Obamacare

The Truth About Health Care and Infant Mortality

Lack of access to health care does not explain America's infant mortality rate

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The American medical system has the latest technology, the greatest variety of new drugs, and unparalleled resources. But anyone who thinks we're getting something great for our dollars inevitably encounters a two-word rebuke: infant mortality.

The United States is the richest nation on Earth, but it comes in 29th in the world in survival rates among babies. This mediocre ranking is supposed to make an irrefutable case for health care reform. If we cared enough to insure everyone, we are told, we would soon rise to the health standards of other modern nations. It's just a matter of getting over our weird resistance to a bigger government role in medical care.

But not every health issue is a health care issue. The reason boxers are unusually prone to concussions is not that they lack medical insurance. Doctors may treat head injuries, but it's a lot easier to prevent them. Absent prevention, we shouldn't blame the medical industry for punch-drunk fighters.

Like life expectancy (the subject of a previous column), infant mortality is a function of many factors. The more you look at the problem, the less it seems to be correctable by a big new federal role in medical insurance—and, in fact, the less it seems to be mainly a medical issue at all.

No one denies the problem. Our infant mortality rate is double that of Japan or Sweden. But we live different lives, on average, than people in those places. We suffer more obesity (about 10 times as much as the Japanese), and we have more births to teenagers (seven times more than the Swedes). Nearly 40 percent of American babies are born to unwed mothers.

Factors like these are linked to low birth weight in babies, which is a dangerous thing. In a 2007 study for the National Bureau of Economic Research, economists June O'Neill and Dave O'Neill noted that "a multitude of behaviors unrelated to the health care system such as substance abuse, smoking and obesity" are connected "to the low birth weight and preterm births that underlie the infant death syndrome."

Nicholas Eberstadt, a scholar at the American Enterprise Institute in Washington, also attributes the gap largely to conduct. Comparing white Americans to Norwegians in his 1995 book, The Tyranny of Numbers, Eberstadt concluded that "white America's higher rates of infant mortality are explained not by poverty (as conventionally construed) or by medical care but rather by the habits, actions, and indeed lifestyles of a critical portion of its parents." Whites are not unique in those types of behavior.

African-American babies are far more likely to die than white ones, which is often taken as evidence that poverty and lack of health insurance are to blame. That's entirely plausible until you notice another racial/ethnic gap: Hispanics of Mexican or Central or South American ancestry not only do consistently better than blacks on infant mortality, they do better than whites. Social disadvantage doesn't explain very much.

Nor does access to prenatal care, as the health care critique implies. It used to be assumed that if you assured that pregnant low-income women could see a physician, their infants would do much better. Not necessarily.

When New York expanded access to prenatal care under Medicaid, the effort reduced the rate of low birth weight infants by just 1 percent. In Tennessee, after a similar effort, researchers found "no concomitant improvements in use of early prenatal care, birth weight or neonatal mortality."

So why does our infant mortality rate exceed that of, say, Canada, where health care is free at the point of service? One reason is that we have a lot more tiny newborns. But underweight babies don't fare worse here than in Canada—quite the contrary.

The NBER paper points out that among the smallest infants, survival rates are better on this side of the border. What that suggests is that if we lived under the Canadian health care system, we would not have a lower rate of infant mortality. We would have a higher one.

A lot of things could be done to keep babies from dying in this country. But the health care "reform" being pushed in Washington is not one of them.

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106 responses to “The Truth About Health Care and Infant Mortality

  1. This just in: Steve Chapman of Reason Magazine advocates legislation mandating lifestyle changes for the American people.

  2. t was once commonly believed that marsupials were a primitive forerunner of modern placental mammals, but fossil evidence, first presented by researcher M.J. Spechtt in 1982, conflicts with this assumption[citation needed]. Instead, both main branches of the mammal tree appear to have evolved concurrently toward the end of the Mesozoic era. In the absence of soft tissues, such as the pouch and reproductive system, fossil marsupials can be distinguished from placentals by the form of their teeth; primitive marsupials possess four pairs of molar teeth in each jaw, whereas placental mammals never have more than three pairs.

  3. The problem with Chapman’s analysis isn’t that he’s wrong. It’s that, *from the perspective of health care reformers* he’s wrong because everything that’s he’s identified as contributing to high infant mortality rates in the U.S. can be treated as a medical issue. The mentality of reformers would hold that all of these factors can be remedied by compelling people to submit to doctors.

    One thing I’ve seen little comment on in the health care “reform” discussion is that it isn’t just about a government take over of medicine, it’s also about a medical takeover of government. We already tend to have doctors as lawmakers (versus engineers in France) who see things in terms of medical paradigms, including bootlegging in a doctor-patient framework where it’s not appropriate.

    If anything should scare us, it’s a poster I’ve seen at the University of Chicago medical center (Michelle Obama’s old stomping grounds, a place, by the way, where she was very unpopular among the workers). The sign encouraged patients to take an “active role” in charge of their medical care. It even offered helpful suggestions: (1) ask medical staff for their IDs to prove they were supposed to be there; (2) ask what drugs they were giving you; (3) ask them where they are taking you. There may have been others there, but you get the picture. I found it terribly insulting and depressing. Despite the rhetoric about taking charge, it was clear that the freedom the hospital imagined was the freedom to do what they tell you to do and keep quiet about it. My experience with the hospital was that any attempt to assert your rights in any way that questioned the absolute authority of the doctors, even if they were wrong or idiots (both surprisingly common among neurosurgery residents) or even actively causing you physical harm (again, more common than you would like to think), it was seen as a hostile act on the part of the patient.

    So what frightens me about the medicalization of government is that it will give the cloak of authority to government to intervene more and more to “fix” societal problems is that this mentality in which patients (Lat. “suffering ones”) are the obstacle to their own welfare and must be compelled to do what they should. It will enshrine an oppositional mentality between the governing parties and the patients/governed. If medicine and government become more entwined than they already are, I can’t imagine that the results will be conducive to any real notion of personal freedom rooted in control of one’s own body. Instead we will increasingly see criminalization of behaviors that “harm” the body and more and more “public health” justifications for forced compulsion.

  4. “The United States is was the richest nation on Earth.”

