditor who was involved in several maternity care audits in a large Northeastern US City, not only is that true, but many continue to engage in behaviors (alcohol, drug use, smoking, inter alia) that produce “adverse outcomes”. I often wondered if these women knew or cared that an auditor could see the most intimate details of their life.

brotio March 29, 2011 at 11:46 pm

Differences in non health-related deaths also explain why American life expectancy is lower than in some other developed countries. When death due to crime, suicide, and auto accidents are factored, US life expectancy is comparable to anywhere else.

Don Boudreaux March 29, 2011 at 11:49 pm

Yep. That’s my take from the (analyses of) the data.

Methinks1776 March 30, 2011 at 12:14 am

Not anywhere else :)

In Russia, life expectancy is very low – somewhere in the mid-50′s! a Russian doctor presenting at a medical conference in California proudly proclaimed that Russians had low rates of colon cancer. It was suggested to him (by a doctor who was a Russian immigrant) that if they can make life slightly more miserable and bring down the life expectancy a little further, they can virtually eliminate colon cancer altogether.

Don Boudreaux March 30, 2011 at 12:18 am

Although one of the marvelous – yet underreported – stories of late is the dramatic reductions in deaths-within-X-number-of-years from cancer, it remains true that we would all be blessed were we all to live in a society in which people, as a matter of civilized convention, expressed something like the following well-wish to others: “May you live long enough to die of cancer.” (I steal this idea from my friend Tom Palmer.)

dan March 30, 2011 at 12:33 am

I believe that current format for ‘survival rate’ of cancer is 5 years beyond diagnosis…….and from what I have read, the US leads the world, save those nations who have life expectancies under 60yrs.
GB survival rate of prostate cancer is around 52%
The US survival rate of prostate cancers is……….drum roll, please………………………………………………………………………………………………………………….92%.
AMAZING!!!!!! That is significant…….Almost, a downright Human rights tragedy…..to borrow from liberals whenever they percieve an inequity.

dan March 30, 2011 at 12:34 am

92%……for prostate cancer survival in US….seems to have gotten chopped off.

Sandre March 30, 2011 at 12:36 am

well, you put a long line with …..

YOu have to scroll right to see the 92%.

dan March 30, 2011 at 12:48 am

Sorry about the long ‘……’.

Methinks1776 March 30, 2011 at 12:37 am

Funny you should mention that. I had a long chat this evening with my 87 year old uncle (a former surgeon). He was just telling me how lucky he felt to live long enough to have some precancerous growth or other removed almost yearly. He wished me the same fate.

BTW, I’m not sure those cancer statistics are as wonderful as you think, Don. We have the ability to catch a lot of very slow-growing cancers at very early stages now – cancers that will take decades to kill us. Those cancers are included in the year survival statistics and skew the statistics to show progress that really hasn’t been made. In aggressive cancers (the ones you really have to worry about – or at least I do), the picture is much less rosy and the progress is much smaller and slower.

dan March 30, 2011 at 12:48 am

Its progress. And more progress is being made in the US than the other nations with whom our system is always being compared to for propaganda purposes. I also, spent some time researching the WHO list of nations who were given higher marks for their health system. The very one a long list of liberals and encouragable independents constantly referred to for the reason that our system needed to be changed, drastically. Countries like San Marino, Andorra, Monaco, Oman, Cypress, Morrocco, etc.,……populations of less than 1 million (not all of these listed nations are under 1 million). Monaco? Monaco? It is a soverign 2 square kilometer resort for millionaires of no more than 16,000 people. Can we really compare Monaco to the US? Not to mention their criteria for rating countries. All bull.

Methinks1776 March 30, 2011 at 12:56 am

“…more progress is being made in the US than the other nations..”

Without question.

“Not to mention their criteria for rating countries. All bull.”

Total bull. Ever been a patient in an Italian hospital? The weight given socialized medicine is 30% – they call it “access”. By now you should be laughing your head off.

