Saturday, December 12, 2009

Do Liberals Consume More Health Care than Conservatives?

The stereotypical Conservative (C-Mind) is well-off financially, attends religious services regularly, and tends to vote Republican, while the stereotype Liberal (L-Mind) is less well-off, less likely to attend religious services, and tends to vote Democratic. Of course there are many well-known exceptions, but I think reasonable people would accept these generalizations on average. One would think that C-Minds, having more disposable income, would tend to spend more on medical care than their poorer L-Mind colleagues. If one thinks that, one would be surprised by the following maps. [Click maps for larger versions.]

US Medicare health care spending by county according to the Congressional Budget Office, varied from a high of $13,900 to a low of $5200 per capita in 2005. That is an amazing ratio of over 2:1. The top map indicates spending by county, with darker shading higher spending and lighter shading lower. On a statewise basis, the people of Massachusetts and New York, for example, employ more than twice as many physicians per capita as Idaho and Utah and spend accordingly.

Winning political party according to Princeton, varied from nearly all Democratic in some counties to nearly all Republican in others in 2004. The middle map indicates voting by county, with blue shading higher Democratic and Red shading higher Republican, with shades of purple in-between. On a statewide basis, the people of Massachusetts and most parts of New York, for example, are much "bluer" than the people of Idaho and Utah.

Church or synagogue attendance according to Wikipedia, varies from over 54% for some states to below 25% for others. The lower map indicates religious attendance by state (I could not find this data by county), with Blue and Green indicating attendance below 34% and Red and Orange above 40%. The people of Massachusetts and New York are in the less religious Green zone, while those in Utah and Idaho are more religious Red and Orange.
Using political party as a proxy, it seems that C-Minds tend to be more religious, which is as expected.
However, C-Minds also spend considerably less on public-funded Medicare than L-Minds. The latter is something of a surprise because C-Minds tend to have more disposable income and many L-Minds live in relative poverty. Also, C-Minds are supposed to be more selfish and L-Minds more generous. Yet, based on the above maps, L-Minds seem to take a larger share of the pie when it comes to public-funded medical care. Is that because L-Minds tend towards physical illness? Does their health suffer from unhealthy or dangerous lifestyles? Do they tend to go to the doctor for slight illness that a C-Mind would dismiss? Does God strike the less religious with more illness? What?
Have a look at the three maps and please provide your explanations.
Ira Glickstein
PS: In a different thread, Howard suggested an interesting explanation. Namely, that specialists tend to be located in larger cities which also tend to vote Democratic. People in rural areas who need specialized medical care would therefore have to go to the nearest large city to see a specialist. At first blush, that seems a reasonable explanation. However, would not Medicare count medical expenses against the home address of the beneficiary rather than the location of his or her doctor and hospital?


Howard Pattee said...

Ira, I don’t see your correlation between red and blue states and Medicare spending. A study by
Hopson and Rettenmaier at Texas A&M Private Enterprise Research Center finds high cost states are Louisiana, Maryland, Oklahoma, Texas, Kansas, and low cost states are New York, Vermont, New Mexico, Virginia, Iowa. That’s closer to the opposite correlation.

Ira Glickstein said...

You've done some great research Howard - congrats!

The amazing thing is that my linked map and data, from the Congressional Budget Office (CBO) is from the exact same year, 2005, and also about Medicare spending, as the data you linked from Hopson and Rettenmaier (NCPA).

The five high cost and five low cost states you list are based on "Example Counties in High- and Low-Cost States After Adjusting for Observable County Differences" (see NCPA page 39). They are not the five lowest and five highest in overall cost per capita as NCPA led you to believe.

Check the bar graph on CBO page 10 that shows states in order of spending.

The lowest CBO five are: Utah, Arizona, Idaho, Nevada and Georgia. NONE of them show up on your NCPA list of five low cost states, New York, Vermont, New Mexico, Virginia, Iowa!

The CBO highest five are: Massachusetts, Maine, New York, Alaska, and Connecticut. Again NONE of them show up on your NCPA list of five high cost states, Louisiana, Maryland, Oklahoma, Texas, Kansas.

Why? Both use the exact same base data?

The reason appears to be the NCPA analysis is based on counties, not states.

