Health Insurance Coverage in the US; Fertility Rates in the World; And More Stories

from Family Inequality

Crying out for more babies

by Philip Cohen

I don’t want to alarm any readers unnecessarily, but sometimes you have to just take the message straight. So here it is:

A turning point has occurred in the life of the human race. The sustainability of humankind’s oldest institution, the family—the fount of fertility, nurturance, and human capital—is now an open question. On current trends, we face a world of rapidly aging and declining populations, of few children—many of them without the benefit of siblings and a stable, two-parent home—of lonely seniors living on meager public support, of cultural and economic stagnation.

That’s the opening to an essay titled, “The Empty Cradle,” by Phillip Longman and others, which led to an interview with NPR’s Lynne Neary last week. She apparently didn’t realize she was dealing with an end-of-days type (even though he wrote a book with the same name as this article in 2004), and naively thought the subject was just the fiscal challenges of aging populations.

So after he described the rising challenge, she naively instigated this exchange:

NEARY: So, what is the solution? Certainly it’s not just go back to have large families, is it?

LONGMAN: Right. Well, we find in much of the developing world people who say they wish they could have children but they can’t find a way because it’s seen as too expensive. So in some ways this is almost a human rights problem…

His answer became incoherent, as for some reason he didn’t seem to want to tell her the solutions he proposed in the essay. These do mostly boil down to just going back to having large families. (That and promoting marriage.) So we get recommendations like this:

RESPECT THE ROLE OF RELIGION AS A PRONATAL FORCE. Childlessness and small families are increasingly common among secularists. Meanwhile, in Europe and the Americas, as well as in Israel, the rest of the Middle East, and beyond, there is a strong correlation between adherence to orthodox Christian, Islamic, or Judaic religious values and larger, stable families.

This point is illustrated with this graph:

I don’t think it’s breaking news that religious people usually have more children than “secularists.” But I haven’t heard the suggestion that governments promote religion as a way to boost populations. But then again, I didn’t know this either:

Even in the remotest corners of the globe, when television is introduced, birth rates soon fall. This is particularly easy to see in Brazil. … Today, the number of hours a Brazilian woman spends watching domestically produced telenovelas strongly predicts how many children she will have.

Hence, recommendation #9: “Clean up the culture.”

Longman’s essay is in a collection published by a group right-wing institutes, including W. Bradford Wilcox’s National Marriage Project, and apparently funded in this case by the Bradley Foundation, known for supporting outfits like the Heritage Foundation, FreedomWorks, and the neoconservative militarist movement.*

Fertility dividends

Anyway, I have written before about what came to be known among demographers as “lowest-low fertility,” and the economic pressures that are both its cause and consequence. It is a tricky issue. As a non-expert, my reaction is that governments trying to get people to have more children is a fool’s errand — the way I view trying to promote marriage. It seems much more practical to look for ways to arrange resources to support populations with fewer children and more old people.

And environmentally, I thought it was good news that population growth is slowing globally. Admittedly, though, this somewhat perplexing argument by Longman et al. for population growth as a solution to the environmental crisis had somehow never occurred to me:

The more brains are available to work on natural-resource challenges, the sooner someone will come up with the idea that provides a solution.

Anyway, so what are the economic implications of population decline? This figure shows how lower fertility rates are generally associated with higher national incomes, from World Bank data.

Low fertility is usually an issue in relatively high-income countries. The average income in the countries with fertility below the replacement level of 2.1 is about $22,000 per person, while above that fertility level the average income is about $4,000 per person. But the figure also shows a lot of variation — all the rich countries have low fertility, but some relatively poor countries do, too.

As Longman et al. correctly point out, falling birth rates create a “demographic dividend,” as a smaller population of children provides opportunities for a generation of adults to invest in other things (such as higher education), and to spend time on other things (such as careers for women). But a few decades later those productive middle-aged adults grow into a big bubble of retirees, and that small group of children becomes an undersized group of prime-age workers, threatening to drag down the society’s total income. This potentially creates a fiscal crunch, as pension and medical costs rise relative to earnings.