Certainly, U.S. health care outcomes are better. However, cancer survival statistics – probably everywhere in the world – likely paint an unrealistically rosy picture. Come to think of it, I think the WSJ did a huge story on this maybe six or seven years ago.

dan March 30, 2011 at 1:02 am

To enter Luxembourg, you must purchase a health plan. Should you have one through the EU, already, than a portion of your dues will be reduced. I can’t remember all the details. But, a healthcare plan is a must for entry into the country. Luxembourg-population of under or close to 500,000.
Cuba is listed right behind US. Oh, I am sure that Cuba has one helluva a healthcare program. If so, then why do so many Cuban ‘doctors’ defect from the country every year. Valenzuela and Cuba have a program that shares doctors. Valenzuela sends doctors over to Cuba. Of which, they in turn look to defect on a boat to US (I joke…..or do I)
But the Cuban doctors do defect whenever they can….the very reason for Chavez to send doctors over to help.

Methinks1776 March 30, 2011 at 1:11 am

Ah…yes, Dan. But, you see…..the Cubans have that all-important socialized medicine. That is, they have medical care for the elites (and medical tourists) and not so much as aspirin for the ordinary Cuban. So, you see, the Cuban medical system is considered far Superior by the WHO. Any defect is surely undermining by the dirty capitalist and the bourgeoisie. Makes total sense, no?

vikingvista March 30, 2011 at 1:59 am

Lead time bias.

Don Boudreaux March 30, 2011 at 7:23 am

Excellent point, Methinks. I’d not thought of that. Thanks!

Superheater March 30, 2011 at 8:30 am

LIfe is a terminal disease, aftrerall.

vikingvista March 30, 2011 at 1:50 am

Notice that Left-skewed heath statistics never do certain things. They never look at just those people who engage the health care system. They almost never adjust for ethnicity. They never control for the type of care sought (e.g. trauma, rare diseases). They never place any value on wait times (even though patients obviously do). And when they poll opinions, they rarely exclude those who haven’t actually utilized the system.

dan March 30, 2011 at 12:26 am

France, Germany, and Belgium are among those who tweak their definition of what is considered to be Infant mortality. From length of baby, to weight, lenght of time outside of womb, and even length of time in womb. Should a baby be born too soon and die, the country does not count it as infant mortality. Can’t remember that nation, except that is was in Europe.
The same kind of ‘definition’ of what consitutes or makes up a particular stat in comparing health related measures exist in other aspects. For instance, the United Kingdom does not count traffic deaths into their stats for ‘life expectancy’. How about the US does the same for one year. Wanna bet that our life expectancy goes up significantly and that no other nation on Earth can even come close ?

Methinks1776 March 30, 2011 at 12:41 am

France (and maybe other countries) records 500 gram preemies who die as a fetal deaths. Fetal deaths are not included in infant mortality statistics. UK doesn’t count traffic deaths? You have got to be kidding.

dan March 30, 2011 at 12:51 am

No kidding on traffic deaths. There is also a significant difference on the amount of travel and usage of cars that can’t be compared to the US. It is like comparing grapes to watermelons. To say the least, nations skew their numbers with different standards.

dan March 30, 2011 at 1:07 am

‘ However, cancer survival statistics – probably everywhere in the world – likely paint an unrealistically rosy picture.’

Probably. But, that might be due to how they determine success. Such as the living 5+ yrs beyond diagnosis. But, then again, most cancer patients are not in their 20′s and 30′s. If you are 70 and diagnosed with cancer and live another 5 yrs………well, congrats. Might have died from other system breakdowns by then.

dan March 30, 2011 at 1:11 am

Thanx for the chats. When you discover I have typed incorrect info, please inform. I prefer to be ‘correct’ as opposed to ‘being right’.

dan March 30, 2011 at 1:15 am

Also, I have not discovered any information that, when comparing healthcare or life expectancy, considers culture and lifestlye. WE eat alot of Cheeseburges and pizza. We (US) also have to consider stress. Stress considers traffic, employment, etc.,…

muirgeo March 30, 2011 at 1:18 am

Birther indeed.