They presented the data in a way that is certainly confusing. The NCPA lists New York as one of the low-cost five while, according to the CBO it is actually in the high-cost five! Figures don't lie, but liars can figure!

Ira Glickstein

CentralCoastRick said...

Ira said: > "Also, C-Minds are supposed to be more selfish and L-Minds more generous."

A reference would be useful here. I haven't heard this comment before, though there is some kind of an 'image' that libs tend to be more inclined to be bleeding-heart types. (You poor person - the taxpayers should do something for you!)

A quick google search of "Charitable giving by party affiliation" yields many hits - the first few of which scanned agree with more than one newspaper article I've seen that state studies showing the opposite of Ira's comment.

As in proxies, all it takes is a predetermined notion of what the outcome SHOULD be to (apparently) provide that same result. All the same, I've NEVER encountered a story that claims as Ira does.

p.s. Just came from a Christmas program in San Diego that collected an impressive total from the audience to support the "Free Wheelchair Mission" that gives rugged wheelchairs to 3rd world recipients. They have shipped an impressive ~$30M of donated wheelchairs in the last few years - via predominately church partnerings. I also note that you can draw as many lines as you like through one datapoint!

JohnS said...

You are comparing apples oranges and grapefruit hoping for a correlation when there probably isn’t one, just coincidence, when you try to compare voting records, church attendance and medicare expense. Also your first chart, medicare spending per beneficiary, probably reflects the distribution of those eligible for medicare , that is senior citizens and other medicare beneficiaries and has no bearing on party affiliation or income distribution.
I do find all three charts individually interesting. The third, religious attendance by state, while not enlightening is interesting.

Howard Pattee said...

I agree with JohnS. Such coarse statistics are meaningless. If you really want to data mine looking for correlations I suggest the Robert Wood Johnson Foundation Dartmouth Atlas of Health Care and the Kaiser Foundation State Health Facts

As a source for C and L-mind politcal values I suggest Pew Trust Study: Trends in Political Values
The regional differences between voting patterns is so great, I doubt if any coarse generalizations are meaningful. For example, in northeast and northwest states the richest people are liberals, while there is a growing number of Limbaugh, Beck, Palin, NASCAR, and NRA conservatives who besides hating any elite experts, are relatively poor.

Ira Glickstein said...

All Right! This Topic seems to have stirred things up, thanks for the comments Howard, John, and CentralCoastRick (our newest Author here at the Blog, who I'll refer to as "Rick").

Rick, I did not say I agreed with the idea that C-Minds are selfish and L-Minds more generous, but I thought that was a generally accepted stereotype. We've had many discussions about L/C-Minds here and generally agreed with Haidt's "Five Channels of Morality" that L-Minds score highest in "Harm-Care" (avoidance of hurting others) and "Fairness-Reciprocity" (giving all an equal chance), while C-Minds scored lower in those two channels. Several of us took the test and our results generally matched expectations. Of course I agree with you that actual actions -giving charitably and personally helping the poor- probably does not match the stereotype.

John, I agree correlation does not always prove causation, but when you see a lot of people with wet clothing it is a good bet it has been raining. How else would you explain the fact the average Massachusetts Medicare beneficiary takes more than twice as much out of the common pot as the Utah recipient?

Howard, thanks for all the great links - you keep me as busy as you did when you were Chairman of my PhD committee. Fortunately, I no longer work full-time and we are between semesters for the U. Maryland online grad courses I teach. I am not sure the richest people in the northeast and northwest are liberals. Perhaps the very richest may be, but are you saying that NY and Mass Democratic voters are richer, on average, than Republicans? I doubt it. Yes, Palin and other Conservative populists appeal to working working-class people which scares the hell out of L-Minds who have Palin Derangement Syndrome.

Ira Glickstein

Howard Pattee said...

Ira doubts whatever data I look up. He appears to regard his personal opinion as superior to data. Take a look at what the conservative National Review reports. Also the Pew Trust poll.

Howard Pattee said...

Ira asks, “However, would not Medicare count medical expenses against the home address of the beneficiary rather than the location of his or her doctor and hospital?”

According to the references I have given, the “Medicare Reimbursements per Enrollee” is measured by the HRR (“Hospital Referral Region”) This is one (but certainly not the only) reason that medical costs near centers of expensive treatments like Boston, New York, and San Francisco cost more that Utah.

