Relevant and even prescient commentary on news, politics and the economy.

Explaining the Gender Wage Gap

From Thomas Edsall in the NY Times

At one end of the scale, men continue to dominate.

In 2016, 95.8 percent of Fortune 500 CEOs were male and so were 348 of the Forbes 400. Of the 260 people on the Forbes list described as “self-made,” 250 were men. Wealth — and the ability to generate more wealth — must still be considered a reliable proxy for power.

But at the other end of the scale, men of all races and ethnicities are dropping out of the work force, abusing opioids and falling behind women in both college attendance and graduation rates.

Edsall’s comments are very compatible with this by Deary et al:

There is uncertainty whether the sexes differ with respect to their mean levels and variabilities in mental ability test scores. Here we describe the cognitive ability distribution in 80,000+ children—almost everyone born in Scotland in 1921—tested at age 11 in 1932. There were no significant mean differences in cognitive test scores between boys and girls, but there was a highly significant difference in their standard deviations (P<.001). Boys were over-represented at the low and high extremes of cognitive ability. These findings, the first to be presented from a whole population, might in part explain such cognitive outcomes as the slight excess of men achieving first class university degrees, and the excess of males with learning difficulties.

It is also compatible with this by Lynn and Kanazawa:

This paper presents the results of a longitudinal study of sex differences in intelligence as a test of Lynn’s (1994) hypothesis that from the age of 16 years males develop higher average intelligence than females. The results show that at the ages of 7 and 11 years girls have an IQ advantage of approximately 1 IQ point, but at the age of 16 years this changes in the same boys and girls to an IQ advantage of 1.8 IQ points for boys.

Lynn and Kanazawa’s paper sample is for all kids born in Great Britain during one fine week in March of 1958. The abstract and the paper focuses on mean differences.  They seem to mean a lot to the two authors, and most especially Lynn, but to me the differences in mean are small and of lesser importance than other things they note.   To mangle a metaphor, the multiplier (when it comes to differences in population outcomes) is the standard deviation.  To see what I mean, here are a couple of tables from the Lynn and Kanazawa paper:

Lynn and Kanazawa tables

Notice the standard deviations are larger for males in every sub-sample. What they tell you is that even if the mean intelligence of men and women is the same, you expect far many more idiots and far many more geniuses among men than among women in most areas of human endeavor that require something identifiable as cognition or IQ.

But it’s not just at the tails; you expect to see more “pretty stupid” and “pretty smart” men than women. The female population simply displays less variance at all ends of the spectrum.

Neuroscientists are also finding that there is more variability in men’s brains than in women’s. Which is to say, patterns of variability in measures of cognition observed in the studies mentioned earlier are very likely to apply to other fields as well.

Now, consider making money. Everyone does it to some extent. But we should see more variation men’s earnings than women’s earnings.

Throw on one more detail: income distributions are truncated at the bottom. There is a minimum wage, after all. People simply don’t get paid less than that. But even in the absence of a minimum wage, people who don’t make enough to survive are very euphemistically removed from the distribution.  In fact, in most careers, there is a baseline and most people earn closer to that baseline than to the level that superstars in the field make.  People’s abilities may fall on a standard normal distribution, but incomes are described by something that more closely resembles a Chi-Squared distribution.

Which is to say, chunks are taken out from the bottom end of the female and male income distributions. However, a larger proportion of the low end of the male distribution is removed because, due to the larger male variance, more men fall below the floor.

That right there is the gender wage gap, as well as Edsall’s observation.

You disagree? Does today’s America’s differ from what you would expect in a world were men and women have similar intelligence, but men have a great deal more variance? If it does, tell me how.

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Gay Pride Around the World

We begin in the US:

…the Dyke March Collective also ejected three people carrying Jewish Pride flags (a rainbow flag with a Star of David in the center).
According to one of those individuals—A Wider Bridge Midwest Manager Laurel Grauer—she and her friends were approached a number of times in the park because they were holding the flag.

