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  1. #2261  
    Quote Originally Posted by davidra View Post
    snip...There is an association between not having insurance and an increased risk of death...snip
    Thanks for confirming what I said. A lack of health insurance can increase the the risk of death. It will never CAUSE it.

    Sure I may not be an expert on medicine, but I know the English language and word definitions.

    Find an ME that will sign a DC with the COD of "lack of health insurance" and you'll have me. Until then youre just regurgitating nonsense to further your cause.
    “There are four boxes to be used in defense of liberty: soap, ballot, jury, and ammo. Please use in that order.”
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  2. #2262  
    Quote Originally Posted by Woof View Post
    Thanks for confirming what I said. A lack of health insurance can increase the the risk of death. It will never CAUSE it.

    Sure I may not be an expert on medicine, but I know the English language and word definitions.

    Find an ME that will sign a DC with the COD of "lack of health insurance" and you'll have me. Until then youre just regurgitating nonsense to further your cause.
    So therefore you will start smoking, stop exercising, eat whatever you want, and totally ignore street signs, since those things won't kill you either. They'll just increase the risk. And guess what? When you die from a heart attack with a major contribution from smoking, your death certificate doesn't say "cigarettes" on it. So light up, bucko. And when you die from running a stop sign, that doesn't appear on your death certificate either.

    Do you have health insurance? If so, that demonstrates that indeed, you are very cognizant of risk; in fact, you're willing to pay your own money because of it.

    Your arguments are specious and absurd.
  3. anthillmob's Avatar
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    #2263  
    Quote Originally Posted by Woof View Post
    Thanks for confirming what I said. A lack of health insurance can increase the the risk of death. It will never CAUSE it.

    Sure I may not be an expert on medicine, but I know the English language and word definitions.

    Find an ME that will sign a DC with the COD of "lack of health insurance" and you'll have me. Until then youre just regurgitating nonsense to further your cause.
    I couldn't agree more with you.

    To be truly fair to the authors, I would have to read the article (and probably will at some stage), but from their comments quoted above it seems that
    (1) The authors have a very clear bias which they have been promoting for years
    (2) They are presenting their theory (which is only one possible reason) as fact
    (3) They are relying upon people to confuse correlation with causality (I will give them the benefit of the doubt and assume they are aware of the difference)

    In summary, there is a correlation between people without insurance and death but it is impossible for lack of insurance to cause death.
    And davidra, making comments like "I realize this concept is way way over your head" when you essentially know nothing of the people you are referring to does not help your argument, but it does confirm in people's minds the image of an arrogant all-knowing never-wrong and if you disagree with me it is because you are not as smart as me medic.
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       #2264  
    I do like this vid that Glenn Beck's team put to music.
    The Law of Logical Argument: Anything is possible if you don't know what you are talking about.
  5. #2265  
    Quote Originally Posted by anthillmob View Post
    I couldn't agree more with you.

    To be truly fair to the authors, I would have to read the article (and probably will at some stage), but from their comments quoted above it seems that
    (1) The authors have a very clear bias which they have been promoting for years
    (2) They are presenting their theory (which is only one possible reason) as fact
    (3) They are relying upon people to confuse correlation with causality (I will give them the benefit of the doubt and assume they are aware of the difference)

    In summary, there is a correlation between people without insurance and death but it is impossible for lack of insurance to cause death.
    And davidra, making comments like "I realize this concept is way way over your head" when you essentially know nothing of the people you are referring to does not help your argument, but it does confirm in people's minds the image of an arrogant all-knowing never-wrong and if you disagree with me it is because you are not as smart as me medic.
    Would you like to address my prior post about whether or not you pay any attention to risk? Do you have health insurance? Do you smoke? Hey, if you're willing to take any risk you want, more power to you. If you're so smart, you realize that in medicine, cause is problematic unless you're talking about Koch's postulates, and those apply only to infectious diseases. Proving cause is very complex and requires judgement, usually applied through Bradford Hill's causal steps. We still cannot prove that cigarette smoking causes lung cancer. In spite of that being pointed out for many years by tobacco companies, most intelligent people are willing to accept that a high risk that is statistically and clinically important should be a proxy for definitive cause. Obviously those intelligent people accepted this concept, which is why we label cigarettes and limit their distribution. Your considered opinion is no less absurd than Woof's, and just because you know the difference between corellation and cause doesn't mean your response makes any more sense than his does. The fact is that corellation is not the pertinent outcome measure anyway in these studies, it's relative risk. But I'm sure you understand why that is so much more important.

