Tuesday, July 12, 2005

L&S: In Case You Were Wondering...

…There hasn’t been much L&S blogging today because we had the afternoon off. Most people spent the time playing at the beach or sightseeing. In the evening, Tom and his wife d hosted their annual barbecue at their home in San Clemente, from which I just returned. (Thanks, Tom and d!)

I did give a lecture this morning, prior to the break, that no one posted about. I can only assume my co-bloggers were so stunned at my keen insights and sharp wit that they were rendered uncharacteristically speechless. The gist of my lecture is summarized in this two-year-old post. But there’s one point I neglected to make this morning that I’d like to note here.

Beyond the fact that externality and public good problems are endemic to democratic and bureaucratic processes – hence making it odd to refer to such problems as “market failures” – it should also be noted that government regularly creates externality problems where they did not exist before. For example, when government socializes health costs (whether through public ERs, Medicare/Medicaid, or full-blown single-payer systems), it turns private health risks into matters of public concern. Helmet laws are justified on grounds that motorcycle riders end up in public ERs. Tobacco lawsuits are justified on grounds that some smokers’ health costs were covered by Medicaid. And now obesity, a quintessentially individual matter, is touted as a matter of “public health” because some of the medical costs associated with obesity get carried by the taxpayers. These government-created externality problems are then used to argue for regulation of lifestyle choices.

(Note to liberals: It is only a matter of time before conservatives use public healthcare costs as the basis for further bludgeoning of homosexuals, since homosexual practices do in fact carry greater health risks. They’ve already done this to some extent, but their arguments smacked too much of bigotry. But soon they will copy the rhetorical templates that liberals have successfully deployed in the tobacco and obesity debates.)


Anonymous said...

In that case, I guess homosexual smokers should be sent to Elba. They might enjoy each others company if it doesn't get too smoky in the island confines.

Your points are all well-taken and perceptive except that the health care costs of smoking must dwarf all the other health issues you mentioned. Also, I wouldn't get carried away with the idea of risky "homosexual practices." I think Magic Johnson can speak to that, not too mention some of my slutty old girlfriends. Safe sex, e.g. using condoms is essential.

ns said...

the nebulous "public health" also impacts immigration policy. anyone with a disease of "public health significance" - such as HIV or AIDS - cannot become a citizen, and needs special permission to just visit the country.

John Noble said...

According to the Agency for Healthcare Research and Quality:

Pregnancies and childbirth-related conditions account for nearly a quarter of hospitalizations. Twelve percent of hospital stays are related to pregnancy and childbirth (the mother’s stay) and 11 percent are related to newborn infant births.

Nos. 1, 2 and 5 on the list of the top 10 "principal diagnoses with the highest mean charges" are related to newborn infants. No STD's in the top 10.

Nos. 1 and 2 on the list of the top 10 "principal diagnoses with the longest mean length of stay" in the hospital are related to newborn infants. No STDs in the top 10.

6 of the top 10 principal diagnoses that are paid for by Medicaid are pregnancy and childbirth related. No STDs on the list.


Glen Whitman said...

John -- I assume your numbers are correct. But the issue is not the magnitude of STD costs, but whether sexual behavior affects the size of such costs, and the answer is clearly yes. Also, looking solely at hospital stays is a strange way to measure health costs generally; for HIV infection, the primary cost is prescription drugs.

John Noble said...

I might have been more clear. My point was that whether you call it a risk (HIV/AIDS) or a consequence (pregnancy), if you're going to "copy the rhetorical templates" from the smoking and obesity issues, the health cares costs associated with homosexual practices have to be compared to the healthcare costs associated with heterosexual practices. While homosexual practices may "carry greater health risks," they do not necessarily -- at least not self-evidently -- impose greater public healthcare costs than heterosexual practices.

Your point that hospitalization costs do not reflect the cost of treating AIDS is well-taken. The most recent figures I can find indicate that hospitalizations accounted for 31% of Medicaid expenditures in 2000, while prescription drugs account for 11.9% of Medicaid Expenditures.

Also, according to the
National Womens Law Center, 71% of adult Medicaid beneficiaries are women, and Medicaid covers nearly 40% of all childbirths in the U.S.

Anonymous said...

"...homosexual practices do in fact carry greater health risks."

I think you mean male homosexual practices. Lesbians have a very low rate of STDs from what I've been told. Have to set you 'straight'.