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Old 07-31-2007, 05:02 PM   #121
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Originally Posted by Rustic23 View Post
Here is an article in the Houston Biz Journal. It uses some of Martha's statistics, and it seems that the answer to the difference in some of the numbers for Houston, may revolve around Employers that don't offer insurance.

Health insurance industry confronting crisis of the uninsured - Houston Business Journal:

Rustic...Colorado has been playing around with healthcare reform a lot over the past several years. Due to modified community rating, Colorado lost a HUGE number of covered lives in the small group market starting in 2000. A couple of years ago, us conservatives were able to get legislation passed that allowed for rating flexibility in the small group market. The result was a flattening in loss of insured lives! Unfortunately, the democrats took office and reversed the decision. Here is a report on how the "old" legislation helped bring healthy lives back into the small group market with discount incentives and how that resulted in a flattening of lost covered lives and a slight upturn in 2006. We were just starting to make headway when they reversed the legislation.

As of next year, healthier groups will no longer qualify for discounted rates....the democrats felt that would be unfair to the unhealthier groups. Therefore, rates will be going up substantially for everyone (including the unhealthy) starting next year, and we will start losing more covered lives again. Great move, Governor!

Here's the link:

http://www.dora.state.co.us/insurance/pb/rateflex07.pdf
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Old 07-31-2007, 05:35 PM   #122
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Quote:
Originally Posted by Martha View Post
Rustic, I have not seen good figures on the number of uninsured by choice. I think it would be hard to quantify. At what point is the cost so high that the choice is meaningless?

For example, COBRA payments can be very high. If you just lost your job and have limited funds, odds are you will forgo COBRA. That was my experience with many staff employees when I was an employer.

The most disturbing statistic to me is the increasing numbers of small employers unable to offer health insurance because of cost. And those which do offer insurance benefits are passing more and more of the cost on to employees. Unless your family is in mighty good health, insurance may very well be unfordable for that family if they end up having to purchase on the non-group market.

So, not only do you have to look at numbers of uninsured, you have to look at cost.
I can tell you about my company. We have 45 employees currently. We get bids every year for insurance and every year it has gone up up up, so much in the last few years that the company went from paying 100% of premiums for employees to paying 50%. It was either that, or drop it altogether.

Our current plan:

United Healthcare

$2000/deductible

I write the checks so yes, I am sure these figures are correct

Employee only $528/month
Employee/spouse $ $940/month
Family/ $1486

I only know of one person who has left the company and done Cobra in the last few years.

We are getting ready to start getting quotes again in a few weeks, it is very very scary.....

If it is too high, our companies owners have talked about just dropping it and giving everyone across the board a $200 month raise like that is going to make up for it. The owners just went on medicare so they are covered. Some like myself, will leave the company I love and have worked at for many years, some will just do without insurance.

Yes, at some point the cost becomes so high that some will just go without.
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Old 07-31-2007, 05:48 PM   #123
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I can tell you about my company. We have 45 employees currently. We get bids every year for insurance and every year it has gone up up up, so much in the last few years that the company went from paying 100% of premiums for employees to paying 50%. It was either that, or drop it altogether.

Our current plan:

United Healthcare

$2000/deductible

I write the checks so yes, I am sure these figures are correct

Employee only $528/month
Employee/spouse $ $940/month
Family/ $1486

I only know of one person who has left the company and done Cobra in the last few years.

We are getting ready to start getting quotes again in a few weeks, it is very very scary.....

If it is too high, our companies owners have talked about just dropping it and giving everyone across the board a $200 month raise like that is going to make up for it. The owners just went on medicare so they are covered. Some like myself, will leave the company I love and have worked at for many years, some will just do without insurance.

Yes, at some point the cost becomes so high that some will just go without.
Have you thought about offering a dual choice option to your employees? Many insurance companies will do that for your size group. You could offer one high end copay plan and a second choice could be an HSA (maybe with a 2500 embedded deductible. Often times, the premium savings on an HSA are enough to allow you to fund your employee's HSA accounts with 1/2 or more of the deductible each calendar year, without having to spend much more than a 5% increase over the prior year. This would be money that your employees could use first dollar towards medical expenses. Just a thought.