    Fixed that for you. When you are deeply in debt and your credit score is in the crapper I don’t think you can be called rich anymore.

  5. Lots of things can cause babies to die, but denying the sick/dying babies access to healthcare (whether it be a brain doctor or a stomach doctor) ensures a lot of unnecessary dead babies.

    I think the boxer analogy is asinine. Deny boxers access to post-fight physicals and medical care, and many more boxers will die from fight complications. No matter what health problems are causing babies to die, denying them medical treatment all but ensures their fate.

    Now, I’m one who hates children and I think we have far too many children – we should have implemented a one-child policy like China 40 years ago. So I’m the last person who is going to balk over infant mortality rates. We have too many people. But saying better access to healthcare wouldn’t decrease our infant mortality rates is ridiculous on its face.

    And I resent the notion that America has all the latest treatments, medicines, etc. Due to the FDA bureaucracy it takes like 15 years to get a new medicine approved.

  6. I always thought that our infant mortality rate was higher because our pre-natal care was so good. In other words, our pre-natal care brings infants to full term that otherwise wouldn’t make it, giving them a fighting chance. That adds to the higher mortality rate.

    If true, that is the best argument against the two-work rebuke of “infant mortality”.

  7. Now, I’m one who hates children and I think we have far too many children – we should have implemented a one-child policy like China 40 years ago.

    It is too early on a Monday to read shit like this, you fascist asshole.

  8. Now, I’m one who hates children and I think we have far too many children – we should have implemented a one-child policy like China 40 years ago.

    Bruce hates human life, check. Thank Science you have no power. Are you completely oblivious to….oh, obviously, you are.

    And I resent the notion that America has all the latest treatments, medicines, etc. Due to the FDA bureaucracy it takes like 15 years to get a new medicine approved.

    You want bureaucrats to control all medical decisions but you resent the application of your own wishes because even you can recognize that they do not work in practice?

  9. Lots of things can cause babies to die, but denying the sick/dying babies access to healthcare (whether it be a brain doctor or a stomach doctor) ensures a lot of unnecessary dead babies.

    BruceM could you please provide one citation where a child in the United States was denied access to healthcare and died as a result? The example can not include a child whose parents failed to avail themselves of available assistance. Not having health insurance is not the same thing as not having access to healthcare.

  10. Adds to the higher infant mortality rate.

    Its early.

  11. You are all wrong. The infant mortality rate is so high because of the medical community. If the medical community would quit interfering with a natural process we would have a lot more live, healthy babies. The countries with the lowest infant mortality rates (i.e., The Netherlands) also have the highest at home birth rates and the lowest c-section rates. Most doctors think pregnancy is a disease. It is not.

    The essential problem with the medical system is their desire to be the only place to receive medical care. No one wants to talk about alternative medicine that is cheaper, safer and more cost effective. Insurance also drives this process by not paying for any alternative care

  12. You left out teen pregnancy as a risk factor for infant mortality.

  13. One thing conspicuously absent from this article is the increased role of surgical deliveries.

    The share of cesarean section births has increased dramatically in the U.S. in modern times. Not just for high risk pregnancies, but for all categories. Unsurprisingly, radical surgery has implications for mother and child. Unsurprisingly, obstetricians get paid way more for these type of deliveries.

    The libertarians among us would do well to study the plight of midwifes in the U.S., whose attempts to beat back this trend are shut down at almost every level (the case of Missouri is particularly interesting).

  14. You are all wrong. The infant mortality rate is so high because of the medical community. If the medical community would quit interfering with a natural process we would have a lot more live, healthy babies.

    Yeah those natural processes worked really well 100 years ago. You know, back when women and children routinely died during labor.

    No one wants to talk about alternative medicine that is cheaper, safer and more cost effective.

    1. Define what constitutes “alternative medicine.” You homeopaths are constantly moving goalposts on your definition.
    2. I notice you didn’t claim that alternative medicine works better.
    3. I’m assuming that’s what you meant by cost effective. So provide citations.

    Insurance also drives this process by not paying for any alternative care

    Of course they don’t, because when “alternative care” works (demonstrably in large sample, double-blinded clinical trials) it becomes a mainstream medical technique.

    The countries with the lowest infant mortality rates (i.e., The Netherlands) also have the highest at home birth rates and the lowest c-section rates.

    They also have the highest proportion of people with blonde hair. The government should subsidize peroxide!

    You new age cum basket.

  15. I agree, Ildiko. Not on the birthing part, but the alternative medicine part. There are lots of people who simply will not partake of alternative medicines in any way, be they old fashioned or think its crap or whatever. There are many people who prefer alternative treatments for the reasons you cited. And there are those of us who will try anything to get better from alternatives to standard hospital care. Insurance plans should be deregulated so they can offer coverages to meet the demands of their customers, rather than giving only those coverages approved by a given state’s Dept of Insurance, or Dept of Health, or both. Then people will be paying for what they want and the resulting statistics on health may lead people to one conclusion or the other as to what services are more effective.

    In other words, as I’ve been saying all along, the government needs to get out of the way.

  16. “You new age cum basket.”

    This is great. I’m stealing it.

  17. Untermensch,

    I’m missing a step of your logic, and don’t get the picture. How, exactly, does the presence of the “active role” posters prove that the hospital covets my medical freedom?

  18. A basket is an inefficient way to move or store ejaculate.

  19. Ildiko: I understand what you mean by treating pregnancy as a disease. Heck, my wife’s OB/GYN made a similar reflection to me as well. That said, the major problem has to do with tort laws. The problem with them isn’t the payouts from tort suits per se. That said, when you know that one off day in the office will get you permanently banned from your job (from the inability to get malpractice insurance that already costs a ton), the panic from doctors is understandable. If this system could be fixes so that every pregnant woman isn’t a tightrope walk for the doc, things could be a bit better.

  20. A basket is an inefficient way to move or store ejaculate.

    Not true. It is my understanding that the ancient Mayans used to weave baskets with the sinew of llama scrotum to carry their loads of the highly coveted parrot seamen to market.

  21. A basket is an inefficient way to move or store ejaculate.

    Of course they are, when they’re manufactured. But new age cum baskets are natural.