But that’s not inevitable. If you take advantage of that period when there are fewer children — but not yet too many retirees — it is possible to reap a “second demographic dividend.” This is described in several papers by Andrew Mason and Ronald Lee, including this one, in which they write:

Given appropriate policy formulation, population aging will yield a second dividend. The same demographic changes that lead to low support ratios (high dependency ratios) in the future, namely few children and longer life, also both raise capital per worker other things equal, and additionally create a powerful incentive for individuals to accumulate assets to provide for old age. The result can be a period of rapid growth in per capita income. The rapid pace of asset accumulation is also transitory. However, per capita assets and income stabilize at a level that is permanently higher. In this respect, the second dividend persists whereas the first dividend is transitory.

They use simulations to work this out, which are quite interesting. It seems to boil down to two factors: increased investment in skills, education and experience; and increased savings (either individual or through taxation) motivated by the need to care for more retirees. I like this solution more than trying to get people to have more children.

Aside: History is interesting this way. I used to associate right-wing foundations in America with funding for anti-population-growth intellectuals, as when the racist Pioneer Fund supported not only eugenics-type sociobiology but also Garrett Hardin’s “tough love” ecology – paraphrasing: “too many people in poor countries, aid and immigration will only drag out the problem, better just let them die.” I don’t know which of these tendencies is more active today.

I also don’t know much about Longman, but I did notice that in 2006 he predicted a renaissance for patriarchy, because conservatives have more children than progressives. He wrote in USA Today:

[progressives having fewer children] is a pattern found throughout the world, and it augers a far more conservative future — one in which patriarchy and other traditional values make a comeback, if only by default. Childlessness and small families are increasingly the norm today among progressive secularists. As a consequence, an increasing share of all children born into the world are descended from a share of the population whose conservative values have led them to raise large families.


from Made in America

Unequal Denial

by Claude Fischer

That economic inequality is great and growing in the United States is now hard to deny. An earlier post reviewed how average Americans see and understand economic inequality. But one of the side stories is the expert debate about this inequality. Having followed the public and academic arguments about inequality for a few decades, I have a sense of how the terms of the debate have shifted and how defenders of post-1960s policies have responded. It’s an interesting dance of denial.

After a brief recap of the basic evidence, I’ll turn to that dance.

Another Look

The two graphs below remind us of recent history. The top graph displays, for several countries, how much more the rich (those at the 90th percentile of income) make than average people (at the 50th percentile) do. The countries I have included are those for which data were available in the source for both in the 1970s and the 2000s. The blue bars are for 1970s data, the red for mid-2000s data.

Two points are striking: One, in the 2000s, only in the U.K. and the U.S. did the affluent make more than twice as much as average citizens did. Two, only in the U.K. and the U.S. was there a substantial increase in that gap, in the 90:50 ratio, between the 1970s and the mid-2000s – not surprising since both countries shared rich-friendly policies during those years (Thatcher/Reagan/Murdoch policies). Closer looks at the data show that it is really the top one percentile that has reaped the huge gains (see here). And all these numbers precede the post-2008 “Great Recession” which further widened inequality.

The next graph draws from the same source but compares the average household, at the 50th percentile, to the poor one, the 10th percentile.  Here the U.S. stand out, with ratios of higher than 2.5 to 1 both in the 1970s and the 2000s – and that ratio grew substantially over the years. If you combine the two graphs and ask about the ratio of the rich to the poor, i.e., the gap between the 90th percentile and the 10th percentile, the U.S. is far ahead of the other nations.

Clearly, then, the U.S. has long had a highly unequal income distribution and that inequality has grown over the last generation. Moreover, neither fact is the result of some natural forces in the world economy. Other western, developed countries have sustained much lower levels of inequality. What’s going on?