    By the way....feel free to quibble with any of my opinions. What I'm saying about risk, relative risk, corellation and other aspects of research design are fact, not opinion. If you consider that arrogant, just disagree with anything I've written and explain why it's wrong.
    Last edited by davidra; 09/18/2009 at 11:27 AM.
  6. anthillmob's Avatar
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    #2266  
    Quote Originally Posted by davidra View Post
    Would you like to address my prior post about whether or not you pay any attention to risk? Do you have health insurance? Do you smoke? Hey, if you're willing to take any risk you want, more power to you. If you're so smart, you realize that in medicine, cause is problematic unless you're talking about Koch's postulates, and those apply only to infectious diseases. Proving cause is very complex and requires judgement, usually applied through Bradford Hill's causal steps. We still cannot prove that cigarette smoking causes lung cancer. In spite of that being pointed out for many years by tobacco companies, most intelligent people are willing to accept that a high risk that is statistically and clinically important should be a proxy for definitive cause. Obviously those intelligent people accepted this concept, which is why we label cigarettes and limit their distribution. Your considered opinion is no less absurd than Woof's, and just because you know the difference between corellation and cause doesn't mean your response makes any more sense than his does. The fact is that corellation is not the pertinent outcome measure anyway in these studies, it's relative risk. But I'm sure you understand why that is so much more important.

    By the way....feel free to quibble with any of my opinions. What I'm saying about risk, relative risk, corellation and other aspects of research design are fact, not opinion. If you consider that arrogant, just disagree with anything I've written and explain why it's wrong.
    "Would you like to address my prior post about whether or not you pay any attention to risk? Do you have health insurance?"

    Yes and Yes! I am aware of risk and in fact quite risk adverse (actually, I am more of paranoid coward......) and I most certainly have health insurance. However, I don't have health insurance because I think it will reduce my risk of death, as it won't (will not, can not!). Of course, not seeking medical attention should I require it probably will increase my risk of death, however that is not the same thing as insurance.

    "If you're so smart, you realize that in medicine, cause is problematic unless you're talking about Koch's postulates, and those apply only to infectious diseases."

    Oh I see, it is problematic..... well that is ok, we can just change the meaning of the word cause for this specific situation and ignore that it misleads people into assuming that the suggested "cause" is a proven fact.

    "Your considered opinion is no less absurd than Woof's"

    Quite right..... thankfully his opinion is not at all absurd :-)!

    Finally...... "If you're so smart" Never made that claim.... merely pointed out that the tone of your message (messages) is that the people disagreeing with you do so because they do not understand relatively simple concepts as they are not as smart as you...... this may not be your intention, but you sure do come off that way!
  7. #2267  
    Quote Originally Posted by anthillmob View Post
    Yes and Yes! I am aware of risk and in fact quite risk adverse (actually, I am more of paranoid coward......) and I most certainly have health insurance. However, I don't have health insurance because I think it will reduce my risk of death, as it won't (will not, can not!). Of course, not seeking medical attention should I require it probably will increase my risk of death, however that is not the same thing as insurance.
    Then, not having health insurance makes people less likely to appropriately seek medical attention, which then increased their risk of death, yes? Therefore lacking medical insurance increases risk of death.

    I'm not sure of why folks are going through such mental gymnastics to deny such a very simple fact.


    Thanks for confirming what I said. A lack of health insurance can increase the the risk of death. It will never CAUSE it.
    That's just a bit of semantics...if I have early stage cancer and don't go to the doctor, it will likely get much worse and it could very well cause my death. While the cancer caused my death, the lack of medical attention (caused my my lack of insurance) prevented my life from being saved.