  22. Doesn’t the United States record infant mortality rates differently than the countries we’re comparing?

  23. A) Have you seen the price of llama scrotum sinews these days? Astronomical. And it’s not exactly and animal-free product, is it?

    B) Parrot semen is 50-60% thicker than human semen.

    C) Natural semen basket-weaving techniques died-out with the Chatterquak tribe of upper northwestern central Michigan. I don’t remember any tea party protest about their deaths.

  24. You’re right, Bo. I live in Missouri, and have followed the midwife issue here – this state would, if they could, outlaw midwifery… they just haven’t found the balls to do it yet. Sad, really, that those in power don’t stand up for this venerable practice.

  25. ben tej,

    The video doesn’t say much to me about home birth. Seems like that poor woman’s real problem is that her husband and sister aren’t doing a damn thing about the Rover that’s attacking her.

  26. My understanding is that most other countries define extremely premature babies (

  27. “Now, I’m one who hates children and I think we have far too many children – we should have implemented a one-child policy like China 40 years ago.”

    I always find it the apex of irony that those who were fortunate enough to successfully be delivered have the “luxury” of deciding whether the next generation should enjoy the same opportunity.

    “So I’m the last person who is going to balk over infant mortality rates. We have too many people.”

    WOW! Even from the most impassioned posters here at H & R, I very rarely see the word “hate” used, except for metaphorical hyperbole. I certainly hope Obamacare won’t recognize your possible emotional neurosis; they could send you to “medical re-education”.

  28. I have read that one reason the statistics are skewed is that most countries define extremely premature babies (less than 24 weeks?) as stillborn, but the US doesn’t, which means that those babies count towards our infant mortality rate but not other countries. I’m not sure if that’s true, or how much of an effect it has on the overall number.

    Has anyone seen a credible analysis of that claim, and/or an adjustment to the statistics to account for it?

  29. A) Have you seen the price of llama scrotum sinews these days? Astronomical. And it’s not exactly and animal-free product, is it?

    C) Natural semen basket-weaving techniques died-out with the Chatterquak tribe of upper northwestern central Michigan. I don’t remember any tea party protest about their deaths.

    Put these two together and what do you get? Exactly, Exxon. I think there can be little question, at this point, that the people at Exxon traveled back in time so that they could cause the extinction of the Noble, semen collecting, Chatterquak natives so that they could corner the future “Synthetic llama scrotum sinew” market. It will be worth billions!

    What is not known is how synthetic llama scrotum sinew baskets actually cause parrot seminal fluid to loose 75% of it’s potency!

  30. What is not known is how synthetic llama scrotum sinew baskets actually cause parrot seminal fluid to loose 75% of it’s potency!

    That even one parrot might not be inseminated with the optimum semen is a crime corporate America must pay for! EXTERNALITIES!

  31. “Has anyone seen a credible analysis of that claim, and/or an adjustment to the statistics to account for it?”

    Qouting from Sally Pipes in “The Top Ten Myths in American Healthcare”:

    “The WHO defines a live birth as any infant that, once removed from its mother, ‘breathes or shows any other evidence of life such as beating of the heart, pulsation of the unbilical cord, or definite movement of voluntary muscles.’ The US follows that definition – counting the births of all citizens that show any sign of life, regardless of birth weight or prematurity.”

    “Other nations are far more conservative. In France, for instance, the government requires a ‘medical certificate stating that the child was born alive and viable’ in order to attest the death of a baby. In Switzerland, ‘ an infant must be at least 30 centimeters long at birth to be counted as living.’ In France and Belgium, babies born at less than 26 weeks are automatically registered as dead.”

    “Plus, the US has very sophisticated (and very expensive) neo-natal units. These help doctors keep premature babies alive, but such babies are at extremely high risk.”

  32. In the past 25 years the only babies I remember not doing well were either multiple births through in vitro fertilization or had genetic problems. That’s it. There’s a cost for mutiple births and I know this procedure is done more in the US than other countries.

  33. …we should have implemented a one-child policy like China 40 years ago.

    I wonder who you think will pay the taxes to pay for the welfare state you believe you’re entitled to have take care of you.

    Homegrown welfare statists have been lamenting for years the fact that the USA is the only country that does not directly subsidize having children with direct cash payments the way that countries like Canada, Australia and France do. Sort of the same refrain they sing about Universal health Care.

  34. Now, I’m one who hates children and I think we have far too many children – we should have implemented a one-child policy like China 40 years ago. So I’m the last person who is going to balk over infant mortality rates. We have too many people.

    I’m going to have to side with Groovus Maximus more or less…

    You do realize that you are part of the We, right?

  35. The Progressive Solution is quite obvious.

    Let Barney Frank be the surrogate mother.

  36. This just in: Steve Chapman of Reason Magazine advocates legislation mandating lifestyle changes for the American people.

    I’ll take your word for it; I stopped wasting my time on Chapman quite some time ago.

  37. Now, I’m one who hates children and I think we have far too many children – we should have implemented a one-child policy like China 40 years ago.

    Any siblings? We could start with you retroactively and see how it goes.

  38. There are quite a few factors for infant mortality in the US, some mentioned already.

    An neonate (infant) in the US is defined as a fetus no longer ‘in situ’ within the mother, whether vaginal or C-section delivery, clinically induced or spontaneous.

    Age and medical history of mom is of course primary. Genetic factors (ethnicity is most germane) are secondary, since this component may not be evident until post-partum.

    Teen pregnancy and mom’s opting for pregnancy later in life (40y

  39. Odd, my post was shortened. I have been given the H & R posting equivalent of a bris.

    First time was bad enough (luckily I was only seven days old, so I can only assume).

  40. +). The former because when menarche onsets early (8 to 12y), the gestanate’s body, pelvic cavity in particular is inadequate for vaginal delivery, i.e. Ceasarian. It is standand OB/GYN protocol that all subsequent deliveries are C-sec. The latter is higher risk as the ovaries “poop out” at that time as the body is preparing for menopause: the risk for miscarriage, congenital defect (aneuploidy, polyploidy, and sex-linked defects such as Down’s synd.) goes up considerably. C-section is also indicated for malpositioned fetuses, determined by ultrasound and Leopold’s maneuver. C-section is also elective as well as more women are requesting the procedure

    It is now not unusual to see neonates at young as 22-25 weeks in a specialized NICU, which is increadible since this was not possible as little as 12 years ago (though these babies are at great risk for infection as humoral immunity and lung surfactant are not deveoloped or present).