I have found no references supporting Ira’s C and L-mind theory.

Howard Pattee said...

One more point before I go to bed.

I do not have the Palin Derangement Syndrome, and Jackie Mason is a comic. So what? That has nothing to do with the issue we are discussing (medical costs and income differences between C and L-minds).

I also do not see Ira’s lists of personal resentments against liberals as relevant. This is certainly not the “ courteous discussion of serious topics” that Ira claims for his blog.

Ira says he does not trust the well-known climate expert, Lindzen, because “he has some baggage regarding lung cancer risks.” Here I agree with Ira. Lindzen’s belief that smoking is not a cause of cancer tells me that he has bad judgment, and does not accept evidence. That is enough to reduce his credibility on any subject.

I do not trust Palin for the exactly same reason. For one example, she explicitly states she does not accept evolution.

Ira Glickstein said...

Howard, I do not doubt you at all, but the linked NCPA report of what they called "High-Cost States" and "Low Cost States" was confusing, to say the least. (I'll have more to say about this in a new Topic soon.)

The stereotype Republican is a rich person who got that way by exploiting the poor, but your research shows this may not be true. I am more than willing to change my opinion on this issue.

Your National Review link shows that Red states (in 2004) had lower average incomes than Blue states, which is a pleasant surprise to me.

Your Pew link shows that, until 2007, the top 10% of American income earners had more Reps than Dems, which supports the "rich Republican" stereotype.

However, in 2007 they were about equal. Of course, in 2007 there were lots more Dem voters than Rep voters, so that data is not definitive, is it? (A horse farmer complained his black horses ate more than his white horses until someone pointed out he had more black horses than white ones!:^)

Regarding Lindzen and the link between smoking and lung cancer. He claims the statistical link is weak. A scientific analysis would show that people only get lung cancer if they have both a genetic susceptability and an environmental factor (e.g., smoking). Many heavy lifetime smokers do not get lung cancer because they are not genetically susceptable. So, if your parents and grandparents smoked and did not get lung cancer, it is likely you are free to smoke. My problem with Lindzen's claim is that it may be misinterpreted by susceptable people who may then smoke and get lung cancer. Also, I hate it when people smoke on me. (On the other hand, all is not negative, lung cancer cures smoking :^)

As for Sarah Palin and evolution. Her father was a SCIENCE teacher in High School. She knows all about the science behind evolution but chooses to believe (as most Americans do) that God directs evolutionary processes according to His Plan.

So, what Palin does not accept is evolution and natural selection by "pure chance". As you know, I, along with Spinoza and Einstein, am a strict determinist, so there is no such thing as "pure chance". Even though I (again along with Spinoza and Einstein) do not share Palin's belief in a sentient God separate from and outside of the Universe, we do believe evolution was inevitable, given the initial conditions.

Here is Palin on Fox News, 17 Sep 2008:

Q: Did you only want to teach creationism in school and not evolution?
A: No. In fact, growing up in a school teacher’s house with a science teacher as a dad, you know, I have great respect for science being taught in our science classes and evolution to be taught in our science classes.

Also see WikiAnwers:

"... she considers herself a creationist in the sense that she thinks God is behind all evolution. However, Sarah Palin is not a literal Creationist in the sense that she believes the world was created in 7 literal days and is only a few thousand years old. She is flexible with dating in the Bible ..."

And, in any case, what does this type of relatively moderate, mainstream religious belief have to do with effective governing?

Ira Glickstein

PS: Last month during an interview about geothermal energy on the Tonight Show, Al Gore said: "...the interior of the earth is extremely hot, several million degrees". He was high by a factor of 1000! Does that make him an untrustworthy numbskull not qualified to be president? (OK, bad example :^)

Ira Glickstein said...

This Topic identified Massachusetts as having the highest health-care spending per capita, one of the lowest percentages of religious attendance, and being the Bluest of Blue states.

Yet, Scott Brown has just defeated the Democratic candidate by about 5% and won the Massachusetts Senate seat held by the late Ted Kennedy! The contest has been viewed primarily as a referendum on national policies. Liberal Democratic Representative Wiener said (even before the votes were cast or counted): "I think you can make a pretty good argument that health care might be dead [if Brown wins]."

