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Old 12-26-2010, 05:46 PM   #61
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Originally Posted by M Paquette View Post
*SIGH*

In other news, 100% of the current population will eventually die, with or without health insurance. So, why would anyone want this stuff?
Well, I think the headline is certainly questionable. I think dex was just trying to point out the false logic there. If people w/o ins are claimed to have a higher mortality rate, it doesn't necessarily follow that covering those people would dramatically reduce the mortality rate of that group.

Take the one quote:

Quote:
Overall, researchers said American adults age 64 and younger who lack health insurance have a 40 percent higher risk of death than those who have coverage.
It's pretty easy to see that there are other factors. People w/o insurance are probably more likely to die because of the same factors that lead them to not have insurance. On average, that group is probably poorer, probably make some poor choices, probably have a lower level of employment (hence no employee coverage), and a slew of factors that would probably correlate with higher mortality. There may be as much 'effect' as there is 'cause' there.

I'm not trying to hold Medicaid up as any great solution, and there are certainly problems that need to be fixed. But claiming that many tens of thousands die each year due to lack of coverage strikes me as a kind of 'bumper sticker slogan' approach to the issue.

-ERD50
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Old 12-26-2010, 05:54 PM   #62
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Also agree. Start again is mostly code for leave it the way it was...it worked alright for me.
Repeating it doesn't make it true.

Show me the posts on this forum where people are saying we don't need any changes to the system. That claim was earlier applied to samclem, and that's certainly not true.

I could turn that around around and say that your statement is code for 'I won't listen to any criticism of the reforms (which are now the new 'status quo')'.

-ERD50
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Old 12-26-2010, 05:56 PM   #63
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ERD & Dex: This study is referring to premature deaths due to preventable causes.
Quote:
"For any doctor ... it's completely a no-brainer that people who can't get health care are going to die more from the kinds of things that health care is supposed to prevent," said Woolhandler, a professor of medicine at Harvard and a primary care physician in Cambridge, Massachusetts.
Not a bumper sticker or a slogan, but instead a summary of a Harvard Medical School study.
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Old 12-26-2010, 05:58 PM   #64
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ERD50 - How many people need to die then ? Is 5,000 preventable deaths per year enough ? Is 50,000 enough ? One death due to the lack of healthcare is one death too many. You do not need to be poor to make "poor choices". As a healthcare provider, I see bad choices being made everyday by patients - irrespective of their wealth.

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Originally Posted by ERD50 View Post
People w/o insurance are probably more likely to die because of the same factors that lead them to not have insurance. On average, that group is probably poorer, probably make some poor choices, probably have a lower level of employment (hence no employee coverage), and a slew of factors that would probably correlate with higher mortality. There may be as much 'effect' as there is 'cause' there.


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Old 12-26-2010, 06:43 PM   #65
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ERD & Dex: This study is referring to premature deaths due to preventable causes.
Not a bumper sticker or a slogan, but instead a summary of a Harvard Medical School study.
A couple of key point is missing from the article:

1. What are the reasons for not having health ins?

2. Perspective - what are the over/under % of death for people with and without insurance for other variables - e.g. education level, income, type of job - manual or office worker, immigration status.
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Old 12-26-2010, 07:59 PM   #66
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ERD50 - How many people need to die then ? Is 5,000 preventable deaths per year enough ? Is 50,000 enough ? One death due to the lack of healthcare is one death too many. You do not need to be poor to make "poor choices". As a healthcare provider, I see bad choices being made everyday by patients - irrespective of their wealth.


I don't know the answer to your question.... just like you do not know the answer to mine.... how much should society pay to keep someone alive who has abused alcohol and drugs their whole life... has never in their life kept a job... in fact has not worked in many years...

Do we spend $1 mill, $10 mill, $1 billion I really want to know the answer to this question... how much should we pay to keep someone alive? And then, how long are they going to live IF we do something to keep them alive...


As has been pointed out in this thread... 100% of us will die sometime... it is just a matter of when... and then there is the cost to keep someone alive for a short time... or a long time... also... will that cost be a one time cost or a cost for lifetime


so you quote "One death due to the lack of healthcare is one death too many." IMO does not look at reality of costs and benefits...