    That's a bit like saying "guns don't kill people, loss of blood kills people from being penetrated by bullets fired from the gun. Guns only increase the risk of blood loss."
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  8. groovy's Avatar
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    #2268  
    Quote Originally Posted by Bujin View Post
    Then, not having health insurance makes people less likely to appropriately seek medical attention, which then increased their risk of death, yes? Therefore lacking medical insurance increases risk of death.

    I'm not sure of why folks are going through such mental gymnastics to deny such a very simple fact.
    I think this is true. But people avoid seeking medical attention for a variety of reasons. In fact, some people avoid getting insurance for some of the same reasons they avoid medical attention. They just don't want to face it. I might add, by the way, that I suspect the biggest single reason people avoid medical care is work/career.

    But, having said that, will you admit by the same logic that people who have free access to medical care are more likely to seek medical attention inappropriately?
  9. anthillmob's Avatar
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    #2269  
    Quote Originally Posted by 1thing2add View Post
    What the authors present is not their theory. What they present is their conclusion which has no less than a 95% confidence interval, basically meaning that their conclusions have a 95% chance of being statistically correct upon the same study being repeated by other researchers. The study methods also had to meet the scrutiny of the board which approves such studies for publishing at the American Journal of Public Health, which is never an easy task.

    If you'd like to provide any evidence to substantiate your claim that the study conclusions should have had confidence intervals less than 95%, and therefore not statistically significant, go right ahead. It appears that you only want to trivialize and politicize the study, but remain distant of actually challenging it in any meaningful way. To continue to do so it to just pick at the edges.
    I will preface this by noting, once again, that I do not have access to the full document at this moment..... however....

    First:
    "What the authors present is not their theory."
    Actually, that is exactly what they are presenting...... although it is becoming increasingly common for people to present theory as fact, that does not make it so.

    Second:
    The authors do not say there is a 95% percent chance that figure of a 40% increase is correct. What they way is that if the work they have done is repeated (presumably using similar assumptions to those they have made) then there is a 95% chance that the value will be between 6% and 84%....... certainly sounds different when put like that huh?
  10. anthillmob's Avatar
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    #2270  
    Quote Originally Posted by groovy View Post
    I think this is true. But people avoid seeking medical attention for a variety of reasons. In fact, some people avoid getting insurance for some of the same reasons they avoid medical attention. They just don't want to face it. I might add, by the way, that I suspect the biggest single reason people avoid medical care is work/career.

    But, having said that, will you admit by the same logic that people who have free access to medical care are more likely to seek medical attention inappropriately?
    "In fact, some people avoid getting insurance for some of the same reasons they avoid medical attention."

    Exactly! My thoughts exactly, and hence why I would like to see the full article..... I suspect the authors have not considered this. Perhaps people who do not seek medical attention frequently also don't see the point in paying for insurance? This may not be a large contribution.... who knows? I am just not inclined to take my science from press releases as they tend to over simplify and misrepresent things.
  11. anthillmob's Avatar
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    #2271  
    Quote Originally Posted by 1thing2add View Post
    To which section of the complete study that you've not seen are you referring (since this was not included in Zelgo's original post)?
    Maybe I made it up :-)? Of course, you have seen more than Zelgo originally posted as well..... hence your quote:

    "Conclusions. Uninsurance is associated with mortality. The strength of that association appears similar to that from a study that evaluated data from the mid-1980s, despite changes in medical therapeutics and the demography of the uninsured since that time. (Am J Public Health. 2009;99:jjj–jjj. doi:10.2105/AJPH.2008.157685)"

    Actually, I just went straight to the journal webpage, on the assumption I would have access to the article. Which it turns out I don't :-(. However, I could see the abstract, which puts as good a spin on things as the authors can (if they are doing their job correctly). The abstract is below for the reading pleasure of others.

    "Abstract

    Objectives. A 1993 study found a 25% higher risk of death among uninsured compared with privately insured adults. We analyzed the relationship between uninsurance and death with more recent data.

    Methods. We conducted a survival analysis with data from the Third National Health and Nutrition Examination Survey. We analyzed participants aged 17 to 64 years to determine whether uninsurance at the time of interview predicted death.