“It was a flag from my congregation which celebrates my queer, Jewish identity which I have done for over a decade marching in the Dyke March with the same flag,” she told Windy City Times.

She added that she lost count of the number of people who harassed her.

One Dyke March collective member asked by Windy City Times for a response, said the women were told to leave because the flags “made people feel unsafe,” that the march was “anti-Zionist” and “pro-Palestinian.”

“They were telling me to leave because my flag was a trigger to people that they found offensive,” Grauer said. “Prior to this [march] I had never been harassed or asked to leave and I had always carried the flag with me.”

Another of those individuals asked to leave was an Iranian Jew named Eleanor Shoshany-Anderson.

“I was here as a proud Jew in all of my identities,” Shoshany-Anderson asserted. “The Dyke March is supposed to be intersectional. I don’t know why my identity is excluded from that. I fell that, as a Jew, I am not welcome here.”

A statement posted June 25 on the Dyke March Twitter account read, in part, “Sadly, our celebration of dyke, queer and trans solidarity was partly overshadowed by our decision to ask three individuals carrying Israeli flags superimposed on rainbow flags to leave the rally. This decision was made after they repeatedly expressed support for Zionism during conversations with Dyke March Collective members.”

“Sadly, our celebration of dyke, queer and trans solidarity was partly overshadowed by our decision to ask three individuals carrying Israeli flags superimposed on rainbow flags to leave the rally. This decision was made after they repeatedly expressed support for Zionism during conversations with Dyke March Collective members.”

“People asked me if I was a Zionist and I said ‘Yes, I do care about the state of Israel but I also believe in a two-state solution and an independent Palestine,'” Grauer said. “It’s hard to swallow the idea of inclusion when you are excluding people from that. People are saying ‘You can be gay but not in this way.’ We do not feel welcomed. We do not feel included.”

In their statement, Dyke March Collective organizers singled out Grauer’s organization A Wider Bridge for what they called “provocative actions at other LGBTQ events [and] for using Israel’s supposed ‘LGBTQ tolerance’ to pinkwash the violent occupation of Palestine.”

Social-media posts in support of the Dyke March Collective also claimed that a rainbow flag with a Star of David is a form of pink washing (a theory postulated by a City University of New York professor which claims that Israeli support of LGBTQ communities is designed to detract attention from civil and human rights abuses of Palestinian people.)

At about the same time, in Turkey:

Turkish police on Sunday prevented an attempt by Gay Pride activists to hold a parade in Istanbul, the country’s largest city, in defiance of an official ban by the local authorities.
Police fired rubber bullets at a group of around 40 activists, an AFP journalist reported, a day after the city governor’s office banned the march citing safety and public order concerns.

Small groups gathered at Taksim Square but witnesses said there was a heavy police presence which outnumbered the activists, and at least four people were detained.

It is the third year in a row that the march has been banned, and organisers denounced the move.

“We are not scared, we are here, we will not change,” the Pride Committee said in a statement.

Of course they were not scared – there were no stars of David around.

In other gay pride news, last month in Tel Aviv:

Some 200,000 people took part in Tel Aviv’s Gay Pride Parade on Friday, of which approximately 30,000 had joined the celebrations from abroad, organizers said. With many roads closed to traffic for the occasion, the parade made its way through the heart of the city to the waterfront in a display of floats, music, dancers and rainbow flags.

It was the city’s 19th pride parade and according to Tel Aviv’s municipality, the largest in the Middle East and Asia, with a high number of international revelers arriving over the course of the week to take part in the parade and its related events. This year, the theme of the parade was “bisexual visibility.”

Not everyone at the parade was there to celebrate, however. Dozens of Israeli LGBTQ activists at one point blocked the Tel Aviv parade in protest against Israel’s occupation of the West Bank and East Jerusalem. The protesters erected a mock separation barrier upon which was written, “There’s no pride in occupation,” the website +972 Magazine reported. The protesters prevented the parade from proceeding through the city center for a few minutes, but were swiftly moved by police.

