society lawyers don't like what he did with the affordable care act but those from other places will be deferential that is pretty much true of all. but not to be crude about this but they cannot stop five of them from doing that they feat there is no way to deal with that. yes they want to be thought
well of on bill whole where they circulate they are well thought of and that is probably even for them. >> host: to having the input from writing the book? >> guest: model. i relied entirely, i have a discussion of judgment of background and academic and i relied on the academic circles. i know her and she was the dean and i had a certain amount of gratitude but that is the only person that i relied on everything else is based on public sources. >> host: it is a pleasure to talk with you the book is "in the balance" by mark tushnet. think you
[applause] thank you for coming. i will talk for about 30 minutes it what i will present it is dated discussing why we talk of the recession not just talk markets and economic growth and debt and deficit but our health in the public health more generally and to do so when i found initially is somewhat of a confusing puzzle perhaps best captured in the old "usa today" newspaper clipping repeated a few times in a variety of different outlets. the notion could recession be good for you? the headline confused me aphorist that i as a student people's health insurance would be lost they took a
job of become depressed but yet they were based on a series of studies these recessionary periods the unemployment spikes were associated with life expectancy which i found confusing. what i want to do is present one solution to this puzzle and in presenting the solution i think we can gain some insight into why we may ask the wrong questions when we correlate the recession into different things. what i will do is first talk about how we may learn natural experiment with cities are states experience the same or similar recessions with policy avenues and ended up in different places alternately
the gold will be to say this safety net the question that seems most apparent right now cannery of for the social safety net and are they effective? so let me return to that puzzle looking at increased life expectancy perhaps if we learn from any major recession the great depression is the best template to have there were numerous reports of death rates around the country with so many other features that we learn about the great depression so one possibility might be there by is maybe they just keep track of people that are insured and the others are
just the uninsured but it turns out with the public health service is now part of the other surveys to declines of the overall death rate and some of the clues for what might have been going on from "the new york times" back in 1933 for the first time in history. greasy if we were to look indicators of the recession which is overall gdp or income they'll most like beer images that the recession hit this is a good example why it is dangerous to look at aggregate level data and if you look across those with the highest gas prices immerse unemployment and if you were the people
driving those of the day's then you did not get -- into a of a car accident without a seatbelt was almost always fatal. also a lot more important going on was people's health perhaps the most obvious is the dramatic spike of suicide rates headed beneath those are such a large cause of death that the decline masks all these other increases at the same time producing a beard collation between with the death rates of the employer rate. the year is another important lesson the suicide rates did not increase universally across the country in fact, suicide rates in the others that are obviously associated with unemployment that are
clearly associated only increase in certain areas where the others see it in some places declined. so that is rarely start to analyze why these variations are occurring. one of the most important is the states that decided to implement part of the new deal and particularly in states where rapid reintegration programs also those affected by prohibitionist the time. also the infectious diseases with tuberculosis that provide rapid rehousing so we begin to see the hypophysis that these rates are affected that we call it
sadistically but to try to answer a story with social policy responses handle its mitt help health outcomes we have to look that much more detailed data while it has the average level data from groth data sources we have to attend more modern recession to come up with the answers to this question. very similar countries are the populations have those at the same time and had very different outcomes those that had roots with the real-estate bubble and of course, our courage great recession so looking first
at russia during the collapse of the soviet union the vast array of different populations all had it to run the same time otherwise demographically similar populations end up having a very different health outcome even if they start off with the same health status and what was weird is a number of demographers from russia in france were all in the same trend you would expect at that time the people who would hurt the most would be these very young and the very old. but what was strange about the russian crisis is that young robust russian men had a huge spike in the death rate that is rather confusing and there was a variety of theories and one was the be the russians were faking the data before the
collapse of the soviet union and amplifying the number of young men that were around to impress the size of their potential or me and that turned out in that context but some independent demographers were worried about this so they were secretly keeping track of the russian male population for this reason, the french demographers during the cold war and to what was dramatic is that it did not occur every where in one saw a dramatic variation that amounts to several million people. in locations in russia that
underwent what has been called shock therapy. so that russia needed to get back on track with the global marketplace and the concern was if the government had to the obligations it would go into too much debt and not really recover as a stable economy. and to dramatically cut social programs our existence these have rapid job reentry -- reentry programs and in particular major alcohol prevention programs. but not everyone agreed belarus, poland, decided this would be a bad idea. they refuse to follow this device while others went whole hog. in this setting we have a
massive divergence between those life expectancies of young men or the shock therapy for those the life expectancy was flat. so we see that it could be a matter of policy choice. also in the east asian crisis. it with the great enthusiasm in ribby the technology up the center of the future. subsidy were being built that bangkok house fire taught since its population.