Since you are an OBGen... you know that there are babies that are born without a brain... they are alive... but we just put them aside and wait for them to die... is this right This is 'one death'... is it to much? Do YOU do this?
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Old 12-26-2010, 08:18 PM   #67
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how much should society pay to keep someone alive who has abused alcohol and drugs their whole life... has never in their life kept a job... in fact has not worked in many years...
Add food to the list.

Rising obesity will cost U.S. health care $344 billion a year - USATODAY.com

If Americans continue to pack on pounds, obesity will cost the USA about $344 billion in medical-related expenses by 2018, eating up about 21% of health-care spending, says the first analysis to estimate the future medical costs of excess weight.
+++++++++
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Old 12-26-2010, 08:32 PM   #68
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Rising obesity will cost U.S. health care $344 billion a year - USATODAY.com

If Americans continue to pack on pounds, obesity will cost the USA about $344 billion in medical-related expenses by 2018, eating up about 21% of health-care spending, says the first analysis to estimate the future medical costs of excess weight.
If one wants to talk strictly about the public costs of lifestyle decisions, IMO it's not complete (or intellectually honest) unless they offset these costs with the SAVINGS that come from the same people (on average) collecting SS and public pensions for several fewer years.

I don't advocate obesity, smoking and alcohol abuse for saving taxpayer money on SS and pensions, BUT if people are going to use the "cost to the taxpayer" argument against bad lifestyle decisions, it's only fair to consider BOTH sides of that ledger. If we should tax people more (or have government charge them more) for health care if they smoke, drink, eat crappy food or weigh too much, shouldn't those same people pay less in SS taxes or receive more of a pension because they'll collect public benefits for 5-7 fewer years on average? That would be the intellectually consistent thing to do.
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Old 12-26-2010, 08:52 PM   #69
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If one wants to talk strictly about the public costs of lifestyle decisions, IMO it's not complete (or intellectually honest) unless they offset these costs with the SAVINGS that come from the same people (on average) collecting SS and public pensions for several fewer years.

I don't advocate obesity, smoking and alcohol abuse for saving taxpayer money on SS and pensions, BUT if people are going to use the "cost to the taxpayer" argument against bad lifestyle decisions, it's only fair to consider BOTH sides of that ledger. If we should tax people more (or have government charge them more) for health care if they smoke, drink, eat crappy food or weigh too much, shouldn't those same people pay less in SS taxes or receive more of a pension because they'll collect public benefits for 5-7 fewer years on average? That would be the intellectually consistent thing to do.
Your basic assumption of 'public costs' is what is being discussed. Should those lifestyle choices and their impact be a public costs.

But not all the causes or earlier than normal death are a lifestyle choice. For example, life expectancy for the black community who descended from slavery is lower than whites. That is a result of slavery, segregation and racism, not a lifestyle choice. If that issue is to be addressed it should be on racial justice grounds and not heath ins.
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Old 12-26-2010, 10:26 PM   #70
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ERD50 - How many people need to die then ? Is 5,000 preventable deaths per year enough ? Is 50,000 enough ? One death due to the lack of healthcare is one death too many. You do not need to be poor to make "poor choices". As a healthcare provider, I see bad choices being made everyday by patients - irrespective of their wealth.
And to add to that, it's not only bad choices that make you seriously ill, it can just be bad luck. I survived cancer. I was fortunate that I had health insurance. I was lucky I lived. There was nothing about my health history that indicated this cancer, nothing I could have done differently.

Had I not had insurance, and had a more virulant form of the cancer, I might have died, like many other people I know. Had I not lived near an ER, I might have died when I went into shock... it was a near thing.