Pride parades are expected to be held in Be’er Sheva and Haifa and August in Jerusalem later on this month.

Also last month

A gay Palestinian man appealed to the High Court of Justice on Thursday to overturn the Interior Ministry’s decision to refuse him residency status, saying he risks death if he returns to the West Bank.

His petition testified that Palestinian police had arrested, tortured and severely beaten him because he is openly gay. Most members of his family have disowned him, and those who haven’t have warned him by phone to never come home, he stated.

The man has lived in Tel Aviv — widely hailed as one of the most gay-friendly cities in the world — with his partner for the last decade. The couple say that the Interior Ministry has repeatedly rejected their petition to legalize the Palestinian’s residence in Israel.

People who don’t understand how the world works do stupid things, make stupid assumptions, and ask stupid questions:

Why won't

Usually that sort of stupid brings on horrible consequences. Fortunately, the universe occasionally displays a sense of humor.
cbs sitcom

Click on images to embiggen.

 

More on the above photo here.

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George Borjas on the New Immigration Meme

George Borjas, perhaps the US’ pre-eminent immigration economist notes:

Maybe it’s just me because I instinctively read in between the lines whenever I read anything about immigration, but I’m beginning to detect such a seismic shift in the immigration debate. We all know the party line by now: Immigrants do jobs that natives don’t want to do. As a result, natives do not lose jobs, and natives do not see their wages reduced. And anyone who claims otherwise is obviously a racist xenophobic moron. They obviously don’t like immigrants, and they obviously are not educated/credentialed enough to understand and appreciate expert opinion.

The flurry of immigration restrictions proposed by the Trump administration demands a switch in tactics–with a corresponding switch in the argument linking immigration and wages. The party line must now be that less immigration is bad. But how can one show that in simple-to-grasp economic terms that can be mass-marketed to the masses? By far the simplest way is to come up with examples that less immigration raises labor costs and makes us miserable because everything becomes more expensive.

Borjas goes on:

There is no upper bound to the hypocrisy of experts. It might be a lot of fun to keep track of this over the next few years, watching the dominos fall and all those “immigration-does-not-affect-wages” experts fall all over themselves as they switch to proving the economic awfulness of Trump’s actions because fewer immigrants mean higher labor costs, higher prices, more inflation.

But don’t hold your breath for any admission that they were wrong in the past. They will instantly switch to the former party line the minute the Trump immigration restrictions fade into history.

I have nothing to add.

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Men, Woman, Cooperation and the Gender Pay Gap

Here is a working paper by Leonie Gerhards and Michael Kosfeld entitled I (Don’t) Like You! But Who Cares? Gender Differences in Same Sex and Mixed Sex Teams. The abstract reads as follows:

We study the effect of likability on female and male team behavior in a lab experiment. Extending a two-player public goods game and a minimum effort game by an additional pre-play stage that informs team members about their mutual likability we find that female teams lower their contribution to the public good in case of low likability, while male teams achieve high levels of cooperation irrespective of the level of mutual likability. In mixed sex teams, both females’ and males’ contributions depend on mutual likability. Similar results are found in the minimum effort game. Our results offer a new perspective on gender differences in labor market outcomes: mutual dislikability impedes team behavior, except in all-male teams.

Aside from that, the paper seems interesting though I should be fair and note I only had time to skim it. Still, if the paper holds up, it requires an explanation.

The first thing to note is that the paper deals with perceived likability rather than actual likability, and the measures come from how participants in the experiment rate photographs of other participants. However, these measures seem to be reasonably stable – an individual rated as likable by one person tends to be rated as likable by others.

Beyond this, we get to a very non-PC explanation for the results the authors found: men and women are said to approach social interactions differently. One often hears that men are more insensitive or otherwise don’t observe social cues the same way women do. There is also some evidence from biology that “males are predisposed to be more ready than females to repair their relationship.” Put another way – it would seem that in a group of people, men are less likely to have friction with others than are women. Two individuals who “get over it” are more likely to successfully cooperate than two individuals who maintain animosity toward each other. And even if only one person is unable to “get over it” that will negatively impact the team performance.

