This week, the United Nations’ special rapporteur for housing presented a new report in Geneva. In it, she condemns the evils of “deregulation of housing markets,” “capital investment in housing,” “excess global capital,” and even takes neo-liberalism to task twice over its “requirement that private actors ‘do no harm’” and “do not violate the rights of others.” Who knew that respecting individual rights was controversial? 

Included in the report are superstitious allusions to banks, investors, and money. Throughout, the U.N.’s special rapporteur trains her angst on markets, and concludes that markets are “undermining the realization of housing as a human right.”

However, in spite of burdensome regulation, worldwide markets are becoming better at providing housing to the poor. For evidence, just look at the data: the percentage of the urban population that is living in slums (houses with inadequate space, sanitation, water, durability, or security) has fallen consistently over the past twenty-five years. 

In some regions, the number has declined even more rapidly. In South America, the percentage of the urban population living in slum housing fell a whopping 37.7 percentage points over the twenty-five year period. 

Meanwhile, the house price index, or price of housing relative to average disposable income per person declined by 25% worldwide since 1970.

The special rapporteur paints a dismal picture of housing in the United States, which is puzzling given a plethora of U.N. member states with genuinely dire conditions that go unmentioned, like Zimbabwe, Cuba, and Venezuela. Still, conditions are even improving in the United States. Housing has become less crowded and more comfortable: as household size has fallen, the median and average SF per home has consistently grown.

Aside from these omissions, the U.N. special report lacks a conceptual understanding of economics and finance. There are many glaring examples:

1. Luxury apartment buildings are not the enemy of low-cost housing. Thanks to filtering, the addition of luxury apartments to a city means that lower-income households have additional, improved-quality housing when luxury options are built. 
2. Housing is not an investment, and as long as bureaucrats continue to talk about it this way over-consumption will occur. As John Allison explains, “We live in a house, and therefore we consume the house. Houses are not used to produce other goods.” As we saw during the financial crisis, policies that encourage over-consumption of housing harm the poor.
3. The implied belief that investors somehow conspire to build luxury condominiums worldwide highlights a gross misunderstanding of the way financial markets operate. Investors don’t decide what type of housing to build, private developers do based on local market signals. For that matter, developers don’t even really decide what to build, often local government’s zoning regulations decide for them.
4. The reason that real estate is typically purchased by Limited Liability Corporations (LLCs) is not due to a conspiracy to anonymously purchase housing and “alienate” people from their communities. LLCs are used because tax codes and other government regulation encourage their use.
5. Mortgages in the context described don’t become “speculative investments” due to changes in market conditions; they could not meet the standard for a speculative investment. Speculative investments are typically understood as a class of investments that are short-term in nature and based on asset pricing dislocation.
6. Bondholders can’t own rental properties (unless they become equity holders through bankruptcy proceedings). Bondholders own debt, not equity.

In light of this confusion, the special rapporteur recommends “a full range of taxation, regulatory and planning measures in order to … prevent speculation and excessive accumulation of wealth.” It seems likely that if the U.N. had an understanding of the vast regulatory web that strangles the production of housing in the developed world, she might have come to a different conclusion.

Recently, some people have wondered aloud at the worldwide crisis of faith in elite international governing bodies. When the U.N. produces a report replete with economic and financial incompetence, an omission of counterarguments and counter facts, and brimming with ideological bias, it simply isn’t difficult to understand.

Raj Chetty, the head of Stanford’s “Equality of Opportunity” project, recently released a paper called “The Fading American Dream” co-authored with another economist, a sociologist, and three grad students. It claims that “rates of absolute mobility have fallen from approximately 90% for children born in 1940 to 50% for children born in the 1980s.” [Though the study ends with 2014, when most of those “born in the 1980s” were not yet 30.]

The title alone was sure to attract media excitement, particularly because the new study thanks New York Times columnist David Leonhardt “for posing the question that led to this research.” 

Leonhardt, in turn, gushed that Chetty’s research “is among the most eye-opening economics work in recent years.” He explained that he asked Chetty to “create an index of the American dream” which “shows the percentage of children who earn more money… than their parent earned at the same age.” The result, he concludes, is “very alarming. It’s a portrait of an economy that disappoints a huge number of people who have heard that they live in a country where life gets better, only to experience something quite different.”

“Another Chetty-bomb just exploded in the mobility debate,” declared a Brookings Institution memo: “Only half of Americans born in 1980 are economically better off than their parents. This compares to 90 percent of those born in 1940.”

At Vox​.com, Jim Tankersley proclaimed “The American Dream [is] collapsing for young adults.”