A lot of times when employees leave the company, they'll go for either individual coverage or short term major medical to get them by in between jobs. The overwhelming majority of people can qualify to do that. The only people that usually elect Cobra are ones with medical problems who can't qualify for individual coverage or who see the risk of not having insurance as greater than the risk of paying for it.
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Old 07-31-2007, 06:41 PM   #124
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Rustic,

Here's a good Kaiser Foundation report about who the uninsured are. It gives a very detailed breakdown.

http://www.kff.org/uninsured/upload/2005DataUpdate.pdf

Notice that there are about 20 million non-us citizen residents included in the figures, and of them 40-50% are uninsured. That nearly 25% of the uninsured population...not a very attractive statistic.

There are also 143 million people with household income of more than $40,000/yr and of them, approx 7% are uninsured......that's 10 more million people who could potentially afford at least major medical coverage coverage who go without.

***these stats are on page 11 of the link.


...and here's another just real quick breakdown:

A recent study1 analyzed the uninsured population and divided them into three categories:

Percentage Number Income Above Medicaid/SCHIP But Can't Afford Coverage = 56% of the Uninsured = 26,320,000
Uninsured but eligible for Medicaid/SCHIP = 25% of the Uninsured = 11,750,000
Uninsured But Likely Able to Afford Coverage On Their Own = 20% of the Uninsured = 9,400,000
47 million uninsured total
1 Health Affairs, Nov 2006, "The Uninsured and the Affordability of Health Insurance Coverage".
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Old 07-31-2007, 07:05 PM   #125
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MyKids, I don't see the 20 million non-us citizens you mention. I see 2.5 million non-citizens who have been here less than 5 years and 6.7 million who have been here more than 5 years comparing to a total of 35.1 million citizens who are uninsured. I believe this is census information which requires at least one full year of no insurance before you are counted as uninsured.

According to table 15, 600,000 of those making more than 40k are uninsured. (Though other studies says this population is growing). In contrast, 22 million making less than 20,000 are uninsured.

Thanks though for the Kaiser information, I forgot about it.
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Old 07-31-2007, 07:19 PM   #126
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MyKids, I don't see the 20 million non-us citizens you mention.
I was looking on page 11, characteristics of the non-elderly uninsured. Under the citizenship section, it shows 5 mil who have been here less than 5 years and 15.6 million who have been here more than 5 years. (approx 20 million.) Of them 56% of the ones here less than 5 yrs are uninsured and 43% here greater than 5 years are uninsured. Am I reading it wrong?

On that same page, it also shows that of the non-elderly population, 177 million are in excellent health. Of them, approx 15% are uninsured. That's 26.5 million people who are uninsured but in very good health. (more than 1/2 of the uninsured population)

Similary, it shows that there are 21.5 mil people who are in poor health. Of them, 20% are uninsured. That's 4.2 million people who are both uninsured and unhealthy or 1.4% of the American population.

Am I reading that wrong? I hope not. I looked at it a couple of times.
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Old 07-31-2007, 07:25 PM   #127
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Originally Posted by mykidslovedogs View Post

A lot of times when employees leave the company, they'll go for either individual coverage or short term major medical to get them by in between jobs. The overwhelming majority of people can qualify to do that. The only people that usually elect Cobra are ones with medical problems who can't qualify for individual coverage or who see the risk of not having insurance as greater than the risk of paying for it.
My hunch is that a good number go bare. It might be cost and/or medical conditions. But I bet that for some it is just a case of not knowing what to do: they don't know that insurance might be available and are put off or confused by the choses, and the application and underwriting process. After all, they are already worried about getting a new job. And willful blindness is a powerful force.
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Old 07-31-2007, 07:29 PM   #128
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[quote=mykidslovedogs;541998]
Quote:
Originally Posted by Martha View Post
MyKids, I don't see the 20 million non-us citizens you mention. quote]

