Policy Beliefs Can Change

When you get immersed in the toil of electoral politics, it is easy to get into the rut of assuming that politics is all about getting people who agree with you to the polls at a higher rate that the people who don't agree with you, and that people's opinions, to the extent that they are based on more than trivial amounts of information, almost never change.

But, in the longer run, that isn't true. While an individual, and even a whole geographic community's place on the political spectrum is very stable over time, in the case of communities, even over more than a century, the location of specific policy stances on that political spectrum can shift dramatically in a couple of a decades or less.

A poll from CNN this week is the latest to show a majority of Americans in favor of same-sex marriage, with 51 percent saying that marriages between gay and lesbian couples “should be recognized by the law as valid” and 47 percent opposed.

This is the fourth credible poll in the past eight months to show an outright majority of Americans in favor of gay marriage. . . Prior to last year, there had been just one survey — a Washington Post poll conducted in April 2009 — to show support for gay marriage as the plurality position, and none had shown it with a majority. . . . opponents of gay marriage almost certainly no longer constitute a majority; just one of the last nine polls has shown opposition to gay marriage above 50 percent.

From here.

In New York State, likely voters polled earlier this year supported gay marriage by a 56-37 margin. In New York City suburbs support for legalizing gay marriage is 61-33. Roman Catholics are more likely to support gay marriage than members of the population at large, notwithstanding church doctrine to the contrary.

If you told me when I started high school in small town Ohio in the mid-1980s that a majority of Americans would support gay marriage two and a half decades later, I would have thought that you were crazy. When I graduated from high school, only about 11% of those polled thought gay marriage should be legal, while about 72% oppose it. Frankly, I'm surprised that support for gay marriage back then was that high, I would have guessed that it was in the single digits, and maybe in small town Ohio it was. It is also possibly that the single pre-1994 poll's number was high and was made public at all only because it was a statistical outlier on the high end.

The AIDS epidemic had started to make most people aware that there were actually people who had intimate relationships with members of the same sex voluntarily, but even the notion that someone could actually identify as "gay" or "lesbian" in real life, as opposed to merely as an insulting and inaccurate description of someone, wasn't real clear to me at the time. I had never met anyone who had come out. I hadn't even seen or heard of anyone who had come out on TV, in a movie, on the radio, or in anything that I'd read in print. There were no organizations for gays, lesbians, transgender individuals that I was aware of in my town, and the only one that I was aware of nationally was ACT-UP. I was aware of a couple of same sex adult couples who lived together as a household, one of which involved an extended family member, but it had never occurred to me that a household like that would be anything other than platonic, and nobody in those households ever said a thing that suggested that more legal rights were necessary for them.

Since then, the trendline has been more or less steady and shows no sign of reversing. Nate Silver notes in the linked article that "If support for gay marriage were to continue accelerating as fast as it has in the past two years, supporters would outnumber opponents roughly 56-40 in the general population by November 2012." Even if the growth in support reverts to the overall trend line, there will be a pretty safe majority that favors legalizing gay marriage by then, and some states will be ahead of that trend while others will be behind it.

Popular understanding of sexual orientation and gender identification has expanded dramatically in a quarter of a century. By the time I finished high school, I learned that there were at least a few people in my community who self-identified as gay or lesbian (I would not meet anyone who had a transgender identity until after I finished college). Oberlin, where I went to college, was a mecca for gay and lesbian students, who were often active in campus politics, were deeply involved in running one of the major social events of the year on campus (the drag ball), and made it a point to be out of the closet in daily life in class and around campus. A large share of our student body came from New York City and some students personally knew people who had participated in the Stonewall Riots.

But, while college changed my views, this took much longer for the rest of the nation. More than one book has recounted what happened in the years that followed, but my point is not to illustrate how this happened. My point is to note that it did.

Even a decade ago, even among liberal minded people and many people in the gay and lesbian community, some form of civil unions seemed possible and desirable, but gay marriage seemed like a remote possibility that might never happen anywhere in anything but the distant future (where author Kate Elliott, who I whose science fiction Jaran novels I was reading in the late 1990s had put a society that had gay marriage). It was a little hard to determine at that point what gay marriage would even mean at a practical level, because not a lot of attention had been given to the question by people in a position to know the answers.