If this result replicates, and if it translates outside a lab environment, it may imply something about the gender pay gap. Playing well with others – coworkers, customers, and other third parties – is an important though often unstated part of every job.

As a sort of aside… I remember once watching a comedy sketch in which the comedian (sorry, I cannot remember who) talked about how, if two women found themselves at a party wearing the same outfits, they’d spend the rest of the rest of the party avoiding each other. On the other hand, according to the comedian, each of two men wearing the same outfit at a party, upon spotting each other would have a new best friend.

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Intelligence and Education

I’ve noted a few times that the political center needs to come to grips with research on genes and intelligence or we risk ceding the field to people with scary impulses and frightening goals. I think something like what the center-left position should be is reasonably well articulated by Richard J. Haier. Haier is a professor emeritus in the University of California at Irvine medical school, editor in chief of the journal Intelligence, and he was one of the signators of the Mainstream Science on Intelligence: An Editorial With 52 Signatories, History, and Bibliography in 1994.

Here is a recent article by Haier:

Historically, assaults on intelligence research were launched as a reaction to studies that suggested that average intelligence test scores were lower for some disadvantaged and minority groups. Combined with the possibility that intelligence might be genetically determined, this incendiary combination resulted in efforts to discredit the validity of intelligence tests and genetic studies. Concurrently, there was a single-minded focus on environmental factors as the predominant, if not only, influence on differences in mental abilities and the cause of achievement gaps.

This has led to 50 years of earnest and expensive but largely futile attempts to reduce education achievement gaps. These include focuses on early childhood education, raising students’ expectations, smaller classes, better teacher training, more testing and greater accessibility of challenging classes. Such interventions should not be expected to reduce gaps appreciably given the consistent research that shows that such variables do not influence academic achievement all that much – especially compared with the large effect of a student’s intelligence.

Education is for individuals. It does not matter if there are average intelligence differences among groups defined by poverty or race because there is more overlap than separation. As in modern medicine, any genetic influences, although real, are best thought about as probabilistic rather than deterministic. Basic neurobiology is the same for all humans, and both genetic and neuroimaging research connects neurobiology to intelligence. Understanding the complexities of how this works has potential for designing ways to improve mental ability and maximise education for all students, irrespective of background.

No one is well served by education reforms that neglect research findings on the nature of intelligence and its central role in student achievement. Neuroscience and intelligence research cannot solve all the issues of failing schools and education, but it is time to follow the data and add what we know from these perspectives to discussions about what research to fund, and what reforms to try next.

(The bolding is mine.)

While this may be anathema to much of our educational and academic establishment, it is, from what I can tell, pretty close to the position of the best -known researchers in the field like Stephen Pinker and James Flynn. Which is to say, the position is mainstream science on intelligence.

We ignore that at all of our peril.

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Cultural Appropriation

From the Canadian Broadcasting Corporation:

Indigenous advocates from around the world are calling on a UN committee to make appropriating Indigenous cultures illegal — and to do it quickly.

Delegates from 189 countries, including Canada, are in Geneva this week as part of a specialized international committee within the World Intellectual Property Organization (WIPO), a United Nations agency.

Here’s more:

Speaking to the committee Monday, James Anaya, dean of law at the University of Colorado, said the UN’s negotiated document should “obligate states to create effective criminal and civil enforcement procedures to recognize and prevent the non-consensual taking and illegitimate possession, sale and export of traditional cultural expressions.”

Anaya said the document should also look at products that are falsely advertised as Indigenous made or endorsed by Indigenous groups.

Canadians often aggravate peaceful and reasonable people all over the world. Because of that, it is no surprise to find Canada among the worst offenders when it comes to abuse of the indigenous population:

There are Indigenous groups from around the world taking part in this round of negotiations, including groups from New Zealand, Kenya, Mexico, Colombia and the United States.
There is no Indigenous representation in the Canadian delegation.