I was looking on page 11, characteristics of the non-elderly uninsured. Under the citizenship section, it shows 5 mil who have been here less than 5 years and 15.6 million who have been here more than 5 years. (approx 20 million.) Of them 56% of the ones here less than 5 yrs are uninsured and 43% here greater than 5 years are uninsured. Am I reading it wrong?
Yes, you need to look at the next column which says how many of the non-citizens are uninsured. As you can see, a good number of the non-citizens are actually insured.
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Old 07-31-2007, 07:40 PM   #129
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[quote=Martha;542002]
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Yes, you need to look at the next column which says how many of the non-citizens are uninsured. As you can see, a good number of the non-citizens are actually insured.
Right...that's what I did. I took the total population of non-us citizens and multiplied it by the rate. 20 million non-us citizens of which approx 9.2 million (2.5+6.7) total are uninsured. (9.2 mil uninsured divided by 44 million total uninsured people = 20.9% of the uninsured population who are non-us citizens.) That's a large percentage of the uninsured population.

Same thing on the unhealthy uninsured. 4.3 million people are both unhealthy and uninsured. That's 1.4% of the American population.
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Old 07-31-2007, 07:49 PM   #130
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OK,
There appears to be a couple of threads here.
1. Should we have UH
2. What should it look like.

What should it look like. This is different than what will it look like. As politics, and lobbyist will no doubt have a fare amount to say on what gets enacted. As we delve into that question, cost, insurance industry, lawyers, pharmaceuticals, and medical industry position should come out.

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Old 07-31-2007, 07:49 PM   #131
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OK Mykids, we just were not communicating quite right.

I am still disinclined to rely on any figures purporting to count the numbers of non-citizens if that number is supposed to cover illegal aliens. The extent of that population is hard to pin down. I am not sure whether the kaiser data or the census data includes only legal non-citizens or includes those who are here illegally.
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Old 07-31-2007, 09:07 PM   #132
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OK Mykids, we just were not communicating quite right.

I am still disinclined to rely on any figures purporting to count the numbers of non-citizens if that number is supposed to cover illegal aliens. The extent of that population is hard to pin down. I am not sure whether the kaiser data or the census data includes only legal non-citizens or includes those who are here illegally.
It's hard to say because it only says, "non-citizen residents". Personally, I would assume that figure includes both legals and non-legals alike. If it doesn't include non-legals, then the total uninsured figures are understated.
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Old 07-31-2007, 09:10 PM   #133
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Have you thought about offering a dual choice option to your employees? Many insurance companies will do that for your size group. You could offer one high end copay plan and a second choice could be an HSA (maybe with a 2500 embedded deductible. Often times, the premium savings on an HSA are enough to allow you to fund your employee's HSA accounts with 1/2 or more of the deductible each calendar year, without having to spend much more than a 5% increase over the prior year. This would be money that your employees could use first dollar towards medical expenses. Just a thought.

A lot of times when employees leave the company, they'll go for either individual coverage or short term major medical to get them by in between jobs. The overwhelming majority of people can qualify to do that. The only people that usually elect Cobra are ones with medical problems who can't qualify for individual coverage or who see the risk of not having insurance as greater than the risk of paying for it.
My company went with a high deductible plan in 2006 and bought a gap policy(basically deductible insurance) that really helped lower our overall rates. We went with a $7,500 deductible from BCBS and purchased $6,000 worth of the deductible insurance from a company known as AmFirst. The net deductible of course was $1,500. Our plan covered roughly 200 employees.

The 2 tier approach lowered our overall rates for year 2006 by approximately 5%(lower than 2005). Year 2007, we had no increase from BCBS or from AmFirst. Amazing considering we used to have a 15-20% increases year after year. I'm not naive enough to think that this is a long term fix but it certainly has been a help in controlling cost so far. I should say, my old company as I am retired now.
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Old 07-31-2007, 09:19 PM   #134
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(once again, gosh this seems repetitive)

Heres a post from a short while ago that specifies homeland security statistics on "non citizen residents", just prior to the current politicization and seeming expansion of the numbers for expedience.