One of our most active Blog participants, Howard Pattee, lives in Massachusetts and has had a front row seat in this controversy. I wonder what your views are and if you think the vote may have been influenced by the fact that more Democrats watch Fox News than MSNBC or CNN?

Other than national issues, why did the Democrat lose by about 5%?
1) Coakley said famed Boston Red Sox pitcher Kurt Shilling - who won game 6 of the American League championship series over the Yankees playing on an injured ankle, his white sock red with blood - was a Yankee fan? That is a high crime in the Red Sox Nation (ask my granddaughters :^).
2) Ahead by over 20% at Christmas, she went on a Caribbean vacation while her opponent continued his campaign?
3) She was seen as an elitist lawyer while her opponent, a "hunk" who posed nude in the 1980's for Cosmo, ran a populist campaign from a pickup truck?
4) She won the Democratic primary against three men. If a one of them had been victorious, he would have beat Brown handily?

According to this Dec 9, 2009 Reuters story "Coakley is heavily favored to win and to serve the rest of Kennedy's term in the Senate, which will run through 2012. The liberal New England state has not elected a Republican to the Senate in almost 40 years, ... 'The election is over,' said Jeffrey Berry, a professor of political science at Tufts University. 'We have to vote in January, but the outcome is preordained. Coakley will win."

I think we are in for a populist revolution in 2010 and 2012 against effete elite intellectuals by those of us with common sense, traditional values, and respect for real work.

Ira Glickstein

Howard Pattee said...

Ira wants to know my take on the MA congressional upset. I’m not a political expert, so I’ll refer him to the voting statistics. Brown won by standard conservative principles of lower taxes and no government health program. He won where unemployment was high and where Democratic voting was low. One can’t expect those suffering from a very bad economy to vote for the incumbents. They are angry and don’t care who caused it.

Ira says, “I think we are in for a populist revolution in 2010 and 2012 against effete elite intellectuals by those of us with common sense, traditional values, and respect for real work.”

I think Ira’s characterization of “elite intellectuals” is nonsense. Common sense, traditional values, and hard work are vague abstract categories that are shared by everyone.

As a matter of fact, when Ira and I address essential concrete liberties like abortion, marriage, sex, religion, and dying, we have a hard time finding any substantial disagreement! So this makes me think his statement above is just an emotional ideological reflex.

What about the concrete issues that dominate today’s politics? Here is my problem with conservatives. They become emotional (or near paranoiac) when the government tries to restrict their hot-button “priority liberties.” These include free-markets, corporate profits, lower taxes (no estate taxes), home schooling, and gun ownership (even assault weapons).

And yet, when it comes to the most important personal liberties ― the main events and decisions of life ― conception, sex, marriage, abortion, health care, and dying, conservatives insist, just as emotionally, on severe government restrictions. I think it is this conservative restricted idea of “liberty” that liberals find hypocritical as well as threatening.

I wonder, has listening to Beck, Limbaugh, and Palin changed Ira’s feelings about these issues?

Howard Pattee said...

I need to add that what Ira calls a “populist revolution” appears to me to be closer to religious fundamentalism. Palin and Beck were brought up Catholic but converted to even wilder religions (Assemblies of God and Mormonism). Their simple message that America is a “Christian Nation” appeals to many fundamentalists. They have no idea of what the founding fathers believed. I don’t think anyone doubts that these fundamentalist groups are the Republican’s base. Science and reason are their greatest threats.

Also, Ira’s derogatory claim about “effete elite” academics and intellectuals is misplaced concern. Academics are not running the country, nor do they want to (although their advice is often sought). The separation of academia and politics has the same historical basis as the separation of church and state. In the Middle Ages the two were inseparable. Attempts by political power to restrict freedom of religious belief and freedom of thought has always failed in the end. Mixing up science and political policy also fails, as we have seen with the Bush administration and with the global warming issue.

In a capitalistic democracy government power is dominated by capital, that is, by money. It is not a populist system! The elite are those with money. They are mainly the owners of the media and the corporations. They have far more control of government by limiting information, propaganda, lobbying, and campaign contributions than any collection of academics. As we have seen, the health care we can get is only what the health insurance and pharmaceutical companies find profitable. How could capitalism work otherwise?

Ira Glickstein said...

Thanks Howard for your views from a front row seat in the MA senatorial race.

