Week In Review

A Weekly Column by Bill Onasch
November 4, 2007

Harvard Prof Goes Beyond Numbers
In today’s New York Times, Harvard economics professor, and adviser to Republican presidents and president wannabees, N. Gregory Mankiw, answers those of us citing empirical evidence showing the failure of American healthcare. He doesn’t question the accuracy of our figures. Instead he goes “beyond the numbers” to argue these statistics are “dangerous ones... that are true but don’t mean what people think they mean.”

Yes, he acknowledges, the Canadians, with their single-payer system, live longer than we do. But it’s not fair to blame our healthcare system because this can be attributed to more Americans dying from accidents and homicides than our northern neighbors. I thought this claim a bit odd so I did some checking.

Actually traffic fatality rates have been declining in both countries since the 1980s--when Canada had a higher rate. In recent years the Canadians have done a much better job and are now at about forty percent of the American rate. But the differences in the rates–which add up to around ten thousand more deaths in the U.S.--don’t come anywhere near explaining the differences in average life span.

Unfortunately, homicide rates have been increasing in Canada and ,while they still lag far behind their more violent southern neighbors, there’s no way a higher murder rate can give them a relative advantage in life span either.

And we’re fatter than the Canadians, says Dr Mankiw. On the one hand, he acknowledges “The causes of American obesity are not fully understood.” But he quickly goes on to cite another economic–not medical–study that “concludes that America’s growing obesity problem is largely attributable to our economy’s ability to supply high-calorie foods cheaply. Lower prices increase food consumption, sometimes beyond the point of optimal health.”

On my visits to Canada I have seen little difference in the availability or price of high calorie foods in either grocery stores or restaurants. While Canada has become more ethnically and culturally diverse over the past generation I have found back bacon to still be readily available in Ontario. Obesity is undoubtedly a problem in both countries but is not likely the result of cheap food and, in any case, the food price index is not a factor in comparing the two countries life spans.

Our expert economist believes social problems, not healthcare, explain the big difference in infant mortality. He claims underweight births, which he correlates with the number of teenage mothers, to be the prime factor in America’s higher rate. He says “One theory is that a teenage mother is still growing and thus competing with the fetus for nutrients.” Since there are more than three times as many teenage mothers in the U.S. as Canada this explains the whole difference in rates to his satisfaction.

Certainly many teenage mothers are confronted with social problems broader than just healthcare. Many may be undernourished. But a decent healthcare system could detect and address both medical and nutritional problems facing both mother and fetus. Canada does such things and that’s why they are better, and many other countries much better yet.

The good professor dismisses the dangerously true figure of 47 million uninsured. “To start with, the 47 million includes about 10 million residents who are not American citizens. Many are illegal immigrants.” Obviously Mankiw thinks these workers producing profits for American bosses, and their families, should be beyond the scope of discussion.

He further argues that there are millions who are eligible for Medicaid but have not applied because they are healthy and therefore “are uninsured in name only.” Apparently he thinks it good that the healthy don’t waste money on preventive care frou-frou. The uninsured–and under-insured–tend to wait until health problems become serious before seeking medical attention–often in hospital emergency rooms. They may suffer needless pain and disability because of delay and the higher costs of such care are charged up to the tax payer or general increases in hospital charges to the rest of us. That’s a far bigger component of increasing national healthcare spending than fat people eating cheap french fries.

But what really gets this prof’s goat is “About a quarter of the uninsured have been offered employer-provided insurance but declined coverage.” If you make ten bucks an hour and turn down the chance to have 500 a month deducted from your paycheck for health insurance, well that’s your choice pal, don’t blame the system.

The man from Harvard Square grants us that the percentage of national income spent on health care has risen from five percent in 1950 to sixteen percent today. “Many pundits regard the increasing cost as evidence that the system is too expensive. But increasing expenditures could just as well be a symptom of success. The reason that we spend more than our grandparents did is not waste, fraud and abuse, but advances in medical technology and growth in incomes. Science has consistently found new ways to extend and improve our lives. Wonderful as they are, they do not come cheap.”