Health care is just as vital a need for people as other public services.
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Old 12-26-2010, 11:05 PM   #71
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For example, life expectancy for the black community who descended from slavery is lower than whites. That is a result of slavery, segregation and racism, not a lifestyle choice. If that issue is to be addressed it should be on racial justice grounds and not heath ins.
Not to get too far afield of the topic, but there are many reasons black Americans have lower life expectancy than white Americans. Smoking rates and diet are important factors, and I think it's entirely fair to say that what you put into your mouth (food and/or tobacco products) is a matter of personal choice.
And, yes, poor black Americans have shorter lifespans than Americans of average income. So do poor white Americans. There's no need to go down the unproductive "racial justice" rabbit hole if we deal with the important things that are relevant today--poverty, economic opportunity, and the importance of making good choices. Black Americans aren't dying younger because their forebears were slaves, they are dying younger because they are poor and their families have been torn up--partially by government policies designed to help them. They can't afford another generation of government "help" like they've had.
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Old 12-27-2010, 07:19 AM   #72
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Originally Posted by ERD50 View Post

I'm not trying to hold Medicaid up as any great solution, and there are certainly problems that need to be fixed. But claiming that many tens of thousands die each year due to lack of coverage strikes me as a kind of 'bumper sticker slogan' approach to the issue.

-ERD50
If you recall, several times I have posted links to studies which show the number of people whose deaths are attributable to lack of access to health care due to lack of insurance. The numbers are increasing. It is a claim that is well supported and not merely a "bumper sticker slogan."
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Old 12-27-2010, 08:12 AM   #73
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They said they saved the life of one 9 YO girl... so it seems that there are problems with a system that sick people will not even go to the doc for free!! Not saying they would go if they were paying for insurance, but when all you got to do is go in.... strange....
The whole point of that show is to get people to go to the doctor, especially if their condition is embarrassing.

Believe it or not, lots of people simply will not go to the doctor, whatever their insurance status, whatever their country's health system, whatever the perceived quality of care. Lots of Americans with 100% insurance will not go. Really. Talk to medical people who know.

I appreciate that you're trying to make a political point here ("free health care must really suck if people with conditions that turn out to be life-threatening don't take it up"), but please understand, things are a lot more complicated than that. The UK's health system is not the world's best by a long way, but it's one plausible OK way of running things, and with no up-front bills to pay, it means that nobody turns down care because they don't have cash in their pocket.

Every other major European country has a different system, many of them with surprisingly little direct government involvement. And most of them outrank the US according to every measure of outcome (other than dollars spent per insured person). Portraying countries which don't have US-style health care as if they're some kind of third-world setup with no antibiotics or anaesthetic, as certain US media outlets like to do, doesn't quite square with life expectancy figures for those countries, but it makes for a good story for consumers of the "all government is by definition evil at all times" narrative.
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Old 12-27-2010, 08:38 AM   #74
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Repeating it doesn't make it true.

Show me the posts on this forum where people are saying we don't need any changes to the system. That claim was earlier applied to samclem, and that's certainly not true.

I could turn that around around and say that your statement is code for 'I won't listen to any criticism of the reforms (which are now the new 'status quo')'.

-ERD50
Fair enough. Iíll retract my earlier statement. Now, you advocate scrapping the reform and starting again. What specific healthcare regulatory improvements do you suggest that are both credible and feasible in our current political environment?

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A couple of key point is missing from the article:

1. What are the reasons for not having health ins?

2. Perspective - what are the over/under % of death for people with and without insurance for other variables - e.g. education level, income, type of job - manual or office worker, immigration status.
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Well, I think the headline is certainly questionable. I think dex was just trying to point out the false logic there. If people w/o ins are claimed to have a higher mortality rate, it doesn't necessarily follow that covering those people would dramatically reduce the mortality rate of that group. -ERD50
Wait a minute. You asked if people were dying due to lack of health insurance. You got the answer and the reference to the study. It doesnít support your view so you challenge the conclusions? Hereís a link http://pnhp.org/excessdeaths/health-...-US-adults.pdf
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In the model adjusted only for age and gender, lack of health insurance was significantly associated with mortality (hazard ratio [HR]=1.80; 95% CI=1.44, 2.26). In subsequent models adjusted for gender, age, race/ethnicity, poverty income ratio, education, unemployment, smoking, regular alcohol use, self-rated health, physician-rated health, and BMI, lack of health insurance significantly increased the risk of mortality (HR=1.40; 95%CI=1.06,1.84; Table 2). We detected no significant interactions between lack of health insurance and any other variables. Our sensitivity analyses yielded substantially similar estimates.
Keep in mind - this study estimates premature death from preventable causes due to lack of insurance coverage. Hardship and illness are not covered. The actual cost to the US is far greater.