Look at the graph. Anyone care to guess what year medicaid was past.

http://www.mhlw.go.jp/english/wp/wp-hw/vol1/images/f3-1-2.gif

Methinks1776 March 30, 2011 at 1:22 am

past what?

muirgeo March 30, 2011 at 1:25 am

It was created on July 30, 1965.

Methinks1776 March 30, 2011 at 1:29 am

After the steepest drop in perinatal, neonatal and infant mortality rates. OK. And?

muirgeo March 30, 2011 at 3:35 am
Methinks1776 March 30, 2011 at 3:43 am

Gotcha what, idiot?

tkwelge March 30, 2011 at 4:33 am

Different graph, same observation. Huge decreases in deaths long before medicaid. .

John Dewey March 30, 2011 at 9:50 am

Muirgeo probably did not intentionally provide misleading data, but his data is misleading nonetheless.

The steepest decline in infant mortality rates occurred before 1950. The chart which muirgeo provided has selected as a starting point the only period in the past century when infant mortality rates plateaued. Here’s some statistics which show the true picture for infant mortality:

U.S. Infant mortality (deaths of children under one year of age per 1,000 live births)

Year ……..Whites ………Non-whites
1940………..43.6…………..73.9
1945………..35.6…………..56.8
1950………..26.8…………..44.7
1955………..23.6…………..42.9
1960………..22.9…………..43.4
1965………..21.5…………..40.6
1970………..17.7…………..31.5

Exploring the Racial Gap in Infant Mortality Rates

Infant mortality was declining sharply long before Medicaid became available. The rates plateaued from 1955 to 1965 for both whites and non-whites before resuming the decline.

Muirgeo attributes the post-1965 decline to Medicaid. But Medicaid primarily benefitted non-whites, particularly in the early years. Yet infant mortaility resumed the decline for both whites and non-whites. Thus, it is likely that other factors caused the resumption of the decades-long trend in infant mortality.

John Dewey March 30, 2011 at 10:34 am

The CDC has provided a longer term chart of U.S. infant mortality rates. When viewed from the longer term perspective, the decline in infant mortality after 1965 is nothing special. Rather than cherry-pick data to try and justify government intervention, a pediatrician or nenatologist might better spend his time trying to find ways to continue the century-long progress which his predecessors achieved.

dan March 30, 2011 at 1:35 am

What the leftwinger is failing to see, is that the standards by which any stat is recorded varys widely and also changes, often. Also, the practices and advancements are constantly changing. Computers have played a vital role in the rapid advancement. Medicare and medicaid are deplorably lagging in quality of care compared to private practices and private insurance practices.

Methinks1776 March 30, 2011 at 1:50 am

Patience, Dan. I expect we are about to be treated to a Tsunami of incoherent, caps lock punctuated ranting about the stupidity of libertarians and the evils of Ronald Reagan, supported by a graph tracking giraffe births in African wildlife preserves.

dan March 30, 2011 at 2:32 am

Reminds me of a person from Tampa. I imagine I am to be scolded on how our fiat system of currency confirms that all money belongs to the federal govt and that the federal govt is ‘us’, the American people. Therefore, any of ‘my properties’ are really the property of the collective, and so on ,and so on…………
Anyone seen the recent report about the doctor, among many others, who has performed repeated surgeries on a patient(s) that were unwarranted, besides the revelation that the surgeon has (alleged) failed to do the surgery properly the first time, intentionally.

muirgeo March 30, 2011 at 3:59 am

Does the Heritage Foundation have estimate of what our neonatal and infant mortality rates would be if we ended Medicaid as they would wish we’d do?

Our success is a result of public provided health care and countries that have better public health do better for less. So I’m not sure what the Heritage Foundation people think they are pointing out. Certainly not that our success has anything to do with following public policies they would promote.

Methinks1776 March 30, 2011 at 4:32 am

Of course, Muirdiot. What with a whopping 19% of the U.S. population enrolled in Medicaid – nearly half of whom are children and 10% are elderly (you know post-menopausal women can’t get pregnant, right?) – we would absolutely expect half the babies and probably two thirds of the mothers in the United States to start croaking immediately if it disappeared.