    Results. Among all participants, 3.1% (95% confidence interval [CI]=2.5%, 3.7%) died. The hazard ratio for mortality among the uninsured compared with the insured, with adjustment for age and gender only, was 1.80 (95% CI=1.44, 2.26). After additional adjustment for race/ethnicity, income, education, self- and physician-rated health status, body mass index, leisure exercise, smoking, and regular alcohol use, the uninsured were more likely to die (hazard ratio=1.40; 95% CI=1.06, 1.84) than those with insurance.

    Conclusions. Uninsurance is associated with mortality. The strength of that association appears similar to that from a study that evaluated data from the mid-1980s, despite changes in medical therapeutics and the demography of the uninsured since that time.

    Key Words: Insurance, Health Financing, Access to Care, Mortality, Surveys"
  12. anthillmob's Avatar
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    #2272  
    Quote Originally Posted by anthillmob View Post
    Maybe I made it up :-)? Of course, you have seen more than Zelgo originally posted as well..... hence your quote:

    "Conclusions. Uninsurance is associated with mortality. The strength of that association appears similar to that from a study that evaluated data from the mid-1980s, despite changes in medical therapeutics and the demography of the uninsured since that time. (Am J Public Health. 2009;99:jjj–jjj. doi:10.2105/AJPH.2008.157685)"

    Actually, I just went straight to the journal webpage, on the assumption I would have access to the article. Which it turns out I don't :-(. However, I could see the abstract, which puts as good a spin on things as the authors can (if they are doing their job correctly). The abstract is below for the reading pleasure of others.

    "Abstract

    Objectives. A 1993 study found a 25% higher risk of death among uninsured compared with privately insured adults. We analyzed the relationship between uninsurance and death with more recent data.

    Methods. We conducted a survival analysis with data from the Third National Health and Nutrition Examination Survey. We analyzed participants aged 17 to 64 years to determine whether uninsurance at the time of interview predicted death.

    Results. Among all participants, 3.1% (95% confidence interval [CI]=2.5%, 3.7%) died. The hazard ratio for mortality among the uninsured compared with the insured, with adjustment for age and gender only, was 1.80 (95% CI=1.44, 2.26). After additional adjustment for race/ethnicity, income, education, self- and physician-rated health status, body mass index, leisure exercise, smoking, and regular alcohol use, the uninsured were more likely to die (hazard ratio=1.40; 95% CI=1.06, 1.84) than those with insurance.

    Conclusions. Uninsurance is associated with mortality. The strength of that association appears similar to that from a study that evaluated data from the mid-1980s, despite changes in medical therapeutics and the demography of the uninsured since that time.

    Key Words: Insurance, Health Financing, Access to Care, Mortality, Surveys"
    And don't get me started on the sentence with
    "uninsurance at the time of interview predicted death."
    Presumably this included those who were without insurance short term as well as those who have been without insurance since the interview (20 years ago). I wonder if the authors take this into account? As I have said before, I don't know, I have not read the article yet...... I just don't trust press releases as a source of science.....
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    #2273  
    Just so everyone knows, according to these numbers, roughly 12-18% of the uninsured will die because the don't have insurance.

    That's a big pill to swallow.
  14. #2274  
    Quote Originally Posted by davidra View Post
    So therefore you will start smoking, stop exercising, eat whatever you want, and totally ignore street signs, since those things won't kill you either. They'll just increase the risk. And guess what? When you die from a heart attack with a major contribution from smoking, your death certificate doesn't say "cigarettes" on it. So light up, bucko. And when you die from running a stop sign, that doesn't appear on your death certificate either.

    Do you have health insurance? If so, that demonstrates that indeed, you are very cognizant of risk; in fact, you're willing to pay your own money because of it.

    Your arguments are specious and absurd.
    No and neither will most folks. Why would they? Talk about "specious and absurd".
    Of course I have health insurance. I have it because it protects against the FINANCIAL risk of illness or injury. It doesn't keep you from dying. If it did it would be the most popular and sought after item on the planet.
    I understand risk very well and take as few as possible. Have always been that way. Even before I had health insurance.

    Man do you really believe the crap you say?
    “There are four boxes to be used in defense of liberty: soap, ballot, jury, and ammo. Please use in that order.”
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    #2275  
    Quote Originally Posted by groovy View Post
    Just so everyone knows, according to these numbers, roughly 12-18% of the uninsured will die because the don't have insurance.