Quote:
Originally Posted by sgeeeee View Post
There is some pretty thorough and useful legitimate data about undocumented aliens available. Here are some links and facts I could find.

Illegal Alien Resident Population according to US Department of Homeland Security.
http://uscis.gov/graphics/shared/abo...lien/index.htm


Some noteworthy statistics from this link:
- Of the estimated 5M undocumented aliens in the US, only 2.7M are from Mexico and only about 2.8M from Latin America.
- Only about 60% of the undocumented aliens actually crossed the border illegaly. The rest crossed legally but failed to return.
- The number of Mexicans who become undocumented is estimated to be about 150,000 a year (includes both legal and illegal initial crossing).
- So, if we spent several billion dollars to create an impenetrable barrier across our 1000 mile Mexican border, we would only be able to reduce the number of undocumented aliens by about 1.5% per year.
- And after many years of maintaining that impenetrable barrier at a cost of several billion dollars per year, we would be able to decrease the total undocumented alien population by as much as 33%(assuming undocumented populations from other countries remain at about the same levels).

The link below provides an updated estimate on the number of undocumented by about 15%.
http://uscis.gov/graphics/publicaffa...s/undocres.htm


A nice link to lots of statistics about undocumented aliens:
http://uscis.gov/graphics/shared/sta...ives/index.htm

There are some scholarly articles about the history of Immigration Law and the effect of undocumented aliens on the US economy.

Impact of the Mexican Immigrant Labor Force
in the United States Economy
http://www1.appstate.edu/~stefanov/student2002.pdf

The Strange Career of the Illegal Alien:
Immigration Restriction and
Deportation Policy in the
United States, 1921-1965
http://history.uchicago.edu/faculty/...i/strange.html

I was unable to find any legitimate scientific articles that addressed the medical costs implied by 5M undocumented aliens in the country, but I did find that we have about 40M American citizens are without Health Insurance.
Chapter 2: The Dynamics of Health Insurance Coverage | Coverage Matters: Insurance and Health Care | Committee on the Consequences of Uninsurance | Board on Health Care Services | Institute of Medicine

If we are really worried about medical costs, we should probably focus on this much larger problem first.
Of course only 2.7M of the undocumented are from Mexico -- comparing that again to 40M uninsured Americans.
And my follow on to this, giving some estimates of the costs of this totally red herring concern.

Quote:
Originally Posted by cute fuzzy bunny View Post
SG provides some good data.

1. SG points out with good sources that the approximate number of undocumented illegal aliens is ~5M.
2. There are approximately 45M americans without health care (DeNavas-Walt, C., B. Proctor, and R. J. Mills. Income, Poverty, and Health Insurance Coverage in the United States: 2003. U.S. Census Bureau., August 2004.)
3. The US spends approximately $100B in care for the uninsured. (Institute of Medicine. Hidden Costs, Values Lost: Uninsurance in America. The National Academies Press. 17 June 2003 .)
4. About $34B of that $100B per year is uncompensated/unpaid (same source as above)
5. Another $37B of that $100B is paid by private and public payers of health care for the uninsured. For those who havent ever heard this, an enormous amount of money is available in grants and other programs for the uninsured. My mother in law, a charge nurse, made us all aware of this when she found grants to cover a car accident for my uninsured brother in law...paid all of his bills for free. ($37B number from same source as above)
6. Another $26B is paid out of pocket by the uninsured.

So if we make several presumptions:
- Citizens and documented aliens dont go to the hospital more often than undocumented aliens, and vice versa; I think this is generous since I think undocumented aliens are far less likely to go to a hospital.
- A hospital stay and/or emergency room treatment for a documented alien or citizen is no more or less costly than for an undocumented alien, which I think is also reasonable.