Advances in medicine have absolutely zero to do with a reduction in neonatal, perinatal and and infant (not to mention maternal) mortality rates. Why, if we’d only dreamt up socialized medicine in 1846, we could have this exact same result then!

The Heritage Foundation is pointing out that despite complete morons like you in the profession, it somehow continues improve the lives of Americans year after year. Misunderstand better now?

Justin Bowen March 30, 2011 at 8:53 am

Advances in medicine have absolutely zero to do with a reduction in neonatal, perinatal and and infant (not to mention maternal) mortality rates.

I wouldn’t go that far. The 50% survival rate of premature babies (of a certain level of prematureness (or is it prematurity)) is partly a consequence of advances in medicine. A baby born too prematurely in the earlier part of the last century and before would simply have died. There was absolutely nothing that could be done for it. Now, tens, if not hundreds, of thousands of babies that are born too prematurely can be saved. We have lung machines, incubators, blood-pumping machines, steroids, and so on. Because of advancements in medicine, we’ve pushed back the age at which it’s possible to save a baby.

Now, whether those babies go on to live long healthy lives (beyond a year or two) and whether the increased survival of those babies greatly affects the statistics is an entirely different matter altogether.

dan March 31, 2011 at 1:35 am

I think he was being sarcastic. Muirgeo, the genius and aristocrat, is opining that govt run health care systems is the very reason for all of the progress in medical care in the US. If so, then if we had only implemented govt run healthcare a hundred or so years ago, why we would have cured cancer by now and people would be living to 150yrs.

Superheater March 30, 2011 at 8:40 am

Maternity care for MC is a joke, largely because the patients are irresponsible.

There’s something very dysgenic about a culture that encourages the least capable to reproduce early and often (my favorite case a 41 yr old with 7 kids, on welfare, three surnames, two boys with the same first name-and the scores of teenagers confident they could be fine mothers) while telling its best and brightest to postpone parenthood indefinitely.

“Idiocracy” isn’t far from the truth. Then again, I think its intentional that the ruling class is breeding a electoral army of the dependent.

dan March 31, 2011 at 1:31 am

Muirgeo says, ‘Our success is a result of public provided health care and countries that have better public health do better for less’.

Have you not read the preceding posts from the very beginning? The WHO reports cannot be taken seriously. Your statement is without merit and fallatious.
I will throw you a bone… Israel. The rest of the public health care systems are worse off than the US.
In Canada, their is a budget. They cannot simply go over like politicians in our Congress always do. Each doctor is allocated up to a certain amount of money for the work they do. When the money runs out……they work no more. Usually, by November, they have topped out and precede to go on vacation or hiatus.
Public Health care systems with beauracrats deciding ‘best practices’ and who shall be treated how often is disturbing and will pan out as GB or Canada. Canada is working on trying to implement open market healthcare. They will continue with what they promised, but are getting the folk who have money to find private practices and pay for thier own care…..Wonder why that is? Govt run systems are no substitute for the open market.

muirgeo March 30, 2011 at 4:06 am

Infant mortality rates go down faster after Medicaid is created.

http://krusekronicle.typepad.com/kruse_kronicle/images/07imr.gif

tkwelge March 30, 2011 at 4:44 am

Awww, he found the right graph. Really, your data is too limited to infer anything. The death rate was dropping quickly before 1956 and then plateaued until 1965 when it continued to drop at the same rate. It would be nice to see the data for before 1950 too.

I’m sure that medicaid did indeed help lower the death rate in some areas. However, the medicaid caused increases in the price rate probably created to ever increasing costs that have contributed to the healthcare situation that we are in now. The data looks better and better right up until the bubble pops and the whole thing comes crashing down.

Methinks1776 March 30, 2011 at 9:45 am

Medicaid was passed in 1965 and left to the states to implement. So, it took a while. The last state implemented Medicaid in 1981 or 1982. Yet, mortality continued to drop steadily throughout the period the minority of the population eligible for Medicaid were yet to enroll.

