Age, Health, and Poverty Lecture 11

1
Age, Health, and PovertyLecture 11

• Todays Readings
• Schiller Ch. 6 Age and Health
• DeParle, Ch. 8 The Elusive President, 1995-1996
• DeParle, Ch. 9 The Radical Cuts the Rolls
  Milwaukee, 1995-1996

2
Todays Topics

• Public support for income maintenance for the
  elderly
• Federal spending for the elderly versus spending
  for children
• Variance in mortality and morbidity rates across
  minority groups
• The question of causality

3
Public Support for the Elderly Poor

• The poverty rate for persons 65 years and older
  was 9.8 percent in 2004, compared to 13.1 percent
  for all persons under 65, and 17.8 percent for
  children under 18. If presented with legislation
  to increase income assistance for the elderly
  poor, would you
• Support it,
• Oppose it, or
• Abstain?
• Explain your vote.

4
Your responses

• Politically savvywin the vote
• Limited job opportunitiesdont expect people to
  work
• I dont want to work past 65
• The poorest of the old poor are 85
• The vast majority of the elderly poor are women
• They suffer extreme hardships
• Always poorcouldnt save for retirement
• Disproportionate share of income goes for health
  care
• Real value of pensions and other savings may be
  eroded by inflation

5
Opposed to more elderly support

• Already have fair share
• Bad investment, no return in the labor market, no
  increase in national income
• A future of poverty provides an incentive to save

6
The War Between the Generations

• Schiller writes that, The dramatic decline in
  poverty among the aged since the 1960s is cause
  for celebration. It is one of our great policy
  accomplishments. Why then has the American public
  has turned this victory against poverty into a
  matter of social injustice, pitting the elderly
  against children rather than setting it up as a
  model to be replicated?

7
Federal Spending on the Elderly and
ChildrenSource Congressional Budget Office,
http//ftp.cbo.gov/showdoc.cfm?index2300sequence
0

• The Congressional Budget Office (CBO) recently
  (2000) completed a preliminary analysis of
  federal spending on people over age 64 and under
  18, which concluded the following
• In fiscal year 2000, the federal government spent
  a little over one-third of its budget--about 615
  billion--on transfer payments and services for
  people age 65 or older.

8
Federal Spending on the Elderly and Children

• Federal spending on children in 2000 will total
  about 148 billion (a little less than 10
  percent), or 175 billion if payments to the
  children's parents are included.
• In 10 years (under current policies), spending on
  the elderly and children combined will account
  for more than half of total government spending,
  with the elderly's share making up roughly 80
  percent of that amount.

9
Federal Spending on the Elderly and Children

• Entitlement programs account for the overwhelming
  share of spending on the elderly (97 percent in
  2000) but a much smaller portion of spending on
  children (about 67 percent).
• Federal spending on the average person 65 or
  older was nearly 17,700 in 2000 compared to
  about 2,100 per child.

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Can we spend more on children without spending
less on the elderly?

• The realities of budget constraints
• Note that the pie charts on the following page do
  not illustrate the growth in the total
  expenditures the pies are all the same size.
  Real GDP grew 308 percent between 1959 and 2000.
• Source Economic Report of the President, 2006,
  http//www.gpoaccess.gov/eop/download.html

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Growing Share of Federal Expenditures Going to
Income Security
Source US Census, Statistical Abstract of the
United States (1997), Table 518 and (2000), Table
533.
12
GDP (trillions of 2000 dollars)
13
Health Disparities across the American Population

• Americans who are members of racial and ethnic
  minority groups, including blacks or African
  Americans, American Indians and Alaska Natives,
  Asian Americans, Hispanics or Latinos, and Other
  Pacific Islanders, are more likely than whites to
  have poor health and to die prematurely.
• CDC, http//www.cdc.gov/omh/AMH/dbrf.htm

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Health Disparities, cont.