Folks that suggest "starting again". What specifically do you propose that is realistic and credible in our current political environment and has a significant effect on access to health care and insurance?
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Old 12-27-2010, 08:46 AM   #75
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Black Americans aren't dying younger because their forebears were slaves, they are dying younger because they are poor and their families have been torn up--partially by government policies designed to help them. They can't afford another generation of government "help" like they've had.
They are poor as a result of slavery, segregation, racism and the 'good intentions' of government.
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Old 12-27-2010, 09:23 AM   #76
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Folks that suggest "starting again". What specifically do you propose that is realistic and credible in our current political environment and has a significant effect on access to health care and insurance?
The "current political environment" reflects the will of the people, just like the last "current political environment" did. There are strong indications that the new health care law is also not realistic in the "current political environment", so it's not simply a case of "executing the present plan." We're learning (in accordance with some predictions) that is what happens when we try to enact sweeping legislation without a mandate from the people. Social Security had a strong bipartisan and popular mandate, Medicare had a strong bipartisan and popular mandate, but this thing never did.

In my view, it's a situation analogous in some ways to the US involvement in Vietnam. It was strongly favored by some political elements, executed based on shaky legislative action (the Gulf of Tonkin resolution) and then pursued despite lack of popular support (though Vietnam initially enjoyed much more public support than the health care law has now). I'm sure some boosters thought public and political support would grow once we got some victories. We got plenty of victories on the battlefield, but the national will and means of execution (on the cheap, based on incorrect assumptions) was always going to prevent a successful outcome. I see some big similarities with where we are now on healthcare.

It's better to have the national discussion first, accurately outline realistic limitations on what we are setting out to do, and go into it with strong public support. We have the opportunity to do that with health care, but basing it on this defective law is a bad idea. We've been sold a lot of things lately as items that must be done immediately--let's instead do this right. The "waste" isn't the time we'll spend now, it's the last two years of back-room dealing shady activity. Is anybody proud of this thing we've been given?

Our present "system" stinks. As we set out to make things better, let's not deliberately include the linkage between employment and health insurance that is the bane of the present setup. Cost control is a huge issue, let's address it. Let's treat people like adults and let them have choices, which can only work when their own resources are involved. Let's recognize that health care is a unique service, but not so unique that the same market forces that bring us cost control and continuous improvement in every other aspect of our lives some how don't apply to medical care.
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Old 12-27-2010, 09:56 AM   #77
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The "current political environment" reflects the will of the people, just like the last "current political environment" did. There are strong indications that the new health care law is also not realistic in the "current political environment", so it's not simply a case of "executing the present plan." We're learning (in accordance with some predictions) that is what happens when we try to enact sweeping legislation without a mandate from the people. Social Security had a strong bipartisan and popular mandate, Medicare had a strong bipartisan and popular mandate, but this thing never did.

In my view, it's a situation analogous in some ways to the US involvement in Vietnam. It was strongly favored by some political elements, executed based on shaky legislative action (the Gulf of Tonkin resolution) and then pursued despite lack of popular support (though Vietnam initially enjoyed much more public support than the health care law has now). I'm sure some boosters thought public and political support would grow once we got some victories. We got plenty of victories on the battlefield, but the national will and means of execution (on the cheap, based on incorrect assumptions) was always going to prevent a successful outcome. I see some big similarities with where we are now on healthcare.

It's better to have the national discussion first, accurately outline realistic limitations on what we are setting out to do, and go into it with strong public support. We have the opportunity to do that with health care, but basing it on this defective law is a bad idea. We've been sold a lot of things lately as items that must be done immediately--let's instead do this right. The "waste" isn't the time we'll spend now, it's the last two years of back-room dealing shady activity. Is anybody proud of this thing we've been given?

Our present "system" stinks. As we set out to make things better, let's not deliberately include the linkage between employment and health insurance that is the bane of the present setup. Cost control is a huge issue, let's address it. Let's treat people like adults and let them have choices, which can only work when their own resources are involved. Let's recognize that health care is a unique service, but not so unique that the same market forces that bring us cost control and continuous improvement in every other aspect of our lives some how don't apply to medical care.
Good post, especially about the mandate.