If Muirdiot were a securities trader…well, he’d be broke…but for the ten days of his career before he blew up, he’d spend a small fortune money buying fashion magazines to educate himself on skirt lengths.

Methinks1776 March 30, 2011 at 10:07 am

Oh, edit button, I miss you so.

Superheater March 30, 2011 at 8:41 am

What can we do to increase Muirbot mortality?

Homesure Services March 30, 2011 at 8:22 am

There is also a significant difference on the amount of travel and usage of cars that can’t be compared to the US. It is like comparing grapes to watermelons. To say the least, nations skew their numbers with different standards..

Greg March 30, 2011 at 11:04 am

“What with a whopping 19% of the U.S. population enrolled in Medicaid – nearly half of whom are children and 10% are elderly (you know post-menopausal women can’t get pregnant, right?) – we would absolutely expect half the babies and probably two thirds of the mothers in the United States to start croaking immediately if it disappeared”

–About 1/3 of births are covered by Medicaid (ranging from about 20% to 60%)
–There is not a significant difference between infant mortality under private insurance and Medicaid.
–There IS a significant difference in infant morality rates between the insured and uninsured.

So yes, we would expect an increase in infant mortality rate if Medicaid benefits suddenly disappeared.

Methinks1776 March 30, 2011 at 11:38 am

So, I take it you agree with Muirdiot that the decline in infant mortality in the United States is the result of the passage of Medicaid and that we will magically return to 16th century mortality rates without it.

JohnK March 30, 2011 at 11:50 am

Without Medicaid there would be nothing to fill the void.
Nobody would voluntarily give to charity, no doctors would reduce or waive fees, and the poor and elderly get no care.
Eliminate Medicaid and they’ll be stacking up the old and poor behind hospitals like cord wood.

Might as well move to Somalia.

dan March 31, 2011 at 1:43 am

Are you being sarcastic. Medicaid has absolutely no relationship with charitable donations. How in the heck do you connect the dots with that one. I happen to know a heart surgeon who regularly looks for ways to cut fees or does charitable work. Has nothing to do with Medicaid. In fact, Medicaid is the bane of his career. He is infuriated with Obamacare.
Good God, the exaggerated nonsense that is perpetrated.
Here is a story -A fedex manager in Texas donated his kidney to an employee who was in need….. no socialized medicine relationship…… and to top it off for the ridiculous liberals who do not experience life but watch it from their couches and tune in to MSNBC…… the donater is white…..the reciever is black….Stick that in your misguided face.

JohnK March 31, 2011 at 7:58 am

“Are you being sarcastic.”

aye

Methinks1776 March 30, 2011 at 12:25 pm

Greg, do you have data to support your claim that there is no significant difference between infant mortality rates under private insurance and medicaid? I only found one document comparing the two and it only covered a handful of states and shows pretty significant differences between infant mortality under medicaid and private insurance.

http://coburn.senate.gov/public//index.cfm?a=Files.Serve&File_id=bf067de0-95ec-4350-9a

muirgeo March 30, 2011 at 1:41 pm

Thanks for an honest reply. Technology and access to care are two very different things which methinks cares not to be honest about.

Plenty more poor babies would die if there was not access to public health care. The idea that charity will take up all the slack is just one more way to advantage the greedy over the caring.

Methinks1776 March 30, 2011 at 2:01 pm

Oh, I uhgree totally with your lojik, Muirdiot. There is nothing more greedy and less caring than charity to the poor.

Of course, you’re now changing the subject because you realize that the graphs you posted did not support your initial assertion that the reason for the precipitous decline in neonatal, perinatal and infant mortality was the introduction of medicaid.

JohnK March 30, 2011 at 2:21 pm

“The idea that charity will take up all the slack is just one more way to advantage the greedy over the caring.”

Why is it considered greed to want to keep what you have, but somehow noble to take property that does not belong to you and spend it in the name of philanthropy?

It may feel like philanthropy, but it is not. It is not your property to share.

Philanthropy is being generous and caring of your own free will with your own property.

Just out of curiosity doc, how often do you lower or waive fees for services that you provide?
If you couldn’t forward the bill to the government, if there was no “public health care”, would you of your own free will help the poor?