but like every price bubble for what was really going on even chile in the context of this currency crisis in this debate that happened is in the current recession essentially ended up with the bursting of the stock market with the subsequent liquidity crisis no one could get loans because of the money has dissipated from the system. there was a great debate about what to do in the imf at the time which is the lender of last resort the major international bank said we don't want you going into inflation and cut down spending dramatically in
order we all have major government obligations with a value of the currency and under protest malaysia and south korea refused to do that while their neighbors went into a whole part of a. this a natural experiment emerged one sees the spikes a suicide rate also malnutrition and they go into shock therapy. remember at this time the siren the years where thailand is viewed as a model in london major programs that were cut with the hiv prevention program in thailand id we saw a huge spike of subsequent infectious diseases that people were getting secondary infections. the malaysian experience was
flat for the malaysian or south korea recover first with a surprisingly his face but more viscerally emphasizes one of the major policy lessons the ada is you will spend or you will recover faster going into inflation or you need to cut down now for the future this was unknown -- showed as a false dichotomy why? the answer was written in the 1950's and only recently reiterated wed countries are in the liquidity crisis they cannot get the loans to retain their staff, is essentially the government does the opposite what the household needs to do.
you don't want to be in debt as an individual. you don't want to continue to accrue interest. governments need to do the opposite to grow the economy all indeed too high a stimulus not just to land to others but as those who spend the vast proportion of their income and a lot of safety nets observe the cycle and help us grow out of the short-term debt. the imf did recognize this they issued a formal apology for the first time. it took five years but one of the most dramatic apologies from the
international institution. getting out to the current recession greasy the vote merchants across the country may have heard that alcohol has gone down that is disingenuous is actually the sales. treaty has diverged across the country. those people have bought one less cup of joe at trader joe's but particularly young men that were able to maintain work see the vast divergence and among those young men recede at harm so overall pc that but what
goes on behind that is the american phenomenon to show the danger of the statistics said the inveigle sea bass divergences within europe people, but in the universal recession is not true. everyone talks about greece but before we talk about greece everyone talked about iceland and said we forgot about it. of course, it was the first country to experience the recession relative to the size of its economy all of the banks collapsed investing in mortgage-backed securities. a of the political and economic situation is quite different. iceland does not depend on the heroes of for bailouts or four assistants did what
i did was dramatic we have then recommended by the imf and others to reduce short-term deficits and made tv obligation to recover faster. and actually the health minister to with that other social safety nets hater erratic mood for the politician. and for the first time since the 8044 they had been country like go to to have the constitutional amendment to put it to a vote even though it was more than they had to percent of state -- gdp but the securities
flopped. we have two options. added to rapidly pay back the creditors. the other is low and repave it programs over time. while preserving the safety that at home and most people voted for the second to one. would be investigated public-health everything was flat some health indicators were slightly improved blakeslee quality but there is no increase of suicide we could not find anything above the scientific investigators. just one a week 52 a sudden spike of respiratory edward to look at what happened delict like a volcano erupted it had nothing to do
with the recession. i cannot pronounce the name of the volcano. [laughter] but greece with a very different route the idea that it must help us to prickly get out of the recession in they quickly cut the public health programs also had higher public health spending but it is not confuse seattle the short-term debts resulted in some of the complications they had to pay much more from the epidemic ensued. for example, with a 4050 percent of employed berate the do drug hits the market to that at the same time the rehab programs were cut one saw a germanic rise of the hiv infections that
resulted in subsequent spending to take care of hiv. similarly the malaria app -- epidemic has broken down for the first time. that of course, cost 10 times more to control the land to prevent in b.c. the same thing unfold. was quite embarrassing for the state department that had a conundrum for the first time to issue a warning to the american travelers to the western european countries creating problems for our trade agreements. now we see the same trend in the u.s. states that with alcoholism and suicide we see spikes' overall but it is very heterogeneous. even simpler cities that face massive unemployment
