Suchergebnisse

It is helpful to know the incidence of different taxes. We should identify the wallet or purse that it comes from because very often this is not the one that people think it is, or the one that the legislators intended it to fall upon.For example, since corporations are not people, they don't pay Corporation Tax. Its incidence is on the workers, who do not receive pay increases when the money goes in tax, on the shareholders, whose shares lower in value because the tax reduces profits, and on the customers, who pay higher prices as the firm increases them to make up for the money taken by the taxman. Numerous studies have shown that the biggest losers are the employees, with estimates showing that 60 percent of Corporation Tax is paid by them.Most people think that they pay National Insurance and that there is an employer contribution. In reality the so-called employer contribution is a wage cost, and comes out of the wage pool that would otherwise be available for wage increases. Its incidence is on the employees.Some people argue for business rates to be frozen or lowered, thinking this will help businesses, but in fact landlords are the beneficiaries when this is done because it allows them to put up the rents. Rents and business rates are inversely proportional. Rising rates make for lower or frozen rents, and rate decreases enable landlords to increase rents. Knowing the incidence of the tax leads to a policy initiative that could direct help to businesses rather than landlords. Business rates could be frozen or reduced for 3 years, but only for businesses whose landlords agree to a rent freeze for 3 years. The rates would not be frozen or cut unless landlords signed up for this. The effect would be to direct the benefit to the businesses, and help them as they struggle with increased costs elsewhere.At a time when the UK needs to boost growth by having its businesses prosper, this is a policy that could help them to do that.

Claims in Republican testimony about the prevalence of illegal voting by noncitizens in the United States don't hold up.

While much of the violence is attributed the drug trade and its ripple effects, the country also grapples with incidences of violent home invasions, kidnapping and femicide.

Expanding access to OUD treatment would reduce the number of people who seek drugs in the dangerous black market and, in turn, reduce the risk and incidence of overdose deaths.

Article by Sambhav Maheshwari The COVID-19 pandemic, by changing experiences across transportation, well-being, caregiving, health care, and jobs, has caused society-wide shifts in behavior with potentially far reaching consequences. One of these is the impact on birth rates with potentially long-lived demographic consequences. In 2020, many academics predicted that the incidence of a pandemic (COVID) […]
The post COVID-19: Baby Bump or Baby Dump? appeared first on The Lowe Down.

One of those things that we're seeing said out there. Only 4% of estates pay inheritance tax. Yet 30% of people are against the tax on the basis that they might have to pay it. Well, of course, it's possible to blame the innumeracy of the general population, which is what many are doing.An alternative to that is to actually think - yes, yes, we know, this is politics, cogitation is not a positive value here - and to wonder why? Why does such a large portion of the population hate this tax upon dead people? Who, after all, can't complain that much, they are dead after all.Yes, we are aware that there's a darn good classical liberal argument for a 100% inheritance tax. We could - should - succeed by our own efforts not by membership of the lucky sperm club. There is also that opposing - and still classically liberal idea - than an increasing portion of the population economically independent of the State might lead to that desired outcome of a smaller state. But leave aside the theory for a moment. Why do so many hate something that won't affect them? One asnwer is that it doesn't matter. Assume, for a moment, that we are a democracy - ahahaha. So, if the folks are against it then it doesn't happen. You know, will of the people and all that.But that point that only 4% of estates pay inheritance tax yet 30% think they will be affected. How do we explain that? The most obvious point is that the incidence of inheritance tax is not actually upon estates. Yes, there is that Australian finding that people will time their death so that death duties do not have to be paid. But, you know. The real point is that the incidence of interitance tax is not upon the dead nor their estates. Recall what tax incidence actually studies. Whose wallet gets lighter as a result of the tax? Given shrouds and pockets it's not the dead, is it? It's the people who inherit less money as a result of the tax. So the number of people against inheritance tax is not the number of people whose estate will be subject to it when they die, it's the number of people who think they might inherit from one when someone does. We're all, as we know, part of that complex system that is society. Inheritance - even perhaps of modest amounts - is common enough among nieces, nephews, friends as well as direct descendants. The number of people against inheritance tax is not the number dying, it's those not benefitting from those dying. Or, rather, benefitting less.This does not, we are aware, answer the question of whether inheritance tax is just, righeous, or the robbing of those no longer able to complain. But it does answer why so many are agin' it. The incidence of inheritance tax is not upon the dead, nor their estates. It's upon those who inherit less as a result of the tax. And that might be greedy, a desire for unearned wealth, inequity producing or even bourgeois freedom generating. But there are many more people hoping to inherit than there are estates being inherited from. Which is why the number of those opposing inheritance tax is higher than the number of estates being taxed.Seems fairly obvious to us to be honest but we've not seen it mentioned elsewhere as yet. The opposition to inheritance tax is those who think they'll receive less money as a result of it. Which, you know, is obvious, no?

