Death rates, gay marriage and health care

Infant Death Rates Continue to Decline

The death rates for children under 5 continues to decline around the world. Apparently the figures previously released by the UN's Children's Fund overestimated said death by 800,000. I note that the UN's figures on many of these issues seems always biased toward the bad news are and regularly revised downward some years later. I suggest this is the result of the political biasing that takes place when figures are accumulated to satisfy politicians.

It need not be said that the current estimate of 7.7 million such deaths for 2010 is far too high, but in 1990 that figure was 11.9 million. Half these deaths take place in Africa, plagued by corrupt, authoritarian governments. The role of the African state in this disaster can not be underestimated. And it should be noted more aid is not the solution as that aid is used by the vampire elite, who are causing the problems, to help cement their hold on the country.

Since 1970 child mortality rates have dropped 60 percent.

Long Term Polling Trends Indicate Gay Marriage is Coming.

The Gallup people have released their most recent figures regarding support for gay marriage. The trend lines indicate small, but relatively stead gains for marriage equality. When Gallup first asked about this issue, in 1996, 68% of Americans wanted to keep legal restrictions on same-sex marriage, and 27% favor deregulation and legal equality. Since then the opposition has declined by 15 points to 53% and support has grown by 17 points to 44%.
During that time support for marriage equality rose from 33% to 56% among Democrats (+23); from 32% to 49% among independent voters (+17) and from 16% to 28% among Republicans (+12). Even among individuals who say they are conservatives support has grown from 14% to 25%, +11 points.

Opponents to deregulation and legal equality remains most solid among people who consider themselves religious. Individuals who think religion is very important oppose equality 70% to 27%. If someone says religion is fairly important the opposition shifts slightly t0 60% against to 37% in favor. Individuals who are not into the mystical or theological tend to be rational about marriage as well, with 71% favoring equality and 27% opposing it.

As to be expected the American South, followed by the Midwest, tends to be most firm in opposition to equality of rights—but that's a tradition with those folks. In the South 62% oppose equality and 35% support it. In the Midwest it is 57% opposed to 40% in favor. The East supports equality of rights by 53% to 43%, as does the West, 53% to 46%.

Obamacare: As the truth seeps out the costs rise, support falls.

It was obvious to everyone, but the true believers, that the Obama White House was lying about the costs of Obamacare. Obama rammed his measure through by deceiving the public and bullying politicians, when not bribing them with taxpayer funds. The most recent figures and polls are not good news politically for the president and the Democrats who tied themselves to his coat-tails.

The most recent Congressional Budget Office estimates show that the legislation will cost at least $115 billion more than the cost that was given when the bill was passed. This means Obamacare will cost at least $1 trillion. Grace-Marie Turner of the Galen Institutes, says these figures are "a conservative estimate that is based upon unrealistically high assumptions about cuts in Medicare spending and unrealistically low assumptions about the cost of the new law." Actually that is par for the course in Washington. Most bills are passed by politicians who intentionally, and dishonestly, underestimate costs and overestimate benefits. Turner notes:

One reason is the billions of dollars in new fees and excise taxes the law imposes that Foster says will "generally be passed through to health consumers in the form of higher drug and devices prices and higher premiums."

These include:

• more than $20 billion in taxes on medical devices

• $60 billion in taxes on health plans

• and $27 billion in taxes on prescription drug companies.

Foster's report also highlights the shaky financial footing of the new long-term care insurance program -- the CLASS Act, which Sen. Kent Conrad, D-N.D., has described as "a Ponzi scheme of the first order."

Foster says the program faces "a significant risk of failure" and finds the program will result "in a net federal cost in the long term."

The CBO estimates that individuals and businesses also will face at least $120 billion in fines and penalties for failing to comply with the law's new health insurance mandates. And it says families purchasing health insurance in the individual market will pay $2,100 a year more for coverage by 2016 than they would had the measure not passed.

On the political front a substantial majority of Americans want Obamacare repealed. The latest Rasmussen poll on the issue finds repeal supported by 63% of the population while opposition to repeal sits at 32%. Support for repealing the measure has gained 8 points since March while support has declined by 10 points.