Now, there are thousands of same sex legally marriage couples in the United States and more in Europe. Colorado doesn't legally recognize same sex marriage and doesn't even have a civil unions law (one was narrowly defeated in this year's session of the Colorado General Assembly). But, it does have a lot of same sex couples who view each other as spouses, who hold themselves out to the public as spouses, who live as a household and who raise children together. They are parents of children who go to school with my children. They are teachers. They are nurses. Their families are my neighbors. Those couples are my clients in large numbers.

It has become obvious to a large share of the population through countless examples that someone can be gay or lesbian as a matter of personal identity, and that a person's sexual orientation is a stable part of who someone is as a person that someone is generally aware of to some extent, even if they may not fully understand their feelings in some social contexts or may be confused at times, for most, if not all, of their lives. (And, who doesn't, at some point in life, find their potential romantic relationships to be confusing?)

It has become clear as well that gay marriage doesn't have negative externalities. It doesn't weaken the institution of marriage for opposite sex couples. It helps many children and harms none. It imparts dignity without taking it away from anyone.

There are still plenty of people in the world who still insist that same sex loves are sinful based on epistles written by John the Gospel writer a couple of thousand years ago, and stories and laws written by Jewish priests centuries before then. But, those scripturally motivated views don't last long in the face of encounters with real life friends, neighbors and colleagues. They don't have much credibility with young people, even those who are evangelical Christians who have grown up in a world that has allowed them to see gays and lesbians and transgender individuals living ordinary (and extraordinary) lives like anyone else.

Decisions from courts and politicians, like the recent Congressional repeal of the Don't Ask, Don't Tell policy in the military and the President's decision not to defend in court the part of the Defense of Marriage Act applicable to the federal government have provided the leadership that has changed the views of the majority, and willingness to hire a gay man as the White House social secretary. Once you abandon the sin theory of sexual orientation the rest flows pretty naturally, and the leadership that our nation's leaders have shown has pretty well discredited that understanding of sexual orientation.

The sin theory of sexual orientation is rapidly going the way of the equally scripturally supported and equally empirically inaccurate demon possession theory of mental illness. Despite the fact that the words in the Bible haven't changed, very few people walking the streets believe in an internalized way that mental illness is caused by demon possession, and likewise, the Biblically based defenses for the institutions of slavery are also now heart felt for only a tiny minority of American Christians.

Lots of people believe that faith healing (which the Gospels devote a great deal of time to) is possible, or at least once was possible, but very few people resort to a clergyman laying on hands as their sole means or even primary means for dealing with poor physical health.

The Pope's official position, reduced to writing ever since 1968 in "Humanae Vitae," is that using contraceptives is a sin. But:

A survey just one year later . . . found that 44% of Catholic women (who were regular churchgoers) were currently using artificial contraception. In 1974, 83% of Catholics said they disagreed with the Pope’s stance on birth control. By 1999, nearly 80 percent of Catholics believed that a person could be a good Catholic without obeying the church hierarchy’s teaching on birth control. A 2005 nationwide poll by Harris Interactive showed that 90% of Catholics supported the use of birth control. The Center of Disease Control and Prevention 2002 National Survey of Family Growth revealed that 97% of American Catholic women over age 18 have used a banned form of contraception, which is the same percentage as the general population.

The sea change in public opinion on gay rights isn't the only recent example.

While he was living, Martin Luther King, Jr., our nation's pre-eminent hero was the civil rights movement, was wary of pressing to strike down miscegenation laws and emphasized civil rights in the public sphere of work and commerce instead. Yet, in the wake of Loving v. Virginia, even prominent segregationist politicians like Strom Thurmond eventually came around to the view (and I genuinely believe that at least that far it was sincere) that miscegenation laws were wrong and that there was nothing wrong with interracial marriage. Large percentages of white, usual Republican primary voters in Mississippi still haven't come around, and we are not a nation of color blind people. But, Jim Crow era laws to enforce segregation and discriminate on the basis of race have been utterly morally discredited for the vast majority of Americans today.

We haven't reached a comfortable answer that tells us how to balance work and family in a world where both men and women are part of almost all parts of the workforce. But, almost nobody wants to return to the status quo that was in place when I was born when the percentage of women in law school student bodies was in the single digits, and there were only a handful of jobs that were open to women, especially to married women. Likewise, almost nobody advocates a return to a legal regime in which women cannot own property, bring lawsuits or enter into contracts in their own name, as was the case when the Founders wrote the United States Constitution.