Some pundits might say that these wonderful technological advances didn’t come cheap to those countries where they live a lot longer than us either--yet the gap in spending comparisons continues to grow. But while trying to be clever sneaking in a different measure–growing dollar amounts of personal income–the learned academic reveals what truly drives market-based health care. He cites a telling quotation from a paper by brother economists on the other coast, “As we grow older and richer, which is more valuable: a third car, yet another television, more clothing — or an extra year of life?”

Showing the cynical contempt of his class for ours it’s all laid out if you can see beyond his numbers.

The problem isn’t the system–the problem is us. We kill one another off on the road and through road rage. We’re gluttons wolfing down too much of that food Free Enterprise furnishes us in cheap abundance. Teenage girls play loose with morals and then selfishly starve their fetus. We’d rather buy third cars and plasma TVs than pay the fair market price for our healthcare. Shame on us.

He’s telling us to get with the program. If you’re working expect to continue to pay ever more for healthcare inferior to Canada--which will mean sacrificing a lot more than a “third car”for most. If you’re poor and healthy better stay that way. If you’re from somewhere else and you get sick go back to where you came from. And we’ll help all of you to be healthier by driving up food costs so you won’t just sit around stuffing yourself.

Of course, the politicians have other advisers that put this agenda less crudely. Some will be for “universal”conscription into the healthcare market, telling us all the while it’s all about “choices.” The more sensitive Democrats are currently getting more campaign funding from the health care robber barons than even the candidates professor Mankiw advises.

While I’m willing to tackle the other social problems leading to traffic deaths, homicides, and malnourished teenage mothers, I think I will continue to advance the dangerously truthful numbers to demand nothing less than single-payer health care. That’s the only “choice” worth talking about.

Can You Handle More Reality?
It’s beginning to look like the balance of the television season will be more dominated than ever by people kicking one another off the island, or amateur entertainers being humiliated in front of millions. When the women and men who write scripts for professional actors and comics down pencils at midnight tonight American television will become saturated with low budget “reality” shows as well as reruns of the best of this and that.

The Writers Guild will be striking over an issue crucial to their future–the growing DVD, Internet, and mobile phone market for the product of their labor. The scribes want a fair share; the producers are offering basically bupkis. This could be a long one. The last major strike lasted 22 weeks.

Ford Promises While Chrysler Delivers
We still haven’t seen any details of the UAW tentative agreement at Ford. It includes the essential elements of the “pattern” established with GM and Chrysler–a “non-core job” second tier along with a VEBA–but rumors are Ford was cut even more slack in these give-backs.

The headlines have focused on “job security.” Ford reportedly has withdrawn six plants from the Way Forward plan of plant closings by the end of next year. But all bets are off if “economic conditions substantially change.”

Ford’s rivals at Chrysler didn’t do them any favors by announcing earlier in the week that they are laying off thousands of UAW members who just approved a contract pitched as their best hope for job security.

Nurses Need Help
Nearly 700 nurses at at nine Appalachian Regional Healthcare (ARH) hospitals in Kentucky and West Virginia have been on the picket line since October 1–with no immediate end in sight. The issues for these members of the United American Nurses are primarily staffing levels and mandatory overtime. Without access to major strike funds they are beginning to feel the financial pinch. You can make a secure online donation by clicking

More Dam Trouble
A couple of weeks ago we reported on the problems of the Three Gorges Dam in China. This week the Washington Post broke a story about an even more imminent danger at the Mosul Dam in northern Iraq. According to the U.S. Army Corps of Engineers the structure has an “unacceptable failure probability.” Should the dam collapse it would leave nearby Mosul under 65 feet of water and parts of Baghdad under 15. A half-million deaths could be expected.

The dam fell into disrepair during the UN sanctions imposed on the Saddam Hussein regime. U.S. contract repairs have been marked by corruption and incompetence. Meanwhile the occupiers and the Baghdad government cannot agree on an emergency plan–or even if an emergency exists.

That’s all for this week.

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