On September 6, 2023, the results of the nationwide popular polls were tallied to select the next presidential candidate for Morena, Mexico's incumbent party. Just hours before the results were announced, prominent candidate Marcelo Ebrard voiced concerns about the integrity of the counting process, calling for a complete restart. He pointed out a "worrisome" 14.4% incidence of cancelled ballot boxes in Morena's main survey. Ebrard also accused the use of police force to prevent his supporters from placing their ballots. Furthermore, he argued that Morena had operated on a clientelist structure which conditioned citizens' social benefits to promote support for his rival. His plea was dismissed by party leaders, who proceeded to declare Claudia Sheinbaum as the winner. Mexico's political ...

Apparently there's something wrong with the water system: Polluted water is causing 60 per cent more hospital admissions than a decade ago, official figures show.The number of people admitted to hospital for water-borne diseases – including dysentery and Weil's disease – has increased from 2,085 people in 2010-11 to 3,286 in 2022-23, according to NHS statistics.OK. Weil's Disease has been rising in incidence for well over a decade, from 2018: A deadly infection spread by rats has reached record levels in the number of hospital appointments taken up by people suffering from the illness.Hospital sessions for people suffering from Weil's disease, which is spread by rats' urine, are three times the level three years ago and are now at unprecedented levels.We'd like to know why of course. Perhaps more rats, perhaps different rats, perhaps councils aren't controlling rats. And we are also told that dysentery cases are up - perhaps it's just more people going to waters where Weil's and dysentery can be caught?We'd clearly like to know why this is happening - so we can decide what, if anything, we're going to do about it.From the Labour Party: Labour pledged it would put failing water companies in special measures to force them to "clean up their toxic mess and protect people's health".Ofwat, the regulator, would get powers to block the payment of any bonuses until water bosses had cleaned up the pollution, while water company bosses who oversaw repeated law-breaking would face criminal charges.Clearly the blame is being placed upon the capitalist nature of the English water companies. For, as The Guardian of all places points out: Waterborne diseases such as dysentery and Weil's disease have risen by 60% since 2010 in England, new figures reveal.OK.We'd still like to find out what is causing this problem in England. And it's true that England has capitalist water companies in a manner that the other Home Nations do not - Wales, Scotland and NI have variants of state owned water companies performing the job. The other home nations also have NHS organisations that are separate and thus their own statistics on this matter. Which does mean that we can test the proposition. It's possible that there is some, or some set of factors, increasing dysentery and Weil's in these isles. Hand washing to more rats to greater water sports patrticipation to the capitalist nature of water provision. We've also the statistics to be able to at least begin to make the distinction. Compare the rise in infections across the Home Nations' versions of the NHS to the ownership of the water companies across the Home Nations.What has actually been done? Noting the rise in incidence in the one country, England, then blaming it upon the one difference in England, that ownership. Without, ever nor at all, actually testing the proposition. Which is, if we are to be very polite about it indeed, not a proof of anything at all other than the ability to project prejudice.So, why do people urinate in the public information pool in this manner? Because it's politically convenient to do so. Which is why politics is such a bad way of running anything - decisions are always based upon biased and piss poor information.