    Preganancy is classified as a medical condition, not a “disease process” (however disease processes such as pre-ecclampsia, gestational diabetes, and placenta abruptio are secondary to pregancy).

    I am not an OB/GYN practioner (I am a general surgeon, sub-specialty in bariatrics) and I am very much in favor of midwivery if Mom’s physical condition will permit (cheaper too).

    OB/GYN’s have the highest malpractice insurance rates, as the practitioner is responsible for 2 (or more) lives, and up to the age of 18 for the child(ren) medically speaking. Anesthesiologists are second highest, since there job is to keep you from feeling pain during a surgical procedure, either local, conscious sedation (MAC), regional block, or general anesthetic. Third is anyone who wields a scalpel (varies within specialty and years of training/practice).

    As far as the disparity regarding ethnicity, obesity, hypertention, diabetes, blood diseases and dysplastic uterus in the black and native american populations occur at higher rates than whites in the US and also contribute higher risks of infant mortality.

    Also of personal note is when I was going through training and residency, OB/GYN was my least favorite, not because of children and babies, but the Moms! Hey-soos Hysterectomy Cristos! Particulary those who went ahead and decided to get pregnant even though they were medically advised NOT to have children due to H & P, age, etc. Patients (and they have the right to do so) have a nasty habit of not following orders or advice because they heard soemthing else from an unreliable source, or just plain obstinant. I’m all for patient empowerment, it’s your body; however, amoung those engaged in their care have higher rates of therapeutic compliance and much better outcomes. And of course, the drug addicted moms, FAS babies, and HIV/STI babies complicate matters. Also of note, and the etiology/pathogenesis is still unknown, is SIDS (Sudden Infant Death Syndrome).

    As an osteopathic physician, I am very open to alternative TX that are PROVEN (i.e. measurable) to have therapeutic benefit, such as accupuncture/pressure, nutritional therapy (not a big fan of health food store supplements as most are not proven to do squat and can actually be dangerous or lethal co-comitantly taken with traditional RX).

  41. “First time was bad enough (luckily I was only seven days old, so I can only assume).”

    I was there and it was bad. Rabbi Mermelstein had the DT’s something fierce. You were a little trouper though, we were all proud.

  42. It is my understanding that the ancient Mayans used to weave baskets with the sinew of llama scrotum to carry their loads of the highly coveted parrot seamen to market.

    Damn, who gets stuck with the unlucky job of jacking the parrot off? How do you jack off a parrot? Do you have to blow the parrot? Would you use a straw?

  43. You sound a little too interested, troy.

    Psittacidaephiliacs disgust me.

  44. Untermensch

    “it’s also about a medical takeover of government. We already tend to have doctors as lawmakers ”

    This is a non-sequitur. Government always has a tendency to look to educated idiots in the creation of busybody legislation. This is why we have the war on drugs. This is why we have so many anti smoking laws. This is also why we have such a mess in the economy.
    The best government is “of the people, by the people, and for the people”. Education or means should not ever give anyone better influence than anyone else, but it does. This is a completely separate issue from health care insurance. Authoritarianism is a constant evil, and democracy must always fight against it. The people must be in charge of the government, and always fight against government that wants to be in charge of the people.
    This said, the debate on health care reform is very much between insurance companies and government. If the government takes full charge of the health insurance, rather than the piecemeal efforts of medicaid, some companies would cease to exist. So what? Business comes and goes. No business is as important as the people that work there. If people can not spend their money at one business, then they will spend it at another. As consumers spend their money, employment opportunities arise and strengthen . Business must protect itself. Government must protect its citizens. Whether this protection comes in the way of police services or medical services, it is the same thing. We do want the police available to us. We don’t want them breaking down our doors. We want the doctors available to us. We do not want them dictating our life styles, even if they often think it might be for our protection.

  45. This is the worst article ever. Go over to Mises.org and you can read an article detailing that one of the reasons our mortality rate is so high is because we have an honest accounting. There are circumstance or periods of time in which a nation won’t count an infant death.

  46. Mermelstein??? Shit, no one ever told me THAT! I’m. Feeling. Woozy. Repressed. Mammaries…..

  47. Seems to me this amounts to nothing more than a rather absurd twist on American exceptionalism.

    It’s our uniquely American habit of being fat lazy slobs that accounts for our health problems! And dadgummit we aren’t gonna change for nobody!

  48. Also of personal note is when I was going through training and residency, OB/GYN was my least favorite, not because of children and babies, but the Moms!

    Groovus, I’m sure you’re aware, the nervous white liberal educated in vitro mom’s tend to be classified as “high functioning/high needs” patients by the medical community. Often more difficult than the low-functioning/high needs patients.

  49. Not the best written article I’ve read on Reason. Not sure if I know any more about this than I did before.

  50. Sean

    Chapman writes for the mainline press. His real audience is people who have had limited exposure to libertarian thought.

    Hence his columns often seem unsophisticated and simplistic to us fart smellers.

    But there are people who may never have heard any of this before and have been swallowing the line fed them by everone else.

    Even so, I still won’t give him a pass for writing that article against lowering the drinking age a while back. That one was really dumb. And scarcely libertarian.

    Mind you, with the way newspapers are going these days I suspect his audience is shrinking by the day.

  51. It’s our uniquely American habit of being fat lazy slobs that accounts for our health problems! And dadgummit we aren’t gonna change for nobody!

    We certainly aren’t going to change for you, Tony.

  52. Paul, it wasn’t just the IVF/GIFT/ZIFT white liberal mommies-to-be, it was just mommies-to-be in general. Granted, pregnancy is an incredible stressful circumstance for all concerned (quite frankly with the variables involved with gestation, I’m amazed we get out of the womb at all); yet, the thing that got me was the evironment of “Relax, you will have the perfect baby and everything it will be alright.” I thought it was a bit unrealistic to promise the world without tactful reminders of risk.

