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Destroying Healthcare in America
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Member:
davidra
at: 08:24 PM 09/17/2009
Originally Posted by groovy:
I'll have to read up on this one. But I hope the scholarship is better than that same couple's flawed analysis of medical bankruptcies.
Author's Woolhandler and her husband Himmelstein are staunch advocates are of a single-payer approach, by the way.
Yes, they are, and have been for many years. But this is the American Journal of Public Health we're talking about here, not The Nation or the National Review. That particular journal has extremely critical reviewers and lax methodology will not be published there.
Member:
Woof
at: 09:47 PM 09/17/2009
Originally Posted by zelgo:
Press Release:
Harvard study finds nearly 45,000 excess deaths annually linked to lack of health coverage
Lack of health insurance now more lethal
...snip...It estimated that lack of health insurance causes 44,789 excess deaths annually.
If a lack of health insurance caused death we'd then have to assume that anyone who didnt have health insurance would die almost immediately or at least in short order. Using that logic our 47 million uninsured would already be dead and we would not need to be having this discussion.
Originally Posted by :
...snip... The uninsured are more likely to go without needed care.
Sounds to me like those who can't pay go without care. Doesn't that sound like those who provide care are refusing to do so without payment? Who is the evil for profit capitalist now?
Originally Posted by :
...snip...
Dr. Steffie Woolhandler, study co-author, professor of medicine at Harvard and a primary care physician in Cambridge, Mass., noted: "Historically, every other developed nation has achieved universal health care through some form of nonprofit national health insurance. Our failure to do so means that all Americans pay higher health care costs, and 45,000 pay with their lives."
She added: "Even the most liberal version of the House bill would have left 17 million uninsured, according to the Congressional Budget Office. The whittled down Senate bill will be worse - leaving tens of millions uninsured, and tens of thousands dying because of lack of care. Without the administrative savings only attainable through a Medicare-for-all, single-payer reform - real universal coverage will remain unaffordable. Politicians are protecting insurance industry profits by sacrificing American lives."
Steffie, as my math teacher used to say, Show Your Work. saying Medicare for all is the only financially viable answer is an opinion without some math to back it up. This is nothing more than an opinion worded to stir emotions. Mainly fear that one doesnt have insurance will cause one to die. Perfect if youre trying to get people to ask someone (government) to save them.
Originally Posted by :
...snip..."The Institute of Medicine, using older studies, estimated that one American dies every 30 minutes from lack of health insurance. Even this grim figure is an underestimate - now one dies every 12 minutes."...snip...
Again, lack of insurance doesnt kill people or we wouldnt be here. It may contribute to their situation but it is not the cause of death. As I have mentioned before, I'll need to see just one verifiable death certificate showing "lack of insurance" as the COD to change my mind. I won't be holding my breath.
Member:
davidra
at: 06:55 AM 09/18/2009
Originally Posted by Woof:
If a lack of health insurance caused death we'd then have to assume that anyone who didnt have health insurance would die almost immediately or at least in short order. Using that logic our 47 million uninsured would already be dead and we would not need to be having this discussion.
Sounds to me like those who can't pay go without care. Doesn't that sound like those who provide care are refusing to do so without payment? Who is the evil for profit capitalist now?
Steffie, as my math teacher used to say, Show Your Work. saying Medicare for all is the only financially viable answer is an opinion without some math to back it up. This is nothing more than an opinion worded to stir emotions. Mainly fear that one doesnt have insurance will cause one to die. Perfect if youre trying to get people to ask someone (government) to save them.
Again, lack of insurance doesnt kill people or we wouldnt be here. It may contribute to their situation but it is not the cause of death. As I have mentioned before, I'll need to see just one verifiable death certificate showing "lack of insurance" as the COD to change my mind. I won't be holding my breath.
Please continue to show your ignorance. There is an association between not having insurance and an increased risk of death. I realize this concept is way way over your head, but let's use cigarettes as an example. Cigarettes increase your risk for lung cancer, but that doesn't mean that everybody who smokes will get lung cancer. There is a strong statistical association. The statement is: if you do not have health insurance, you have a greater risk of dying than someone who does not. Is that really so hard to grasp? Try doing a search and reading about the terms relative risk, absolute risk, and causality. Then come back and make some more cogent comments. And as far as her opinion, my guess is that it's much more based in reality than yours, since she's been studying this academically for many years as a Harvard faculty member. Not that she's any better a person than someone with no direct knowledge of health care on a phone forum...it's just that she knows more than you do about it. Of course, from your statements, that would really not be very difficult.
Guest:
KAM1138
at: 08:54 AM 09/18/2009
Originally Posted by zelgo:
No industrialized country has a successful direct payer system. In fact, the whole concept of insurance came about because direct payer didnt work for healthcare (as well as any other area with insurance).
To try to go back to direct payor is to pretend it didn't fail in the first place.
Actually, direct payer worked until just fine. Insurance became popularized because of wage controls (government manipulation in the economy) in the FDR administration. Additionally, Direct payer works for many other economic transactions, so to claim it "failed" is really off base I think.