A slightly worrying report: Rising temperatures mean that nearly half the world's population may now be at risk of dengue infection, new modelling forecasts. Analysis from Airfinity, a science data analyst company, shows that the incidence of dengue has already increased by at least 30-fold over the past 50 years.Half a million cases were reported to the WHO in 2000, rising to 5.2 million in 2019, with the true number of annual infections now estimated to be up to 96 million.Once specific to small pockets of Asia, the disease is now considered endemic in more than 100 countries globally and its geographical reach is continuing to spread, according to the WHO.If this is true then why is it that British government policy is to increase the number of swamps in hte country? The Somerset Levels are to be returned to that ague ridden swamp it was before drainage, beavers are being reintroduced to create swamps - even in the middle of London.We all know how to limit the spread of mosquito bourne diseases, have fewer mosquitoes around. Do as is done in places like Singapore, make absolutely certain there's no standing water for them to breed in. So why is it that government policy is to create swamps by the hundreds of square miles in this green and pleasant land? Is it just that government is incompetent or is there really a plot to murder us all in our beds? And, umm, shouldn't we find out?

As the modern world shows us it's not, in fact, necessary to be religious in order to be a Puritan. So they're trying again, everyone in the country must live on raw turnip to appease the liberal and modern thinkers: Britain faces a "tidal wave" of heart disease due to a dependence on ultra-processed food which is causing harm similar to smoking, research shows.Two landmark studies have revealed that ultra-processed food significantly increases the risk of high blood pressure, heart attacks and strokes. Even "healthy" processed options, such as protein bars, breakfast cereals, low-fat yoghurts and supermarket sliced bread were linked to worse heart health.Gosh, well, yes. We're certainly willing to examine such claims. They go on:More than half of the typical British daily diet is made up of ultra-processed food, more than any other country in Europe. The products, made using a series of industrial processes, include breakfast cereals, ready meals, frozen pizzas, sweets and biscuits.So, if the British eat more of these UPFs and UPF causes these medical horrors then the British must suffer more from such medical horrors. Certainly, if the effect is large enough that we need to do anything - move back to the raw turnips say - then this would be readily apparent in the population health statistics.Hmm. Deaths by heart attack we're middling across Europe. Stroke incidence we appear to be low (with our internal ranking going Oxford, South London, Scotland, the last being the lowest. Which isn't what we'd expect if it's a diet high in UPFs as a cause).Britain has the lowest rates of high blood pressure in Europe, with around one in eight women and one in five men with high blood pressure, compared to more than a third of men in several central and eastern European countries.Oh.Now we all do know that correlation is not causation. But if you ain't even got correlation then you ain't got nuttin'. Recall, the claim is UPF causes these diseases, the British eat more UPF therefore these diseases should be worse here. They're not. Collapse of the theory then.Oh well, luckily the major purveyor of this idea still has a back up career as a purveyor of fish finger sandwiches at his fast food chain. And the rest of us don't have to subsist on raw turnips.

