Bad teeth

Here’s one example I’ve found. According to the NYT, Americans have worse teeth now than a decade ago.

That isn’t a surprise. Americans are growing fatter, as well. The same foods that lead to poor body health also lead to poor dental health. Brushing and flouridated water can’t help you if you eat junk. Also, the positive effects of flouridated water are overblown.

Then there’s the striking fact that Europeans are getting taller while Americans are not This seems to be true right up the class spectrum, so a simple explanation based on access to health care and dietary info is problematic.

Height has both nutritional and dietary components. Our diet has definitely been worsening, but also, “American” is much more nebulous a genetic concept than “Dutch”. It would be more useful to compare the height of Americans of different ethnicities with their home countries: Irish Americans to Ireland, Italian Americans to Italy, black Americans to Western Africa (understanding that this is a weaker relationship), etc.

What about increased consumption of sugary foods?

I wonder about education too. My own experience (in Canada) is that my children will get a worse university education than I did at greater cost. But then far more students are going to university, so maybe that compensates?

The cost of food has declined precipitously over the past 30 years. I read somewhere that it has gone from close to 20% of household spending down to around 11% today. There could be your reason for identifying more consumption with the same or less income.

@7: I’m not sure that height or its lack is so readily attributed to genetics. The original colonists were surprised at the height of the natives and there are some accounts that the natives found their visitors to be short and a bit unclean/smelly.

@3: insurance has a lot to do with this: preventive dental care is something many do without if they have to shell out their own money. We’re going through a round of catch-up on stuff in my house right now. What is insurance if not using the bargaining power of a pool to get prices down? Not in the pool? Pay full fare.

@4: meet 2 . . .

Food — especially bad food — keeps getting cheaper, so we may have increased real consumption with decreased expenditures.

The same applies to information.

The NYT article is pretty clear about the fact that more cavities are being left untreated. “Being left untreated” doesn’t have to do with what you eat, but does have to do with what you will pay to go to the dentist to treat you.

A few years ago, in his book, The Working Poor, Invisible in America, David Shipler pointed out that among the poor, dental health care has declined dramatically.

Of course, nobody gives a shit about the working poor, between the two of them the Reps and Dems will do nothing to either break the lock of the Dental Union on the amount of dentists or what dental hygienists are legally allowed to do or provide any kind of national health solution, and we will just keep drifting. Because there are no solutions in America, just spin, decline, and waiting for foreseeable disasters. The country seems to have lost its ability to solve any of its problems.

Roger, I haven’t seen the underlying study, but the “left untreated” piece obviously isn’t entirely unrelated to the incidence of cavities–if the latter increases while treatment holds steady, then you’ve got an increase in the number of cavities left untreated. I don’t think that’s the source. In fact, I think you’ve identified the problem (supply), if not the solution (supply).

John, don’t the numbers you cite (household income, wages) at the beginning leave out most health care spending (provided through employer-sponsored private health insurance or through public health spending)? Hasn’t spending on health care skyrocketed? The figures I’ve seen say that health care spending has moved from 7.4% of US GDP to over 15%. How do you account for this consumption (and how do the income stats)? Are you suggesting that most health care spending is for “life threatening health conditions”? That’d surprise me, because it is entirely inconsistent with my experience, but I’m open to persuasion. Is your suggestion that this skyrocketing health care spending (if that’s accurate) isn’t spending that benefits the median household/median wage earner–that health care for the median American is declining while health care spending increases? (Is your complaint one about quality–that spending has increased, but hasn’t purchased the same, much less increased, quality?)

“most measures of median income haven’t changed much in recent decades. […] That doesn’t seem to square with casual observation suggesting that consumption of most things by most people has gone up.”

If examples of goods where consumption has gone down can’t be found, wouldn’t it seem to indicate that the hedonic adjustments are missing something? And inflation is overstated?

I think the median wage earner making ~40k today is relatively poorer than he was in 1970, as compared to those above them in the upper brackets. But it does seem that the median wage can buy more than it could in 1970, in spite of the numbers indicating stagnant wages, after the inflation adjustment.

There are all kinds of new products, and improved goods available now that weren’t around in 1970. Seems possible the hedonic adjustments have understated the advancements in, say, electronics, and that comparable goods prices should have been falling faster.

And could the shift to much more cheap imports from Asia during this time make the GDP-deflator calculation fishy? The OECD says “a decrease in the price of imports is added to the GDP deflator (resulting in higher domestic inflation) although such a decrease may still lead to price deflation when the lower-priced imports are incorporated into domestically produced goods.”