Even supporters of the measure don't believe the B.S. that Obama and Democrats were spreading about the measure. The public was told that the measure would actually bring down health care costs. But only 18% of the public believes that, well below the support level for the bill, indicating that a substantial number of supporters disbelieve the president—and with good reason as the CBO estimates show. Those believing the measure will raise costs include 55% of the public. Only 20% of the public think the plan will improve health care, a decline of 7 points. And only 12% believe the hype that the measure will reduce the federal deficit, a decline of 7 points.

Life expectancy and infant mortality: a rerun

Because the hard Left, who favor state control of medicine (and almost everything else) are conducting a bogus campaign in favor of nationalizing care, I want to rerun a piece I wrote some time ago. The proponents of bureaucratic control of medical care insist on using bogus statistics to prove their case. They continue to resort to two numbers. One is the life expectancy rate and the other is infant mortality. Both measure many factors completely outside the control of the health system. Here is something I wrote almost two years ago to the day—so it was written long before Jesus Obama walked across the reflecting pool to the White House. Everything that follows is from the older article. A few minor typos were corrected but the article was not changed.

Life expectancy is the result of dozens of factors. At best it is a general indicator of life in a specific area. In and of itself, it does not tell you much about any specific policy.

I am convinced that life expectancy is only tangentially connected to health care, with the exception of birth. Once an infant survives the first year or so of life, health care is almost secondary. Prime factors include diet, safety, clean water and sanitary conditions, and lifestyle choices.

If you look at the history of the rise of life expectancy it was basic improvements in life that caused much of the increase. The problem our ancestors had was to survive birth and the first year or two of life, and then to have food to eat, clean water and to avoid disease. Get that out of the way and life expectancy shot up.

The second great advance in life expectancy was when we discovered how to immunize people against diseases like flu, polio, measles, small pox, etc. It should be noted that the great advances in this field predated nationalized health care systems for the most part.

Most of the major medical expenses in the world today actually have little impact on life expectancy. While for some people we are talking about adding a few years to the life of a person, for most we are talking of adding weeks or months at best.

The reality is that spending a bit less on expensive care, and a bit more on basic, preventative care and check ups, will do a lot more good. Americans could reduce their health spending dramatically without having much, if any, of a negative impact on their life. Individuals could easily repriortize their concerns. It isn’t that health care is too expensive as much as it is that Americans are over buying expensive care and under consuming basic, preventative care. A major factor that puts US spending, per capita, above that of Europe is that Americans tend to prefer to solve problems with expensive care rather than taking cheaper precautions in advance. That is a problem of individual choice, not health care systems.

Americans, no doubt, do overspend on health care for the benefits they receive. On the other hand the nationalized systems intentionally under spend on care. They brag they are cheaper but they are cheaper because they deny care that people want and often need. Cheaper is not necessarily the determinate of good care any more than more expensive is. Both could be serious misallocations of resources.

This said, I should get back to the main point, which is the role of health care on life expectancy. Life expectancy is only a general indicator regarding the qualify of life. It is not an indicator that says much about specific policies. And that is where some advocates of nationalized care get dishonest. They will argue that Americans have a slightly lower life expectancy than do people living in nations with nationalized health care.

Normally they are very selective as to which countries they choose. The truth is that Americans live, on average, longer than people in many countries with socialized care, but not as long as people in some countries. If one were to compare the EU average life expectancy to that of the average American the difference is only a matter of weeks.

But that small difference is used to champion socialized care. Somehow turning health care over to the people who run the post office is supposed to add a few weeks to our life expectancy, and this is supposed to be a vast improvement.

But are the differences in life expectancy between the US and some European countries (and not others), actually the result of different health care systems? Or are there other factors that directly lower US life expectancy?