Similarly, nobody is advocating that the franchise be limited to white male property owners over the age of twenty-one as it was when the Founders wrote the United States constitution. Indeed, while non-whites can no longer constitutionally be denied the right to vote based on race, women can no longer constitutionally be denied the right to vote based on gender, and eighteen to twenty year olds can no longer constitutionally be denied the right to vote based on age, laws restricting the franchise to property owners would quite possibly not violate the federal constitution, although such laws would be politically impossible to pass at the moment.

Abortion remains controversial, but popular opinion today would never support the laws struck down by the U.S. Supreme Court in Griswold v. Connecticut in 1965 that made it illegal to use "any drug, medicinal article or instrument for the purpose of preventing conception."

Support for legalizing marijuana is at about the same point that support for legalizing gay marriage was two years ago. The year that I graduated from high school, about 74% opposed that and 24% supported it. Now, about 50% oppose legalizing it, while 46% support legalizing it, and support for legalization has grown more or less steadily for the last fifteen years. According to the executive director of NORML:

Thirteen states have decriminalized marijuana, and that covers 130 million Americans. We now have fifteen states and the District of Columbia that have legal protections for qualified medical-marijuana patients, and that covers 90 to 95 million Americans.

The President has taken the position of not using federal law to punish people who use marijuana in compliance with state medical marijuana laws, and has paid essentially no price (and perhaps gains support) for taking this position.

In aspects of life where people have real experience and are affected in their daily lives, religious texts and doctrines and even community traditions are all but irrelevant to people's opinions. The previous generation's unthinkable possibilities can become the current generation's moral norms.

READ MORE - Policy Beliefs Can Change

The Case For D.C. Statehood

There are two ways that the residents of the District of Columbia are disadvantaged in our political system relative to other states. First, they lack a representative of Congress or Senators of their own (although they do get electoral voters as if they did in Presidential elections). Second, the Congress in which they lack voting representation messes around with how they run their local affairs on a routine basis.

District of Columbia officials expressed outrage on Saturday about two provisions of the budget deal between Democrats and Republicans, saying they dictate how the capital should spend money. One bans it from using its own locally raised funds to pay for abortions for poor women. The second is a federally financed school voucher program, which city officials said was unnecessary because 40 percent of students already go to public charter schools.

There are upsides, of course, as well. The District of Columbia has far more revenues than it would as a state with mostly less affluent residents and a very large share of the District's tax base in the form of tax exempt governmental and non-profit enterprises.

There are also legitimate concerns that the District of Columbia, as a mere part of a larger metropolitan area, doesn't have a "complete" enough economy to be an economically viable entity, and that an independent District of Columbia, through its local control of the place where the nation makes its laws, could have undue influence on the legislative process.

Some alternatives that have been suggested to statehood for the District of Columbia (or all of it except a small federal district), which could be accomplished with a vote of Congress alone, would be the retrocession of the territory of the District to Maryland with Maryland's consent as well as that of Congress. This would follow the precedent of the retrocession the territory of the District that came from Virginia, called the County of Alexandria, in 1846 which allowed it to retain its slave trade. The slave trade, although not slavery, were banned in the District in 1850.

A retrocession of territory to Maryland would probably give Maryland an additional safe Democratic seat in Congress and would make some Senators accountable to D.C. residents, but would not tip the balance in the Senate any further towards Democrats, would actually slightly reduce the power of D.C. in the Presidential election (assuming that rump D.C. loses its electoral votes via constitutional amendment), would make already Democratic party leaning Maryland more safe politically at the state level, would provide greater local control, and would alleviate any doubts about economic viability. On the other hand, it would also suddenly impose upon the residents of D.C. a great many unfamiliar Maryland laws, in lieu of the laws that residents had crafted themselves in the District.

READ MORE - The Case For D.C. Statehood

Deconstructing the Concept of Health Care And Options For Dealing With It

The convention of lumping all of the issues that fit under the rubric of health care is necessarily somewhat arbitrary. As we look to improve ways to control costs and find better ways to finance care, which is a never ending process despite the passage of the Affordable Health Care Act, which makes major reforms, it is worth examining ways to break the overall field of health care into parts, and to see if there are things that we commonly don't define as health care that are appropriate to address with the same tools.

Group health insurance plans and Medicare define health care quite broadly, but exclude certain procedures and treatments commonly deemed to be cosmetic or recreational or fitness related; long term care in nursing homes or with home health care services; and sometimes abortion. Medicaid often includes a broader definition that includes, for example, nursing home care.