“Sons born in 1984 are only 41 percent likely to earn more than their fathers, compared to 95 percent of sons born in 1940,” wrote USA Today reporter Nathan Bomey. “If the American dream is defined as earning more money than your parents,” said Bomey, “today’s young adults are just as likely to have a nightmare as they are to achieve the dream.”

The Chetty study proved to be a politically irresistible story, since it appears to confirm a popular nostalgia for the good old days and belief that it has become more and more difficult to get ahead. But that is not what the study really shows. What it really shows is:

First: Incomes were extremely low in 1940, so it was quite easy to do better 30 years later.

Second: Doing better than your parents is not defined by your income at age 30, but by income and wealth accumulated over a lifetime (including retirement).

Third: A rising percentage of young people remain in grad school at age 30, so their current income is lower than that of their parents at that age but their future income is likely to be much higher.

Consider those three points in more detail.

Regarding the First point, it should be no surprise that children born during the Great Depression or World War II did better than their parents. Of course they did. We don’t need an intricate statistical study to make such an obvious point.

I was born on a Texas Army base in 1942 where my father was a lieutenant earning $167 a month. That was not a difficult target for me to exceed in 1972. 

Comparing incomes of children and their parents at age 30 over many decades tells us more about the very low incomes of poorly-educated and poorly-employed parents in the early decades than it does about the incomes of their children more recently. 

Only 38.1% of Americans age 25–29 had a high school diploma or higher in 1940, compared with 75.4% in 1970. Only 25.7% of American age 18–24 were enrolled in college in 1970, compared with 40.5% in 2015.

To return to the “absolute mobility” of children born in the 1940s would require another 1930–38 Great Depression, another World War, and a massive loss of college degrees. 

Turning to the Second point, “Fading American Dream” depends entirely on an indefensible caricature of that dream—namely, as earning more than your parents did at a very young age (30).

The study claims “One of the defining features of the ‘American Dream’ is the ideal that children have a higher standard of living than their parents.” But that means over a lifetime (importantly including retirement)—not just at age 30. Labor incomes of peak at age 50 for most college grads, and in the mid-50s for those with advanced degrees. Investment incomes commonly peak in retirement.

The Graph from Advisor Perspectives shows cumulative changes in real median income by age groups from 1967 to 2015. Median income rose much more at ages 45–64 than it did at ages 25–34, and the growth of median income has been fastest by far for those over age 65 (thanks in large part to rapid growth of tax-favored savings plans for retirement).

To judge yourself a failure at age 30 because your income had not yet passed your father’s income at the same age would be a psychological problem, not an economic problem.

Finally, switching to the Third point, a large and growing share of college grads now remain in graduate school past age 30, so (unlike their parents) they have little or no earned income. That would have been quite unusual at age 30 in 1940–80. The “average graduate student today is 33 years old. Students in doctoral programs are a bit older.” Grad students have low current incomes at age 30, but high lifetime incomes.

An Urban Institute report finds “The share of adults ages 25 and older who have completed graduate degrees rose from eight percent in 1995 to 10 percent in 2005, and to 12 percent in 2015, growing from 34 percent to 37 percent of individuals with bachelor’s degrees.”

Most men born around 1940 went to work right after high school, assuming (often wrongly) they waited to finish high school. By age 30 most men my age had many years of valuable work experience, known as “human capital” or on-the-job-training. Most of us married in our twenties and were in two-earner families with children by age 30.

Chetty and company compare incomes of children at age 30 with the ages of their parents when sampled sometime between the ages of 25 and 35. Most parents of those turning 30 in the study’s last year (2014) were born during the Reagan years of 1983–89 when economic growth averaged 4.4% a year. To compare incomes between President Reagan’s boom years and President Obama’s prolonged slump reflects the poor economy of 2008–2014, not poor “mobility.” Those born in 1984 turned 30 in 2014, when median household income was $53,718 in 2015 dollars—6.5% below 2007 and nearly the same as $53,367 in 1989 (when tax rates were much lower). 

The finding of a 2014 study by Chetty and Emmanuel Saez that “measures of intergenerational mobility have remained extremely stable for the 1971–1993 birth cohorts” is still credible and relevant. Mr. Chetty’s latest 30-year parent-child comparisons involving those born from 1940 to 1984, by contrast, are not credible and not relevant.