Everyone knows that obesity, a result of affluence, is rampant in the United States. And this problem is worse in the US than in Europe. Having lived on both continents I can verify that observation personally. The size of some Americans is astounding to me. Micheal Moore is becoming far more the norm than the exception. This is having a major impact on life expectancy. Americans are still living longer than ever, but the rate of improvement has slowed allowing less obese nations to surpass the US average. This is a personal choice issue, not a health system issue.

Another cause for lower life expectancy can be crime. This is especially true for one group of American -- black males. The average life expectancy of black Americans is five years shorter than that of white Americans. And crime is a major reason. One study showed that a white male of 15 years of age had a 1-in-345 chance of being murdered before he turned 45. For black males those odds were 1-in-45. And in Washington, DC, the city in America with more politicians than any other, the odds were 1-in-12.

This study says that ending the criminal carnage in the black community would bring the average life expectancy of black males up by three years. This is not a health system issue. Yet, it severely impacts US life expectancy rates which is then used to “prove” nationalized care is better. In addition, the African-American community has higher rates of various unhealthy lifestyle choices, such as drug use, smoking and consumption of alcohol. All these factors drag down the life expectancy in that community and reduce US rates as well. While some European countries have similar communities with similar problems they are a smaller percentage of the population and thus have less impact on the life expectancy average.

A study out of Harvard says: “young black men living in poor, high-crime urban America have death risks similar to people living in Russia or sub-Saharan Africa.”

One study I looked at recently, from the Commonwealth Fund, showed that if you reach the age of 60 your life expectancy, in the US is another 17 years. Under the nationalized health systems in the UK and New Zealand the remaining years are also 17 years. No difference. Canada was higher at 18 years but there are still various factors that impact this, which are outside the health system -- as already mentioned.

MSNBC repeated an Associated Press report stating that “A relatively high percentage of babies born in the U.S. die before their first birthday, compared with other industrialized nations.” What they refer to is the infant mortality rates. Again this is slightly dishonest since different nations define infant mortality differently.

The U.S. has a much broader definition of "live birth" than does other nations. They aren’t measuring the same thing. US News & World Report explained the differences:

First, it's shaky ground to compare U.S. infant mortality with reports from other countries. The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don't reliably register babies who die within the first 24 hours of birth. Thus, the United States is sure to report higher infant mortality rates. For this very reason, the Organization for Economic Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country.

Infant mortality in developed countries is not about healthy babies dying of treatable conditions as in the past. Most of the infants we lose today are born critically ill, and 40 percent die within the first day of life. The major causes are low birth weight and prematurity, and congenital malformations. As Nicholas Eberstadt, a scholar at the American Enterprise Institute, points out, Norway, which has one of the lowest infant mortality rates, shows no better infant survival than the United States when you factor in weight at birth.

Infant mortality rates are also connected to many factors not related to health care. For instance, teen mothers are more likely to give birth to sick infants. Mothers who smoke, or are obese, or simply lack education, have riskier pregnancies. And the U.S. has more of these problems than some other nations, yet these are not directly linked to the health system.

Nationalized health care won’t reduce crime rates. It won’t reduce obesity. The Harvard study indicates this. The main reason some communities, in the U.S., have lower life expectancy is due to injuries and some chronic diseases “including heart disease, cancer, and diabetes. These killers, in turn, are a consequence of well-known and largely controllable risk factors such as smoking, alcohol use, obesity, high blood pressure, and high cholesterol. In high-risk urban black communities, male mortality is increased by homicides and exposure to AIDS.” These are “largely controllable risk factors”. Controlled by whom? By the individual at risk, not by the health system.

The Harvard study looked at eight distinct groups of Americans and concluded: “"The variation in health plan coverage across the eight Americas is small relative to the very large difference in health outcome. It is likely that expanding insurance coverage alone would still leave huge disparities in young and middle-aged adults." Universal coverage, as envisioned by advocates of socialized care, will have little direct impact on U.S. life expectancy. But cheaper, if not free, individual changes in life style can have a major impact.