Individual health insurance plans, out of concerns about moral hazard in the purchase of health insurance, have narrower definitions of covered health care. Routine services are often covered by a deductible on the theory that the tax advantage that applies to group health care plans creating an incentive to include as much as possible in the plan coverage scope for tax reasons does not apply in individual plans of employees who are not self-employed where risk management and price negotiation with providers, but not tax minimization is the goal.

Individual health insurance plans also usually exclude, or include only at prohibitively expensive rider rates (far more than this kind of care contributes to the whole in group health insurance plans) types of health care for which moral hazards exist because patients can know that they will need coverage in advance and buy it only if they need it. These conditions include pregnancy related care, mental health coverage, and coverage for pre-existing conditions (mitigated by a variety of devices to allow pre-existing condition coverage where moral hazard risks are not as serious, such as quasi-group COBRA continuation coverage).

Pregnancy is very expensive to insure against in individual health insurance plans because it is highly controllable by the insured, even though the lifetime costs of pregnancy related care frequently don't vary much from one woman to the next.

Mental health coverage has been further divided into categories that look more or less medical (biologically based conditions). There is dispute over whether some treatment regimes such as non-allopathic medical approaches (such as chiropractic, aromatherapy, herbal remedies, psychological therapy, acupuncture, personal training, and massage therapy remedies) are really health care in the sense intended, and over whether treatments such as fertility treatments are genuinely necessary as opposed to recreational.

Long term care coverage is an example of a very expensive, high probability event, with moderate risks regarding duration and costs, that is further complicated by the fact that long term care typically covers not only medical-like expenses but also non-medical-like expenses such as rent and food costs for the resident. Similarly, loss of income due to disability, or the disabilities presumptively inferred from old age called retirement, are typically handled separately from medical care.

We make distinctions between "emergency care" which everyone who comes to an emergency room is entitled to regardless of ability to pay, at least until stabilized, and other kinds of medical care.

We have different financing regimes for dental care, vision care, work related injuries (worker's compensation or the equivalent), non-work related accidental injuries (tort remedies and casualty insurance), health care for foster children, health care for Medicaid v. non-Medicaid patients, health care for the uninsured who can and cannot pay in cash, health care for certain veterans, out-of-pocket and insurance paid care, over the counter and prescription treatments, and so on.

Within the area of Medicaid covered health care, there are two groups of beneficiaries whose care is very expensive: older people who need nursing home care, and people with disabilities, and another, poor people who are not disabled or old served by the minority of providers willing to accept new Medicaid patients for below market rate reimbursements, for whom it is very inexpensive to provide health care.

A large share of all people covered by health insurance or governmental health care programs are entitled to that coverage not in their own right, but by virtue of their status of dependents of someone else. Medicare is one of the few programs that does not cover the entire family (although individual policies and CHIP enrollment in Medicaid for children only in a family are another).

The Affordable Care Act has made several strategic choices, which made political sense at the moment, but may not be the best long term solutions. One is to focus on a scope of care similar to bare bones group health insurance plans. Group plans are encouraged. Individual plans are made more like group plans through prohibitions on pre-existing condition denials, through mandatory coverage, and through expanded scope of coverage, in order to address moral hazard issues. The scope of Medicaid is expanded to include the near poor. And, tax credits and incentives ease the ability to pay problem for both group and individual plans.

There are other ways that the task could have been divided.

We could have chosen to deliver some or all health care services to children (and even college students) through educational institutions. Most school districts have school nurses and psychologists already, administer a few routine screening tests, provide health education (mostly, but not entirely sex education and illegal drug use propaganda), and refer children who seemed to be in need of medical attention but are denied it to social services authority. But, it wouldn't have been hard to establish a system of comprehensive, single payer health care for children through the school system. This would prevent the current system from suffering strain from the fact that large families do not fully bear the cost of their own care in many cases (particularly with more generous employers), and would in some ways reinforce the notion of connecting health care to one's place of employment - extending the idea to school aged children.

Colorado until recently, and some other states, have experimented with no fault automobile accident medical coverage, in which care for automobile accident injuries are financed through the injured person's car insurance, with particularly severe cases to be settled via subrogation actions by the insurer who pays for the care. There have been proposals to make such no fault coverage universal and finance it with a gas tax or other excise tax that functions as a "pay at the pump" user's fee. Worker's compensation, in theory, at least, covers work related injuries and diseases without regard to fault.