I don’t think you would.

Methinks1776 March 30, 2011 at 3:13 pm

To be fair, John, the fees he commands are already so low he’s probably barely surviving.

muirgeo March 30, 2011 at 11:27 am

Simple questions.

Who is for abolishing Medicaid?

Who thinks infant mortality will go down if we get rid of Medicaid?

I mean you guys can’t even honestly answer these most simple of questions that call into question the very basis of your philosophy.

Are you ok with poor people dying outside the walls of the hospital? Why would that not happen if your policies were in place?

I am fully prepared for some name calling but totally unprepared for a real honest answer.

Don and Russ can’t and won’t attempt to answer such questions. Way too inconvenient. But again it’s me that is the troll for asking honest questions. I think you guys are the trolls for not even being able to attempt to answer these questions and then still feeling comfortable about your self and your philosophy.

Methinks1776 March 30, 2011 at 11:39 am

Simple question: can you read your own graphs? Do you understand basic math? What year is it? How many fingers am I holding up?

brotio April 1, 2011 at 12:11 am

It’s posts like that that make me miss the ‘like’ button as much as I miss ‘edit’!

:D

John Dewey March 30, 2011 at 1:33 pm

muirgeo,

I am in favor of getting rid of medicaid.

I do not believe Medicaid has changed infant mortality rates in the past, and I do not believe the absence of medicaid would change infant mortality rates inthe future.

No one was dying in the streets due to lack of medical insurance before Medicaid was enacted. I see no reason to believe they will be dying in the streets if Medicaid were abolished.

What would change – if Medicaid were abolished – is that hospitals and physicians would provide much more charity care than they do today. Because they would be providing unreimbursed charity care, those hospitals and physicians would reduce the quantity of services they provide to those who would remain unable to provide for themselves. I have no problem with that.

brotio March 31, 2011 at 12:22 am

The King of Question-Duckers is bitching because our hosts don’t jump to answer his inanities. My heart bleeds for you, Yasafi. In stereo.

Greg March 30, 2011 at 1:34 pm

re: Methinks–

No, I do not think Medicaid is the sole reason for the decline in infant mortality rate. The downward trend in infant mortality rates prior to Medicaid was due to improvement in infant mortality temporally further removed from birth. After its enactment, Medicaid probably played a role to the extent that it increased access to perinatal care. Medicaid is less effective, however, at improving live birth weight–the most important predictor for infant morality. Especially in regards to explaining variations between white and black infant mortality.

The article I get my data is (unfortunately) behind a paywall. Here’s the basic citation info:

The Effect of WIC and Medicaid on Infant Mortality in the United States.
Nancy Moss and Karen Carver
American Journal of Public Health 1998.

If you have trouble finding it let me know, we can work something out if you’re really interested.

re: John K

The question wasn’t whether or not private care would eventually replace, for the better, Medicaid. My post was a response to the suggestion that the repeal of Medicaid would have little effect on infant mortality rates. Again, I strongly support the critique of the shallow use of statistics that portray US infant mortality in a negative light compared to other countries. For the past 20 odd years countries and some researchers have recognized the difficulty in, and trying to improve, international comparisons. But it seems odd that the critique has undertones of support for privatization of medical care when so many US births are paid for under Medicaid.

So in short, I will not be moving to Somolia.

Methinks1776 March 30, 2011 at 3:12 pm

Greg,

Thanks. I’m okay paying for the article – depending on the price. I pulled this off the web based on the info you gave me:

http://ajph.aphapublications.org/cgi/reprint/88/9/1354.pdf

It seems to only study medicaid patients who either participate or don’t participate in WIC. I don’ t see a comparison between Medicaid and private insurance. What am I missing?

Greg March 30, 2011 at 4:28 pm

In Table 3, Model 3, the odds of an endogenous cause of death for births paid for by Medicaid do not significantly differ from births paid for by private insurance. 35% of their sample received Medicaid.