Officials with Global Affairs Canada, Innovation, Science and Economic Development Canada and Canadian Heritage are taking part in this round of negotiations, but the lack of Canadian Indigenous representatives is drawing criticism from the Assembly of First Nations.

In any scenario in which property rights are being assigned, there are always eager claimants. Fortunately, when it comes to the Canadian First Nations, one of the tribal elders and knowledge keepers can tell us precisely who are the authorities who should oversee the creation of guidelines and a process for utilizing Indigenous knowledge in any activities:

“The elders and knowledge keepers are the authorities who should oversee the creation of guidelines and a process for utilizing Indigenous knowledge in any activities,” Assembly of First Nations national chief Perry Bellegarde told CBC in a written statement.

But once again there is the issue of the exploitative nature of the Canadians:

There was no word on whether the federal government plans to consult with the AFN after this round of negotiations wraps up on Friday.

Now, I am not an attorney, but I cannot understand how this could work separately from the copyright and patent process. And to my knowledge, copyrights and patents don’t touch on culture. Nor to my knowledge do they get assigned to large groups of people and administered by a council of elders.

Culture, from what I can tell, is a tough thing to assign. For example, the Navajo (mentioned in the CBC article) are well known for their blankets, suggesting that production of anything resembling such blankets and their design should involve royalties paid to the Navajo. And for a new design, copyright laws work fine. But my reading of the UN’s intent is that older designs (say those that have been in use for a long time) or even the very concept of a “Navajo design” rate protection and payment to the Navajo tribe.

However, there is some evidence that the creation of those blankets is a recent phenomenon. It may be that a Spanish trader came up with the whole idea. It hasn’t, so far, been in anyone’s interest to dig very deeply into the issue. But, if it turned out that the concept of Navajo blankets is, in fact, the brainchild of some unwashed and forgotten Spaniard of a few centuries back, what then? Would the Navajo owe the Spanish three hundred years worth of royalties? And which Spanish people are owed? No doubt among the various claimants to the Spanish empire, a council of elders could be assembled. And of course, the council of elders would decide that the council of elders should decide.

If the UN goes the route it’s headed, someone will have to tackle problems like these. Plus, it isn’t going to stop with the rights of what tend to be called indigenous people. After all, the First People seem to actually be the second people, having mostly wiped the actual first people out. That, of course, is a sadly consistent feature of human history. With the possible exception of the San, every one of us descend from butchers who engaged in genocide and other atrocities.

In a world where “indigenous” seems to simply mean “former conquerors who have since been vanquished” here’s the sort of issue that will eventually come up: is it cultural appropriation for non Jews to treat Jerusalem as a Holy City? Even accounting for the UN’s anti-Semitism, that question alone will result in quite a show. So when it comes, get comfortable. Take out your mouth-plate, loosen up your piu piu, adjust your koteka, kick off your moccasins, put up your feet and enjoy.

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Where Have All the Unions Gone and Where Are All the Jobs?*

Economics is a simple field. Just about everything can be described in terms of supply and demand. If the supply of something is scarce but the demand for it is strong, its price rises. On the other hand, if there is a lot of supply but little demand, its price will go down.

Now, buyers and sellers can engage in certain strategies to weight the scales. For example, sellers of a product can band together (perhaps by buying each other out) to achieve some amount of monopoly power. Conversely, buyers of a product can collude to bid down the cost of purchasing.

This is, of course, true for the market for labor. And in the labor market, one classic way for sellers of labor (i.e., workers) to raise their bargaining power, and therefore their pay, is to band together into unions. What makes unions effective is that:

1. Union members commit to acting in concert
2. While it is easy for a company with a 1,000 person assembly line to replace a few people at a time without missing a beat, replacing all 1,000 at once would seriously crimp operations.

As a result, the cost of workforce dissatisfaction to a company with a unionized workforce is greater than the cost of workforce of dissatisfaction to a company without a unionized workforce. Therefore, a company with unionized workforce will, all else being equal, be willing to make greater concessions on pay and working conditions than the same company would be if its workforce was not unionized.