However, I don't think that health care is a unique service. A large factor in the health care insurance cost/confusion is the politicization of it in the states - where it is currently regulated. Like the tax code; heath ins. is used for politicians to address political issues - ultimately increasing the costs and decreasing participation.

Imagine a system where a health insurance company can not be mandated to pay for costs for the uninsured incurred by hospitals (some states), or other mandates. A person's insurance costs are based upon a minimum insurance requirement (nation wide) and options they choose. Health related companies did not pay federal income taxes. Fraud was taken seriously and reduced substantially. Insurance rates would be much more affordable.
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Old 12-27-2010, 10:26 AM   #78
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Here's a change I would like to see, don't MAKE people have to "buy" the govt healthcare or be penalized........ That's change number one. Get rid of the "death panel" provision in the bill from November 2009 that was "snuck in there". BOTH sides of Congress need to start listening to Paul Ryan more, he seems to be the only one who actually has figured out how to AFFORD all the unfunded liabilities we have now on the books.........
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Old 12-27-2010, 10:41 AM   #79
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If you recall, several times I have posted links to studies which show the number of people whose deaths are attributable to lack of access to health care due to lack of insurance. The numbers are increasing. It is a claim that is well supported and not merely a "bumper sticker slogan."
I was responding to the one linked in this thread, I don't recall if your sources were substantially different, but the conclusion in this article is extremely questionable. Just because these people didn't have insurance outside of Medicaid, and just because they died does not mean that every one of those deaths, or a majority, or even a significant number of them, were due to them not having insurance outside of Medicaid.

Maybe the number is significant, but that conclusion cannot be drawn from that study.

Again, this is not to diminish the problems that we have that need reform, I just don't accept that 45,000 pa number at face value.

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Old 12-27-2010, 11:15 AM   #80
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Fair enough. Iíll retract my earlier statement. Now, you advocate scrapping the reform and starting again. What specific healthcare regulatory improvements do you suggest that are both credible and feasible in our current political environment?
Thank you. I'm fine with the general outline that samclem posted months/years ago. I should have bookmarked it, maybe samclem has it handy, it's been repeated so I won't do it again here.



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Wait a minute. You asked if people were dying due to lack of health insurance. You got the answer and the reference to the study. It doesnít support your view so you challenge the conclusions? Hereís a link http://pnhp.org/excessdeaths/health-...-US-adults.pdf
I responded to the first link and quote you provided. There was no mention of any adjustments in that article, and I don't see a reference link to the study you posted (I guess some googling would bring it up). I didn't read every word of that study, but they have a pretty long 'limitations' section, and some of their definitions seem pretty fuzzy to me. 'Uninsured' means uninsured at some X point in time (I guess when the study began), and doesn't factor if they got insurance later or not (to me, THAT would be the most relevant aspect). There was some talk here that some of these people might live far from a source of Medicaid treatment. OK, but would that mean they also live far from a source of 'in network' treatment with whatever private insurance they might be able to obtain? Would the outcomes be similar?

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ERD50 - How many people need to die then ? Is 5,000 preventable deaths per year enough ? Is 50,000 enough ? One death due to the lack of healthcare is one death too many. You do not need to be poor to make "poor choices". As a healthcare provider, I see bad choices being made everyday by patients - irrespective of their wealth.
Yes, bad choices are just part of it, and wealthy people also make bad choices. But I suspect that more bad choices are made by those in a lower economic class than higher - as an observer of the world around me, I've seen that too.

On an emotional level, it's easy to say "one death is too many". But as a society, we can't realistically run our lives like that. I suppose we should have 3 FDA inspectors in kitchens of every food service establishment 24-7? And I've seen stats that more food poisoning takes place in homes than in restaurants - so should the govt provide an FDA inspector for every meal that every American prepares? Should we all have govt provided mechanics on staff to do a safety inspection of our car, furnace, dryer, etc, etc, every time we use them? That could save some lives, and it stands to reason we should do it if you stick to your "one death is too many" statement? You can't let money stand in the way of a preventable death, can you?.

You can say those are ridiculous examples, but without real numbers we can't say if there are better places to spend our money. Maybe something else would provide better overall quality of life for more people with the same expenditure. IMO, to not do that thing (whatever it may be) would be the real immoral choice.

-ERD50
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