Another Harvard study found that Americans could add 6.7 years to their life expectancy by following healthier guidelines for living. Europeans could add only 5.5 years, implying that 1.2 years of the current difference in life expectancy rates between the US and Europe is due to lifestyle factors, not to health care systems. That difference would put US life expectancy on par with the UK and Germany, indicating that the differences in life expectancy rates is due to lifestyle choices not health systems.

Another indicator that health systems are not the main issue is that Hong Kong, not known for socialized health care, or much of a welfare state at all, has one of the highest life expectancy rates in the world, at 80.2 years. That exceeds all the European socialized states. Switzerland also has a high life expectancy, yet most health care is provided privately and covered by private, individual insurance policies. Recently, Swiss voters rejected a single-payer health proposal.

Singapore also has a high life expectancy yet they have little in the way of nationalized health care. Individuals in Singapore are expected to establish their own private, health accounts which belong to them or their heirs when they die. These private accounts pay for most care in the country. Out of these accounts citizens purchase catastrophic insurance to cover major problems and draw down the account for minor problems. About 10% of the population is deemed impoverished and are directly helped in health care by the state, but the bulk of the population pays for their care out of their own resources. They also have health care expenditures that are far lower than any of the nationalized systems.

Some countries, often with very little in the way private or public health care, have life expectancy rates that are still rather impressive. Costa Rica has a higher life expectancy than Luxembourg. And two U.S. territories, Puerto Rico and Virgin Islands, have higher life expectancies than the U.S. mainland. Yet, I know of no one who attributes this to greater access to health care, socialized or not.

Another indication that life expectancy is only tangentially tied to health systems is that every nation in the world, no matter their health care system, sees dramatic differences in life spans between men and women. And much of that is due to life style differences tied to biology. Men are more violent, on average, than women. That means they get killed more often. They also tend to be risk takers, more so than women, and that also means they are more likely to die young.

In most socialized health systems women live five to seven years longer than men, on average. Yet this is not because women receive superior health care. At least I’ve yet to hear that claim.

Life expectancy is primarily a matter of factors outside the health care systems. As such it can not be considered evidence, one way or the other, that nationalized care is superior to private health care.

Wealthy and healthy leads to decline in infant mortality

As someone who spent a decade of my life living in the Third World I have long challenged the gloom and doom advocates. The reality was never as dim as the pessimists made it out to be. For the most part, in most places, the poor of the world have seen vast improvements in their lives.

The new Matlhusians, like Paul Ehrlich, had a tendency to be wrong. Wrong would be a vast understatement. They have been spectacularly wrong. Even phony psychics had better “hit” rates. But then “psychics” know they are frauds and make educated guesses. The neo-Malthusians are blinded by ideology and thus unable to digest unpleasantries such as facts.

Today’s New York Times has an article based on the most recent data from the United Nations Children Fund which confirms that reasons for optimism are still strong. The paper reports, “For the first time since record keeping began in 1960, the number of deaths of young people around the world has fallen below 10 million a year....”

This achievement is more spectacular when you realize that the size of the childbearing population has grown significantly since 1960. The report notes: “In 1960, about 20 million children died annually, but the drop since then has been steeper than 50 percent because the world population has grown. If babies were still dying at 1960 rates, 25 million would die this year.”

UNICEF says they expect further massive drops in infant mortality rates in the next few years. There are storm clouds on the horizon, however. The report notes that “malnutrition is an underlying factor in 53 percent of all child deaths, anything that feeds children — whether that means large-scale aid during famines or simply better seeds and fertilizer — reduces deaths.”

Actually this is partially right, about the role of hunger in mortality, and massively wrong in suggesting food aid is necessarily a panacea. Not everything that is done, in regards to food aid, helps. Sometimes it is counterproductive. Here are a few reasons.

1. Food aid is bureaucratic and often takes so long to arrive that it becomes available only after the underlying cause for the aid is over.
2. The aid, if it arrives after the problem is mitigated, tends to suppress or destroy local food production making future food problems more likely.
3. Food aid is often channeled through national governments who use the aid to cement power for themselves. Yet these governments, through various policies including armed conflict, are often the underlying cause of the malnutrition. Food aid helps these regimes remain in power which allows them to inflict higher death rates on their people for decades to come.
4. Food aid is periodically channeled by corrupt national regimes to the world market where it is sold. The revenue from the sale of the aid has been used to purchase arms used to attack the very people it was meant to help.