Yet another attempt from the founder of a fast food chain to tell us that - well, fast food actually - obesity is one of the grand public costs: Britain's weight problem is costing almost £100 billion a year and will scupper Rishi Sunak's plans to get the sick back to work, analysis suggests.This is not, in fact, true. It's not true in the slightest. We assume that the idea is if the insistence is made forcefully and often enough then the political system can be stampeded into doing the wrong thing. The cost to the NHS of obesity-related illness is now estimated at £19.2 billion a year, up from £10.8 billion, while the wider social costs include productivity losses of £15.1 billion, compared with £1.7 billion previously. The total cost of £98 billion, which includes the £63 billion cost of shorter, unhealthier lives, is equivalent to about 4 per cent of GDP.As we've pointed out, repeatedly, obesity does not cost the NHS money. Yes, obviously, treating obesity related diseases has a cost. But we have a lifetime health care system. Therefore it is lifetime health care costs that matter. People dying young of exploding hearts save the system the money required for decades of hip replacements and Alzheimer's care. The researchers found that from age 20 to 56, obese people racked up the most expensive health costs. But because both the smokers and the obese people died sooner than the healthy group, it cost less to treat them in the long run.On average, healthy people lived 84 years. Smokers lived about 77 years and obese people lived about 80 years. Smokers and obese people tended to have more heart disease than the healthy people.Cancer incidence, except for lung cancer, was the same in all three groups. Obese people had the most diabetes, and healthy people had the most strokes. Ultimately, the thin and healthy group cost the most, about $417,000, from age 20 on.The cost of care for obese people was $371,000, and for smokers, about $326,000.That NHS cost of £19.2 billion therefore does not exist. The correct number is actually negative, not positive. The £63 billion is a private, individual, cost not a societal nor public one. We'd be willing to take a bet that those public costs, all in, are negative given that the NHS cost is negative. All of which really does leave us with something of a puzzle. Why are people trying to influence public policy with numbers that are so obviously untrue? We've even been quoted making this point: Tim Worstall, of the Adam Smith Institute, has called warnings that obesity poses an NHS funding crisis "nonsense on stilts". He wrote: "When you add in the costs of the state pensions that those who die young don't get, smoking and gorging save the government vast sums of money. Having us all slim . . . would cost the NHS very much more money than the current level of topers, smokers and lardbuckets does."Disagreeing with us is obviously no sin but being at odds with reality is. So why are they doing this? What's the plot here?

Life in prison doesn't mean life in prison in
Louisiana, even for murder. Given the current state of capital punishment in
America, this translates into more heinous criminal activity and is something
incoming governor Republican Atty. Gen. Jeff Landry and Legislature need to
fix.

Just before Christmas, Democrat Gov. John Bel Edwards commuted
the sentences of 40
murderers. This requires four of five votes from the Board of Pardons prior
to that choice and has the practical effect of allowing out of prison people
sentenced to life without the possibility of parole, in essence making a mockery
out of the original sentence specifically but more generally eroding the
deterrent effect of that punishment for first and second degree murder on the
incidence of commission of homicide.

In recent years with Edwards at the helm and with
the chance to appoint or reappoint members to the Board, who serve four-year
terms concurrent with the governor, it has tilted
more and more towards granting commutations and for murderers. Excepting
2020 when the Wuhan coronavirus pandemic limited activity, Board approval of
commutations and gubernatorial approvals have increased steadily. Most notably,
reviewing the more than 50 years sentenced category of commutations which is murderers,
he commuted only 17 in his first term and none in 2018 the year before his
attempted reelection, whereupon his commutations in this category skyrocketed to
28, 12, 49, and at least 40 this year once he had achieved reelection and
became term limited.

Thus, a determined governor with a board acquiescing
to his thinking can subvert the meaning of life without parole attached to
murder convictions (if not capital punishment in the case of first degree). This
makes matters worse because, with the many obstacles thrown in front of
carrying out capital punishment over the past couple of decades in Louisiana,
LWOP becomes the fallback position both to keep incorrigible individuals out of
public and to deter those of a similar nature from homicidal activities in the
future. Devalue LWOP, and crime increases.

Naturally, a governor like Landry who would
impress upon his Board appointees his worldview on this matter that strengthens
the deterrent impact of LWOP can reverse this unhealthy trend. Still, it would
be better to prevent future governors, if any, of Edwards' attitude from being
able to short-circuit the intent of judges and juries.

However, removing the ability to commute for
certain sentences not only would require a constitutional amendment but also
would remove a necessary, if rarely needed, tool to implement just outcomes.
For example, one murderer who just gained commutation has
had questions swirling around the quality of his defense of his conviction –
originally given a capital sentence – ever since he went into the dock.