The important question to ask, as the authors do, is to what extent unmeasured characteristics of program participants are also associated with infant mortality rates. They’re able to control for a number of factors but it’s not an experiment under controlled conditions so any claims about the “effect” of Medicaid need to avoid causal language.

Unfortunately, its tough to do randomized trials with these sorts of questions. Some quasi-experimental designs using Medicaid expansion as the treatment have been done, and they support the idea that increased Medicaid availability is associated with reduced infant mortality, above and beyond the secular downward trend.

Methinks1776 March 30, 2011 at 6:00 pm

Thanks!

Steve March 30, 2011 at 2:58 pm

Where do deaths due to abortion fit into this statistic?

Greg March 30, 2011 at 4:44 pm

Good question. My immediate thoughts are that

1.) abortion is probably more common among the Medicaid eligible population.

2.) this would affect the estimate if babies who are aborted have an increased risk of mortality had they come to term.

3.) If 1 and 2 are correct, then the Medicaid population is effectively selecting healthier babies. However, I have serious doubts about assumption number 2. I think most women choose an abortion not because of fetal health issues but because of cost and career considerations.

John Dewey March 30, 2011 at 6:15 pm

Greg, I don’t have statistics about the women who receive abortions, only anecdotal evidence.

Unfortunately, a very close relative assisted in dozens of abortions at a surgery center in California in the 1980s. She told me that the patients for most surgeries at that center reflected the general population as a whole – some poor, some middle class, and some wealthy. However, the patients receiving abortions were generally from the more “at risk” population: prostitutes, dopers, and young girls from poor families, usually minorities. I don’t know whether the national mix of abortion patients would mirror what my relative observed. But that’s what I would expect absent statistics to the contrary.

John Dewey March 30, 2011 at 6:31 pm

I found a few facts on U.S. abortions at the Guttmacher Institute website:

“• Forty-two percent of women obtaining abortions have incomes below 100% of the federal poverty level ($10,830 for a single woman with no children).

• Twenty-seven percent of women obtaining abortions have incomes between 100-199% of the federal poverty level

• Thirty percent of abortions occur to non-Hispanic black women, 36% to non-Hispanic white women, 25% to Hispanic women and 9% to women of other races..”

Those statistics seem to confirm my relative’s observation that the majority of U.S. abortions are performed on the population most “at risk” in the U.S. So I would believe that abortion likely accounts for a significant part of the decline in infant mortality rates since 1973.

dan March 31, 2011 at 1:52 am

Career considerations?
Most abortions are by low or no income folks. Career considerations?
Costs? yes…. but, not just monetary costs. Costs of time and labors to raise a child. Costs of loss ‘free’ time as opposed to time spent caring for youth.
No assumptions here. Witnessed experience. The pregnancy is a nusiance for some. For others, they will have to give up their ‘time’. Many factors are in play, but I don’t think that careers ranks up there in the top three or five.

Slappy McPhee March 30, 2011 at 5:29 pm

Has anyone come across any research where race is accounted for? My scandanavian relatives seem to live forever, even tho they don’t live the healthiest of lives here in the States. With the diversity of our population, it seems like it would be a factor.

Andrew_M_Garland March 30, 2011 at 5:32 pm

The usual criticism of US health care is “We spend more and get less”. This is the position of the WHO, which is more of a political organization than a medical one.

USA Healthcare is First – Infant Mortality is Low

() The U.N. World Health Organization (the WHO) itself ranks the US #1 in care delivery that is important to patients. It issues another ranking at 37th because this quality of care costs more and is not delivered by government. The 37th rank is a political judgment that is not related to the quality of care delivered. That is the ranking that the liberal press always references.

Arguments against the quality of US health care are based on flawed infant mortality and life expectancy statistics, a confusion that the WHO promotes.

() Life expectancy at birth is a bad measure of healthcare quality, because it is exactly the countries with socialized healthcare who do not record premature births and births where the child dies within 24 hours. US hospitals record every birth having a single breath, including malformed and premature births, and the subsequent unavoidable deaths. Each time the US includes such a birth and death, it lowers our life expectancy statistic and raises our infant mortality statistic.