All of this would mean that inflation was overstated, and growth for the median wage is actually higher, not stagnant for the past 30 years. Which sounds crazy. Personally, I usually feel that inflation must be understated, and hedonic adjustments overstate GDP growth.

Sorry, re-read the first paragraph and realised that it did say something about that issue already. Always risky skimming blog posts first thing in the morning before I’ve woken up properly; reading skills are even worse than usual. (Although I still find it hard to believe it doesn’t make that much difference.)

I’m old enough to remember when older people were mostly very poor (in Australia when increases in the basic pension were a big deal). I think those days are coming back!

Re dentistry. It’s a service, so we’d expect it to become more expensive relative to manufactures, wouldn’t we? (John, your post on the “Baumol Effect” is still number 2 on Google for that phrase.)
So as something becomes relatively more expensive, wouldn’t we expect people to consume less of it?

Maybe they are just consuming more stuff that’s more junky than it used to be. Plastic bottles, plastic cars, vinyl siding, particleboard furniture, freaky food, junky entertainment, junky news coverage.

‘we don’t expect services to get more expensive do we?’

We would for those services provided by people above median income, like dentists.

I suspect it would be a lot more useful to stop talking about arbitrary quantitative data points like ‘median income’ and break things up into good old-fashioned qualitative distinctions:socioeconomic clases. Otherwise, you can’t distinguish between the change in size of different classes and the change in prosperity of typical members of that class.

Here’s a mixed blessing: the new HIPPA laws allow for your employer to set up ‘Wellness Programs’ that in effect penalize those who don’t take part. If your employer sees that you have bad teeth and munching candy all day, you can be charged more on your premium for not taking care of yourself. The bad news is that it brings about all sorts of privacy invasion issues. There’s an interesting video running on YouTube called ‘The Raymond Report’. You can search it or go to their website: theraymondreport.com

The guy is a health insurance veteran that has set up the web show to help consumers with their problems and I’d be interested what he has to say on the subject. He does make a big issue of these new HIPPA laws that most people don’t know about.

A good source for critical analysis of US statistics is Michael Hodges “Grandfathere Eonomic Report” which debunks most of the government’s statistics

“I’d be interested to know how fluoridation has affected this.”

I’d guess it’s due to increased intake of sugary acidic drinks. It might also be due to kids having their ‘teeth sealed’, and the sealant products not actually providing as much protection as the parents expect. Then the parents think their kids’ teeth is invincible, and they slack off on dental care and avoiding sweets.

I think 2 big items which are consumed less would be “leisure” and time-with-children. (Leisure in quotes, because I’m not certain that a stay-at-home mother is experiencing anything I’d recognize as leisure.)

Hmmm — let’s see if we can spot the sleight of hand in the Warren and Tyagi piece:

“In fact, the size and amenities of the average middle-class family home have increased only modestly. The median owner-occupied home grew from 5.7 rooms in 1975 to 6.1 rooms in the late 1990s—an increase of less than half of a room in more than two decades.”

What’s the problem? We don’t want to know how many rooms, we want to know how many square feet. And we don’t even want to know square feet per house, we want to know square feet per person, for example:

http://www.theglobeandmail.com/servlet/story/RTGAM.20070926.wreynolds0926/BNStory/Business/columnists

I grew up in a family of six (during the 1970s) in brick ranch with 1200 sq feet (later expanded by a couple hundred more) — or about half the space per person that the average poor American now has. And we were solidly middle class (college educated parents, dad had a white-collar job).

This trend in increased space has meant kids sharing bedrooms has become rare enough to be notable as an exception:

http://db.inman.com/inman/content/subscribers/inman/column.cfm?StoryId=021102KS&columnistid=salant

With respect to dentistry, it sounds like the problem is similar to that in the UK — namely that poor people can’t find dentists who will accept their government insurance plan:

http://ap.google.com/article/ALeqM5iDDt8fDclNuTDLxJhPVRIvxL3bPQD8SALLJ00

In general, people who live in the U.S. and are old enough to remember the 1970s are perfectly aware the improvements in living standards between then and now, but it may be possible to convince people outside the U.S. that things are stagnating here (and suppose there’s some political advantage in doing so).

reason: My ex-landlords had a full-size “walk in” second fridge in the garage. It was quite possibly their old fridge when they bought a new one, presumably using my rent money!

re:slocum #38

That Globe and Mail article also practices some sleight of hand when it compares the living space of poor Americans to that of the average person living in London, Paris, Vienna, or Munich. I’ll bet the average poor American also has more living space than the average high income Yuppie inhabitant of NYC, because the average poor American doesn’t live in an expensive high density city.