Better would be to revalue capital punishment,
which would encourage more of these sentences to be sought instead of LWOP,
that would require a commitment for the state to restart executions because otherwise
capital punishment becomes meaningless as a deterrence instrument. Landry
has voiced support for restoring the deterrent value of it, which means changing
the law to encompass
methods of execution other than lethal injection (where politics has interfered
with the ability of the state to obtain the chemicals necessary to perform it) –
practically speaking, any of electrocution, firing squad, hanging, or lethal
gas (including the newest
variant to be tried within the month).

That the Legislature should do as soon as
possible, and likely majorities exist to do it. Put this on the list of things
to do to reverse the deterioration Louisiana has suffered over the past eight
years.

Just to try to capture neoliberalism - well, just good sense in fact - in a nutshell. Markets often work and when they do use markets. Markets sometimes don't work and when they don't don't use them. A neoliberal is just any person who thinks markets work more often than you do.With that in mind: Yet for some patients with rare diseases, commercial interests are dictating who gets to access life-saving treatment and who doesn't. Pharmaceutical companies have long been driven by global demand and the potential for the highest profits. In the past two decades, the market has exploded: pharma revenues worldwide have exceeded $1tn. For patients with common conditions, this investment in healthcare can only be good news. But the narrow focus of this strategy means that, in the UK, the one in 17 of us who will at some point be affected by a rare condition risk being forgotten.OK - the claim is commercial pharma works just great for many things but doesn't for all. So, where it doesn't use some other system. We can't see any objection to that. However, it's not, perhaps, quite as simple as is being portrayed. Great Ormond Street hospital (Gosh) recently announced that it was taking the unprecedented step of attempting to obtain the licence itself for a rare gene therapy on a non-profit basis, after the pharmaceutical company that planned to bring it to market dropped out. If successful, it will be the first time that an NHS trust has the authorisation to market a drug for this kind of treatment. The move could act as a proof of concept for bringing drugs to UK patients that pharmaceutical companies aren't willing to risk their profits on.Ah, well, no. The development costs of a new treatment are high. It's possible to have the most lovely arguments about how high, estimates range from "only" $500 million up to $2 billion. The vast majority of that cost being the testing regime and the seeking of authorisation and licence to be able to market. The new and interesting chemical is a small fraction of that cost.The rare disease problem is that the disease is rare. Whether we use profit making companies, charities, government or whatever else to perform the task we do still want whatever it is that is done to be value additive. If we're to spend $500 million (or $2 billion) we still want a profit on that expenditure - profit in the real sense, that the value gained from having done it is greater than the alternative uses of the same scarce economic resources. Whther that profit then becomes a profit to the capitalists or just the general value addition to society as a whole is an entirely secondary question. We still want the value from having spent $500 million to be greater than the $500 million spent. Changing who spends and how the $500 million, changing who gains that value added, doesn't change that base calculation. This particular rare gene therapy is for bubble baby - the absence of an immune system. The incidence is somewhere between 5 and 15 children a year in the UK. Spend $500 million to save 15 children? Well, maybe. 70 years of life from a one off treatment at $40,000 per QUALY gives us $2.8 million a treatment and $42 million a year in societal benefit. If the treatment can be marketed elsewhere as well then that cost per life saved falls precipitately. But again, note that that calculation is the same whether it's Great Ormond St or vile capitalist b'stard spending the $500 million. The problem isn't the capitalists and their lust for profit. It's the rarity of the disease being treated and the costs of gaining authorisation for the use of the treatment. There is an easy way out of this of course. Lower the cost of gaining that authorisation. Cull the bureaucracy and so solve the problem - but doesn't culling the bureaucracy solve so many problems, eh?

The faux outrage over a commonsense bill
illustrates the agenda of Louisiana's political pro-abortion left.