The Debate Devolves

For much of the 20th century, economic inequality narrowed; the poor and the middle class started catching up with the rich. Then, when observers started to note widening inequality starting in the 1970s, the initial response of those who defended the policies of the Nixon and then the Reagan administrations was to deny that widening was real. They offered all sorts of reasons for thinking that the signs of a growing gap were a statistical mirage or a temporary aberration.

Eventually, it became clear that economic inequality really was widening. The next line of defense was to argue that the widening inequality was OK, because everyone was doing better. Did it matter if the rich moved up faster than other Americans so long that everyone’s vessel – yacht to rowboat – was being lifted? But then it became clear that the tide was not raising everyone. The poor were falling behind and middle class folks were stagnating, treading water faster, mainly by having wives work more hours.

The defense now involved challenging the data again, to say that if you counted things differently – say, add in health benefits, count food stamps, throw in the value of expected social security payments, and such – then the non-rich were doing OK.

One major exercise here was a Republican-appointed commission to reconsider the consumer price index. It argued that the rate of inflation was being over-estimated and such overestimates made it appear that average wages were falling behind. Commission members were mesmerized by electronics and pointed to how much more tech stuff a dollar could get you now than it could before – a much faster computer, a bigger TV, and such. But the costs of the key, big-ticket elements of the American middle-class lifestyle — housing, health care, and college – were rising even faster than the overall cost of living. American families would have gladly settled for smaller TVs to get better homes or easier college payments.

There was another part of the inflation-is-not-that-bad argument used to deny that the middle class was falling behind: The usual inflation calculations do not take into account “substitution.” If beef prices go up faster than wages, people buy more chicken; if children’s shoe prices go up faster, parents buy them flip-flops; if gasoline prices go up faster, people … well, never mind. The re-calculations assumed the substitutes were just as good. By the way, using a cost of living index adjusted downward for substitutions is one way some experts imagine slowing down the rising expense of Social Security. (For a more detailed dismissal of these bobs and weaves, see John Quiggen.)

These arguments continue to be heard, but in the last decade the basic contention of the leave-it-as-it-is crowd seems to be this: OK, inequality is widening, and OK, middle-class and working-class families are struggling, but you cannot change things. The economic forces are either too strong or meddling with them — say, getting more revenues out of corporations — will wreck havoc on our economy. Yet, if one looks to the graphs above and to much other data, one can see that other countries — countries where average people live at least as well as average Americans do –  have managed to sustain much lower levels of inequality for the last 40 years. It can be done.

The question is whether we want it to be done. (This 1996 book by several colleagues and myself pursues that question.)

(This column was cross-posted on The Public Intellectual)


Income, Poverty and Health Insurance Coverage in the United States: 2010

  The U.S. Census Bureau announced today that in 2010, median household income declined, the poverty rate increased and the percentage without health insurance coverage was not statistically different from the previous year.

Real median household income in the United States in 2010 was $49,445, a 2.3 percent decline from the 2009 median.

The nation’s official poverty rate in 2010 was 15.1 percent, up from 14.3 percent in 2009 ─ the third consecutive annual increase in the poverty rate. There were 46.2 million people in poverty in 2010, up from 43.6 million in 2009 ─ the fourth consecutive annual increase and the largest number in the 52 years for which poverty estimates have been published.

The number of people without health insurance coverage rose from 49.0 million in 2009 to 49.9 million in 2010, while the percentage without coverage −16.3 percent – was not statistically different from the rate in 2009.

This information covers the first full calendar year after the December 2007-June 2009 recession. See section on the historical impact of recessions.

These findings are contained in the report Income, Poverty, and Health Insurance Coverage in the United States: 2010. The following results for the nation were compiled from information collected in the 2011 Current Population Survey (CPS) Annual Social and Economic Supplement (ASEC):


  • Since 2007, the year before the most recent recession, real median household income has declined 6.4 percent and is 7.1 percent below the median household income peak that occurred prior to the 2001 recession in 1999. The percentages are not statistically different from each another.

Race and Hispanic Origin (Race data refer to people reporting a single race only. Hispanics can be of any race.)