That said, My family and I just moved out of our first house, a 1978 vintage 3 bedroom house that gave us 467 sq ft per person. According to the Globe and Mail article, that’s pretty close to the average living space for poor Americans, but it felt much more spacious than the solidly middle class homes owned by my relatives in nondescript parts of the UK (larger closets, wider hallways, etc).

We moved into a new 2006 home that was probably targeted at almost exactly the same demographic as our original home when it was new. The 2006 home has two additional rooms, larger kitchen, wider hallways, bigger closets, much better wiring, better insulation, and some nice touches like passive solar layout and solar hot water. It’s a veritable mansion compared to housing I’ve seen (and inhabited) in Europe.

watson #43:

I certainly agree that living space alone isn’t a good measure of standard of living. I also suspect that the point at which space limits do affect quality of life is both personally and culturally variable.

However, I don’t agree that a large house on small lots is necessarily a self defeating status symbol. While I and my wife personally prefer a larger lot, lots of people don’t like to garden. For them, a large house on a smaller lot probably makes more sense with regard to quality of life (and I’d go for a big house on a small lot before a small house on a small lot). Internal layout is probably a better indicator of a house that enhances standard of living versus one that is a status symbol.

I suspect that even cheap modern houses are more energy efficient than a house built before the 1980s. That’s definitely been my experience moving from a 1978 house to a 2006 house, and my parents found the same thing when they moved from a 1960s tract house to a 1990s tract house. For me, lack of draughts and a smaller heating bill is also a quality of life issue, and quite frankly, our new house exhibits better workmanship than the one built at the height of the Jimmy Carter malaise.

Thomas, cavities are not filled on a one to one basis – for every cavity, a dental visit. Dentists can fill one or more in a dental visit. So an increase in the number of cavities could well be met by the same number of dental visits. So the question is, is there simply an increase in untreated cavities that goes beyond that which used to be taken care of in a dental visit, or is there an increase in cavities due to less dental visits? The idea that we are eating more sugar now than in 1970 may have some merit, but that we are eating more sugar now than in 1990 seems much less plausible. Plus, of course, the population group most liable to cavities is children, and there should be less children now than in the hind end of the baby boom years as a percentage of the population.

Now, as the article suggested, one reason for the increasing cost is a decreasing labor supply as a a service. So the explanation that the service has more money thrown at it as we all get wealthier, which is why it is more expensive, only makes sense if we accept the labor bottleneck as natural. But we only accept that rule for medicine. We’d expect that, in the nature of things, more people would be attracted to a service in which they could make dentist’s money, and that the influx of more dentists would cause the cost to go down. We would also expect changes in job description over the last fifty years. Technology should make it easier for people with a lower level of dental training to apply those skills to their clients pearly whites than was the case in an era when dentristy involved a lot of tacit knowledge. However, they are prevented by law from doing so – and of course, the strangehold on the law is implemented by dentists.

It is part of the absurdity of American conservatism to defend both monopolistic practices that favor the wealthy – thus undermining capitalism – and socialistic schemes to have the state underwrite services – again, favoring the wealthy. In other words, they favor the wealthy regardless of the perfomance of the system. This is why we have such a unique health care system in America, and why conservatives are always urging us to be proud that Americans pay more for medicine than anywhere else, as we are ‘helping R and D’. It is a beautiful way of combining the worst of socialism and the worst of capitalism to get – well, that sack of horse manure which was Tom Delay’s ruling philosophy, and is Bush’s too.

As Warren & Tyagi point out, housing costs have risen but not necessarily because most middle-income people are buying larger houses — rather demand for housing in locations w/ good schools has driven up housing prices, and even middle-income people will pay more for better schools, more than they should.

W&T also argue that after housing, healthcare, a 2nd, and higher tax rates (due to dual-income families) mean that middle-income persons are less able to save and more likely to take on debt. With dual-incomes and kids in daycare, two cars is mandatory, not a luxury, unless you are fortunate enough to have excellent public transport, or proximity to work or co-workers.

As W&T argue, it is a myth that Americans, especially middle-income ones, are consuming more than they can afford on luxury goods. Let’s face it, if your iPod Nano lasted only a year, it cost $0.41 per day. A pair of Nikes of year would cost less than that. That consumption may be conspicuous, but it costs far less than a month’s mortgage payments.