SB 276 by
Republican state Sen. Thomas
Pressly would prohibit coerced abortion by drugs and inhibit that by
making illegal purchase of over-the-counter mifepristone and misoprostol.
While separately the two drugs can address certain ailments, when used together
they can cause a chemical abortion, which is outlawed in Louisiana except for rare
instances. As a result, possession without a prescription would be legal only
for pregnant females, as the bill assumes other people will use these to coerce
an abortion. A pregnant female with these in possession without prescriptions
would not be breaking the law unless she subsequently consumed these to induce
an abortion, under a different statute.

Pressly has a compelling story to demonstrate need
for such a bill. His sister while pregnant without her knowledge was
manipulated into consuming these drugs. Fortunately, her child survived but with
impairment. That demonstrates the harm from misuse unambiguously. And, if taken
improperly, they can have serious consequences, such as for pregnant females miscarriages,
premature labor, or birth defects, or more generally several life-threatening
conditions.

Leftists didn't mind the bill when it created just
the crime. But they went ballistic when putting in the bill a means to prevent
the crime by making more difficult the otherwise easy obtaining of the two
drugs. This is because shipping the drugs interstate has become a popular
method of getting around prohibitions to abortion except in rare incidences in
states like Louisiana, so this strikes directly at their ideology of abortion
on demand and thwarts whatever pleasure they may receive by trying to put one
over on the state in causing abortions in it despite the law.

Classifying the two as prescription needed,
Schedule IV, will mean some inconvenience to providers and patients. While most
providers already have the proper licensure and facilities to treat the drugs
in this fashion, some may not and would have to arrange for that by the Oct. 1
effective date. Patients who now pick up the drugs off the shelf will have to
arrange this through a pharmacy.

This the left has decried, but their apocalyptic characterization
of the change is way overblown. Minor changes will set up a smooth system of
dispensing, and their non-abortifacient uses – controlling hyperglycemia, treating
certain types of brain tumors, combatting endometriosis or fibroids, preventing
ulcers, inducing labor early – don't require immediate or emergency application
that might be slowed through a prescription regime.

The left also has attempted another hollow
argument against the change, that controlled substances "usually" are addictive
and so therefore somehow this disqualifies the reclassification. That's
irrelevant: if something is casually available and dangerous that can cause
harm to others if surreptitiously introduced, increased regulation is entirely
appropriate to reduce the chances of improper administration, regardless of its
addictive qualities. After all, even as its possession in the U.S. is illegal,
the trade-named Rohypnol
– a relaxant that can so incapacitate people when surreptitiously administered as
to make them vulnerable to physical harm including rape – is not addictive but
legally treated in exactly the same fashion at the federal level.

There's absolute justification to classify these
drugs as harmful enough to make them subject to prescription, which has made
leftist opposition even more shrill to deflect from that. The bill will return
to the Senate with expected concurrence and then signed into law by GOP Gov. Jeff Landry, providing
a rare instance where the state provides positive policy leadership.

On the whole, the law's coming into effect won't
make that much of a difference. Informed users – in tandem, the drugs can do
this until about 10 weeks into a pregnancy – will contract with an out-of-state
provider in states where abortion remains legal in various forms, as pro-abortionist
doctors and special interests already have established networks to accomplish
this, to obtain the pills whether by prescription. Others – or even those wanting
to coerce a chemical abortion – will take a chance through illegal means of
obtaining. There will be some deterrence, but not a whole lot.

Yet the left has gone bonkers about this, precisely
because it closes even slightly the pill pipeline loophole. Most laughably, it disingenuously
claims the different treatment will affect maternal health outcomes which objectively
clearly is highly unlikely, yet doesn't mention at all the threat to children's
health, specifically at nearly a 100 percent fatality rate, through misuse of
the pills that the bill reduces.

But it's never been about health or safety with
that crowd, only about cranking out as many abortions as possible. Which will
have long-term political ramifications not to its liking, as a future post will
show.