  53. I think Tony is pregnant.

  54. I think Tony is pregnant.

    Nah, his belly is just distended ’cause he can’t stop drinkin’ all that Haterade.

  55. Anyone who brings up this point when arguing against current US health care is either a liar or a retard.

    Ignore anything else they say.

  56. This is just another in a long line of lame attempts by libertarians to justify a problem in America with after-the-fact rationalizations in order not to admit that our country has systematic problems.

    Infant mortality is directly linked with poverty in this country, and less so in other countries with fuller access to health care regardless of wealth status. This is the most parsimonious explanation for the disparity.

    I mean fuck. We’re supposed to accept abysmal infant mortality rates and an abysmal health system over all because of American exceptionalism (we innovate… and we’re fat and unhealthy, go America!)? That’s just twisted and insane.

  57. @Allan Manchester:

    This is a non-sequitur.

    Methinks you don’t know what that term means, so I’m not sure what you’re arguing against in what I wrote. I stated no logical premises and made a statement. To have a non sequitur there have to be premises from which the conclusion doesn’t follow (the literal meaning of the Latin). I’m not trying to be pedantic here, but I have no idea from what you’re arguing that my statement doesn’t follow.

    Of course, the fact that you quoted part of one of my sentences with no context (and in a way that leaves off a big chunk of its meaning) doesn’t help make it clear what you’re arguing against. In any event, even after I read your response I still have no idea what it is in what I wrote that you’re arguing against. As best as I can tell, your point is that government doesn’t need a medical paradigm to be oppressive. You’ll get no argument from me on that, but that doesn’t mean that a medical mindset and treating societal issues as health issues doesn’t suggest particularly oppressive ways of dealing with them. After all, look at the way medical “public health” paradigms are being used to impose taxes and try to limit all sorts of things.

    My statement was meant to imply that when you get the medical profession so entwined with government, the government is of necessity going to adopt a medical viewpoint. The leading profession (or one of them) of legislators in the U.S. was already doctors. Other countries elevate lawyers or engineers. So all I was stating was that there is a pre-existing tendency in the U.S. for many legislators to see things from a medical paradigm (rather than from an economics, or engineering, or some other sort of paradigm).

    But if we have the government take over health care then a huge portion of the government will consist of health care employees and health care interests and perspectives will be endemic in the government.

  58. And that treating citizens as “patients” is hardly conducive to freedom. I can’t see a similarly oppressive and systematic framework for thought among engineers or economists.

  59. We’re supposed to accept abysmal infant mortality rates and an abysmal health system over all because of American exceptionalism (we innovate… and we’re fat and unhealthy, go America!)? That’s just twisted and insane.

    How about I accept it because it is none of my business? Should you wish to make it yours I can point you to dozens of legitimate charities who do exactly what you want the state to do, only much better.

  60. A very important consideration is who is doing the counting and the counting criteria. In the USA, if a baby has any chance at all of living, doctors will try everything to save it. Babies born at 22-23 weeks run up huge bills. If the baby dies, its death is recorded as a live birth and infant death. In many other countries, that baby’s birth is not counted as a live birth and so the statistics are not comparable.

  61. Paul, it wasn’t just the IVF/GIFT/ZIFT white liberal mommies-to-be, it was just mommies-to-be in general.

    I live in Seattle, so… mommies-to-be tend to be older, educated yuppies who are obsessed with food miles and organic produce.

    My wife (a liberal Democrat) strangely didn’t really get into the bizarre over-indulgence of her own paranoias. I dunno, maybe because she knows she wouldn’t have had me on board with that. I remember standing with her at a pre-natal birthing class talking to another pregnant mom who was telling us how hard this was because she had to cut everything “bad” out of her diet, like coffee. My pregnant wife smiled and nodded while gripping her double-shot Grande latte.

  62. I mean fuck. We’re supposed to accept abysmal infant mortality rates and an abysmal health system over all because of American exceptionalism (we innovate… and we’re fat and unhealthy, go America!)? That’s just twisted and insane.

    Tony… please. Slow down with words like ‘abysmal’. It’s been pretty clearly debunked that the reason our mortality rates are higher in this country has to do with counting methods. A lot of those egalitarian countries with ‘low’ mortality rates either keep poor records, or call any infant that lives for less than 24 hours a ‘do-over’.

    This obsession with mortality rate in this country is obfuscating by design. We have the best prenatal care in the world here in the U.S.– and largely free to poor people. If you think only rich folks were in the NICU where my wife worked? You got another thing comin’.

  63. I had always suspected that the poor infant mortality performance of the US was the result of statistical apples and oranges. Either it was the result of superior healthcare that brought more risky pregnancies to term, or it was due to more optimistic categorization of “live birth” in the US as compared to other places. I’d be happy to read a factual rebuttal of both of these, but I only seem to ever see repetitions of the national statistics as if they are all apples.

    Chapman’s article is the first I’ve read suggesting a cause other than the lack of a national health service. I’d like to see some numbers supporting it before I’d be ready to accept that obesity rates are the real cause.

  64. I had always suspected that the poor infant mortality performance of the US was the result of statistical apples and oranges. Either it was the result of superior healthcare that brought more risky pregnancies to term, or it was due to more optimistic categorization of “live birth” in the US as compared to other places.

    You are 100% correct.

  65. Is it a fact that other countries use a different criteria than we do to establish infant mortality.
    I believe we count infant death if at some point during birth the baby dies.
    Don’t other countries use a time frame of 3 to 4 days before counting the death of an infant. In other words if a child dies at birth or up to a 3 or 4 day time frame after birth the statistic is not recognized.
    It would be interesting if we all used the same system. Perhaps new standing would appear.

  66. Don’t other countries use a time frame of 3 to 4 days before counting the death of an infant. In other words if a child dies at birth or up to a 3 or 4 day time frame after birth the statistic is not recognized.

    Yes, it varies widely from country to country, and even culture to culture.

  67. So we have a pathetic infant mortality rate because our healthcare system is so good. Got it.

    You know, there is a striking lack of thinking that goes into the inane talking point about the US healthcare system being superior. A good metaphor I heard was that we have islands of excellence in a sea of mediocrity. We may have the best care in the world, but we also one of the worst systems.