You say what I called a "populist revolution" is closer to what you call "religious fundamentalism". I agree most Americans profess religious conviction in a literal sense that I do not happen to accept personally. Never-the-less, I respect moderate religion as a force for good. So far, the Tea Party movement has not excluded any mainstream religion but instead embraced -and been embraced by- Mormons (Beck and Gov. Romney), Catholics (O'Reilly) and Christian Fundamentalists (Palin). In the past some of my Christian fundamentalist friends have told me the Pope is the antiChrist and Mormonism is a cult, yet the Tea Party brings all together in common purpose! I have seen nothing in Gov. Palin's book or her public references to God that appears extreme.

In my online novel set in the second half of this century, I imagine an anti-religious time when proclaiming one's belief can be career-limiting. Are you suggesting we ban believers from public office and responsible employment?

The populist Tea Party movement is as much -or more- opposed to the capitalist monied elite as to the academic elite I called "effete intellectuals". As you know the monied elite will support any politico they think will gain them government contracts and pass laws that protect their industry. Intellectuals are also attracted to power and government grants.

When I speak of free markets, traditional values, common sense, and respect for real work they are not abstract categories and I am not driven mainly what you call "near paranoic" emotion. Absent market forces, and people willing to do the real work -manual labor- of digging ditches, farming, manufacturing, repairing, and so on, there is no human civilization.

My professional life has been devoted to intellectual work -pushing technological ideas and paper- but I am "grounded" by the real work I did as a youngster and continue to do as an adult. I have soldered hundreds of electronic circuits, written thousands of lines of computer code, installed copper and plastic water and drain pipes. Over the past several years, I dug the fish pond and placed the liner and all the stones and planted the bushes myself. Just this afternoon I spent almost an hour up to my elbows in fish poop cleaning the filter!

I am attracted to people like Palin who are not ashamed to do manual labor and know how to hunt and kill and field dress animals, and to Scott Brown who drives a pickup truck. They may not be as academically adept or intellectually intelligent as President Obama, but they are firmly grounded!

No government can guarantee what you call "personal liberties" - the must be fought for -and defended- in each generation. What you see as "severe government restrictions" in the area of "conception, sex, marriage, abortion, health care, and dying" are, in my view, defense of traditional views that have served humanity well during and prior to the American experiment.

What kind of "liberty" sanctions killing perfectly healthy babies weeks from birth, promiscuous sex, calling homosexual partnership no matter how sincere "marriage", and guaranteeing levels of health care to those who cannot pay for it at levels unsustainable by public funds?

These effete elite liberal revolutionary ideas about "liberty" are seen as changing the basic social contract and call for a popular counter-revolution. Just watch as it develops!

Ira Glickstein

Howard Pattee said...

In my earlier post I made the assertion that, “As a matter of fact, when Ira and I address essential concrete liberties like abortion, marriage, sex, religion, and dying, we have a hard time finding any substantial disagreement!”

From Ira’s response I’m having my doubts. In past discussions Ira approved of abortion in the first trimester. I thought he favored equal rights for committed couples of any sex. I thought he approved of artificial means of couples having children. I’m sure our theological beliefs are similar (except for determinism). Of course we agree on “promiscuous sex" (whatever that is). And his views on choices on dying are certainly not like the conservatives like Palin with scare talk about “death panels,” and outsiders who interfere with the death of the terminally ill or the brain dead.

But now he is attracted to Palin for her “manual labor,” even though she would disagree with him on most of these private liberties.

Ira apparently respects only those intellectuals who are “grounded in real work.” He has mentioned several of his own grounded accomplishments to show he is not an "elite intellectual."

I feel I should also qualify because Ira has known me only as an elite theoretical intellectual (the most dangerous kind!).

My first job as a teenager was as apprentice steamfitter swaging copper tubes into heat exchangers. In WWII I also learned to solder, but not circuit boards. I taught a lab on how to repair radars and transmitters on shipboard. As a graduate student I did my own machining. My Phd topic was designing and constructing the first compound reflection X-ray microscope. (This type of optics is now used in the Chandra X-ray telescope.) Enough of that real work.

I agree with Ira that the fundamentalist/populist movement will grow. That is what is scary. They are largely motivated respectively by fear and resentment. There is a mob psychology involved (as shown by the Tea Party meetings), and history shows that they are often subverted by charismatic leaders (e.g., see Wiki on populism).