• African American women are more than twice as
  likely to die of cervical cancer than are white
  women and are more likely to die of breast cancer
  than are women of any other racial or ethnic
  group.
• In 2000, rates of death from diseases of the
  heart were 29 percent higher among African
  American adults than among white adults, and
  death rates from stroke were 40 percent higher.

15
Health Disparities, cont.

• American Indians and Alaska Natives were 2.6
  times more likely to have diagnosed diabetes
  compared with non-Hispanic Whites, African
  Americans were 2.0 times more likely, and
  Hispanics were 1.9 times more likely.

16
Health Disparities, cont.

• Although African Americans and Hispanics
  represented only 26 percent of the U.S.
  population in 2001, they accounted for 66 percent
  of adult AIDS cases and 82 percent of pediatric
  AIDS cases reported in the first half of that
  year. For
• http//www.cdc.gov/omh/AMH/factsheets/mental.htm

17
Comparison of black and white death
rates(http//www.cdc.gov/omh/AMH/AMH.htm)
18
Estimated Life Expectancy at Birth in
Years(source http//www.cdc.gov/nchs/data/dvs/nv
sr53_06t12.pdf)
19
Infant mortality rates (the rate at which babies
less than one year of age die)

• Infant mortality is used to compare the health
  and well-being of populations across and within
  countries.
• The leading causes of infant death include
  congenital abnormalities, pre-term/low birth
  weight, Sudden Infant Death Syndrome (SIDS),
  problems related to complications of pregnancy,
  and respiratory distress syndrome

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Infant mortality rates, cont.

• The US infant mortality rate has continued to
  steadily decline over the past several decades,
  from 26.0 per 1,000 live births in 1960 to 6.9
  per 1,000 live births in 2000.
• The United States ranked 28th in the world in
  infant mortality in 1998.

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Infant mortality rates, cont.

• Infant mortality among African Americans in 2000
  occurred at a rate of 14.1 deaths per 1,000 live
  births, twice the national average.
• The black-to-white ratio in infant mortality was
  2.5 (up from 2.4 in 1998). This widening
  disparity between black and white infants is a
  trend that has persisted over the last two
  decades.
• Source CDC, Eliminate Disparities?in Infant
  Mortality http//www.cdc.gov/omh/AMH/factsheets/i
  nfant.htm

22
Infant mortality rates, cont.

• SIDS deaths among American Indian and Alaska
  Natives is 2.3 times the rate for non-Hispanic
  white mothers

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Why do Minorities have higher morbidity and
mortality rates?

• Minorities
• have less access to, and availability of, health
  services including mental health services.
• (See http//www.cdc.gov/omh/AMH/factsheets/mental
  .htm)
• are less likely to receive needed health
  services,
• receive a poorer quality of health care,
• are underrepresented in health research and among
  health care professionals,
• have lower levels of education, and
• are more likely to live in poverty

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Access to Health Care

• See P60-229 In 2004,
• 84.3 percent of the population had health
  insurance from one of three sources
• Employer-based health care (59.8 of the insured)
• Government health insurance programs (27.2)
• Privately purchased policies
• 45.8 million people (15.7) were without health
  insurance

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Access to Health Care, cont.

• The uninsured rates were highest for Hispanics
  (32.7 ), American Indians and Alaskan Natives
  (29.0), Native Hawaiians and Other Pacific
  Islanders, Blacks (19.7), Asians (16.8), and
  non-Hispanic Whites (11.3).

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Access to Health Care, cont.

• The likelihood of being insured rises with
  income
• Full-time workers are more likely to be insured
  than part-time workers or nonworkers
• Children in poverty were more likely to be
  uninsured than all children (18.9 were
  uninsured)
• Children 12 to 17 years were more likely to be
  uninsured than those under 12

27
Source Economic Report of the President, 2006,
p. 85
28
The Direction of Causality

• Does poverty increase the incidence of disease
  and result in higher mortality rates?
• Does chronic illness lead to poverty?
• Clearly the answers to both questions is yes.
  But sorting out the relative importance of poor
  health as a cause of poverty has proven
  intractable.