will relate very strongly to the central programs. those are the answer to the major question why i applaud it does not correlate it is not causation and that is the point why we investigate land they don't occur like it is very closely followed by suicide rates but despite a very large recession with they have their own treaty crisis suicide rates continue to climb. water they doing? is it just so robust? why swedish translate to think that but with a slew of different programs one program that is particularly
effective to prevent the alcoholism of health-related problems have not in spite of be a physician but the active labor market programs these are part tear it and part stick if someone becomes unemployed they do get the unemployment check but this program involves a person to insist them to actively working with their firms you were also required to with part-time reemployment into the workforce. it turns out a pre-emptive spending actually results in economic stimulus that ends up paying for itself with the downstream cost but if
it is just the swedish maybe the of your people are your feelings they? a number of us work on these randomized controlled like in detroit where you go off on your own if you get benefits then good luck to you. all of this city's no on four different continents the same results are of reducing health outcomes as a side effect for ultimately what is a drop of the u.s. jobs program. we were seeing that in much of the u.s. economic recovery corresponded to stimulus where the u.k. under when the austerity program in day clipped the
recovery down there in the triple digit recession. this ended for us around the time of the sequester when we would flash and now with the recovery and at the same time there was a working paper a policy document and public statement from the chief economist that amounted at 400 pages in what is a fascinating document if you get through the rhetoric but it amounts to the following all the advice previously was based on the assumption of one number and that is for every dollar of government spending how many dollars you get back? the others assumed it was 0.five as a footnote you can find the reason is because it is a nice round number.
for different groups calculated out by how many dollars you get back when you invest white food stamps or job security programs cover how much to stimulate the economy and get back with job growth and overall gdp? you get back about $1.70 for every dollar the you invest. but these groups now watching each other ended up with the same number but the irony is germany while recommending for greece they actually calculated the number called the fiscal to acquire for themselves and decided to undergo stimulus internally weld recommending the opposite for greece.
but then we bailout texas that then is remembered. so we have seen this manifesto as changes have correlated to the changes a recovery across time. this takes the question will be spent for ever? so for example, 1997 would be a good time to look back but as argues lower the deeded trivia and approach to undergo the spending increases, a food stamps are a good example. people have concerns and hater and reduce safety net program they will do that forever. we cheat the system so there is a good study that was recently by the editor that
found there was no data to support in fact, quite a bit was the opposite that food stamps in general was welfare assistance people come off as the economy recovers and furthermore the multipliers are high because the people who are eligible for food stamps are often not spending on other things when they are not able to get food stamps there is that each convention that it they can spend on each team or food. . . . .
>> the goal is to find a novel funding source and discourage the kind of thing that tamper with that. we all know that this can lead to the recession. and it is something that we can all relate to. i doubt any of you bought a bunch of mortgage-backed securities, as an example. so a small percentage, .005%, which is based of this old idea called the turn pack, for those
americans. so i will end with that and i would like to thank the many people that have worked on this data analysis i have talked about at oxford and i will take any questions that you might have. [inaudible conversations] >> i had not yet seen the book and and we wrote about the hospital in new
orleans. i'm sure you are aware of that. so just to get some context here, this house bill in new orleans, there are a number of situations going on with health care in new orleans. but a number of locations around the country are suffering from
such extensive datasets that hospitals are closing among the safetynet group amongst private hospitals we have seen the cherry picking phenomenon, which was during this recession we didn't talk a lot about health care or health care insurance so i will say that there was these really interesting studies done back in
the 1990s of the portion of help that we could buy if we did everyone universal health care insurance and everyone had this. how much could we improve u.s. health care. and so that is part of the financial situation.
but from what i understand everyone had public health care we could die of 15 to 20% of preventable death. so it's very low. so the question is where does the rest come from? and why we talk so much about the social phenomenon. it comes from how much we smoke and drink and exercise in the quality of the diet that we eat. and is much that is going on with the health care system has to be addressed with what is going on in our neighborhoods and communities. we have to understand what is driving the major desperation across the united states. [inaudible conversations] >> here we go.
