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N. Gregory Mankiw , a former adviser to George Bush, and current adviser to Mitt Romney, has a piece in the New York Times this morning spewing more of the Republican lies about the status of the American health care system. Let's spend a few moments deconstructing those lies:

We'll start with the first one he told in his article:

For example, Americans are more likely than Canadians to die by accident or by homicide.

But what he does not tell you is that those who are most likely to die are lower income individuals who lack health insurance, and therefore, are less likely to receive adequate care after an accident. He also does not tell you that approximately 18,000 Americans per year die because they lack health insurance, and can't get the care they need.

Americans are also more likely to be obese, leading to heart disease and other medical problems...David Cutler, Ed Glaeser and Jesse Shapiro 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.

But what he does not tell you is that obesity affects low income groups more severely than any other group, and that this is because they tend to stretch their budgets by buying large quantities of cheap, high carbohydrate foods such as rice and pasta--which in turn leads not only to obesity but also nutritional deficiencies. He seems to think that raising the price of food will cause Americans to eat less--but what it will actually do is lead to greater food insecurity among the poor, especially children.

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

Leave it to a neocon to blame everything on sex. The fact of the matter is that teenage birth rates have been falling. According to the March of Dimes, however, many factors play into the problem of infant mortality and low birth weight, including birth defects, health problems in the mother, and having a baby past the age of 35. In addition, blacks and low income women are more likely to have low birth weight babies. Smoking, alcohol, and drug use during pregnancy can lead to low birth weight.

To start with, the 47 million includes about 10 million residents who are not American citizens. Many are illegal immigrants. Even if we had 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 counts millions of the poor who are eligible for Medicaid but have not yet applied. These individuals, who are healthier, on average, than those who are enrolled, could always 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 haven’t. The Census Bureau reports that 18 million of the uninsured have annual household 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.

Even if 10 million of the uninsured are illegal immigrants, what about the other 37 million? He doesn't tell you that 9 million of the uninsured are children. He also does not tell you that in general, the only adults who even qualify for Medicaid in most states are people receiving TANF and individuals who are eligible for SSI.

And what about those who declined coverage offered by their employers? I thought we could do a little bit of second grade math to illustrate why so many of these individuals opt out of employer sponsored health insurance I'm going to use a friend's earnings, living expenses, and her employer's insurance premiums to illustrate why many people opt not to receive health insurance:

At 10.75 per hour, my friend grosses about $1860 per month. Her health insurance premium through her employer would cost her $623 per month. I'll lay it all out in clear terms that even the mathematically challenged should be able to understand:

Payroll Taxes $400

Rent $580

Natural Gas (she's on the budget plan) $100

Electricity, water, and trash pick-up $130

Car Insurance $48

Gasoline (she works right in town)$50

Health Insurance $623


Those numbers don't include the cost of food, a phone, or childcare--even if she gets food stamps and child care subsidies, she will still be in the hole $70 per month. One can understand why she might choose not to sign up for her employer's health insurance plan.

Let's do another one, but this time, let's assume that it's someone making $50,000 per year. Since a person earning this much money won't qualify for public assistance, I'll include the cost of childcare for 2 kids, based on what the rates are in Indiana, and add in the cost of groceries--assuming that this family is going to eat one of those cheap, high carb diets that lead to obesity and other health problems that we detailed above. I assumed that this person will have about 25% of their paycheck go out the window for payroll taxes. I calculated this one on a yearly basis, and assumed that this family is going to live as cheaply as possible, like my friend above.

Payroll Taxes $12500

Rent $6960

Natural Gas (they are on the budget plan) $1200

Electricity, water, and trash pick-up $1560

Car Insurance $576

Gasoline (they work right in town) $600

Health Insurance $7476

Daycare $10400

Food $7200


Gee, it looks like that family earning  $50,000 per year is going to have a hard time affording health insurance, too. Notice that ,again, I treated a phone as a luxury item, and assumed that the family has no other debts. They had better hope no unexpected bills come up--like needing to get the car fixed (or worse yet, having to go in debt to get another one), or having their rent go up. They had also better plan on buying all their clothes and household items at garage sales. One can see why some families earning $50,000 per year might decide to drop their health coverage, can't we?

In 1950, about 5 percent of United States national income was spent on health care, including both private and public health spending. Today the share is about 16 percent. Many pundits regard the increasing cost as evidence that the system is too expensive.

Actually, many European countries spend half as much as we do, and still deliver better health care. In addition, much of our health care expenses are eaten up by administrative costs. Private insurers continue to raise premiums while covering fewer and fewer services. Profiteering has more to do with the rising cost of health care in America than advances in medical science.

Fortunately, our incomes are growing...

Whose income? The truth of the matter is that the only people in this country who are seeing a rise in their incomes are the very rich--which is who benefits most from our current health care system.

Our health care system is broken beyond repair--and the only thing that will fix it is a complete overhaul.

Also posted on my crappy little blog.

Originally posted to tonyahky on Mon Nov 05, 2007 at 11:48 AM PST.

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