Support for the ACA’s community-rating provisions flips from 63%-33% support to 60%-31% opposed if it harms the quality of health care. 55% say more free-market competition not government management would best deliver high-quality affordable health care. FULL RESULTS (PDF)

Most polling of the Affordable Care Act finds popular support for many of its benefits when no costs are mentioned. However, a new Cato Institute/​YouGov survey finds that support plummets, even among Democrats, if its popular provisions harm the quality of health care. The poll finds that risks of higher premiums, higher taxes, or subsidies to insurers are less concerning to Americans than harm to the quality of care. 

By a margin of 63% to 33%, Americans support the ACA’s community-rating provision that prevents health insurers from charging some customers higher rates based on their medical history. However, support flips with a majority opposed 60%-31% if the provision caused the quality of health care to get worse.

Majorities also come to oppose the ACA’s community-rating provision if it increased premiums (55% oppose, 39% favor), or raised taxes (53% oppose, 40% favor). However, threats to the to quality of care appear to be a pressure point for most Americans.

When respondents were asked follow-up questions about specific types of quality reductions, Americans turned against the ACA’s community-rating provision most if:

• It limits access to medical tests and treatments (66% oppose, 27% favor)
• People have to wait several months before seeing a specialist to receive medically necessary care (65% oppose, 25% favor)
• It limits access to top rated medical facilities and treatment centers for serious illnesses (62% oppose, 31% favor).
• If people received more surprise medical bills for services they thought were covered (64% oppose, 25% favor)

Democrats Turn Against ACA’s Popular Provisions When Quality at Risk

Democrats are key to the shift on quality. Majorities of Democrats (58%) would be willing to pay more in health insurance premiums or pay higher taxes (60%) to prevent insurers from charging higher rates to people with preexisting conditions. But a majority would oppose (55%) this rule if it meant the quality of health care would get worse. 

Several demographic groups are less sensitive to financial costs associated with the provision. But, threats to quality narrow the gap.

For instance, 48% of Americans under 35 say they would oppose the community-rating provision if it meant their taxes would increase compared to 57% of Americans 35–54. However, two-thirds of both groups would oppose if the provision resulted in limited access to medical tests and treatments.

Americans earning above $80,000 a year (47%) are more willing than Americans making less than $40,000 a year (37%) to pay higher premiums to prevent insurers from charging higher rates to people with pre-existing conditions. However, 60% and 62% respectively would turn against the provision if it meant they’d have less access to top-rated medical facilities and treatment centers.

Quality considerations bridge the gap across partisanship, income, and age.

Quality Concerns Move People Most on Guaranteed-Issue

We find the same pattern in the second Cato Institute/​YouGov survey when asking about the ACA’s guaranteed-issue provision that requires health insurers cover anyone who applies for health insurance, including those with pre-existing conditions. Support for this provision flips from 77%-20% support, to 75%-20% opposed if it caused the quality of health care to get worse. Although majorities also come to oppose the provision if it raised premiums (60%) or taxes (55%), threats to quality result in the most dramatic shift.

By asking these questions on a separate survey, respondents were not impacted by the community-rating provision questions. Thus, we find that quality is a key pressure point for most Americans in two separate surveys.

Once again, Democrats are essential to the dramatic shift on quality. Although majorities of Democrats would be willing to pay higher taxes (60%) and higher premiums (51%), a majority would oppose (65%) the guaranteed-issue provision it caused the quality of health care to decline.

The survey also found that Americans might continue their support for the ACA’s guaranteed-issue (52%) and community-rating (47%) provisions if either required Congress to provide taxpayer subsidies to private insurance companies. This indicates that Americans distinguish between potential costs, are willing to accept some more than others, but are unwilling to sacrifice on quality.

Dependent-Coverage Mandate

At first glance, a strong majority (72%) of Americans support a provision in the ACA that allows young adults to stay on their parents’ insurance plans until age 26, while 25% oppose. However support plummets to 38% and a majority would instead oppose (58%) if the provision cost $1,200 a year to allow young adults to stay on their parents’ insurance plan. (This number comes from a NBER study of the costs of the dependent-coverage mandate.)

Americans Believe Free-Market Competition Offers Path Forward

A majority (55%) of Americans say that more free-market competition among health insurers, hospitals and doctors is the “better way” to sustainably provide high-quality affordable insurance to people. Thirty-nine percent (39%) say that more government management of health insurers, doctors and hospitals would be more effective.

These results are consistent with similar polling from the Kaiser Family Foundation, which found 51% believe market competition would better reduce prescription drug prices than government regulation (40%).

Unsurprisingly, respondents line up by partisanship. A majority (59%) of Democrats believe more government management of the health care system is what’s needed while 82% of Republicans and 59% of independents believe free-market competition would be more effective.