But a union is not a guarantee of anything. After all, a union can be broken. And all you need to break is to make sure there is a sufficiently large, inexpensive workforce capable of replacing the unionized workforce. There might be short term pain, but on paper at least, after that its all profit.

Which brings me to this story in the NY Times. Its about a small town in Iowa heavily reliant on the meat packing industry. Despite the Times’ clear and omnipresent bias that more immigration is always a positive thing, the following paragraph provides a good summary of the entire piece:

At that point, Mr. Smith returned to do night cleanup, earning $5.50 an hour with no benefits, but a vast majority of his former co-workers were turned away, he said, because the new owner did not want to hire union supporters. Instead, the company began actively recruiting in Mexico and immigrant communities in Texas and California.

If there are enough low-skilled immigrants, unions cannot compete. They chose to turn a blind eye toward illegal immigration because they felt it was good for business. Democrats also understood that decades ago and sided with unions. This is because Democrats felt it was good for society if factory workers could enjoy a middle class lifestyle. In the past decade, Democrats have changed. (The reason for this may be the subject of a future post.)

But regardless of politics, the facts are simple: except in very limited circumstances, one cannot simultaneously have strong both unions and virtually unrestricted immigration.

* With apologies to Bonnie Tyler. And my sympathies to American workers who also need a hero.

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Small Pieces of Academia

I’ve recently stumbled on a twitter account called New Real Peer Review. The twitter account is largely (but not entirely) dedicated to posting abstracts of journal articles and links to the papers. Here’s one such abstract:

This article explores the formation of a tranimal, hippopotamus alter-ego. Confronting transgender with transpecies, the author claims that his hippopotamus “identity” allowed him to (verbally) escape, all at once, several sets of categorization that govern human bodies (“gender,” “sexuality,” age). He starts with an account of how his metaphorical hippo-self is collectively produced and performed, distinguishing the subjective, the intersubjective and the social. The article then investigates the politics of equating transgender and transpecies, critically examining the question of the inclusion of “xenogenders” in the trans political movement. Finally, the author returns to the magical power of metaphors, arguing that metaphors do materialize insofar as the flesh does not remain unchanged by them. Analogizing his hippo-self to a “cut” as theorized by Eva Hayward – a regeneration of the boundaries of the self – he offers a final crossing to the world of fiction by showing how the His Dark Materialstrilogy outlines an aesthetics of porosity, which suggests that the self is, as much as a novel, a work of fiction.

The author has gotten an appointment as a visiting scholar at the U of Arizona. Here is the announcement from the Gender and Women’s Studies department:

GWS and the UA Institute for LGBT Studies welcome visiting scholar! Florentin Félix Morin is a French student who just started his PhD this year at Université Paris 8. He works at the intersection of Trans Studies and Animal Studies, focusing on tranimal body modifications, practices and subjectivities. He is beyond excited to be in Tucson for the Spring semester, benefit from all the department’s and the Institute’s activities, conduct fieldwork in the US, and meet everyone! (He uses the name ‘Felix’ in English.)

Welcome, Felix.  The U of A GWS department faculty also includes Professor Whitney Stark. Here’s the abstract of “Reconfiguring Quantum Identities,” a paper she recently wrote:

In this semimanifesto, I approach how understandings of quantum physics and cyborgian bodies can (or always already do) ally with feminist anti-oppression practices long in use. The idea of the body (whether biological, social, or of work) is not stagnant, and new materialist feminisms help to recognize how multiple phenomena work together to behave in what can become legible at any given moment as a body. By utilizing the materiality of conceptions about connectivity often thought to be merely theoretical, by taking a critical look at the noncentralized and multiple movements of quantum physics, and by dehierarchizing the necessity of linear bodies through time, it becomes possible to reconfigure structures of value, longevity, and subjectivity in ways explicitly aligned with anti-oppression practices and identity politics. Combining intersectionality and quantum physics can provide for differing perspectives on organizing practices long used by marginalized people, for enabling apparatuses that allow for new possibilities of safer spaces, and for practices of accountability.