Direct payer went away, in exchange for indirect payer systems that promised great things and instead led to skyrocketing prices. I hear everyone talking about how we need to change the current system. Well, the current system that led to this "crisis" is an indirect payer system. Ignoring the damage caused by that will get us nowhere.
One other thing--just as a point--I don't believe that changing the current medicare plans of seniors (other than general reform) is going to work, and wasn't included in my direct payer plans...if you had asked.
KAM
Guest:
KAM1138
at: 08:56 AM 09/18/2009
Originally Posted by zelgo:
Healthcare is a large money-making business. When companies are threatening economically by what is happening, protests are engineered.
Look at all the people complaining about the nearly $1 trillion it might cost for this reform. There wasn't a peep out of them when the Medicare Drug Benefit was passed at the same $1 trillion cost.
Follow the money.
Well, you are wrong about that--conservatives who oppose excessive Federal spending (like now) because many of them also opposed the Medicare drug expansion. People who have beliefs based on principles generally don't shift gears like that. Now politicians...well, that says something about their principles I guess.
KAM
Guest:
KAM1138
at: 09:00 AM 09/18/2009
Hello Everyone,
Well, other than some loose ends, I think I'm pretty much done here. Zelgo pointed out the back and forth in a small pool here isn't going to accomplish much of anything.
So, thanks to the majority of folks here who I was able to have good discussions with (even those I disagree with).
KAM
Member:
davidra
at: 09:06 AM 09/18/2009
Originally Posted by KAM1138:
Hello Everyone,
Well, other than some loose ends, I think I'm pretty much done here. Zelgo pointed out the back and forth in a small pool here isn't going to accomplish much of anything.
So, thanks to the majority of folks here who I was able to have good discussions with (even those I disagree with).
KAM
Thanks for trying to raise the level. We all get very contentious about things we are passionate about. The challenge is to avoid acting like Kanye West or Joe Wilson. Of course, you have more in common with Michelle Bachman....
Member:
Micael
at: 09:11 AM 09/18/2009
Originally Posted by haydur:
You know something, nothing that Obama does or will do in the next 3 years will please the conservatives. Nothing. I just find it funny how they despise his administration so much...
I guess that's how I was feeling when Bush won the election for the first time in 2004.
You felt that way about Bush. But don't project yourself off on the conservatives with blanket statements like that, just because that's what you'd do. If Obama reduces spending, reduces the size of government, takes proactive steps to insure the security and military capabilities of the United States, many conservatives will support him and his administration.
Just because the left acted like unruly children throughout the Bush administration, does not mean the right will follow suit.
Member:
davidra
at: 09:19 AM 09/18/2009
Originally Posted by Micael:
Just because the left acted like unruly children throughout the Bush administration, does not mean the right will follow suit.
You're kidding, right? That horse has left the barn.
Originally Posted by zelgo:
The only way direct payor would work is if you scrapped Medicare. Pressure to reduce prices in a competitive market occurs only if there are lots of people buying. The young and healthy don't tend to use health care--overwhelmingly, it's the elderly.
Thus, direct payor is currently a pipe dream.
I believe it has merits--we just can't evolve to that in America.
In other words, when a 35 year old woman is faced without prior warning with the immediate need for double mastectomy, followed by standard of care injections, once per week for 4 weeks, each of which costing $8000.00, in preparation for chemotherapy which will add $10s of thousands in the very short term, she shouldn't expect to have to cut a check to our healthcare providers for nearly six figures because private-pay, as a system of healthcare delivery does not work? Why can't she just sell her home and live in a refrigerator box? Certainly you jest as the healthcare market always works for the benefit of the customer!
Member:
dustysa4
at: 09:57 AM 09/18/2009
Originally Posted by mdmogren:
Eliminate the FDA and the AMA and allow private institutions to fill their roles both cheaper and more effectively, that'd be a great start.
FDA isn't necessarily all that bad. People only hear about the 1 thing that slips through every year or so and judge only on failures. The FDA has taken a near impossible job and made short-work of it. My hat goes off to them. Extreme testing is a good thing, and unfortunately when testing meds the time aspect comes into play (long-term effects). I just don't see how the private sector could have the same incentive for our safety, when these companies are actually in place to keep the private sector in check.
Bottom line, drugs are expensive, but the biggest cost to pharmaceutical companies comes from r&d. I don't think streamlining our safety net is the solution to our healthcare issue.
But then again, I don't think we have a healthcare issue. We've got the best healthcare in the world. Generally the best of anything costs more.
Member:
Woof
at: 10:57 AM 09/18/2009
Originally Posted by davidra:
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.
Member:
davidra
at: 11:34 AM 09/18/2009
Originally Posted by Woof:
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.
Originally Posted by Woof:
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.
Member:
Micael
at: 11:44 AM 09/18/2009
Member:
davidra
at: 12:08 PM 09/18/2009
Originally Posted by anthillmob:
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.
Originally Posted by davidra:
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!
Originally Posted by anthillmob:
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)
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.
Originally Posted by :
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)
Member:
Bujin
at: 02:33 PM 09/18/2009
Originally Posted by anthillmob:
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.
Originally Posted by :
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."
Moderator:
groovy
at: 02:41 PM 09/18/2009
Originally Posted by Bujin:
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?
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Destroying Healthcare in America