i have actually two questions. one has to do with, i really appreciate your data-driven perspectives and information. because it seems like we lack that so much. when it is there in black-and-white, black and white, it seems like people cannot dispute it sometimes. but i was with some friends today. and i have mentioned that i was coming to this tonight. this one friend of mine who is german but married to a french man spends a lot of time in france was railing about france and what france has been doing and how one in four workers are government workers and how people want their pensions to be paid, but france doesn't have the money to do it. i'm just curious what you would say to that. the number one requested.
>> there are a lot of concerns about the so-called european welfare state. including mass obligation results in these huge problems in terms of pensions and so on. many are blamed for the same in the class of detroit. the data doesn't show that. to summarize briefly, france actually pays pensions at rates that are actually better than the cultural myth that is there, but the cultural myth is so strong that it is so hard to dispute. similarly with the germany and greece episode, all the people were blaming the greeks for this. people are working hard, there is a very common survey that uses the same type of survey across the european countries to sample how hard people work and we go to similar type places and multiple local businesses. the greeks actually did quite a
bit higher to the germans prior to the recession. so i think it's very difficult when you have cultural myths that are sort of perpetuating themselves. the concern, i understand, is that the government has a degree of inefficiency that private markets care. that is based on assumptions. those assumptions are that we have perfect competition. that we are in some settings under full employment and a couple dozen go across borders. all of which are essentially violated under this view of the economy. so it's very hard. i do math models for a living. but the carter ricardo actually said very clearly that this cany be a part of it when it is violated. >> my second question has to do with is there anyone in
washington dc listening and inquiring and wanting to know more about what you are doing? >> many people who work on this besides myself, there is a lot of people for whom this is old hat, to be honest. and the difficulty is that a lot of discussion about deficits and debt is really unintuitive. the standard macroeconomic advice, that is really unintuitive and it makes it a lot easier and therefore we should cut back, which is true for a household and it's very hard to go through keynesian economic reasoning with this speech. that being said, there are many folks who do want a daily german approach to this. we have to make sure that we understand this is very
compelling. >> do you mind speaking in the microphone for your question, please? >> in your book, you give an example of ricardo's assumptions did you kind of wisdom? >> yes, they are buried in footnotes. and it's actually, if you're interested in these issues with ricardo and comparative advantage, there is an old report that was published, i think, it in 2003. if you look in chapter two of that report, it was their major trader program. they discuss in great detail what the data is regarding trade agreements and the sanctions for which it seems to be violated and how it has drawn out of the rest the last two decades.
so i would recommend that. it is cited in the book. and that is a chapter there that is one of the best chapters i have seen in terms of revisiting the original that it was based on. >> okay, thank you. [applause] [applause] >> our authors here, and i'm sure that he will be happy to sign them for you. [applause] >> thank you. >> we would like to hear from you. tweet us your feedback at twitter.com/booktv. here's a look at some books that are being published this week. investigative journalist eric
schlosser uses declassified information to examine the complexity and dangers of the u.s. nuclear arsenal in command and control, nuclear weapons, the damascus accident and the illusion of safety. and a new answer for our broken immigration system, ron paul presents his thoughts on how to improve the education system. assistant secretary of education diane ravage presents her thoughts on the privatization of the education system in reign of error, the hoax of the privatization movement and the danger to america's public schools. an entity and iv, race and slavery in the troubled history of america's universities, greg steven wilder, american history professor at the massachusetts institute of technology report on the relationship between ivy league schools and slavery. and bill mckibben talks about his thoughts on oil and honey, the education of an unlikely activist. and in the mayor's wife, david
dinkins recounts his career as the first african-american mayor of new york city. look for these titles this coming week and watch for these authors on the near future and on booktv.org. >> booktv continues with sylvia ann hewlett. she argues that the key is to find a sponsor in life. a senior-level person who will champion your career and advocate for you. she argues that mentors will build your self-esteem but will not help you move up. this is about one hour. [applause] >> belinda, thank you. welcome to this amazing evening. you know, this is our third book launch at the new york stock