Roger, I don’t take the supply of dentists to be natural in any sense. I do disagree about a couple of things. First, in our current regulated system, it isn’t enough for more people to want to become dentists; there must be schools to train them. And in recent years, schools (particularly private schools) were closing, not opening. So the increasing returns to the training likely means that it now requires better qualifications (in some academic sense) to become a dentist, not that there are or will be more dentists. Second, the strangehold on the law isn’t implemented by dentists, but by state governments. Many of those state governments are in the hands of folks you might describe as progressive, and DeLay and Bush control none of them. I, for what it’s worth, would favor measures to increase the number of dentists, and would favor measures to allow hygienists and the like to perform more tasks than some states allow them to do. But I am a conservative, and so I could probably be persuaded to support such socialistic schemes as integrating dental care into low-income health clinics and increasing funding for dental care under Medicaid, but only because these help rich dentists.

Baumol effect has to be a red herring here; although it would explain rising prices, for an absolutely lower amount of services to be consumed in response to a manufacturing productivity increase would have to imply some very odd things about preferences.

Oh, and there’s a 2007 update on the Census Bureau report I linked above.

It says in the introduction: “Real median household income increased between 2005 and 2006 for the second consecutive year.”

But it also has this:

“Earnings represent the largest component of income. Earnings trends and income trends are not perfectly correlated. While median household income in 2006 rose by 0.7 percent, the real median earnings of both men and women who worked full-time, year-round declined between 2005 and 2006 (Table 1 and Figure 2). The median earnings of men declined 1.1 percent to $42,261. The median earnings of women declined 1.2 percent to $32,515. This is the third consecutive year that men and women experienced a decline in earnings.”

Roger, you miss the point. I know who lobbies for the resrictions, but who actually implements the restrictions? Do the restrictions on the practice of dentistry not exist in progressive strongholds like CA, NY, MA? Also, the story on dental schools is a bit more complicated, isn’t it? I mean, at one point private schools (e.g., Northwestern) made a decision that they couldn’t compete financially with public dental schools, because public dental schools received state support for their clinics, while private schools did not. As a (partial) consequence, public school tuitions were lower and private schools found it hard to compete for students. (I say partial because obviously a school with Northwestern’s extensive financial resources had a choice as to how to respond.) My understanding is that the round of closings is over, and that there are dental schools that will soon open. And application volume apparently is up 65% since 2001 (according to the American Dental Education Association), so apparently people do respond to incentives.

“Overall, it seems reasonable to put down non-critical health care as a likely example of declining real median consumption in the US.”

Given the vast increase in the proportion of total resources devoted to health care in the U.S. — not exceeding 15% of GDP, more than in any other developed country — a decline in median consumption of “non-critical” health care would be a bizarre and ironic development.

So– if I’ve got this argument right– US household income hasn’t gone up much since the 1970s, but Americans have more and cooler stuff; that’s partly because working-age Americans have smaller families (meaning more money to spend on stuff per person), and partly because the stuff is cheaper (or delivers more fun for the same real price). But education and health care and, in many markets, housing are way more expensive, raising the question of how the households with stagnant real incomes can afford all the cool stuff plus all the expensive education and health care.

Isn’t part of the answer that we are saving much less, and borrowing more? What’s happened to household savings since the 1970s? And aren’t people now far more likely to borrow against the value of their homes?

I think one factor that should be taken into account more is savings. When we talk about the size of average person’s house or car, we need to know how much of it he actually owns and how much is owned by the bank. I’m still amazed how people in the UK have no qualms juggling loans, credit cards and mortgages and from what I hear it’s not much different in the US. It seems to work fine for now and actually be better for the economy than people behaving more conservatively in this regard, but I always think that one day the whole system will crash spectacularly and a good chunk of the so-called middle class will be left with nothing.

nick, they are even soaring in hobart.

When house prices are soaring in hobart, the world has gone badly wrong.

“eudoxis, going to the CDC reports, it’s clear that it should be “adults over 65”.

Professor Quiggin, one would reasonably expect that to be the case. However, the numbers graphed by the NYT for ’88-’94 (31%)and ’99-’02 (25%) are the numbers cited in the 2005 CDC report for adults 60 and over. The number graphed for ’03-’04 (27%) is cited in the 2007 CDC report for adults 65 and over. They are looking at the same cohort and excluding the younger, healthier seniors.