  • Among race groups, real median income declined for white and black households between 2009 and 2010, while changes for Asian and Hispanic-origin households were not statistically different. Real median income for each race and Hispanic-origin group has not yet recovered to the pre-2001 recession all-time highs. (See Table A.)


  • Households in the Midwest, South and West experienced declines in real median income between 2009 and 2010. The apparent change in median household income for the Northeast was not statistically significant. (See Table A.)


  • Median income for households maintained by native-born householders declined between 2009 and 2010 in real terms. The change in the median income of all foreign-born households was not statistically significant. (See Table A.)


  • In 2010, the earnings of women who worked full time, year-round were 77 percent of that for men working full time, year-round, not statistically different from the 2009 ratio. The 2010 real median earnings of these men and women were not different from the 2009 earnings.
  • Since 2007, the number of men working full time, year-round with earnings decreased by 6.6 million and the number of corresponding women declined by 2.8 million.

Income Inequality

  • Based on the Gini Index, the change in income inequality between 2009 and 2010 was not statistically significant, while the changes in shares of aggregate household income by quintiles showed a slight shift to more inequality. The Gini index was 0.469 in 2010. (The Gini index is a measure of household income inequality; zero represents perfect income equality and 1 perfect inequality.)


  • The poverty rate in 2010 was the highest since 1993 but was 7.3 percentage points lower than the poverty rate in 1959, the first year for which poverty estimates are available. Since 2007, the poverty rate has increased by 2.6 percentage points.
  • In 2010, the family poverty rate and the number of families in poverty were 11.7 percent and 9.2 million, respectively, up from 11.1 percent and 8.8 million in 2009.
  • The poverty rate and the number in poverty increased for both married-couple families (6.2 percent and 3.6 million in 2010 from 5.8 percent and 3.4 million in 2009) and female-householder-with-no-husband-present families (31.6 percent and 4.7 million in 2010 from 29.9 percent and 4.4 million in 2009). For families with a male householder no wife present, the poverty rate and the number in poverty were not statistically different from 2009 (15.8 percent and 880,000 in 2010).


  • As defined by the Office of Management and Budget and updated for inflation using the Consumer Price Index, the weighted average poverty threshold for a family of four in 2010 was $22,314.
    (See <> for the complete set of dollar value thresholds that vary by family size and composition.)

Race and Hispanic Origin (Race data refer to people reporting a single race only. Hispanics can be of any race.)

  • The poverty rate for non-Hispanic whites was lower in 2010 than it was for other racial groups. Table B details 2010 poverty rates and numbers in poverty, as well as changes since 2009 in these measures, for race groups and Hispanics.

Doubled-Up Households

  • Doubled-up households are defined as households that include at least one “additional” adult: a person 18 or older who is not enrolled in school and is not the householder, spouse or cohabiting partner of the householder. In spring 2007, prior to the recession, doubled-up households totaled 19.7 million. By spring 2011, the number of doubled-up households had increased by 2.0 million to 21.8 million and the percent rose by 1.3 percentage points from 17.0 percent to 18.3 percent.
  • In spring 2011, 5.9 million young adults age 25-34 (14.2 percent) resided in their parents’ household, compared with 4.7 million (11.8 percent) before the recession, an increase of 2.4 percentage points.
  • It is difficult to precisely assess the impact of doubling up on overall poverty rates. Young adults age 25-34, living with their parents, had an official poverty rate of 8.4 percent, but if their poverty status were determined using their own income, 45.3 percent had an income below the poverty threshold for a single person under age 65.


  • The poverty rate increased for children younger than 18 (from 20.7 percent in 2009 to 22.0 percent in 2010) and people 18 to 64 (from 12.9 percent in 2009 to 13.7 percent in 2010), while it was not statistically different for people 65 and older (9.0 percent).
  • Similar to the patterns observed for the poverty rate in 2010, the number of people in poverty increased for children younger than 18 (15.5 million in 2009 to 16.4 million in 2010) and people 18 to 64 (24.7 million in 2009 to 26.3 million in 2010) and was not statistically different for people 65 and older (3.5 million).