With a universal health care system, it would be possible to remove health care payments from the domain of automobile insurance, casualty insurance, tort judgments and worker's compensation entirely, by making health insurance the primarily responsible party for all health care, with legal responsibility for medical expenses related to fault in accidents or on the job injuries or diseases limited to subrogation actions. This would take a great many personal injury cases outside the tort law system entirely, and narrow dramatically the scope of the issues presented in these cases. Even more dramatically, we could decide that compensation for lost income due to disabilities that arise from injuries or diseases (or perhaps otherwise) ought to be entirely the province of insurance or social safety net programs, rather than the courts, perhaps via a more robust version of Social Security, or mandatory comprehensive disability insurance, in lieu of separate regimes for work related injuries, general tort cases, sick leave policies, and cases covered partially by private disability insurance policies and social security. Subrogation cases could allocate fault in cases where it was necessary to provide the proper incentives not to engage in negligent conduct (although in a society where everyone is adequately insured, this is harder to justify, particularly for small cases where the burden of the risk faced by different insurance companies can be expected to average out over time). In a regime like this one, only "pain and suffering" and dignitary injuries would be left to litigate.

Less radically, health insurance companies would process all health care claims, regardless of the nature of the injury, and then would be reimbursed by casualty insurance companies, with their actual costs entitled to presumptive validity. Tort lawsuits might establish liability for medical costs, but simply order the insurer for the tortfeasor to pay those costs as they come due, avoiding litigation involving expert witnesses over the validity of medical costs incurred and the estimated future medical costs involved in a personal injury case. Casualty insurers and health insurers could resolve medical expense disputes in individual cases through intercorporate arbitration.

We could have had a single payer system for some conditions, perhaps mental health care, or pregnancy care, or congenitally disabled people whose high cost of care is a certainty at the outset, that are hard to deal with through individual insurance due to moral hazard issues, while utilizing the Affordable Health Care Act insurance regime approach only for more ordinary cases. Mental health care or pregnancy care could be quite affordable to provide via a single payer system since they are a small part of the total national health care expense.  Failure to provide adequate mental health and/or pregnancy care has immense externalities for the rest of society as well, so perhaps these need to be redefined as public health issues.

We could have medical care in all trauma cases handled by one program or insurance regime, and handle non-trauma causes in another regime.  The public interest in universal trauma care is greater than the public interest in many kinds of universal non-trauma care.
Pregnancy care could be insured not through employers, but on a basis similar to universal life insurance or long term care policies, with premiums made over a lifetime or many years, to cover a lifetime of coverage. Rather than expiring for want of premium payments, these policies could create non-dischargable debts, a bit like student loans, which insurers could collect with bad debt figured into their pricing. Alternately, we could have a system of guaranteed pregnancy care loans that is directly analogous to the student loan regime, allowing births to be paid for over the course of a decade or two, rather than all at once, and could focus on transparency in pricing as a way to control costs in this area.

Guaranteed medical care loans also make sense as a back stop to a regime with catastrophic coverage in which not all patients have funds in a health savings account or otherwise sufficient to pay their current out of pocket costs.

We could distinguish between catastrophic care, which might be handled by a government program or secondary tier of insurers (a bit like umbrella insurance), and ordinary health care which would de-emphasize risk sharing and emphasized price negotiating and cash flow management. The greater ability of patients to pay for non-catastrophic care would make more ordinary market-like arrangements such as those seen in the area of dental health, seem more workable.

If coupled with a system of guaranteed medical loans, non-catastrophic care could be optional, and only catastrophic care would have to be universal either because it is mandatory in some form, or is a tax financed government program. The downside of making this a mandatory form of insurance, is that compliance can be difficult to secure for a program that actually makes insurance payments to the people who pay the bills only very infrequently, while accounting for something on the order of half of the cost of health insurance. But, catastrophic care on an umbrella insurance model would have very low administrative costs relative to premiums, and relatively few of the really controversial insurance coverage issues involve catastrophic care cases. This could give a government program a fairly large economic role in health care without having much of a day to day administrative role in it that people would fear would interfere with doctor-patient relationships.

Medicare and Medicaid are currently mostly programs that pay providers directly on a fee for service basis, but could be organized to pay for a menu of health insurance options, or to pay providers on capitation or similar basis. The Ryan plan that would provide mere flat dollar vouchers to buy health insurance would be problematic standing alone, but if there was a core set of coverages that could be purchased with the voucher without additional expenses from a vendor of last resort who was required to provide it, this would not be worrisome.