That makes uninsured, uncompensated losses at $34B, spread across the 45 million uninsured and the 5 million illegal aliens. Simple math given the above constraints says 1/10th of the cost is borne by illegal aliens, making this a $3.4B problem.

That makes the unreimbursed illegal alien healthcare problem 3.4% of the total uninsured healthcare "problem". Which is in the vicinity of statistical drift, lost in the noise.

If you care to argue that illegal aliens visit hospitals more often and/or cost more per visit than US citizens, please factor in that as many as 82 million...as much as 1/3 of the US population...spent at least part of 2002 or 2003 without health insurance for some period. See the same US census report above as source for this data.

As overall healthcare in the US reached 1.7 trillion and is estimated at 1.8 trillion in 2004 (3. Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group; and U.S. Department of Commerce, Bureau of Economic Analysis and Bureau of the Census) the uninsured costs are a notable problem, but unreimbursed illegal alien healthcare costs become reduced in stature to incredibly irrelevant.

Which brings us back to lack of insurance being an issue. Healthcare costs overall being a huge problem. And all that other stuff I mentioned a few pages back.

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Old 07-31-2007, 09:28 PM   #135
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We also should pay a lot of attention to what Terry Rudd has to say about all of this.
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Old 08-01-2007, 09:57 AM   #136
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OK, if CFB's sources are right and there are only 5M illegal aliens in the US, where do the 'We can't deport 20M illegal aliens' come from. I am not trying to switch the thread, I truly don't understand.
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Old 08-01-2007, 10:20 AM   #137
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Because 5M, only half of them from mexico, wasnt a big enough problem to make a big deal about. People are upset about all these mexicans running across the border, and since there really arent that many, we need to find a way to make the number bigger so it suits the relevant politics.

You want to make a big political issue, create a big distraction, get lots of people worried about something other than what they'd normally worry about or confirm the concerns that they're sure exist, maybe throw a few hundred billion into a construction project...well...you take a number thats implausible to determine and run it through a few 'experts' that can make the number bigger.

Either that or our illegal alien population quadrupled in 2 years, or the department of homeland security cant count for beans.

This is about the same mechanism that we went through when california wanted to pass a "no cell phone use when driving law". Everyone knows that cell phones cause accidents. So the california highway patrol did a study while the lawmakers crafted their bills. Unfortunately the CHP study determined that cell phones had practically no influence on accident rates. So the lawmakers changed the terms of the study so that it produced the numbers that supported their bill.

Bringing this back around, we're getting the same BS in health care. Pharmaceutical companies and insurance companies are ripping our wallets out of our pants and their lobbies protect that. Theres a whole bureaucracy set up at doctors offices, insurance companies and 3rd parties to "fix" the problems in it. Everyone charges extra because they're going to get knocked down once or twice in negotiated rates.

In the meanwhile, theres a poor parent with a sick kid and no insurance who has to decide whether to take their kid to the pediatrician or make the mortgage payment. Theres a disabled woman with no insurance that has undiagnosed and unmedicated diabetes that'll lose all of her fingers and toes when she finally goes to the emergency room. Theres a father of four who has a heart attack and dies because he wasnt on the right meds because his construction job doesnt give insurance.

But thats okay, we'll take up all that slack with welfare and medicaid eventually.

In the meanwhile, we have shills that work in the industry throwing out ridiculous stats from organizations funded by the lobby's , movies made by a bunch kids who produce anti-government hate videos, and claims that not only have no basis, the opposite of what they claim is generally true.

The latter by the way, being called trolls because thats what they are. That label never applies to people with reasoned opinions based on quality factual data.

Lets remember, we're talking about someone whose "facts" lie somewhere between the US having four billion people, and that the reason why the US infant mortality rate is so much higher than the canadian one isnt because canadians have better health care, its because the US has too many brown people who dont take care of their children, so if we sent them all to canada the canadian mortality rate would go up.