  68. So we have a pathetic infant mortality rate because our healthcare system is so good. Got it.

    Tony, you can’t be this stupid. You can’t be. So I’ll assume you’re not this stupid, and are just being annoying.

    Yes, Tony, if I’m a golfer, and I give myself multiple mulligans on every hole, my scorecard might actually look better than Tiger Woods’ scorecard– even though Tiger Woods is the better golfer. Let that soak in for half an hour (Oh yeah, I promised I wouldn’t assum you’re stupid).

  69. I guess I’m too stupid to make up fantastic rationalizations for the sad state of our healthcare system in order to defend a status quo everyone thinks is embarrassingly bad except of course the insurance industry and you guys.

  70. Tony, almost no one here defends the “status quo”. We want a revolutionary change in healthcare (I’ll let you search the site to learn what those changes are), Obama et. al. wants more the of the same… emphasis on the word “more”. Ie, since government does so well with Medicare and the VA, we’re going to give it an even bigger role in healthcare.

  71. And I joez-lawed myself so… before anyone catches it I thought I’d fess up to it.

  72. My daughter would be dead if we had used a midwife.

  73. Tony | August 24, 2009, 4:41pm | #
    So we have a pathetic infant mortality rate because our healthcare system is so good. Got it.

    Actually, Tony, there is a lot of merit to this point. I once saw a peer-reviewed article that found that essentially the entire difference between France’s infant mortality rate and ours occured during the first 24 hours, yet we are just as good as them from hour 25 through the first year (the standard definition of “infant”). The article surmised that the differences in mortality rate were not of health care quality but rather in the definition of “live birth”.

    Our system isn’t BAD…it is simply mediocre, for twice the price and and with half the security.

  74. My daughter would be dead if we had used a midwife.

    I have no problem with midwives. For healthy uncomplicated births, they’re cheaper and just as good (maybe better) for both mom and child.* But any couple delivering by midwife in the comfort of their spacious bathroom for the natural water-birth should always have a solid plan B if something goes sour.

    *We had our baby at the Group Health birthing center which made the rooms look like master bedrooms. They were wood paneled with lots of indirect lighting. Personally, I thought it was a great experience. Oh yeahs… our healthcare is teh pathetic and our baby was undoubtedly teetering on the brink of death due to our third world conditions. I almost forgot. We may as well have had our baby at the city dump under a cardboard box.

  75. “It’s our uniquely American habit of being fat lazy slobs that accounts for our health problems! And dadgummit we aren’t gonna change for nobody!”

    Well, Comrade Tony, your fearless leader and his minions are working on the Fat Tax, broader smoking bans, and forcing restaurants to stop using trans-fats… all that’s missing is a mandatory daily calisthenics program.

    So, get the lead out, and start pushing for more laws to force us to be healthy. What’s keeping you, prickface? You know you want it.

  76. The complaints about Cost are not complaints about quality. Would you rather complain about the price of a Ct of the Soft Tissue Neck, Chest, Abdomen and Pelvis every 4 weeks w/ Lymphoma.. or… Complain about being on a waiting list for 6 mos w/ lymphoma. No one in the world comes close to our cancer survival rates.

  77. The Libertarian Guy | August 24, 2009, 5:58pm | #

    all that’s missing is a mandatory daily calisthenics program.

    Naah, we just need to stop subsidizing automobiles, oil, and the related infrastructure, and poor that money into public transit and walkable spaces in order to offset decades of mis-allocated resources.

    God forbid, people might have to walk ten minutes to the bus stop or subway station instead of rolling themselves ten feet to their SUV.

  78. ben tej,

    The video doesn’t say much to me about home birth. Seems like that poor woman’s real problem is that her husband and sister aren’t doing a damn thing about the Rover that’s attacking her.

    Should have prefaced that the video was purely for humor’s sake (“HER HEAD IS SO BIG!!!”) and not a rebuttal. I was looking for a different one my brother in law had shown me on YouTube before (which had been shown to him by someone trying to convince his wife to have a home birth), but didn’t have enough time to locate before work. This lady literally squats and just craps out this baby in like 4 seconds. One of the most unbelievable things I’ve ever seen. Was decidedly more disgusting than the other as well.

  79. Chad, as someone who has to drive about fifteen miles to work – where I get in another vehicle and deliver office supplies, payrolls, court documents, and print-shop products, among other items – your fantasy world would put me and thousands of other people out of work.

    Unless you think I could get all that work done on foot…

  80. Naah, we just need to stop subsidizing automobiles, oil, and the related infrastructure, and poor that money into public transit and walkable spaces in order to offset decades of mis-allocated resources.

    I agree. However, some prickly issues arise with this which might give the Obama administration pause.

    1. Subsidizing automobile companies. Well g’bye stimulus, cash for clunkers, auto bailouts, UAW protections.
    2. What you’re suggesting is without oil subsidies, the price of oil would be much, much higher. Doh! Stop all the senate investigations when the price of oil goes up sharply.
    3. As for subways and light rail (something us progressive western cities are implementing at break-neck pace) well, people just don’t seem to want to ride ’em. And those that already do ride the public transit, don’t much like it.

  81. Heyo… I drive 40 miles a day to work and back! Hooray for Los Angeles. And *gasp*, like most people I stop at the grocery store on my way home, and I barely drive at all on the weekends. How utilitarian of me!

    That said, Chad’s right that we shouldn’t subsidize oil or automobiles. However. He seems to forget to note that in virtually all cases, the taxpayers are also on the hook for light rail, subways, monorails, Amtrak, city buses, special needs transportation, etc. etc. etc.

    How about we stop subsidizing all those things too while we’re at it, keep a ton more of our own money and let the chips fall where they may eh? I’d have several hundred dollars a year more in my own pocket and I’d still need a car.

  82. I’m curious… The only city I’ve ever lived in in which public transit was worth the price of admission was New York. Now part of that has to do with the frequency the trains run, and the redundancy (a byproduct of the system’s private, highly competitive roots) allowing me to get within a few blocks of where I’d need to go at any time… But the biggest reason it’s great is simply geography. Manhattan is a small island. Getting cars on or off it is a pain as you have to wait 20 minutes just to get through the bottleneck at one of the bridges. I didn’t have a car the whole time I lived there (I barely know anyone who does to this day), and I wouldn’t have wanted one either… However… I lived in Astoria, Queens – right across the river from Midtown. IF I’d lived in, say… Jamaica, I’d have wanted a car regardless.

