Wilful murder

Haley Barbour cuts Medicaid. Infant mortality soars.

Verdict of a coroner’s jury, Bantry, County Cork, 1847:

From the multitude of deaths which have taken place in the locality, and the number of inquests which have already been held, without any good resulting, he thought, with his fellow-jurors, that they ought to bring in a general verdict, inculpating Lord John Russell, as the head of the Government. That Minister had the power of keeping the people alive, and he would not do so. Notwithstanding the fatal consequences which had attended his policy, he had expressed his determination to persevere in the same course, and therefore he (the foreman) thought that he was guilty of this death and of the rest. He would bring in no other verdict but one

of wilful murder against Lord John Russell.

Report from the New York Times on Mississippi, 2007:

In 2004, Gov. Haley Barbour came to office promising not to raise taxes and to cut Medicaid. Face-to-face meetings were required for annual re-enrollment in Medicaid and CHIP, the children’s health insurance program; locations and hours for enrollment changed, and documentation requirements became more stringent.

As a result, the number of non-elderly people, mainly children, covered by the Medicaid and CHIP programs declined by 54,000 in the 2005 and 2006 fiscal years. According to the Mississippi Health Advocacy Program in Jackson, some eligible pregnant women were deterred by the new procedures from enrolling.

One former Medicaid official, Maria Morris, who resigned last year as head of an office that informed the public about eligibility, said that under the Barbour administration, her program was severely curtailed.

“The philosophy was to reduce the rolls and our activities were contrary to that policy,” she said.

[snip, with inversion]

In Mississippi, infant deaths among blacks rose to 17 per thousand births in 2005 from 14.2 per thousand in 2004, while those among whites rose to 6.6 per thousand from 6.1. (The national average in 2003 was 5.7 for whites and 14.0 for blacks.)

The overall jump in Mississippi meant that 65 more babies died in 2005 than in the previous year, for a total of 481.

Sounds to me like a case of wilful murder by Gov. Haley Barbour, former chair of the RNC. Think about that the next time you hear the mantra “limited government, low taxes.”

Of course the causes of high infant mortality are various, and some of them are hard to change. But whatever the “root causes,” the phenomenon seems to respond to intervention:

In the past 10 years, the infant mortality rate for blacks in most of the Delta has averaged about 14 per thousand in some counties and more than 20 per thousand in others. But just to the south of Hollandale, Sharkey County, one of the poorest, has had a startlingly different record. From 1991 through 2005, the rate for blacks hovered at around 5 per thousand.

State officials say the county’s population is too small &#8212 it registers only 100 births a year &#8212 to be statistically significant. But many experts feel it is no coincidence that a steep drop in infant deaths followed the start of an intensive home-visiting system run by the Cary Christian Center, using local mothers as counselors.

“If this is a fluke it’s a 15-year fluke,” said Dr. Glick, the neonatologist.

The significance test is left as an exercise for the reader. Hint: aggregate across years.

So we have an extra sixty-five babies per year dying as the direct result of a policy instituted by Haley Barbour. Perhaps he could have claimed that he didn’t anticipate the result. But if he doesn’t change that policy now &#8212 and there’s no indication in the story that he has any such intention &#8212 then it seems to me a Bantry verdict is entirely justified.

Footnote I hate to cavil about an otherwise excellent story, but the “state officials say/but some experts feel” formulation is completely inadequate. Was there any reason for the reporter not to consult a statistician, or even a statistics textbook, and report as fact that a difference between a proportion of 1.5% and a proportion of 0.5%, in two samples where the smaller sample is 1500, has a probability of less than one in a hundred of arising purely by chance?

(On-line difference-in-proportions calculator )

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact: Markarkleiman-at-gmail.com