She said this stuff. Really.
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Old 08-01-2007, 10:42 AM   #138
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Is Costco any better as a source? While this is only a hunch, I’ll bet most large employers would love to see a single payer i.e. Gov. system. One that would allow them to do away with their current healthcare cost, and that is why the business appears to be getting on board with UH.

Would they then lower prices to the consumer for their products equal to the reduction in expense? Would the government raise taxes on corporations to pay for the system? If this happens we pay. In fact, no matter how the government attempts to pay for a single payer system, the tax payer will pay, unless it can be shown that a single payer system can be paid from savings in the healthcare system. i.e. If doctors no longer have to put up with the hassle of multiple insurance companies, and there is a reduction in their malpractice insurance, maybe they would be willing to take a cut in gross for net pay remaining neutral. Question on that would be are lawyers and insurance companies willing to give up malpractice business.

I’m going to go out on the limb and say that a UH system will look like Medicare/Medicaid. Every citizen will pay monthly for Part B, a Part D drug plan will exist. Those below the poverty level or some other set family income, will have their premiums waved or rebated. Part B, may be administered by current insurance companies. In fact, Part B may be like Part D. You sign up with your provider of choice, and that provider gets your monthly premium. The provider’s compete for your business. Supplemental policies will exist to pay what UH does not pay, and the rich will be able to buy services that UH does not cover.
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Old 08-01-2007, 10:49 AM   #139
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The costco thing was a joke...stay with me here...although that quote sure sounds familiar

Most of the UH systems I've seen put in place or proposed to be put in place have employers contribute to the system rather than the insurance companies, or require that employers of a certain size fund health care. Some of the funding comes from grants, existing taxed funds, etc...see in my writeup above of uninsured costs that a third of the costs are funded through existing grants.

As far as whether lawyers and doctors would be willing to accept the plan...in an unscientific study it appears every lawyer and doctor on this board supports a UH plan.

Some people might be required to pay in a little, as they're able.

What you probably wont have is people being turned down by every insurer because they might actually get sick and file a claim, and then when they finally do get insured, having to pay $1400/mo for a family of three.
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Old 08-01-2007, 11:10 AM   #140
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Lets remember, we're talking about someone whose "facts" lie somewhere between the US having four billion people, and that the reason why the US infant mortality rate is so much higher than the canadian one isnt because canadians have better health care, its because the US has too many brown people who dont take care of their children
She said this stuff. Really.
He's right - I did say something similar to those things, although not exacly in those words, and for anyone I offended I apologize profusely. Most of the time, I am not a complete idot, although I am sure I could never convince Cute of that.

In my own defense, I'd like to clarify, and then drop the subject. On the infant mortality issue, I was trying to get across the point that infant mortality has a whole lot to do with socioeconomics and a lot less to do with a healthcare system. In my explosive sarcasm, which I sometimes have a problem with, I said that part of the reason why America may have higher infant mortality rates is because we have much heavier concentrations of blacks and hispanics and other minorities in our country than in other countries, and if they all lived in Canada instead of the USA, then Canada's infant mortality rates would probably be higher too. I did not say nor did I mean to imply that that has anything to do with Blacks or Hispanics not taking care of their children. The fact is that in populations stricken with poverty, we have higher incidences of crime and mortality. That's it....and that was the point I was trying to make. Again, I truly apologize for offending people on the board. I deserve whatever negative comments I get on that subject and hope that those I offended have forgiveness in their hearts.

On the population count issue - that was just a stupid mistake, that I'm sure I'll never live down. I didn't know the number off the top of my head and took a wild guess. I didn't state the figure as fact, but rather I said something more like, "we have how many people? Isn't is something like 4 billion?" Of course, I was totally way off. However, the point I was trying to make on that issue is that if only 18,000 people out of the entire population die because of lack of health insurance, that is a pretty small percentage. (not that I meant to minimize anyone's death, I was just trying to point out it's a pretty small percentage) It's a very small percentage of 300 million.
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