And the dark clouds include the so-called global warming “solution” of biofuels. As I have pointed out in Save the Planet, Starve the World, biofuel programs, pushed by the political elites in Europe and the United States, are consuming vast amounts of food to produce biofuels of questionable advantage. At least with oil consumption drivers weren’t directly taking food off the plates of the world’s poor.

Now to make matters worse the Stalinists who run the current Russian government are pushing to create an “OPEC” of grain producers to cartelize grain production the way the OPEC governments control the supply of oil. I suspect this measure is likely to fail as the US is the Saudi Arabia of grain and unlikely to join such a cartel.

China is so worried about the use of food to produce fuel that it has stopped the building of new biofuel production facilities. Yet wealthy “environmentally active” governments in the West are throwing billions in subsidies to produce this fuel, which has little advantage over normal fuels. The net result is that politicians in the West are using the confiscated wealth of their taxpayers to bid food away from the world’s poor to turn that food into fuel for other wealthy people to use. They call this “caring”.

And this ill-conceived “solution” is only going to get worse as the U.S. presidential candidates jockey for position. They will use biofuels as a way to throw money at America’s prosperous farming community, in order to buy support. And then they will coo about how “environmental aware” they are in addressing “the global warming crisis.”

Environmental disasters like Al Gore promised to drive up food prices to “protect our vital agricultural lands” (which weren’t under threat to begin with). And they did. Gore says “I’ve always supported ethanol, I have a consistent record of shoring up the farm safety net.” This translates into policies that starve poor people in order to subsidize rich American farmers. As vice president he promised, “Our administration’s goal is to triple the use of biomass technologies, ethanol, gasoline additives, plant-based textiles and other environmentally friendly products by 2010.” He got his way, biofuel is the new rage and people are dying because of him. So much for the compassion of this sanctimonious sermonizer.

Keep in mind the UNICEF figure that 53% of all child deaths are the result of malnutrition. Diverting food from tables and into fuel tanks is contributing to the death of almost five million children per year.

We should also note that almost 1 million infants die from malaria every year. One of the most efficient methods of preventing malaria was DDT which, after the hysteria whipped up by Rachel Carson in 1962, was eventually withdrawn from the market. Infections from malaria skyrocketed as a result of the ban and millions more died every year. After several decades of shunning DDT various governments, along with the World Health Organization, have realized that the ban, once touted as a “solution” to problems, actually made the situation worse. The ban is being lifted and we should see more improvement in the infant mortality rates as a result of ignoring the greenies on that issue.

Apparently the politicians learn slowly. While realizing that the DDT “solution” of the past created problems worse than the problems they were meant to solve they are still embracing new policies which have similar results.

UNICEF says that “public health” measures are the reason infant mortality rates have declined. And no one disputes that such measures are a contributing cause. But UNICEF, which funds such measures, is also blowing their own horn to the exclusion of the other instruments in the orchestra.

A large degree of improvement in the life span of individuals is caused by changes that are not normally seen as health measures but as wealth measures.

There is a direct correlation between economic freedom and individual wealth and a direct correlation between wealth and health. Prof. James Gwartney, of Florida State University says: “Free economies grow faster, have a cleaner environment, a lower infant mortality rate and less political corruption. The per capita gross domestic product is about 10 times the income level of the least free quartile. Further, the life expectancy of the freest group is 77 years, compared to 52 years in the least free group."

Nowhere is this more apparent than in places like China, India and Vietnam. All three nations experienced famine -- though in Vietnam is was much less severe -- when their populations were significantly smaller. Yet, in spite of increased populations they are more food secure today than in the past. All three instituted major reforms which liberalized the economy and all three have seen food production increase along with massive declines in poverty.