It would be possible to structure health care claim processing a bit like the way we structure credit card progressing today, where cooperatives like Mastercard and Visa process claims and adjudicate billing disputes, but the loans are extended by member banks that set interest rates, set credit limits, and establish their own reward programs. The vast majority of health insurers could be united in a small number of cooperatives, which would receive claims from providers and process them in a standardized process, set provider compensation rates for member providers, and leave the actual health insurers with only a few key terms like copay amounts or deductibles being set by the actual health insurer which would bear the financial cost of claims processed for its insureds, but would not actually administer those claims. This could produce many market efficiencies even if the claim processing cooperative had no formal monopoly.

Of course, to some extent, this is the easy part of the equation. Once you have universal health insurance coverage, it is a relatively bloodless affair to reshuffle the expense from one pocket to another in the interests of more efficient administration and more sensible cost distribution that is consistent with ability to pay. The really hard part of the issue is figuring out which scenario is not going to be to reduce just administrative and marketing costs to a minimum, giving health care consumers the best value for their money. This is the low hanging fruit, which shouldn't be that hard to realize.

The truly hard part of the health care reform question, which still remains largely unanswered, is who is both willing and able to effectively negotiate lower compensation rates for providers that will translate into lower compensation for doctors, nurses, pharmacists, drug companies, medical equipment makers, hospital administrators, and so on. The deepest problem with the American health care system is that the people who are currently making these decisions, with other people's money, are leaving American providers much better compensated than those anywhere else in the world by a large margin, for the same or less or inferior work. And, very few people in the policy world are entirely clear on what precise flaws in the provider rate system is most to blame. Notably, the truly iconic seats of medical excellence in the United States, like Mayo and Bethesda, are not the ones with the most highly paid providers.

Even in a perfect world with high levels of transparency, the sick and the injured are simply not in a good position to bargain for lower provider costs at the time of treatment as one would with many goods and services. They need intermediaries to handle this for them. But, how do we get the intermediaries (who might be civil servants or insurance company bureaucrats that we have never met) the clout that they need visa-a-vis medical providers who we know and love and the incentive to do their job well?

READ MORE - Deconstructing the Concept of Health Care And Options For Dealing With It

Teen Births at Record Lows In U.S.

The birth rate for [U.S.] teenagers fell to 39 births per 1,000 girls ages 15-19. . . . It was a 6 percent decline from the previous year and the lowest since health officials started tracking the rate in 1940. . . . The total number of births also has been dropping, as have birth rates among all women except those 40 and older.

For comparison, look to the peak year of teen births — 1957. There were about 96 births per 1,000 teen girls that year, but it was a different era, when women married younger . . . Overall, about 4.1 million babies were born in 2009, down almost 3 percent from 2008.

It's the second consecutive drop in births, which had been on the rise since 2000. . . . A preliminary count of U.S. births through the first six months of this year suggests a continuing drop.

From here citing data from the Center for Disease Control (a federal government agency).

Colorado's teen birth rate followed national trends in declining, and is about 9% less than the national average.

In Colorado, 24.9% of all births are to unmarried mothers, compared to 41.0% of all births nationally. Utah is the only state in the United States with a lower proportion of births to ummarried mothers (19.4%). In, Idaho, which like Utah and unlike Colorado, has a prevasive Mormon cultural influence, 25.6% of births are to unmarried mothers (the lowest in the United States after Utah and Colorado). There is no obvious reason that Colorado is such an outlier in this regard, but this number is consistent from 2008 to 2009. Unlike Utah and Idaho where first marriage ages are far lower than the rest of the nation, Colorado is not particularly atypical in its average ages at first marriage and Colorado is far more ethnically diverse than many states with higher rates of unmarried motherhood. This number is so unexpected that I am suspicious that it might be a mistake, as it does not seem to be a good fit to unmarried motherhood rates in Denver, although Colorado's retention of the institution of common law marriage could also be factor and births in Denver are almost certainly atypical of the state as a whole.

According to the CDC report: "The [birth] rate for the youngest teenagers, 10-14 years, fell from 0.6 to 0.5 per 1,000, the lowest level ever reported. . . . The birth rate for teenagers 15-17 years declined 7 percent to 20.1 per 1,000. This rate dropped 9 percent from 2007 (22.1) to 2009, and was 48 percent lower than the rate reported in 1991 (38.6 per 1,000)."