    Now that I live in L.A., I wouldn’t take public transit unless you paid me and I had absolutely nothing else to do with my day.

  83. Ugh… the “I’m curious” part meant to be, “I’m curious – does anyone prefer public transit outside of New York?”

  84. Paul | August 24, 2009, 7:09pm | #

    3. As for subways and light rail (something us progressive western cities are implementing at break-neck pace) well, people just don’t seem to want to ride ’em.

    Of course not. We subsidize the competition in every way.

    And those that already do ride the public transit, don’t much like it.

    Try riding a bus in Europe or Japan. It’s a perfectly boring and normal experience. Yes, riding an American bus through the crappy part of town ain’t all that great. However, there is a feedback at work here. The worse it gets, the fewer “good” people ride the bus, which only encourages the bad people to misbehave. In a place like Japan, where just about everyone rides public transit, the mischief-makers get subdued by the mass of normalcy.

    Sean W. Malone | August 24, 2009, 7:30pm | #
    Heyo… I drive 40 miles a day to work and back! Hooray for Los Angeles. And *gasp*, like most people I stop at the grocery store on my way home, and I barely drive at all on the weekends. How utilitarian of me!

    Glad do see that you are part of the problem, Sean. I wouldn’t have guessed otherwise.

    That said, Chad’s right that we shouldn’t subsidize oil or automobiles. However. He seems to forget to note that in virtually all cases, the taxpayers are also on the hook for light rail, subways, monorails, Amtrak, city buses, special needs transportation, etc. etc. etc.

    I am perfectly well aware of it. All transportation systems will be subsidized, always. Get over it. It is only a question of which ones we should subsidize how much. Arguing about what would happen if all subsidies were dropped, or if no subsidies had ever been, is purely academic.

    Sean W. Malone | August 24, 2009, 7:35pm | #
    I’m curious… The only city I’ve ever lived in in which public transit was worth the price of admission was New York.

    DC is decent. Nothing else in the US is worth squat. Try living abroad. It will open your eyes.

    The value of a transportation system scales roughly as its number of nodes SQUARED. Our public transit system is small and patchworked, which keeps its value low. However, each additional line increases the value of every line connected to it. At some point, you reach a self-sustaining critical mass. However, it is perfectly possible to get stuck in an economic “valley” where building one more line is not profitable, but building a hundred or a thousand would be. That is where we are now.

  85. ben tej,

    Re “1. Define what constitutes “alternative medicine.” You homeopaths are constantly moving goalposts on your definition.”

    That wasn’t my comment you were referring to, but why do you instantly jump to accusations of ‘homeopathy’ (the definition of which, I think, you are a bit fuzzy on)?

    The homeopathy vs. allopathy distinction has nothing to do with any call for more access to (i.e., less legal restriction on access to) ‘alternative care’. If you’re looking for a quick digest of ‘alternative medicine/care’, look to CEO of Wholefoods Mackey’s blog entry that was published as an editorial.

    As for the “100 years ago” quasi-ad-hominem attack…puhleeze! You anti-‘homeopaths’ are always jump to accusations of snake oil salesmanship whenever someone mentions what a clear win alternative care is over “conventional medicine”. As if your beloved M.D.s had any clue as to what good science is at its core. I could rattle off 100 different reasons why (e.g., that chemo is still prescribed for lung cancer when it doesn’t have a statistically significantly better prognosis than doing nothing, etc., etc.), but I’ll let you find those out for yourself.

    I’m wondering, when you levy the “that shit worked like 100 years ago and shit, dude!”-type critique, whether you had scientifically sound medical studies in mind. Or are you just expecting us ‘homemopaths’ [sic.] to provide detailed figures while you are absolved from doing so? (Cuz it’s scientific and shit.)

    Oh, and not being a new-ager or a cum basket (or in any way hippyish), your final remark smacks of closeted new-age cumbasketry, you douchebag.

  86. I can’t quantify this unfortunately, but there is one other major contribution to our high infant mortality rate that wasn’t mentioned: hospitals and C-sections.

    The WHO states that any nation that exceeds a 15% C-section rate is needlessly putting moms and babies at risk. The US? Well over 30% and climbing!!! Remember, a C-section is a major abdominal surgery, and brings with it all of the potential complications of any surgery: infection, anesthesia problems, and even death for mom and baby.

    (Unfounded assertion) I was told by a midwife that there are a large number of elective “early C-sections” (a la Britney and such — fewer stretch marks!). This would contribute to the lower overall average birth weight, but I’m not sure about how much more (if any) it affects the infant mortality rate.

    The C-section rate for home birth? (No, not the people still convinced that Obama’s from Kenya!) About 4%!

    Note: I deliberately tried not to throw too many numbers in here without references… look it up yourself. There’re some scary stats out there, especially when you start thinking about the vast difference in reimbursement rates for C-sections vs. “natural” or vaginal births, and the fact that most of a hospital’s revenue often comes from their O-B and birth divisions.

  87. … chemo is still prescribed for lung cancer when it doesn’t have a statistically significantly better prognosis than doing nothing…

    I hear this often from alternative medicine supporters, always in the same way you have just stated it, i.e. thrown out as an isolated factoid without sources or context. Do you have a source or did you just hear that somewhere? I am really curious.

  88. “The countries with the lowest infant mortality rates (i.e., The Netherlands) also have the highest at home birth rates and the lowest c-section rates.”

    Couldn’t it throw off the record-keeping a little if people are having babies at home? I mean, for infant deaths during or shortly after birth, that don’t occur in a hospital, is it certain that many of them are properly making it into the statistics?

    “The WHO states that any nation that exceeds a 15% C-section rate is needlessly putting moms and babies at risk.”

    Like I give a shit what Pete Townshend thinks about medical issues. Know your place, you busybody liberal celebrities!

  89. I got into a midwifery argument with a local Democrat a while back, and it wasn’t pretty. She (yeah, go figure) said it should be outlawed, and I said “so, being ‘pro-choice’ only extends so far, huh.”… damn, could she spit out the profanity.