Quality Concerns in Historical Context

The pattern of quality concerns moving public opinion the most is consistent with polling data over the past 20 years. Back in 1994, Gallup asked a similar set of questions about universal health insurance coverage. Like these results, the poll first found strong support 80%-16% for universal coverage. When Gallup asked follow-up questions, as we have done here, support declined to 55% if universal coverage raised premiums. But the poll measured the most dramatic shift against universal coverage if it were to limit the availability of health services with 69%-26% opposed. 

Once again in 2012, the Reason-Rupe poll, which I directed at the time, asked a comparable set of questions about the ACA’s community rating provision and found the same pattern. At first, the poll found a majority (52%) who supported the provision. But 50% would oppose if it raised premiums, and 76% would oppose if it reduced health care quality.

A CBS/New York Times July 2009 survey used a similar wording construction to the questions used in the Cato Institute poll. First, it asked if it was the federal government’s responsibility to guarantee insurance for all Americans, finding 55% in agreement. However, “if that meant the cost of your own health insurance would go up,” support declined to 43%. This survey did not measure how support changed if health care quality was at risk.

These surveys demonstrate that polls presenting only the benefits of health care policies risk inflating support for such policies. Support for even the most popular provisions in the ACA drop when the public is asked to consider their likely costs in concert with the benefits. Furthermore, reductions in the quality of care, more so than premium increases, have the most significant impact on support.

Survey results and methodology can be found here. The Cato Institute in collaboration with YouGov conducted two health care surveys online February 22–23, 2017. The first survey interviewed 1,152 American adults with a margin of error of ± 2.93 percentage points. The second survey interviewed 1,103 American adults with a margin of error of ± 2.85 percentage points. The margin of error for items used in half-samples is approximately ± 5.1 percentage points.

In today’s Wall Street Journal, I discuss new economic research showing ObamaCare is making health insurance worse for patients with high-cost medical conditions.

Republicans are nervous about repealing ObamaCare’s supposed ban on discrimination against patients with pre-existing conditions. But a new study by Harvard and the University of Texas-Austin finds those rules penalize high-quality coverage for the sick, reward insurers who slash coverage for the sick, and leave patients unable to obtain adequate insurance…

If anything, Republicans should fear not repealing ObamaCare’s pre-existing-conditions rules. The Congressional Budget Office predicts a partial repeal would wipe out the individual market and cause nine million to lose coverage unnecessarily. And contrary to conventional wisdom, the consequences of those rules are wildly unpopular. In a new Cato Institute/​YouGov poll, 63% of respondents initially supported ObamaCare’s pre-existing-condition rules. That dropped to 31%—with 60% opposition—when they were told of the impact on quality.

Republicans can’t keep their promise to repeal ObamaCare and improve access for the sick without repealing the ACA’s penalties on high-quality coverage.

The lesson is clear. To repeal ObamaCare, opponents need to talk to voters about how the law is reducing the quality of health insurance and medical care for the sick.

Read the whole thing.

The Supplemental Nutrition Assistance Program (SNAP) aims for recipients to “make healthy food choices within a limited budget.” SNAP is supposed to “permit low-income households to obtain a more nutritious diet.”

However, the lofty goals of federal programs often differ from the actual results. It turns out that about $15 billion of SNAP benefits are for junk food. Apparently, recipients are not making the nutritious and healthy choices that the government promised.

SNAP, or food stamp, benefits totaled $67 billion in 2016. Food stamps can be used to buy just about any edible item in grocery stores other than alcohol, vitamins, and hot food. But exactly what is being purchased by the program’s 44 million recipients has been mainly shrouded in secrecy—until now.

A November study by the U.S. Department of Agriculture finally shed light on food stamp purchases. The study examined detailed data for SNAP and non-SNAP shoppers for one large food retailer over a one-year period.

The study found that SNAP shoppers bought slightly more junk food than non-SNAP shoppers. For example, 9.25 percent of total purchases by SNAP shoppers were for “sweetened beverages” such as cola, which compared to 7.1 percent for non-SNAP shoppers. At the same time, SNAP shoppers spent relatively less on nutritious foods such as fruits and vegetables.

For SNAP shoppers, “sweetened beverages,” “prepared desserts,” “salty snacks,” “candy,” and “sugar” accounted for 22.6 percent of purchases. These junk food items thus accounted for $15 billion of SNAP purchases in 2016, if the study is representative of all SNAP purchases.

SNAP is a bloated program, and cutting out junk food would be one way to reduce costs. The program was created to tackle hunger, but Harvard University’s Robert Paarlberg noted that on a typical day less than 1 percent of households now face “very low food security.” That low figure contrasts with the 17 percent of U.S. households that currently receive food stamps.