Teen births are down 59% from their 1957 modern peak, about 33% from their most recent peak in the late 1980s (when I was 15-19 years old), and significantly below the depressed levels of World War II which rebounded from a long period of muted fertility with the baby boom. With the exception of a surge in teen birth rates in the late 1980s and some small, short term statistical blips, teen birth rates have declined steadily from the 1957 peak of the baby boom to the present.

While accurate national teen birth rate statistics go back only to 1940, it is unlikely that there is any time in the history of the United States when teen birth rates have been as low as they are now, because women tended to marry younger, have children immediately upon getting married, end their formal educations sooner, had higher birth rates in generally (in part because fewer children were likely to survive to adulthood), and contraception and abortion were both far less available then. Ages at first marriage are currently at or near near record highs.

We care about teen birth rates as a social indicator, of course, mostly because teen pregnancy creates an acute risk of poverty and reduced socio-economic expectations for both the mother and the children, and because, particularly for the youngest mothers, it is often an indicator of coerced sexual relationships, usually outside marriage or in forced marriages. Low teen birth rates are expected to translate into lower long term poverty rates.

I haven't seen the parallel abortion statistics for 2009 yet, but if the trend of births and abortions the last couple of decades is any indication, the decline in births generally, and in teen births in particular, is almost entirely due to fewer pregnancies, rather than due to a smaller share of pregnancies ending in live births. Abortion rates have fallen at least as fast as teen birth rates.

Births to married mothers fell faster than births to unmarried mothers in 2009, so the share of all births to unmarried mothers rose, reaching 41.0% in 2009.

The 2009 trends were widespread amongst almost all age and ethnic categories, but the actual teen birth rates differed greatly by ethnicity.

The birth rate per 1,000 girls aged 10 to 14 in 2009 by ethnicity was:
Asian or Pacific Islander 0.2
Non-Hispanic White 0.2
American Indian or Native American 0.8
Non-Hispanic Black 1.2
Hispanic 1.0

The birth rate per 1,000 women aged 15 to 17 in 2009 by ethnicity was:
Asian or Pacific Islander 7.1
Non-Hispanic White 11.0
American Indian or Native American 30.6
Non-Hispanic Black 32.6
Hispanic 41.0

The birth rate per 1,000 women aged 18 to 19 in 2009 by ethnicity was:
Asian or Pacific Islander 25.7
Non-Hispanic White 46.1
American Indian or Native American 90.5
Non-Hispanic Black 97.5
Hispanic 114.0

The recession, a weak job market, and declining immigrant populations have been cited as possible factors in the declining birth dates.

The "total fertility rate" in the United States has been below the "replacement rate" at which births match deaths as it has in every year from 1972 to 2009 except 2006 and 2007.

This year's data continues to support the very recent trend (i.e. of the last decade or so), in which poverty has tended to reduce, rather than increase fertility. It is safe to assume that in the one group of women in whom birth rates have risen, women 40 and over, that this is driven almost entirely by affluent women who are getting pregnant with the help of fertility treatments.

To the extent that lower teen birth rates, and indeed lower birth rates generally, are an indicator of a weaker economy, 2010 may very well be the year with the lowest teen birth rate for a very long time, as teen birth rates in the U.S. may rise modestly when the economy recovers, although the fact that teen birth rates remain higher in the U.S. than in much of the rest of the developed world leaves open the possibility that there is more room for a secular decline in teen birth rates in the United States.

READ MORE - Teen Births at Record Lows In U.S.

Abortion in China

[A reputable study in China last year] found . . .

• 22.4% of Chinese youth age 15 to 24 were participating in premarital sex
• 51.2% of those sexually active youths did not use any form of birth control
• More that 20% of the sexually active youths had experienced an unexpected pregnancy
• 91% of those youths had opted to end that pregnancy in abortion.

These estimates for pregnancy and abortion rates are . . . higher in studies that just look at university students. In one such study (which had 80,000 participants), 26% of sexually active students had an unexpected pregnancy with an abortion rate of 92%.

From here.

Westerners are more likely to have premarital sex, but via birth control, less likely to get pregnant and far less likely in every demographic (with the possible exceptions of pre-teens and rape victims) to get abortions. The study also found that knowledge about what birth control methods do and don't work is scarce in China, as 95% of women use “feminine wash”, as a form of birth control even though it doesn't actually work.

READ MORE - Abortion in China