Might American deaths of despair spread to other developed countries? On the one hand, perhaps not. Parsing the data shows just how uniquely bleak the situation is in the United States. When it comes to deaths of despair, the United States is hopefully less a bellwether than a warning, an example for the rest of the world of what to avoid. On the other hand, there are genuine reasons for concern. Already, deaths from drug overdose, alcohol, and suicide are on the rise in Australia, Canada, Ireland, and the United Kingdom. Although those countries have better health-care systems, stronger safety nets, and better control of opioids than the United States, their less educated citizens also face the relentless threats of globalization, outsourcing, and automation that erode working-class ways of life throughout the West and have helped fuel the crisis of deaths of despair in the United States.
Why have so many young men withdrawn from the U.S. labor force since1965? This paper presents a model in which men invest time in employment to enhance their value as marriage partners. When the marriage market return on this investment declines, young men’s employment declines as well, in preparation for a less favorable marriage market. Taking this prediction to data, I show that fewer young men sought employment after 2 interventions that reduced the valueof gender-role-specialization within marriage: i) the adoption of unilateral divorce legislation, and ii) demand-driven improvements in women’s employment opportunities. I then show, using a structural estimation, that half of the employment effect of a labor market shock to men’s wages is determined by endogenous adjustment of the marriage market to the shock. These findings establish the changing marriage market as an important driver of decline in young men’s labor market involvement.
Although the decline in marriage has been cited as a possible contributor to the “despair” afflicting marginalized White communities, these studies have not directly considered mortality by marital status. This paper uses complete death certificate data from the Mortality Multiple Cause Files with American Community Survey data to examine age-specific mortality rates for married and non-married people from 2007 to 2017. The overall rise in White mortality is limited almost exclusively to those who are not married, for men and women. By comparison, mortality for Blacks and Hispanics has fallen or remained flat regardless of marital status (except for young, single Hispanic men). Analysis by education level shows death rates have risen most for Whites with the lowest education, but have also increased for those with high school or some college. Because mortality has risen faster for unmarried Whites at all but the lowest education levels, there has been an increase in the marriage mortality ratio. Mortality differentials are an increasingly important component of the social hierarchy associated with marital status.
SeaTE: Subjective ex ante Treatment Effect of Health on Retirement by Pamela Giustinelli, Matthew D. Shapiro :: SSRNJanuary 2, 2019
This paper develops an innovative approach to measuring the effect of health on retirement. The approach elicits subjective probabilities of working at specified time horizons fixing health level. Using a treatment-effect framework, within-individual differences in elicited probabilities of working given health yield individual-level estimates of the causal effect of health (the treatment) on working (the outcome). We call this effect the Subjective ex ante Treatment Effect (SeaTE). The paper then develops a dynamic programming framework for the SeaTE. This framework allows measurement of individual-level value functions that map directly into the dynamic programming model commonly used in structural microeconometric analysis of retirement. The paper analyzes conditional probabilities elicited in the Vanguard Research Initiative (VRI)—a survey of older Americans with positive assets. Among workers 58 and older, a shift from high to low health would on average reduce the odds of working by 28.5 percentage points at a two-year horizon and 25.7 percentage points at a four-year horizon. There is substantial variability across individuals around these average SeaTEs, so there is substantial heterogeneity in taste for work or returns to work. This heterogeneity would be normally unobservable and hard to disentangle from other determinants of retirement in data on realized labor supply decisions and health states. The paper’s approach can overcome the problem that estimates of the effect of health on labor supply based on behavioral (realizations) data can easily overstate the effect of health on retirement whenever less healthy workers tend to retire earlier for reasons other than health.
Hunger Pains? SNAP Timing, and Emergency Room Visits by Chad D. Cotti, John Gordanier, Orgul D. Ozturk :: SSRNJanuary 2, 2019
The impact of poor nutrition has been established as an important determinant of health. It has also been demonstrated that the single monthly treatment of SNAP benefits leaves meaningful nutritional deficiencies in recipient households during the final weeks of the benefits cycle. Further, health related behaviors have been documented to be altered on the date of food stamp receipt. This project exploits highly detailed and linked administrative data on health care utilization of food stamp recipients and randomized food stamp receipt dates to allow us to measure the impact of food stamp treatment days and the low nutritional periods created by the SNAP benefits cycle on the likelihood of emergency department (ER) utilization among the Medicaid population. Our main finding is that among SNAP receiving individuals in the ER on a particular day, the share that received benefits on that day is 3.5% lower than would be expected. This effect is present across all age groups, although the magnitude is smallest for young children. Further, we find that for individuals 55 and over, the share of ER visits that comes from individuals that are past the third week of their SNAP benefit month, i.e. received benefits more than 21 days ago, is 1.5% larger than would be expected. This suggests that these older individuals are more likely to visit the ER late in the SNAP benefit cycle, which is consistent with increased food insecurity as a possible mechanism linking the food stamp benefits cycle to emergency care utilization. We find no such effect for younger individuals.
Medical-Legal Partnerships and Mental Health: Qualitative Evidence that Integrating Legal Services and Health Care Improves Family Well-Being by Dayna Bowen Matthew :: SSRNJanuary 2, 2019
Medical-Legal partnerships are an innovative health care delivery model that integrates lawyers into primary care clinical settings. The objective is to preventively address patients’ legal needs that also have an adverse impact on their health outcomes. Since the first medical-legal partnership formally opened at the Boston Medical Center in 1993, nearly 300 of these entities have formed around the country. The empirical evidence that they improve health, however, is still emerging. This essay contributes results of interviews conducted among families who received medical legal partnership help as an intervention in Colorado. The evidence supports the conclusion that addressing patients’ legal stressors improves their mental health and family well-being.
Social Security Administration Payments to State Vocational Rehabilitation Agencies for Disability Program Beneficiaries Who Work: Evidence from Linked Administrative Data by Jody Schimmel, Paul O’Leary :: SSRNJanuary 2, 2019
This article’s authors use linked administrative data from the Social Security Administration (SSA) and the Department of Education’s Rehabilitation Services Administration to evaluate SSA’s investment in services provided by the federal-state Vocational Rehabilitation (VR) program. A unique data resource permits a comparison of the value of SSA payments to state VR agencies for services provided to disability program beneficiaries who find and maintain a substantial level of work with the value of the cash benefits those beneficiaries forgo because of work. The authors find that the value of cash benefits forgone by beneficiaries after applying for VR services is substantially greater than the value of SSA payments to state VR agencies for those services.
via Social Security Administration Payments to State Vocational Rehabilitation Agencies for Disability Program Beneficiaries Who Work: Evidence from Linked Administrative Data by Jody Schimmel, Paul O’Leary :: SSRN