US infant mortality is as low as the best statistics in Europe when comparable cases are considered.

It is almost as if the relevant US government agencies want US healthcare to look bad. I haven’t seen any statistics from those agencies that make an adjusted comparison.

() The US has much more accident and crime related death than Europe. This also lowers the life expectancy statistic, but has nothing to do with healthcare.

() For treatment of diseases, such as cancer, US citizens pay more and do better. This doesn’t show ineffective healthcare. It shows that people are willing to pay to live longer, if they have the money and the option.

() When people cite the low costs of Medicare administration, they do not include activities that support Medicare but are not included in the spending figures. All governments have the incentive to under-report their healthcare costs. Despite Medicare’s supposed efficiency, it suffers large losses to error and fraud, underpays for the care it proimises to deliver, and is so well planned that it is rapidly going broke. That is all within the government’s control. They must like the situation.

() It is easy to spend less on healthcare and have great statistics: give the government a monopoly on paying for the care and for compiling the statistics. Cuba routinely issues infant mortality statistics that are lower than the US. I don’t believe them.

() Britian is a great example of controlled costs with poor delivery.
Lack of British Maternity Care

Quip: We find do-it-yourself is much cheaper.

Andrew_M_Garland March 30, 2011 at 5:34 pm

The usual criticism of US health care is “We spend more and get less”. This is the position of the WHO, which is more of a political organization than a medical one.

easyopinions.blogspot.com/2009/01/usa-healthcare-is-first-infant.html
USA Healthcare is First – Infant Mortality is Low

() The U.N. World Health Organization (the WHO) itself ranks the US #1 in care delivery that is important to patients. It issues another ranking at 37th because this quality of care costs more and is not delivered by government. The 37th rank is a political judgment that is not related to the quality of care delivered. That is the ranking that the liberal press always references.

Arguments against the quality of US health care are based on flawed infant mortality and life expectancy statistics, a confusion that the WHO promotes.

() Life expectancy at birth is a bad measure of healthcare quality, because it is exactly the countries with socialized healthcare who do not record premature births and births where the child dies within 24 hours. US hospitals record every birth having a single breath, including malformed and premature births, and the subsequent unavoidable deaths. Each time the US includes such a birth and death, it lowers our life expectancy statistic and raises our infant mortality statistic.

US infant mortality is as low as the best statistics in Europe when comparable cases are considered.

It is almost as if the relevant US government agencies want US healthcare to look bad. I haven’t seen any statistics from those agencies that make an adjusted comparison.

() The US has much more accident and crime related death than Europe. This also lowers the life expectancy statistic, but has nothing to do with healthcare.

() For treatment of diseases, such as cancer, US citizens pay more and do better. This doesn’t show ineffective healthcare. It shows that people are willing to pay to live longer, if they have the money and the option.

() When people cite the low costs of Medicare administration, they do not include activities that support Medicare but are not included in the spending figures. All governments have the incentive to under-report their healthcare costs. Despite Medicare’s supposed efficiency, it suffers large losses to error and fraud, underpays for the care it proimises to deliver, and is so well planned that it is rapidly going broke. That is all within the government’s control. They must like the situation.

() It is easy to spend less on healthcare and have great statistics: give the government a monopoly on paying for the care and for compiling the statistics. Cuba routinely issues infant mortality statistics that are lower than the US. I don’t believe them.

() Britian is a great example of controlled costs with poor delivery.
easyopinions.blogspot.com/2009/01/usa-healthcare-is-first-infant.html#nhsMaternity
Lack of British Maternity Care

Quip: We find do-it-yourself is much cheaper.

WFH Market March 31, 2011 at 5:12 am

Infant mortality was declining sharply long before Medicaid became available. The rates plateaued from 1955 to 1965 for both whites and non-whites before resuming the decline..Thanks for the post..

2010 Acura TL parts April 5, 2011 at 7:06 am

Well, I do not think Medicaid is the sole reason for the decline in infant mortality rate. The downward trend in infant mortality rates prior to Medicaid was due to improvement in infant mortality temporally further removed from birth..Really such a great post..

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