Ira Glickstein said...

I knew, Howard, that you worked on X-ray microscope technology and am encouraged to learn you have swagged as a steamfitter in earlier years. Did that "real work" experience help inform your later work as a physicist and professsor as my experiences grounded my system engineering and teaching? I suspect it did!

You and I agree "the fundamentalist/populist movement will grow." We differ when you say: "That is what is scary. ... largely motivated ... by fear and resentment. ... mob psychology ..."

Brown won because Independents abandoned the Democrats in a "perfect storm" of local and national developments, including:

1) Kurt Shilling. Anyone in the Red Sox Nation who thinks Shilling is a Yankee Fan is not one of "us"!

2) Partisan National Health Care. Government is screwed up if the super-majority party can't even pass the same bill in the Senate and House and if they expect us to pay for shenanigan deals with favored states and unions when we already have bipartisan, near-universal health care in MA, passed under Gov. Romney.

3) Caribbean Vacation. Don't take us for granted and go away in the middle of the campaign because you don't like to shake hands in the cold wind and mess your hair.

4) Coddling Terrorists. Who decided to allow the underwear bomber to lawyer up? Why give the 9/11 mastermind the same legal protection as a US citizen? You say the Constitution requires it? In a time of war? Tell that to FDR who tried and executed the Germans who sneaked in at Long Island from a submarine.

5) Who'd You Have a Beer With?. Pick one: a) A "hunk" in a pickup truck or b) A fussy lady lawyer?

Yes Howard, you and I do agree on a wide range of specific issues, even those that change traditional law. It has long been established that governments must establish laws for marriage and to protect the life and liberty of all. Yes, these laws should change with the times, but only with Legislative and Executive approval.

I do favor "civil unions" to give legal rights similar to marriage to gay couples. But not if it is called "marriage" and not if it is enacted by court edict.

I do favor "choice" in the first and second trimesters, and to save the mother's life in the third. The Constitution speaks of the right to life and liberty, but that includes the rights of the baby! When does his or her life begin? Biologically, it is at conception, but I am willing to compromise if legal processes change the law.

I am not a literal believer in any mainstream religion, but I accept that most of my fellow Americans are, and I believe religion, to a point, is necessary for human civilization.

Medical advances have extended life and promise to extend it indefinitely. Therefore, we need to reconsider end-of-life law. I am in favor of Comparative Effectiveness Research (CER) and Quality-Adjusted Life Years (QALY) as a determinant of when to end heroic measures and give only palliative care. Again, there is a role for the government to set applicable law.

Ira Glickstein

Howard Pattee said...

As I said, I think Palin would not agree with you and me on all these points. That's assuming she could fully grasp our positions, which I doubt. So I am puzzled why you are so enthusiastic about her?

Ira Glickstein said...

Gov. Palin called the government medical boards that will set end-of-life policy "death panels" while Pres. Obama called them "honest brokers". No matter what you call them, they will affect the quality of life and literal life or death for Americans with chronic or terminal conditions. As everyone knows, insurance companies and hospital boards already sentence some of us to death and torture others with excessive treatments to raise profits.

While governor of Alaska, with 80% approval ratings, she never pushed her religion or restricted abortion or marriage or otherwise imposed her views on others. She did express her views as part of the national dialog as is her right and duty under freedom of speech.

If you read her book, as I did, you would realize you are judging the SNL Tina Fey cartoon character when you doubt Palin's ability to grasp our positions.

The real Palin, without benefit of family money or fame or political connection, first upset the "good old boy" network in her hometown of Wasilla (as councilwoman and mayor for multiple terms) and then uncovered corruption by both Democrats and Republicans in service to Big Oil while she was on the Alaska Oil and Gas Commission. She won the Republican candidacy against the party machine by pure grit and honesty, and yes, by personally driving herself and children from one end of the state to the other.

Obama, after a year in office and with a string of defeats administered by his own super-majority party, is finally approaching the level of administrative knowledge and grasp of the real issues that Palin demonstrated in Alaska prior to her run for the VP job.

Don't confuse pure academic intelligence and sterling speech-making with the ability to grasp the issues and make government work. It takes grounding to know what is really important to the people.

Ira Glickstein