The main food-related health problem for low-income households today is not hunger, but obesity. CDC data show that people with low incomes are more obese than people with high incomes, on average. In general, low-income Americans are suffering not from too little food, but from too much of the wrong kinds of food.

Ending SNAP’s junk food subsidies would likely cut demand for the program and reduce taxpayer costs. If policymakers decided that food stamps could only be used for items such as fruits and vegetables, fewer people would use the program, which would be a good thing.

An even better reform would be to end federal involvement in food stamps. Each state could then decide on the overall level of benefits it wanted, and on whether taxpayers should be subsidizing cola, candy, crackers, and cookies.

For more on food stamps, see here and here.

In a recent working paper, economists Thomas Buchmueller and Colleen Cary find that one particular kind of restriction does reduce opioid misuse among Medicare beneficiaries:

The misuse of prescription opioids has become a serious epidemic in the US. In response, states have implemented Prescription Drug Monitoring Programs (PDMPs), which record a patient’s opioid prescribing history. While few providers participated in early systems, states have recently begun to require providers to access the PDMP under certain circumstances. We find that “must access” PDMPs significantly reduce measures of misuse in Medicare Part D.

Yet, they also find

no statistically significant effect [of must access PDMP’s] on a key medical outcome: opioid poisoning incidents.

How is this possible?

The simplest explanation is that, despite all the hype, prescription opioids are not that dangerous, even in heavy doses, when used under medical supervision. Instead, most poisonings reflect use of diverted prescription opioids, or black market opioids like heroin, that users obtain when doctors cut them off from prescription opioids. These alternate sources may be adulterated, of higher dosage than the user realized, or consumed with other drugs that generate adverse reactions.

Under this interpretation, restrictions on opioid prescribing might even increase opioid poisonings. 

Last night’s CNN duel between Senators Bernie Sanders and Ted Cruz on the future of Obamacare was pretty illuminating for a recent arrival to the United States, with Senator Sanders’ playbook all-too-familiar to those of us from the UK.

Sanders wants a single-payer socialized healthcare system in the United States, just as we have in Britain. Any objection to that is met with the claim that you are “leaving people to die.” The only alternatives on offer, you would think, are the U.S. system as it exists now, or the UK system. Sanders did not once acknowledge that the UK structure, which is free at the point of use, inevitably means rationed care, with a lack of pre-screening. He also failed to acknowledge that lower health spending levels (indeed, even public spending on health is lower in the UK than the United States now) are not the same as efficiency—which is about outputs per input.

In the face of anecdote after anecdote about those saved by Obamacare and the virtues of a government-run health system, Cruz countered with some anecdotes from the UK showing the consequences of rationed care: a Scottish hospital turning away pregnant women, a woman in Wales waiting eight hours on the floor for an ambulance to arrive after a fall, and a hospital in Essex canceling life-saving cancer treatment because there were no free beds in intensive care. He could also have talked about the Mid-Staffs scandal, or a recent documentary showing doctors deciding between saving a cancer patient or a pensioner bleeding to death.

Anecdotes are powerful in helping to persuade people, and there are good reasons to use them in debates. Yet they are always susceptible to the charge that all health systems have extreme failures. Perhaps more powerfully then, the inadequacies of the UK system show up systematically in the data about how well conditions are dealt with (data from my former colleague Kristian Niemietz’s reports here and here):

• In the United States, the age-adjusted breast cancer 5‑year survival rate is 88.9 percent, compared with just 81.1 percent in the UK
• The United States leads the world on the equivalent stat for prostate cancer (97.2 per cent) vs. 83.2 percent in the UK
• Lung cancer: 18.7 percent in the United States vs. 9.6 percent in the UK; bowel cancer: 64.2 percent vs. 56.1 percent
• Just in case you think I am cherry picking: U.S. survival rates are also better for leukemia, ovarian cancer, stomach cancer, and liver cancer—all of those for which I can find comparisons
• The age- and sex-standardized 30-day mortality rate for ischaemic stroke is just 3.6 per cent in the United States vs. 9.2 per cent in the UK; for haemorrhagic stroke, the figures are 22 percent vs. 26.5 percent

I could go on. All of which is to show that your probability of dying from a range of common conditions is much higher in the UK than here. Perhaps that’s why (with no hint of irony) The Guardian’s write-up of a Commonwealth Fund Report suggesting the UK’s health system was “the best in the world” said “the only serious black mark against the NHS was its poor record on keeping people alive.”