  90. I salute your effort to show that the state of health care in the US is more complex than the inanity of the current debate suggests.
    You make a good point with the higher rate of underweight newborns in the US compared to other countries.
    Where I disagree however is to jump to the conclusion that under a Canadian style insurance scheme, infant death rate in the US would be even higher because death rate of underweight infants is higher in Canada than in the US.
    Being underweight is not a life threatening illness per se, but is often a symptom of poor pre-natal care.
    It is very possible that a higher rate of underweight infants suffer of life threatening illness in Canada than in the US. In effect, they are underweight due to illness not because of poor pre-natal care.

  91. One thing I’ve not seen mentioned is the actual numbers. All I’ve seen is the rank. So, here are some of the numbers. I got these from the wikipedia so I don’t know if these are the best but they’ll do for comparison.

    US 6.3 deaths per 1000
    Canada 4.8 per 1000
    Italy 5.0 per 1000
    UK 4.8 per 1000
    France 4.2 per 1000

    Now, let me say infant deaths suck and I wish they could all live a full life. However, are these numbers statistically significant? The difference between the wonderful and amazing France and the evil US is 2 per 1000! We base our health care debate on that?

  92. Multiple births (twins, triplets etc.) and fertility treatments also effect infant mortality. People of east Asian decent have the fewest multiple births west Africans the most.

    This is part of the difference between people of Mexican and West African descent.

    Fertility treatment is much more common in the USA than in Norway and Canada.

  93. Nasikabatrachus:

    … chemo is still prescribed for lung cancer when it doesn’t have a statistically significantly better prognosis than doing nothing…

    I hear this often from alternative medicine supporters, always in the same way you have just stated it, i.e. thrown out as an isolated factoid without sources or context. Do you have a source or did you just hear that somewhere? I am really curious.

    http://www.webmd.com/lung-cancer/tc/lung-cancer-medications

    An excerpt: …but [chemo] cures lung cancer in only a small number of people…

    That’s medical orthodoxy, not alternahippiecrystalvoodoo. Most M.D.s practicing “conventional medicine”, however, don’t read their own journals or bother to do any critical thinking about what the root cause of disease is, so they unthinkingly use cookbook medicine for ‘treating’ cancer or any other degenerative disease that doesn’t have a pill-for-this-shot-for-that cure.

    Thanks for having a true scientific spirit, Nasikabatrachus. More people in this forum need to use their dispassionate scientific observer mode when approaching ‘alternative’ medicine. Too often, there is this notion that all supporters of ‘alternative medicine’ are hippies, or food nannies, or whatever. In reality, a large number of us just want the freedom to explore ways of improving our own health without interference from the FDA, and without side-effect laden drugs or surgery.

  94. I notice that conspicuously absent from this article is the argument that unnecessary medical interventions actually complicate pregnancy and childbirth and give rise to the level of infant mortality in this country.

  95. Examples please of unnecessary procedures.

    By unnecessary, do you mean elective procedures in general, or an invasive procedure, such a amniocentesis or CVS (chorionic villus sampling)?

  96. Untermensch

    “it’s also about a medical takeover of government. We already tend to have doctors as lawmakers ”
    This is a non-sequitur. You state that doctors are law makers and so we should not have doctors as law makers.
    “Methinks you don’t know what that term means”
    Methinks you ascribe any disagreement with you as inherently ignorant.
    “As best as I can tell, your point is that government doesn’t need a medical paradigm to be oppressive.”
    Government oppression is an evil. It is a problem. This doesn’t mean that we should take police away from the government. We need always to watch at how government uses the police, and we should ensure absolute minimum influence of the police on government, but we don’t want the government to stop paying for police. We don’t want a police state, and we don’t want a police-less state. We need balance.
    “My statement was meant to imply that when you get the medical profession so entwined with government, the government is of necessity going to adopt a medical viewpoint.”
    Just as the government now has a tendency to adopt a “law and order” police viewpoint.
    “So all I was stating was that there is a pre-existing tendency in the U.S. for many legislators to see things from a medical paradigm”
    And this means what? We should be afraid that the medical viewpoint will drown out all others? Frankly I fear that ‘law and order’ drowns out all the rest too often. I think that barristers should be banned from politics, so that a firmer separation of the courts and the legislature should exist.
    Seems to me that you are peddling fear. Fear is the debilitating emotion. People that feed you fear are purposely trying to debilitate you.
    “But if we have the government take over health care…”
    It is not a takeover of health care! It is a takeover of health insurance! You make it sound that we’re going to go to government offices to have our prescriptions filled.

  97. Actually, what’s missing from this article, and most claims about infant mortality rates, is the basis on which they are calculated, which is different in other countries.

    Not sure why this fact is omitted so often. I have to assume it doesn’t help make one’s argument.

  98. Jennifer: “I notice that conspicuously absent from this article is the argument that unnecessary medical interventions actually complicate pregnancy and childbirth and give rise to the level of infant mortality in this country.”

    **********************

    I had several medical interventions during my child’s birth and immediately afterward. My child turned out to be fine, but no one could have predicted this based on the circumstances. I’m glad they took no chances.

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  100. My only point is that if you take the Bible straight, as I’m sure many of Reasons readers do, you will see a lot of the Old Testament stuff as absolutely insane. Even some cursory knowledge of Hebrew and doing some mathematics and logic will tell you that you really won’t get the full deal by just doing regular skill english reading for those books. In other words, there’s more to the books of the Bible than most will ever grasp. I’m not concerned that Mr. Crumb will go to hell or anything crazy like that! It’s just that he, like many types of religionists, seems to take it literally, take it straight…the Bible’s books were not written by straight laced divinity students in 3 piece suits who white wash religious beliefs as if God made them with clothes on…the Bible’s books were written by people with very different mindsets

  101. I’m not concerned that Mr. Crumb will go to hell or anything crazy like that! It’s just that he, like many types of religionists, seems to take it literally, take it straight…the Bible’s books were not written by straight laced divinity students in 3 piece suits who white wash religious beliefs as if God made them with clothes on…the Bible’s books were written by people with very different mindsets

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