Monday, July 16, 2007

Why do overweight workers earn less?

I am not very au fait with the intricacies of American health insurance but the authors below seem to be saying that overweight workers cost the employer more to insure so the employers pay them less in wages. I would favour a social class explanation. Overweight people are more likely to be working class and hence more likely to be of low intelligence and hence less valuable to an employer. I guess that explanation is too obnoxious for most people but there is plenty of evidence for each step in the reasoning. The truth is rarely politically correct

Obese workers earn less per hour than their thinner colleagues—a finding that is surprisingly robust and does not appear to be explained by differences in education, age, or training. This obesity wage gap is greater for female workers, but it is also true for men. Most often, economists attribute the gap to discrimination against the obese. Occasionally, economists argue that in some jobs (think of supermodels), thinner workers are more productive than obese ones.

My colleague Kate Bundorf and I have developed evidence that favors a different explanation. We think an important reason for the obesity wage gap is that the costs of health insurance are passed through to obese workers. This would be consistent with the theory of wage pass-through, because expected medical expenditures and hence the value of health insurance are greater for obese workers than for thin workers.

In our research, we examined the wage path over a decade for a nationally representative cohort of 12,686 people ages 24 to 31 years old in 1989. For our study, we focused on full-time workers but excluded pregnant women. We separated the workers into two groups: one with health insurance provided by their employer and one without.

We first looked at the wage paths for the group with health insurance (see figure 1). As expected, given the discussion so far, obese workers earn less than thinner workers and the gap grows as the cohort ages and becomes more likely to use medical care. By 2000, obese workers were earning nearly $4.60 an hour less than thinner workers. This wage gap is at least as big as the expected difference in medical expenditures between obese and thin workers.

We then looked at wage paths for the group without health insurance (see figure 2). For this group, the obesity wage gap never develops—thin and obese workers earned about the same, on average, exactly what one would expect to find under the theory of wage pass-through.

Our evidence has important implications for pooling in health insurance between thin and obese workers. Because wages are lower for obese workers only at jobs where health insurance is provided, the obesity wage gap would seem to undo whatever nominal pooling there is of health insurance premiums. If there is no real pooling, Carl and Lenny do not pay for Homer’s body weight decisions and there is no public health crisis.

This reasoning does not extend to government-provided health insurance, which is also common in the United States but less so than private coverage. In 2004, there were 174.2 million Americans covered by employer health insurance, 39.7 million covered by Medicare (provided by the federal government to elderly and disabled people), and 37.5 million covered by Medicaid (provided by states to the poor). Under both Medicare and Medicaid, enrollees’ premiums do not depend on body weight and are always much lower than expected medical bills. In many cases, enrollees are not charged premiums at all. Unlike in employer-provided health insurance, there is no wage pass-through that can undo pooling between obese enrollees and taxpayers.

Much more here

New IVF wisdom: Autoimmune syndrome can cause infertility

After three failed attempts at IVF, Julia Kantecki began to lose hope that she and her husband Robert would ever conceive a child. "My baby dream was slipping away. I was 40 and fearful of shrivelling into menopause and a childless future," says Julia, 45, a former marketing director. Robert, 56, had had a vasectomy 20 years earlier and IVF was the couple's only chance of having a child together.

Since her mother had had five children without a problem, Julia, who lived in Doncaster at the time, assumed everything would go smoothly. So it came as an enormous disappointment when she failed to become pregnant. The worst part was that the IVF doctors couldn't offer any definitive explanation for the failure. But her experience is far from unusual - although many women assume that the wonders of modern medicine mean they will conceive easily with IVF, in fact the success rate is around 20 per cent. Julia's doctors simply suggested she might get lucky if she kept trying. She did keep trying, twice over - but without any luck.

Conventional medicine holds that IVF failure and miscarriage are the result of hormonal problems, abnormalities of the uterus, genetically defective embryos or ageing eggs. But doctors from the Alan E Beer Center for Reproductive Immunology, in San Francisco, believe they may be caused by a woman's immune system going into overdrive and wrongly attacking her embryos as if they were foreign bodies. The Beer Center, which has treated more than 7,000 couples for fertility-related immune problems, claims a pregnancy success rate of 85 per cent within three natural cycles or IVF attempts.