Public health measures in these nations are minimal, especially compared to West. But economic liberalization has improved individual prosperity and that has resulted in better health, including lower infant mortality rates and longer life expectancy.

UNICEF, however, can’t take credit for changes in economic policies so one can understand them ignoring the role of prosperity in reducing infant mortality. After all the purpose of the press release is also to promote UNICEF. But the role of economic freedom in improving living standards can’t be ignored by those who are truly concerned about the poor of the world. Nor should we ignore the reality that “environmental solutions” that once were chic and politically popular inflicted a great deal of harm and that it took decades to remove those policies. The DDT ban may now be removed but it took the deaths of millions and millions of people for that to happen. I suspect deaths caused by the ethanol craze will continue to climb for decades to come before this disastrous program is finally taking off political life-support.

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Health care: Too much of a good thing?

I’ve often seen ideologues play with numbers. It’s easy to do but inherently dishonest though some of it is simply due to ignorance and not intentional dishonesty. People have a tendency to stop looking when they find what they want to find.

One of my private passions has been understanding the role of incentives and economics. One thing a decent economist can teach you is to think beyond the obvious. Much of economics is counterintuitive.

For instance, raising the minimum wage doesn’t raise the income of the poorest workers. They tend to become unemployed. Most workers are above the minimum wage so it has no impact on them. Only a small number of workers have productivity levels higher that what their pay scale indicates. They will see their incomes increase and remain employed since their productivity is worth more than their wages. Those with lower productivity, at the bottom of the wage scale, will end up on unemployment. This is a bit more complicated that the simplistic idea that a high wage minimum raises income.

Recently, in the Christian Science Monitor, Donald Boudreaux took on Corinne Maier from the New York Times. She claimed that French workers were more productive than American workers. And since the French work fewer hours this difference is “proof that you can work better by working less.” That may be a good sound bite but its not necessarily good economics.

Boudreaux noted that French labor regulations make hiring people very expensive -- one of the reasons for the very high rates of unemployment especially among the least educated. High labor costs weed out the least productive workers from the workplace.

In Boudreaux’s example he suggests a $500 per hour minimum wage would automatically make American workers the most productive in the world. The reason is simple. Only those whose productivity is worth more than $500 per hour would have jobs while the zero productivity of the unemployed is never factored in to the productivity rates.

Strictly speaking, if the French also included the vast numbers of people who can’t find work in their productivity ratings they wouldn’t look so good. Consider a race between two groups of kids. In one group the teacher goes around breaking the legs of slowest runners. Then they have a competition where only those who can run do so. They add up the times and declare the first class has a higher average speed. Breaking the legs of slow runners would increase the average of those who run. That is what the French do -- they break the “productivity legs” of their slowest runners.

I thought Boudreaux’s editorial was quite enlightening and one of the best things on economics I’ve read in a long time. It takes a “fact,” as the media reports it and scrutinizes it -- something the media is not likely to do for a number of understandable reasons.

Over at Slate Darshak Sanghavi has done something similar. He looks at the much touted infant mortality rate. The Left, in particular, loves to quote this number. America has a higher infant mortality rate than most developed countries. That fact, in isolation, doesn’t tell us much. We really need to ask why this is and what it means. But people assume this is a marker for conclusions they have already drawn. So it is alleged to mean, “that capitalism fails”, that the “lack of national health care” kills people, “that welfare cuts are killing babies”, and a host of other conclusions looking for evidence.

Save the Children had one of the ready made conclusions: “We are the wealthiest country in the world” but children “are not getting the health care they need.” Really? Anna Bernasek, at the New York Times, blamed the high rate on the lack of national health care. Another one of those conclusions looking for evidence.

But Sanghavi says “a closer look reveals the counterintuitive possibility that high infant mortality in the United States might be the unintended side effect of increased spending on medical care.” We should consider this for a moment.

Americans spend more on health care than any other nation. The very idea that the US isn’t spending enough is absurd. The reason couldn’t be a lack of spending as Save the Children claimed. America is condemned by the advocates of socialized health care for both spending too much and for not spending enough. It is condemned no matter the spending level.