  • The 2010 poverty rate for naturalized citizens was not statistically different from 2009, while the poverty rates of native-born and noncitizens increased. Table B details 2010 poverty rates and the numbers in poverty, as well as changes since 2009 in these measures, by nativity.


  • The South was the only region to show statistically significant increases in both the poverty rate and the number in poverty — 16.9 percent and 19.1 million in 2010 — up from 15.7 percent and 17.6 million in 2009. In 2010, the poverty rates and the number in poverty for the Northeast, Midwest and the West were not statistically different from 2009. (See Table B.)

Health Insurance Coverage

  • The number of people with health insurance increased to 256.2 million in 2010 from 255.3 million in 2009. The percentage of people with health insurance was not statistically different from 2009.
  • Between 2009 and 2010, the percentage of people covered by private health insurance declined from 64.5 percent to 64.0 percent, while the percentage covered by government health insurance increased from 30.6 percent to 31.0 percent. The percentage covered by employment-based health insurance declined from 56.1 percent to 55.3 percent.
  • The percentage covered by Medicaid (15.9 percent) was not statistically different from 2009.
  • In 2010, 9.8 percent of children under 18 (7.3 million) were without health insurance. Neither estimate is significantly different from the corresponding 2009 estimate.
  • The uninsured rate for children in poverty (15.4 percent) was greater than the rate for all children (9.8 percent).
  • In 2010, the uninsured rates decreased as household income increased from 26.9 percent for those in households with annual incomes less than $25,000 to 8.0 percent in households with incomes of $75,000 or more.

Race and Hispanic Origin (Race data refer to those reporting a single race only. Hispanics can be of any race.)

  • The uninsured rate and number of uninsured in 2010 were not statistically different from 2009 for non-Hispanic whites and blacks, while increasing for Asians. The number of uninsured Hispanics was not statistically different from 2009, while the uninsured rate decreased to 30.7 percent. (See Table C.)


  • The proportion of the foreign-born population without health insurance in 2010 was about two-and-a-half times that of the native-born population. The 2010 uninsured rate was not statistically different from the 2009 rate for native-born, the foreign-born overall and noncitizens but rose for naturalized citizens. Table C details the 2010 uninsured rate and the number of uninsured, as well as changes since 2009 in these measures, by nativity.


  • The Northeast and the Midwest had the lowest uninsured rates in 2010. Between 2009 and 2010, there were no statistical differences in uninsured rates for any of the regions. The number of uninsured increased in the Northeast, while there were no statistically significant changes for the other three regions. (See Table C.)

Historical Impact of Recessions

Since 2010 represents the first full calendar year after the recession that ended in June 2009, one can compare changes in income, poverty and health insurance coverage between 2009 and 2010 with changes during the first year after the end of other recessions:

  • Median household income declined the first full year following the December 2007 to June 2009 recession, as well as in the first full year following three other recessions (March 2001 to November 2001, January 1980 to July 1980 and December 1969 to November 1970). However, household income increased the first full year following the November 1973 to March 1975 recession, and the changes following the July 1990 to March 1991 and July 1981 to November 1982 recessions were not statistically significant.
  • The poverty rate and the number of people in poverty increased in the first calendar year following the end of the last three recessions. For the recessions that ended in 1961 and 1975, the poverty rate decreased in the next full calendar year.
  •      After the most recent recession, there was no significant difference in the uninsured rate during the first full year after the recession. However, in the year following the recessions that ended in 1991 and 2001, the uninsured rate increased.

Supplemental Poverty Measure

The Census Bureau’s statistical experts, with assistance from the Bureau of Labor Statistics and in consultation with the Office of Management and Budget, the Economics and Statistics Administration and other appropriate agencies and outside experts, are now developing a Supplemental Poverty Measure. The Supplemental Poverty Measure, for which the Census Bureau expects to publish preliminary estimates in October 2011, will provide an additional measure of economic well-being. It will not replace the official poverty measure and will not be used to determine eligibility for government programs. See Income, Poverty, and Health Insurance Coverage in the United States: 2010 for more information.