While on holiday with her mother, Julia visited a clinic run by Dr Beer. She was told that three IVF failures indicated possible immune problems. Blood test results showed that Julia had abnormally high levels of natural "killer" (NK) cells - thought to help keep the body from developing cancer - and harmful antibodies that doctors at the clinic said were attacking her embryos. "They told me that my body was treating pregnancy as if it was dealing with a cancer and killing my babies before they'd had time to implant in my uterus properly," says Julia. An added complication was an inherited clotting disorder making her susceptible to developing blood clots in the placenta, which could also endanger her embryos.

The good news, one of the nurses told her, was that they knew exactly how to treat these conditions. With the right medications, she stood an 80 per cent chance of having a baby.

It was in the Eighties that Alan Beer, an academic who had trained in immunology and obstetrics, began to suspect that NK cells produced by an over-active immune system could damage embryos and cause implantation failure. He tested women who were miscarrying and suffering IVF failure and found that they had abnormally high levels of NK cells. These, he believed, could attack both the developing embryo and hormones essential to maintain pregnancy. "When women tell me they're always healthy and never get infections, alarm bells start ringing since it suggests their immune systems are working overtime," says Dr Raphael Stricker, who took over as medical director of the Beer Center after the death of Dr Beer last year.

The theory is that this can be redressed artificially, with drugs. "Immune therapy for reproductive failure is a temporary measure. "It's designed to replicate the natural suppression of the immune system at the very beginning of a normal pregnancy," explains Dr Stricker. "The drugs involved are taken for the least amount of time and prescribed at the lowest doses possible."

For Julia, the Beer Center's theories were a revelation. "I was shocked that my body might be such a non-baby friendly environment," she says. "Symptoms like the mild arthritis I had in my fingers, which is also apparently an immune problem, now made sense. "It all sounded too good to be true - but it was worth a try."

She returned home with her first prescription for the drugs, but her GP dismissed the treatment as "unorthodox". Among the UK medical establishment, such methods are regarded as at best unproven and at worst akin to "snake oil". The concern is that vulnerable women undergoing such unproven treatments risk being financially exploited and exposed to potentially dangerous drugs. However, the consultant she saw at Doncaster Royal Infirmary was, says Julia, more "open-minded" and agreed to prescribe the drugs privately.

A few weeks before undergoing her next IVF cycle, she was given a course of prednisolone - a corticosteroid that would suppress her immune system and stop it attacking the embryo - and heparin injections to thin her blood, which would prevent blood clots from blocking the placenta. Three embryos were transferred and two weeks later, she got the result she had waited so long to hear. "To my absolute, total disbelief and delight, the test was positive," she recalls. "At first I was a bit stunned. Robert and I both cried later when the news sank in that I was really pregnant." To their amazement, successive scans revealed a good-sized baby with a strong, regular heart beat.

Even after the pregnancy was achieved it was vital she continued to take the drugs to prevent her NK cells from increasing and killing her growing baby. Julia's consultant assured her that the dose was very low and would have no effect on her baby. Towards the end of the pregnancy her intake of prednisone was gradually reduced and, a few weeks before the anticipated delivery date, she stopped taking the bloodthinning anticoagulant, in case doctors needed to perform an emergency Caesarean. In August 2003, Julia gave birth to her son Thomas.

Her experiences inspired her to help other women find out more about reproductive immunology and she approached Dr Beer with the idea of writing a book - they called it Is Your Body Baby Friendly? Dr Beer died in May 2006, just after its completion. "Without Dr Beer's determination to identify the immune reactions that cause reproductive failure and his pioneering use of immunotherapy, our son would not be here," says Julia. "The debt we owe him is immeasurable."



Just some problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

Trans fats:

For one summary of the weak science behind the "trans-fat" hysteria, see here. Trans fats have only a temporary effect on blood chemistry and the evidence of lasting harm from them is dubious. By taking extreme groups in trans fats intake, some weak association with coronary heart disease has at times been shown in some sub-populations but extreme group studies are inherently at risk of confounding with other factors and are intrinsically of little interest to the average person.


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