Marc Joffe


With so many people obtaining Medicaid coverage in the wake of the Affordable Care Act and during the pandemic, it is worth investigating whether this expanded eligibility is improving health outcomes. Overall, decreases in the proportion of uninsured individuals over the last decade are not being matched by improved life expectancy. Indeed, life expectancy at birth in 2021 was lower than it was when the Affordable Care Act passed. But this fact tells us little about the benefits of Medicaid coverage since the decline has been driven in large part by COVID-19 deaths among elderly patients (often not on Medicaid) as well as increased mortality from accidents and drug overdoses.
To better gauge the benefits of Medicaid, it is necessary to look at more specific health indicators. The federal Center for Medicaid and CHIP Services (CMCS) compiles a large variety of healthcare quality measures that could help us analyze outcomes. Unfortunately, most of these measures are not available for all states and all years, making it difficult to assess performance in a systematic way.
One indicator that is generally available is the rate of low birth weight, which is the percentage of newborns weighing less than 2500 grams, or about five pounds eight ounces. Low birth weight (LBW) babies have "a higher risk of morbidity, stunting in childhood, and long‐​term developmental and physical ill health including adult‐​onset chronic conditions such as cardiovascular disease." Consequently, reducing the incidence of LBW should improve public health, but Medicaid services are not achieving this outcome.
A 2019 study in JAMA found no correlation between Affordable Care Act Medicaid expansion and LBW. The authors used administrative records to obtain rates of LBW (and some other adverse birth outcomes) before and after Medicaid expansion in states that accepted the expansion and those that did not. The change in LBW rates in expansion states was not significantly different than that in non‐​expansion states. The authors did find some improvement for Black infants in expansion states, but not for white or Hispanic infants.
Overall, the US is not among the countries that have had the best success in minimizing low birth weight. A 2015 World Health Organization analysis ranked the US 64th among 146countries, with such less affluent nations as Albania. China, and Cuba performing better. Poor US outcomes have been attributed to the use of fertility drugs (which increases the likelihood that a mother will give birth to twins or triplets) and the high rate of Caesarian sections.
According to data from the CDC WONDER Database, 8.3% of US babies born in 2019 were low birth weight. The LBW rate among Medicaid patients was substantially higher, coming in at 9.8% (WONDER also has 2020 and 2021 data, but I chose 2019 data to avoid any pandemic‐​related affects).
In the District of Columbia, the LBW disparity between Medicaid‐​financed births and those with other types of coverage is especially stark. In 2019. DC's overall LBW rate was 9.9%. For Medicaid births, it was 12.7% and for non‐​Medicaid births it was only 7.4%. And, it does not appear that this disparity is caused by a lack of access to government‐​paid medical services: the Medicaid and CHIP Payment and Access Commission (MACPAC) reports that (in 2018) 99.3% of DC Medicaid births took place in a hospital and that 91.7% were attended by a physician, with almost all of the remainder attended by a Certified Nurse Midwife.
The risk of low birth weight can be minimized through proper nutrition, not smoking, and avoiding narcotics. These risks can be controlled with non‐​medical interventions. For example, at‐​risk mothers can be accommodated at maternity homes, where their diet and substance use can be carefully supervised. The widespread use of maternity homes in Cuba may explain the low rate of LBW in that country (although Cuba's health statistics have been subject to criticism).
WONDER provides statistics on tobacco use in pregnant women. In DC, the LBW rate among Medicaid tobacco users was 23.7%. Unfortunately, data are not available for other types of substance abuse or malnutrition, however Wallethub recently ranked DC's drug use fifth among all states (plus DC).
Some states are devoting Medicaid resources to the "social determinants of health", funding non‐​medical services such as housing and nutrition that are intended to address health inequities. DC has an Office of Health Equity that supports "projects, policies and research that will enable every resident to achieve their optimal level of health — regardless of where they live, learn, work, play or age." But these added efforts are not making a dent in LBW.
Despite spending over $3 billion on Medicaid annually, DC (like other parts of the US), has pregnancy outcomes that are on a par with or even below those of developing countries. It appears that providing costly pregnancy services cannot substitute for the basic health precautions we hope all expectant mothers will take.