I’ve always had a lay interest in physics, but Stark’s paper covers ground that is new to me.

Here’s some more college news.

To wrap up this post, I think it behooves society to a pay a bit more attention to what is happening on college campuses these days. After all, we (the public) are usually funding a big part of it, and colleges can be the tip of the cultural-change spear.  I am pretty sure most people don’t want to end up where some of academia is trying to lead us.

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Healthcare Costs, Externalities, and Changing Social Norms

One of the topics I’ve railed about many times during the decade and change in which I’ve been blogging is that society would be much better off if we forced people to pay the cost of negative externalities they impose on other people through their behavior. An obvious example would be making polluters pay for the cost that the pollution they emit inflicts on everyone else.

But it turns out there are a lot of these behavioral externalities in healthcare. For instance, here’s an infographic I took from Blue Cross Blue Shield:

screen capture bcbs unhealthy behavior healthcare cost 20170528a

I imagine there are a few instances where obesity is a medical condition due to circumstances outside the control of a patient’s willpower, but I suspect that accounts for very few cases. Most people in today’s America have the ability, during most of their life, to control to a fair extent how much they eat, drink, smoke and exercise.

Elsewhere, Blue Cross Blue Shield also tells us this:

screen capture bcbs cost of treating chronic diseases 20170528a

So assuming BCBS is correct, 86 percent of US healthcare costs come from treating chronic diseases. Chronic diseases include:

screen capture bcbs list of chronic diseases 20170528a

I am no doctor, but I understand some (and I hasten to repeat the word  “some”) of the conditions can, in some cases, be brought about by a person’s behavior. For example, HIV can come from unprotected sex with prostitutes or IV drug use, diabetes from poor dietary choices and lack of exercise, and some psychotic disorders can be brought on or worsened by by drug use.

What if, going forward, we should cease to cover the costs of health conditions brought on by a person’s own behavior (when they can be identified as such)? This would be disruptive, so I don’t think it should be done cold turkey, but rather the way Social Security benefits get cut by ratcheting up the age at which a person can get benefits. For example, we could simply state that on date X, any new cases of lung cancer which are traceable to a person’s tobacco use are not to be treated at the expense of Medicare or Medicaid, and private insurance companies might be encouraged to do the same.

Note – people who used to smoke, or eat unhealthy, or not exercise a long time ago might have been submitting to societal pressures. But for the past few decades, the world has been a different place. Societal pressures now are to eat healthy, eschew illegal drugs, avoid smoking, avoid drinking in excess, and to exercise. We’ve moved from “smoke ’em if you got ’em” to “if you want to smoke, you need to do it in the smoking section.” Then we went to “you need to go outside to smoke.” These days you see smokers forced to stand some distance away from many office buildings if they want to get their nicotine hit.  Next to where I work are some office buildings occupied by a health insurance company.  Smokers who work there seem to be forced leave the premises completely  (they are usually standing in the street, even in the rain).   For many people, getting lung cancer went from the cost of conforming to social norms to being a consequence of anti-social behavior.

So what would be the effect of taking the treatment for these conditions off the public purse? I’d say the following:

1. We would see some number of cases of fraud where people would insist their behavior did not induce some outcome. A lying patient is harder to treat, so I’m guessing this would go some way toward worsening the outcomes of successful fraudsters.
2. The life expectancy and perhaps qualify of life of people who self-induce these problems would go down.
3. The incentive of people to minimize these behaviors would go up. Of course, not all of them would respond the right way, but some would. Particularly in light of the life expectancy issue in point 2. Overall healthcare costs would go down.
4. The cost to the public would go down.

Thoughts?

(One comment… I am pretty sure I recently read something proposing some part of this recently, but for the life of me, I cannot remember what or where. My apologies if I’m inadvertently stealing someone else’s idea.)

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