OCTOBER 8, 2009
Wider Health-Care Access Pays Off
By DAVID WESSEL
WSJ
(snip)
Amid all this, it is easy to lose sight of one big, underlying issue: the enormous value of broadening access to quality health care, both to individuals and the entire society. In new research drawing approving attention from their peers, three economists -- Kenneth Chay of Brown University, Jonathan Guryan of the University of Chicago's Booth School of Business and Bhashkar Mazumder of the Federal Reserve Bank of Chicago -- offer a powerful reminder. The trio links improvements in test scores of black teenagers from the South in the 1980s to improved health care they received as children after Southern hospitals were integrated in the 1960s. The bottom line, in a working paper circulated by the Chicago Fed, is this: "Improved post-neonatal health among blacks born between the early 1960s and early 1970s...led to long-term improvements in the academic and cognitive skills of these cohorts as teenagers." Yeah, right, you say. Like someone could actually prove that. Read on.
It is impossible to measure today how healthy children were in the 1960s, so the trio uses death rates in children between 1 month and 1 year old as a proxy. Untreated diarrhea and pneumonia were killers back then for children who didn't get health care; the decline in death rates points to improved health care for children all round. During the 1950s and '60s, about 14 more black children died per 1,000 births than white children in the U.S. After 1964, the gap narrowed significantly. By 1972, the gap was down to four deaths per 1,000 births. The narrowing was particularly pronounced in the South. Before then, blacks who came to emergency rooms were sent to separate waiting rooms and often had to wait until all whites were treated. As Mr. Chay and others have documented previously, the quality of health care offered to blacks in the South improved markedly after the Civil Rights Act of 1964 outlawed segregated hospitals, and the 1965 Medicare law enforced the ban and gave hospitals a financial incentive to go along. The Medicare law said the federal government would pay for elderly Americans' care only at racially integrated hospitals.
A separate strain of study focuses on a narrowing in the 1980s of the differences between black and white teenagers' scores on the National Assessment of Educational Progress test and the Armed Forces Qualifying Test, the first a national yardstick overseen by the Department of Education and the second administered to those who try to enlist in the military. The changes were particularly sharp in the South. The trend didn't persist and has proved difficult to explain, a quest in which Mr. Guryan has been a participant.
School desegregation isn't the key; the timing isn't right. But something good happened to black children born in the mid-1960s and early 1970s. "It's remarkable," says Mr. Chay. "If you are born in 1962 in the South and you are black, you did much worse on those tests than if you were born in 1969 in the South and you are black. But in the North
, it doesn't matter when you were born." As the charts accompanying this column show, the two trends coincide, and Messrs. Chay, Guryan and Mazumder find clear statistical links between the two, and pinpoint the importance of childhood health care while ruling out other potential explanations.
(snip)
Although the U.S. has changed a lot since this 1960s, there are lessons for the U.S., as well, as it contemplates priorities at a time of recessionary stress on state and local government budgets, and the national restructuring of its massive health-care system. The consequences of these decisions will reverberate for decades to come and the quality of the health care children get today will shape their contributions to the economy when they grow up.
http://online.wsj.com/article/SB125493500031971173.html (subscription)
Printed in The Wall Street Journal, page A2
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