    That's a big pill to swallow.
    Well sure... if you actually look at the numbers and ask yourself does this make sense/does this seem reasonable, then things start to seem a little less reliable. However, I am frequently surprised by what people who look no further than the that the big scary numbers support their argument are willing to swallow......
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    #2276  
    Quote Originally Posted by zelgo View Post
    They became staunch advocates of single-payer because their research shows what not have a single-payer system is doing to people in this country.
    So it would be safe to say you do want a single payer system? I mean, I hear a lot of people denying that. I just want to make sure you're on the record as being for that.
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    #2277  
    Quote Originally Posted by zelgo View Post
    I have been on the records many times in this thread that the only viable system, shown to work in other industrialized nations, with much cheaper costs than here and much better quality, is single payer.

    ...and looking at the evolution of healthcare in other countries, we'll get it in about 10 years.
    So, then, why would you want Obama's reform? Or are you saying that Obama's reform is a good stepping stone to a single-payer health care system?
  18. #2278  
    Quote Originally Posted by Woof View Post
    Of course I have health insurance. I have it because it protects against the FINANCIAL risk of illness or injury. It doesn't keep you from dying.
    Well, that in and of itself is a huge issue, particularly when the rates of insurance are climbing so quickly that many of us who are currently insured may not be in the fairly near future, as companies lose the ability to pay for it.

    It would be nice to know that if my wife or I get seriously ill, that I don't have to lose my house and my kids can still go to college.

    I will disagree about the fact that insurance doesn't keep you from dying - if you didn't have insurance and thus didn't get early care, you very well could die. The data clearly supports that, and I've yet to see anyone show data to show that lack of insurance isn't correlated with mortality.

    So my challenge to anyone is to show the data, rather than simply saying "that data can't be valid".
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  19. #2279  
    Quote Originally Posted by groovy View Post
    So, then, why would you want Obama's reform? Or are you saying that Obama's reform is a good stepping stone to a single-payer health care system?
    It doesn't have to be either - it could simply be that Obama's vision of health care is politically doable and better than what we have now. I've never been a believer that you can't make any change unless you get everything you want....as has been said many times in this debate "we can't let the perfect be the enemy of the good".
    Everything's Amazing and Nobody's Happy

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  20. #2280  
    Quote Originally Posted by Bujin View Post
    Well, that in and of itself is a huge issue, particularly when the rates of insurance are climbing so quickly that many of us who are currently insured may not be in the fairly near future, as companies lose the ability to pay for it.
    data please. show us which companies are in danger of not being able to pay. Not denying that it's true, I'd just like you to substantiate your claim.
    It would be nice to know that if my wife or I get seriously ill, that I don't have to lose my house and my kids can still go to college.
    Sell the house and make the kids pay for their own college. Home ownership and college arent rights, just healthcare remember.

    I will disagree about the fact that insurance doesn't keep you from dying - if you didn't have insurance and thus didn't get early care, you very well could die. The data clearly supports that, and I've yet to see anyone show data to show that lack of insurance isn't correlated with mortality.
    Gee what about those that didnt have insurance and got care? Punches a whole in that no insurance kills theory I think. And let's not forget those folks that have insurance and just never seek care. Do their terminal illnesses suddenly become non-terminal? Do their severe injuries from that head on collision suddenly vanish because the have coverage? Nope.

    To use your words "if you didn't have insurance and thus didn't get early care, you very well could die." But anyone with an ounce of common sense also knows that if you DID have insurance and didn't get early care, you very well could still die.


    So my challenge to anyone is to show the data, rather than simply saying "that data can't be valid".
    What data? that's an opinion. Where did I say the data was invalid?

    How about we try an experiment. Let's all go down to our respective ERs and see how many of the folks that die have insurance and how many that don't walk out. I'm gonna bet that you will find members of both.
    “There are four boxes to be used in defense of liberty: soap, ballot, jury, and ammo. Please use in that order.”
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    "A government big enough to give you everything you want, is big enough to take away everything you have."- Thomas Jefferson

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