     The Current Population Survey Annual Social and Economic Supplement is subject to sampling and nonsampling errors. All comparisons made in the report have been tested and found to be statistically significant at the 90 percent confidence level, unless otherwise noted.

     For additional information on the source of the data and accuracy of the estimates for the CPS, visit <>.

Table A. Median Household Income
2009 2010 Percent change in real median income
(in 2010 dollars)
$50,599 $49,445 *-2.3
$53,949 $53,283 -1.2
$49,684 $48,445 *-2.5
$46,368 $45,492 *-1.9
$54,722 $53,142 *-2.9
Race and Hispanic Origin of Householder
$52,717 $51,846 *-1.7
   White, not Hispanic
$55,360 $54,620 -1.3
$33,122 $32,068 *-3.2
$66,550 $64,308 -3.4
Hispanic origin
$38,667 $37,759 -2.3
Nativity of Householder
$51,337 $50,288 *-2.0
$44,648 $43,750 -2.0
   Naturalized citizen
$52,833 $52,642 -0.4
   Not a citizen
$36,685 $36,401 -0.8
*Change statistically significant at the 90 percent confidence level.


Table B. People in Poverty
2009 2010 Change in poverty
Number Percent Number Percent Number Perecnt
43,569 14.3 46,180 15.1 *2,611 *0.8
6,650 12.2 6,987 12.8 336 0.6
8,768 13.3 9,148 13.9 380 0.6
17,609 15.7 19,072 16.9 *1,463 *1.2
10,542 14.8 10,973 15.3 431 0.5
Race and Hispanic Origin
29,830 12.3 31,650 13.0 *1,819 *0.7
   White, not Hispanic
18,530 9.4 19,599 9.9 *1,070 *05
9,944 25.8 10,675 27.4 *732 *1.6
1,746 12.5 1,729 12.1 -17 -0.4
Hispanic origin
12,350 25.3 13,243 26.6 *893 *1.3
36,407 13.7 38,568 14.4 *2,161 *0.7
7,162 19.0 7,611 19.9 *450 0.9
   Naturalized citizen
1,736 10.8 1,906 11.3 *169 0.5
   Not a citizen
5,425 25.1 5,706 26.7 281 *1.5
*Statistically different from zero at the 90 percent confidence level.

Table C. People Without Health Insurance Coverage
2009 2010 Change
Number Percent Number Percent Number Perecnt
48,985 16.1 49,904 16.3 *919 0.2
6,434 11.8 6,779 12.4 *345 0.6
8,368 12.7 8,605 13.0 237 0.4
21,576 19.2 21,665 19.1 88 -0.1
12,606 17.7 12,855 17.9 249 0.2
Race and Hispanic Origin
37,124 15.3 37,385 15.4 261
   White, not Hispanic
22,715 11.5 23,093 11.7 378 0.2
7,838 20.3 8,132 20.8 294 0.5
2,317 16.5 2,600 18.1 *284 *1.6
Hispanic origin
15,450 31.6 15,340 30.7 -110 *-0.9
36,305 13.6 36,881 13.8 576 0.2
12,680 33.7 13,023 34.1 343 0.4
   Naturalized citizen
2,951 18.4 3,356 20.0 *405 *1.6
   Not a citizen
9,729 45.1 9,667 45.1 -62
*Change statistically significant from zero at the 90 percent confidence level.

2 thoughts on “Health Insurance Coverage in the US; Fertility Rates in the World; And More Stories

  1. Pingback: Best of 2011: A Tale of Two Fathers, Income and Health Insurance Coverage, and More Family Centered Stories « Welcome to the Doctor's Office

  2. Pingback: Best of 2011: A Tale of Two Fathers, Income and Health Insurance Coverage, and More Family Centered Stories « Welcome to the Doctor's Office

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