You would almost conclude that the reason for the condemnation has nothing to do with the spending patterns. Perhaps the advocates of socialized care condemn both too much spending and not enough spending for reasons that have nothing to do with the actual spending but with their purported solution. If you want to propose a “solution” you sometimes have to invent the crisis that needs solving, or at least convince people that one exists. Condemning US health care for spending too much on Tuesday and too little on Wednesday has a lot to do with the new system they want to impose on Thursday.

Elsewhere I have investigated some of the illusionary arguments used by advocates of socialized medicine noting that Americans have an abundance of health care, especially of the expensive kind. One way to keep health care costs down in nationalized systems is to ration it out. Deny expensive treatments to people and costs will drop. Americans get more of those expensive treatments.

And America’s infant mortality rate may be directly connected to this crisis of abundance. Sanghavi asks what is the cause of infant mortality in the US. He notes that in poor countries the cause is usually easily treated problems such as diarrhea in the first few months of life. Two things are necessary to be included in this statistic. First the infant must be born alive and second it must die before the age of one. If it is born dead it doesn’t count in the statistic.

Sanghavi says that somewhere between one third and one half of all infant mortality in the US is due to complications of prematurity. I checked this out and he’s right. MedicineNet.com puts the rate even higher: “In the United States, about two-thirds of infant deaths occur in the first month after birth and are due mostly to health problems of the infant or the pregnancy, such as preterm delivery or birth defects.”

Sanghavi argues that modern medicine is not particularly good at preventing premature births. And some new medical techniques actually increases the risk but are still used for understandable reasons. He notes that the number of women using technology to conceive has doubled and that the technology increases the number of multiple births and multiple births are “at a high risk of premature delivery.”

And he writes: “Despite a doubling of health-care spending as a portion of the gross domestic product since 1981, the rate of preterm birth has jumped 30 percent.” If, as Save the Children complained, the problem is not spending enough then the rate of premature births should not have increased as spending increased.

Another counter-intuitive problem for prematures is that the number of neonatal units the country has increased. So much money is available for neonatal care that more care is available than needed. Infants who normally wouldn’t be given this care are sent to the unit as a precaution. Sanghavi writes about a study in the New England Journal of Medicine: “The authors ominously suggest that ‘infants might be harmed by the availability of higher levels of resources.’ They argue that the availability of a NICU may mean that infants with less-serious illnesses may be admitted to one and then ‘subjected to more intensive diagnostic and therapeutic measures, with the attendant risks.’”

He also notes that hospitals which treat large numbers of premature babies have high success rates. The increase in the number of neonatal units has meant that each hospital treats fewer cases. With less experience the number of deaths increases. A study in the Journal of American Medicine noted that concentrating these prematures in fewer hospitals could reduce the death rate and lower costs as well.

If this study is correct then reducing costs by reducing the number of hospitals offering neonatal care may increase the survival rate for premature infants. It is possible that one can have too much of a good thing. And spending more on neonatal care may exacerbate the problem. The reason for it seems obvious. And if I may allow me to use Ikea as an example.

Putting together that furniture is a real chore. Sometimes is it is downright difficult. And if you are doing one of this and one of that each piece is hard work. But if you have ever done multiple examples of the same piece you quickly learn the process. With more experience you make fewer mistakes, are more prone to notice details and faster. Experience makes you better at the work. Why would neonatal health care be any different? The more experience one has the better one becomes.

American health care has so much money thrown at it that care is being diffused. More and more hospitals have neonatal units, even though such units are expensive. The number of patients are spread over a greater number of hospitals reducing the average experience at each hosptial. With reduced experience there is a higher mortality rate. As the JAMA article noted: “Risk-adjusted neonatal mortality was significantly lower for births that occurred in hospitals with large (average census, >15 patients per day) level III NICUs.” So by concentrating such care, in urban areas particularly, “has the potential to decrease neonatal mortality without increasing costs.”

As I said sometimes life is counter-intuitive.